Course Of Acute Respiratory Infections Research Articles

Комплексна оцінка постнатальних факторів ризику рекурентних респіраторних інфекцій у дітей дошкільного віку

Purpose - to determine the influence degree of particular postnatal risk factors to the likelihood of the recurrent course of acute respiratory infections (ARI) in preschool children. Materials and methods. Three hundred and fourteen children (176 boys and 138 girls) aged 1 to 6 years old, undergoing inpatient treatment on ARI, were involved in the clinical study. The number of ARI episodes during their previous year of life, as well as the presence or absence of 19 potential postnatal risk factors associated with recurrent respiratory infections (RRI), were taken into account for the examined children. Additionally, two integral indices of ARI recurrence, namely the infection index (InI) and resistance index (InR), were calculated. The statistical processing of the primary digital data obtained was performed by IBM SPSS Statistics 28 licensed program. A сross-tabulation method was applied to compute the odds ratio (OR) and its 95% confidence interval (CI). Results. The difference between the age subgroups of the examined preschool children in the ARI episodes number during their previous year of life was demonstrated (H=11.243; p=0.047). First of all, the higher incidence of ARI was detected among the patients aged 36 to 71 months compared with those aged 12 to 35 months. Besides, the weak but significant correlation was revealed between six stratified age subgroups of children and their clinical diagnoses (φc=0.183; p=0.006). The studied integral indicators of the recurrent course of ARI (InI and InR) are inversely correlated with the majority of the postnatal risk factors considered, with the degree of the relationship strength being higher for InR than for InI. Conclusions. The majority of the potential RRI risk factors registered, namely 10 out of 19, separately increase the probability of children belonging to the group with more frequent ARI episodes. The most significant risk factors of RRI were as follows: 1) breastfeeding for 0-4 months after birth (OR=2.868; p<0.001; 95% CI: 1.681-4.895), 2) an older child in a family attending an organized childhood group (OR=2.814; p<0.001; 95% CI: 1.662-4.763); 3) second-hand smoke exposure (OR=2.537; p<0.001; 95% CI: 1.509-4.267). The prevalence of the studied RRI risk factors among the preschool children does not correlate with their significance in contributing to more frequent ARI episodes. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the author.

Сімейні фактори ризику рекурентного перебігу гострих респіраторних інфекцій у дітей віком 2-5 років

Purpose - to find out the influence degree of particular family risk factors on the propensity of preschool children to the recurrent course of acute respiratory infections (ARI). Materials and methods. A total of 237 children (128 boys and 109 girls) aged 2-5 years, undergoing inpatient treatment on ARI, were involved in the clinical study. Initially, the number of ARI episodes were taken into account for the examined children during the previous year of their lives as well as the presence or absence of 19 potential family risk factors associated with recurrent respiratory infections (RRI). In addition, 2 integral indices of ARI recurrence - the infection index (InI) and the resistance index (RI) - were calculated. The statistical processing of the digital material obtained was performed using IBM SPSS Statistics 28 licensed software. The odds ratio (OR) was calculated by crosstabulation. Besides, the Kaplan-Meier method with adjusted indicators was applied for statistical analysis. Results. The studied integral indicators of ARI recurrent course - InI and RI - are inversely correlated with the majority of the considered family risk factors, and the degree of connection strength for InI and RI is approximately the same. Almost 50% of the examined risk factors for RRI, specifically 9 out of 19, rise the chance of children belonging to a group with more frequent episodes of ARI. The most significant RRI risk factors were as follows: 1) mother’s and father’s susceptibility to RRI during their preschool age (OR=3.529; p<0.001; 95% CI: 1.791-6.954); 2) the presence of other children in family who have or had a tendency to RRI (OR=2.945; p=0.009; 95% CI: 1.292-6.717); 3) mother’s susceptibility to RRI during her preschool age (OR=2.742; p<0.001; 95% CI: 1.495-5.029); 4) maternal full-time employment at work during the previous year (OR=2.364; p=0.005; 95% CI: 1.287-4.342); 5) maternal and paternal secondary education (OR=2.333; p=0.031; 95% CI: 1.069-5.095). Conclusions. The prevalence of reported RRI risk factors among preschool children does not correlate with their significance in contributing to more frequent episodes of ARI. The Kaplan-Meier method makes it possible to determine the average and median age of children when the frequency of ARI episodes reaches the established threshold level under the influence of the considered risk factors for RRI. The results obtained substantiate the reasonability of using combined statistical methods to detect the most significant RRI risk factors and their combinations in preschool children. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the authors.

Клиническая оценка наличия взаимосвязи между хориоидальным и ретинальным уровнем гемодинамики у молодых женщин с окклюзионными поражениями ретинальных вен

Purpose. To study the relationship between choroidal and retinal hemodynamics of the eyes in retinal vein occlusion (RVO) in young women to determine the features of their clinical course. Material and methods. The main group included 15 women (15 eyes) with an average age of 39.7 ± 4 years (35–45 years). The control group was formed by 20 somatically healthy women of comparable age. In addition to standard examination methods, all women underwent a comprehensive study of chorioretinal hemodynamics. The linear velocity of blood flow (LVBF) in the posterior short ciliary arteries (PSCA) was evaluated using a multifunctional ultrasound diagnostic device Logiq e, General Electric, USA. Macular blood flow features were studied using an optical coherence tomograph in angiography mode (angio-OCT) RTVue-100, Optovue, Inc., USA. A comparative analysis of the studied indicators between the groups was carried out. Results. The results of the study revealed the presence of an interrelated statistically significant decrease in choroidal and retinal hemodynamics in young women with RVO relative to the group of healthy women (p < 0.001). Conclusion. Taking into account the revealed direct relationship between choroidal and retinal hemodynamics in women with acute respiratory infections, we consider it appropriate and necessary to perform a simultaneous comprehensive study of various components of the hemodynamics of the posterior segment of the eye in the presence of this pathology: LVBF in the PSCA by color Doppler mapping and macular blood flow by angio-OCT. These data can significantly expand the diagnostic capabilities of identifying the severity of the clinical course of acute respiratory infections and help predict the possible formation of neovascularization. Keywords: retinal vein occlusions; young women; chorioretinal hemodynamics; color Doppler mapping; optical coherence tomography in angiography mode

Role of antitussive agents in the treatment of acute respiratory viral infections and influenza

Viral upper respiratory infection (VURI)-associated acute cough is the most common symptom worldwide among children and adults. It causes serious economic and social problems both for individual patients, patients’ families, and the health care system as a whole. There is still no effective pharmacological agent capable of interfering with all the main pathophysiological mechanisms involved in VURI-associated acute cough. This circumstance partly explains the increased prevalence of the prolonged course of acute respiratory infections, when the cough takes on the features of subacute or post-infectious course. The pathophysiology of this symptom is being actively investigated to optimize the treatment of cough. A viral infection provokes an acute cough induced by various irritative stimuli, the main one being secretions from the respiratory tract, which directly acts on reflexogenic areas of the mucosa. Inflammatory mediators also play an important role, acting on the peripheral sensory terminations of airways. Inflammatory mediators also induce post-infectious bronchial hyperreactivity, which is an important component of the pathogenesis of post-infectious cough. Recently, researchers are becoming increasingly interested in the role of the voluntary or conscious cough component, which is implemented due to the cortical response to afferent information from the receptors of the upper respiratory tract.This hypothesis explains the ineffectiveness of central antitussive agents in patients with viral infection-associated dry cough and expands the possibilities of peripheral antitussive agents represented by levodropropizine. In addition to the action on nerve endings, the agent also affects inflammatory mediators, which enhances its ability to break the “vicious circle” of this symptom, prevents the development of post-infectious cough and promotes rehabilitation of the bronchial tree. The efficacy and safety of levodropropizine has been demonstrated in clinical trials in both children and adults.

Комплексное исследование состояния и взаимосвязи хориоидальной и ретинальной гемодинамики при окклюзиях ретинальных вен у молодых женщин

Purpose. To study the relationship between choroidal and retinal hemodynamics of the eyes in retinal vein occlusion (RVO) in young women to determine the features of their clinical course. Material and methods. The main group included 15 women (15 eyes), whose age ranged from 35 to 45 years, averaging 39.7±4.0 years. 20 somatically healthy women of comparable age were included in the control group. In addition to standard examination methods, all women underwent a comprehensive study of chorioretinal hemodynamics. The linear velocity of blood flow (LVBF) in the posterior short ciliary arteries (PSCA) was evaluated using a multifunctional ultrasound diagnostic device Logiq e (General Electric, USA). Macular blood flow features were studied using an optical coherence tomograph in angiography mode RTVue-100 (Optovue, Inc., USA). A comparative analysis of the studied indicators between the groups was carried out. Results. The results of the study revealed the presence of an interrelated statistically significant decrease in choroidal and retinal hemodynamics in young women with RVO relative to the group of healthy women (p<0.001). Conclusion. Taking into account the revealed direct relationship between choroidal and retinal hemodynamics in women with acute respiratory infections, we consider it appropriate and necessary to perform a simultaneous comprehensive study of various components of the hemodynamics of the posterior segment of the eye in the presence of this pathology: LVBF in the PSCA by color Doppler mapping and macular blood flow by OCT in angiography mode. These data can significantly expand the diagnostic capabilities of identifying the severity of the clinical course of acute respiratory infections and help predict the possible formation of neovascularization. Key words: retinal vein occlusions, young women, chorioretinal hemodynamics, color Doppler mapping, optical coherence tomography in angiography mode

Features of cough therapy in children

This article discusses the problem of cough in children as one of the symptoms of a complicated course of acute respiratory infection. The data on the peculiarities of the course of cough in children depending on the cause, the level of damage, and age are presented. Virulence of infectious agents, immune status, and the child’s constitution may influence the development of local inflammation covering the tonsils, adenoids, pharynx, larynx. The study of respiratory problems in children remains relevant due to the need to improve therapy tactics and rehabilitation after an infection. Acute upper respiratory tract infections affect about 23 million children annually, which is 52% of the total morbidity of children and adolescents aged 0-17 years. Various therapeutic options are discussed. Thus, central drugs have a direct antitussive effect and cause inhibition of the cough center: narcotic antitussive drugs, such as codeine-containing drugs; non-narcotic antitussive drugs (glaucine hydrochloride, butamirate citrate, etc.). Peripheral medications reduce the sensitivity of cough afferent receptors and act on the mucosa of the airways. There are drugs of combined action, as well as bronchodilators, mucoactive drugs, and chest cough sets. Particular attention is paid to the multicomponent drug, which has a complex anti-inflammatory, antitussive and antimicrobial action in cough. The results of various foreign and domestic studies on the efficacy and safety of this drug are given. The necessity of early treatment is emphasized to improve the quality of life of patients and to prevent the formation of chronic bronchial processes. It is concluded that for the treatment of children it is necessary to choose the best drugs. It should be drugs that have proven efficacy and safety, and most importantly - they should be registered for use in the Russian Federation.

Application of a herbal preparation in the therapy of acute tonzillopharyngitis in children

Introduction. Tonsillopharyngitis often accompanies the course of acute respiratory infections in children (up to 12-15%). The use of systemic antibacterial drugs for viral etiology of the disease has not been shown, therefore, the interest of researchers in the use of herbal products is increasing. In numerous clinical trials conducted around the world, the liquid extract of the roots of Pelargonium sidoides EPs® 7630 has been shown to be effective and safe in the treatment of acute respiratory infections, acute tonsillopharyngitis, rhinosinusitis, acute bronchitis in adults and children.Objective of the study: assessment of the efficacy and safety of the drug EPs® 7630 (Umckalor) in acute tonsillopharyngitis of non-streptococcal etiology in children 2-6 years old on an outpatient basis.Materials and methods. A prospective analysis of cases of treatment with Umckalor for acute tonsillopharyngitis of non-streptococcal etiology against the background of acute respiratory infection in children 2-6 years old (n = 23, group 1) was carried out.The comparison group (2) consisted of children receiving standard therapy (n = 22). Systemic antibiotics and antiviral drugs were not used in all patients. The study was conducted over 6 months (2019-2020). The research results were processed using the Statistica 7.0 software (StatSoft, USA).Results and discussion. Therapy with Umckalor in children with acute tonsillopharyngitis contributed to the elimination of the main clinical symptoms of the disease on the 4th day of treatment (efficiency was 69.9%, p < 0.05). The most persistent symptom was hyperemia of the tonsils and oropharynx. The period of convalescence occurred 2 days earlier than in the children of group 2 (p < 0.05). Umckalor was well tolerated, no side effects of the drug were identified.Conclusions. The drug Umckalor can be recommended for monotherapy for 7 days in patients with acute non-streptococcal tonsillopharyngitis on an outpatient basis with mild and moderate disease.

Inhalation therapy for bronchial obstruction in children: traditional approaches and new opportunities

Acute respiratory infections are widespread in the pediatric population and represent a significant burden to the health care system and families of patients. Anatomic ans physiological features of preschool children and individual predisposition, especially atopic phenotype, determine high risk of complicated course of acute respiratory infections with bronchial obstruction syndrome. The etiological factors of recurrent AR are quite diverse from chronic infections to foreign bodies of the bronchi or genetically determined diseases, but the most common cause of recurrent AR in children remains bronchial asthma. Therapy of acute obstructive episode in real clinical practice is most often similar to therapy of bronchial asthma attack and includes effects on the main components of pathogenesis: contraction of smooth muscles, mucus hypersecretion and inflammatory edema of the bronchial wall. There has been accumulated a great practical experience of using combined preparation of fenoterol and ipratropium bromide, which currently exists also in the form of domestic medicinal product Astmasol-SOLOpharm. In addition to standard bronchodilator and mucoconstrictor therapy, hypertonic solutions, in particular Ingasalin 3%, are an important component of therapy of prolonged obstruction and relapse prevention. The possibilities of this remedy in shortening of terms of obstructive disorders and decrease of risk of antibiotic therapy are demonstrated by clinical example.

Strategy of Rational Therapy of Acute Respiratory Infections in Patients with Comorbidity

Abstract. The paper discusses specific features of acute respiratory infections (ARI) progression in patients with comorbidity. The relevance of this study is accounted for by severe progression of ARIs in this group of patients, as well as by specific considerations of combining causal treatment of infections with life-long treatment of chronic diseases.The aim of the study was to use a clinical case to substantiate an optimal treatment strategy for influenza and associated complications in a comorbid patient.Results: the analysis of the clinical case showed that an unfavourable course of ARI in the patient was due to the lack of timely antiviral therapy, adverse effects of paracetamol during statin therapy, exposure to pneumonia pathogen degradation products, general intoxication, and immune response. The compromised medical history contributed to the development of severe complications. The paper proposes a strategy for selecting the most eff ective and safe approach to the treatment of ARIs in a comorbid patient.Conclusions: ARIs in patients with chronic diseases entail increased risks of complications that may arise both due to specific characteristics of the infection and unfavourable combination of drugs. Treatment regimens for infl uenza and other ARIs in comorbid patients should be eff ective and timely. Early antiviral treatment is especially important in patients with comorbidity. When choosing a treatment regimen, it is necessary to assess potential benefi ts of pharmacotherapy as well as associated risks, including those related to previously prescribed medicines.

Профилактика и лечение заболеваний верхних дыхательных путей, осложняющих течение острых респираторных инфекций

Профилактика и лечение заболеваний верхних дыхательных путей, осложняющих течение острых респираторных инфекций

Local antibiotic therapy for acute upper respiratory tract infections

The article discusses the possibilities of local antibiotic therapy for acute respiratory infections in children. Despite the fact that most acute respiratory infections are caused by viruses, unreasonably high (up to 70% and higher in different countries) prescription of antibacterial drugs by primary care physicians has been observed. At the same time, it is highly likely that bacterial superinfection may develop in young children, in children with a prolonged course of acute respiratory infection, as well as in children with chronic ENT pathology, which requires the prescription of antibacterial therapy both to treat and, possibly, to prevent bacterial superinfection. In this case, the drug of choice should be antibiotics for topical (inhalation) use, such as Fluimucil®-antibiotic IT, which act directly at the infection site with the achievement of a quick therapeutic effect, without side effects that are associated with systemic antibiotics.

Acute Respiratory Diseases and Influenza in Modern Obstetrics: Epidemiological Features and Diagnostic Problems: Literature Review

Relevance Acute respiratory infections (ARI) are a serious health problem. Pregnant women are patients with risk factors for the development of severe/complicated course of ARI and influenza. Aims To review the literature on epidemiological features and problems of diagnosis of ARI and influenza in modern obstetrics. Conclusions. The review showed indicators of the incidence of acute respiratory diseases (ARI) among infectious diseases, described the specificity of ARI in pregnant women, risk factors for severe influenza and secondary complications among pregnant women, a comparative analysis of modern approaches used for the diagnosis of ARI. There is an urgent need to create a comprehensive diagnostic test panel adapted for use in obstetrics.

The current course of acute respiratory infections and the possibility of pathogenetic therapy.

Acute respiratory viral infections (ARVI) are leading in the structure of the general morbidity of the population. To date, more than 200 viruses that affect the respiratory tract and ENT organs are known [1]. The reservoir of ARVI pathogens is only human, the highest incidence is observed in the cold season [8]. It is also possible to infect several ARVI pathogens together, which is accompanied by a severe course of the disease and the addition of bacterial complications [6, 7]. To date, prevention and treatment of ARVI, both in adults and children, is one of the important tasks facing the medical community [1, 2]. The etiotropic therapy of most ARVI has not been developed, and the use of interferon preparations and interferon synthesis inducers has not proved their clinical efficacy [11]. As an alternative, bioregulatory agents that have proven their safety and clinical efficacy can be used [12]. The article presents numerous studies of clinical efficacy and safety of the bioregulatory drug Engystol in different age groups.

EXPERIENCE OF CYCLOFERON THERAPY IN THE COMPLEX THERAPY OF RECURRENT RESPIRATORY INFECTIONS IN CHILDREN

The article contains materials on the use of antiviral and immune stimulating drugs for treatment of infectious processes of viral aetiology. The potential of using Cycloferon in children with recurrent infections are shown. Prescription of nonspecific immune modulators of the topical (derinat) and systemic (cycloferon) effect as etiotropic and immune modulating therapy for sickly children was justified from the pathogenetical point of view. The findings of our studies on the efficacy of the latter in children with different states of the pharyngeal lymphoid ring and complicated course of acute respiratory infection are presented. It is shown that the frequency of acute respiratory infections in children depends on the child’s age, immune status, and not on the state of the pharyngeal lymphoid ring.

ASSOCIATION OF TLR2, TLR4, TLR9 GENE EXPRESSION RELATED TO INNATE IMMUNITY WITH IN VIVO ACUTE RESPIRATORY INFECTIONS CAUSED BY KLEBSIELLA PNEUMONIAE

The aim of this work was to study features of gene expression TLR2, TLR4, and TLR9 in the course of acute respiratory infection, depending on the time elapsing since the contamination, and dose of infection. The studies of in vivo models of acute respiratory infections caused by Gram-negative Klebsiella pneumoniae showed that, at infection dose of 10 4 CFU/ml, the TLR4 gene expression levels in epithelium of upper respiratory tract at 1, 3, 10 days were increased 30 times and more, complete elimination of the pathogen was observed at 3 days. At the dose of infection of 10 7 CFU/ml, persistence of the pathogen in upper respiratory tract was observed within a few days, accompanied by a significant increase in the level of TLR9 expression in epithelium of upper respiratory tract, and TLR4 levels in the lungs 1 day after infection, in parallel to elimination of the pathogen from the lower respiratory tract. Thus, the characteristic features of TLR4 and TLR9 gene expression in the upper respiratory tract may be considered a potential diagnostic and prognostic factors in evaluation of the course of acute respiratory infections caused by Klebsiella pneumoniae.

Treatment of the complicated course ORI by means of natural origin

In the article the authors consider the problem of treatment of the complicated course of acute respiratory infection (ARI) by natural origin drugs. The efficacy and adverse reactions of official medicine drugs and complex homeopathic medicines are discussed. The basic principles of homeopathic treatment are set forth. Data of international and Russian researchers are provided to prove the feasibility and effectiveness of treating symptoms of cough and rhinitis by natural origin drugs. Schemes of treatment by the example of some complex homeopathic preparations are proposed.

Особенности течения острых респираторных заболеваний у детей с гиперплазией лимфоглоточного кольца

Особенности течения острых респираторных заболеваний у детей с гиперплазией лимфоглоточного кольца

Causal Treatment of Inflammatory Diseases of ENT organs — Complications of Acute Respiratory Infection

Inflammatory diseases of ENT organs often complicate the course of acute respiratory infections in children and remain one of the most common causes of prescribing antibacterial drugs. The article describes the results of analyzing an antiviral therapy in patients with acute uncomplicated rhinosinusitis (n = 175) and non-perforated form of acute otitis media (n = 71). It was shown that, irrespective of diagnosis, the children were most commonly prescribed with rimantadine and homeopathic remedy produced by Boiron. The administration of antibacterial drugs was initiated in 38% of patients with acute otitis media. No deterioration on the background of receiving drugs with antiviral activity was observed in patients with acute rhinosinusitis. In general, a low patient compliance to antiviral therapy can be noted. This problem can be solved by prescribing short-course drugs. Key words: acute respiratory infections, complications, rhinosinusitis, otitis media, anti-viral drugs.

The influence of gel-like recombinant interferon α-2b on the clinical course of acute respiratory infection and the state of mucosal immunity in the pregnant women

The objective of the present study was to evaluate the state of local immunity of the mucous membrane in the nose of the pregnant women presenting with acute respiratory infection (ARI). A total of 55 women with this condition were examined at the outpatient basis starting from week 14 of the gestation period. Viferon gel was administered intranasally to 34 such patients. The clinical and immunological effectiveness of the application of the topical form of this recombinant interferon α-2b preparation in these patients was evaluated. It is concluded that the inclusion of Viferon in the combined treatment of ARI in the pregnant women significantly decreases the frequency of bacterial complications. Simultaneously, this preparation reduces the IL-8 level in the nasal secretion in comparison with its initial value.

Nasal Middle Meatal Specimen Bacteriology as a Predictor of the Course of Acute Respiratory Infection in Children

To test our hypothesis that children with potentially pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis) in the nasal middle meatus might have more prolonged symptoms of acute respiratory infection than children without such bacteria, we conducted a prospective cohort study of such children. We recruited prospectively child volunteers between 6 and 13 years of age with acute respiratory infections present for fewer than 10 days. Nasal middle meatal bacterial culture was taken with a rigid endoscope at enrollment and again after 3 weeks and evaluated for presence or absence of 3 potential pathogens: S. pneumoniae, H. influenzae and M. catarrhalis. The subsequent persistence of acute symptoms (nasal discharge: clear/colored, nasal obstruction and cough) was determined by means of a diary. Viral etiology was studied with polymerase chain reaction methods. The 82 children had had symptoms for an average of 4 days (range, 1-10) at entry, and viruses were detected in 54% (39 of 72). The endoscopic procedure and bacteriologic sampling succeeded in all cases. Thirty-eight children (46%) had at least 1 of the 3 pathogens in the middle meatus specimen. The children with nasal pathogens present at entry had a significantly longer mean duration of symptoms than those with nonpathogenic bacteria (difference, 3.6 days; 95% confidence interval, 0.7-6.5; P = 0.025). The effect remained significant after adjustment for age, sex, allergic symptoms and the presence of virus (adjusted relative hazard of delayed recovery, 2.0; 95% confidence interval, 1.1-3.6). We found that the use of endoscopic swab culture sampling from the nasal middle meatus is well-tolerated by children older than 6 years of age and that it can be useful in selected situations to determine pathogenic bacteria in the culture of these specimens.