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Choi DH, Choi SW, Kim KH, Choi Y, Kim Y. Early identification of suspected serious infection among patients afebrile at initial presentation using neural network models and natural language processing: A development and external validation study in the emergency department. Am J Emerg Med 2024; 80:67-76. [PMID: 38507849 DOI: 10.1016/j.ajem.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To develop and externally validate models based on neural networks and natural language processing (NLP) to identify suspected serious infections in emergency department (ED) patients afebrile at initial presentation. METHODS This retrospective study included adults who visited the ED afebrile at initial presentation. We developed four models based on artificial neural networks to identify suspected serious infection. Patient demographics, vital signs, laboratory test results and information extracted from initial ED physician notes using term frequency-inverse document frequency were used as model variables. Models were trained and internally validated with data from one hospital and externally validated using data from a different hospital. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CIs). RESULTS The training, internal validation, and external validation datasets comprised 150,699, 37,675, and 85,098 patients, respectively. The AUCs (95% CIs) for Models 1 (demographics + vital signs), 2 (demographics + vital signs + initial ED physician note), 3 (demographics + vital signs + laboratory tests), and 4 (demographics + vital signs + laboratory tests + initial ED physician note) in the internal validation dataset were 0.789 (0.782-0.796), 0.867 (0.862-0.872), 0.881 (0.876-0.887), and 0.911 (0.906-0.915), respectively. In the external validation dataset, the AUCs (95% CIs) of Models 1, 2, 3, and 4 were 0.824 (0.817-0.830), 0.895 (0.890-0.899), 0.879 (0.873-0.884), and 0.913 (0.909-0.917), respectively. Model 1 can be utilized immediately after ED triage, Model 2 can be utilized after the initial physician notes are recorded (median time from ED triage: 28 min), and Models 3 and 4 can be utilized after the initial laboratory tests are reported (median time from ED triage: 68 min). CONCLUSIONS We developed and validated models to identify suspected serious infection in the ED. Extracted information from initial ED physician notes using NLP contributed to increased model performance, permitting identification of suspected serious infection at early stages of ED visits.
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Affiliation(s)
- Dong Hyun Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae Won Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Ki Hong Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeongho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yoonjic Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Martins Januário W, Prata ERBDA, Natali AJ, Prímola-Gomes TN. Normal gastrointestinal temperature values measured through ingestible capsules technology: a systematic review. J Med Eng Technol 2024:1-7. [PMID: 38780358 DOI: 10.1080/03091902.2024.2354793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Climate change has amplified the importance of continuous and precise body core temperature (Tcore) monitoring in the everyday life. In this context, assessing Tcore through ingestible capsules technology, i.e., gastrointestinal temperature (Tgastrointestinal), emerges as a good alternative to prevent heat-related illness. Therefore, we conducted a systematic review to point out values of normal Tgastrointestinal measured through ingestible capsules in healthy humans. The study followed PRISMA guidelines and searched the PubMed and Scielo databases from 1971 to 2023. Our search strategy included the descriptors ("gastrointestinal temperature") AND ("measurement"), and eligible studies had to be written in English and measured Tgastrointestinal using ingestible capsules or sensors in healthy adults aged 18-59 at rest. Two pairs of researchers independently reviewed titles and abstracts and identified 35 relevant articles out of 1,088 in the initial search. An average value of 37.13 °C with a standard deviation of 0.24 °C was observed, independently of the gender. The values measured ranged from 36.70 °C to 37.69 °C. In conclusion, this systematic review pointed out the mean value of 37.13 ± 0.24 °C measured by ingestible capsules as reference for resting Tgastrointestinal in healthy adult individuals.
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Affiliation(s)
- William Martins Januário
- Departamento de Educação Física, Laboratório de Performance Humana, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brasil
| | | | - Antônio José Natali
- Departamento de Educação Física, Laboratório de Biologia do Exercício, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brasil
| | - Thales Nicolau Prímola-Gomes
- Departamento de Educação Física, Laboratório de Performance Humana, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brasil
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Ceklarz J. Symptom intensity of post-COVID and long COVID syndromes in patients entering rehabilitation treatment. Reumatologia 2024; 62:18-25. [PMID: 38558899 PMCID: PMC10979377 DOI: 10.5114/reum/183912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The problem of post-COVID symptoms is still being analysed. Many of them may be related to other conditions, but the new appearance and greater intensity of some of them, e.g. fatigue, musculoskeletal pain, and neuropathic pain, seem to be related to a previous viral infection. Efforts are being made to determine in more detail the most characteristic symptoms of post-COVID syndrome. The conditions of rehabilitation after COVID-19 provide an opportunity for such observations. In rehabilitation centres and sanatoriums, it is possible to compare patients with post-COVID syndrome and other patients referred for rehabilitation, who constitute a natural control group. Such a comparison is the aim of the present work. Material and methods The study included 59 post-COVID-19 patients and 57 sanatorium patients without COVID (non-COVID group) as a control group. The 31-element questionnaire ("Post-COVID syndrome symptoms assessment card") was part of the routine management of post-COVID patients referred for rehabilitation after symptomatic SARS-CoV-2 infection in Polish conditions. In the control group, the questionnaire was introduced as a part of a physical examination and an interview regarding the symptoms reported by the patient before standard rehabilitation. The questions were scored in the scale from 0 to a maximum of 10 points. Each patient gave informed consent to the use of the questionnaire for research purposes. Results Symptoms of the highest intensity in the COVID-19 group were: feeling unwell after physical effort (avg. 6.25 points), chronic fatigue (avg. 5.97 points), dyspnoea on exertion (avg. 5.83 points), concentration disturbances (avg. 4.93), muscle pain (avg. 4.92), joint pain (avg. 4.86), memory disorders (avg. 4.81 points), sleep disorders (avg. 4.05 points), numbness of the limbs (avg. 3.73 points), tingling in the limbs (avg. 3.68 points).Symptoms of highest intensity in patients in the non-COVID-19 group: joint pain (avg. 4.61 points), tingling in the limbs (avg. 2.84 points), numbness of the limbs (avg. 2.79 points), muscle pain (avg. 2.11 points).There was no statistically significant difference between the group under examination and the control group in the following symptoms: fever, diarrhoea, abdominal pain, resting dyspnoea, olfactory disorders, joint pain, tingling in the limbs and numbness of the limbs. Conclusions The results of this study show symptoms of the highest intensity with post-COVID syndromes. However, also symptoms that are a problem both in post-COVID and non-COVID patients, i.e. joint pain, tingling in and numbness of the limbs were identified. This confirms that the control non-COVID group consisted of patients referred for rehabilitation treatment mainly due to musculoskeletal problems and chronic pain.
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Affiliation(s)
- Jan Ceklarz
- Department of Systemic Rehabilitation, Rabka Sanatorium, Poland
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Bashir MA, Awoonor-Williams JK, Amponsah-Manu F. Prevalence of fever and its associated risk factors among patients hospitalised with coronavirus disease 2019 (COVID-19) at the Eastern Regional Hospital, Koforidua, Ghana. PLoS One 2024; 19:e0296134. [PMID: 38363790 PMCID: PMC10871519 DOI: 10.1371/journal.pone.0296134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/06/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND In Ghana, temperature check at various points of entry was adopted as a means of screening people for coronavirus disease 2019 without taking into consideration data on the local prevalence of fever associated with the disease. Our objective was to assess fever prevalence and its associated risk factors among patients hospitalised with coronavirus disease 2019 at the Eastern Regional Hospital, Koforidua in Ghana. METHODS We reviewed medical records of 301 coronavirus disease 2019 patients who were admitted at the Eastern Regional Hospital, Koforidua between May 5, 2020, and August 31, 2021. Data collected on a pre-designed extraction sheet was processed, entered and analysed using Microsoft excel 2019 and Stata/IC version 16.1 software. Prevalence of fever was estimated and a multivariable logistic regression model was fitted to establish risk factors associated with fever among hospitalised coronavirus disease 2019 patients. A relationship was accepted to be significant at 5% level of significance. RESULTS The prevalence of fever among hospitalised coronavirus disease 2019 patients was 21.6% (95% CI, 17.1%-26.7%). Risk factors associated with fever were age group [0-19 years (AOR, 5.75; 95% CI, 1.46-22.68; p = 0.013); 20-39 years (AOR, 3.22; 95% CI, 1.42-7.29; p = 0.005)], comorbidity (AOR, 2.18; 95% CI, 1.04-4.59; p = 0.040), and disease severity [moderate (AOR, 3.89; 95% CI, 1.44-10.49; p = 0.007); severe (AOR, 4.08; 95% CI, 1.36-12.21; p = 0.012); critical (AOR, 4.85; 95% CI, 1.03-22.85; p = 0.046)]. CONCLUSIONS The prevalence of fever was low among hospitalised coronavirus disease 2019 patients at the Eastern Regional Hospital, Koforidua. However, there was an increasing risk of fever as the disease severity progresses. Fever screening may be utilised better in disease of higher severity; it should not be used alone especially in mild disease.
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Affiliation(s)
- Muhyideen Alhassan Bashir
- Medical Department, Eastern Regional Hospital, Koforidua, Ghana
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - John Koku Awoonor-Williams
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Tan DJ, Chen J, Zhou Y, Ong JSQ, Sin RJX, Bui TV, Mehta AA, Feng M, See KC. Association of body temperature and mortality in critically ill patients: an observational study using two large databases. Eur J Med Res 2024; 29:33. [PMID: 38184625 PMCID: PMC10770998 DOI: 10.1186/s40001-023-01616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Body temperature (BT) is routinely measured and can be controlled in critical care settings. BT can impact patient outcome, but the relationship between BT and mortality has not been well-established. METHODS A retrospective cohort study was conducted based on the MIMIC-IV (N = 43,537) and eICU (N = 75,184) datasets. The primary outcome and exposure variables were hospital mortality and first 48-h median BT, respectively. Generalized additive models were used to model the associations between exposures and outcomes, while adjusting for patient age, sex, APS-III, SOFA, and Charlson comorbidity scores, temperature gap, as well as ventilation, vasopressor, steroids, and dialysis usage. We conducted subgroup analysis according to ICU setting, diagnoses, and demographics. RESULTS Optimal BT was 37 °C for the general ICU and subgroup populations. A 10% increase in the proportion of time that BT was within the 36-38 °C range was associated with reduced hospital mortality risk in both MIMIC-IV (OR 0.91; 95% CI 0.90-0.93) and eICU (OR 0.86; 95% CI 0.85-0.87). On the other hand, a 10% increase in the proportion of time when BT < 36 °C was associated with increased mortality risk in both MIMIC-IV (OR 1.08; 95% CI 1.06-1.10) and eICU (OR 1.18; 95% CI 1.16-1.19). Similarly, a 10% increase in the proportion of time when BT > 38 °C was associated with increased mortality risk in both MIMIC-IV (OR 1.09; 95% CI 1.07-1.12) and eICU (OR 1.09; 95% CI 1.08-1.11). All patient subgroups tested consistently showed an optimal temperature within the 36-38 °C range. CONCLUSIONS A BT of 37 °C is associated with the lowest mortality risk among ICU patients. Further studies to explore the causal relationship between the optimal BT and mortality should be conducted and may help with establishing guidelines for active BT management in critical care settings.
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Affiliation(s)
- Daniel J Tan
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Jiayang Chen
- National University Hospital, Singapore, Singapore
| | - Yirui Zhou
- School of Computing, National University of Singapore, Singapore, Singapore
| | | | | | - Thach V Bui
- Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | | | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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Lee T, Lee J, Shin DH, Lee H, Kim SK. Prognostic and Diagnostic Power of Delta Neutrophil Index and Mean Platelet Component in Febrile Patients with Suspected Sepsis. Biomedicines 2023; 11:3190. [PMID: 38137411 PMCID: PMC10740452 DOI: 10.3390/biomedicines11123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The delta neutrophil index (DNI), a prognostic and diagnostic marker for sepsis, is based on the leukocyte count. Platelet activation, similar to leukocyte activation, plays a crucial role in host defense against pathogens and may serve as a predictor of sepsis outcome. However, the combined evaluation of mean platelet component (MPC) and DNI has rarely been used to assess sepsis. METHODS To assess the prognostic and diagnostic validity of the simultaneous evaluation of DNI and MPC in cases of human febrile sepsis, we conducted measurements of cellular indices, including DNI and MPC, as well as molecular biomarkers, including procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out in patients admitted to the emergency department with suspected sepsis. RESULTS Using a cutoff value of 2.65%, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the DNI in sepsis were found to be 69%, 73.9%, 77.9%, and 64.1%, respectively. Furthermore, significant differences in DNI and MPC levels were observed between the sepsis and non-sepsis groups (6.7 ± 7.8% versus 2.1 ± 2.2% (p = 0.000) and 26.0 ± 1.9 g/dL versus 26.8 ± 1.4 g/dL (p = 0.002), respectively). Notably, there was a negative correlation between DNI and MPC, with the strength of the correlation varying based on the cause of sepsis. By setting the cutoff value of the DNI to 6.2%, its sensitivity, specificity, and NPV improved to 100%, 80.3%, and 100%, respectively, although the PPV remained at 10.6%. CONCLUSIONS In our study, the DNI demonstrates superior effectiveness compared with other molecular biomarkers, such as CRP and procalcitonin, in distinguishing septic febrile patients from non-septic febrile patients. Additionally, a negative correlation exists between MPC and DNI, making MPC a valuable marker for differentiating the etiology of sepsis. These findings hold significant clinical implications, as DNI/MPC evaluation is a cost-effective and readily applicable approach in various impending sepsis scenarios. Notably, this study represents the first examination of the prognostic and diagnostic validity of employing the simultaneous evaluation of DNI and MPC in human cases of febrile sepsis.
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Affiliation(s)
- Taehun Lee
- Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea;
| | - Jongwook Lee
- Department of Laboratory Medicine, Konyang University Hospital, Daejeon 35465, Republic of Korea;
| | - Dong Hoon Shin
- Department of Laboratory Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea;
| | - Hyungdon Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea
| | - Soo-Ki Kim
- Department of Microbiology, Wonju College of Medicine, Research Institute of Metabolism and Inflammation Research, Yonsei University, Wonju 26426, Republic of Korea
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Cartuliares MB, Søgaard SN, Rosenvinge FS, Mogensen CB, Hertz MA, Skjøt-Arkil H. Antibiotic Guideline Adherence at the Emergency Department: A Descriptive Study from a Country with a Restrictive Antibiotic Policy. Antibiotics (Basel) 2023; 12:1680. [PMID: 38136712 PMCID: PMC10740443 DOI: 10.3390/antibiotics12121680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Denmark has a low level of antimicrobial resistance (AMR). Patients hospitalized with suspected infection often present with unspecific symptoms. This challenges the physician between using narrow-spectrum antibiotics in accordance with guidelines or broad-spectrum antibiotics to compensate for diagnostic uncertainty. The aim of this study was to investigate adherence to a restrictive antibiotic guideline for the most common infection in emergency departments (EDs), namely community-acquired pneumonia (CAP). METHOD This multicenter descriptive cross-sectional study included adults admitted to Danish EDs with a suspected infection. Data were collected prospectively from medical records. RESULTS We included 954 patients in the analysis. The most prescribed antibiotics were penicillin with beta-lactamase inhibitor at 4 h (307 (32.2%)), 48 h (289 (30.3%)), and day 5 after admission (218 (22.9%)). The empirical antibiotic treatment guidelines for CAP were followed for 126 (31.3%) of the CAP patients. At 4 h, antibiotics were administered intravenously to 244 (60.7%) of the CAP patients. At day 5, 218 (54.4%) received oral antibiotics. CONCLUSION Adherence to CAP guidelines was poor. In a country with a restrictive antibiotic policy, infections are commonly treated with broad-spectrum antibiotics against recommendations.
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Affiliation(s)
- Mariana B. Cartuliares
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark; (M.B.C.)
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Sara N. Søgaard
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark; (M.B.C.)
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Flemming S. Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Christian B. Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark; (M.B.C.)
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Mathias Amdi Hertz
- Department of Infectious Diseases, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern, 5000 Odense, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark; (M.B.C.)
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
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Doman M, Thy M, Dessajan J, Dlela M, Do Rego H, Cariou E, Ejzenberg M, Bouadma L, de Montmollin E, Timsit JF. Temperature control in sepsis. Front Med (Lausanne) 2023; 10:1292468. [PMID: 38020082 PMCID: PMC10644266 DOI: 10.3389/fmed.2023.1292468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Fever can be viewed as an adaptive response to infection. Temperature control in sepsis is aimed at preventing potential harms associated with high temperature (tachycardia, vasodilation, electrolyte and water loss) and therapeutic hypothermia may be aimed at slowing metabolic activities and protecting organs from inflammation. Although high fever (>39.5°C) control is usually performed in critically ill patients, available cohorts and randomized controlled trials do not support its use to improve sepsis prognosis. Finally, both spontaneous and therapeutic hypothermia are associated with poor outcomes in sepsis.
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Affiliation(s)
- Marc Doman
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Michael Thy
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Julien Dessajan
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Mariem Dlela
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Hermann Do Rego
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Erwann Cariou
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Michael Ejzenberg
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Lila Bouadma
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Etienne de Montmollin
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Jean-François Timsit
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
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Ley C, Heath F, Hastie T, Gao Z, Protsiv M, Parsonnet J. Defining Usual Oral Temperature Ranges in Outpatients Using an Unsupervised Learning Algorithm. JAMA Intern Med 2023; 183:1128-1135. [PMID: 37669046 PMCID: PMC10481327 DOI: 10.1001/jamainternmed.2023.4291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/05/2023] [Indexed: 09/06/2023]
Abstract
Importance Although oral temperature is commonly assessed in medical examinations, the range of usual or "normal" temperature is poorly defined. Objective To determine normal oral temperature ranges by age, sex, height, weight, and time of day. Design, Setting, and Participants This cross-sectional study used clinical visit information from the divisions of Internal Medicine and Family Medicine in a single large medical care system. All adult outpatient encounters that included temperature measurements from April 28, 2008, through June 4, 2017, were eligible for inclusion. The LIMIT (Laboratory Information Mining for Individualized Thresholds) filtering algorithm was applied to iteratively remove encounters with primary diagnoses overrepresented in the tails of the temperature distribution, leaving only those diagnoses unrelated to temperature. Mixed-effects modeling was applied to the remaining temperature measurements to identify independent factors associated with normal oral temperature and to generate individualized normal temperature ranges. Data were analyzed from July 5, 2017, to June 23, 2023. Exposures Primary diagnoses and medications, age, sex, height, weight, time of day, and month, abstracted from each outpatient encounter. Main Outcomes and Measures Normal temperature ranges by age, sex, height, weight, and time of day. Results Of 618 306 patient encounters, 35.92% were removed by LIMIT because they included diagnoses or medications that fell disproportionately in the tails of the temperature distribution. The encounters removed due to overrepresentation in the upper tail were primarily linked to infectious diseases (76.81% of all removed encounters); type 2 diabetes was the only diagnosis removed for overrepresentation in the lower tail (15.71% of all removed encounters). The 396 195 encounters included in the analysis set consisted of 126 705 patients (57.35% women; mean [SD] age, 52.7 [15.9] years). Prior to running LIMIT, the mean (SD) overall oral temperature was 36.71 °C (0.43 °C); following LIMIT, the mean (SD) temperature was 36.64 °C (0.35 °C). Using mixed-effects modeling, age, sex, height, weight, and time of day accounted for 6.86% (overall) and up to 25.52% (per patient) of the observed variability in temperature. Mean normal oral temperature did not reach 37 °C for any subgroup; the upper 99th percentile ranged from 36.81 °C (a tall man with underweight aged 80 years at 8:00 am) to 37.88 °C (a short woman with obesity aged 20 years at 2:00 pm). Conclusions and Relevance The findings of this cross-sectional study suggest that normal oral temperature varies in an expected manner based on sex, age, height, weight, and time of day, allowing individualized normal temperature ranges to be established. The clinical significance of a value outside of the usual range is an area for future study.
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Affiliation(s)
- Catherine Ley
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Frederik Heath
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- currently with University of California, Irvine, School of Medicine
| | - Trevor Hastie
- Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, California
- Division of Biostatistics, Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Zijun Gao
- Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, California
- currently with USC Marshall Business School, University of Southern California, Los Angeles
| | - Myroslava Protsiv
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- currently with Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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Pires CV, Chawla J, Simmons C, Gibbons J, Adams JH. Heat-shock responses: systemic and essential ways of malaria parasite survival. Curr Opin Microbiol 2023; 73:102322. [PMID: 37130502 PMCID: PMC10247345 DOI: 10.1016/j.mib.2023.102322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
Fever is a part of the human innate immune response that contributes to limiting microbial growth and development in many infectious diseases. For the parasite Plasmodium falciparum, survival of febrile temperatures is crucial for its successful propagation in human populations as well as a fundamental aspect of malaria pathogenesis. This review discusses recent insights into the biological complexity of the malaria parasite's heat-shock response, which involves many cellular compartments and essential metabolic processes to alleviate oxidative stress and accumulation of damaged and unfolded proteins. We highlight the overlap between heat-shock and artemisinin resistance responses, while also explaining how the malaria parasite adapts its fever response to fight artemisinin treatment. Additionally, we discuss how this systemic and essential fight for survival can also contribute to parasite transmission to mosquitoes.
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Affiliation(s)
- Camilla V Pires
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jyotsna Chawla
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States; Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Caroline Simmons
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States; Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Justin Gibbons
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States
| | - John H Adams
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States; Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.
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11
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Etienne S, Oliveras R, Schiboni G, Durrer L, Rochat F, Eib P, Zahner M, Osthoff M, Bassetti S, Eckstein J. Free-living core body temperature monitoring using a wrist-worn sensor after COVID-19 booster vaccination: a pilot study. Biomed Eng Online 2023; 22:25. [PMID: 36915134 PMCID: PMC10010220 DOI: 10.1186/s12938-023-01081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Core body temperature (CBT) is a key vital sign and fever is an important indicator of disease. In the past decade, there has been growing interest for vital sign monitoring technology that may be embedded in wearable devices, and the COVID-19 pandemic has highlighted the need for remote patient monitoring systems. While wrist-worn sensors allow continuous assessment of heart rate and oxygen saturation, reliable measurement of CBT at the wrist remains challenging. In this study, CBT was measured continuously in a free-living setting using a novel technology worn at the wrist and compared to reference core body temperature measurements, i.e., CBT values acquired with an ingestible temperature-sensing pill. Fifty individuals who received the COVID-19 booster vaccination were included. The datasets of 33 individuals were used to develop the CBT prediction algorithm, and the algorithm was then validated on the datasets of 17 participants. Mean observation time was 26.4 h and CBT > 38.0 °C occurred in 66% of the participants. CBT predicted by the wrist-worn sensor showed good correlation to the reference CBT (r = 0.72). Bland-Altman statistics showed an average bias of 0.11 °C of CBT predicted by the wrist-worn device compared to reference CBT, and limits of agreement were - 0.67 to + 0.93 °C, which is comparable to the bias and limits of agreement of commonly used tympanic membrane thermometers. The small size of the components needed for this technology would allow its integration into a variety of wearable monitoring systems assessing other vital signs and at the same time allowing maximal freedom of movement to the user.
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Affiliation(s)
- Samuel Etienne
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | | | | | | | | | | | | | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Eckstein
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department Digitalization and ICT, University Hospital Basel, Basel, Switzerland.
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12
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Mackowiak PA. The 'Body Temperature' Myth. Am J Med 2023; 136:221. [PMID: 36356921 DOI: 10.1016/j.amjmed.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Philip A Mackowiak
- Department of Medicine, University of Maryland School of Medicine, Baltimore.
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13
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Sakr F, Toufaili Z, Akiki Z, Akel M, Malaeb D, Dabbous M, Salameh P. Fever among preschool-aged children: a cross-sectional study assessing Lebanese parents' knowledge, attitudes and practices regarding paediatric fever assessment and management. BMJ Open 2022; 12:e063013. [PMID: 36198469 PMCID: PMC9535157 DOI: 10.1136/bmjopen-2022-063013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study investigated parental knowledge, attitudes and practices towards fever in preschool children to help address gaps in public health and provide information with the aim of supporting clinical reports for parental education. DESIGN A cross-sectional study design was used to explore parental experiences with fever. SETTING Participants were recruited randomly from schools all over Lebanon targeting the preschool divisions. PARTICIPANTS Parents of children aged 5 years or less. INTERVENTIONS An electronic self-administered questionnaire was sent to the parents through the schools' emails and e-learning mobile applications. PRIMARY AND SECONDARY OUTCOMES The primary outcome measure was to assess parental knowledge about the precise definition of fever, correct use of medications and to evaluate the impact of sociodemographic factors on this knowledge. The secondary outcome measures were to assess parental attitudes and practices of fever management, sources of information and reasons to seek primary medical attention. RESULTS A total of 733 parents were included in the study. Only 44% identified fever correctly according to the recognised definition by international guidelines. A significant association between parents' knowledge of antibiotics and years of parenting experience was found (adjusted OR, ORa=4.23, 95% CI 1.41 to 12.68, p=0.01). Other sociodemographic factors that were significantly associated with parents' knowledge of antibiotics were age (ORa=3.42, 95% CI 1.09 to 10.73, p=0.036) and education level (ORa=7.99, 95% CI 3.71 to 17.23, p<0.001). Greater than 75% usually give their children antipyretics without consulting a doctor. Approximately one-quarter of parents (26.3%) consulted different doctors at the same time, of which more than half (58.4%) had received different medical information. CONCLUSIONS This research determines deficiencies in parents' knowledge of fever with some malpractices in its management particularly regarding antipyretic use. It provides insight for healthcare providers to empower parental experiences by offering the necessary information to enhance general outcomes of febrile sickness.
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Affiliation(s)
- Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSERM U955, Institut Mondor de Recherche Biomédicale, University Paris-Est Créteil, Creteil, France
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Créteil, France
| | - Zeinab Toufaili
- Department of Operations, Primary Health Care Corporation, Doha, Qatar
| | - Zeina Akiki
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- International Pharmaceutical Federation, The Hague, Netherlands
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- School of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- School of Education, Lebanese International University, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- University of Nicosia Medical School, Nicosia, Cyprus
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14
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Dass NLM, Botto LD, Tinker SC, Canfield MA, Finnell RH, Gallaway MS, Hashmi SS, Hoyt AT, Nembhard WN, Waller DK. Associations between maternal reports of periconceptional fever from miscellaneous causes and structural birth defects. Birth Defects Res 2022; 114:885-894. [PMID: 35932236 PMCID: PMC10580304 DOI: 10.1002/bdr2.2068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Associations between birth defects and fevers attributed to colds, influenza, and urinary tract infections (UTIs) have been observed in previous studies. Our aim was to study associations between birth defects and fevers attributed to other causes. METHODS We analyzed data from 34,862 participants in the National Birth Defects Prevention Study, a multistate case-control study of major structural birth defects. Using multivariable logistic regression, we assessed the association between maternal report of fever during early pregnancy due to causes other than colds, influenza, or UTI and 36 categories of birth defects. RESULTS Maternal reports of fever due to other causes were associated with significantly elevated odds ratios ranging from 1.93 to 10.60 for 8 of 36 birth defects, primarily involving the spine, limbs, and heart (spina bifida, intestinal atresia, intercalary limb deficiency, transverse limb deficiency, congenital heart defect with heterotaxy, tetralogy of Fallot, pulmonary atresia and atrial septal defect, not otherwise specified). CONCLUSION Our data suggests fever itself or other physiologic changes associated with many infections are associated with some birth defects. Women who are pregnant or planning to become pregnant may want to consider speaking with their healthcare provider about the best ways to avoid infections that may cause fever and for guidance on how to treat fevers during pregnancy.
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Affiliation(s)
| | | | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | | | - Michael Shayne Gallaway
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Phoenix, Arizona, USA
| | | | - Adrienne T. Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Wendy N. Nembhard
- University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
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15
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Chrószcz MW, Barszczewska-Rybarek IM, Kazek-Kęsik A. Novel Antibacterial Copolymers Based on Quaternary Ammonium Urethane-Dimethacrylate Analogues and Triethylene Glycol Dimethacrylate. Int J Mol Sci 2022; 23:ijms23094954. [PMID: 35563344 PMCID: PMC9103508 DOI: 10.3390/ijms23094954] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
The growing scale of secondary caries and occurrence of antibiotic-resistant bacterial strains require the development of antibacterial dental composites. It can be achieved by the chemical introduction of quaternary ammonium dimethacrylates into dental composites. In this study, physicochemical and antibacterial properties of six novel copolymers consisting of 60 wt. % quaternary ammonium urethane-dimethacrylate analogues (QAUDMA) and 40 wt. % triethylene glycol dimethacrylate (TEGDMA) were investigated. Uncured compositions had suitable refractive index (RI), density (dm), and glass transition temperature (Tgm). Copolymers had low polymerization shrinkage (S), high degree of conversion (DC) and high glass transition temperature (Tgp). They also showed high antibacterial effectiveness against S. aureus and E. coli bacterial strains. It was manifested by the reduction in cell proliferation, decrease in the number of bacteria adhered on their surfaces, and presence of growth inhibition zones. It can be concluded that the copolymerization of bioactive QAUDMAs with TEGDMA provided copolymers with high antibacterial activity and rewarding physicochemical properties.
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Affiliation(s)
- Marta W. Chrószcz
- Department of Physical Chemistry and Technology of Polymers, Faculty of Chemistry, Silesian University of Technology, Strzody 9 Str., 44-100 Gliwice, Poland;
- Correspondence: ; Tel.: +48-32-237-1793
| | - Izabela M. Barszczewska-Rybarek
- Department of Physical Chemistry and Technology of Polymers, Faculty of Chemistry, Silesian University of Technology, Strzody 9 Str., 44-100 Gliwice, Poland;
| | - Alicja Kazek-Kęsik
- Department of Inorganic Chemistry, Analytical Chemistry and Electrochemistry, Faculty of Chemistry, Silesian University of Technology, Krzywoustego 6 Str., 44-100 Gliwice, Poland;
- Biotechnology Centre, Silesian University of Technology, Krzywoustego 8 Str., 44-100 Gliwice, Poland
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