Acute Upper Respiratory Infection Research Articles

A pharmacovigilance study of adverse events associated with polymyxins based on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database

ABSTRACT Background Polymyxins have been regarded as last-line treatment for multidrug-resistant gram-negative bacterial infections. Nonetheless, concerns regarding toxicity persist. This study aimed to explore and compare potential adverse events (AEs) between colistin and polymyxin B (PMB). Methods Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study Polymyxins-related AEs were retrieved from the U.S. Food and Drug Administration Adverse Event Reporting System between 2004 and 2022. Potential signals were estimated by the reporting odds ratio (ROR), and subgroup analyses were preformed to adjust for potential factors in AEs with significant disproportionality. Results Analysis of 3,915 records involving 718 patients revealed a higher disproportionality of renal and urinary disorders (ROR 1.62, 95% CI 1.01–2.59) and acute kidney injury (ROR 1.75, 95% CI 1.07–2.87) with colistin treatment. Conversely, colistin exhibited a lower risk for neurotoxicity (ROR 0.47, 95% CI 0.30–0.73). Seven cases of skin hyperpigmentation were reported with PMB, whereas none were reported with colistin. Over 80% of cases involving polymyxin-related AEs occurred during the first two weeks of therapies, with a median onset time of 4.5 days. Conclusions Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study Patients received colistin displayed a higher potential risk of nephrotoxicity but a lower risk of neurotoxicity. Clinicians should be vigilant in monitoring the AEs of hyperpigmentation disorders induced by PMB.

Exploring viral aetiology in upper respiratory tract infections: insights from metagenomic next-generation sequencing in Swiss outpatients before and during the SARS-CoV-2 pandemic.

Upper respiratory tract infections are among the most common reasons for primary care consultations. They are diagnosed predominantly based on clinical assessment. Here, we investigated the benefit of viral metagenomic next-generation sequencing (mNGS) in an outpatient setting. This prospective cross-sectional study included immunocompetent patients with acute upper respiratory tract infections. General practitioners collected pharyngeal swabs and demographic and clinical data. Specimens were analysed using viral mNGS and conventional tests. Two hundred seventy-seven patients were recruited by 21 general practitioners between 10/2019 and 12/2020, of which 91% had a suspected viral aetiology. For 138 patients (49.8%), mNGS identified one or more respiratory viruses. The mNGS showed a high overall agreement with conventional routine diagnostic tests. Rhinoviruses were the most frequently detected respiratory viruses (20.2% of patients). Viral mNGS reflected the influenza wave in early 2020 and the SARS-CoV-2 pandemic outbreak in Switzerland in March 2020. Notably, rhinoviruses continued to circulate despite non-pharmaceutical hygiene measures. Viral mNGS allowed the initial diagnosis to be retrospectively re-evaluated. Assuming reduced turnaround times, mNGS has the potential to directly guide the treatment of upper respiratory tract infections. On an epidemiological level, our study highlights the utility of mNGS in respiratory infection surveillance, allowing early detection of epidemics and providing information crucial for prevention.

The effect of probiotic Bifidobacterium lactis Bl-04 on innate antiviral responses invitro

Consumption of certain probiotic strains may be beneficial for reducing the risk of acute upper respiratory tract infections (URTIs), however, underlying immunological mechanisms are elusive. Bifidobacterium lactis Bl-04™ has been reported in humans to significantly reduce the risk of URTIs, affect the innate immunity in the nasal mucosa, and reduce nasal lavage virus titer after a rhinovirus (RV) challenge. To study the immunological mechanisms, we investigated the effect of Bl-04 on cytokine production and transcriptomes of human monocyte-derived macrophages (Mfs) and dendritic cells (DCs), and further on RV replication and cytokine production in MRC-5 fibroblasts. The results showed that Bl-04 modulates antiviral immune responses and potentiates cytokine production during viral challenge mimic in immune cells. However, effect of Bl-04 on RV replication and cytokine production in fibroblasts was negligible. Overall, the findings suggest that Bl-04 mildly stimulates antiviral immunity in Mfs and DCs, and potentially influences viral replication in fibroblasts that however warrants further investigations.

Analysis Of Risk Factors For Hypoxic Damages Of Newborn`S Central Nervous System

Currently, perinatal damage to the central nervous system of newborns occupies an important place in the structure of pathology of young children, which is associated with high prevalence, severity of clinical manifestations and the risk of disability formation. The purpose of our study was to determine the significance of risk factors for the development and to develop criteria for the severity of hypoxic-ischemic CNS damage in newborns. We examined 120 newborns with moderate to severe perinatal CNS damage. The examination consisted of the collection of maternal history, which included information on somatic and gynecological diseases, the course of this pregnancy, childbirth, general clinical examination methods, examination of a newborn with an assessment of somatic and neurological status. The results of the study showed that modifying risk factors for the development of moderate perinatal encephalopathy are the threat of miscarriage, toxicosis, the age of the mother over 35 years old, moderate anemia, acute upper respiratory tract infections, gynecological pathology, taking antifungal drugs, rapid and protracted childbirth, weak birth activity. We also found that the modifying risk factors for the development of severe perinatal encephalopathy are stillbirth, bad habits in the father, closely related marriage, obesity, chronic foci of infection, acute bacterial infectious diseases, urogenital infection, NSAIDs, rapid and protracted childbirth, chronic fetal hypoxia.

Registered incidence of acute upper respiratory tract infections diagnosed by primary care physicians in Poland - 5-year retrospective analysis of the national health insurance database.

Upper respiratory tract infection (URTIs), caused by a variety of viruses and sometimes by bacteria, represents the most common acute illness in primary health care. The aim of the study was to explore the registered incidence of URTIs in Poland in the period between 2015-2019, and its burden on the health care system. A retrospective analysis was carried out of all medical encounters in Poland registered within the national billing database of public healthcare services. Medical services provided due to acute URTIs were classified according to the ICD-10 codes. Registered Incidence Rate (RIR) was calculated yearly, in a 100,000 population. A generalised additive model was used to calculate the Incidence Rate Ratio (IRR). In the analysed 5-year period, acute URTI was diagnosed in 24.3 million patients (61.7% of the whole population registered in PHC). The RIR of all acute URTIs in PHC was 50,762/100,000/year. Nearly 99% of consultations in this group of patients were provided by PHC physicians. Only 0.8% were referred to an OSC consultation and 0.4% were hospitalised. In PHC, indeterminate URTIs were most frequently diagnosed. The estimated IRR for children aged 1-4 years was 1.65 (95% CI: 1.64; 1.66, p<0.01) and for men 0.79 (95% CI: 0.79; 0.79; p<0.01). In the studied period, the number of patients consulted for acute URTI decreased slightly in PHC, but significantly in specialist services. The registered incidence of URTIs in Poland burdens mainly PHC physicians. Women and children aged 1-4 years are more frequent users of medical services related to URTIs. It appears that strategies for increasing patient empowerment to provide efficient self-care reducing the utilisation of PHC services are needed.

Acute Effect of Particulate Matter 2.5 (PM2.5) on Acute Upper Respiratory Tract Infection in Chiang Mai, Thailand

Background: Air pollution, especially PM2.5, is one of the most concerning problems around the world, leading to health problems. There are few studies on acute upper respiratory tract infection (URTI), especially in adults. Objective: To investigate the association between PM2.5 and acute URTI. Materials and Methods: Retrospective data analyses of patients between 2017 and 2019 who visited the outpatient department in Maharaj Nakorn Chiang Mai Hospital with acute URTI was performed. The authors also collected the daily data of PM2.5, PM10, O₃, NO₂, temperature, and humidity from the center of Chiang Mai Province. The Pearson correlation method was used to identify correlations between acute URTI and those variables. Results: The data of 104,711 patients with acute URTI were collected. Acute nasopharyngitis, acute pharyngitis, and acute tonsillitis were the three most common diseases. The highest level of PM2.5 each year was in January to February. The results were also the same for PM10, O₃, and NO₂. The present study revealed that PM2.5 had a significant correlation with number of acute respiratory infection patients, r=0.17 (p&lt;0.001), which meant higher level of PM2.5 was associated with higher number of patients. The results were also the same for PM10, O₃, and NO₂. For temperature and humidity, the results were the opposite correlations, which meant the higher the temperature and humidity, the fewer patients were observed that day. The present study also found the regression question, which was every 1 point higher of PM2.5, there would be 19% more patients that day. Conclusion: There was a relationship between pollution, especially PM2.5 and acute URTI. The higher level of PM2.5 is related to an increased number of URTI patients. It is the same results for PM10, O₃, and NO₂. Keywords: Fine particulate matter; PM2.5; Acute upper respiratory tract infections

Pharmaceutical and Recreational Drug Usage Patterns during and Post COVID-19 Determined by Wastewater-Based Epidemiology.

Wastewater-based epidemiology (WBE) was applied to evaluate the consumption trends of pharmaceuticals (i.e., antibiotics, non-steroidal anti-inflammatory drugs, antiepileptics, antihypertensives, and others), as well as recreational drugs (caffeine, alcohol, and nicotine), in Latvia from December 2020 to July 2023. The time period covers both the COVID-19 pandemic and the post-pandemic periods; therefore, the impact of the implemented restrictions and the consequences of the illness in terms of the usage of pharmaceuticals thereon were investigated. Additionally, the seasonality and impact of the seasonal flu and other acute upper respiratory infections were studied. The results revealed that the pandemic impacted the consumption of alcohol, nicotine, and caffeine, as well as several pharmaceuticals, such as antihypertensives, antidepressants, psychiatric drugs, and the painkiller ibuprofen. The findings suggest that the imposed restrictions during the pandemic may have had a negative effect on the population's health and mental well-being. Distinct seasonal trends were discovered in the consumption patterns of caffeine and alcohol, where lower use was observed during the summer. The seasonal consumption trends of pharmaceuticals were discovered in the case of antibiotics, the antiasthmatic drug salbutamol, and the decongestant xylometazoline, where higher consumption occurred during colder seasons.

Effectiveness and safety of AROMAFORCE® junior cough syrup in pediatric patients with acute upper respiratory conditions

Aim: The purpose of this study was to evaluate the effectiveness and safety of Aromaforce® Junior Cough Syrup (AJCS) in treating acute upper respiratory tract infection-related coughs in children, and it served as a post-marketing clinical follow-up. Methods: Prospective, multicenter, open-label, controlled clinical investigation conducted under normal conditions of use to evaluate the antitussive effectiveness of a mucilage-based syrup in pediatric patients (aged 2 to 12 years) as compared to increased hydration measures (control group), with a 1-week follow-up. Likert severity scores were used to evaluate coughs and related symptom severity. Results: The results demonstrate that AJCS effectively reduces cough severity, including daytime and night-time cough, and the number of times the child was woken up, particularly within the first three days, surpassing the effectiveness of hydration measures. The results of the degree of satisfaction with AJCS show that the majority of physicians and parents had positive feedback. Furthermore, the safety analysis confirms the syrup's non-toxic nature in children. However, the initial differences in baseline characteristics between the study and control groups, with the study group exhibiting higher combined cough scores, limit the strength of the evidence. Conclusions: This study provides further evidence supporting the efficacy and safety of AJCS in the treatment of cough associated with acute upper respiratory tract infections in children. Further randomized studies may provide further evidence of the efficacy and safety of AJCS.

Clinical and epidemiological characteristics of acute respiratory viral infections in the Arkhangelsk region

In recent years, the incidence of acute respiratory viral diseases (ARVI) in Russia has increased significantly. The Arkhangelsk region is a territory where the incidence of SARS is also increasing. Having considered the data for the last five years, at first there was a decrease in the incidence in 2018– 2019 in the Arkhangelsk region, namely, the incidence of SARS per 100 thousand population in 2018 amounted to 36,211.0, and in 2019–33,275.8. So, in comparison with 2018. The incidence of SARS decreased by 8.1 %, while the incidence increased over the next three years, namely SARS in 2020. This figure was 38,681.9, in 2021–44,643.2, and in 2022–46,566.1. In comparison with the previous year, the incidence of SARS in 2022 increased by 4.3 %. The incidence of SARS in the Arkhangelsk region is 1.6 times higher than in the Russian Federation (28,797.29). According to the state report «On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2022», SARS exceed the long-term average (SMP) and amount to 29,059.21 cases per 100,000 population in 2022 against SMP 20,753.87 cases, which determines the epidemiological significance of this infection and reflects the urgency of the problem. Only for 2022. In the Russian Federation, 42.4 million cases of acute upper respiratory tract infections of multiple and unspecified localization (ARVI) were registered, the incidence rate was 29,059.21 per 100,000 population, which exceeds the long — term average incidence rate by 40 % (SMP — 20,753.87 per 100,000 population). In comparison with 2021, there was an increase in the incidence of SARS by 10.7 %. In 2022, 29.1 % of the country's population had SARS (2021–26.25 %) [4–9].

PCSK9 genetic variants and risk of vascular and non-vascular diseases in Chinese and UK populations.

Lowering low-density lipoprotein cholesterol (LDL-C) through PCSK9 inhibition represents a new therapeutic approach to preventing and treating cardiovascular disease (CVD). Phenome-wide analyses of PCSK9 genetic variants in large biobanks can help to identify unexpected effects of PCSK9 inhibition. In the prospective China Kadoorie Biobank, we constructed a genetic score using three variants at the PCSK9 locus associated with directly-measured LDL-C (PCSK9-GS). Logistic regression gave estimated odds ratios (ORs) for PCSK9-GS associations with CVD and non-CVD outcomes, scaled to 1SD lower LDL-C. PCSK9-GS was associated with lower risks of carotid plaque (n=8340 cases; OR=0.61 [95%CI: 0.45-0.83]; P=0.0015), major occlusive vascular events (n=15,752; 0.80 [0.67-0.95]; P=0.011), and ischaemic stroke (n=11,467; 0.80 [0.66-0.98]; P=0.029). However, PCSK9-GS was also associated with higher risk of hospitalisation with chronic obstructive pulmonary disease (COPD: n=6836; 1.38 [1.08-1.76]; P=0.0089), and with even higher risk of fatal exacerbations among individuals with pre-existing COPD (n=730; 3.61 [1.71-7.60]; P=7.3x10-4). We also replicated associations for a PCSK9 variant, reported in UK Biobank, with increased risks of acute upper respiratory tract infection (URTI) (pooled OR after meta-analysis of 1.87 ([1.38-2.54]; P=5.4x10-5) and self-reported asthma (pooled OR 1.17 ([1.04-1.30]; P=0.0071). There was no association of a polygenic LDL-C score with COPD hospitalisation, COPD exacerbation, or URTI. LDL-C-lowering PCSK9 genetic variants are associated with lower risk of subclinical and clinical atherosclerotic vascular disease, but higher risks of respiratory diseases. Pharmacovigilance studies may be required to monitor patients treated with therapeutic PCSK9 inhibitors for exacerbations of respiratory diseases or respiratory tract infections.

Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study

BackgroundOver-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem.MethodsThis qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software.ResultsTwo main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients’ demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed.ConclusionsThe study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.

Characteristics of pediatric patients claimed with acute upper respiratory infection during otorhinolaryngology consultations: A descriptive study of a large Japanese medical claims database

This study aimed to clarify other diseases claimed simultaneously with acute upper respiratory infection (URI), antibiotic prescriptions, and examinations associated with infectious diseases in pediatric patients with acute URI insurance claims at otorhinolaryngology outpatient visits. Pediatric patients who visited an otolaryngology department between 2019 and 2021 and were definitively diagnosed with URI were selected using a large Japanese medical claims database. Patient backgrounds, antibiotic use, and examinations were descriptively evaluated. In total, 8010 patients were included in the analysis. The median number (interquartile range) of diseases claimed in the same month as acute URI was 4 (3–6). Only 519 (6.5 %) patients were claimed as acute URI alone. Regardless of the prescription of antibiotics, the most commonly redundantly claimed disease in these patients was allergic rhinitis, followed by acute bronchitis, acute sinusitis, and earwax impaction. The frequently prescribed antibiotics were third-generation cephalosporins, macrolides, and penicillins with extended-spectrum, including amoxicillin which was recommended by the Japanese manual; the proportion of patients with examinations was low (2.9–21.7 %). Among patients with acute URI, diagnoses requiring antibiotics were also claimed; therefore, when evaluating acute URI using the Japanese medical claims database, care must be taken in patient selection. Moreover, the implementation rate of examinations necessary for diagnosis was low, so there is an urgent need to develop an environment where examinations can be conducted in outpatient settings.

Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center.

This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures. Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients' outcomes were recorded. Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction. Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

Research on the Aided Diagnosis Method of Diseases Based on Domain Semantic Knowledge Bases

The health care domain is a knowledge-intensive domain. The quality of clinical diagnosis relies mainly on the medical knowledge and experience held by doctors. However, the ability of a single doctor is very limited, so the quality of clinical diagnosis is currently not high. In this paper, an aided diagnosis method based on domain semantic knowledge bases is proposed. Firstly, a domain semantic knowledge base is established by extracting and refining the knowledge of the medicine subject matter domain from the Freebase RDF dumps. Then, based on the semantic knowledge base, the algorithms for calculating the weights of the symptoms in the knowledge base, the relative weights of the diseases related to the input symptom set from a patient, and the related symptom set related to the input symptom set from the patient are proposed. Finally, the clinical medical record data of several common diseases are selected to make an evaluation on the proposed method. For each medical record, the symptom information is extracted from the chief complaint as the patient’s input symptom set. Based on the input symptom set, the method of this paper is used to obtain the list of related diseases and the ranking of disease relative weights. From the disease relevance rankings, the Top 1 (first diagnosis) and Top-3 (first 3 diagnoses) are compared with the doctor’s diagnoses in the medical records. Among them, ovarian cyst has the highest Top-1 and Top-3 hit rates of 67.3% and 89.1%, respectively. Followed by acute upper respiratory tract infection, Top-1 and Top-3 hit rates are 56.6% and 85.2%, respectively. The average Top-1 and Top-3 hit rates are 47.9% and 79.7%, respectively. Compared with the relevant methods, the method of this paper is better. The evaluation results show that based on the domain semantic knowledge base and the aided diagnosis method of diseases constructed in this paper, it is possible to provide aided diagnosis services of a large number of common diseases for general practitioners (especially inexperienced doctors) at the grass-roots level as well as self-diagnosis services of diseases for patients.

Associations between ultrafine particle pollution and daily outpatient visits for respiratory diseases in Shanghai, China: a time-series analysis

Previous epidemiological studies have linked short-term exposure to particulate matter with outpatient visits for respiratory diseases. However, evidence on ultrafine particle (UFP) is still scarce in China. To investigate the association between short-term UFP exposure and outpatient visits for respiratory diseases as well as the corresponding lag patterns, information on outpatient visits for main respiratory diseases during January 1, 2017, to December 31, 2019 was collected from electronic medical records of two large tertiary hospitals in Shanghai, China. Generalized additive models employing a Quasi-Poisson distribution were employed to investigate the relationships between UFP and respiratory diseases. We computed the percentage change and its corresponding 95% confidence interval (CI) for outpatient visits related to respiratory diseases per interquartile range (IQR) increase in UFP concentrations. Based on a total of 1,034,394 hospital visits for respiratory diseases in Shanghai, China, we found that the strongest associations of total UFP with acute upper respiratory tract infection (AURTI), bronchitis, chronic obstructive pulmonary disease (COPD), and pneumonia occurred at lag 03, 03, 0, and 03 days, respectively. Each IQR increase in the total UFP concentrations was associated with increments of 9.02% (95% CI: 8.64–9.40%), 3.94% (95% CI: 2.84–5.06%), 4.10% (95% CI: 3.01–5.20%), and 10.15% (95% CI: 9.32–10.99%) for AURTI, bronchitis, COPD, and pneumonia, respectively. Almost linear concentration–response relationship curves without apparent thresholds were observed between total UFP and outpatient-department visits for four respiratory diseases. Stratified analyses illustrated significantly stronger associations of total UFP with AURTI, bronchitis, and pneumonia among female patients, while that with COPD was stronger among male patients. After adjustment of criteria air pollutants, these associations all remained robust. This time-series study indicates that short-term exposure to UFP was associated with increased risk of hospital visits for respiratory diseases, underscoring the importance of reducing ambient UFP concentrations for respiratory diseases control and prevention.

[Meta-analysis and trial sequential analysis of Compound Qinlan Oral Liquid in treatment of acute upper respiratory tract infection].

This study aims to evaluate the efficacy and safety of Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. Computer-based online searching of CNKI, VIP, SinoMed, Wanfang, ChiCTR, ClinicalTrials.gov, Cochrane Library, PubMed, EMbase, and Web of Science was performed to retrieve the randomized controlled trial(RCT) regarding Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. In addition, manual searching of gray literature was conducted. After two evaluators independently selected articles, extracted data, and evaluated the quality of methodology included in the studies, Meta-analysis was carried out in RevMan 5.4 and trial sequential analysis(TSA) in TSA 0.9.5.10 Beta. GRADE profiler 3.6.1 was employed to evaluate the evidence quality. A total of 21 RCTs were included in this study, involving 2 651 patients(1 330 patients in the observation group and 1 321 patients in the control group). Meta-analysis showed that compared with conventional western medicine alone, Compound Qinlan Oral liquid improved the total response rate(RR=1.15, 95%CI[1.12, 1.19], P&lt;0.000 01) without increasing the incidence of adverse reactions(RR=0.77, 95%CI[0.47, 1.25], P=0.16). The results of subgroup analysis are described as follows:(1) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid improved the total response rate(RR=1.10, 95%CI[1.05, 1.14], P&lt;0.000 01) and shortened the time to symptom relief(SMD=-0.76, 95%CI[-1.02,-0.51], P&lt;0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=1.16, 95%CI[0.54, 2.47], P=0.71).(2) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid + conventional western medicine improved the total response rate(RR=1.20, 95%CI[1.15, 1.25], P&lt;0.000 01), decreased traditional Chinese medicine(TCM) syndrome scores(MD=-0.58, 95%CI[-0.75,-0.41], P&lt;0.000 01), shortened the time to symptom relief(SMD=-2.44, 95%CI[-3.09,-1.80], P&lt;0.000 01) and physical sign improvement(MD=-2.57, 95%CI[-4.11,-1.04], P=0.001), lowered the serum levels of inflammatory cytokines(SMD=-2.16, 95%CI[-2.61,-1.70], P&lt;0.000 01), improved respiratory function indicators(SMD=1.48, 95%CI[1.00, 1.96], P&lt;0.000 01), and enhanced the humoral immunity(MD=0.94, 95%CI[0.69, 1.18], P&lt;0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=0.57, 95%CI[0.29, 1.09], P=0.09). TSA showed that the cumulative Z curve of total response rate crossed the traditional threshold and TSA threshold, further confirming the clinical efficacy of Compound Qinlan Oral Liquid. The GRADE graded the evidence of the above outcome indicators as low or extremely low, and yielded weak recommendation. Compared with conventional western medicine alone, Compound Qinlan Oral Liquid can improve the total effective rate and reduce the time to symptom relief. The combination of Compound Qinlan Oral Liquid and conventional western medicine can improve the total response rate, mitigate the symptoms and improve the physical signs, reduce inflammation, and improve respiratory function and immunity of the patients with acute upper respiratory tract infection. In view of the limited number and quality of the included studies, the above conclusions still require high-quality RCT to provide evidence support.

The association between COVID-19 infection and incident atrial fibrillation: results from a retrospective cohort study using a large US commercial insurance database

BackgroundWe sought to examine a 1-year incidence of atrial fibrillation (AF) among patients with SARS-CoV-2 virus (COVID-19) in comparison to those with non-COVID-19 acute upper respiratory infection (AURI).MethodsPatients with a...

Improving antibiotic prescribing quality in out-of-hours primary care: a mixed-methods study using participatory action research

Abstract Background During out-of-hours (OOH) primary care, GPs overprescribe antibiotics for respiratory tract infections (RTIs). Many interventions have been shown to improve antibiotic prescribing quality, but their implementation in practice remains difficult. Participatory action research (PAR) aims to explore, implement and evaluate change in practice with an active involvement of local stakeholders, while generating knowledge through experience. Objectives To evaluate whether PAR improves antibiotic prescribing quality for RTIs during OOH primary care and simultaneously identify the pivotal lessons learned. Methods A mixed-methods study with a PAR approach in three OOH GP cooperatives (GPCs). Each GPC co-created a multifaceted intervention focusing on improving antibiotic use for RTIs through plan-do-study-act cycles. We quantified antibiotic prescribing quality indicators and formulated the lessons learned from a qualitative process analysis. Results Interventions were chosen with the GPs and adapted to be context-relevant. The willingness to work on quality and engagement of local stakeholders led to ownership of the project, but was time-consuming. In one GPC, antibiotic prescribing significantly decreased for tonsillitis, bronchitis, otitis media and acute upper RTI. In all three GPCs, use of guideline-recommended antibiotics for otitis media significantly increased. Conclusions Implementing multifaceted interventions through PAR can lower total and increase guideline-recommended antibiotic prescribing for RTIs in OOH primary care. Co-creating interventions with GPs to suit local needs is feasible, but reaching all GPs targeted is challenging.

Meta-analysis of the efficacy of budesonide and ambroxol hydrochloride inhalation in children with pneumonia and their effects on inflammatory response

Childhood pneumonia, often caused by acute upper respiratory tract infections or bronchitis, is one of the leading causes of mortality in children. Nebulized inhalation, as a low-risk treatment method, has garnered significant attention. However, its effectiveness and safety remain controversial. In this study, a systematic review of relevant literature on the use of budesonide (BUD) and ambroxol hydrochloride (AMB) inhalation in the treatment of childhood pneumonia was conducted, and a total of 10 articles were included. The meta-analysis revealed an odds ratio (OR) of 1.61 and an I2 value of 0.00 % for the effectiveness of combined BUD and AMB inhalation therapy in children with pneumonia, indicating no heterogeneity among the studies in terms of effectiveness. The OR values for BUD or AMB inhalation in alleviating cough, lung auscultation abnormalities, respiratory distress, body temperature, and cyanosis of the lips in children with pneumonia all favored the combined BUD therapy, showing significant relief of the aforementioned symptoms. However, due to variations in drug dosage and administration methods, high heterogeneity was observed. This study suggested that combined BUD and AMB inhalation therapy has better efficacy in treating childhood pneumonia, and BUD combined with AMB inhalation is more effective in alleviating symptoms such as cough, lung auscultation abnormalities, respiratory distress, normalizing body temperature, and reducing cyanosis of the lips. Nevertheless, further validation is required due to the limited sample size and substantial heterogeneity in the included studies. To sum up, this study provides the first analysis of the efficacy and inflammatory response of BUD and AMB inhalation in children with pneumonia. Future research should aim to verify and clarify these findings, considering the limitations of the existing studies in terms of sample size and heterogeneity.

Different volatile organic compounds in local point source air pollution pose distinctive elevated risks for respiratory disease-associated emergency room visits

Air pollution increases risk of respiratory disease but prior research has focused on particulate matter and criteria air pollutants, and there are few studies on respiratory effects of volatile organic compounds (VOC). We examined zip code level relationships between emergency room (ER) visits for respiratory illness and VOC pollution in New York State from 2010 to 2018. Detailed information on VOC pollution was derived from the National Emissions Inventory, which provides point source information on VOC emissions at the zip code level. We considered four respiratory diseases: asthma, acute upper respiratory infections, chronic obstructive pulmonary disease (COPD), and lower respiratory disease, using mixed effects regression with a random intercept to account for county level variability in single pollutant models, and Random Forest Regression (RFR) to assess relative importance of VOC exposures when considered together in multipollutant models.Single pollutant models show associations between respiratory-related ER visits with all pollutants of interest across all study years, even after adjusting for poverty and smoking by zip code. The largest relative single pollutant effect sizes considered included benzene, ethylbenzene, and total (summed) VOCs. Results from RFR including all VOC exposures indicate that ethylbenzene has the greatest variable importance for asthma, acute upper respiratory infections, and COPD, with toluene and benzene most important for lower respiratory ailments. RFR results also demonstrate presence of pairwise interactive effects between VOC pollutants. Our findings show that local VOC pollution may offer a significant contribution to the risk of respiratory disease-related ER visits, and that effects vary by illness and by VOC compound. ER visit rates for respiratory illness were elevated in high poverty zip codes, although this may be attributable to the fact that the poor lack basic access to health care and use ERs more frequently for routine care.