Crimean-Congo hemorrhagic fever:Pathogenesis,transmission and public health challenges

The dangerous Crimean-Congo hemorrhagic fever virus(CCHFV),an encapsulated negative-sense RNA virus of the family Nairoviridae,is transmitted from person to person via ticks.With a case fatality rate between 10%to 40%,the most common ways that the disease may spread to humans are via tick bites or coming into touch with infected animals'blood or tissues.Furthermore,the transfer of bodily fluids between individuals is another potential route of infection.There is a wide range of symptoms experienced by patients throughout each stage,from myalgia and fever to extreme bruising and excess bleeding.Tick management measures include minimising the spread of ticks from one species to another and from people to animals via the use of protective clothing,repellents,and proper animal handling.In order to prevent the spread of illness,healthcare workers must adhere to stringent protocols.Despite the lack of an authorised vaccine,the main components of treatment now consist of preventative measures and supportive care,which may include the antiviral medicine ribavirin.We still don't know very much about the virus's mechanisms,even though advances in molecular virology and animal models have improved our understanding of the pathogenesis of CCHFV.A critical need for vaccination that is both safe and effective,as well as for quick diagnosis and efficient treatments to lessen the disease's impact in areas where it is most prevalent.Important steps towards lowering Crimean-Congo hemorrhagic fever mortality and morbidity rates were to anticipatethe future availability of immunoglobulin products.

King's College criteria and the Clichy-Villejuif criteria require adjustments for assessing acute liver failure due to yellow fever

BACKGROUND Acute liver failure(ALF)is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease.Liver transplantation(LT)is the most impactful treatment.Yellow fever(YF)is an infectious disease that primarily affects the liver and has a high mortality rate.However,LT can be a viable option for treating rare cases with extensive liver involvement.However,the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.AIM To present necessary adjustments to established scoring systems for ALF secondary to YF.METHODS This was an observational,retrospective,single-center study.Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil.During hospitalization,general supportive therapeutic measures were implemented,and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure.LT is considered a viable measure for patients with signs of end-stage liver failure.RESULTS Eight of 14(57%)patients developed severe neurological alterations within the first 96 hours after hospital admission.Four patients underwent emergency LT,and despite a moderate viral infection of the graft after transplantation,the 5-year survival rate was 50%.Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF,they are insufficient for predicting the risk of mortality in this context,primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.CONCLUSION To ensure good applicability in cases of YF-induced ALF,the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.

A rapid and visual detection method for Crimean-Congo hemorrhagic fever virus by targeting S gene

Crimean-Congo hemorrhagic fever(CCHF)is a zoonotic disease caused by the CCHF virus(CCHFV),which is primarily transmitted by ticks(Lorenzo Juanes et al.2023).It is an emerging disease that occurs sporadically in Africa,Asia,and Europe,with a high morbidity and mortality rate,as high as 30%in humans(Ceylan et al.2013).CCHFV,belonging to genus Nairovirus,family Bunyaviridae,was first identified in the Congo in the 1960s.

Dengue fever in Egypt:Current situation and future risks

Dengue or dengue fever(DF)is an acute infectious disease of a febrile nature.It is caused by the dengue virus(DENV),which belongs to the family Flaviviridae and has four antigenically distinctive serotypes(DENV-1,DENV-2,DENV-3 and DENV-4).DENV is regarded as one of the most prevalent fast-emerging mosquito-borne viruses,which has a wide distribution in many tropical and subtropical regions worldwide.The virus is typically transmitted following the bite of an infected female mosquito of the species,Aedes(Ae.)aegypti and Ae.albopictus[1].

The global,prevalence,and risk factors of postoperative fever after percutaneous nephrolithotomy:A systematic review and meta-analysis

Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching was conducted without time limitation until December 30,2020 in Web of Sciences,Scopus,and PubMed based on inclusion and exclusion criteria.Results:The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5%(95%confidence interval[CI]:9.3%-9.7%),and 4.5%(95%CI:4.2%-4.8%),respectively.Nephrostomy tube was used in 9.96%(95%CI:9.94%-9.97%)of patients.The mean preoperative white blood cells of patients were 6.401×109/L;18.3%and 4.55%of patients were considered as the positive urinary culture and pyuria,respectively.About 20.4%of patients suffered from residual stones.The odds ratios(ORs)of fever in patients who suffering from diabetes mellitus,hydronephrosis,staghorn stones,and blood transfusion were 4.62(95%CI:2.95-7.26),1.04(95%CI:0.81-1.34),2.57(95%CI:0.93-7.11),and 2.65(95%CI:1.62-4.35),respectively.Patients who underwent PCNL in prone position were more likely to develop fever(OR:1.23;95%CI:0.75-2.00)than patients in supine position.Conclusion:The current study showed that patients who suffer from diabetes mellitus,hydronephrosis,staghorn stones,nephrostomy tube or double-J stent,blood transfusion,and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.

Global systematic review and meta-analysis of knowledge, attitudes, and practices towards dengue fever among the general population

Objective:To determine the global level of knowledge,attitudes,and practices towards dengue fever among the general population.Methods:To complete this systematic review and meta-analysis,a thorough search for pertinent English-language literature was undertaken during the study's extension until October 2023.The search used Google Scholar,Scopus,PubMed/MEDLINE,Science Direct,Web of Science,EMBASE,Springer,and ProQuest.A quality assessment checklist developed using a modified Newcastle-Ottawa Scale for the cross-sectional study was used to evaluate the risk of bias in the included papers.Inverse variance and Cochran Q statistics were employed in the STATA software version 14 to assess study heterogeneity.When there was heterogeneity,the Dersimonian and Liard random-effects models were used.Results:59 Studies totaling 87353 participants were included in this meta-analysis.These investigations included 86278 participants in 55 studies on knowledge,20196 in 33 studies on attitudes,and 74881 in 29 studies on practices.The pooled estimates for sufficient knowledge,positive attitudes,and dengue fever preventive behaviors among the general population were determined as 40.1%(95%CI 33.8%-46.5%),46.8%(95%CI 35.8%-58.9%),and 38.3%(95%CI 28.4%-48.2%),respectively.Europe exhibits the highest knowledge level at 63.5%,and Africa shows the lowest at 20.3%.Positive attitudes are most prevalent in the Eastern Mediterranean(54.1%)and Southeast Asia(53.6%),contrasting sharply with the Americas,where attitudes are notably lower at 9.05%.Regarding preventive behaviors,the Americas demonstrate a prevalence of 12.1%,Southeast Asia at 28.1%,Western Pacific at 49.6%,Eastern Mediterranean at 44.8%,and Africa at 47.4%.Conclusions:Regional disparities about the knowledge,attitude and preventive bahaviors are evident with Europe exhibiting the highest knowledge level while Africa has the lowest.These findings emphasize the importance of targeted public health interventions tailored to regional contexts,highlighting the need for region-specific strategies to enhance dengue-related knowledge and encourage positive attitudes and preventive behaviors.

Protectivity of Freeze Dried Inactivated Rift Valley Fever Vaccine

Background: Vaccinations for animals are crucial for food production, animal welfare, public health, and animal health. They are an affordable way to stop animal sickness, increase food production efficiency, and lessen or stop the spread of zoonotic diseases to humans. Animal vaccines that are both safe and efficacious are vital to modern culture. The vaccine should induce a strong, protective and prolonged immune response against the antigenic factor. In order to achieve these goals, novel vaccination techniques and an efficient adjuvant are required to render the vaccine immunogenically protective and trigger a strong immune response. Aim: Our study aims to promote and enhance the immunogenicity against RVF virus disease through lyophilized inactivated RVF vaccine through induction of early cellular, high and prolonged humeral immunity in vaccinated animals using cabopol as stabilizer and Saponin or normal saline as a diluent at time of vaccination. Moreover, manufacturing of these vaccines is easy to be done. Results: The gained results revealed that RVF freeze-dried vaccine with Carbopol that reconstituted using Saponin elicited better immune response than that reconstituted using normal saline (NaCl). The cell mediated immune response as represented by lymphocyte blastogenesis and phagocytic activity were markedly increased with high levels when we used Saponin as a diluent than that in group vaccinated with vaccine diluted with NaCl, on the other side the humeral immune response in group vaccinated using the Saponin as diluent is more detected and stayed within the protective level till the end of 11th month post vaccination (1.5 TCID50) while the immune response induced after using normal saline as a diluent stayed within the protective level till the end of 10th month post vaccination (1.8 TCID50). Conclusion: The use of Saponin as a diluent for reconstitution of the freeze dried RVF vaccine is preferable than the use of normal saline enhancing both sheep cellular and humeral immune response.

Typhoid fever presenting as neuropsychiatric oddities:A case report

Rationale:Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent.Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country.Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor.Patient concerns:A 19-year-old male,presented with a 10-day history of altered mental status,high-grade fever and violent behaviour.2 Days prior to admission,he developed decreased responsiveness and a muttering delirium with self-talking.Diagnosis:Coma vigil secondary to salmonellosis.Interventions:Intravenous ceftriaxone and dexamethasone.Outcomes:The resolution of the coma vigil and the associated Salmonella infection were observed;however,the patient developed residual mutism.Lessons:The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide.Additionally,the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.

Establishment of an indirect immunofluorescence assay for the detection of African swine fever virus antibodies

African swine fever(ASF)continues to cause enormous economic loss to the global pig industry.Since there is no safe and effective vaccine,accurate and timely diagnosis of ASF is essential to implement control measures.Indirect immunofluorescence assay(IFA)is a gold standard serological method recommended by the World Organization for Animal Health(WOAH).In this study,we used primary fetal kidney cells to establish a wild boar cell line(BK2258)that supported the efficient replication of ASF virus(ASFV)SD/DY-I/21 and showed visible cytopathic effect(CPE).Moreover,using BK2258,we established a sensitive and specific IFA for ASFV antibody detection.To standardize and evaluate the performance of this assay,we used serum samples from pigs infected with the low virulent genotype I SD/DY-I/21 and genotype II HLJ/HRB1/20,and immunized with the vaccine candidate HLJ/18-7GD,field samples,and negative serum samples.The IFA reacted with the ASFV-positive sera and displayed bright fluorescence foci.There was no non-specific green fluorescence due to cellular senescence or other cell damage-causing factors.Compared to a commercial indirect enzyme-linked immunosorbent assay(iELISA),ASFV antibodies were detected 1–4 days earlier using our IFA.The detection limits of the IFA and iELISA for the same ASFV-antibody positive serum samples were 1:25,600 and 1:6,400,respectively,indicating that the IFA is more sensitive than iELISA.The newly established IFA was highly specific and did not cross-react with sera positive for six other important porcine pathogens(i.e.,Classical swine fever virus(CSFV),Porcine reproductive and respiratory syndrome virus(PRRSV),Porcme circovirus type 2(PCV2),Pseudorabies virus(PRV),Foot-and-Mouth disease virus type O(FMDV/O),and Porcine epidemic diarrhea virus(PEDV)).This study thus provides a sensitive,specific,and reliable detection method that is suitable for the serological diagnosis of ASF.

Geographically and Temporally Weighted Regression in Assessing Dengue Fever Spread Factors in Yunnan Border Regions

Objective This study employs the Geographically and Temporally Weighted Regression(GTWR)model to assess the impact of meteorological elements and imported cases on dengue fever outbreaks,emphasizing the spatial-temporal variability of these factors in border regions.Methods We conducted a descriptive analysis of dengue fever’s temporal-spatial distribution in Yunnan border areas.Utilizing annual data from 2013 to 2019,with each county in the Yunnan border serving as a spatial unit,we constructed a GTWR model to investigate the determinants of dengue fever and their spatio-temporal heterogeneity in this region.Results The GTWR model,proving more effective than Ordinary Least Squares(OLS)analysis,identified significant spatial and temporal heterogeneity in factors influencing dengue fever’s spread along the Yunnan border.Notably,the GTWR model revealed a substantial variation in the relationship between indigenous dengue fever incidence,meteorological variables,and imported cases across different counties.Conclusion In the Yunnan border areas,local dengue incidence is affected by temperature,humidity,precipitation,wind speed,and imported cases,with these factors’influence exhibiting notable spatial and temporal variation.

Dengue hemorrhagic fever with rectus sheath hematoma:A case report

Rationale:Acute pain is a medical emergency that requires prompt abdominal evaluation and management.Dengue,a mosquito-borne arboviral infection,can lead to complications such as acute abdominal pain.Patient concerns:A 72-year-old hypertensive female presented with high-grade intermittent fever with chills and rigors for four days.She was diagnosed with dengue fever(NS1Ag-reactive)the day before admission.A contrast-enhanced computed tomography of the abdomen showed a hematoma along the rectus sheath which was managed conservatively as per surgical opinion.Diagnosis:Dengue hemorrhagic fever with rectus sheath hematoma.Interventions:Blood transfusion and fluid therapy.Outcomes:Ten days after discharge,the patient reproted no pain in the right iliac fossa and the size of the hematoma was significantly reduced.Lessons:Although it is rarely seen as a cause of acute abdomen,complaints of adnominal pain should never be ignored in critical or convalescent phase of dengue fever.Radiological investigations should be promptly conducted as hematoma is often difficult to be diagnosed clinically.Delay in diagnosis of rectus sheath hematoma can be fatal.

Characterization of three African swine fever viruses from diferent clinical settings revealed a potential attenuation mechanism

African swine fever(ASF)is an acute and fatal hemorrhagic disease in domestic pigs and wild boars caused by African swine fever virus(ASFV)that currently threatens the pig industry worldwide.Since the 2018 ASF outbreak in China,ASFV has evolved and caused diverse clinical manifestations,such as chronic and asymptomatic infections.Therefore,it is important to understand the molecular mechanisms underlying ASFV attenuation in the feld.Here,we isolated three ASFVs from one diseased and two asymptomatic pigs by using primary porcine alveolar macrophages(PAMs)from both domestic pigs and Bama minipigs.The three ASFVs exhibited similar phenotypes in cell culture,includ‑ing cytopathic efects(CPEs),hemadsorptions(HADs),viral protein expressions and growth curves.Genome sequenc‑ing revealed that all three ASFVs were genotype II strains.Genomic comparisons suggested that the disruption of the viral genes MGF360 and MGF110,rather than EP402R and EP153R,is likely involved in the potential attenuation of ASFV via the upregulation of innate immune responses.

Advances in research on the efcacy of traditional Chinese herbal medicine in combating African swine fever

African swine fever(ASF)is a highly contagious disease of domestic and wild pigs caused by African swine fever virus(ASFV).The mortality rate associated with ASF is remarkably high,almost approaching 100%.Since the introduction of ASF into China in 2018,its rapid spread has caused marked economic losses in the country’s swine industry.To date,there are no safe and efective commercial vaccines or antiviral drugs against ASF;thus,there is an urgent need to develop novel prevention and control strategies.Traditional Chinese medicine(TCM),which comprises various herbs that are abundant in various potential functional components,holds great promise for the prevention and control of ASF.Here,we provide a comprehensive review of the advancements in TCM and the efects of its compound formulas against ASF,including the antiviral abilities,immunoregulatory activities,and practical application of these formulas for the prevention and control of ASF.We specifcally examined the potential and constraints of natural product-derived extracts and TCM formulas in combating ASFV.This review aims to ofer insights and ideas for the holistic management and containment of ASF.

Cat scratch disease in children with nocturnal fever:A case report

BACKGROUND Cat scratch disease(CSD)is the most common human infection caused by Barto-nella henselae(B.henselae).The main manifestation is self-limited lymphaden-opathy that primarily affects adolescents,and typically resolves without treat-ment within 2-4 months.However,individuals with compromised immune systems or immunodeficiency require specific antibacterial therapy following diagnosis.Due to its low incidence,nonspecific clinical manifestations,and diagnostic limitations,this condition often poses challenges for clinicians in terms of missed diagnoses and misdiagnoses.CASE SUMMARY The child was ultimately diagnosed with CSD.The primary manifestations included nocturnal fever,enlargement of lymph nodes in the neck,axilla and groin,and suspected brucellosis;however,both brucellosis tests conducted during the course of the illness yielded negative results.Bone marrow cytology indicated stimulated proliferation.Lymph node biopsy indicated hyperplasia of lymphoid tissue in the cervical lymph nodes(right),with combined immunohisto-chemical findings indicating reactive hyperplasia.Immunohistochemical analysis revealed CD20 B(+),CD3 T(+),BCL-6(+),and BCL-2(-).CD21 FDC networks were present and Ki67 expression in the germinal center was~80%.Blood next-generation sequencing indicated B.henselae sequence number was 3.Serological test results demonstrated positive antibody response to B.henselae IgG(+),B.henselae IgM(+),Bartonella quintana(B.quintana)IgG(-)and B.quintana IgM(-),and the final diagnosis was CSD.CONCLUSION In patients presenting with fever at night and swollen lymph nodes of unknown origin,CSD should be considered.

Current research progress on the viral immune evasion mechanisms of African swine fever virus

African swine fever(ASF),caused by the ASF virus(ASFV),is an acute,severe,and highly contagious infectious disease in domestic pigs and wild boars.Domestic pigs infected with a virulent ASFV strain can have morbidity and mortality rates of up to 100%.The epidemic of ASF has caused serious economic losses to the global pig industry.Currently,there is no safe and efective vaccine or specifc drug for treating ASF.Therefore,ASFV still poses a great threat to pig factories.ASFV is a double-stranded DNA virus with a complex icosahedral multilayer structure.The ASFV genome contains 150-170 open reading frames(ORFs)that encode 150-200 proteins.Some ASFV-encoded proteins are involved in virus invasion,genome replication,DNA repair,and virion formation.Some ASFV proteins execute immunomodulatory functions by regulating the host antiviral innate immune response.Accumulating studies have shown that the immunomodulatory functions of ASFV genes are closely related to the virulence and pathogenicity of ASFV isolates.This review summarizes the research advances on ASFV immune evasion mechanisms in African swine fever patients and provides new insights for developing attenuated live vaccine candidates to prevent and control ASF.

Development and application of a SYBR Green I fuorescent PCR assay for the diferentiation of genotypes I and II African swine fever viruses

African swine fever(ASF)is a highly fatal hemorrhagic disease afecting domestic pigs caused by African swine fever virus(ASFV).Genetic analysis of ASFV isolates to date has identifed 24 geographically related genotypes with various subgroups,but only genotype I and II ASFVs have been reported outside Africa.ASFV genotype II and genotype I viruses were reported in China in 2018 and 2021,respectively.In this study,unique and highly conserved noncoding regions were found between MGF_505-9R and MGF_505-10R in the 188 genomes of ASFV genotypes I and II.A pair of primers was designed on the basis of this region.By optimizing the reaction system and conditions,a SYBR Green I fuorescence PCR assay that can distinguish between ASFV genotypes I and II was established,and the sensitivity,reproducibility and specifcity were evaluated.The detection limit was 1 TCID_(50)/0.1 mL for both genotypes,with no cross-reactivity observed with other common pig pathogens.The intra-and interbatch variation coefcients were both less than 1.2%.Clinical sample detection analysis revealed 47 positive cases out of 100,including 3 for genotype I and 44 for genotype II,aligning with results from the WOAH-recommended and national standard methods.The method developed in this study allows for the diferentiation of ASFV genotypes I and II without the need for genome sequencing,ofering a convenient and rapid approach for ASFV detection and genotype identifcation.

Effect of Milk Processed Arnebiae Radix on Body Temperature of Fever Rats

[Objectives]To investigate the synergistic effect of Arnebiae Radix after processing.[Methods]The effects of raw Arnebiae Radix and milk processed Arnebiae Radix on hypothermia in yeast-induced febrile rats were compared.[Results]The processed and unprocessed Arnebiae Radix at high,medium and low doses all had a certain effect on inhibiting the rise of body temperature in rats.The high dose unprocessed group,the medium dose processed group and the high dose processed group had the best inhibitory effect on body temperature,the low dose processed group could delay the fever time,and the low dose unprocessed group had poor inhibitory effect on fever.[Conclusions]The prepared Arnebiae Radix has enhanced drug effect,and milk processed Arnebiae Radix can be used to replace common Arnebiae Radix to reduce the dosage of Arnebiae Radix and save Arnebiae Radix resources.

Assessing Dual Approaches for Ranking Score Computation via Transitive Triads

The possibility of developing a complete graph invariant computable in polynomial time remains an open question. Consequently, creating efficient algorithms to verify non-isomorphism, including heuristic approaches, is essential. Effective implementation of these heuristics necessitates both the adaptation of existing graph invariants and the invention of novel ones, which continues to be a relevant challenge. Numerous current invariants are capable of distinguishing a significant number of graphs rapidly in real-time scenarios. In this study, we present an invariant tailored for tournaments, a specific class of directed graphs. Tournaments are particularly intriguing because the count of distinct tournaments for a given number of vertices aligns with that of undirected graphs of the same size. The introduced invariant evaluates all possible tournament subsets derived from the original digraph that share the identical arc set. For each subset tournament, standard rankings are computed and aggregated to produce the final vertex scores, which serve as the new invariant. Our analysis indicates that this newly proposed invariant diverges from the most straightforward tournament invariant, which typically assigns scores to each participant. Preliminary computational tests demonstrate that the minimal correlation between the sequences generated by these two invariants occurs at a vertex count of 15.

Afferent loop syndrome of a patient with recurrent fever:A case report

BACKGROUND Afferent loop syndrome(ALS)is a rare complication,Aoki et al reported that the incidence of distal gastrectomy in Billroth-II is 0.3%-1.0%.The clinical manifest-ations of ALS are atypical,which can manifest as severe abdominal pain,vomiting,obstructive jaundice,malnutrition,etc.CASE SUMMARY The patient was a 58-year-old man who complained of recurrent high fever for more than 1 week.Laboratory tests showed an increase in neutrophil ratio,procal-citonin,C-reactive protein,and abnormal liver function.Enhanced computed tomography scan of the abdomen showed small intestinal obstruction between the anastomosis of the gastrojejunum,bile duct,and pancreaticoduodenum.Gastroscopy revealed significant narrowing of the lumen 15 cm from the anasto-mosis into the afferent loop.After performing balloon dilation and placement of the nutrition tube,the patient did not experience further fever.CONCLUSION ALS is relatively rare after pancreaticoduodenectomy,and the treatment depends on the nature of the obstructive lesion.The traditional treatment method is surgery,and in recent years,endoscopy has provided a new treatment method for ALS.

Fever assessment in children under five: Are we following the guidelines?

BACKGROUND Fever is a common cause of medical consultation and hospital admission,particularly among children.Recently,the United Kingdom’s National Institute for Health and Care Excellence(NICE)updated its guidelines for assessing fever in children under five years of age.The efficient assessment and management of children with fever are crucial for improving patient outcomes.AIM To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline.METHODS We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between June and July 2023.Demographic data,vital signs during the first 48 h of admission,route of temperature measurement,and indications for admission were gathered.Fever was defined according to the NICE guideline.The children were divided into five groups according to their age(0-3 months,>3-6 months,>6-12 months,>12-36 months,and>36-60 months).Patients with and without fever were compared in terms of demography,indication for admission,route of temperature measurement,and other vital signs.Compliance with the NICE Fever in the under 5s guideline was assessed.Full compliance was defined as>95%,partial compliance as 70%-95%,and minimal compliance as≤69%.Pearson’sχ^(2),Student’s t test,the Mann-Whitney U test,and Spearman’s correlation coefficient(rs)were used for comparison.RESULTS Of the 136 patients reviewed,80(58.8%)were boys.The median age at admission was 14.2[interquartile range(IQR):1.7-44.4]months,with the most common age group being 36-60 months.Thirty-six(26.4%)patients had fever,and 100(73.6%)were afebrile.The commonest age group for febrile patients(>12-36 months)was older than the commonest age group for afebrile patients(0-3 months)(P=0.027).The median weight was 8.3(IQR:4.0-13.3)kg.Patients with fever had higher weight than those without fever[10.2(IQR:7.3-13.0)vs 7.1(IQR:3.8-13.3)kg,respectively](P=0.034).Gastrointestinal disease was the leading indication for hospital admission(n=47,34.6%).Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile(P=0.030 and P=0.011,respectively).The mean heart rate was higher in the febrile group than the afebrile group(140±24 vs 126±20 beats per minute,respectively)[P=0.001(confidence interval:5.8-21.9)]with a positive correlation between body temperature and heart rate,r=0.242,n=136,P=0.004.A higher proportion of febrile patients received paracetamol(n=35,81.3%)compared to the afebrile patients(n=8,18.6%)(P<0.001).The axillary route was the most commonly used for temperature measurements(n=40/42,95.2%),followed by the rectal route(n=2/42,4.8%).The department demonstrated full compliance with the NICE guideline for five criteria:the type of thermometer used,route and frequency of temperature measurement,frequency of heart rate measurement,and use of antipyretics as needed.Partial compliance was noted for two criteria,the threshold of fever at 38°C or more,and the respiratory rate assessment in febrile patients.Minimal compliance or no record was observed for the remaining three criteria;routine assessment of capillary refill,temperature reassessment 1-2 h after each antipyretic intake,and refraining from the use of tepid sponging.CONCLUSION This study showed that fever assessment in hospitalized children under five years of age was appropriate,but certain areas of adherence to the NICE guideline still need to be improved.