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Tang F, Hou XF, Cheng Y, Liu Y, Sun J, Liu HY, Lv LP, Fu L. Longitudinal associations between serum IL-34 with severity and prognosis in community-acquired pneumonia patients. Respir Investig 2024; 62:223-230. [PMID: 38218098 DOI: 10.1016/j.resinv.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Interleukin-34 (IL-34) is a hematopoietic cytokine and a ligand of colony-stimulating factor 1 receptor (CSF-1R). Numerous studies have demonstrated that IL-34 is involved in several inflammatory diseases. Nevertheless, the role of IL-34 is obscure in community-acquired pneumonia (CAP) patients. This research aimed to assess the associations of serum IL-34 with severity and prognosis in CAP patients through a longitudinal study. METHODS CAP patients and healthy volunteers were recruited. Peripheral blood samples were collected. Serum IL-34 and inflammatory cytokines were tested by enzyme linked immunosorbent assay (ELISA). Demographic characteristics and clinical information were acquired through electronic medical records. RESULTS Serum IL-34 was elevated in CAP patients compared with healthy volunteers. The content of serum IL-34 was gradually upregulated with increased CAP severity scores. Mixed logistic and linear regression models suggested that serum IL-34 elevation was associated with increased PSI and SMART-COP scores. Correlative analysis found that serum IL-34 was positively correlated with inflammatory cytokines among CAP patients. A longitudinal study indicated that higher serum IL-34 at admission elevated the risks of mechanical ventilation and death during hospitalization. Serum IL-34 had a higher predictive capacity for death than CAP severity scores. CONCLUSION There are prominently positive dose-response associations between serum IL-34 at admission with the severity and poor prognosis, suggesting that IL-34 is implicated in the occurrence and development of CAP. Serum IL-34 may serve as a biomarker to forecast disease progression and poor prognosis in CAP patients.
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Affiliation(s)
- Fei Tang
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China
| | - Xue-Feng Hou
- School of Pharmacy, Drug Research & Development Center, Wannan Medical College, Wuhu, Anhui, 241002, China
| | - Yu Cheng
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China
| | - Ying Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
| | - Jing Sun
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
| | - Hong-Yan Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China; Institute of Respiratory Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China.
| | - Li-Ping Lv
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China.
| | - Lin Fu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China; Institute of Respiratory Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China.
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Wahl B, Nama N, Pandey RR, Garg T, Mishra AM, Srivastava S, Ali S, Verma SK, Erchick DJ, Sauer M, Venkatesh U, Koparkar A, Kishore S. Neonatal, Infant, and Child Mortality in India: Progress and Future Directions. Indian J Pediatr 2023; 90:1-9. [PMID: 37695418 DOI: 10.1007/s12098-023-04834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.
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Affiliation(s)
- Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Johns Hopkins India, Lucknow, Uttar Pradesh, India.
| | - Norah Nama
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Raghukul Ratan Pandey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tushar Garg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Aman Mohan Mishra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Swati Srivastava
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Sana Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Shival Kishore Verma
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - U Venkatesh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Anil Koparkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Surekha Kishore
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
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Agarwal D, Gore M, Kawade A, Roy S, Bavdekar A, Nair H, Juvekar S, Dayma G. Feasibility and acceptability of the paediatric pulse oximeter in integrated management of neonatal and childhood illnesses (IMNCI) services by public health facilities: A qualitative study in rural Western India. J Glob Health 2023; 13:04105. [PMID: 37712148 PMCID: PMC10502527 DOI: 10.7189/jogh.13.04105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Background Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. Methods We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. Results At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Conclusions Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management.
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Affiliation(s)
- Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre Pune
- Community Health Research Unit, KEM Hospital Research Centre Pune
| | - Manisha Gore
- Symbiosis Community Outreach Programme and Extension, Faculty of Medical and Health Sciences, Symbiosis International Deemed University, Pune
| | - Anand Kawade
- Vadu Rural Health Program, KEM Hospital Research Centre Pune
| | - Sudipto Roy
- Indian Council of Medical Research, New Delhi
- Community Health Research Unit, KEM Hospital Research Centre Pune
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre Pune
| | - Girish Dayma
- Vadu Rural Health Program, KEM Hospital Research Centre Pune
- Community Health Research Unit, KEM Hospital Research Centre Pune
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Yadav KK, Awasthi S. Childhood Pneumonia: What's Unchanged, and What's New? Indian J Pediatr 2023:10.1007/s12098-023-04628-3. [PMID: 37204597 DOI: 10.1007/s12098-023-04628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.
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Affiliation(s)
- Krishna Kumar Yadav
- Department of Pediatrics, Dr R.M.L. Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
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Dharel S, Shrestha B, Basel P. Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey. BMC Public Health 2023; 23:264. [PMID: 36750815 PMCID: PMC9903409 DOI: 10.1186/s12889-022-14839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. METHODS This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. RESULTS Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0-2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2-3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4-3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1-5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4-1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. CONCLUSIONS Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized.
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Affiliation(s)
- Sunita Dharel
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Binjwala Shrestha
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prem Basel
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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Awasthi S, Kohli N, Agarwal M, Pandey CM, Rastogi T, Pandey AK, Roy C, Mishra K, Verma N, Kumar CB, Jain PK, Yadav R, Dhasmana P, Chauhan A, Mohindra N, Shukla RC. Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India. PLoS One 2022; 17:e0276911. [PMID: 36520841 PMCID: PMC9754232 DOI: 10.1371/journal.pone.0276911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018. The primary objective of this study was to evaluate the effectiveness of PCV13 on chest radiograph (CXR)-confirmed pneumonia, in children hospitalized with WHO-defined severe CAP. METHODS This prospective, multi-site test-negative study was conducted in a hospital-network situated in three districts of Northern India where PCV13 had been introduced. Children aged 2-23 months, hospitalized with severe CAP and with interpretable CXR were included after parental consent. Clinical data was extracted from hospital records. CXRs were interpreted by a panel of three independent blinded trained radiologists. Exposure to PCV13 was defined as ≥2 doses of PCV13 in children aged ≤ 12 months and ≥ 1 dose(s) in children > 12 months of age. Our outcome measures were CXR finding of primary endpoint pneumonia with or without other infiltrates (PEP±OI); vaccine effectiveness (VE) and hospital mortality. RESULTS From 1st June 2017-30th April 2021, among 2711 children included, 678 (25.0%) were exposed to PCV1. CXR positive for PEP±OI on CXR was found in 579 (21.4%), of which 103 (17.8%) were exposed to PCV. Adjusted odds ratio (AOR) for PEP±OI among the exposed group was 0.69 (95% CI, 0.54-0.89, p = 0.004). Adjusted VE was 31.0% (95% CI: 11.0-44.0) for PEP±OI. AOR for hospital mortality with PEP±OI was 2.65 (95% CI: 1.27-5.53, p = 0.01). CONCLUSION In severe CAP, children exposed to PCV13 had significantly reduced odds of having PEP±OI. Since PEP±OI had increased odds of hospital mortality due to CAP, countrywide coverage with PCV13 is an essential priority.
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Affiliation(s)
- Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radio-diagnosis, King George’s Medical University, Lucknow, India
| | - Monika Agarwal
- Department of Community Medicine, King George’s Medical University, Lucknow, India
| | - Chandra Mani Pandey
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Tuhina Rastogi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Anuj Kumar Pandey
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Chittaranjan Roy
- Department of Community Medicine, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Kripanath Mishra
- Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Neelam Verma
- Department of Pediatrics, Patna Medical College and Hospital, Patna, India
| | | | - Pankaj Kumar Jain
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Rajesh Yadav
- Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Puneet Dhasmana
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Abhishek Chauhan
- Department of Radio-diagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Namita Mohindra
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ram Chandra Shukla
- Department of Radio-diagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Xie F, Chen R, Zhao J, Xu C, Zan C, Yue B, Tian W, Yi W. Cell cycle kinase CHEK2 in macrophages alleviates the inflammatory response to Staphylococcus aureus-induced pneumonia. Exp Lung Res 2022; 48:53-60. [PMID: 35075953 DOI: 10.1080/01902148.2022.2029625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Excessive macrophage-mediated inflammation participates in the development of Staphylococcus aureus (S. aureus)-induced pneumonia. Checkpoint kinase 2 (Chek2) was screened out as macrophage-related infantile pneumonia gene after the differentially expressed analysis of RNAseq data derived from pam3CSK4 stimulated bone marrow-derived macrophages (BMDMs). METHODS RAW264.7 macrophage cells were transfected with Chek2-specific gRNA, which were further overexpressed with wide-type Chek2 or Chek2 kinase activity mutant (Chek2 KD, D368N). At the same time, the relative protein and mRNA expression of inflammatory cytokines were determined. C57BL/6J WT mice were intranasally infected with S. aureus to induce S. aureus-induced pneumonia, which was treated with BML-277, an inhibitor of Chek2. The symptoms of pneumonia mice and inflammatory cytokines associated with the nuclear factor kappa B (NF-κB) signaling pathways were further examined. RESULTS In vivo, BML-277 significantly promoted pneumonia symptoms, including mortality, lung infiltration of immune cells, and the abundance of lung pro-inflammatory cytokines. Mechanically, BML-277 did not affect BMDMs survival but up-regulated the mRNA expression of tumor necrosis factor (Tnf), nitric oxide synthase 2 (Nos2), interleukin (Il)23a, and the secretion of Tnf-α and Il-23a. At the same time, genetic complementation experiment testified that Chek2 KD did not inhibit NF-κB and relevant inflammatory cytokines expression. CONCLUSION Chek2 functions through the kinase mechanism to down-regulate the NF-κB pathway in macrophages to alleviate S. aureus-induced pneumonia in mice.
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Affiliation(s)
- Fei Xie
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Ruidong Chen
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jie Zhao
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Chunyan Xu
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Chunxiang Zan
- Child Healthcare Department, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Bin Yue
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Wenqiu Tian
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Wenxia Yi
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Zheng W, Huang W, Yu X, Tan S. Study on Serum miR-204 Expression Levels in Patients with Severe Pneumonia and Patients with Primary Bronchial Lung Cancer and Its Diagnostic Value. Evidence-Based Complementary and Alternative Medicine 2021; 2021:1-7. [DOI: 10.1155/2021/6034413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective. To analyze the expression and clinical significance of miR-204 in the serum of patients with severe pneumonia (SP) and primary bronchial lung cancer (LC). Methods. 65 SP patients and 43 primary bronchial LC patients who were treated in the hospital from January 2017 to December 2018 were randomly selected as the SP group and LC group. At the same time, healthy patients from the physical examination department of the hospital were selected. 65 cases were the control group. QRT-PCR detected serum miR-204 expression and compared the differences between groups. The pathological data of patients were collected, and the relationship between serum miR-204 and the patient’s pathological data was compared; the area under the ROC curve and Kaplan–Meier curve were used to evaluate the diagnostic value of serum miR-204 for the two conditions and to explore the relationship between serum miR-204 and prognosis. Results. The serum miR-204 of the SP group was (0.43 ± 0.09), the serum miR-204 of the LC group was (0.40 ± 0.10), the serum miR-204 of the control group was (1.00 ± 0.09), and the miR-204 level of was significantly higher than that of the control group, and the difference between the groups was statistically significant (
< 0.05). There was no significant difference in serum miR-204 levels between the SP group and the LC group (
> 0.05). Serum miR-204 levels in SP patients with cumulative organs ≥3 were higher than those with cumulative organs <3, and the difference was statistically significant (
< 0.001). In the LC group, in patients with stage III to IV and low and undifferentiated patients, the level of miR-204 was higher than that of stage I∼II and high and moderately differentiated patients, and the difference was statistically significant (
< 0.001). The level of miR-204 in the two groups of patients (0.89 ± 0.10, 0.83 ± 0.13) who died of illness was significantly higher than that of the surviving patients (1.00 ± 0.11, 1.00 ± 0.10), and the difference was statistically significant (
< 0.05); the survival rate of patients with high expression of miR-204 was higher than that of patients with low expression. The AUC of serum miR-204 level to SP and LC was 0.766 and 0.818, respectively. Conclusion. The level of miR-204 in the serum of SP patients and patients with primary bronchial LC was significantly lower than that of healthy people, and patients who died were lower than those who survived; the miR-204 in serum has a good diagnostic value for SP and LC and is related to the survival and prognosis of patients.
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Schueller E, Nandi A, Summan A, Chatterjee S, Ray A, Haldar P, Laxminarayan R. Public Finance of Universal Routine Childhood Immunization in India: District Level Cost Estimates. Health Policy Plan 2021; 37:200-208. [PMID: 34522955 PMCID: PMC8826633 DOI: 10.1093/heapol/czab114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/06/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
India’s Universal Immunization Programme (UIP) is among the largest routine childhood vaccination programmes in the world. However, only an estimated 65% of Indian children under the age 2 years were fully vaccinated in 2019. We estimated the cost of raising childhood vaccination coverage to a minimum of 90% in each district in India. We obtained vaccine price data from India’s comprehensive multi-year strategic plan for immunization. Cost of vaccine delivery by district was derived from a 2018 field study in 24 districts. We used propensity score matching methods to match the remaining Indian districts with these 24, based on indicators from the National Family Health Survey (2015–16). We assumed the same unit cost of vaccine delivery in matched pair districts and estimated the total and incremental cost of providing routine vaccines to 90% of the current cohort of children in each district. The estimated national cost of providing basic vaccinations—one dose each of Bacillus Calmette–Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis and tetanus vaccines—was $784.91 million (2020 US$). Considering all childhood vaccines included in UIP during 2018–22 (one dose each of BCG, hepatitis B and measles–rubella; four doses of OPV; two doses of inactivated polio; and three doses each of rotavirus, pneumococcal and pentavalent vaccines), the estimated national cost of vaccines and delivery to 90% of target children in each district was $1.73 billion. The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion (2020 US$). In comparison, $1.73 billion would be needed to vaccinate 90% of children in all Indian districts with the recommended schedule of routine childhood vaccines. Additional costs for infrastructural investments and communication activities, not incorporated in this study, may also be necessary.
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Affiliation(s)
- Emily Schueller
- Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Arindam Nandi
- The Population Council, New York, NY.,Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Amit Summan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Susmita Chatterjee
- George Institute for Global Health, New Delhi, India.,University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Arindam Ray
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India.,High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
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Simões EAF, Dani V, Potdar V, Crow R, Satav S, Chadha MS, Hessong D, Carosone-Link P, Palaskar S, Satav A. Mortality From Respiratory Syncytial Virus in Children Under 2 Years of Age: A Prospective Community Cohort Study in Rural Maharashtra, India. Clin Infect Dis 2021; 73:S193-S202. [PMID: 34472578 PMCID: PMC8411248 DOI: 10.1093/cid/ciab481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV. METHODS This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods. RESULTS In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality. CONCLUSIONS Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited.
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Affiliation(s)
- Eric A F Simões
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
- Centre for Global Health, Department of Epidemiology,Colorado School of Public Health, Aurora, Colorado, USA
| | - Vibhawari Dani
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Varsha Potdar
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Rowena Crow
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Shilpa Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Mandeep S Chadha
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Danielle Hessong
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Sameer Palaskar
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
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Ghia CJ, Horn EK, Rambhad G, Perdrizet J, Chitale R, Wasserman MD. Estimating the Public Health and Economic Impact of Introducing the 13-Valent Pneumococcal Conjugate Vaccine or 10-Valent Pneumococcal Conjugate Vaccines into State Immunization Programs in India. Infect Dis Ther 2021; 10:2271-2288. [PMID: 34313958 PMCID: PMC8572948 DOI: 10.1007/s40121-021-00498-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Although the pneumococcal conjugate vaccine (PCV) has been introduced into select state immunization programs (SIPs) in India, many children remain unvaccinated. Recently, India’s Advisory Committee on Vaccines & Immunization Practices recommended PCV on the pediatric immunization schedule nationally. This study estimates the public health and economic impact of introducing either Pfizer’s 13-valent PCV (PCV13-PFE), GlaxoSmithKline’s 10-valent PCV (PCV10-GSK), or Serum Institute of India’s 10-valent PCV (PCV10-SII) into every pediatric SIP. Methods A model was developed to predict the disease cases, deaths, and costs associated with implementing PCV13-PFE, PCV10-GSK, or PCV10-SII in SIPs compared to no vaccination program across a 5-year period (2021–2025). State and national-level uptake rate and clinical and economic input parameters were collected from published literature. Disease outcomes included invasive pneumococcal disease, inpatient and outpatient pneumonia, and otitis media. Costs were estimated as vaccine-related costs and direct medical costs incurred to the healthcare system. Results were reported by individual state and aggregated nationally.
Results Estimated over 5 years, implementing PCV13-PFE in SIPs could avert 12.1 million cases and save 626,512 lives among children under 5 years old compared to no vaccination. This corresponds to net national cost savings of over $1.0 billion. Both lower-valent PCVs are estimated to provide less economic savings than PCV13-PFE inclusive of vaccine-related costs. Compared with PCV13-PFE, implementing PCV10-GSK or PCV10-SII nationally is estimated to have a smaller public health impact, with PCV10-GSK averting 8.4 million cases (436,577 deaths) and PCV10-SII preventing 10.3 million cases (531,545 deaths) in India compared to no vaccination, respectively. Conclusion Implementation of PCV13-PFE throughout India is estimated to provide greater public health and economic benefits than PCV10-GSK or PCV10-SII SIPs. Our analysis highlights the substantial disease cases, deaths, and health system cost savings that may be realized from implementing PCV programs throughout India. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00498-4.
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Affiliation(s)
- Canna J Ghia
- Pfizer Inc., Medical Affairs, Mumbai, India. .,Pfizer Limited, The Capital, 1802, 18th Floor, Plot No. C-70, 'G Block', Bandra Kurla Complex, Bandra East, Mumbai, 400051, India.
| | - Emily K Horn
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | | | - Johnna Perdrizet
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Ramaa Chitale
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Matt D Wasserman
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
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Pandey A, Galvani AP. The burden of childhood pneumonia in India and prospects for control. Lancet Child Adolesc Health 2020; 4:643-645. [PMID: 32827486 PMCID: PMC7438049 DOI: 10.1016/s2352-4642(20)30238-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA.
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