Diseases Of Upper Respiratory Tract Research Articles

The odours in the ambient air: analysis of the relationship with the state of health and quality of life in adults residing in the town with food industries

Introduction. The article is devoted to studying atmospheric air pollution by industrial odours on the health, quality of life, and the occurrence of various somatic and emotional disorders in the population of neighboring residential areas. According to most abroad studies, a literature review showed different conditions mediated by “annoyance” of smell, a “predictor” of deviations in health status. Material and methods. The data for this study were obtained as a result of the survey of residents of the city with a population of about 50 thousand residents living at different distances from odour sources: coffee factory, bone meal factory, a sugar factory, and solid waste landfill. The distances from the primary sources ranged from 1500 m to > 5 km. Results. The analysis showed that odour pollution is one of the priority factors affecting residents’ health and quality of life. The frequency and intensity of specific odours in the atmospheric air, according to the results of the survey, decrease as respondents’ place of residence is removed from sources (from 1500 m to > 5 km), as well as the degree of their “annoyance” with odours (from 87.5% to 51.2%), remaining at a very high level at the farthest distances (over 5 km). Conclusion. Besides to the area of residence and, accordingly, the level of atmospheric air pollution by odours, extent of this “annoyance” can be influenced by concern of residents about possible impact of air pollution, particularly by odours, on health. It has been established that there is a certain category of residents (making up about one-third of the population) who tend to associate their health problems with the state of the environment and, mainly, with the presence of industrial odours. This group of respondents is characterized by a lower tolerance to odours and, at the same time, a higher frequency of upper respiratory tract diseases, allergies, cardiovascular, and some other diseases.

CLINICAL OPHTHALMIC PARAMETERS OF THE TEXAS TORTOISE (GOPHERUS BERLANDIERI).

Ophthalmic studies of the Texas tortoise (Gopherus berlandieri) established normal ophthalmic parameters for select diagnostic tests in captive tortoises and assessment of differences among individuals of differing size and health status. Sixty-one tortoises of varying weight, shell size, Mycoplasma seroprevalence, and herpesvirus exposure were included. Complete ophthalmic examinations, including neuro-ophthalmic reflexes, phenol red thread test, rebound tonometry, fluorescein staining, palpebral fissure length measurement, slit lamp biomicroscopy, indirect fundoscopy, and ocular ultrasound measurements of axial globe length, anterior chamber depth, lens thickness, and vitreous length, were recorded. All tortoises had negative dazzle and pupillary light reflexes, inconsistent menace responses, and positive palpebral reflexes. Mean ± SD tear production and intraocular pressure (IOP) were 14.2 ± 5.6 mm/15 sec and 13.8 ± 2.4 mm Hg in healthy tortoises, respectively. Mycoplasma-seropositive tortoises (with or without herpesvirus exposure) had significantly increased tear production (20.2 ± 8.1 and 19.9 ± 8.9 mm/15 sec, respectively) compared with healthy seronegative tortoises (14.2 ± 5.6 mm/15 sec; P = 0.02). As body size decreased, so too did palpebral fissure length and ocular ultrasound measurements, while IOP increased. Overall, palpebral fissure length appeared relatively small, and tear production relatively increased compared with other chelonian species, likely on the basis of the relatively arid native habitat. Further work is recommended to establish baseline values in related species, as well as comparison in aquatic versus terrestrial chelonians. The authors further suggest that the finding of relatively increased tear production in tortoises may indicate the need to rule out mycoplasmosis as a cause of upper respiratory tract disease.

Comprehensive health assessment and blood analyte reference intervals of gopher tortoises (Gopherus polyphemus) in southeastern FL, USA.

The gopher tortoise (Gopherus polyphemus), a keystone species, is declining throughout its geographic range. Lack of knowledge with respect to the potential infectious diseases present within wild populations creates a dilemma for wildlife biologists, conservationists and public policy makers. The objective of this study was to conduct a health assessment of two previously unstudied gopher tortoise aggregations located at two sites in southeastern FL. Samples were collected from 91 tortoises (48 adults, 35 juveniles, 8 hatchlings) captured at Florida Atlantic University's Harbor Branch Oceanographic Institute, in Fort Pierce, FL, USA in 2019, and Loggerhead Park in Juno Beach, FL, USA, during 2018-2019. Samples of blood, nasal swabs and oral/cloacal swabs were analyzed for hematology, plasma protein electrophoretic profiles and infectious disease testing including Mycoplasma spp. serology and polymerase chain reaction (PCR) assays for Ranavirus, Herpesvirus and Anaplasma spp. Hematological and plasma protein electrophoresis reference intervals are presented for adult and juvenile tortoises from both sites combined. Clinical signs consistent with upper respiratory tract disease (URTD) were observed in 18/91 (20%) tortoises, and antibodies to Mycoplasma agassizii were detected in 33/77 (42.9%) tortoises. Adult tortoises were significantly more likely than juveniles to have URTD clinical signs, and statistically significant, positive relationships were observed between the presence of antibodies to Mycoplasma spp. and carapace length, packed cell volume and plasma globulin concentrations. Anaplasma spp. inclusions were observed in 8/82 (10%) tortoises, but PCR detected Anaplasma sp. in 21/83 (25%) tortoises. Herpesvirus and Ranavirus were not detected in any blood or swab samples. This work contributes important baseline information on the health of gopher tortoises toward the southern end of the species' range.

Medicinal products in the treatment and prevention of occupational diseases of the upper respiratory tract

Occupational diseases of the upper respiratory tract (URT) represent a significant section of occupational pathology of the respiratory system, since the mucous membrane of the nasal cavity and paranasal sinuses is the outpost that first comes into contact with inhaled agents (pollutants), including professional aerosols. The pathogenesis of occupational diseases of URT is based on long-term contact of pollutants with cells of the scintillating epithelium and violation of the function of the mucociliary system of URT. Occupational diseases of URT include: chronic catarrhal, subatrophic, atrophic, hypertrophic rhinitis, rhinopharyngolaryngitis; all forms of laryngitis, laryngotracheobronchitis, allergic diseases. Treatment and prevention of these diseases should be comprehensive with the use of personal respiratory protection equipment, mandatory preventive examinations and various local effects (inhalation, instillation, lavage, herbal medicine, etc.).

Intergenic recombination in feline calicivirus associated with ahemorrhagic-like disease in the Republic of Korea.

Feline calicivirus (FCV) is a common cause of upper respiratory tract disease in cats. In this study, the complete genome sequence of FCV 14Q315, which was detected from a dead domestic cat with a hemorrhagic-like disease, was analyzed to identify the genetic characteristics. The FCV 14Q315 genome was 7,684bp. Phylogenetic analyses based on the ORF1, ORF2, and ORF3 sequences indicated that FCV 14Q315 is more closely related to FCV 15D022 than to other FCV strains. ORF1 of FCV 14Q315 shared high sequence similarity with ORF1 of FCVs 15D022 and UTCVM-H1. We further evaluated genetic recombination in ORF1 of FCV 14Q315 and detected intergenic recombination between p30 and the ORF1/ORF2 junction with high significance. Particularly, the non-recombination region in ORF1 of FCV 14Q315 showed high sequence similarity with FCVs GX2019, CH-JL2, and 15D022. The recombination region in ORF1 of FCV 14Q315 showed the highest similarity with FCV UTCVM-H1, which is associated with a hemorrhagic-like disease. The results suggest that the UTCVM-H1-like FCV was introduced into the Republic of Korea and presumably recombined with Korean FCVs by occasional mixed infections. In addition, the Korean FCV strains were located in several phylogenetic clusters with marked genetic diversity in the ORF2 region. These results imply that Korean FCVs possess high genetic diversity owing to mutations and recombination. Furthermore, it is possible that certain FCVs caused cyclical infections in the Korean cat population based on a phylogenetic analysis of FCVs isolated at different time points. Keywords: calicivirus; virulent systemic feline calicivirus; recombination; hemorrhagic-like disease.

Impact of Valopro and Ruprocol fodder additives on meat productivity of Kalmyk bull calves

The study concerns the influence of Valopro and Ruprocol fodder additives on the change of the growth energy and formation of meat productivity of Kalmyk bull calves during their nursery from 9 to 18 months of age. The addition of Valopro at a rate of 20 grams and Ruprocol at a rate of 50 grams per head per day to the basic diet during 273 days contributed to a daily gain of 1580–1560 g, which is 200–250 g higher than the control animals. The bull calves of the experimental group used 2.0 % more daily time for eating fodders and 1.6 % less for their chewing, besides, they had less rest standing and moved in a pen, and during the whole experimental period gave 426 kg of absolute gain, or 76 kg more than the herdmates of the control group. The experienced bull calves showed higher resistance to upper respiratory tract diseases, eye diseases, laminitis and hepatosis. During the control slaughter, the body weight and heavy carcasses of bull calves of both groups met the requirements of the current GOST category Super. The hot carcass weight of the bull calves of the experimental group averaged a little more than 362 kg, i.e. 62 kg more than the control group (P≤0.01). Each bull calf gave 11488 rubles profit, which is almost 4.5 thousand rubles more than the herdmates of the control group. Therefore, the latter have almost 5 % lower profitability.

Early medical school graduation during the COVID-19 pandemic: preliminary assessment

Abstract: Introduction: The current outbreak of the new coronavirus or SARS-CoV-2, which causes COVID-19, was first reported to the World Health Organization on December 31, 2019, being declared a pandemic on March 11, 2020. As for the clinical spectrum of SARS-CoV-2 infection, it is a broad one, ranging from asymptomatic, mild upper respiratory tract disease to severe viral pneumonia with respiratory failure and death. With a chance of severe clinical presentation close to 25%, SARS-CoV-2 infection can lead to health service overload and increase the demand for material and human resources. Aiming to increase the availability of health professionals directly involved in care during the pandemic, the Ministry of Education authorized the early graduation for students pursuing careers in health, including medicine. Objective: The aim of this article is to obtain preliminary results of the impact of early graduation for medical students during the COVID-19 pandemic. Method: Observational and cross-sectional study, carried out by applying a questionnaire with 13 questions, five of which used a Likert scale of assessment, six in multiple choice format and two descriptive, via Google Forms, applied to medical students from the universities of Curitiba-PR that graduated earlier in mid-year 2020, due to the COVID-19 pandemic. Results: 113 recently graduated students answered the questionnaire.101 participants reported that they are working as physicians and, among them, 63.36% stated that they are working directly in the treatment of COVID-19 cases. Regarding the importance of an early graduation, most participants fully agree or agree, while only three participants totally disagree. More than half of the interviewees do not feel harmed by the early graduation. However, 43.3% believe they have failed to acquire important information for their training. Finally, regarding their performance in the pandemic, 79.6% consider important their role in the fight against COVID-19 pandemic. Conclusion: The study shows that, at first, the efforts to give the Class of 2020 an early graduation were successful, since these new physicians are contributing to alleviate workforce shortages and provide better care for patients during the pandemic.

Early medical school graduation during the COVID-19 pandemic: preliminary assessment

Abstract: Introduction: The current outbreak of the new coronavirus or SARS-CoV-2, which causes COVID-19, was first reported to the World Health Organization on December 31, 2019, being declared a pandemic on March 11, 2020. As for the clinical spectrum of SARS-CoV-2 infection, it is a broad one, ranging from asymptomatic, mild upper respiratory tract disease to severe viral pneumonia with respiratory failure and death. With a chance of severe clinical presentation close to 25%, SARS-CoV-2 infection can lead to health service overload and increase the demand for material and human resources. Aiming to increase the availability of health professionals directly involved in care during the pandemic, the Ministry of Education authorized the early graduation for students pursuing careers in health, including medicine. Objective: The aim of this article is to obtain preliminary results of the impact of early graduation for medical students during the COVID-19 pandemic. Method: Observational and cross-sectional study, carried out by applying a questionnaire with 13 questions, five of which used a Likert scale of assessment, six in multiple choice format and two descriptive, via Google Forms, applied to medical students from the universities of Curitiba-PR that graduated earlier in mid-year 2020, due to the COVID-19 pandemic. Results: 113 recently graduated students answered the questionnaire.101 participants reported that they are working as physicians and, among them, 63.36% stated that they are working directly in the treatment of COVID-19 cases. Regarding the importance of an early graduation, most participants fully agree or agree, while only three participants totally disagree. More than half of the interviewees do not feel harmed by the early graduation. However, 43.3% believe they have failed to acquire important information for their training. Finally, regarding their performance in the pandemic, 79.6% consider important their role in the fight against COVID-19 pandemic. Conclusion: The study shows that, at first, the efforts to give the Class of 2020 an early graduation were successful, since these new physicians are contributing to alleviate workforce shortages and provide better care for patients during the pandemic.

Implementation of a screening tool for primary ciliary dyskinesia (PCD) in a pediatric otolaryngology clinic

BackgroundPrimary ciliary dyskinesia (PCD) is a rare genetic disease arising from motile ciliary dysfunction and associated with recurrent and chronic upper and lower respiratory tract infections. Pediatric otolaryngologists may see these patients prior to the development of lung disease. Features of PCD may overlap with other suppurative respiratory diseases, creating diagnostic challenges. A simple screening tool would be beneficial to identify potential patients who have chronic upper respiratory tract disease requiring further specialist evaluation. ObjectiveTo test a simple screening tool consisting of four questions to detect PCD in children with chronic otitis media and chronic rhinosinusitis seen in a tertiary otolaryngology clinic. MethodsA prospective, single site, observational study in a tertiary care pediatric otolaryngology clinic. Children aged 3–17 years diagnosed with chronic otitis media or rhinosinusitis with onset at less than 2 years of age were recruited. All study subjects had at least one of four key clinical features for PCD as determined by answers to screening questions, while control subjects had none. All participants completed a medical history questionnaire and nasal nitric oxide measurements. Those with reduced nasal nitric oxide levels were referred to our PCD center for further evaluation. ResultsA total of 153 patients were screened and 62 subjects were enrolled. Of those, 35 were enrolled as study subjects and 27 as matched controls. Study subjects had mean age of 7.5 years (3.2–16.5) with pre-screening diagnosis of chronic otitis media (n = 29) or chronic rhinosinusitis (n = 6). Control subjects (n = 27) had mean age 7.2 years (3.0–16.3) with pre-screening diagnosis of chronic otitis media (n = 25), and chronic rhinosinusitis (n = 2). There were no differences in subject demographics or mean nasal nitric oxide values between the two groups (179.8 vs 210.8 nl/min). Ten individuals had low nasal nitric oxide values, 7 of which were normal on repeat testing. Three subjects failed to return for follow up evaluations. Four referrals were made for further evaluation on the basis of clinical symptoms and nasal nitric oxide results. While no new cases of PCD were detected, a subject and his sibling with recurrent sinopulmonary infections were referred for immunologic evaluation. ConclusionThe use of standardized screening questions can be used in an otolaryngology clinic to identify patients who require further evaluation for PCD or primary immunodeficiency.

Anatomical variability of the sphenoid and ethmoid sinuses according to the computed tomography

The peculiarities of the structure of the cells of the lattice labyrinth and the sphenoid sinus were determined. On the basis of the Merefa CRH of the Kharkiv region 400 male and female patients aged 20 to 60 years were examined, which were divided into three age groups. Patients in all groups underwent CT scans for reasons unrelated to upper respiratory tract disease (suspected stroke, which was not confirmed, etc.). On the basis of CT studies, the structure parameters of the lattice and sphenoid sinuses were calculated and it was established that they largely depend on sex. One of the calculated parameters was the minimum wall density of the lattice and sphenoid sinuses. In both cases, it was found that in women this parameter was lower than in men. It was also found that some variants of the structure can serve as a substrate for the narrowing of the natural anastomosis, the deterioration of sinus ventilation and the emergence of inflammatory processes in them. Thus, the presence of a Galer cell significantly reduces the size of the message between the nasal cavity and paranasal sinuses. Most often among all variants of pneumatization of cells of a lattice labyrinth the frontal cell was defined, the Onodi's cell was the rarest. The volume of the cells of the lattice sinus was smaller in women than in men. Keywords: CT, рaranasal sinuses, ethmoid sinus, sphenoid sinus.

Novel Inactivated Subtype B Avian Metapneumovirus Vaccine Induced Humoral and Cellular Immune Responses.

Avian metapneumovirus (aMPV), a highly contagious agent, is widespread and causes acute upper respiratory tract disease in chickens and turkeys. However, currently, there is no vaccine licensed in China. Herein, we describe the development of an inactivated aMPV/B vaccine using the aMPV/B strain LN16. Combined with a novel adjuvant containing immune-stimulating complexes (ISCOMs), the novel vaccine could induce high virus-specific and VN antibodies. In addition, it activated B and T lymphocytes and promoted the expression of IL-4 and IFN-γ. Importantly, boosting vaccination with the inactivated aMPV/B vaccine could provide 100% protection against aMPV/B infection with reduced virus shedding and turbinate inflammation. The protection efficacy could last for at least 6 months. This study yielded a novel inactivated aMPV/B vaccine that could serve as the first vaccine candidate in China, thus contributing to the control of aMPV/B and promoting the development of the poultry industry.

Could BCG Vaccination Indeed Have a Key Role for Reducing the Spread and Mortality of COVID-19 Worldwide?

Dear Editor, COVID-19 is a new type of respiratory infection and might lead to serious pneumonia causing acute respiratory distress syndrome (ARDS). Most people infected with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) manifest as having asymptomatic or mild to moderate upper respiratory tract disease. However, a minority of all can have severe course and even death, especially elderly patients.1 Here, one of the possible reasons, BCG vaccination and its impact, causing this difference in a population is delineated more. Can BCG vaccine reprogram natural (innate) immunity and decrease spread of COVID-19? Since the first use of BCG vaccine in Europe in the 1920s, a serious decrease in infant mortality has been reported. It is not likely to explain this decline only with the decrease in tuberculosis frequency. The reason for this decrease in infant mortality was reported to be associated with decline in neonatal sepsis and respiratory infections. In another study, this hypothesis was supported by showing that the frequency of respiratory syncytial virus (RSV) infection reduced in population after BCG vaccine.2 In a South African study, 70 percent of BCG vaccinated adolescents had a decrease in respiratory infections as well. BCG application also reduced influenza A viral load in mice through affecting macrophages. Similarly, BCG vaccine increased the cytokines and peritoneal macrophages against many unrelated pathogens in mice. In the healthy population, BCG vaccination increased the release of proinflammatory cytokines (eg. IL-1β, TNF-α and IL-6).3 Could BCG vaccine be a weapon in reducing the morbidity and mortality of COVID-19? The countries such as Italy, Holland and USA applying non-universal BCG vaccination policies, it is noteworthy that COVID-19 progresses more severely, compared to the countries following the universal policy. In epidemiological studies, the rate and death of COVID-19 in countries where BCG vaccination applied was also quite lower than non-vaccinated countries. Statistical evaluation of the current data of both European countries and countries in the Northern and Southern Hemisphere, the incidence and mortality of COVID-19 per population was also found lower in BCG-vaccinated countries. If same countries were separately assessed, BCG vaccination has not been performed in Italy, England and France where mortality of COVID-19 was higher. Nevertheless the mortality rates were relatively lower in the countries (Qatar, Saudi Arabia and China); whose BCG vaccination rates in 2018 were very high at 99%, 98%, 99%; respectively.4,5 Although there are differences in genetic, demographic, non-pharmacological measures, diagnosis and reporting between nations, possible inverse direct relation between BCG vaccination and COVID-19 looks interesting. Severity of SARS-CoV-2 infection in elderly might be due to long time past after the BCG’s positive effect on innate immunity. Consistently, COVID-19 often manifests as asymptomatic/mildly symptomatic since shorter time passed in younger than in the elderly after BCG vaccination.

LEADERSHIP EMERGENCY PREPAREDNESS IN RELATLION TO COVID-19: A CASE STUDY IN WEST POKOT COUNTY

Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans, these viruses cause respiratory tract infections that can range from mild to lethal. Mild illnesses include some cases of the common cold (which is also caused by other viruses, predominantly rhinoviruses), while more lethal varieties can cause SARS, MERS, and COVID-19. Symptoms in other species vary: in chickens, they cause an upper respiratory tract disease, while in cows and pigs they cause diarrhea. There are as yet no vaccines or antiviral drugs to prevent or treat human coronavirus infections. Coronaviruses constitute the subfamily Orthocoronavirinae, in the family Coronaviridae, order Nidovirales, and realm Riboviria. They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses ranges from approximately 26 to 32 kilobases, one of the largest among viruses. They have characteristic club-shaped spikes that project from their surface, which in electron micrographs create an image reminiscent of the solar corona, from which their name derives The name coronavirus is derived from Latin corona, meaning crown or wreath, itself a borrowing from Greek κορώνη korṓnē, garland, wreath. The name was coined by June Almeida and David Tyrrell who first observed and studied human coronaviruses. The word was first used in print in 1968 by an informal group of virologists in the journal Nature to designate the new family of viruses. The name refers to the characteristic appearance of virions (the infective form of the virus) by electron microscopy, which have a fringe of large, bulbous surface projections creating an image reminiscent of the solar corona or halo. This morphology is created by the viral spike peplomers, which are proteins on the surface of the virus. Coronaviruses were first discovered in the 1930s when an acute respiratory infection of domesticated chickens was shown to be caused by infectious bronchitis virus (IBV). Arthur Schalk and M.C. Hawn described in 1931 a new respiratory infection of chickens in North Dakota. The infection of new-born chicks was characterized by gasping and listlessness. The chicks mortality rate was 40–90%. Fred Beaudette and Charles Hudson(1998) six years later successfully isolated and cultivated the infectious bronchitis virus which caused the disease In the 1940s, two more animal coronaviruses, mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), were isolated.[17] It was not realized at the time that these three different viruses were related. Human coronaviruses were discovered in the 1960s. They were isolated using two different methods in the United Kingdom and the United States. E.C. Kendall, Malcolm Byone, and David Tyrrell working at the Common Cold Unit of the British Medical Research Council in 1960 isolated from a boy a novel common cold virus B814 The virus was not able to be cultivated using standard techniques which had successfully cultivated rhinoviruses, adenoviruses and other known common cold viruses. In 1965, Tyrrell and Byone successfully cultivated the novel virus by serially passing it through organ culture of human embryonic trachea. The new cultivating method was introduced to the lab by Bertil Hoorn. The isolated virus when intranasally inoculated into volunteers caused a cold and was inactivated by ether which indicated it had a lipid envelope. Around the same time, Dorothy Hamre and John Procknow at the University of Chicago isolated a novel cold virus 229E from medical students, which they grew in kidney tissue culture. The novel virus 229E, like the virus strain B814, when inoculated into volunteers caused a cold and was inactivated by ether.

Bioregulatory therapy in the treatment and prevention of upper respiratory tract diseases in children

Influenza and other acute respiratory viral infections (ARVI) are among the most widespread infectious diseases, accounting for up to 90—95% annually in the structure of the registered infectious morbidity. According to the World Health Organization (WHO), every adult on average a year suffers from respiratory infections 2 times, a schoolchild — 3 times, a preschool child - 6 times. Currently, among this group of infections, only influenza is controlled by annual immunoprophylaxis. According to the results of numerous studies, it has been found that with timely vaccination, flu can be prevented in 80–90% of children and adults. It should also be noted that in the vaccinated, the disease proceeds in a milder form and without complications. Therefore, specific immunoprophylaxis against influenza is the most effective means of protecting a susceptible organism, helping to reduce the circulation of influenza viruses among the population, which makes it possible to recommend it for the general population. However, most of the viruses belonging to the ARVI group do not lend themselves to specific immunoprophylaxis, therefore, it is necessary to use non-specific means of preventing infections caused by respiratory viruses. In recent years, there has been a tendency for the widespread use of natural products, which include complex preparations of bioregulatory medicine. This approach is based on the concept of the complexity of diseases and is aimed at eliminating those dysregulation in biological networks that underlie diseases. The goal of bioregulatory medicine is to improve patient outcomes by maintaining the body’s ability to self-regulate. Drugs related to bioregulatory medicine have antiviral, immunomodulatory and cytoprotective effects. This group of drugs has practically no side effects and toxic effects, they do not create a pharmacological load on the organs of detoxification and excretion, therefore they can be recommended among the child population. This group of funds includes the drug Engystol®; Euphorbium compositum®, which is used for rhinitis, sinusitis and rhinosinusitis; Girel®, used as a symptomatic remedy for ARVI, including influenza. The article presents data on the effective use of bioregulatory medicine in the complex therapy and prevention of respiratory viral infections.

Рossibilities of clinical application of modern nebulizers

The simplicity of converting medicinal solutions and suspensions into aerosols using mechanical and thermal energy, convenient delivery to the airways allows nebulizers to take a worthy place in the treatment of hospitalized and outpatient patients. Different types of nebulizers are available for use in the home and in medical settings (jet, ultrasound, membrane), and researches show that the performance and characteristics of the aerosol vary between different devices and manufacturers. Jet nebulizers are still the most used devices that do not require coordination of inhale and delivery of aerosol to the respiratory tract. To reduce the consumption of medicinal aerosol and optimize the air flow, virtual valve technology (V.V.T.) is being improved, and breath-actuated nebulizers are being created. The advantage of nebulizer therapy is the ability to apply large doses of medications, use substances that exist only in inhaled form. The choice falls on the nebulizer in cases where the patient can not use other delivery devices, for example, if the patient is unable to coordinate the inhalation and intake of the drug into the respiratory tract, with a severe exacerbation of obstructive disease, in the presence of motor disorders. The optimal delivery device for children of any age, including newborns, is a nebulizer. The most common indication for nebulizer therapy is the delivery of bronchodilators and inhaled corticosteroids for asthma or chronic obstructive pulmonary disease, as well as the treatment of upper respiratory tract diseases, in particular croup in children. An important place is given to nebulizers when it is necessary to prescribe certain mucolytics and antibiotics. In the treatment of emergency conditions, inhalation administration of drugs may be required, including situations when the patient is on mechanical ventilation or has a tracheostomy installed. The significance of nebulizers in the treatment of cystic fibrosis, pulmonary arterial hypertension, and alpha-1-antitrypsin deficiency is being studied. The possibilities of endobronchial delivery of heparin, insulin, and monoclonal antibodies are evaluated.

Probiotic nasal spray development by spray drying

The upper respiratory tract (URT) is the main entrance point for many viral and bacterial pathogens, and URT infections are among the most common infections in the world. Recent evidences by our own group and others imply the importance of lactobacilli as gatekeepers of a healthy URT. However, the benefits of putting health-promoting microbes or potential probiotics, such as these URT lactobacilli, in function of URT disease control and prevention is underestimated, among others because of the absence of adequate formulation modalities. Therefore, this study entails important aspects in probiotic nasal spray development with a novel URT-derived probiotic strain by spray drying. We report quantitative and qualitative analysis of several spray-dried formulations, i.e. powders for reconstitution, based on disaccharide or sugar alcohol combinations with a polymer, including their long-term stability. Four formulations with the highest survival of >109 (Colony Forming Units) CFU/g after 28 weeks were further examined upon reconstitution which confirmed sufficiency of one bottle/dosage form during 7 days and rheological properties of shear-thinning. Tests also demonstrated maintained viability and cell morphology overall upon spraying through a nasal spray bottle in all 4 formulations. Lastly, application suitability in terms of high adherence to Calu-3 cells and antimicrobial activity against common URT pathogens was demonstrated and was not impacted neither by powder production process nor by spraying of reconstituted powder through a nasal spray device.

Remdesivir: From Ebola to COVID-19

Human coronaviruses (HCoV) were discovered in the 1960s and were originally thought to cause only mild upper respiratory tract diseases in immunocompetent hosts. This view changed since the beginning of this century, with the 2002 SARS (severe acute respiratory syndrome) epidemic and the 2012 MERS (Middle East respiratory syndrome) outbreak, two zoonotic infections that resulted in mortality rates of approximately 10% and 35%, respectively. Despite the importance of these pathogens, no approved antiviral drugs for the treatment of human coronavirus infections became available. However, remdesivir, a nucleotide analogue prodrug originally developed for the treatment of Ebola virus, was found to inhibit the replication of a wide range of human and animal coronaviruses in vitro and in preclinical studies. It is therefore not surprising that when the highly pathogenic SARS-CoV-2 coronavirus emerged in late 2019 in China, causing global health concern due to the virus strong human-to-human transmission ability, remdesivir was one of the first clinical candidates that received attention. After in vitro studies had shown its antiviral activity against SARS-CoV-2, and a first patient was successfully treated with the drug in the USA, a number of trials on remdesivir were initiated. Several had encouraging results, particularly the ACTT-1 double blind, randomized, and placebo controlled trial that has shown shortening of the time to recovery in hospitalized patients treated with remdesivir. The results of other trials were instead negative. Here, we provide an overview of remdesivir discovery, molecular mechanism of action, and initial and current clinical studies on its efficacy.

Novel Coronavirus 2019 Outbreak: A Global Epidemic

Background: In the 1960s, the human coronavirus was designated, which is responsible for the upper respiratory tract disease in children. Back in 2003, mainly 5 new coronaviruses were recognized. This study directly pursues to govern knowledge, attitude and practice of viral and droplet infection isolation safeguard among the researchers during the outbreak of the COVID-19. Introduction: Coronavirus is a proteinaceous and infectious pathogen. It is an etiological agent of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Coronavirus, appeared in China from the seafood and poultry market last year, which has spread in various countries, and has caused several deaths. Methods: The literature data has been taken from different search platforms like PubMed, Science Direct, Embase, Web of Science, who.int portal and complied. Results: Corona virology study will be more advanced and outstanding in recent years. COVID-19 epidemic is a threatening reminder not solely for one country but all over the universe. Conclusion: In this review article, we encapsulated the pathogenesis, geographical spread of coronavirus worldwide, also discussed the perspective of diagnosis, effective treatment, and primary recommendations by the World Health Organization, and guidelines of the government to slow down the impact of the virus are also optimistic, efficacious and obliging for the public health. However, it will take a prolonged time in the future to overcome this epidemic.

Changes in air quality and its effect on emergency admissions

INTRODUCTION: Air pollution is an emerging problem in developing countries as well as the world. Effects of air pollution due to short-term exposure may lead to increase in daily mortality, respiratory and cardiovascular hospital admissions, respiratory and cardiovascular emergency room admissions, respiratory and cardiovascular primary care visits and acute respiratory symptoms. The objective of our study was to examine the relationship between air pollution and diagnoses of patients in family medicine outpatient clinic located in emergency room. MATERIAL AND METHODS: Our study enrolled 17869 patients who were admitted to the family practice outpatient clinic implemented in emergency department. The relationship between patients’ diagnosis and air quality was examined. RESULTS: The genders of the patients were 50.8% female (n = 9077) and 49.2% male (n = 8792). The mean age was 43.9 ± 19.9. Respiratory system diagnosis showed a statistically significant relationship with the air quality measurement of PM10 (p < 0.05). Patients diagnosed with upper respiratory tract disease and fatigue and hypertension on sensitive air days were found to be significantly higher than those with good air quality. There was a statistical significance between air temperature, and fatigue and cough complaints (p < 0.05). CONCLUSIONS: For human health protection, continuity of life, and environmental sustainability, air pollution should be reduced and brought under control. In our study, with the increase of particulate matter, we observed that patients with respiratory system diseases, fatigue complaints, and hypertension increased. Sharing these results with province-wide authorities may help the settlement and industrial planning in the upcoming years.

Randomized clinical trial to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with respiratory disease using respiratory scoring and lung ultrasound

The primary objective of this randomized field study was to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with naturally occurring respiratory disease, using respiratory scoring and portable lung ultrasound. A secondary objective was to determine whether treatment response depended on clinical presentation at the time of diagnosis. Holstein calves (n = 357) were enrolled at 3 to 6 d of age and followed until 52 d on 2 commercial dairies. Calves were examined twice weekly by blinded members of the research team. Clinical respiratory and ultrasonographic lung scores were assigned at each exam and used to classify the first detected respiratory disease event (BRD1) into upper respiratory tract disease (clinical, no significant consolidation); subclinical lobular pneumonia (not clinical, patchy consolidation ≥1 cm2); clinical lobular pneumonia (clinical, patchy consolidation ≥1 cm2); subclinical lobar pneumonia (not clinical, ≥1 lobe consolidated); and clinical lobar pneumonia (clinical, ≥1 lobe consolidated). At BRD1, calves were blocked by their respiratory disease status and randomized to receive an antibiotic (tulathromycin, 2.5 mg/kg subcutaneous) or placebo (sterile saline, equal volume subcutaneous). Multivariable linear and logistic regression analyses were used to model response to therapy. At BRD1 (n = 289), the distribution of diagnoses was 29% (upper respiratory tract disease), 43% (subclinical lobular pneumonia), 13% (clinical lobular pneumonia), 8% (subclinical lobar pneumonia), and 7% (clinical lobar pneumonia). Early antibiotic therapy limited progression of lung consolidation immediately following treatment, reduced the likelihood of requiring treatment within 7 d of BRD1, and improved growth and mortality before weaning. Despite receiving multiple doses of antibiotics after BRD1, calves treated with either antibiotic or placebo were equally likely to enter the weaning phase with pneumonia. Clinical presentation was associated with response to treatment for worsening of consolidation, early treatment failure, days to retreatment, and average daily gain. Overall, treatment was associated with short-term benefits, but more research is needed to develop treatment protocols that more effectively treat pneumonia and ensure that calves enter the weaning period with ultrasonographically clean lungs.