Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies

"first_pagesettingsOrder Article Reprints Open AccessSystematic Review Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies by Carlos J. Toro-Huamanchumo 1ORCID,Cielo Cabanillas-Ramirez 2,3ORCID,Carlos Quispe-Vicuña 3,4ORCID,Jose A. Caballero-Alvarado 5ORCID,Darwin A. León-Figueroa 3,6ORCID,Nicolás Cruces-Tirado 7 andJoshuan J. Barboza 3,8,*ORCID 1 Escuela de Medicina, Universidad Cesar Vallejo, Trujillo 13007, Peru 2 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru 3 Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru 4 Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru 5 Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo 13007, Peru 6 Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 14000, Peru 7 Facultad de Ciencias de la Salud, Universidad Señor de Sipán, Chiclayo 14006, Peru 8 Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru * Author to whom correspondence should be addressed. Children 2022, 9(12), 1821; https://doi.org/10.3390/children9121821 Received: 5 October 2022 / Revised: 21 November 2022 / Accepted: 22 November 2022 / Published: 25 November 2022 (This article belongs to the Section Pediatric Infectious Diseases) Download Browse Figures Review Reports Versions Notes Abstract Introduction: Early onset neonatal sepsis (EONS), particularly in preterm sepsis, is a potentially fatal issue. Evaluation of mean platelet volume (MPV) as an EONS predictor was the goal. Methods: Four databases were used to conduct a systematic evaluation of cohort and case–control studies. Up till the end of October 2022, 137 articles were found utilizing the search method. Following the review, 12 studies were included. Leukocytes, MPV, platelets, gender, birth weight, gestational age, mortality, and C-reactive protein (CRP) were all taken into account while analyzing the prediction of EONS. Inverse-variance methodology and the random-effects model were used. Using GRADE, the evidence’s quality was evaluated. Results: Neonatal patients with sepsis had significantly higher MPV levels than do neonates without sepsis (MD 1.26; 95% CI 0.89–1.63; p < 0.001). An increased MPV during the first 24 h postpartum was associated with high CRP values and high risk of neonatal mortality. In the investigations, the MPV cutoff for sepsis patients was 9.95 (SD 0.843). Overall certainty of the evidence was very low. Conclusions: The increased MPV during the first 24 h postpartum may be predictive of EONS and mortality. Future studies are warranted.

Cribado de Citomegalovirus en mujeres embarazadas

Introduction: Cytomegalovirus (CMV) is a DNA virus of the family Herpesviridae, constitutes one of the main causes of congenital infections in the world, the overall prevalence of births in developed countries is 0.64% and the incidence of 1% -7%. The rate of acquisition of CMV in pregnant women is 2% per year, in the medium-high socioeconomic level and 6% at lower levels. The susceptibility is greater in African-American and Hispanic women. The risk ofmaternal-fetal transmission increases with advancing gestational age, also (30-40%) depends on maternal primary infection both seroconversion and in the revival (1-2%), highlighting that the pre-existing maternal immunity not prevent intrauterine transmission or the development of the disease. Objective: To evaluate the frequency of Cytomegalovirus infection in pregnant women. Material and methods: a study of non-experimental, observational -cross in the pro-life basic Hospital, of the city of Latacunga,Ecuador. Analyzed 981 results of screening for IgG and IgM for CMV, pregnant womages between 14 and 45 years who were enrolled in the first trimester of pregnancy, the period between January 1, 2013 to December 31, 2016. Descriptive statistical methods were used. Results: IgG positive was 95.7% and no positive result for IgM. Conclusions: We cannot support universal screening for CMV, by the low prevalence of infection.Introducción: El citomegalovirus(CMV)es un ADN virus, de la familia Herpesviridae, constituye una de las principales causas de infecciones congénitas en el mundo, la prevalencia general de nacimientos en países desarrollados es de 0,64% y la incidencia del 1% -7%. La tasa de adquisición de CMV en mujeres embarazadas es de 2% anual,en el nivel socioeconómico medio-alto y 6% en niveles más bajos. La susceptibilidad es mayor en mujeres afroamericanas e hispanas. El riesgo de transmisión materno-fetalseincrementa con el avance de la edad gestacional, además depende de la seroconversión materna tanto en la primoinfección (30-40%) como en la reactivación (1-2%), poniendo en evidencia que la inmunidad materna preexistente no previene la transmisión intrauterina o el desarrollo de la enfermedad. Objetivo: Evaluar la frecuencia deinfección por Citomegalovirus en mujeres embarazadas. Material y métodos: Se realizó un estudio no experimental, observacional –transversal en el Hospital Básico PROVIDA, de la cuidad de Latacunga, Ecuador. Se analizaron 981 resultados de screening de IgG e IgM para CMV, de mujeres gestantes en edades entre 14 y 45 años que cursaban el primer trimestre de embarazo, del periodo comprendido entre el 1 de enero de 2013 al 31 de diciembre de 2016.Se utilizaron métodos estadísticos descriptivos. Resultados: La IgG fue positiva el 95,7% y ningún resultado positivo para IgM. Conclusiones: No podemos apoyar el cribado universal de CMV, por la baja prevalencia de primoinfeccion

Asociación entre el riesgo nutricional, estancia hospitalaria y diagnóstico médico en pacientes de un hospital del seguro social peruano

Objective: To determine the association between nutritional risk, hospital stay and medical diagnosis among patients admitted at Centro Especializado de Rehabilitación Profesional (CERP) of Hospital Nacional Guillermo Almenara Irigoyen. Materials and methods: An observational retrospective longitudinal cohort study was conducted with inpatients between July 1, 2021 and February 27, 2022. The patients were followed up until they left the hospital (discharge). Individualsunder 18 years of age, pregnant or puerperal women, and those whose stay was less than 24 hours were excluded. The data of interest was collected from the patients’ medical records and diet cards. The main variable was the nutritional risk, which was detected using the Nutritional Risk Screening (NRS) 2002. The secondary variables were age group, sex, hospitalstay, main medical diagnosis, discharge condition and nutritional status. Data analysis was performed using the chi-square test to compare the qualitative or categorical variables, and the Student’s t-test and ANOVA for the quantitative variables. A value of p &lt; 0.05 was considered as statistically significant. Results: A total of 1,929 patients were included in the study. Nutritional risk prevalence accounted for 33.13 %. Patients with this condition showed the highest mortality rates (57.51 %). It was found that nutritional risk prevalence was related to a longer hospital stay (4.6 more days) (p &lt; 0.001), a diagnosis of constitutional thinness (48.67 %) (p &lt; 0.001) and themedical diagnosis, being oncology disorders the most associated ones (50.93 %). Conclusions: Nutritional risk is associated with disease progression, resulting in an increased hospital stay, mortality rate and therefore hospital costs. Early detection is important to provide adequate dietary interventions.Objetivo: Determinar la asociación que existe entre el riesgo nutricional, la estancia hospitalaria y el diagnóstico médico en pacientes hospitalizados en el Centro Especializado de Rehabilitación Profesional (CERP) del Hospital Nacional Guillermo Almenara Irigoyen. Materiales y métodos: Se realizó un estudio observacional de cohorte longitudinal, retrospectivo, que incluyó a las personas hospitalizadas durante el periodo comprendido entre el 1 de julio del 2021 y el 27 de febrero del 2022. Hubo un seguimiento de los pacientes hasta su alta del centro hospitalario (egreso). Se excluyeron los individuos menores de 18 años, gestantes o puérperas, y cuya permanencia fue menor a 24 horas. Los datos de interés fueron recogidos a partir de la revisión de las historias clínicas y kárdex de nutrición. La variable principal fue el riesgo nutricional, el cual fue detectado mediante el Nutritional Risk Screening (NRS) 2002; las variables secundarias fueron los grupos etarios, el sexo, la estancia hospitalaria, el diagnóstico médico principal, la condición de egreso y el estado nutricional. En el análisis de los datos, para la comparación de variables cualitativas o categóricas se utilizó la prueba chi-cuadrado y para variables cuantitativas, la prueba t de Student y ANOVA. Se consideró significancia estadística al valor de p &lt; 0,05. Resultados: Se incluyó un total de 1 929 pacientes. La prevalencia del riesgo nutricional fue 33,13 %. Los pacientes con esta condición presentaron tasas de mortalidad más altas (57,51 %). Se observó que la prevalencia del riesgo nutricional está relacionada con una mayor estancia hospitalaria (4,6 días más) (p &lt; 0,001), con el diagnóstico nutricional de delgadez (48,67 %) (p &lt; 0,001) y con el diagnóstico médico, donde la enfermedad oncológica es la más asociada (50,93 %).Conclusiones: El riesgo nutricional se asocia a una evolución negativa de la enfermedad, lo que origina un aumento de la estancia hospitalaria, la tasa de mortalidad y, por ende, los costos intrahospitalarios. Es importante realizar su detección temprana para poder brindar intervenciones nutricionales adecuadas

Cribado de Citomegalovirus en mujeres embarazadas

Introduction: Cytomegalovirus (CMV) is a DNA virus of the family Herpesviridae, constitutes one of the main causes of congenital infections in the world, the overall prevalence of births in developed countries is 0.64% and the incidence of 1% -7%. The rate of acquisition of CMV in pregnant women is 2% per year, in the medium-high socioeconomic level and 6% at lower levels. The susceptibility is greater in African-American and Hispanic women. The risk ofmaternal-fetal transmission increases with advancing gestational age, also (30-40%) depends on maternal primary infection both seroconversion and in the revival (1-2%), highlighting that the pre-existing maternal immunity not prevent intrauterine transmission or the development of the disease. Objective: To evaluate the frequency of Cytomegalovirus infection in pregnant women. Material and methods: a study of non-experimental, observational -cross in the pro-life basic Hospital, of the city of Latacunga,Ecuador. Analyzed 981 results of screening for IgG and IgM for CMV, pregnant womages between 14 and 45 years who were enrolled in the first trimester of pregnancy, the period between January 1, 2013 to December 31, 2016. Descriptive statistical methods were used. Results: IgG positive was 95.7% and no positive result for IgM. Conclusions: We cannot support universal screening for CMV, by the low prevalence of infection.Introducción: El citomegalovirus(CMV)es un ADN virus, de la familia Herpesviridae, constituye una de las principales causas de infecciones congénitas en el mundo, la prevalencia general de nacimientos en países desarrollados es de 0,64% y la incidencia del 1% -7%. La tasa de adquisición de CMV en mujeres embarazadas es de 2% anual,en el nivel socioeconómico medio-alto y 6% en niveles más bajos. La susceptibilidad es mayor en mujeres afroamericanas e hispanas. El riesgo de transmisión materno-fetalseincrementa con el avance de la edad gestacional, además depende de la seroconversión materna tanto en la primoinfección (30-40%) como en la reactivación (1-2%), poniendo en evidencia que la inmunidad materna preexistente no previene la transmisión intrauterina o el desarrollo de la enfermedad. Objetivo: Evaluar la frecuencia deinfección por Citomegalovirus en mujeres embarazadas. Material y métodos: Se realizó un estudio no experimental, observacional –transversal en el Hospital Básico PROVIDA, de la cuidad de Latacunga, Ecuador. Se analizaron 981 resultados de screening de IgG e IgM para CMV, de mujeres gestantes en edades entre 14 y 45 años que cursaban el primer trimestre de embarazo, del periodo comprendido entre el 1 de enero de 2013 al 31 de diciembre de 2016.Se utilizaron métodos estadísticos descriptivos. Resultados: La IgG fue positiva el 95,7% y ningún resultado positivo para IgM. Conclusiones: No podemos apoyar el cribado universal de CMV, por la baja prevalencia de primoinfeccion

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation

<p>Abstract</p> <p>Background</p> <p>A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy.</p> <p>Methods</p> <p>40 Alerta reporting units (18 clinics and 22 ships) were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively.</p> <p>Results</p> <p>Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p < 0.001) and from 46.9% to 77.3% on ships (+30.4 [95% CI, +16.9 to +43.8]; p < 0.001). Visit and control groups did not show significant changes in timeliness. Error rates decreased in the visit group from 7.1% to 2% in clinics (-5.1 [95% CI, -8.7 to -1.4]; p = 0.007), but only from 7.3% to 6.7% on ships (-0.6 [95% CI, -2.4 to +1.1]; p = 0.445). Phone and control groups did not show significant improvement in data quality.</p> <p>Conclusion</p> <p>Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.</p

Launching of the Anaemia Research Peruvian Cohort (ARPEC): a multicentre birth cohort project to explore the iron adaptive homeostasis, infant growth and development in three Peruvian regions.

BACKGROUND: Preventing infantile anaemia and ensuring optimal growth and development during early childhood, particularly in resource-constrained settings, represent an ongoing public health challenge. Current responses are aligned to treatment-based solutions, instead of determining the roles of its inter-related causes. This project aims to assess and understand the complex interplay of eco-bio-social-political factors that determine infantile anaemia to inform policy, research design and prevention practices. METHODS: This is a longitudinal birth cohort study including four components: (1) biological, will assess known blood markers of iron homeostasis and anaemia and stool microbiota to identify and genetically analyse the participants' flora; (2) ecological, will assess and map pollutants in air, water and soil and evaluate features of nutrition and perceived food security; (3) social, which will use different qualitative research methodologies to explore key stakeholders and informants' perceptions related to nutritional, environmental and anaemia topics, participant observations and a participatory approach and (4) a political analysis, to identify and assess the impact of policies, guidelines and programmes at all levels for infantile anaemia in the three regions. Finally, we will also explore the role of social determinants and demographic variables longitudinally for all study participants. This project aims to contribute to the evidence of the inter-related causal factors of infantile anaemia, addressing the complexity of influencing factors from diverse methodological angles. We will assess infantile anaemia in three regions of Peru, including newborns and their mothers as participants, from childbirth until their first year of age. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Research Ethics Committee of the Instituto Nacional de Salud del Niño (Lima, Peru), CIEI-043-2019. An additional opinion has been granted by the Ethical Committee of Queen Mary University of London (London, UK). Dissemination across stakeholders is taking part as a continues part of the research process

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy

Study on multi-ELVES in the Pierre Auger Observatory

Since 2013, the four sites of the Fluorescence Detector (FD) of the Pierre Auger Observatory record ELVES with a dedicated trigger. These UV light emissions are correlated to distant lightning strikes. The length of recorded traces has been increased from 100 μs (2013), to 300 μs (2014-16), to 900 μs (2017-present), to progressively extend the observation of the light emission towards the vertical of the causative lightning and beyond. A large fraction of the observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. The nature of the multi-ELVES is not completely understood but may be related to the different types of lightning in which they are originated. For example, it is known that Narrow Bipolar Events can produce double ELVES, and Energetic In-cloud Pulses, occurring between the main negative and upper positive charge layer of clouds, can induce double and even quadruple ELVES in the ionosphere. This report shows the seasonal and daily dependence of the time gap, amplitude ratio, and correlation between the pulse widths of the peaks in a sample of 1000+ multi-ELVES events recorded during the period 2014-20. The events have been compared with data from other satellite and ground-based sensing devices to study the correlation of their properties with lightning observables such as altitude and polarity

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data