Influenza-Associated Myositis in Children

Abstract. : Background: : Influenza-associated myositis (IAM) is an infrequent and poorly known complication of influenza virus infection in children. The aim of this study was to describe five cases of IAM and to review the literature on IAM in children. Patients and Methods: : We conducted a retrospective analysis of cases of IAM diagnosed at two university children's hospitals in Switzerland during two consecutive influenza seasons. Findings were compared with 39 individual case reports and five publications summarizing an additional 272 cases identified by a medical online library (MEDLINE) search. Results: : Overall, 316 cases were analyzed. IAM typically occurred in school-aged children with a 2:1 male predominance. Influenza B and A viruses were identified in 76% and 24% of cases, respectively. The median interval between onset of influenza and onset of IAM was 3 days (range 0-18). The calf muscles were involved alone or together with other muscle groups in 69% and 31% of cases, respectively. Blood creatine phosphokinase (CPK) concentration was invariably elevated. Median duration to clinical recovery was 3 days (range 1-30). Rhabdomyolysis occurred in ten of 316 patients (3%), was more common in girls (80%), more often associated with influenza A (86%), and led to renal failure in eight patients (80%). Conclusion: : Clinical and laboratory findings of IAM are highly characteristic and allow a rapid diagnosis during the influenza seaso

The Emergent Vinifera Wine Industry in North Carolina: A Descriptive Overview

The North Carolina (NC) wine industry has grown rapidly over the past decade and is expected to grow even more as the worldwide wine consumption and export of wines rises. In the United States, the wine market has grown by 13.7 percent since 2002 in volume and by more than 15 percent in dollars as wine has progressed from being a beverage of an elite segment of the market to becoming a mainline beverage, taking its place alongside beer and liquor (MKF Research LLC, 2007; Oches, 2009). The Piedmont Triad Region is uniquely positioned to increase its presence in this industry. Of the 80 wineries in NC that are currently open to the public, nearly half are located in the Piedmont Triad Region. However, growing grapes and making wine is a long term commitment to a community, both financially and physically. The MKF Research report states that the capital-intensive nature of the winery and vineyard sectors is often underestimated, with new entrants to the industry at times unprepared for the extended cash requirements. In addition, only a few local institutions are familiar with the unique needs of the winemaking business. In order to address factors that will impede growth in this nascent industry, it is important to identify the state of the industry and obtain management perspectives on the needs and challenges facing their operations. This study provides information that would help gain a better understanding of the business issues and needs related to the wine and grape industry in North Carolina. Data for this study was drawn from a census of 34 wine producers located in the Yadkin, Swan Creek, and the Haw River valley regions of North Carolina. Descriptive statistics using frequencies and means is used to provide a demographic overview of the industry and to identify the factors that wine producers perceive to be important in affecting their profitability. Results from the study shows that most of the wineries share some common traits: they are small, relatively new to the wine and grape industry and grow grapes other than the traditional native Muscadine grape. Primarily, a majority of the wineries are family-based entrepreneurial businesses that have to behave like mini-conglomerates. These findings are consistent with a study conducted by Taplin and Breckenridge (2008).Profitability Constraints, Financial Management, Marketing, Distribution, Agribusiness, Community/Rural/Urban Development, Farm Management,

In vitro inhibition of Clostridium difficile by commercial probiotics: A microcalorimetric study

The aim of the study was to investigate the influence of some commercial probiotics on the growth of Clostridium difficile using isothermal microcalorimetry, a technique which can monitor the real time growth of bacteria. Commercial probiotic strains and products, Lactobacillus acidophilus LA-5(®), Bifidobacterium lactis BB-12(®), Probio 7(®) and Symprove™ were co-cultured with C. difficile in Brain Heart Infusion (BHI) broth supplemented with 0.1% (w/v) l-cysteine hydrochloride and 0.1% (w/v) sodium taurocholate and monitored in the microcalorimeter. Pseudomonas aeruginosa NCIMB 8628 was also co-cultured with C. difficile and studied. The results indicated inhibition of C. difficile by the probiotics. The inhibition of C. difficile was shown to be pH-dependent using neutralized and unmodified cell free supernatant (CFS) produced by the probiotic strains. However, concentrated CFS of the probiotics also inhibited the intestinal pathogen in a non pH-dependent manner, likely due to specific antimicrobial substances produced. The results also indicated that C. difficile growth was greatly influenced by the presence of sodium taurocholate and by the pH of the medium. A medium pH of between 6.45 and 6.9 demonstrated maximum growth of the organism in the microcalorimeter

Towards Adequate Policy Enhancement: An AI-Driven Decision Tree Model for Efficient Recognition and Classification of EPA Status via Multi-Emission Parameters

Accurate and timely evaluation and assessment of emission data and its impact on environmental status has been a key challenge due to the conventional manual approach utilized for independently computing most emission parameters. To resolve this long-standing issue, we proposed an Artificial Intelligence (AI)-driven Decision Tree model to adequately classify Environmental Protection Agency (EPA) status based on multiple Emission Parameters. The model's performance was systematically evaluated using multiple emission parameters obtained from a two-stroke motorcycle dataset collected in Nigeria across various metrics such as K-S Statistics, Confusion Matrix, Correlation Heat Map, Decision Tree, Validation Curve, and Threshold Plot. The K-S Statistics plot's experimental results showed a considerable correlation between HC, CO, and the target variable, with values ranging from 0.75-0.80. At the same time, CO2 and O2 do not correlate with the target variable with values between 0.00 and 0.09. The Confusion Matrix revealed that the proposed model has an overall accuracy of 99.9% with 481 true positive predictions and 75 true negative predictions, indicating the effectiveness of the proposed AI-driven model. In conclusion, our proposed AI-driven model can effectively classify EPA status based on multiple emission parameters with high accuracy, which may spur positive advancement in policy enhancement for proper environmental management

Microcalorimetric evaluation of a multi-strain probiotic: Interspecies inhibition between probiotic strains

Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus acidophilus and Enterococcus faecium, which are the component species of a commercially available probiotic mixture (Symprove®, P1), were grown in co-culture to determine whether they would inhibit each other in vitro using an isothermal microcalorimeter (IMC). The growth profiles in the IMC were characteristic and unique to each species while the growth profile of P1 was most similar to that of L. plantarum, suggesting this is the dominant organism in mixed-culture. Bacterial growth in the cell free supernatants (CFS) of the probiotic species were also evaluated by IMC and viable counts determined. L. plantarum was found to be the most effective species at inhibiting L. rhamnosus. Conversely, L. rhamnosus was the most effective at limiting the growth of L. plantarum. Both L. plantarum and L. rhamnosus were inhibitory toward L. acidophilus and E. faecium. E. faecium was the least inhibitory towards all the other species

Trends in multiplicity of Plasmodium falciparum infections among asymptomatic residents in the middle belt of Ghana.

BACKGROUND: Malaria is the most important cause of mortality and morbidity in children living in the Kintampo districts in the middle part of Ghana. This study has investigated the multiplicity of infection (MOI) within asymptomatic residents of the Kintampo districts, and the influence of age and seasonality on MOI, by studying the distribution of the polymorphic Plasmodium falciparum antigen merozoite surface protein 2 (MSP2). METHODS: DNA was extracted from an asymptomatic cohort of children and adults infected with P. falciparum during the period November 2003 to October 2004. Polymerase chain reaction was carried out and multiplicity of infection (MOI) was determined. RESULTS: Children under 10 years of age had an average MOI of 2.3 while adults 18 years and above had an average MOI of 1.4. Children below five years had high and low average MOIs of 2.8 in the March/April survey and 0.9 in the May/June survey respectively. A similar trend in the monthly distribution of MOI was observed for the entire cohort. IC/3D7 strains outnumbered the FC27 strains throughout the year by a ratio of about 4:1 with the difference between the prevalence of the two strains being least marked in the March/April survey, at the beginning of the rainy season. MOI was not linked to the level of malaria transmission as measured by the entomological inoculation rate. DISCUSSION/CONCLUSION: The impact of interventions, introduced since this baseline study was carried out on the parasite diversity of asymptomatic residents will be the subject of further investigations

A Prospective Multicenter SPOG 2003 FN Study of Microbiologically Defined Infections in Pediatric Cancer Patients with Fever and Neutropenia.

BACKGROUND: Fever and neutropenia (FN) often complicate anticancer treatment and can be caused by potentially fatal infections. Knowledge of pathogen distribution is paramount for optimal patient management. METHODS: Microbiologically defined infections (MDI) in pediatric cancer patients presenting with FN by nonmyeloablative chemotherapy enrolled in a prospective multi-center study were analyzed. Effectiveness of empiric antibiotic therapy in FN episodes with bacteremia was assessed taking into consideration recently published treatment guidelines for pediatric patients with FN. RESULTS: MDI were identified in a minority (22%) of pediatric cancer patients with FN. In patients with, compared to without MDI, fever (median, 5 [IQR 3-8] vs. 2 [IQR1-3] days, p < 0.001) and hospitalization (10 [6-14] vs. 5 [3-8] days, p < 0.001) lasted longer, transfer to the intensive care unit was more likely (13 of 95 [14%] vs. 7 of 346 [2.0%], p < 0.001), and antibiotics were given longer (10 [7-14] vs. 5 [4-7], p < 0.001). Empiric antibiotic therapy in FN episodes with bacteremia was highly effective if not only intrinsic and reported antimicrobial susceptibilities were considered but the purposeful omission of coverage for coagulase negative staphylococci and enterococci was also taken into account (81% [95%CI 68 - 90] vs. 96.6% [95%CI 87 - 99.4], p = 0.004) CONCLUSIONS: MDI were identified in a minority of FN episodes but they significantly affected management and the clinical course of pediatric cancer patients. Compliance with published guidelines was associated with effectiveness of empiric antibiotic therapy in FN episodes with bacteremia

Limited Correlation of Shotgun Metagenomics Following Host Depletion and Routine Diagnostics for Viruses and Bacteria in Low Concentrated Surrogate and Clinical Samples

The etiologic cause of encephalitis, meningitis or meningo-encephalitis is unknown in up to 70% of cases. Clinical shotgun metagenomics combined with host depletion is a promising technique to identify infectious etiologies of central nervous system (CNS) infections. We developed a straightforward eukaryotic host nucleic acid depletion method that preserves intact viruses and bacteria for subsequent shotgun metagenomics screening of clinical samples, focusing on cerebrospinal fluid (CSF). A surrogate CSF sample for a CNS infection paradigm was used to evaluate the proposed depletion method consisting of selective host cell lysis, followed by enzymatic degradation of the liberated genomic DNA for final depletion with paramagnetic beads. Extractives were subjected to reverse transcription, followed by whole genome amplification and next generation sequencing. The effectiveness of the host depletion method was demonstrated in surrogate CSF samples spiked with three 1:100 dilutions of Influenza A H3N2 virus (qPCR Ct-values 20.7, 28.8, >42/negative). Compared to the native samples, host depletion increased the amount of the virus subtype reads by factor 7127 and 132, respectively, while in the qPCR negative sample zero vs. 31 (1.4E-4 %) virus subtype reads were detected (native vs. depleted). The workflow was applied to thirteen CSF samples of patients with meningo-/encephalitis (two bacterial, eleven viral etiologies), a serum of an Andes virus infection and a nose swab of a common cold patient. Unlike surrogate samples, host depletion of the thirteen human CSF samples and the nose swab did not result in more reads indicating presence of damaged pathogens due to, e.g., host immune response. Nevertheless, previously diagnosed pathogens in the human CSF samples (six viruses, two bacteria), the serum, and the nose swab (Human rhinovirus A31) were detected in the depleted and/or the native samples. Unbiased evaluation of the taxonomic profiles supported the diagnosed pathogen in two native CSF samples and the native and depleted serum and nose swab, while detecting various contaminations that interfered with pathogen identification at low concentration levels. In summary, damaged pathogens and contaminations complicated analysis and interpretation of clinical shotgun metagenomics data. Still, proper consideration of these issues may enable future application of metagenomics for clinical diagnostics