Tuberculosis (TB) is a serious threat to children′s health.The world health organization (WHO) reported that there were almost 1 million patients and 230 000 deaths among children globally in 2017.In order to control the prevalence of childhood TB, WHO put forward a blueprint of towards zero death for childhood TB . However, due to the difficulty in obtaining specimens, the lack of typical symptoms and the insufficient of existing diagnostic methods for children, it is hard to achieve the goal of zero death.The summary of the diagnosis status will promote to solve the current problems in children.
Key words:
Child; Tuberculosis; Diagnostic methods; Problems; Prospects
Abstract As the long‐term consequences of coronavirus disease 2019 (COVID‐19) have not been defined, it is necessary to explore persistent symptoms, long‐term respiratory impairment, and impact on quality of life over time in COVID‐19 survivors. In this prospective cohort study, convalescent individuals diagnosed with COVID‐19 were followed‐up 2 and 3 years after discharge from hospital. Participants completed an in‐person interview to assess persistent symptoms and underwent blood tests, pulmonary function tests, chest high‐resolution computed tomography, and the 6‐min walking test. There were 762 patients at the 2‐year follow‐up and 613 patients at the 3‐year follow‐up. The mean age was 60 years and 415 (54.5%) were men. At 3 years, 39.80% of the participants had at least one symptom; most frequently, fatigue, difficulty sleeping, joint pain, shortness of breath, muscle aches, and cough. The participants experienced different degrees of pulmonary function impairment, with decreased carbon monoxide diffusion capacity being the main feature; results remained relatively stable over the 2–3 years. Multiple logistic regression analysis demonstrated that female sex and smoking were independently associated with impaired diffusion capacity. A subgroup analysis based on disease severity was performed, indicating that there was no difference in other parameters of lung function except forced vital capacity at 3‐year follow‐up. Persistent radiographic abnormalities, most commonly fibrotic‐like changes, were observed at both timepoints. At 3 years, patients had a significantly improved Mental Component Score compared with that at 2 years, with a lower percentage with anxiety. Our study indicated that symptoms and pulmonary abnormalities persisted in COVID‐19 survivors at 3 years. Further studies are warranted to explore the long‐term effects of COVID‐19 and develop appropriate rehabilitation strategies.
Early target attainment is the key factor influencing the outcome of antimicrobial therapy. The objective of the present study was to evaluate the relationship between azithromycin concentrations during the first 24-48 h of therapy and the clinical outcome in order to optimize antimicrobial therapy.All children with lower respiratory tract infections receiving intravenous azithromycin monotherapy were included. The relationship between azithromycin trough concentrations during the first 24-48 h and the effectiveness and safety was explored.Data from 44 children [mean (SD) age = 5.25 (3.72) years] were available for final analysis. Children with trough concentrations >0.25 mg/L (n = 8) had a more significant improvement in antibacterial efficacy in terms of decreased C-reactive protein (P = 0.006) and the percentage of neutrophils (P = 0.043) compared with children with trough concentrations ≤0.25 mg/L (n = 36). No drug-related adverse events were shown to have a causal association with azithromycin therapy.Our study showed the clinical benefits of early target attainment of azithromycin therapy. A target trough concentration of 0.25 mg/L in the first 24-48 h of hospitalization was required to ensure better antibacterial efficacy.
Background:The conclusions about risk factors for rapid cognitive decline (RCD) in Alzheimer's disease (AD) and mild cognitive impairment (MCI) remain contradictory. Objective:To explore the factors predicting RCD in AD and MCI. Methods:We searched the PubMed, EMBASE, and the Cochrane Library from inception to May 27, 2017 for studies investigating factors associated with faster cognitive progression in AD and MCI. Effect sizes were meta-analyzed using fixed-effects and random-effects models. Results:Fifty-three studies with 14,330 patients (12,396 AD and 1,934 MCI) were included in the systematic review. The following factors were identified to increase the risk of RCD in AD: Apolipoprotein E4 (ApoE4) (SMD [95% CI]: 0.52 [0.06,0.98]), early age at onset (SMD [95% CI]: –0.42 [–0.71, –0.13]), high level of education (RR = 2.05, 95% CI = 1.26 to 3.33), early appearance of extrapyramidal signs (RR = 2.18; 95% CI = 1.30 to 3.67), and neuropsychiatric conditions including hallucination (RR = 2.01, 95% CI = 1.40 to 2.87), strolling (RR = 1.99, 95% CI = 1.38 to 2.86), agitation (RR = 1.66, 95% CI = 1.23 to 2.24), and psychosis (RR = 1.42, 95% CI = 1.07 to 1.89). Instead, advanced age (≥75 years) (RR = 0.96, 95% CI = 0.93 to 0.99), diabetes (RR = 0.57; 95% CI = 0.35 to 0.93), and multidrug therapy (RR = 0.61, 95% CI = 0.60 to 0.62) would lower the risk of RCD. Furthermore, systematic research also reviewed seven risk factors associated with RCD in MCI. Conclusion:ApoE4, early onset, early appearance of extrapyramidal signs, high education level, and neuropsychiatric conditions might increase the risk of RCD while older age, diabetes, and multidrug therapy were the protective factors for AD.
We sought to identify the risk factors for predicting the progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD).We searched 6 electronic databases for cohort studies published from January 1966 to March 2015. Eligible studies were required to be relevant to the subject and provide sufficient data for our needs.60 cohort studies with 14,821 participants from 16 countries were included in the meta-analysis. The strongest positive associations between risk factors and the progression from MCI to AD were found for abnormal cerebrospinal fluid (CSF), phosphorylated τ (p-τ) (relative risk (RR)=2.43, 95% CI=1.70 to 3.48), abnormal CSF τ/Aβ1-42 (RR=3.77, 95% CI=2.34 to 6.09), hippocampal atrophy (RR=2.59, 95% CI=1.95 to 3.44), medial temporal lobe atrophy (RR=2.11, 95% CI=1.70 to 2.63) and entorhinal atrophy (RR=2.03, 95% CI=1.57 to 2.62). Further positive associations were found for the presence of apolipoprotein E (APOE)ε4ε4 and at least 1 APOEε4 allele, CSF total-τ (t-τ), white matter hyperintensity volume, depression, diabetes, hypertension, older age, female gender, lower mini-mental state examination (MMSE) score and higher AD assessment scale cognitive subscale (ADAS-cog) score. Negative associations were found for high body mass index (RR=0.85, 95% CI=0.76 to 0.96) and higher auditory verbal learning test delay score (RR=0.86, 95% CI=0.77 to 0.96).Patients with MCI with APOEε4, abnormal CSF τ level, hippocampal and medial temporal lobe atrophy, entorhinal atrophy, depression, diabetes, hypertension, older age, female gender, lower MMSE score and higher ADAS-cog score, had a high risk for the progression to AD.
Background: The community-acquired respiratory distress syndrome toxin (CARDS), a key exotoxin produced by Mycoplasma pneumoniae, can induce cytopathology. M. pneumoniae pneumonia (MPP) is characterized by ciliary ultrastructural abnormalities. The effect and mechanism of CARDS on ciliary function remain to be fully elucidated.Methods: We used recombinant CARDS to establish a mouse model to explore its effect and role. We also collected bronchoalveolar lavage fluid (BALF) and analysed the differences in proteomics between patients with MPP and those with other infectious diseases using liquid chromatography-tandem mass spectrometry (LC-MS/MS).Findings: CARDS increased the inflammatory response, decreased the expression of ciliary genes, and disrupted motile cilia formation. The expression of FMRP, essential for multiciliogenesis, was decreased in the lungs of mice treated with CARDS. DHPG, an agonist that promotes the expression of FMRP, attenuated cilia injury and inflammatory responses in mice treated with CARDS. Ciliary FMRP was down-regulated in BALF from patients with MPP.Interpretation: Our study identified FMRP down-regulation as a pathogenic mechanism that may facilitate inflammation spread to the entire lung parenchyma, suggesting that FMRP acts as a critical regulator for maintaining immune homeostasis.Funding: This work was supported by the Capital's Funds for Health Improvement and Research (Grant No. 2022-1-1061).Declaration of Interest: The authors declare no competing interests.Ethical Approval: Human samples collection was approved by the Ethics Committee of Beijing Chaoyang Hospital (2021-Ke-501). All animal experiments were performed with the approval of the Capital Medical University Animal Care and Use Committee, Beijing, China (8DE8FF07-8179-4D19-971D-385B3649EF30).
OBJECTIVE To study the value of quantitative electroencephalography (qEEG) in evaluating the effect of blood glucose on the brain function of preterm infants. METHODS The preterm infants who were admitted to the Department of Neonatology, The Third Xiangya Hospital of Central South University, from January to December 2019 were enrolled. According to the level of blood glucose, they were divided into group 1 (blood glucose <4.95 mmol/L), group 2 (blood glucose 4.95 to <6.60 mmol/L), group 3 (blood glucose 6.60 to <8.55 mmol/L), and group 4 (blood glucose ≥8.55 mmol/L). The changes in qEEG parameters were compared between groups, and a correlation analysis was performed for blood glucose and qEEG parameters. RESULTS A total of 39 preterm infants were enrolled (84 blood glucose measurements). Compared with group 4, the other three groups had significant increases in the total spectral power of each brain region and the absolute power of each frequency band in the frontal and occipital regions (P<0.05). The total spectral power, δ/θ ratio, and (δ+θ)/(α+β) ratio of each brain region were negatively correlated with blood glucose level, while the relative power of θ frequency band was positively correlated with blood glucose level (P<0.05). CONCLUSIONS With the change in blood glucose, there are significant changes in the total spectral power of each brain region, the power of each frequency band, and the frequency spectrum composition on qEEG in preterm infants. qEEG may therefore become an important tool to monitor the effect of abnormal blood glucose on brain function in preterm infants.
Abstract Objective: The aim of this study was to investigate the role of serum IgE level in the clinical features and outcome of IgG-4 related disease (IgG4-RD). Methods: We retrospectively enrolled 459 newly diagnosed IgG4-RD patients with serum IgE examined at baseline from 2012 to 2019, and compared the clinical features between high IgE group (Serum IgE level>60KU/L) and normal IgE group (Serum IgE level≤60KU/L) patients. Then 312 patients who have been followed up for ≥ 1 year were further selected to evaluate the correlation of serum IgE level and disease outcome. Results: At baseline, Serum IgE level was positively correlated with serum IgG4 level (r=0.1779, P=0.0001), eosinophil count (r=0.3004, P<0.0001), serum IgG level (r=0.2189, P<0.0001) in IgG4-RD patients. Compared with normal IgE group patients, high IgE group patients had more patients with allergy disease (P=0.004), more organ involvements (P=0.003), and higher IgG4-RD RI scores (P=0.002). During follow-up, normal IgE group patients had higher remission induction rate than high IgE group patients (88.4% vs. 73.6%, P=0.035), while high IgE group patients had more relapse rate compared with normal IgE group patients (29.0% vs. 16.2%, P=0.039), and relapsed patients had higher serum IgE level at baseline (P=0.046). Cox regression analysis showed that elevation of the eosinophil count was the risk factors of relapse for both normal and high IgE groups patients (HR 8.504 (1.071-42.511), P=0.009; HR 2.078 (1.277-3.380), P=0.003), and the involvement of lacrimal gland (HR 1.756 (1.108-2.782), P=0.017), submandibular gland (HR 1.654 (1.037-2.639), P=0.035), kidney (HR 3.413 (1.076-10.831), P=0.037) were also the risk factors of relapse for high IgE group patients. Conclusion: IgG4-RD patients with high serum IgE level at baseline were more likely to have higher disease activity, and baseline high IgE level were associated with disease relapse.
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