Acute Upper Respiratory Infection Research Articles

Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study

BackgroundInformation and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services.ObjectiveTo describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China.MethodsThe simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies.ResultsThree Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice.ConclusionsThe electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.

Mechanistic Evidence of Andrographis paniculata (Burm. f.) Wall. ex Nees, Pelargonium sidoides DC., Echinacea Species and a Combination of Hedera helix L., Primula veris L./Primula elatior L. and Thymus vulgaris L./Thymus zygis L. in the Treatment of Acute, Uncomplicated Respiratory Tract Infections: A Systematic Literature Review and Expert Interviews.

Reducing inappropriate antibiotic (AB) use by using effective non-antibiotic treatments is one strategy to prevent and reduce antimicrobial resistance (AMR). Andrographis paniculata (Burm. f.) Wall. ex Nees, Pelargonium sidoides DC., Echinacea species and a combination of ivy (Hedera helix L.), primrose (Primula veris L./Primula elatior L.) and thyme (Thymus vulgaris L./Thymus zygis L.) have promising clinical effects in uncomplicated, acute upper respiratory tract infections (URTI) treatment. However, mechanistic evidence of these herbal treatments is lacking. The objective of this Pstudy is to provide an overview of mechanistic evidence for these effects. Thirty-eight databases were searched. Included studies were mechanistic studies (in vitro, animal, and human studies and reviews) on these herbs; published before June 2021. Non-mechanistic studies or studies on combinations of herbs other than ivy/primrose/thyme were excluded. Furthermore, three experts in traditional, complementary and integrative healthcare (TCIH) research and pharmacognosy were interviewed to collect additional expert knowledge. The results show that A. paniculata acts through immunomodulation and antiviral activity, possibly supplemented by antibacterial and antipyretic effects. P. sidoides acts through antiviral, indirect antibacterial, immunomodulatory and expectorant effects. Echinacea species likely act through immunomodulation. The combination of ivy/primrose/thyme combines secretolytic and spasmolytic effects from ivy with antibacterial effects from thyme. Studies on primrose were lacking. This mechanistic evidence supports the difference-making evidence from clinical studies, contributes to evidence-based recommendations for their use in URTI treatment, and guides future mechanistic studies on URTI treatments.

Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019

The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China. We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness. Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected. Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China. This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].

Ambient Nitrogen Dioxide and Hospitalizations of Full-Spectrum Respiratory Diseases: A National Case-Crossover Study.

Few multicity studies have examined the acute effects of nitrogen dioxide (NO2) on respiratory disease (RD), especially its specific causes. This study aimed to investigate the associations between short-term exposure to NO2 and hospitalization of full-spectrum RDs in China. Hospitalization of 10 major categories and 40 cause-specific RDs were obtained from 20 provinces over the study period of 2013-2020. A time-stratified case-crossover study was conducted at the individual level to explore the associations between NO2 and RDs. NO2 was significantly associated with increased hospitalization of eight major RDs (acute upper respiratory infections, influenza and pneumonia, acute lower respiratory infections, upper respiratory tract diseases, chronic lower respiratory diseases, respiratory interstitium diseases, pleura diseases, and other respiratory diseases) and 18 specific causes of RDs, with the largest associations observed on lag 0-1 day. The effect estimates ranged from 0.75 to 4.09% per 10 μg/m3 of NO2 exposure. The associations remained robust after controlling for copollutants. The concentration-response curves were mostly positive and linear. This nationwide study provides comprehensive information on the acute effects of NO2 on respiratory morbidity across the full spectrum, highlighting the need for caution with regard to this important traffic-related air pollutant in current pollution control programs.

Recurrent Episodes of Encephalopathy/Encephalitis Secondary to Influenza Virus in a Pediatric Patient.

Influenza virus commonly causes acute upper respiratory tract infections in pediatrics. Rarely, influenza-associated encephalopathy/encephalitis may occur in 4 of 100,000 children annually in the United States. North American literature, however, is sparse regarding the incidence of recurrent episodes. This report characterizes the clinical manifestations and identifies genetic, virologic and/or epidemiologic factors making children susceptible for recurring episodes of influenza-associated encephalopathy/encephalitis.

Application of machine learning to predict hospital visits for respiratory diseases using meteorological and air pollution factors in Linyi, China.

Urbanization and industrial development have resulted in increased air pollution, which is concerning for public health. This study evaluates the effect of meteorological factors and air pollution on hospital visits for respiratory diseases (pneumonia, acute upper respiratory infections, and chronic lower respiratory diseases). The test dataset comprises meteorological parameters, air pollutant concentrations, and outpatient hospital visits for respiratory diseases in Linyi, China, from January 1, 2016 to August 20, 2022. We use support vector regression (SVR) to build models that enable analysis of the effect of meteorological factors and air pollutants on the number of outpatient visits for respiratory diseases. Spearman correlation analysis and SVR model results indicate that NO2, PM2.5, and PM10 are correlated with the occurrence of respiratory diseases, with the strongest correlation relating to pneumonia. An increase in the daily average temperature and daily relative humidity decreases the number of patients with pneumonia and chronic lower respiratory diseases but increases the number of patients with acute upper respiratory infections. The SVR modeling has the potential to predict the number of respiratory-related hospital visits. This work demonstrates that machine learning can be combined with meteorological and air pollution data for disease prediction, providing a useful tool whereby policymakers can take preventive measures.

Obstructive sleep apnea is associated with use of assisted ventilation among children with bronchopulmonary dysplasia hospitalized with respiratory illness: A nationwide inpatient cohort

Objective (s)Children with bronchopulmonary dysplasia (BPD) are at higher risk of respiratory insufficiency during respiratory illness. We aimed to investigate whether obstructive sleep apnea (OSA) is associated with increased morbidity among children with BPD hospitalized with acute respiratory illnesses. Study designHospital discharge records were obtained from the Kid's Inpatient Database for children <21 years of age with BPD hospitalized for acute respiratory illness between 1997 and 2012. Acute respiratory illnesses included bacterial and/or viral pneumonia, bronchiolitis, acute upper respiratory tract infections, aspiration pneumonia, or asthma exacerbation. The primary exposure was OSA. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were noninvasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for BPD-associated comorbidities. ResultsAmong 33,640 hospitalizations of children with BPD for acute respiratory illness, there were 607 (1.8%) cases with comorbid OSA vs. 33,033 (98.2%) controls without OSA. Patients with OSA were more likely to have aspiration pneumonia, central sleep apnea, obesity, laryngeal stenosis, congenital airway, and skull/face/jaw anomalies. Multivariable regression showed that OSA was associated with IMV (OR 1.45, 95% CI 1.09–1.94, p = 0.012) and NIMV (OR 2.61, 95% CI 1.71–3.98, p < 0.001), but not LOS or IACH. ConclusionsIn BPD patients hospitalized with acute respiratory illness, having OSA is associated with increased risks for respiratory insufficiency requiring noninvasive or invasive mechanical ventilation. Clinicians should consider OSA, along with other BPD-associated comorbidities, in the management of this population.

The Multi-Strain Probiotic OMNi-BiOTiC® Active Reduces the Duration of Acute Upper Respiratory Disease in Older People: A Double-Blind, Randomised, Controlled Clinical Trial.

Immunosenescence is the adverse change in the human immune function during aging, leaving older people more prone to an increased risk of infections and morbidity. Acute upper respiratory tract infections (URTIs) are very common among older people, often resulting in continued morbidity and mortality. Therefore, approaches, such as consuming probiotics, that shorten the duration or even reduce the incidence of URTIs in older people are being studied. The aim of this study was to determine the effects of a multi-strain probiotic OMNi-BiOTiC® Active, which contains 11 live probiotic strains, on the incidence, duration, and severity of URTIs in older people. In this randomized double-blinded placebo-controlled study, 95 participants, with an average age of 70.9 years in the probiotic group and 69.6 years in the placebo group, were randomly allocated to two groups: 1010 cfu per day of the multi-strain probiotic intervention OMNi-BiOTiC® Active (49) or placebo (46). The incidence of URTIs in older people after 12 weeks supplementation with OMNi-BiOTiC® showed no statistically significant difference between the two groups (p = 0.5244). However, the duration of the URTI infections was statistically significantly different between the groups (p = 0.011). The participants that consumed the probiotic had an average duration of illness of 3.1 ± 1.6 days, whilst participants that received the placebo had symptoms for an average of 6.0 ± 3.8 days (p = 0.011). Statistically significant differences in lymphocyte counts in both groups after supplementation (p = 0.035 for the probiotic group and p = 0.029 for the placebo group) and between both groups were found (p = 0.009). Statistically significant differences in eosinophil (p = 0.002) and basophil counts (p = 0.001) in the probiotic groups before and after supplementation with probiotics were also found. Supplementation with the multi-strain probiotic OMNi-BiOTiC® Active may benefit older people with URTIs. Larger randomised controlled clinical trials are warranted. Clinical Trial Registration; identifier NCT05879393.

What are the effects of probiotics to prevent acute upper respiratory tract infections (URTIs)?

What are the effects of probiotics to prevent acute upper respiratory tract infections (URTIs)?

Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study.

There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.

The incidental finding of otitis media with effusion in children admitted for adenoidectomy or adenotonsillectomy

Background and objectives: Otitis media with effusion is a common condition in the pediatric population, and is a leading cause of hearing loss in this age group. This condition is commonly missed by the parents due to lack of objective symptoms especially in young children, in turn leading to learning difficulties and communication problems. This study focused on the incidental finding of asymptomatic, undiagnosed otitis media with effusion in children with adenotonsillar diseases admitted for adenoidectomy or adenotonsillectomy (aged 2-12 years) Methods: A cross sectional study conducted from January 2020 to February 2021. We randomly selected 110 children (aged 2-12 years), admitted purely for adenoidectomy or adenotonsillectomy at Rizgari Teaching Hospital in Erbil / Iraq. Those with acute upper respiratory tract infection, other otological problems, or craniofacial abnormalities were excluded. Selected children were examined by otoscopy and sent for tympanometry preoperatively. Results: Of total 110 patients, 23 (20.9%) cases had hidden, undiagnosed otitis media with effusion, which was missed by parents (14.5% bilateral, 6.4% unilateral). The majority (n= 15; 65.2%) in (5-8) years age group (mean age of 5.1 years) (p=0.02), with gender distribution; males (n = 15; 65.2%), females (n= 8; 34.8%) (p=0.123). Conclusion: Adenotonsillar disease carries an extra risk for developing otitis media with effusion in children. Otoscopic examination and simple test such as tympanometry can diagnose this condition in order to take the necessary steps for management and prevent future complications.

Analysis of the infectious morbidity in the children's population in the city of Krasnodar

Aim. Our aim hereof is to assess the status of infectious morbidity in the pediatric population in the territory of the Russian Federation and the City of Krasnodar in the period 2021-2022 by an example of the State Health Institution “Pediatrics Polyclinic No 2”, Department of Health Care of the City of Krasnodar. Material and Methods. Our work has been completed with use of official statistical data of the Federal Service of the state statistics of the Russian Federation, the database of Rospotrebnadzor of the Krasnodar territory, statistical data set collections of FGBI “The Central Research Institute of the Management and Information of Public Health Care” at the Ministry of Health Care of the Russian Federation. A retrospective analysis was performed using data from the State Report “The state of sanitary and epidemiological welfare of the population in the Russian Federation in 2021”. Statistical processing was carried out using GraphPad Prism 5.0 and Word Excel. Results. According to the data on the sanitary and epidemiological well-being of the population, an increase in the number of cases of infectious and parasitic diseases was recorded in the Russian Federation in 2021. The sharp rise in the incidence of infectious diseases is directly related to the spread of the new COVID-19 infection. The incidence of ARVI among children in 2021 was 68,062.49 per 100,000 that is 15.4% higher than in 2020. In Krasnodar, there were 236,332 patients diagnosed with infectious diseases in 2021. According to the data submitted by Branch No. 2 of the Krasnodar City Pediatrics Hospital at the City Health Care Department, the overall morbidity of children in the first year of life in 2022 has decreased. No cases of diphtheria, pertussis, poliomyelitis, measles, and viral hepatitis B were recorded by the outpatient clinical institution during the study period. As a part of preventive measures, children are routinely vaccinated by the Pediatrics Hospital No. 2; at the end of 2022, 98.3% of children in risk groups had been successfully treated and were allowed to be vaccinated. Conclusion. Over the period 2021-2022, there has been a decline in the incidence of diseases in children in the first year of life in the Krasnodar Region. At the same time, the recorded overall occurrence rate of acute upper respiratory tract infections of multiple and unspecified localization remains high that is due to the difficulty of diagnosing them at the early stages of infection, and, as a result, the effectiveness of their treatment is low that may be accompanied by high mortality.

PO-05-187 DOES COVID-19 INCREASE THE RISK OF ATRIAL FIBRILLATION? A RETROSPECTIVE ANALYSIS OF A LARGE ADMINISTRATIVE CLAIMS DATABASE OF COMMERCIALLY INSURED NON-ELDERLY AND MEDICARE ADVANTAGE BENEFICIARIES IN THE UNITED STATES.

Studies have suggested that myocardial damage due to severe acute respiratory syndrome-2 (SARS-CoV-2), commonly referred to as COVID-19, may increase the risk of arrhythmias. To compare the one-year incidence of atrial fibrillation (AF) among patients with COVID-19 as compared to patients with non-COVID-19 acute upper respiratory infection (AURI). The Optum Clinformatics database, an administrative claims databaseof commercially insured beneficiaries in the United States (US), was used for study purposes. Three cohorts of patients were identified: patients with COVID-19 diagnosis in any setting (April 2020-June 2021); patients with AURI in the pandemic period (April 2020-June 2021); and patients with AURI in the pre-pandemic period (January 2018-December 2018). Patients with prior AF diagnosis were excluded from each cohort. Three sets of analysis comparing AF incidence were performed: COVID-19 cohort vs AURI pandemic cohort; COVID-19 cohort vs AURI pre-pandemic cohort; and AURI pandemic cohort vs AURI pre-pandemic cohort. For each of the three comparisons, a matching weight method was used to help ensure balance among groups on baseline socio-demographic and clinical comorbidities. Logistic regression was used to assess the odds of 1-year incident AF among matched patients. When comparing the matched COVID-19 (n=102,227) and AURI pandemic (n=102,101) cohorts, one-year incidence of AF was significantly higher in the COVID-19 cohort (2.2% vs 1.2%; p<0.001), who were 83% more likely to develop AF (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.72-1.95) as compared to the AURI group. COVID-19 patients were also observed to have significantly higher risk of incident AF as compared to AURI pre-pandemic cohort (2.7% vs 1.6%; p<0.001; OR 1.70, 95% CI 1.63-1.78). No significant difference was observed in AF incidence among the AURI pandemic versus AURI pre-pandemic cohort (1.1% vs 1.2%; p=0.133; OR 0.95, 95% CI 0.90-1.01). Figure 1 depicts differences in AF incidence across the comparator cohorts. Patients with COVID-19 were observed to have a higher incidence of AF as compared to those with upper respiratory infections. Awareness amongst clinicians of an increased AF incidence in COVID-19 affected patients appears warranted.

Exploring the effective components and potential mechanisms of Zukamu granules against acute upper respiratory tract infections by UHPLC-Q-Exactive Orbitrap-MS and network pharmacology analysis

Acute upper respiratory tract infections (AURTIs) are common diseases of respiratory system, which are caused by adenoviruses and generate the mix of severe clinical presentation. Zukamu granules (ZKMG), a traditional Chinese medicine (TCM) prescription within Health Commission of Xinjiang Uygur Autonomous Region possesses anti-influenza virus, antibacterial and anti-inflammatory effects that exerts therapeutic effects in treatment of AURTIs. However, the main effective chemical components and their corresponding action mechanisms have not been clarified. Therefore, ultra-performance liquid chromatography coupled with quadrupole Exactive orbitrap tandem mass spectrometry (UHPLC-Q-Exactive Orbitrap MS) and network pharmacology were used to detect and identify potentially effective components in ZKMG as well as uncover their pharmacological mechanisms against AURTIs. As a result, a total of 265 components from all 12 composed herbal medicines were characterized based on self-built database and fragmentation patterns, of which 38 compounds were unambiguously confirmed using reference standards. Then, the compound-target-pathway network was constructed that implied potential therapeutic mechanisms of ZKMG on AURTIs. Compounds noscapine, cryptopine, steviol-19-O-glucoside, N-methylnarcotine, allocryptopine, naringenin, boldine, methyl rosmarinate with related targets EGFR, PTGS2, IL2, MMP9, TNF, AKT1, PIK3CA, F3 were considered as the key components and targets. Besides, the results also indicated that PI3K-Akt, AGE-RAGE, PD-L1, HIF-1 signaling pathways contributed significantly to the therapeutic effects of ZKMG on AURTIs. Overall, ZKMG could have an effect on AURTIs based on multicomponent, multitarget, and multichannel mechanisms of action as well as this method provides guiding significance for the further development of TCM treatment.

Higher mold levels found in in the deteriorated housing in the Sun Valley neighborhood of Denver, Colorado compared to other Denver housing and higher rates of health insurance claims for some diseases documented for the Sun Valley residents compared to other Denver residents.

The Sun Valley Homes public housing in Denver, Colorado (CO) will be replaced because of its deteriorated condition. Our goal was to document the mold contamination and particulate matter (PM2.5) concentrations in Sun Valley homes and the circulatory and respiratory health of Sun Valley compared to all Denver residents (total 2761 and 1,049,046, respectively) based on insurance claims data for 2015 to 2019. Mold contamination in Sun Valley homes (n=49) was quantified using the Environmental Relative Moldiness Index (ERMI) scale. Indoor PM2.5 concentrations were measured in Sun Valley homes (n=11) using time-integrated, filter-based samples and quantified using gravimetric analysis. Outdoor PM2.5 concentrations data were obtained from a near-by United States Environmental Protection Agency monitoring station. In Sun Valley homes, the average ERMI value was 5.25 compared to -1.25 for other Denver homes. The PM2.5 median concentration inside Sun Valley homes was 7.6μg/m3 (interquartile range - 6.4μg/m3). The ratio of indoor to outdoor concentrations of PM2.5 was 2.3 (interquartile range - 1.5). In the last five years, ischemic heart disease was significantly more likely for Denver compared to Sun Valley residents. However, acute upper respiratory infections, chronic lower respiratory diseases and asthma were all significantly more likely for Sun Valley than Denver residents. Since the process of replacing and occupying the new housing will take several years, the next phase of the study will not occur until that process is complete.

A prospective, post-marketing surveillance (PMS) study to monitor the safety of fixed dose combination of Triprolidine Hydrochloride IP 2.5 mg and Phenylephrine Hydrochloride IP 5 mg [Recofast Tablets] for the symptomatic relief in patients with upper respiratory tract infections

Upper Respiratory Tract Infection (URTI) is the most frequent illness in humans. The vast majority of acute upper respiratory tract infections are caused by viruses. These cause a variety of patient diseases including acute bronchitis, common cold, influenza, and respiratory distress syndromes.The study was conducted in patients with upper respiratory tract infections to see if the medication provides symptomatic relief in these conditions. Other conditions like allergic rhinitis and influenza were also included in the study for symptomatic relief.This is an open label, multicentric, active Post Marketing Surveillance (PMS) study with an objective to assess safety of fixed dose combination regarding Recofast tablets (Triprolidine Hydrochloride IP 2.5 mg and Phenylephrine Hydrochloride IP 5 mg) which was evaluated in 150 participants from different geographical regions. And then results were documented. A total of 19 (13%) patients recorded minor adverse event from these regions. Out of 150 patients 95 were male &amp; 55 were female. All the patients were in the range of 18-80 years.No significant adverse events were observed during the course of the study, only 13% patients recorded minor adverse events from all regions. Thus this formulation is completely safe and effective in the management of Upper Respiratory Tract Infections and allergies.

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries.

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Association between PM2.5-bound metals and pediatric respiratory health in Guangzhou: An ecological study investigating source, health risk, and effect.

The adverse effects of 2.5-μm particulate matter (PM2.5) exposure on public health have become an increasing concern worldwide. However, epidemiological findings on the effects of PM2.5-bound metals on children's respiratory health are limited and inconsistent because PM2.5 is a complicated mixture. Given the vulnerability of children's respiratory system, aim to pediatric respiratory health, this study evaluated the potential sources, health risks, and acute health effects of ambient PM2.5-bound metals among children in Guangzhou, China from January 2017 to December 2019. Potential sources of PM2.5-bound metals were detected using positive matrix factorization (PMF). A health risk assessment was conducted to investigate the inhalation risk of PM2.5-bound metals in children. The associations between PM2.5-bound metals and pediatric respiratory outpatient visits were examined with a quasi-Poisson generalized additive model (GAM). During 2017-2019, the daily mean concentrations of PM2.5 was 53.39 μg/m3, and the daily mean concentrations of PM2.5-bound metals range 0.03 ng/m3 [thorium (Th) and beryllium (Be)] from to 396.40 ng/m3 [iron (Fe)]. PM2.5-bound metals were mainly contributed by motor vehicles and street dust. PM2.5-bound arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr)(VI), nickel (Ni), and lead (Pb) were found to pose a carcinogenic risk (CR). A quasi-Poisson GAM was constructed that showed there were significant associations between PM2.5 concentrations and pediatric outpatient visits for respiratory diseases. PM2.5 was significantly associated with pediatric outpatient visits for respiratory diseases. Moreover, with a 10 μg/m3 increase in Ni, Cr(VI), Ni, and As concentrations, the corresponding pediatric outpatient visits for respiratory diseases increased by 2.89% (95% CI: 2.28-3.50%), acute upper respiratory infections (AURIs) increased by 2.74% (2.13-3.35%), influenza and pneumonia (FLU&PN) increased by 23.36% (20.09-26.72%), and acute lower respiratory infections (ALRIs) increased by 16.86% (15.16-18.60%), respectively. Our findings showed that PM2.5 and PM2.5-bound As, Cd, Co, Cr(VI), Ni, and Pb had adverse effects on pediatric respiratory health during the study period. New strategies are required to decrease the production of PM2.5 and PM2.5-bound metals by motor vehicles and to reduce levels of street dust to reduce children's exposure to these pollutants and thereby increase child health.

Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria — a retrospective cross-sectional study

BackgroundAntibacterial resistance is an ongoing global issue, threatening the lives of millions and affecting the quality of health systems, resulting in high costs to the worldwide economy. Syria is one of many countries with a high rate of antibiotic prescription or consumption, even before the war. MethodsA retrospective cross-sectional study was conducted to assess the pattern of antibiotic prescribing with regard to acute upper respiratory tract infection (AURTI) cases throughout the year 2019; data were collected from GlobeMed Syria (now Modern Healthcare Claims Management Company) following ethical approval. ResultsThe study comprised 14 913 cases, of which 13 382 (90%) had received an antibiotic prescription. All age groups showed high prescribing rates, with the 46–55 years age group having the highest (95.0%). Acute tonsillitis had the most significant percentage of antibiotics prescribed (98.7%). Cephalosporins were the most commonly prescribed antibiotic class. Family physicians were more inclined to prescribe antibiotics than those in other specialism groups. ConclusionSyria has a high rate of prescribing antibiotics for AURTIs, which may contribute to the evolution of resistant bacteria. The rate is higher than those reported in other Arab countries. Physicians need to commit to following the official guidelines, taking the appropriate prescribing of antibiotics more seriously, and should take more care in distinguishing viral origins of AURTIs.

Persistent Flaccid Paralysis in a Patient with Bartter Syndrome.

A two-year-old girl with an unremarkable family history was transferred to our tertiary care centre showcasing a severe dyselectrolytemia and a suspicion of tubulopathy. She was born to healthy nonconsanguienous parents at 35 weeks of gestation from dizygotic twins with birth weight of 2,550 g, polyhydramnios was not reported. One week prior to her admission to our department, she exhibited symptoms of acute upper respiratory tract infection and was admitted to the local hospital. Her physical examination showed mild dehydration, general muscle weakness, significantly reduced spontaneous physical activity and feeding difficulties initially attributed to an electrolyte imbalance. Laboratory examination revealed severe hypokalemia (2.1 mmol/L), hypernatremia (154.9 mmol/L), hypochloremia (91.0 mmol/L) and metabolic alkalosis (pH 7.6, bicarbonate 31.0 mmol/L). Both plasmatic renin and aldosterone were high: 643.5 ng/L and 5.9 nmol/L, respectively.