Duration Of Cough Research Articles

Cough symptoms in children following COVID-19: a single-center retrospective study.

Cough is the most common respiratory symptom in children with mild coronavirus disease 2019 (COVID-19); however, evidence regarding the duration and severity of COVID-19-related cough is sparse. Herein, we investigated the correlation between cough severity/duration and disease duration in children with allergic diseases following COVID-19. This single-center, retrospective case-control study was conducted at the Department of Pediatrics, Peking University Third Hospital, from February 6-13, 2023. Children aged 0-16 completed a questionnaire survey collecting basic information and weekly cough scores for 8 consecutive weeks after COVID-19 in December 2022. The Kaplan-Meier method was used to draw event curves, and the log-rank method was used to compare inter-group differences. Stepwise regression was applied for multivariate analysis of correlations between age, sex, allergic diseases, and the degree and duration of cough following COVID-19. Overall, 686 children were included, of whom 183 (26.7%) had allergic diseases and 503 (73.3%) did not. Kaplan-Meier analysis identified significant differences between patients with and without allergic disease (log-rank test, P = 0.002) and between patients with no allergic disease and those with one and more than one allergic disease (log-rank test, P = 0.003). Multivariate regression identified a link between the presence of more than one allergic disease and coughing for >4 weeks after infection (P < 0.001). Allergic disease was the primary factor linked to cough symptoms lasting 8 weeks and cough severity (P < 0.001). Allergic disease contributes to the prolonged duration and severity of coughing in children with mild COVID-19.

Development of a machine learning model and nomogram to predict seizures in children with COVID-19: a two-center study.

This study aimed to use machine learning to evaluate the risk factors of seizures and develop a model and nomogram to predict seizures in children with coronavirus disease 2019 (COVID-19). A total of 519 children with COVID-19 were assessed to develop predictive models using machine learning algorithms, including extreme gradient boosting (XGBoost), random forest (RF) and logistic regression (LR). The performance of the models was assessed using area under the receiver operating characteristic curve (AUC) values. Importance matrix plot and SHapley Additive exPlanations (SHAP) values were calculated to evaluate feature importance and to show the visualization results. The nomogram and clinical impact curve were used to validate the final model. Two hundred and seventeen children with COVID-19 had seizures. According to the AUC, the RF model performed the best. Based on the SHAP values, the top three most important variables in the RF model were neutrophil percentage, cough and fever duration. The nomogram and clinical impact curve also verified that the RF model possessed significant predictive value. Our research indicates that the RF model demonstrates excellent performance in predicting seizures, and our novel nomogram can facilitate clinical decision-making and potentially offer benefit for clinicians to prevent and treat seizures in children with COVID-19.

Molecular characteristics and biofilm formation capacity of nontypeable Haemophilus influenza strains isolated from lower respiratory tract in children

With the widespread introduction of the Hib conjugate vaccine, Nontypeable Haemophilus influenzae (NTHi) has emerged as the predominant strain globally. NTHi presents a significant challenge as a causative agent of chronic clinical infections due to its high rates of drug resistance and biofilm formation. While current research on NTHi biofilms in children has primarily focused on upper respiratory diseases, investigations into lower respiratory sources remain limited. In this study, we collected 54 clinical strains of lower respiratory tract origin from children. Molecular information and drug resistance features were obtained through whole gene sequencing and the disk diffusion method, respectively. Additionally, an in vitro biofilm model was established. All clinical strains were identified as NTHi and demonstrated the ability to form biofilms in vitro. Based on scanning electron microscopy and crystal violet staining, the strains were categorized into weak and strong biofilm-forming groups. We explored the correlation between biofilm formation ability and drug resistance patterns, as well as clinical characteristics. Stronger biofilm formation was associated with a longer cough duration and a higher proportion of abnormal lung imaging findings. Frequent intake of β-lactam antibiotics might be associated with strong biofilm formation. While a complementary relationship between biofilm-forming capacity and drug resistance may exist, further comprehensive studies are warranted. This study confirms the in vitro biofilm formation of clinical NTHi strains and establishes correlations with clinical characteristics, offering valuable insights for combating NTHi infections.

Prognostic factors for tracheostomy early decannulation in acquired brain injury patients.

After severe brain injuries, a tracheostomy tube is usually inserted for respiratory support. This study aimed to clarify the prognostic factors for tracheostomy early decannulation in patients with acquired brain injuries. We retrospectively reviewed the medical records of inpatients with acquired brain injuries who underwent successful tracheostomy decannulation between March 2021 and June 2022. Fifty-six patients were included; median age was 68 (59-72) years; 28 (50%) were men; 28 (50%) underwent tracheostomy due to stroke. The median time to decannulation was 47 days. The patients were divided into the early and the late decannulation groups based on the median time, and compared. In univariate analysis, the early decannulation group had a higher BMI, peak cough flow, and acquired brain injuries due to trauma, and a lower penetration-aspiration scale score, duration of antibiotic use, and duration of oxygen use. Multivariate Cox regression analysis revealed that a higher initial peak cough flow [hazard ratio (HR) 1.142; 95% confidence interval (CI) 0.912-0.954; P < 0.001] and lower duration of oxygen use (HR 0.930; 95% CI 0.502-0.864; P = 0.016) were independent factors for early tracheostomy decannulation, with each unit increase in peak cough flow corresponding to a 14.2% increase and each additional day of duration of oxygen use corresponding to a 7.0% decrease in the likelihood of early decannulation. In conclusion, key prognostic factors for early tracheostomy decannulation were identified as the initial cough strength and duration of oxygen use. These results could play important role in decannulation plans for patients with tracheostomy tube.

Point of care lung ultrasonographic findings in patients with clinical diagnosis of severe childhood community acquired pneumonia in the tropics

Objectives: This study aimed at defining the Lung ultrasonographic (LUS) features of severe Childhood community-acquired pneumonia (CAP) in under-5s with clinical pneumonia, as well as the correlation between clinical and ultrasonographic findings. Materials and Methods: A prospective descriptive study conducted at the Children Emergency Ward of the University College Hospital (UCH), Ibadan, Nigeria over a 1-year period. Children aged 1month to 59 months, with clinical features of severe pneumonia were recruited for the study. LUS was done at the bedside. Ethical approval was obtained for the study. Results: There were 86 children with mean age ± SD of 13.59 ± 15.55 and 50 (58.1%) males. The highest number of patients (56, 65.1%) were in the 1-12-month age group. Ultrasonographic signs of pneumonia were detected in 68 (79.1%) of the children; 55(64%) had consolidation, 29(23.3%) showed florid B-lines and 20 (23.3%) had pleural fluid. Duration of cough, and crackles on auscultation were the only features that showed significant association with the LUS diagnosis of pneumonia. Conclusion: LUS is a good point of care diagnosis of CAP in under-5 children and it can be safely done at the bedside. It is therefore recommended as a first line imaging modality in children with clinical suspicion of CAP in the Tropics.

Efficacy and tolerability of SEDIFLÙ in treating dry or productive cough in the pediatric population (SEPEDIA): A pilot, randomized, double-blind, placebo-controlled, multicenter clinical trial.

The aim of this trial was to assess the effectiveness of Sediflù, a medical device containing active herbal ingredients, on nocturnal and diurnal persistent coughs in children, with a duration of 3 to 7 days. Children with a dry and/or productive cough were enrolled in this prospective, interventional, multicenter, placebo-controlled, double-blind, randomized clinical study. Clinical efficacy was assessed through the evaluation of the soothing action of Sediflù against dry and/or productive coughing, both at night and during the day, and other effects of coughing associated with quality of sleep: frequency, child's quality of sleep, parental quality of sleep and severity. Treatment with Sediflù improved both night-time and day-time cough scores from day 2. The diurnal score also improved significantly in the Sediflù group at days 3 and 7. Sediflù syrup can be considered a valid treatment for cough management in younger children with upper respiratory tract infections, shortening the cough duration.

Acute bronchitis: issues and options

Introduction. Acute bronchitis (AB) is a very common disease of viral etiology. In real-life practice, the treatment of AB is associated with widespread irrational antibiotic prescribing, which requires the overall implementation of patient management algorithms comprising the identification of biomarkers of inflammation, including C-reactive protein. Mucoactive therapy remains the mainstay of treatment for patients with AB, however the debate over the most effective treatments continues to this day. The emergence of new original drugs, in particular, Erdosteine, expands efficient therapeutic opportunities for AB.Aim. To analyse the clinical effectiveness of the use of the mucoactive agent Erdostein (Edomari) vs routine use of mucolytics in AB.Materials and methods. We reviewed the management of 60 patients with AB, 30 of which received Erdosteine (Group 1), the remaining 30 patients received standard mucoactive therapy (Acetylcysteine, Ambroxol, etc.). The following variables were assessed: the time required for reversal of all symptoms of the disease expressed as a total BSS scale score (Bronchitis Severity Score), the time required for reversal of productive cough that needs the use of mucolytics, the period of temporary disability, and levels of C-reactive protein.Results and discussion. The average CRP level at disease onset was 18.4 ± 8.2 mg/L. The average WBC count was 7.8 ± 3.5 (×109/l). In AB, the duration of productive cough in the Erdosteine group was 5.7 ± 1.4 days, while in group 2 (real-life practice) the duration of mucolytics therapy was 7.1 ± 1.3 days (p &lt; 0.05). The total BSS scale score in group 1 on day 7 was 3.2 ± 0.9, in group 2 – 3.5 ± 0.9. The reversal of physical signs of AB required 5.3 ± 1.2 days in the Erdosteine group, and 5.7 ± 1.4 days in group 2. The period of temporary disability in group 1 was 8.7 ± 1.2 days, in group 2 – 9.1 ± 1.3 days.Conclusion. Thus, we collected objective data supporting the possibility of using C-reactive protein test in deciding the issue of antimicrobial therapy prescribing. The CRP level observed (18.4 ± 8.2 mg/l) indicated a viral etiology of AB. The use of original Erdosteine (Edomari) in the treatment of acute bronchitis is estimated as highly effective. The average duration of effective mucolytics therapy in AB is 5–7 days.

Sex Differences in Chronic Cough Epidemiology: The Korean Cough Study Group.

Chronic cough is a common symptom encountered by healthcare practitioners. The global prevalence of chronic cough is 9.6%, with a female predominance. The aim of our study is to reveal the sex differences in prevalence and severity of chronic cough in South Korea, stratified by age and etiology. This study included adult patients with chronic cough who were recruited from 19 respiratory centers in South Korea. Patients completed the cough numeric rating scale (NRS) and COugh Assessment Test (COAT) questionnaire to assess the severity and multidimensional impact of cough. Among the 625 patients, 419 (67.0%) were females, with a male-to-female ratio of 1:2.03. The mean age was 49.4 years, and the median duration of cough was 12 weeks. The mean NRS and COAT scores were 5.5 ± 1.8 and 9.5 ± 3.6, respectively. Female patients were older (45.3 ± 15.4 vs. 51.6 ± 15.2, P < 0.001) and more likely to have asthma/cough variant asthma (CVA) (26.7% vs. 40.8%, P = 0.001) than male patients. There was no difference in the duration or severity of cough between sexes, regardless of the cause. The male-to-female ratio was lower for upper airway cough syndrome (UACS), asthma/CVA, and gastro-esophageal reflux disease (GERD), but not for eosinophilic bronchitis (EB) or unexplained cough. The mean age of female patients was higher in UACS and asthma/CVA, but not in EB, GERD, or unexplained cough. The majority (24.2%) fell within the age category of 50s. The proportion of females with cough increased with age, with a significant rise in the 50s, 60s, and 70-89 age groups. The severity of cough decreased in the 50s, 60s, and 70-89 age groups, with no significant sex differences within the same age group. The sex disparities in prevalence and severity of cough varied significantly depending on the age category and etiology. Understanding the specific sex-based difference could enhance comprehension of cough-related pathophysiology and treatment strategies.

The effect of topical drugs on the course of ARVI in children in modern conditions

The purpose of the study. To evaluate the results of using a drug based on benzidamine hydrochloride in the treatment regimens of acute respiratory viral infections in children today. Materials and methods. The study included 875 children aged 3 to 18 years with acute respiratory viral infections, which occurred in mild or moderate forms, and were treated on an outpatient basis. During the non-interventional study, a retrospective analysis of information from medical records was made. The main group included 318 children who were recommended therapy with a drug based on benzidamine hydrochloride, the comparison group included 557 children who received other topical drugs. Results. Recovery was statistically significantly earlier in the group receiving benzidamine hydrochloride: from the moment of initiation of therapy, the disease period in the main group was 6.78±1.72 days, while in the comparison group it was 1.34 days longer – 8.12±3.32. It was found that benzidamine hydrochloride significantly reduces the period of tickling and sore throat from 5.10±1.38 in the comparison group to 4.08±1.41 in the main group, hyperemia of the posterior pharyngeal wall – from 8.11±3.27 in the comparison group to 6.68±1.6 days in the main group, hyperemia of the tonsils – from 7.85±1.84 in the comparison group to 6.86±1.77 in the main group. Relief of dry cough was recorded in the group receiving benzidamine hydrochloride at 4.23±1.66 days, and in the group where other drugs were used – at 4.64±1.85 days. According to other indicators, no significant differences were found between the compared groups. Conclusion. The administration of a drug based on benzidamine hydrochloride as part of complex therapy statistically significantly, on average, reduces the total duration of acute respiratory viral infections in children from 3 years old by 1.34 days, reduces the period of tickling and sore throat by 1.08 days; by 1.43 days – visual manifestations of pharyngitis, by 1.0 days – tonsillitis; reduces the duration of dry cough.

Нутритивная поддержка у детей с внебольничными пневмониями

The nutritional status (NS) of a patient with an acute infectious disease often determines its course and prognosis. One of the factors involved in the formation and maintenance of NS is the state of the microbiome of various loci of the macroorganism. Such an integrated approach to the treatment of lower respiratory tract infections in pediatric practice has not been studied. Objective. Optimization of dietary therapy of children over 3 years old with out-of-hospital pneumonia based on the study of NS. Patients and methods. Eighty children (3–10 years old, 43 girls and 37 boys) hospitalized with out-of-hospital pneumonia of moderate severity in the children's infectious diseases department of the Khimki Regional Hospital were examined. The main group (40 children) received Resource® Clinutren® Junior product throughout hospitalization, the comparison group (40 children) received a standard diet. Additionally, the physical development of patients was assessed using the World Health Organization AnthroPlus program, Nutrishional Risk Screening (NRI). Bioimpedanceometry was performed daily (active cell mass (ACM) and fat mass were determined). The gut microbiome was examined by 16S genome sequencing before and after antibiotic therapy. Results. Protein metabolism disorders were recorded in 88.7% of children with out-of-hospital pneumonia in the acute febrile period according to bioimpedanceometry. By the time of discharge in children who received general-age nutrition, the decrease of ACM index remained in 57% of cases (23/40 of the comparison group). The use of Resource® Clinutren® Junior in children in the acute febrile period leads to the recovery of ACM already on the second day from the beginning of diet therapy. From the second day of observation, reliable differences between the number of children with normalization of temperature and appetite in the main group and the comparison group (57.5% &amp; 25%, p &lt; 0.01) were registered. Normalization of temperature was achieved in all children of the main group by the 4th day of hospitalization, in all children of the comparison group – by the 5th day. Normalization of appetite by the time of discharge was achieved in all patients of the main group and in 97.5% of patients of the comparison group. The duration of productive cough in the main group was shorter than in the experimental group (Me in the main group was 3 (IQR 2–4) days, in the comparison group – 4 (IQR 3–5.25) days. In the main group of patients who took specialized nutrition Resource® Clinutren® Junior, we observed a rarer development of antibiotic-associated syndrome (ASS) symptoms (45% &amp; 55%) and rapid relief of its manifestations (reduction of abdominal bloating in 47.5% of patients, reduction of diarrheal syndrome in 70% of cases). Analysis of 16S sequencing data demonstrated a more rapid recovery of beta diversity by reducing the proportion of diseaseassociated microorganisms. Conclusions. Connection of Resource® Clinutren® Junior product in the acute febrile period of out-of-hospital pneumonia in children 3 years and older from the first days of the disease leads to faster relief of the main symptoms of the disease, prevents the development of AAS due to normalization of protein metabolism indicators and restoration of intestinal microbiome. Key words: Resource® Clinutren® Junior, nutritional status, nutritional deficiency, nutritional support, bioimpedanceometry

Effect of the combination of oseltamivir, artificial cowbezoar, chlorphenamine maleate, and interferon nebulization on immune function in children with influenza

Purpose: To determine the effect of combining oseltamivir, artificial cow-bezoar, chlorphenamine maleate, and interferon inhalation on immune function and serum amyloid A (SAA) levels in children with influenza.&#x0D; Methods: A total of 114 children with influenza treated at the Second Affiliated Hospital of Hainan Medical University, Hainan Province, China from December 2019 to December 2022 were randomly divided into two groups, viz, study group (n = 57) and control group (n = 57). Control group received oseltamivir sodium chloride infusion, artificial cow-bezoar, and chlorphenamine maleate granules. Study group was treated with interferon alpha-1b in addition to control group treatment. Their clinical symptoms, duration of symptoms, immune function, SAA and C-reactive protein (CRP) levels were determined before and after treatment. Adverse reactions were also recorded.&#x0D; Results: Study group had a significantly shorter duration of fever, cough, sore throat, and nasal congestion after 5 days of treatment than control group (p &lt; 0.05). The study group also showed higher CD3+ and CD8+ levels and lower CD4+ and CD4+/CD8+ levels than control group after treatment. However, both groups showed lower levels of SAA, CRP, and SAA/CRP after treatment than before treatment (p &lt; 0.05). Furthermore, the levels of SAA, CRP, and SAA/CRP were lower in study group than in control group after treatment (p &lt; 0.05). The incidence of adverse reactions in the study group after treatment was significantly lower than in the control group (p &lt; 0.05).&#x0D; Conclusion: Quadruple therapy using oseltamivir, artificial cow-bezoar, chlorphenamine maleate, and interferon inhalation significantly shortens symptoms, boost immunity, lower SAA levels, and reduce side effects in children with influenza.

Introduction of a systematic examination framework for chronic cough: a before-after cohort study in a clinical setting

ABSTRACT Cough is a condition that can be caused by several different mechanisms. There are numerous guidelines for diagnosing the cause of cough, yet the effect of a well-constructed examination framework has not been investigated. At the Department of Internal Medicine, Lillebaelt Hospital, Vejle, a systematic examination framework for diagnosing cough was introduced. Two hundred consecutive patients referred to the pulmonary outpatient clinic with cough were included. The first 100 patients (Group 1) were included before implementation of the examination framework and diagnosed as usual. The next 100 patients (Group 2) were examined using the systematic framework. The primary endpoint was the number of appointments required to establish a diagnosis. A multivariable Poisson regression was performed, adjusting for age, sex, body mass index, pulmonary function (FEV1/FVC), duration of cough, and smoking status. A diagnosis was established within 1–2 visits in 47% in Group 1 compared to 83% in Group 2. When adjusting for confounders, fewer appointments was required to establish a diagnosis in Group 2 (Incidence rate ratio = 0.713 (95% confidence interval: 0.592–0.859), P = 0.000). Using a systematic examination framework for diagnosing cough may reduce the number of appointments required to establish a diagnosis, seemingly without compromising the diagnostic outcome.

Symptomatic treatment of cough in children

Cough is one of the most common symptoms in paediatric practice. Cough nature, duration, intensity, frequency, time and cause of occurrence should be considered in the differential diagnosis of its causes. Sputum evacuation disorders and changes in its rheological properties are indications for the prescription of mucoactive drugs. Despite the fact that the drugs included in this group have different mechanisms of action, all of them restore mucociliary clearance and lead to effective evacuation of secretions from the respiratory tract. Herbal medicinal products can be used along with classic mucoactive drugs (mucolytics, mucopegulators and mucokinetics). Ivy leaves are an example of a well-known and meticulously researched source of phytopharmaceutical products, they are included in the ESCOP monograph and entered into the positive list of the German Commission E. The efficacy and safety of ivy leaf products have been demonstrated in various controlled clinical studies. The authors presented a review of published clinical studies and non-interventional studies involving a total of 65,383 patients suffering from both acute and chronic respiratory diseases. The studies demonstrated the efficacy of ivy leaf extract preparations as achievement of a higher level of bronchodilation and surfactant production, which led to bronchospasmolytic, secretolytic, expectorant and, in turn, antitussive action. Herbal medicinal products are now actively used in the treatment of new coronavirus infection. Hedelix is one of the ivy leaf extract pharmaceutical preparations approved for use in children over the age of two years.

FRI563 Subacute Thyroiditis Is An Uncommon Cause Of Pyrexia Of Unknown Origin

Abstract Disclosure: N. Luke: None. D. Tay: None. Introduction: Subacute thyroiditis is a rare self-limiting inflammatory thyroid disorder often follows a viral infection. It is a diagnosis that is made clinically when patients present with typical features of anterior neck pain and thyrotoxic symptoms. We share our experience in unraveling a diagnostic challenge of a patient with an atypical presentation of subacute thyroiditis presenting with pyrexia of unknown origin during the Covid 19 pandemic. Clinical case: A 29 years old previously healthy Burmese domestic helper was admitted to a hospital in Singapore for persistent fever of 2 weeks duration associated with persistent sore throat. She had a brief 3 days duration of cough at the onset of fever with no other localizing infective symptoms. She had a booster dose of COVID 19 Moderna vaccination 6 months prior to her presentation with 2 preceding doses of Pfizer-BioNtech vaccine 12 months prior. She was empirically treated for acute pharyngitis with a course of intravenous antibiotics without improvement of her fever. Extensive workup for the fever was performed. A complete blood count showed monocytosis. Blood and urine cultures, urinalysis, COVID polymerase chain reaction (PCR), CMV, EBV, and HIV testing were negative. Respiratory multiplex PCR was negative for adenovirus, coronavirus, influenza, parainfluenza, respiratory syncytial virus, metapneumovirus, rhinovirus, chlamydia, mycoplasma, and Bordetella. CT of the thorax, abdomen, and pelvis was normal. She denied heat intolerance, weight loss, diarrhea, palpitations, or hand tremors. Clinical examination revealed mild anterior neck tenderness but no thyrotoxic features. There were no signs of Graves ophthalmopathy or pre-tibial myxoedema. Thyroid function tests were performed in view of persistent tachycardia which showed elevated free T4 at 51.6 pmol/L (12.7-20.3) with suppressed TSH &amp;lt;0.005 mIU/L (0.3-4.2). TSH receptor stimulating antibody levels (TRab) was elevated at 5.23IU/L (&amp;lt;1.76) and ESR was markedly elevated (115 mm/hr). Thyroid ultrasound showed homogeneous thyroid echotexture with no discrete suspicious nodules or abnormal vascularity. She was started on non-steroidal anti-inflammatory drug (Etoricoxib) with resolution of her fever and neck pain Clinical lesson: Clinicians should be aware that subacute thyroiditis can be a rare cause of pyrexia of unknown origin even in the absence of typical features. Presentation: Friday, June 16, 2023

Assessment of radio(chemo)therapy-related dysphagia in head and neck cancer patients based on cough-related acoustic features: a prospective phase II national clinical trial (ACCOUGH-P/A trial)

BackgroundRadiation-associated dysphagia is defined as impaired swallowing efficiency/safety following (chemo)radiotherapy in head and neck cancer patients. In a dysphagia framework, impaired coughing may lead to lung aspiration and fatal lung infection. Although cough efficacy is a predictor of the risk of aspiration, cough investigation is minimal in patients with radiation-associated dysphagia. Because cough is a transient signal, existing software for speech analysis are not appropriate. The goal of our project is to develop an assessment method using acoustic features related to voluntary and reflexive coughs as biomarkers of the risk of penetration/aspiration in patients with radiation-associated dysphagia.MethodsHealthy subjects and head and neck cancer patients with and without dysphagia will produce voluntary coughs, throat clearings and reflexive coughs. Recordings will be made using an acoustic microphone and a throat microphone. The recorded signals will be manually segmented and subsequently analysed with a software under development. Automatic final segmentation enables to measure cough duration. The first method of analysis includes temporal features: the amplitude contour, the sample entropy and the kurtosis. These features report respectively the strength, the unpredictability (turbulence noise due to the air jet) and the impulsive quality (burst) of the signal. The second method of analysis consists of a spectral decomposition of the relative cough signal energy into several frequency bands (0–400 Hz, 400–800 Hz, 800–1600 Hz, 1600–3200 Hz, > 3200 Hz). The primary outcome of this exploratory research project is the identification of a set of descriptive acoustic cough features in healthy subjects as reference data (ACCOUGH). The secondary outcome of this research in head and neck cancer patients with radiation-associated dysphagia includes the identification of (1) a set of descriptive acoustic cough features as biomarkers of penetration-aspiration (ACCOUGH-P/A), (2) swallowing scores, (3) voice features and (4) aerodynamic cough features.DiscussionThis study is expected to develop methods of acoustic cough analysis to enhance the assessment of radiation-associated dysphagia in head and neck cancer patients following (chemo)radiation.Trial registrationInternational Standard Randomized Controlled Trials Number (ISRCTN) registry ISRCTN16540497. Accepted on 23 June 2023.

Patient Global Impression of Severity Scale in Chronic Cough: Validation and Formulation of Symptom Severity Categories

The Patient Global Impression of Severity (PGI-S) scale is a self-reported, single-item categorical scale that is increasingly used when assessing chronic cough (CC). This study aimed to establish validity, repeatability, and responsiveness of the PGI-S scale in CC and use the scale to define discrete categories of severity when measured with other commonly used patient-reported outcome (PRO) tools. Consecutive patients with CC completed the PGI-S scale, cough severity and urge to cough visual analog scales (VAS), and cough-specific health status Leicester Cough Questionnaire (LCQ) at a clinic visit. Validity, repeatability, and responsiveness were assessed, and threshold scores for PRO severity categories determined. A total of 482 participants completed the assessments; the median (interquartile range [IQR]) age was 57 (46-67) years, 71% were female, and the median (IQR) duration of cough was 48 (24-120) months. They reported a median (IQR) PGI-S score of 3 (3-4; moderate severity), cough severity VAS of 57 (31-75) mm, urge to cough VAS of 62 (40-81) mm, and LCQ of 11.5 (8.7-14.4). There were strong associations between PGI-S scores and cough severity VAS (ρ= 0.81), urge to cough VAS (ρ= 0.73), and LCQ (ρ=-0.73) (all P < .001). Repeatability of the PGI-S scale was high (n= 77); the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.77-0.91) (P < .001). The PGI-S scale was responsive in participants with a treatment response (P< .001). The suggested PRO thresholds to define severe cough are ≥61 mm (cough severity VAS), ≥71 mm (urge to cough VAS), and ≤10 (LCQ). The PGI-S scale is a simple and valid tool that characterizes cough severity and is repeatable and responsive in CC. The proposed categorical severity thresholds for VAS and LCQ can provide intuitive meaning for patients and clinicians.

Predictors of treatment response to pregabalin in unexplained or refractory chronic cough

BackgroundPatients with chronic cough (>8 weeks) often remain symptomatic after appropriate investigations and therapeutic trials. Prior research has shown a benefit in certain individuals from pregabalin, but clinical improvement is quite unpredictable and variable. ObjectiveThe main objective of this study was to identify the demographic and clinical characteristics associated with a higher likelihood of cough improvement with a trial of pregabalin therapy. Methods50 consecutive patients with chronic cough were enrolled in this prospective cohort study. Subjects were prescribed pregabalin 75 mg oral qhs for 4 weeks followed by 75 mg oral bid. Leicester Cough Questionnaire (LCQ) was completed at treatment initiation and after 3 months of therapy. A comparison was performed between treatment responders (LCQ total score improvement ≥1.3) and non-responders. Results56% of patients reported a LCQ total score improvement ≥1.3 (minimal clinically important difference). Responders to pregabalin therapy were more likely to have refractory (with underlying pulmonary disease) versus unexplained chronic cough (p = 0.01). Patients with significant improvement were also on average more symptomatic at baseline (mean LCQ total score 10.2 versus 13.0, p < 0.01). No significant relationship was identified with age, gender, body mass index, history of anxiety and/or depression, cigarette smoking history, or cough duration (p > 0.05). The unexplained chronic cough group had a strong female predominance (85.7% versus 40.9% for refractory cough, p < 0.01). ConclusionThis is the first study that has investigated clinical predictors of treatment response to pregabalin in chronic cough patients. Further research is needed to develop therapies for subjects who do not improve with currently available neuromodulating medications.

Effects of bepotastine, a nonsedating H1-antihistamine, for the treatment of persistent cough and allergic rhinitis: a randomised, double-blind, placebo-controlled trial.

Empirical therapy with oral histamine-1 receptor antagonists (H1RAs) is often used for patients with suspected upper airway cough syndrome. No placebo-controlled trials with nonsedating H1RAs (nsH1RAs) have evaluated validated cough outcomes. The objective of the present study was to assess the effect of an nsH1RA, bepotastine, on cough outcomes in patients with allergic rhinitis and persistent cough. A randomised, double-blind, placebo-controlled trial was conducted. Adult patients with persistent cough (>3 weeks in duration) and symptomatic allergic rhinitis were recruited and randomly assigned to receive either bepotastine or placebo at a 1:1 ratio. The primary outcome was cough-specific quality of life assessed using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included cough severity visual analogue scale (VAS), throat VAS, Cough Hypersensitivity Questionnaire, Sinonasal Outcome Test-22 score and drug adverse events. Between October 2021 and September 2022, 50 participants (43 females; mean age 46.28 years; median cough duration 3 months) were assigned to either the bepotastine 10 mg twice daily or placebo group in a 1:1 ratio. After 2 weeks of treatment, both bepotastine and placebo groups showed significant improvements in the LCQ scores, but there was no significant difference in the magnitude of change between the groups (3.45±2.10 versus 3.04±2.94, p=0.576). Secondary outcomes were also comparable. Despite the relatively small sample size, our study clearly demonstrated that a 2-week treatment with bepotastine did not provide therapeutic benefits for cough outcomes. These findings suggest against the use of nsH1RAs with the intention of improving cough outcomes, even in patients with persistent cough and allergic rhinitis.

Prevalence, drug-susceptibility pattern and associated factors of Mycobacterium tuberculosis infection among prisoners in western Arsi zonal prisons, Oromia, South West Ethiopia

ObjectivesEach year, tuberculosis (TB) in prisons is a major worldwide health concern that results in millions of diseases. It is particularly prevalent in low socio-economic countries like Ethiopia because of the poverty, overcrowding, starvation, lack of access to basic healthcare services, and high prevalence of HIV infection in these countries. MethodsA cross-sectional study with 259 prisoners was carried out in the western Arsi zonal prison from November to January 2021. The sputum samples were taken from suspected TB patients and evaluated using the Gene Xpert Mycobacterium tuberculosis/rifampcine test. Line probe assay was used to assess the molecular drug susceptibility of isolates from positive sputum. A bivariate and multivariate logistic regression was analyzed using SPSS version 24 packages. Odds ratio (OR) and corresponding 95% CI were used to quantify the degrees of association between target potential risk factors and Mycobacterium tuberculosis positivity. P-value of less than 0.05 was considered statistically significant. ResultsThe prevalence of undiagnosed pulmonary TB (PTB) verified positive cases was 5.4% (95% CI 2.7, 8.5) out of 259 research participants that were recruited in this study. One (0.38%) occurrence of mono-drug resistance to isoniazid was found among them. In this study, variables that were significantly linked with PTB positive were age ≥30 years, smoking (adjusted OR [AOR] = 0.087, 95% CI = 0.01-0.93, P = 0.043), body mass index 18.5 kg/m2, cough duration 4 weeks (AOR = 0.03, 95% CI = 0.1-0.13 P = 0.001), and coughing before incarceration (AOR = 6.2, 95% CI = 3.6-10.59, P = 0.004). ConclusionIn West Arsi zonal prisons, PTB and mono-drug resistance for isoniazid were found to be more common than in the general population.

The value of the wireless stethoscope in patients with COVID-19 infection in a makeshift hospital

ObjectiveWhen COVID-19 sweeps the world, traditional stethoscopes are seen as infectious agents and then the use of stethoscopes is limited especially when health providers were in their personal protective equipment. These reasons led to the ignoring of the values of stethoscopes during pandemics. This study aims to explore the value of wireless stethoscopes in patients of a makeshift hospital.Material and methods200 consecutive hospitalized patients with confirmed SARS-CoV-2 at Lingang Makeshift Hospital in Shanghai, China, were enrolled from April 10 to May 10, 2022 (Trial Registration Number: ChiCTR2000038272,2020/9/15). They were randomly divided into two groups. In group A (n = 100), patients were examined without a stethoscope. In group B (n = 100), lung breath sounds and heart sounds were examined with a wireless stethoscope, and positive signs were recorded. The duration of cough and tachycardia symptoms, as well as emergency cases, were compared between the two groups. In addition, the pressure, anxiety, and depression of patients in the two groups were investigated using the DAS-21 questionnaire scale, to observe the psychological impact of the stethoscope-based doctor–patient communication on patients in the makeshift hospital.ResultsThere was no significant difference in baseline characteristics between the two groups. In group B, some significant positive signs were detected by wireless stethoscopes, including pulmonary rales and tachycardia, etc. Moreover, the therapeutic measures based on these positive signs effectively alleviated the symptoms of cough and tachycardia, which showed that the duration of symptoms was significantly shorter than that of group A (cough: 2.8 ± 0.9 vs. 3.6 ± 0.9; palpitation: 1.4 ± 0.7 vs. 2.6 ± 0.7). In particular, the number of emergency cases in group B is less than that in group A (1% vs. 3%), and the severity is lower. Notably, stethoscope-based doctor–patient communication was found to be effective in alleviating psychological measures of group B patients.ConclusionWireless stethoscopes in makeshift hospitals can avoid cross-infections and detect more valuable positive signs, which can help health providers make accurate decisions and relieve patients' symptoms more quickly. Moreover, stethoscope-based doctor–patient communication can diminish the psychological impacts of the epidemic on isolated patients in makeshift hospitals.Trial registration This study was registered in the Chinese Clinical Trial (ChiCTR2000038272) at http://www.chictr.org.cn. http://www.chinadrugtrials.org.cn/clinicaltrials.searchlistdetail.dhtml.