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Epidemiology and natural history of respiratory syncytial virus in hospitalized children an evaluation of ribavirin utilization and clinical effectiveness.Ohmit, Suzanne E. January 1993 (has links)
Dissertation (D.P.H.)--University of Michigan.
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Investigating the aetiology of respiratory tract infections in children admitted to Tygerberg Children’s Hospital using molecular methods and viral cultureMaree, Leana 12 1900 (has links)
Thesis (MMed)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Introduction
Acute respiratory tract infections cause significant morbidity and mortality worldwide, and are
the main reason for the utilisation of health care services. Identifying the aetiological cause of lower
respiratory tract infections (LRTIs) is difficult at the best of times, and more than 20 viruses and bacteria
have been associated with LRTIs, which cannot be distinguished with clinical examination alone. Viruses
can be detected in respiratory samples by a variety of methods, and without exception molecular
methods have proven to be more sensitive than non-molecular-based tests. The increased sensitivity of
molecular methods may assist in expanding our knowledge of the pathogenesis of severe respiratory
tract infections, and could have a positive influence on patient management, infection control,
vaccination strategies and public health.
Aims and objectives
1. Determine the viral causes of lower respiratory tract infections requiring admission in using shell
vial culture with immunofluorescent staining and two multiplex PCR assays, the Seeplex® RV15
ACE Detection system (Seeplex® RV15 ACE) and the Respiratory Multiplex Real-Time RT-PCR
LightMix® Customised Kit (Resp Multiplex RT-PCR).
2. Compare the Seeplex® RV15 ACE and the Resp Multiplex RT-PCR with shell vial culture for the
detection of respiratory viruses in routine diagnostic respiratory samples.
3. Examine the demographic and clinical characteristics associated with each respiratory viral
pathogen.
Materials and Methods
One hundred and thirty-eight paediatric patients, admitted to Tygerberg Children’s Hospital from
May 2010 to August 2010 with a presumptive diagnosis of an acute respiratory tract infection were
included in the study. Nasopharyngeal or tracheal aspirates were collected, and all samples were tested
by all three diagnostic methods. Clinical, demographic and laboratory data were collected through a
systematic review of medical and laboratory records and subsequently anonymised
Results
Thirty-seven viruses were detected in 36 samples (26.1%) by shell vial culture with
immunofluorescent staining; 169 viruses in 102 samples (73.9%) with the Seeplex® RV15 ACE; and 90
viruses in 73 samples (52.9%) with the Resp Multiplex RT-PCR. Shell vial culture had excellent specificity,
but low sensitivity for all of the respiratory viruses. Conversely, the Seeplex® RV15 ACE had excellent
sensitivity for all viruses, but slightly lower specificity. This was due to the detection of additional viruses,
which may have been true positives due to the increased sensitivity of this assay. The Resp Multiplex RTPCR
had excellent sensitivity and specificity.
At least one respiratory pathogen could be identified in 80% of the patients. At least one virus
was detected in 57% of patients, bacterial micro-organisms in 6%, and both viral and bacterial pathogens
in 17%. Viral-bacterial co-infections were associated with increased severity compared to other
infections, as these children were more likely to receive steroids and a blood transfusion (p = 0.002), and
more likely to require mechanical ventilation (p < 0.001) and admission to the intensive care unit (p =
0.04).
Conclusions
We confirmed that molecular techniques are significantly more sensitive than shell vial culture
for the detection of respiratory viruses in children. Due to their highly specific nature and the genetic
variability observed in viruses, an excellent, continuous quality control programme is essential to ensure
the continued superiority of these assays. Viral-bacterial co-infection is associated with increased
severity of LRTIs in children. Further research is needed to elucidate the precise pathogenic and
immunologic mechanism of this interaction. / AFRIKAANSE OPSOMMING: Inleiding
Akute lugweg infeksies is verantwoordelik vir beduidende morbiditeit en mortaliteit wêreldwyd
en is die hoofrede vir die benutting van gesondheidsdienste. Identifisering van die oorsaak van laer
lugweg infeksies is baie moeilik en meer as 20 virusse en bakterieë word hiermee geassosieer.
Ongelukkig kan kliniese ondersoek alleen nie onderskei tussen die verskillende organismes nie.
Respiratoriese virusse kan deur ‘n wye verskeidenheid van toets metodes aangetoon word. Molekulêre
metodes is sonder uitsondering meer sensitief as nie-molekulêre metodes. Hul verhoogde sensitiwiteit
mag help om ons kennis oor die patogenese van erge lugweg infeksies te verbreed en kan ’n positiewe
invloed op pasiëntbehandeling, infeksiebeheer, immunisasie strategieë en publieke gesondheidsorg hê.
Doel van die Ondersoek
1. Bevestig die virale oorsake van laer lugweg infeksies deur gebruik te maak van “shell vial” kultuur
met immunofluoressensie en twee veelvoudige molekulêre toetse, die Seeplex® RV15 ACE en die
Resp Multiplex RT-PCR.
2. Vergelyk die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR met “shell vial” kultuur vir die
aantoning van respiratoriese virusse in roetine diagnostiese monsters.
3. Ondersoek die demografiese en kliniese eienskappe wat met elke respiratoriese patogeen
geassosieer word.
Metodiek en Materiaal
Een honderd agt-en-dertig kinders wat toegelaat is tot Tygerberg Kinderhopitaal vanaf Mei 2010
tot Augustus 2010 met ’n voorlopige diagnose van ’n akute lugweg infeksie is in die studie ingesluit.
Nasofaringeale of trageale aspirate is van elke pasiënt gekollekteer en met al drie diagnostiese metodes
ondersoek. Kliniese, demografiese en laboratorium data is gekollekteer deur ’n sistematiese ondersoek
van mediese en laboratorium rekords en daarna anoniem gemaak.
Resultate
Sewe-en-dertig virusse is in 36 monsters (26.1%) aangetoon deur “shell vial” kultuur met
immunofluoressensie; 169 virusse in 102 monsters (73.9%) deur die Seeplex® RV15 ACE; en 90 virusse in
73 monsters (52.9%) deur die Resp Multiplex RT-PCR. “Shell vial” kultuur het uitstekende spesifisiteit
gehad, maar sensitiwiteit was laag vir al die virusse. Teenoorgesteld hiermee het die Seeplex® RV15 ACE
hoë sensitiwiteit vir al die viruses gehad, maar effe laer spesifisiteit. Dit was as gevolg van die aantoning
van addisionele virusse, wat moontlik ware positiewe resultate kon wees as gevolg van die verhoogde
sensitiwiteit van hierdie toets metode. Die Resp Multiplex RT-PCR het uitstekende sensitiwiteit en
spesifisiteit gehad.
Ten minste een respiratoriese patogeen is in 80% van die pasiënte geidentifiseer. Een of meer
virusse was in 57% van die pasiënte aangetoon, bakterieë in 6% en beide virale en bateriële patogene in
17%. Virale-bakteriële ko-infeksies, in vergelyking met ander infeksies, was geassosieer met meer
ernstige lugweg infeksies aangesien hierdie kinders meer geneig was om steroïede en ’n bloedtransfusie
te ontvang (p = 0.002). Hulle het ook meer waarskynlik meganiese ventilasie (p < 0.001) en toegang tot
die intensiewe sorg eenheid benodig (p = 0.04).
Gevolgtrekkings
Ons het bevesitg dat molekulêre tegnieke aansienlik meer sensitief is as “shell vial” kultuur vir die
aantoning van respiratoriese virusse in kinders. As gevolg van hul hoogs spesifieke aard en die genetiese
variasie waargeneem in virusse, is ’n uitstekende deurlopende kwaliteitsbeheer program noodsaaklik vir
die voortgesette uitneemendheid van hierdie metodes. Virale-bakteriële ko-infeksies word geassosieer
met meer ernstige laer lugweg infeksies in kinders. Verdere navorsing is nodig om die presiese
patogenetiese en immunologiese meganisme van hierdie interaksie toe te lig.
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The epidemiology of respiratory infections diagnosed in Western Australian hospital emergency departments 2000 to 2003Ingarfield, Sharyn Lee January 2007 (has links)
[Truncated abstract] Background Emergency department (ED) presentations of respiratory infections are not well described. Baseline ED data are needed to monitor trends, and to help evaluate the impact of health interventions, and assess changes in clinical practice for these conditions. Aims: To describe the epidemiology of respiratory infections diagnosed in Western Australian hospital EDs from 2000 to 2003; to determine the extent and usefulness of bacterial cultures ordered in hospital, and to describe and evaluate the antibiotic prescribing pattern in the ED setting. Methods: The cohort consisted of patients diagnosed with a respiratory infection at the ED of Perth's major metropolitan teaching hospitals from 1 July 2000 to 30 June 2003. The analysis was based on a linked data set containing patient data from the Emergency Department Information System, the Hospital Morbidity Data Set, the death registry, and the Ultra Laboratory Information System. Further, a sample of patient medical records from 1 adult hospital was examined to assess antibiotic prescribing practice. Results: Overall, there were 37,455 presentations (28,885 patients) given an ED diagnosis of a respiratory infection. Of these, 14,884 (39.7%, 95% CI: 39.2 to 40.2) were admitted and 715 (1.9%, 95% CI: 1.8 to 2.0) died in hospital. The infections included; 48.1% acute upper respiratory infections (URI), 18.5% pneumonia, 23.5% other acute lower respiratory infections (LRI), 7.4% chronic obstructive pulmonary disease with lower respiratory infection (COPD+), 1.3% influenza or viral pneumonia and 1.2% other URI. Children accounted for 80.7% of acute URI diagnoses, COPD+ mainly affected the elderly, just over 40% of pneumonia diagnoses were in patients 65 years or older and 30.7% in patients younger than 15 years. ... The most common pathogen isolated from blood was Streptococcus pneumoniae and 10.4% (95% CI: 4.8 to 16.0) had reduced susceptibility to penicillin. For those diagnosed with pneumonia, Strep. pneumoniae accounted for over 90% of pathogens isolated from the blood of young children and isolation of Enterobacteriaceae from blood increased with age. Around 30% of patients had positive sputum cultures and from these Haemophilus influenzae, Strep. pneumoniae and Pseudomonas aeruginosa were the most common organisms grown. Of those diagnosed with pneumonia, acute LRI or COPD+, 34.7% (95% CI: 26.1 to 43.3) of S. aureus isolated from sputum and 16.4% (95% CI: 7.1 to 25.7) from blood were methicillin resistant. Of 366 adult patient medical records reviewed, 56.8% (95% CI: 51.7 to 61.9) noted that an antibiotic was prescribed in the ED and amoxycillin was the most frequently prescribed. For those with pneumonia, concordance between prescribing guidelines and practice was low. Conclusions The administrative data sets used in the present study are useful for monitoring outcomes for respiratory infections diagnosed in the ED. Pneumonia continues to place a burden on the hospital system. Routine blood and sputum cultures have limited value. However, an appropriately designed surveillance program is needed to monitor potential Abstract v respiratory pathogens and assist in monitoring the appropriateness of current empiric antimicrobial therapy.
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Alcohol-based hand rub in the prevention of diarrhoea and respiratory-tract infection among children in community settings : a systematic reviewSteyn, Joelynn Geraldine Rachelle 04 1900 (has links)
Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Annually more than 3.5 million children worldwide, less than five years of age die of
diarrhoea and acute lower respiratory-tract infections. Over the last two decades, the
care of pre-school children outside of their homes has become more common in
most parts of the world and has contributed to an increased risk of respiratory-tract
and gastrointestinal infections in children. Children attending day-care centres are at
an increased risk for diarrhoea and respiratory-tract infections and hands are the
primary vehicle for transmission of infectious diseases. Thus, hand hygiene is
essential for preventing and controlling of infection in the health care and community
settings. Waterless hand sanitizer as an alternative to hand washing was
investigated. Rinse-free hand sanitizer programmes in the community may be
effective, safe and feasible.
The aim of the study was to systematically appraise evidence on the effect of
alcohol-based hand rub in the prevention of diarrhoea and acute respiratory-tract
infection among children aged five years and below in community settings.
The primary outcome of the study was to assess the incidence of respiratory-tract
infection and diarrhea. Diarrhoea is defined by the World Health Organization as the
excretion of three or more loose or liquid stools per day (or more frequent excretion
than is normal for the individual). The secondary outcome was to assess mortality,
admission to hospital and duration of hospital stay.
A comprehensive search for relevant studies was conducted on the following
databases from 1990 to 2014: EMBASE, MEDLINE, CINAHL, Google Scholar and
Cochrane Central Register of Controlled Trials (CENTRAL). We searched the
reference lists of all relevant articles and textbooks for more studies. Unpublished
data previously presented at international and scientific meetings have been
included in the review. Proceedings of international conferences on diarrhoea and
respiratory-tract infection among children were searched for relevant articles. Subject
experts were contacted.
Two reviewers, Joelynn Steyn (JS) and Oswell Khondowe (OK) selected studies
following a two-step study selection process. This review considered all published randomized controlled trials and quasi-experimental designs published from January
1990 to July 2014. The first step was the selection of studies based on titles and
abstracts. Both reviewers selected eligible studies which met the set criteria. During
the second step, both reviewers retrieved the full-text articles of the studies and
assessed the methodological quality of the studies. Four studies were included in
this review. The included studies met most of the quality assessment criteria as
stipulated in the Cochrane risk assessment tool. Two studies were clusterrandomized
controlled trials, one was a block randomized controlled trial and one
was a randomized controlled trial. Disagreements were resolved by discussion and
where a lack of consensus existed, consultation with a third reviewer occurred.
The use of alcohol hand rub as compared to control interventions significantly
reduced the incidence of diarrhoea in children (RR 0.79, 95% CI 0.63 to 0.99).
Statistical heterogeneity was observed among the included studies (I²=69, p=0.04).
However this review found no significant difference in respiratory-tract infections
between intervention groups versus control as observed from the confidence interval
(RR 0.98, 95% CI 0.90 to 1.07, p=0.63). The results should be interpreted with
caution due to the limited number of studies conducted in communities with alcoholbased
hand rub used by caregivers. Due to limited studies in this review, it makes it
difficult to make strong conclusions on findings and to provide sufficient evidence to
guide future research. We therefore recommend that more studies with high quality
methodologies, using randomized controlled trial designs be conducted especially in
poor resourced communities. / AFRIKAANSE OPSOMMING: Meer as 3.5 miljoen kinders jonger as vyf jaar oud sterf jaarliks wêreldwyd as gevolg
van diarree en akute laer respiratoriese lugweginfeksies. Oor die laaste dekades het
die versorging van voorskoolse kinders buite hul tuiste meer algemeen geword in die
meeste dele van die wêreld wat bygedra het tot ’n risiko in die toename van
respiratoriese en spysverteringskanaalinfeksies by kinders. Kinders by
dagsorgsentrums het ’n groter risiko vir diarree en respiratoriese lugweë infeksies
want die oordra van siekte-infeksies word veral deur die hande wat as die primêre
bron daarvan beskou word, gesien. Dus is hand-higiëne noodsaaklik om infeksies in
gesondheidsorg en gemeenskapsentrums te voorkom en te beheer. ’n Waterlose
hande-ontsmettingsmiddel as ’n alternatief om hande te was, is ondersoek. Spoelvrye
hande-ontsmettingsmiddel programme in die gemeenskap mag effektief, veilig
en uitvoerbaar wees.
Die doel van die studie was om sistematies die geslaagdheid van bewyse op die
effek van alkoholgebaseerde hande-smeermiddel in die voorkoming van diarree en
akute lugweginfeksies by kinders 5 jaar en jonger in gemeenskapsentrums te
ondersoek.
Die primêre uitkoms van die studie was om die voorkoms van respiratoriese
lugweginfeksie en diarree te asseseer. Diarree soos gedefinieer deur die WGO is die
uitskeiding van drie of meer los- of waterige stoelgange per dag (of meer gereelde
uitskeiding wat normaal vir die individu is). Die sekondêre uitkoms was om
mortaliteit, toelating tot die hospitaal en duur van hospitaalverblyf te assesseer.
’n Omvattende soektog vir relevante studies was op die volgende databasisse van
2004-2014 uitgevoer: EMBASE, MEDLINE, CINAHL, Google Scholar en Cochrane
Sentrale Register van Beheerde Toetse. Ons het die verwysingslyste van alle
relevante artikels en handboeke vir meer navorsingstudies nagegaan.
Ongepubliseerde data wat voorheen aangebied is by internasionale en
wetenskaplike vergaderings, is ingesluit in die oorsig. Bevindings by internasionale
konferensies oor diarree en lugweginfeksies by kinders was nagegaan in die soektog
na relevante artikels. Onderwerpdeskundiges was gekontak. Die twee navorsers, Joelynn Steyn (JS) en Oswell Khondowe (OK) het studies
geselekteer deur ’n twee-stap studieselekteringsproses te volg. Die oorsig het alle
gepubliseerde, ewekansige gekontroleerde proewe en kwasi-eksperimenteerde
studies oorweeg tussen Januarie 1990 en Julie 2014. Die eerste stap was die
selektering van studies gebaseer op hul titels en opsommings. Beide navorsers het
geskikte studies slegs geselekteer as die studie aan die bepaalde kriteria voldoen
het. Tydens die tweede stap het beide navorsers die volledige artikels geneem van
die studies geselekteer en die gehalte van die metodologie geassesseer. Vierstudies
is in die oorsig ingesluit. Die ingeslote studies het aan die meeste vereistes soos
deur die Cochrane risiko assesseringsinstrument gestipuleer voldoen. Twee studies
was groep-ewekansige gekontroleerde proewe, een was ’n blok ewekansige
gekontroleerde proef en een was ’n ewekansige gekontroleerde proef. Verskille is
opgelos deur bespreking en waar daar onderbreking in konsensus was, het ’n
konsultasie met ’n derde beoordelaar plaasgevind.
Die gebruik van ’n alkohol handreiniger, soos vergelyk met kontrole-intervensies, het
die voorkoms van diarree in kinders beduidend verminder (RR 0.79, 95% CI 0.63 to
0.99). Statistiese heterogeniteit is egter tussen die ingeslote studies waargeneem
(I²=69, p=0.04). Hierdie studie het geen beduidende verskille in lugweg infeksies
tussen die intervensiegroepe teenoor die kontrolegroep gevind nie soos
waargeneem uit die vertroue interval (RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die
resultate moet met omsigtigheid geïnterpreteer word as gevolg van die beperkte
aantal studies wat in gemeenskappe uitgevoer was met alkohol-gebasseerde
handreiniger wat deur versorgers gebruik word. As gevolg van die beperkende
aantal studies in hierdie studie, is dit moeilik om sterk gevolgtrekkings te maak op
bevindinge en om voldoende bewyse te gee om toekomstige navorsing te rig. Ons
beveel dus aan dat meer studies met hoë kwaliteit metodologie en wat ewekansige
gekontroleerde proef-ontwerpe gebruik, uitgevoer word, veral in swak-toegeruste
gemeenskappe.
(RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die resultate moet met omsigtigheid geïnterpreteer
word as gevolg van die beperkte aantal studies wat gedoen is in gemeenskappe met
alkohol-
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Frequent attendance for upper respiratory infection in university health service: a retrospective studyWong, Ho-cheong., 黃浩昌. January 2007 (has links)
published_or_final_version / Community Medicine / Master / Master of Public Health
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Epidemiology of novel viruses associated with human respiratory tract infections in Hong KongYip, Chik-yan., 葉植恩. January 2008 (has links)
published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy
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Incidence of Respiratory Viruses in Peruvian Children With Acute Respiratory InfectionsDel Valle Mendoza, Juana, Cornejo Tapia, Ángela, Weilg, Pablo, Verne, Eduardo, Nazario Fuertes, Ronald, Ugarte, Claudia, del Valle, Luis J., Pumarola, Toma´ s 23 March 2015 (has links)
jdelvall@upc.edu.pe / Acute respiratory infections are responsible for high morbi–mortality in Peruvian children. However, the etiological agents are poorly identified. This study, conducted during the pandemic outbreak of H1N1 influenza in 2009, aims to determine the main etiological agents responsible for acute respiratory infections in children from Lima, Peru. Nasopharyngeal swabs collected from 717 children with acute respiratory infections between January 2009 and December 2010 were analyzed by multiplex RT-PCR for 13 respiratory viruses: influenza A, B, and C virus; parainfluenza virus (PIV) 1, 2, 3, and 4; and human respiratory syncytial virus (RSV) A and B, among others. Samples were also tested with direct fluorescent-antibodies (DFA) for six respiratory viruses. RT-PCR and DFA detected respiratory viruses in 240 (33.5%) and 85 (11.9%) cases, respectively. The most common etiological agents were RSV-A (15.3%), followed by influenza A (4.6%), PIV-1 (3.6%), and PIV-2 (1.8%). The viruses identified by DFA corresponded to RSV (5.9%) and influenza A (1.8%). Therefore, respiratory syncytial viruses (RSV) were found to be the most common etiology of acute respiratory infections. The authors suggest that active surveillance be conducted to identify the causative agents and improve clinical management, especially in the context of possible circulation of pandemic viruses
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Avaliação da variabilidade do candidato vacinal PspC (Pneumococcal surface protein C) em isolados de Streptococcus pneumoniae do Hospital Universitário da Universidade de São Paulo. / Evaluation of the variability of the vaccine candidate PspC (Pneumococcal surface protein C) in Streptococcus pneumoniae isolates from the University Hospital of the University of São Paulo.Moreno, Adriana Tonet 09 August 2013 (has links)
Streptococcus pneumoniae é o agente causador de diversas doenças, tais como meningite e pneumonia. PspC (Pneumococcal surface protein C) foi descrito como um importante candidato vacinal proteico de ampla cobertura e com baixo custo de produção. Trata-se de um fator de virulência, capaz de ligar-se ao Fator H (FH) e a IgA secretório (sIgA). Como PspC é um antígeno polimórfico, é crucial a avaliação da sua variabilidade. Foi determinado o grupo de PspC de treze linhagens de pneumococo isoladas no Hospital Universitário da Universidade de São Paulo. Soros contra diferentes grupos de PspC foram produzidos e PspC do grupo 3 (PspC3) foi capaz de induzir anticorpos que reconhecem diferentes grupos de PspC. Foi observada ainda uma pequena redução na ligação de FH e sIgA por anticorpos anti-PspC3 em ensaios in vitro. No entanto, não foi possível observar proteção contra um modelo de colonização da nasofaringe de camundongos através da imunização com PspC3, possivelmente por deficiências no modelo experimental. / Streptococcus pneumoniae is the causative agent of several diseases, such as meningitis and pneumonia. PspC (Pneumococcal surface protein C) has been described as an important vaccine candidate protein as it could provide wide coverage with low cost of production. PspC is a virulence factor capable of binding to Factor H (FH) and secretory IgA (sIgA). PspC is polymorphic antigen, and therefore it is crucial to evaluate its variability. In the present work we have determined the PspC group of 13 pneumococcal isolates obtained at the University Hospital of the University of São Paulo. Antisera against different PspC groups were produced and PspC group 3 (PspC3) was able to induce antibodies that recognized different groups of PspC. Antibodies to PspC3 reduced binding of FH and sIgA to pneumococcus in in vitro assays. However, no protection was observed against a murine model of nasopharyngeal colonization by immunization with PspC3. This was possibly due to deficiencies in the experimental model.
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Seroprevalences of a typical respiratory infections, SeroCp ELISA reproducibility, electrocardiographic rhythm and ischaemic changes, socioeconomic deprivation and survival outcome in elderly stroke and control medical patientsNgeh, Joseph Kho Tong January 2008 (has links)
This thesis was based on a collection of my published works. Chapter 1 introduced the idea that infections, both acute and chronic, were risk factors for stroke. Various infections and micro-organisms associated with stroke were discussed. Specifically, the relationship between micro-organisms such as Cytomegalovirus, Helicobacter pylori, dental pathogens, and stroke were discussed. The theories of the pathogenesis of atherosclerosis were presented. Chapter 1 also reviewed the association between Chlamydia pneumoniae, an atypical respiratory pathogen, and atherosclerosis in detail. Chapter 2 introduced the ‘Chlamydia pneumoniae in elderly patients with stroke’ or ‘C-PEPS’ study from which published works in subsequent chapters of this thesis were based. The C-PEPS was a case-control study that investigated the seroprevalence of C pneumoniae in 100 elderly acute stroke and transient ischaemic attack (TIA) patients versus 87 control medical patients. The C-PEPS study showed a high seroprevalence (immunoglobulin IgG) of C pneumoniae infection in both cases and controls. There was no significant association between C pneumoniae seropositivity and stroke / TIA. Chapter 3 presented a study that investigated the reproducibility of a commercial enzyme linked immunosorbent assay (ELISA) kit (SeroCP, Savyon) used in the CPEPS study. The study concluded that SeroCP ELISA had a good reproducibility for the detection of C pneumoniae IgA and moderately good reproducibility for C pneumoniae IgG and IgM. In chapter 4, the ‘Mycoplasma pneumoniae in elderly patients with stroke’ or ‘MPEPS’ case-control study was based on the same cohort of patients as in the C-PEPS study. The M-PEPS study showed a high seroprevalence of M pneumoniae, another atypical respiratory pathogen, in the cohort. However, the study had ruled out M pneumoniae as a major risk factor for stroke / TIA. In chapter 5, the ‘Legionella pneumophila in elderly patients with stroke’ or ‘L-PEPS’ was another case-control study based on the same cohort of patients as in the C-PEPS 3 study. The L-PEPS study established that there was no statistical difference between the seroprevalence of L pneumophila, another atypical respiratory pathogen, in both the stroke / TIA patients and control medical patients. However, when the results of C-PEPS, M-PEPS and L-PEPS studies were analysed together, it appeared that the aggregate number or infectious burden of chronic atypical respiratory infections was associated with the risk of stroke / TIA. Chapter 6 presented a pilot study that investigated the seroprevalence of Coxiella burnetii, another atypical respiratory pathogen, in the same cohort of patients as in the C-PEPS study. Due to very low seropositivity and zero counts, a conclusion could not be made on any association between C burnetii seropositivity and stroke / TIA. Chapter 7 presented the electrocardiographic findings such as rhythms and ischaemic changes of the same cohort of patients as in the C-PEPS study. Atrial fibrillation was the commonest rhythm abnormality in both elderly stroke / TIA cases and medical controls. After adjusment for background history of ischaemic heart disease, there was a statistical trend to suggest an association between ischaemic elctrocardiographic changes and stroke / TIA. Chapter 8 presented a case-control study that investigated the relationsips between socioeconomic deprivation (SED) status, atypical respiratory infections and survival outcome in the same cohort of patients as in the C-PEPS study. The SED status of stroke / TIA cases and controls were similar. Although an association between acute atypical respiratory infection and SED was only found in the control medical patients, acute atypical respiratory infectious burden was found to associate with income deprivation in the whole cohort of elderly stroke / TIA and medical patients. SED on its own had only a modest effect on the association between chronic atypical respiratory infectious burden and stroke / TIA. Elderly patients’ duration of survival after an acute stroke / TIA appeared not to be affected by their background SED status. Chapter 9 was the concluding chapter. The main findings of the published works submitted for the thesis were summarised and discussed. Some directions for future research were also discussed.
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A community randomised controlled trial evaluating a home-based environmental intervention package of improved stoves, solar water disinfection and kitchen sinks in rural Peru: Rationale, trial design and baseline findingsHartinger, S.M., Lanata, Claudio F., Hattendorf, J., Gil, I., Verastegui, H., Ochoa, T., Mäusezahl, D. 24 March 2015 (has links)
clanata@iin.sld.pe / Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence. / This study received financial support of the UBS Optimus
Foundation, through a grant given to the IIN and Swiss TPH.
The sponsors had no role in the design and conduct of the
study; collection, management, analysis, and interpretation of
the data; or preparation, review, or approval of the
manuscript. / Revisión por pares
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