Development Of Severe Pneumonia Research Articles

LncRNA RP11-773H22.4 is upregulated in severe pneumonia and may be a diagnostic and prognostic marker for severe pneumonia.

The incidence of pneumonia has become increasingly prevalent, and its severity has been continuously escalating, bringing significant damage and stress to people's lives. The regulatory role of RP11-773H22.4 in the onset and development of severe pneumonia is emerging as an important factor, however, the exact mechanisms controlling its effects have not been fully elucidated. ROC curve and Kaplan-Meier curve were employed to assess the diagnostic and prognostic significance of RP11-773H22.4 in severe pneumonia. qRT-PCR was employed to assess the RP11-773H22.4 and miR-1287-5p expression. The CCK-8 was employed to assess cell viability. The rate of apoptosis was measured utilizing flow cytometric. The concentration of inflammatory factors was detected by ELISA kit. The interaction between RP11-773H22.4 and miR-1287-5p was verified by dual luciferase reporter gene assay. In individuals afflicted with severe pneumonia, there was an observed up-regulation in RP11-773H22.4 expression and a corresponding decline in miR-1287-5p expression. RP11-773H22.4 demonstrated diagnostic and prognostic significance for severe pneumonia. RP11-773H22.4 augmented the viability of MRC-5 cells with LPS treatment by modulating miR-1287-5p, leading to a reduction in apoptosis and lower levels of inflammatory cytokines. RP11-773H22.4 was highly expressed in severe pneumonia and may serve as a diagnostic and prognostic marker for severe pneumonia. miR-1287-5p was downregulated in severe pneumonia, and RP11-773H22.4 participated in the pathogenesis of severe pneumonia by regulating the expression of miR-1287-5p.

An analysis of risk factors associated with recurrent wheezing in the pediatric population

BackgroundRecurrent wheezing is a common clinical problem in early childhood, which is associated with significant morbidity. There is no international consensus on the management and prevention of recurrent wheezing; therefore, identifying the risk factors associated with recurrent wheezing is crucial to prevent episodes of wheezing in young children.MethodsIn this retrospective study, we collected the data of 24,737 patients who were admitted to our hospital between 27th April 2012 and 11th September 2019. After screening for patients with wheezing, we identified 8572 patients with a primary diagnosis of pneumonia with wheezing. Patients’ clinical data were collected from the hospital medical records. Patients were stratified for age in the groups of < 6 months, 6–12 months, and > 12 months.ResultsAmong the 8569 pediatric pneumonia patients with wheezing, there were 343 patients with recurrent wheezing. Most enrolled patients were under 6 months of age (45.17%) and had a normal birth weight (86.95%). Winter was the most common onset season for the first episode of wheezing, while spring was the most common season for the second episode of wheezing for those with recurrent wheezing. The univariate and multivariate logistic regression analysis for the risk factor associated with recurrent wheezing showed that male gender, past history of respiratory and cardiovascular diseases, low birth weight, development of severe pneumonia, and PICU admission were significantly associated with recurrent wheezing.ConclusionMale gender, past history of respiratory and cardiovascular diseases, low birth weight, severe pneumonia, and PICU admission are independent risk factors of recurrent wheezing in the pediatric population.

Cold-adapted SARS-CoV-2 variants with different temperature sensitivity exhibit an attenuated phenotype and confer protective immunity.

As novel SARS-CoV-2 Variants of Concern emerge, the efficacy of existing vaccines against COVID-19 is declining. A possible solution to this problem lies in the development of a live attenuated vaccine potentially able of providing cross-protective activity against a wide range of SARS-CoV-2 antigenic variants. Cold-adapted (ca) SARS-CoV-2 variants, Dubrovka-ca-B4 (D-B4) and Dubrovka-ca-D2 (D-D2), were obtained after long-term passaging of the Dubrovka (D) strain in Vero cells at reduced temperatures. Virulence, immunogenicity, and protective activity of SARS-CoV-2 variants were evaluated in experiments on intranasal infection of Syrian golden hamsters (Mesocricetus auratus). In animal model infecting with ca variants, the absence of body weight loss, the significantly lower viral titer and viral RNA concentration in animal tissues, the less pronounced inflammatory lesions in animal lungs as compared with the D strain indicated the reduced virulence of the virus variant. Single intranasal immunization with D-B4 and D-D2 variants induced the production of neutralizing antibodies in hamsters and protected them from infection with the D strain and the development of severe pneumonia. It was shown that for ca SARS-CoV-2 variants, the temperature-sensitive (ts) phenotype was not obligate for virulence reduction. Indeed, the D-B4 variant, which did not possess the ts phenotype but had lost the ability to infect human lung cells Calu-3, exhibited reduced virulence in hamsters. Consequently, the potential phenotypic markers of attenuation of ca SARS-CoV-2 variants are the ca phenotype, the ts phenotype, and the change in species specificity of the virus. This study demonstrates the great potential of SARS-CoV-2 cold adaptation as a strategy to develop a live attenuated COVID-19 vaccine.

Clinical Features and Risk Factors of Severe Pneumonia in Children With Acute Lymphoblastic Leukemia.

ObjectiveThis study aims to analyze the clinical characteristics of pediatric acute lymphoblastic leukemia (ALL) complicated by pneumonia and the risk factors of severe cases to preliminarily construct a prediction model for ALL complicated by severe pneumonia.MethodsA retrospective analysis was carried out on the clinical data of children diagnosed with ALL complicated by pneumonia hospitalized at the Department of Pediatrics of the Affiliated Hospital of Southwest Medical University between January 2013 and December 2020. The risk factors of severe ALL complicated by pneumonia were investigated with logistic regression analysis, and the risk prediction model was constructed.ResultsA total of 116 cases of pediatric ALL complicated by pneumonia were analyzed. There were 71 cases of mild pneumonia and 45 cases of severe pneumonia. The main clinical manifestations were cough in 112 cases and fever in 109. Pathogens were detected in 23 cases. Multiple regression factor analysis indicated that the use of hormones (OR 4.001, 95% CI: 1.505–10.632), neutropenia or agranulocytosis (OR 7.472, 95% CI: 2.710–20.602), hemoglobin (Hb) < 90 g/L (OR 3.270, 95% CI: 1.256~8.516), and C-reactive protein (CRP) >15 mg/L (OR 3.253, 95% CI: 1.209~8.751) were independent risk factors that were associated with severe pneumonia. Logistic regression was used to establish the risk prediction model of ALL with severe pneumonia. The p-value was 0.659. The area under the receiver operating characteristic curve was 0.851, and the sensitivity and specificity were 84.4 and 71.8%, respectively.ConclusionThe development of severe pneumonia may be affected by the use of hormones, neutropenia or agranulocytosis, Hb < 90 g/L, and CRP > 15 mg/L. The prediction model based on the risk factors is effective, which can provide a reference for the clinical evaluation of acute lymphoblastic leukemia with severe pneumonia.

Type-H, and Type-L COVID-19: are they different subtypes or the same?

SARS-CoV-2 infection, which causes severe pneumonia, caused an epidemic that started in Wuhan, China in December 2019 and spread to the whole world. COVID-19 mainly affects the respiratory system and causes the development of severe pneumonia and related acute respiratory distress syndrome (ARDS) in some patients. We aimed to investigate whether COVID-19 pneumonia cases can be evaluated in different categories in clinical and radiological terms. COVID-19 associated ARDS cases being treated with the diagnosis of severe pneumonia between March 21, 2020 and June 15, 2020 in Anesthesia Intensive Care Unit were examined and divided into 2 groups (type-L and type-H, total 29 cases) according to their clinical findings (according to whether they benefited from high PEEP and their lung compliance) and lung computed tomography findings (according to the severity of the ground glass appearance). The groups were compared with each other in terms of inflammatory markers [CRP (C reactive protein), ferritin, D Dimer, PCT (procalcitonin), white blood cell, lymphocyte count, arterial blood gas analysis] and imaging findings. It was observed that the prone position was beneficial in improving oxygenation in both H-type and L-type patients. 7 of 22 L-type patients were intubated and 5 of these patients died. There was no statistical difference between the two groups in terms of intubation times, hospital stays, cytokine levels, prone position application responses and mortality rates. Are there two separate forms of COVID-19 pneumonia, such as h-type and l-type, or are they intertwined and describe the early and late stages of the disease? This question needs to be discussed. In addition, we believe that subtyping COVID-19 pneumonia patients does not make a difference in the treatments to be applied.

Does Smoking and Alcohol Increase the Risk of COVID-19? A Review

AbstractThe first case of pneumonia of unknown origin was identified in Wuhan, the capital city of Hubei Province situated in the Republic of China. The pathogenic organism that has been identified as a causative organism is a novel enveloped RNA betacoronavirus, which has been designated as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This virus has been found to have a similar phylogeny to SARS-CoV. The novel coronavirus or COVID-19 can be symptomized through clinical manifestations like pyrexia or fever, cough, dyspnea/difficulty in breathing, myalgia/muscle pain, and constant fatigue. COVID-19 can be transmitted through respiratory tract secretions. It mainly results in respiratory tract infections and the development of severe pneumonia in infected patients. Severe disease may ultimately cause death due to progressive respiratory failure. The coronavirus disease 2019 or COVID-19 has been declared a public health emergency of international proportions by the World Health Organization (WHO). Thus, an analysis of cases might help in the identification of the disease's defining clinical characteristics, association with underlying lifestyle habits, and disease severity. This present article studied the probability of smoking and alcohol consumption in increasing the risk involved in increasing the severity of COVID-19 infection among affected subjects.

Морфофункциональные изменения в проводящих и респираторных отделах бронхолегочной системы при COVID-19 (аналитический обзор)

The article reflects the analysis of the state of the problem concerning the of COVID-19 (CoronaVirus Disease 2019), the epidemic of which began from the end of 2019 to the beginning of 2020, from the position of the bronchopulmonary system, which is associated with the main route of penetration of the virus of this infectious disease (SARS-CoV-1) with the development of severe pneumonia, often fatal. And if the study and results of the study of this problem are to a certain extent highlighted in the literature, then they concerned mainly the respiratory regions of the respiratory tract (RT), given that mainly complications leading to death are associated with them. At the same time, studies on conducting RT are reflected in a few foreign works, although there are data suggesting their not small contribution to the of COVID-19. In the domestic literature, studies of this kind have not been reflected. The aim of the work is to analyze, reflect and assess the role of possible morphological and functional regional changes in the mucous membrane of the RT in the of COVID-19. Methodologically, the analysis was carried out using a systematic approach based on the material of various databases of biomedical and biomedical scientific information, including such as Index Medicus, PubMed, EMBASE, Cochrane, and others for the period, mainly 2020. Results. An analysis of the mechanisms of influence on the morphofunctional state of the mucous membrane of the RT of coronavirus infection is given, depending on their departments, including conductive and respiratory. Methods and approaches to the study of such influence are reflected. The possible role of disturbances in the morphofunctional state and defense mechanisms of the lungs is shown, hypotheses and paradigms regarding the of coronavirus infection are presented. The results of the analysis indicate that there is a whole complex of morphological and functional disorders that determine the development of this pathology, its virulence. The fundamental role of the epithelium of the respiratory tract has been established and multicellular receptor tropism in the of COVID-19 is reflected. In conclusion, it is pointed out that the essential role of epithelial cells not only of the respiratory, but also of the conductive parts of the LTP, mainly ciliates, which are involved in the of COVID-19 not only from the position of functional receptors, but also in terms of violations of the earliest leading protective mechanism - mucociliary clearance aggravating the vicious circle of pathogenesis of this pathology. © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

To describe antibiotic prescribing patterns in ambulatory children with community-acquired pneumonia and to assess the relationship between antibiotic selection and clinical outcomes. This was a retrospective cohort study of ambulatory Medicaid-enrolled children 0-18years of age diagnosed with community-acquired pneumonia from 2010 to 2016. The exposure was antibiotic class: narrow-spectrum (aminopenicillins), broad-spectrum (amoxicillin/clavulanate and cephalosporins), macrolide monotherapy, macrolides with narrow-spectrum antibiotics, or macrolides with broad-spectrum antibiotics. The associations between antibiotic selection and the outcomes of subsequent hospitalization and development of severe pneumonia (chest drainage procedure, intensive care admission, mechanical ventilation) were assessed, controlling for measures of illness severity. Among 252 177 outpatient pneumonia visits, macrolide monotherapy was used in 43.2%, narrow-spectrum antibiotics in 26.1%, and broad-spectrum antibiotics in 24.7%. A total of 1488 children (0.59%) were subsequently hospitalized and 117 (0.05%) developed severe pneumonia. Compared with children receiving narrow-spectrum antibiotics, the odds of subsequent hospitalization were higher in children receiving broad-spectrum antibiotics (aOR, 1.34; 95% CI, 1.17-1.52) and lower in children receiving macrolide monotherapy (aOR, 0.64; 95% CI, 0.55-0.73) and macrolides with narrow-spectrum antibiotics (aOR, 0.62; 95% CI, 0.39-0.97). Children receiving macrolide monotherapy had lower odds of developing severe pneumonia than children receiving narrow-spectrum antibiotics (aOR, 0.56; 95% CI, 0.33-0.93). However, the absolute risk difference was <0.5% for all analyses. Macrolides are the most commonly prescribed antibiotic for ambulatory children with community-acquired pneumonia. Subsequent hospitalization and severe pneumonia are rare. Future efforts should focus on reducing broad-spectrum and macrolide antibiotic prescribing.

COVID-19 Pandemisi ve Diabetes Mellitus

Coronavirüs ailesinden SARS-CoV-2’nin neden olduğu COVID-19 pandemisi, ilk olarak Çin’de görülen ve bulaşıcılık özelliği yüksek bir hastalıktır. Hastalığın mortalite ve morbiditesinde diyabet başta olmak üzere komorbid hastalıkların varlığı ve ileri yaş belirleyici olmaktadır. COVID-19 tarafından tetiklenen hücresel mekanizmalar ve diyabet patofizyolojisi, diyabetli bireyleri potansiyel organ hasarı ile sonuçlanacak bir sitokin fırtınasına daha duyarlı hale getirmektedir. COVID-19 ile infekte olmuş diyabetik hastalarda hastaneye başvuru, yatış oranları, şiddetli pnömoni gelişimi ve diğer komorbit hastalıklara göre daha yüksek mortalite oranlarının olduğu gösterilmiştir. Bu risk, iyi glisemik kontrol ile tamamen ortadan kaldırılmasa da azaltılabilmektedir. Diyabetli hastalarda hem glisemik regülasyon hem de eşlik eden kalp hastalığı, hipertansiyon, obezite veya böbrek hastalığı gibi komorbid durumların stabilizasyonu sağlanmalıdır.

Potential Effect of COVID-19 on Maternal and Infant Outcome: Lesson From SARS.

The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is highly infectious and its ongoing outbreak has been declared a global pandemic by the WHO. Pregnant women are susceptible to respiratory pathogens and the development of severe pneumonia, suggesting the urgent need to assess the potential maternal and infant outcome of pregnancy with COVID-19. The intrauterine vertical transmission potential of SARS-CoV-2 also remains controversial. Herein, we discuss the potential effect of COVID-19 on maternal and infant outcomes based on current studies, including those published in Chinese, in a total of 80 mothers with COVID-19 and 80 infants. We also comprehensively explored the mother-to-child transmission routes of SARS-CoV-2, in particular the route of intrauterine vertical transmission. Given SARS-CoV-2 is a sister to SARS-CoV, of the SARS-related coronavirus species, we made a comprehensive comparison between them to learn from experiences with SARS. Although there is no evidence supporting the intrauterine vertical transmission of SARS-CoV-2, our comprehensive analysis suggests that the adverse maternal and infant outcomes caused by COVID-19 cannot be underestimated. Further, we speculated that the inconsistency between nucleic acids and serological characteristics IgM to SARS-CoV-2 of infants' specimens may be caused by the disruption of the amniotic barrier by the inflammatory factors induced by SARS-CoV-2 infection. Our review is beneficial to understand the effect of SARS-CoV-2 on maternal and infant outcomes.

A novel coronavirus infection COVID-19 in practice of obstetrician-gynecologist: a review of current data and guidelines

In December 2019, a new type of coronavirus was identified in China, called SARS-CoV-2 (COVID-19) that quickly spread not only within the People’s Republic of China, but also far beyond its borders. On March 11, 2020, the World Health Organization announced that the infection caused by novel coronavirus SARS-CoV-2 became a pandemic. Prior to this, two global epidemics were caused by pathogenic coronaviruses: in 2002 – by SARS-CoV that caused severe acute respiratory syndrome (SARS), and in 2012 – by MERSCoV that resulted in the Middle East respiratory syndrome (MERS). All coronavirus infections in humans are characterized by damage of lower respiratory tract with development of severe pneumonia and respiratory distress syndrome. According to reports, males become sick more often than females. It is known that due to developing immunological suppression pregnant women are at higher risk of contracting infectious diseases. However, the clinical course of SARS-CoV-2 infection during pregnancy, its effect on outcome of gestation, and the likelihood of vertical transmission to the fetus still remain unanswered. In this review, we present data on cases of SARS-CoV-2 disease during pregnancy published globally, its effect on outcome of gestation, as well as data on potential routes of infection for fetus and neonates. In addition, we also provide currently available clinical recommendations released by the Royal Society of Obstetricians and Gynecologists (UK), the American Society of Obstetricians and Gynecologists (USA), and the National Institute for Reproductive Health Research (India) on the management of pregnant patients infected with SARS-CoV-2.

IL-6: Relevance for immunopathology of SARS-CoV-2

COVID-19 mortality is strongly associated with the development of severe pneumonia and acute respiratory distress syndrome with the worst outcome resulting in cytokine release syndrome and multiorgan failure. It is becoming critically important to identify at the early stage of the infection those patients who are prone to develop the most adverse effects. Elevated systemic interleukin-6 levels in patients with COVID-19 are considered as a relevant parameter in predicting most severe course of disease and the need for intensive care. This review discusses the mechanisms by which IL-6 may possibly contribute to disease exacerbation and the potential of therapeutic approaches based on anti-IL-6 biologics.

Analysis of intestinal patients' flora changes with severe pneumonia based on 16SrDNA sequencing technology

To investigate the characteristics of gut microbiota dysbosis in patients with severe pneumonia using 16SrDNA sequencing. A prospective observational research was conducted. The stool samples retained by natural defecation or enema within 2 days after hospital were collected from 16 patients with severe pneumonia admitted to department of intensive care unit (ICU) of General Hospital of Ningxia Medical University from June to December in 2018 and 10 persons for physical exam were enrolled as the healthy control group. The 16SrDNA sequencing technology was used to detect fecal flora and analyze biological information. (1) 1 015 475 effective sequences were obtained from the stool samples from the severe pneumonia group and the healthy control group. Using 16SrDNA method, it was found that the average effective length of the sample sequence was 458.35 bp and the average sequence number of the total samples was 39 056.73. (2) Analysis of α diversity of gut microbiota showed that, compared with the healthy control group, the Ace index, Chao index and the Shannon index of gut microbiota diversity in the severe pneumonia group were significantly decreased [Ace index: 167.23 (143.14, 211.26) vs. 227.71 (214.53, 247.05), Chao index: 152.38 (138.09, 182.54) vs. 228.25 (215.49, 248.95), Shannon index: 2.37 (1.68, 2.89) vs. 3.39 (3.03, 3.63), all P < 0.01], and the Simpson index was significantly increased [0.21 (0.11, 0.33) vs. 0.07 (0.06, 0.12), P < 0.01], which indicated the gut microbiota diversity of the severe pneumonia group was decreased. (3) Analysis of β diversity of gut microbiota, principal coordinate analysis (PCoA) showed that gut microbiota structural with the healthy control group was similar, while that in the severe pneumonia group was different. Adonis analysis showed that the structural of the gut microflora revealing significant differences between the severe pneumonia group and the healthy control group (R2 = 0.061, P = 0.05). (4) Analysis of phylum difference gut microflora showed that, compared with the healthy control group, the proportion of Firmicutes in severe pneumonia group was decreased [27.36 (18.12, 39.28)% vs. 52.25 (38.36, 63.82)%, P = 0.02], the proportions of Actinobacterias, Synergistetes and Fusobacterias were increased [2.30 (0.30, 4.80)% vs. 0.02 (0.00, 0.06)%, 0.36 (< 0.01, 0.57)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, all P < 0.05]. (5) Analysis of genus difference gut microflora showed that, the proportions of Bifidobacterium, Ruminococcus, Pseudobutyrivibrio, Coprococcus, Lachnospira and Prevotella in the severe pneumonia group were significantly lower than those in healthy control group [0.18 (0.01, 0.25)% vs. 3.40 (0.46, 5.78)%, 0.01 (< 0.01, 0.29)% vs. 2.26 (0.84, 4.86)%, 0.01 (< 0.01, 0.02)% vs. 2.73 (1.87, 5.74)%, 0.02 (< 0.01, 0.07)% vs. 0.80 (0.50, 2.32)%, < 0.01 (< 0.01, < 0.01)% vs. 0.88 (0.33, 2.08)%, 0.02 (< 0.01, 0.31)% vs. 7.74 (0.07, 36.27)%, all P < 0.05]; the proportions of Escherichia and Enterococcus in the severe pneumonia group were higher than those in healthy control group, but there was no difference between the two groups [2.00 (0.57, 10.23)% vs. 1.16 (0.23, 2.68)%, 0.02 (< 0.01, 0.42)% vs. < 0.01 (< 0.01, 0.04)%, both P > 0.05]; the proportions of Fusobacterium and Staphylococcus in severe pneumonia group were significantly higher than those in healthy control group [0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.02)% vs. < 0.01 (< 0.01, < 0.01)%, both P < 0.05]. Gut microbiota dysbiosis in patients with severe pneumonia shows that the abundance and diversity decrease, structure of intestinal flora changes, and beneficial symbiotic bacteria decrease and pathogenic bacteria increase, which may be associated with the occurrence and development of severe pneumonia.

Passive Smoking and Disease Severity in Childhood Pneumonia Under 5 Years of Age.

To objectively investigate the effect of passive smoking on pneumonia and disease severity in children aged less than 5 years by using cotinine as an indicator of passive smoking. Between December 2015 and April 2016, children aged less than 5 years with pneumonia and age-matched healthy controls were included in this study, which was conducted at three tertiary pediatric pulmonology centers. A questionnaire was given to the parents regarding demographic data and smoking status at home. Urinary cotinine/creatinine ratio (CCR) was measured. The data from the pneumonia and control groups, as well as children with mild and severe pneumonia within the pneumonia group, were compared. A total of 227 subjects were included in the study; there were 74 children in the pneumonia group and 153 in the control group. The mean age of all the children was 33.4 ± 1.28 months. Of all subjects, 140 were male and 102 were exposed to passive smoking by their parents at home. There were statistically significant differences in age, number of people in the home, and mother's and father's age between the control and pneumonia groups (p < 0.05). No difference was found in the CCR in the control and pneumonia group (p > 0.05). Age and urinary CCR were significantly different between children with mild and severe pneumonia (p < 0.05). We showed that passive smoking exposure was associated with the development of severe pneumonia in children. Further studies are needed to examine the underlying cause in detail.

Angiodysplasia Combined with Thymic Aplasia in an Infant: A Rare Clinical Case

Background. The prevalence of congenital malformations of the vessels or angiodysplasia ranges from 1:50,000 to 1:5,000,000. Congenital angiodysplasia is a consequence of impaired formation and development of the vascular system in embryogenesis. The aetiology of angiodysplasia remains poorly studied, and the diagnosis involves significant difficulties in some cases. Clinical Case Description. The observation of a rare case of a combined malformation of vessels and thymic aplasia in a female infant is presented. Angiodysplasia included the syndrome of congenital generalised phlebectasia (synonym: congenital telangiectatic marbled skin) combined with multiple vascular malformations with predominant vascular lesions of the brain, lungs, heart, kidneys, and mesentery. Clinically, the disease was characterised by a generalised change in the skin in the form of livedo reticularis accompanied by the development of severe pneumonia, persistent urinary syndrome, neurological symptoms (convulsive seizures, motor disorders), and progressive heart failure. The diagnosis was confirmed in the course of a pathological study. Conclusion. The presented case allows expanding the notion of the variety of clinical manifestations of congenital angiodysplasia, as well as its possible combinations with other malformations.

Chronic obstructive pulmonary disease severity is associated with severe pneumonia.

CONTEXT:Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients.AIMS:We examined the risk factors associated with severe pneumonia in a COPD population.MATERIALS AND METHODS:We performed a retrospective observational study using a prospectively collected database of pneumonia patients who were admitted to our hospital through emergency department between 2008 and 2012. Patients with hospital-acquired pneumonia and those with an immunocompromised status were excluded.RESULTS:Of 148 pneumonia patients with COPD for whom chest computed tomography (CT) scans were available, 106 (71.6%) and 42 (28.4%) were classified as non-severe and severe pneumonia, respectively. Multivariate logistic regression analysis revealed that the severity of airflow limitation [odds ratio (OR), 2.751; 95% confidence interval (CI), 1.074-7.050; P = 0.035] and the presence of emphysema on a chest CT scan (OR, 3.366; 95% CI, 1.104-10.265; P = 0.033) were independently associated with severe pneumonia in patients with COPD.CONCLUSIONS:The severity of COPD including the airflow limitation grade and the presence of pulmonary emphysema were independently associated with the development of severe pneumonia.

Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus

Event Abstract Back to Event Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus Juan Moran1, 2, Alfredo Cruz-Lagunas1, Luis A. Jimenez-Alvarez1, Gustavo Ramirez-Martinez1 and Joaquin Zúñiga1* 1 Instituto Nacional de Enfermedades Respiratorias "Ismael Coso Villegas", Inmunologia, Mexico 2 Universidad Nacional Autónoma de México, Posgrado en Ciencias Biológicas, Mexico RATIONALE. Current evidence suggests that the development of severe pneumonia in patients with pandemic (pdm) A/H1N1 infection is associated with an excessive immune activation. High levels of pro-inflammatory mediators have been detected in blood and lung from patients with pdm A/H1N1 infection. Even though cytokines, chemokines, and growth factors are required to control influenza virus infection, their overproduction in an uncontrolled inflammatory response can lead to lung tissue damage. MicroRNAs (miRNAs) regulate most of the cellular processes including antiviral inflammatory responses. The profiles of circulating miRNAs in patients with severe pneumonia associated to pdm A/H1N1 virus have not been described. METHODS. We analyzed the genome-wide circulating miRNA profile by RT-PCR in 29 individuals (8 with diagnosis of severe pneumonia by A/H1N1 virus, 8 with mild pneumonia by A/H1N1, 8 household asymptomatic contacts and 5 healthy controls). Total circulating RNA was extracted from a serum volume of 250μL using Trizol. TaqMan miRNA low-density arrays (TLDAs) covering 768 miRNA species and endogenous controls were used for miRNA profiling in all the individuals. miRNA TLDAs microarray data analyses were performed with an algorithm designed in Perl language. We performed standard normalization using U6 endogenous control. ANOVA and Mann Whitney tests were performed to analyze differences between groups. RESULTS. We found a set of circulating miRNAs that were differentially expressed (p<0.05) in the group of patients with A/H1N1 severe pneumonia (miR-150, 29c, miR-22). In other side miR-210 and miR-145 were marking the symptomatic form of the infection without a distinction between severity and non-severity of the included patients. Interestingly, we found a diminished expression of miR-126 and miR-222 at all the patients that were exposed to (pdm) A/H1N1 virus independently from the clinical outcome of the disease. KEEG pathways enrichment and interactome network (Cytoscape V3.1.1) analysis of the differentially expressed miRNAs in A/H1N1 infection shows a connection between miR29c, miR150, miR-210, miR-145, miR-222 and miR-126 networking principally with the (PI3K)-Akt-mTOR, VEGF, Cancer and antiviral pathways. CONCLUSIONS. The expression of circulating miRNAs is altered in patients with different clinical outcomes of A/H1N1 infection. To our knowledge, this is the first evidence of deregulated miRNA expression in severe A/H1N1 disease, providing insights that may lead to the identification of novel biomarkers and altered molecular pathways of the disease. Keywords: miRNAs, H1N1pdm, Pneumonia, Cytokines, TLDAs Conference: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015. Presentation Type: Oral Presentation Topic: Immunogenetics Citation: Moran J, Cruz-Lagunas A, Jimenez-Alvarez LA, Ramirez-Martinez G and Zúñiga J (2015). Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus. Front. Immunol. Conference Abstract: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología. doi: 10.3389/conf.fimmu.2015.05.00304 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 15 May 2015; Published Online: 15 Sep 2015. * Correspondence: PhD. Joaquin Zúñiga, Instituto Nacional de Enfermedades Respiratorias "Ismael Coso Villegas", Inmunologia, Mexico City, 14080, Mexico, joazu@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Google Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Google Scholar Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga PubMed Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis

AimTo identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality.MethodsWe performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies.ResultsWe identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding – more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition – weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74).ConclusionThis study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia.

Increased levels of cytokines and high-mobility group box 1 are associated with the development of severe pneumonia, but not acute encephalopathy, in 2009 H1N1 influenza-infected children

BackgroundThe 2009 A(H1N1) influenza virus has caused a large outbreak, and resulted in major complications of severe pneumonia and acute encephalopathy in the pediatric population in Japan. MethodsThis study examined six patients with acute encephalopathy, 34 patients with severe pneumonia, five patients with both pneumonia and encephalopathy, and 46 patients without severe complications. The concentrations of 27 cytokines were examined in the cerebrospinal fluid of patients with encephalopathy, and the levels of these cytokines, Cytochrome c, high-mobility group box 1 (HMGB1) were measured in the serum of all patients. ResultsPatients with severe pneumonia had higher serum concentrations of 16 cytokines, including Th1 cytokines, Th2 cytokines, chemokines, and growth factors, than patients with uncomplicated influenza. The distribution of 27 cytokines in the CSF did not parallel the serum levels in 11 patients with acute encephalopathy. HMGB1 concentrations in the serum were significantly higher in pneumonia patients with or without encephalopathy than in uncomplicated influenza patients, and were significantly associated with the upregulation of 10 cytokines. ConclusionsElevated levels of Th2 cytokines appear to be unique to influenza caused by 2009 H1N1 influenza virus and HMGB1 could play an important role in the pathogenesis of severe pneumonia. There appear to be different pathologic processes for encephalopathy and pneumonia.

Severity of Pneumonia Due to New H1N1 Influenza Virus in Ferrets Is Intermediate between That Due to Seasonal H1N1 Virus and Highly Pathogenic Avian Influenza H5N1 Virus

Background. The newly emerged influenza A(H1N1) virus (new H1N1 virus) is causing the first influenza pandemic of this century. Three influenza pandemics of the previous century caused variable mortality, which largely depended on the development of severe pneumonia. However, the ability of the new H1N1 virus to cause pneumonia is poorly understood. Methods. The new H1N1 virus was inoculated intratracheally into ferrets. Its ability to cause pneumonia was compared with that of seasonal influenza H1N1 virus and highly pathogenic avian influenza (HPAI) H5N1 virus by using clinical, virological, and pathological analyses. Results. Our results showed that the new H1N1 virus causes pneumonia in ferrets intermediate in severity between that caused by seasonal H1N1 virus and by HPAI H5N1 virus. The new H1N1 virus replicated well throughout the lower respiratory tract and more extensively than did both seasonal H1N1 virus (which replicated mainly in the bronchi) and HPAI H5N1 virus (which replicated mainly in the alveoli). High loads of new H1N1 virus in lung tissue were associated with diffuse alveolar damage and mortality. Conclusions. The new H1N1 virus may be intrinsically more pathogenic for humans than is seasonal H1N1 virus.