Progress in the Use of Glucocorticoids and Biological Agents in Non-Infectious Uveitis

One of the main immune-mediated diseases that lead to avoidable blindness is non-infectious uveitis. Glucocorticoids are the first-line therapy choice for noninfectious uveitis;however, biologics are also showing promise in the management of this condition. The description of glucocorticoid and biologic usage in non-infectious uveitis is the main topic of this paper.

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.

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.

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.

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.

Predicting factors and adverse effect of non-infectious fever in patient with aortic dissection after endovascular aortic repair

Background Non-infectious fever in patients with aortic dissection after endovascular aortic repair （EVAR） is very common and can cause a series of adverse effects. However, the etiology and pathophysiology of non-infectious postoperative fever is seldom studied. Methods According to predefined criteria, 148 patients underwent EVAR were divided into two groups： non-infectious fever group and non-fever group. Clinical data were compared between groups and multiple logistic regressions were performed to detect the risk factors of non- infectious fever. Results A total of 54.1% （80/148） EVAR patients suffered non-infectious fever. Fever （37.3- 38 ℃ ） was almost universally presented in 57.5% patients. And 37.5% of the patients had fever ranging from 38.1 to 39 ℃ and 5% of the patients had fever above 39℃. Increased levels of D-dimer, white blood cell count （WBC）, procalcitonin （PCT）, C-reactive protein （CRP）, operation time duration and the length of stents and decreased levels of hemoglobin were presented in the non-infectious fever group as compared to non-fever group （P〈0.005）. Multiple logistic regression analysis revealed that D-dimer （OR=2.533, P=0.031 ）, PCT （OR= 3.307, P=0.009）, operation time duration （OR=2.631, P=0.021 ） and the length of stents （OR=2.851, P=0.015） were independently associated with non-infective fever EVAR. Furthermore, we also found that the duration of stay in CCU （3.2±2.2 vs. 2.5±2.0）, hospital time （8.6±2.2 vs. 7.5±2.3） and hospitalization expense （131.2 ±30.8 vs. 120.6 ±25.9 thousand yuan） were significant different between the two groups. Conclusions Increased levels of D-dimer, procalcitonin concentration, operation duration and the length of stents are risk factors for non-infectious fever of EVAR, which may prolong the duration of stay in CCU and hospital, and increase the hospitalization expense.

Developing a duplex ARMS-qPCR method to differentiate genotype Ⅰ and Ⅱ African swine fever viruses based on their B646L genes

Africanswinefever(ASF),causedbythe African swine fever virus (ASFV), is an acute, hemorrhagic, and contagious disease of domestic pigs and wild boars.The disease is notifiable and listed by the World Organization for Animal Health (WOAH)(Wang N et al. 2019).

A multiplex real-time PCR assay for simultaneous detection of classical swine fever virus,African swine fever virus,and atypical porcine pestivirus

With the implementation of the C-strain vaccine,classical swine fever(CSF) has been under control in China,which is currently in a chronic atypical epidemic situation.African swine fever(ASF) emerged in China in 2018 and spread quickly across the country.It is presently occurring sporadically due to the lack of commercial vaccines and farmers’ increased awareness of biosafety.Atypical porcine pestivirus(APPV) was first detected in Guangdong Province,China,in 2016,which mainly harms piglets and has a local epidemic situation in southern China.These three diseases have similar clinical symptoms in pig herds,which cause considerable losses to the pig industry.They are difficult to be distinguished only by clinical diagnosis.Therefore,developing an early and accurate simultaneous detection and differential diagnosis of the diseases induced by these viruses is essential.In this study,three pairs of specific primers and Taq-man probes were designed from highly conserved genomic regions of CSFV(5’ UTR),African swine fever virus(ASFV)(B646L),and APPV(5’ UTR),followed by the optimization of reaction conditions to establish a multiplex real-time PCR detection assay.The results showed that the method did not cross-react with other swine pathogens(porcine circovirus type 2(PCV2),porcine reproductive and respiratory syndrome virus(PRRSV),foot-and-mouth disease virus(FMDV),pseudorabies virus(PRV),porcine parvovirus(PPV),and bovine viral diarrhea virus BVDV).The sensitivity results showed that CSFV,ASFV,and APPV could be detected as low as 1 copy μL–1;the repeatability results showed that the intra-assay and interassay coefficient of variation of ASFV,CSFV,and APPV was less than 1%.Twenty-two virus samples were detected by the multiplex real-time PCR,compared with national standard diagnostic and patented method assay for CSF(GB/T 27540–2011),ASF(GB/T 18648–2020),and APPV(CN108611442A),respectively.The sensitivity of this triple real-time PCR for CSFV,ASFV,and APPV was almost the same,and the compliance results were the same(100%).A total of 451 clinical samples were detected,and the results showed that the positive rates of CSFV,ASFV,and APPV were 0.22% (1/451),1.3%(6/451),and 0%(0/451),respectively.This assay provides a valuale tool for rapid detection and accurate diagnosis of CSFV,ASFV,and APPV.

Non-Infectious Complications of Peritoneal Dialysis in Senegal

Introduction: Senegal has pioneered the implementation of peritoneal dialysis (PD) in West Africa, practicing it since 2004. Non-infectious complications are a significant cause of failure of this technique and the transfer of patients to haemodialysis. The aim of this study was to determine the prevalence and the different types of non-infectious complications in our context. Patients and Methods: This was a 5-year, descriptive, retrospective study of patients on chronic peritoneal dialysis for more than 3 months. Results: During the study period, 75 patients were included. The prevalence of non-infectious complications was 88%, including 45.3% mechanical complications and 76% metabolic complications. Catheter migration was the most common mechanical complication (55.9%), followed by catheter blockage (23.5%). Metabolic complications were dominated by hypoalbuminemia (76.3%). Dyslipidaemia and hypokalaemia affected more than 50% of patients, occurring in 59.3% and 56.9% of cases, respectively. Conclusion: In our study, non-infectious complications related to PD were frequent and varied. They remain a significant cause of technical failure. Mechanical complications are often the cause of permanent transfer to haemodialysis.

A Clinical Analysis of 293 FUO Patients, A Diagnostic Model Discriminating infectious Diseases from Non-infectious Diseases

Objective A diagnostic model was established to discriminate infectious diseases from non-infectious diseases. Methods The clinical data of patients with fever of unknown origin(FUO) hospitalized in Xiangya Hospital Central South University, from January, 2006 to April, 2011 were retrospectively analyzed. Patients enrolled were divided into two groups. The first group was used to develop a diagnostic model: independent variables were recorded and considered in a logistic regression analysis to identify infectious and non-infectious diseases(αin = 0.05, αout = 0.10). The second group was used to evaluate the diagnostic model and make ROC analysis.Results The diagnostic rate of 143 patients in the first group was 87.4%, the diagnosis included infectious disease(52.4%), connective tissue diseases(16.8%), neoplastic disease(16.1%) and miscellaneous(2.1%). The diagnostic rate of 168 patients in the second group was 88.4%, and the diagnosis was similar to the first group. Logistic regression analysis showed that decreased white blood cell count(WBC < 4.0×109/L), higher lactate dehydrogenase level(LDH > 320 U/L) and lymphadenectasis were independent risk factors associated with non-infectious diseases. The odds ratios were 14.74, 5.84 and 5.11(P ≤ 0.01), respectively. In ROC analysis, the sensitivity and specificity of the positive predictive values was 62.1% and 89.1%, respectively, while that of negative predicting values were 75% and 81.7%, respectively(AUC = 0.76, P = 0.00).Conclusions The combination of WBC < 4.0×109/L, LDH > 320 U/L and lymphadenectasis may be useful in discriminating infectious diseases from non-infectious diseases in patients hospitalized as FUO.

Biologics in non-infectious uveitis past,present and future

Our increase in knowledge of the pathophysiology of non-infectious uveitis(NIU)and other immune-mediated diseases has been mirrored over the last two decades by the expansion of therapeutic options in the realm of immunosuppressive medications.Principal among these advances is the emergence of biologics,which offer the promise of targeted therapy and the hope of reduced toxicity when compared to corticosteroids and“standard”immunosuppression.Among the biologics,monoclonal antibodies blocking tumor necrosis factor alpha(TNF-α)have been shown to be a very effective therapeutic target for uveitis and many associated systemic inflammatory diseases.Multiple TNF blockers have shown benefit for uveitis,and in 2016,adalimumab became the first biologic and non-corticosteroid immunosuppressive to obtain Food and Drug Administration(FDA)approval in the treatment of NIU.Although effective,TNF blockers are not universally so,and safety concerns such as infection and demyelinating disease must be carefully considered and ruled out prior to their use,especially in patients with intermediate uveitis with which multiple sclerosis is a known association.Ongoing study has identified novel targets for regulation in the treatment of immune-mediated and inflammatory diseases.Interferons,interleukin and Janus kinase inhibitors in addition to antibodies targeting T cell and B cell activation highlight the expanding field of treatment modalities in NIU.Ongoing study will be required to better determine the safety and efficacy of biologics in the armamentarium of immunosuppressive treatments for NIU.

The Role of Mediterranean Spotted Fever in the Spectrum of Pediatric Fever with Rashes

When febrile illnesses develop a rash in children, parents are very concerned about a serious disease. Many rashes associated with fever are caused by infectious diseases. Rashes are generally nonspecific and play a supportive role in differential diagnosis, but for some diseases, the appearance of the rash is essential in making a diagnosis. Here is presented the case of a 4-year-old boy with high fever, headache, abdominal pain, vomiting, diarrhea, and a generalized maculo-papular rash including palms and soles. On physical examination were found a black eschar, cervical lymphadenopathy, and hepatosplenomegaly. Laboratory findings resulted in moderate leukocytosis and moderate involvement of the liver and renal function. Based on this finding, a diagnosis of Mediterranean Spotted Fever was performed. The child recovered after medication with azithromycin. Because there is no reliable test that can confirm MSF in its early stages, the diagnosis is commonly made on the basis of clinical findings, so a high index of suspicion should be maintained while evaluating a child with fever and rash.

Virucidal activity of MICRO-CHEM PLUS against African swine fever virus

African swine fever(ASF) was first discovered and reported in East Africa in 1921 and it has been listed as a notifiable animal disease by the World Organization for Animal Health(WOAH) due to the high morbidity and mortality(WOAH 2019). African swine fever virus(ASFV) can persist in pig farm environments, carcasses, and various pig products(Petrini et al. 2019). ASF has caused significant economic losses to the pig industry since its outbreak in China in 2018(Zhao et al. 2019).

Fever induced Brugada electrocardiographic pattern converted to the early repolarization pattern after fever abatement in an elderly man

Brugada syndrome(BrS)is one of inherited arrhythmia syndromes characterized by ST-segment elevation in the right precordial leads and is associated with increased risk of ventricular fibrillation(VF)and sudden cardiac death(SCD)in the absence of a structural heart disease.Fever is a known trigger for Brugada ECG pattern(BrP).[1]Relevant studies showed that BrS patients with a fever induced type 1(F-type 1)BrP have a worse prognosis due to the higher risk of future arrhythmic events.[2]However,the prognosis of asymptomatic subjects with F-type 1 BrP remains to be elucidated,especially in the elderly.Recent studies have found that in elderly patients,F-type 1 BrP led to VF or even syncope.[3,4,5]Thus,more clinical attention should be given rise on cases of elderly asymptomatic patients with F-type 1 BrP.

Electrocardiographic changes in dengue fever

Dengue fever(DF)is one of the most commonly prevalent viral diseases in the world,primarily affecting tropical countries.It is transmitted by the bite of female Aedes(Ae.)aegypti mainly and Ae.albopictus mosquito infected with the virus.Dengue virus is a flavivirus,arbovirus.There are four strains of dengue virus(DENV1,DENV2,DENV3,DENV4).The clinical spectrum of the disease ranges from mild to severe forms with complications.

Structure and Composition of Non-Infectious Phosphate Calculi Formed in Patients with Low and High Urinary Phosphate Concentrations

Objective: The aim of this paper was to assess the relationships among chemical, phase and structural composition and?etiopathogenic factors of non-infectious phosphate calculi formed in patients with low and high urinary phosphate concentrations, and to characterize the mechanism of their formation related on biochemical results. Material and Methods: Twelve samples of phosphate renal calculi were obtained, 4 from patients with low phosphaturia and 6 from patients with high urinary phosphate concentrations. Their chemical composition was determined qualitatively by energy dispersive X-ray analysis and quantitatively by spectrophotometric and thermal analysis;and their phase composition was determined by Fourier transform infrared transmission spectroscopy and X-ray diffraction. The structure of the calculi was assessed by scanning electron microscopy. Results: Non-infectious phosphate renal calculi of patients with low phosphaturia consist of poorly crystalline carbonate hydroxyapatite, whereas those of patients with high urinary phosphate concentrations consist of poorly crystalline hydroxyapatite with some amount of calcium oxalate crystals. Calculi of patients with high urinary phosphate concentrations are formed at urinary supersaturation with respect to hydroxyapatite and calcium oxalate about 4 times higher than in patients with low phosphaturia. Conclusion: In patients with low phosphaturia, the non-infectious phosphate renal calculi are formed in urine near pH 7 and contain only poorly crystalline carbonate hydroxyapatite. In patients with high urinary phosphate concentrations and hypercalciuria, the calculi are formed in urine near pH 6 and consist of both poorly crystalline hydroxyapatite and some amount of calcium oxalate crystals.

Eff ect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis

BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.