Frequent Respiratory Infections Research Articles

Рекурентні епізоди гострого обструктивного ларингіту в дітей: можливі причини та підходи до профілактики

Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup. Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention. Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years. Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (>6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D>30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D>30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29). Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to >30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: recurrent episodes, viral croup, children, causes, prevention.

Impact of Septoplasty on Oxidative DNA Damage Levels in Patients with Marked Nasal Septal Deviation

Objectives:Nasal septal deviation (NSD) is a common dilemma which cause nasal obstruction. Septoplasty is usually accomplished to solve nasal obstruction in patients with NSD. NSD is related strongly with hypoxia. Hypoxic conditions increase oxidative DNA damage in cells. This study aimed to investigate the effect of septoplasty on the level of antioxidant agents in patients with marked NSD. Methods: Sixty-one patients who submitted to septoplasty were involved in our prospective investigation. Results: The difference between the pre- and postoperative levels of MDA and 8-OHdG/106 dG was statistically significant. Conclusions: Septoplasty is an elective surgery performed to prevent the decrease in quality of life due to nasal obstruction and frequent respiratory tract infections in patients with NSD. As seen in this study, septoplasty is an urgent surgery that should be performed urgently to prevent DNA damage in patients with NSD

Zakażenia układu oddechowego o etiologii atypowej

The frequency of respiratory infections, especially atypical pneumonia, is increasing significantly. Most often, atypical pneumonia is caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae. Human is the only reservoir of these atypical bacteria. The infection occurs via droplets or direct contact with a sick person or convalescent. Pneumonia of the etiology of Mycoplasma pneumoniae and Chlamydophila pneumoniae most often affects children without comorbidities and is usually mild, while most patients with Legionella infection require intensive care treatment. Symptoms of mycoplasma infection can range from mild symptoms in the upper respiratory tract to pneumonia and extrapulmonary symptoms. The infection is often underdiagnosed, and patients usually do not seek medical attention and treatment. Chlamydial pneumonia is, in most cases, mild, similar to Mycoplasma pneumoniae, and tends to heal itself. The drugs of choice in the treatment of atypical pneumonia are macrolides, and because of the best compliance in children – azithromycin.

Epidemic process of respiratory infections and particulate matter as a route for transmission of multidrug-resistant microorganisms in medical organisations

Aim. To study the trends in the prevalence of respiratory tract infections in the population of Kemerovo Region and to interrogate the particulate matter as a possible route for the transmission of multidrug-resistant microorganisms into medical organisations.Materials and Methods. We investigated the prevalence of acute respiratory infections and community-acquired pneumonia among the population of Kuzbass (Kemerovo Region) according to the offcial medical records collected from 2004 to 2020. The study included 10,320,384 cases of acute respiratory infections, 145,357 cases of community-acquired pneumonia, 344,703 hospitalisations of the adults (subjects ≥ 18 years of age) and 75,041 hospitalisations of children (< 18 years of age). Collection of particulate matter samples (n = 97) was performed using sterile gloves and containers from ventilation grilles and adjacent air ducts of the exhaust ventilation systems in various healthcare settings. Bacterial composition of the dust was examined using a VITEK 2 Compact biochemical analyzer. Viral diversity was screened by polymerase chain reaction.Results. Over the study period, respiratory infections were common in Kemerovo Region (average prevalence 22,155.9 per 100,000 population) and showed an increasing incidence. Frequency of respiratory infections among the hospitalised patients was 207.14 per 1,000, being 1.63-fold higher in children than in adults (304.15 and 186.02, respectively). In 2020, the proportion of cefotaxime-resistant Klebsiella spp. was 26.20% that was strikingly high compared to 2019. Hospital particulate matter frequently (71.13% samples) harboured multidrug-resistant microorganisms.Conclusions. High prevalence and morbidity from respiratory infections in Kemerovo Region are combined with high prevalence and biodiversity of airborne microorganisms, in particular multidrug-resistant microbes contaminating the hospital particulate matter.

Lessons Learned From the Clinical Presentation of Common Variable Immunodeficiency Disorders: A Systematic Review and Meta-Analysis.

BackgroundDiagnostic delay in common variable immunodeficiency disorders (CVID) is considerable. There is no generally accepted symptom-recognition framework for its early detection.ObjectiveTo systematically review all existing data on the clinical presentation of CVID.MethodsPubMed, EMBASE and Cochrane were searched for cohort studies, published January/1999-December/2019, detailing the clinical manifestations before, at and after the CVID-diagnosis.ResultsIn 51 studies (n=8521 patients) 134 presenting and 270 total clinical manifestations were identified. Recurrent upper and/or lower respiratory infections were present at diagnosis in 75%. Many patients had suffered severe bacterial infections (osteomyelitis 4%, meningitis 6%, septicemia 8%, mastoiditis 8%). Bronchiectasis (28%), lymphadenopathy (27%), splenomegaly (13%), inflammatory bowel disease (11%), autoimmune cytopenia (10%) and idiopathic thrombocytopenia (6%) were also frequently reported. A bimodal sex distribution was found, with male predominance in children (62%) and female predominance in adults (58%). 25% of CVID-patients developed other manifestations besides infections in childhood, this percentage was much higher in adults (62%). Immune-dysregulation features, such as granulomatous-lymphocytic interstitial lung disease and inflammatory bowel disease, were more prominent in adults.ConclusionsThe shift from male predominance in childhood to female predominance in adults suggests differences in genetic and environmental etiology in CVID and has consequences for pathophysiologic studies. We confirm the high frequency of respiratory infections at presentation, but also show a high incidence of severe bacterial infections such as sepsis and meningitis, and immune dysregulation features including lymphoproliferative, gastrointestinal and autoimmune manifestations. Early detection of CVID may be improved by screening for antibody deficiency in patients with these manifestations.

Altered Macrophage Function Associated with Crystalline Lung Inflammation in Acid Sphingomyelinase Deficiency.

Deficiency of ASM (acid sphingomyelinase) causes the lysosomal storage Niemann-Pick disease (NPD). Patients with NPD type B may develop progressive interstitial lung disease with frequent respiratory infections. Although several investigations using the ASM-deficient (ASMKO) mouse NPD model revealed inflammation and foamy macrophages, there is little insight into the pathogenesis of NPD-associated lung disease. Using ASMKO mice, we report that ASM deficiency is associated with a complex inflammatory phenotype characterized by marked accumulation of monocyte-derived CD11b+ macrophages and expansion of airspace/alveolar CD11c+ CD11b- macrophages, both with increased size, granularity, and foaminess. Both the alternative and classical pathways were activated, with decreased in situ phagocytosis of opsonized (Fc-coated) targets, preserved clearance of apoptotic cells (efferocytosis), secretion of Th2 cytokines, increased CD11c+/CD11b+ cells, and more than a twofold increase in lung and plasma proinflammatory cytokines. Macrophages, neutrophils, eosinophils, and noninflammatory lung cells of ASMKO lungs also exhibited marked accumulation of chitinase-like protein Ym1/2, which formed large eosinophilic polygonal Charcot-Leyden-like crystals. In addition to providing insight into novel features of lung inflammation that may be associated with NPD, our report provides a novel connection between ASM and the development of crystal-associated lung inflammation with alterations in macrophage biology.

Chlamydial Infections (Intracellular Infection) in the Development of Bronchitis (Review)

Respiratory diseases dominate in the pathology of childhood, having a significant impact on child mortality and causing the formation of persistent deviations in the health status of children. The high prevalence of acute respiratory infections among children is an important social problem, the solution of which is one of the main tasks of public health in pediatrics. It is known that children with frequent acute respiratory infections are at risk of developing acute bronchitis, bronchiolitis, the formation of recurrent bronchitis, including obstructive forms, and chronic bronchopulmonary pathology.

EVALUATION OF ASSOCIATED RISK FACTORS IN CHRONIC SUPPURATIVE OTITIS MEDIA PATIENTS REPORTED IN COMMUNITY HEALTH CENTER, CHENANI

Background: Chronic suppurative otitis media or CSOM is characterized by recurrent or persistent ear discharge, or otorrhoea, for a period of 2 to 6 weeks, through the tympanic membrane perforation. Studies often present a varying incidence of CSOM, but it is the most important cause of deafness in India. Risk factors are mainly associated with low socioeconomic status, crowded atmosphere, low parental education level, poor nutrition, frequent upper respiratory tract infection and chronic diseases. Methods: A retrospective- observational study of 300 patients of CSOM, selected from OPD of the Department of Otorhinolaryngology, CHC, Chenani, Udhampur, Jammu, J&K, was conducted during August 2018 to January 2019. Detailed clinical examination was done and statistical socio-demographic analysis was performed. Associated factors of CSOM were also recorded and a resultant chart was obtained. Results: Our study showed that urban as well as rural poor were equally affected population. Highest incidence found in the range of 11 to 20 years (36.67%), with only 54 (17.67%) cases reported for age group: 41 and above. 55.33% of cases pertained to lower Socio-economic status with major occupational incidence amongst urban labour class (82/300, i.e. 27%). The major contributing factor for CSOM came out to be the crowded living conditions (52.0%) and aseptic and unsupervised handling or ears (49.0%). Conclusions: Congestion and crowded household, bathing in contaminated ponds and canals, unsterile ear piercing, constituted significant risk factors, therefore preventive strategies and awareness program, based upon the above, should be planned to counter the burden of CSOM. Key words: Chronic Suppurative Otitis Media (CSOM), Ear Discharge, Socio-demographic Status

Tobacco, alcohol use and other risk factors for developing symptomatic COVID-19 vs asymptomatic SARS-CoV-2 infection: a case-control study from western Rajasthan, India.

BackgroundUnderstanding risk factors of symptomatic coronavirus disease 2019 (COVID-19) vis-à-vis asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severe disease and death is important.MethodsAn unmatched case–control study was conducted through telephonic interviews among individuals who tested positive for SARS-CoV-2 in Jodhpur, India from 23 March to 20 July 2020. Contact history, comorbidities and tobacco and alcohol use were elicited using standard tools.ResultsAmong 911 SARS-CoV-2-infected individuals, 47.5% were symptomatic, 14.1% had severe COVID-19 and 41 (4.5%) died. Older age, working outside the home, cardiac and respiratory comorbidity and alcohol use were found to increase the risk of symptomatic disease as compared with asymptomatic infection. Current tobacco smoking (odds ratio [OR] 0.46 [95% confidence interval {CI} 0.26 to 0.78]) but not smokeless tobacco use (OR 0.81 [95% CI 0.55 to 1.19]) appeared to reduce the risk of symptomatic disease. Age ≥60 y and renal comorbidity were significantly associated with severe COVID-19. Age ≥60 y and respiratory and cardiac comorbidity were found to predispose to mortality.ConclusionsThe apparent reduced risk of symptomatic COVID-19 among tobacco smokers could be due to residual confounding owing to unknown factors, while acknowledging the limitation of recall bias. Cross-protection afforded by frequent upper respiratory tract infection among tobacco smokers could explain why a similar association was not found for smokeless tobacco use, thereby being more plausible than the ‘nicotinic hypothesis’. Those with comorbidities and age ≥60 y should be prioritized for hospital admission.

Роль биопленок в развитии и хронизации ЛОР-патологии и способы воздействия на них

The improvement of treatment efficacy for any disorder, including infectious diseases, is one of the most important tasks for current medicine. One of possible ways to achieve it is to find some therapeutic agents that can affect microbial biofilms, since they have been shown to play an important role in the development of 80% of diseases, including chronic ones. So far, there have been no optimal methods of destroying biofilms. In this article, we discuss non-antibiotic treatments with antibiofilm activity in the upper respiratory tract mucosa. Essential oils (EOs) and their complexes are a promising treatment for patients with infectious diseases. They have been used in dental and gynecological practice, treatment of infections of the urinary and upper respiratory tracts (rhinitis, sinusitis, nasopharyngitis) and demonstrated their effectiveness. The antibacterial activity of EOs from plants depends on the complexity of the composition of a specific EO complex and the type of microorganism. We provide the evidence of the efficacy of the EO complex "Maslo Dyshi" (Akvion, Russia), whose antibiofilm activity was demonstrated by Russian scientists on the model with mycobacterial (MBT) biofilms and compared with EOs used alone (eucalyptus, pine, bergamot). The authors proved complete suppression of various biofilm states in all studied MBT strains exposed to vapors of the EO complex "Maslo Dyshi" (high antibacterial and antibiofilm activity), probably associated with the synergistic effect of EOs included in the complex. The bactericidal activity of a similar EO composition was evaluated in a German study, which demonstrated that mint and cajuput oils had the highest activity. This study also ranked activity of all EOs included in a complex similar in its composition to "Maslo Dyshi" and emphasized its association with the exposure time and concentration, since EOs evaporate over time. We discuss the results of studies that demonstrated virucidal activity of "Maslo Dyshi" against influenza virus, rhinovirus, adenovirus, and respiratory syncytial, as well as its clinical activity. All authors reported decreased frequency and duration/number of complications of viral infections, including that in children with frequent respiratory infections. New data on the antibiofilm activity of this EO complex opens new horizons for its use in outpatient clinical practice. Key words: biofilm, children with frequent respiratory infections, acute respiratory infections

Состояние кишечной микробиоты и местного иммунного ответа желудочно-кишечного тракта у часто болеющих детей, находящихся в трудной жизненной ситуации

During evolution, microorganisms and humans have evolved to live in symbiosis with each other. The microbiome, in particular the intestinal microbiota that includes bacteria, archaea, fungi, viruses, their metabolites and genomic elements, plays an essential role in maintaining homeostasis. Alterations in the microbiome composition have been shown to affect the immune system of the host, triggering not only infectious, inflammatory or allergic intestinal pathology, but also frequent recurrent infections of the respiratory tract and ENT organs. Objective. To analyze intestinal microbiota and local immune response in the gastrointestinal tract among young children with frequent respiratory infections, who are in a difficult life situation (in an orphanage) in order to identify possible pathogenetic association between intestinal dysbiosis and inadequate immune responses. Patients and methods. In the period between October 2018 and May 2019, residents of the specialized psychoneurological orphanage (PNDR) in St. Petersburg were examined. To carry out the study, 46 respondents with health groups II-III aged from 11 to 36 months were selected. The average age was 21.2 ± 6.75 months. Among them were 25 (54.34%) boys and 21 (45.6%) girls. When analyzing the incidence of acute respiratory infections, we took into account the severity of each episode, its duration, complications, the need for antimicrobial therapy, and hospitalization of the child. All results were recorded on specially designed record forms. Results. The analysis of medical record confirmed that the incidence of acute respiratory infections in children living in the orphanage is higher than that among children living in families. Respondents with an altered state of the nose and oropharynx usually had longer episodes of respiratory infections and more frequent complications. These patients were also found to have severe diversification of the intestinal microbiota and less pronounced mucosal immune response of the intestinal mucosa as demonstrated by bacteriological examination of feces and testing of fecal filtrates using ELISA. We discuss the effectiveness of fermented dairy products enriched with probiotics and prebiotics with a proven effect on the local immunity. Conclusion. Our findings suggest possible association between dysbiosis and inadequate local and systemic immune response. Key words: intestinal microbiota, mucosal immune response, secretory immunoglobulin A (sIgA), children with frequent respiratory infections, fermented dairy products, probiotics, prebiotics

Проблемы вакцинации и пути ее оптимизации: обзор рандомизированных клинических исследований Анаферона детского

In this article, we discuss the problem of improving vaccination efficacy in children using an antiviral drug with an immunomodulatory effect Anaferon for children produced in Russia. We analyzed the results of randomized clinical trials (RCTs) evaluating the efficacy and safety of Anaferon for children during vaccination against influenza and pneumococcal infection, including that in children with frequent respiratory infections. According to RCT, Anaferon for children used for the prevention of acute respiratory viral infections (ARVI) in combination with specific immunoprophylaxis of influenza and pneumococcal infection, increased the vaccination coverage by reducing the frequency of ARVI episodes before vaccination period and facilitating the development of an adequate immune response after vaccination. Anaferon for children also demonstrated a good safety profile. We described the schemes of ARVI/influenza prevention: 1 tablet a day for 2–4 weeks before vaccination with possible continuation after vaccination for up to 3 months, depending on the clinical situation during the development of active immunity. The results of RCTs and many years of experience allow us to recommend Anaferon for children combination with specific immunoprophylaxis to optimize the vaccination campaign, especially in children with low resistance to infections. It is particularly important during the pandemic of new coronavirus infection. Key words: vaccination, Anaferon for children, prevention, acute respiratory viral infections

Konjenital Nötropenili Çocuklarda Enfeksiyon Ataklarının, Tedavi ve Uzun Dönem Sonuçlarının Değerlendirilmesi

Objective: Infections are an important cause of morbidity and mortality for patients with congenital neutropenia. In the present study, we report on the incidence, type, localization of documented infections, as well as the clinical features and long-term outcome in patients with congenital neutropenia in our clinic. Method: We performed a retrospective chart review of children with neutropenia seen at our hospital from 2000-2018. The data of 15 patients with congenital neutropenia were included in this study. Clinical and laboratory data were analyzed retrospectively using patients’ files and an electronic data system. Results: The median age at diagnosis was 34 months (range, four months- 150 months) and the median follow-up time was 48 months (range, 13-179 months). The leading causes of hospital admission before the establishment of the diagnosis were upper respiratory tract infection in six, pneumonia in four, gingival stomatitis in three and soft tissue infection in two patients. We reached the documented 74 hospitalization episodes and the most common reasons for hospitalization were pneumonia (35%), fever (21%), stomatitis (16%), cutaneous and deep soft tissue infections (12%). Conclusion: The management of infectious complications in children with congenital neutropenia is crucial. Early diagnosis is essential to prevent infections and permanent organ damage. Congenital neutropenia should be suspected in patients with a history of frequent upper respiratory tract infection, and necessary investigations should be performed accordingly. However, it should be kept in mind that the clinical findings of the patients may vary despite having the same mutation.

A Novel Mutation (p.Met1?) of a Cuban Patient in the NAGLU Gene with Mucopolysaccharidosis IIIB

Abstract Mucopolysaccharidosis III (MPSIII) or Sanfilippo syndrome is an autosomal recessive disorder of lysosomal metabolism. MPS III is caused by mutations in genes that encode for the enzymes involved in the degradation of heparan sulfate. It is classified into 4 subtypes (MPSIII A-D). MPS IIIB is induced by mutations in the gene encoding the alpha-N-acetylglucosaminidase enzyme. We report a 6-year-old boy with phenotypic findings of Sanfilippo syndrome type B, such as mild coarse facie, clear corneas, hirsutism, hepatomegaly, mild joint stiffness and mild dysostosis multiplex. He also presents frequent upper respiratory infections, bilateral hearing loss, sleep disturbances, progressive neurologic deterioration and behavioral problems. He is compound heterozygous for the NAGLU gene (c.503G˃A; p.Trp168Ter/ c.3G˃A; p.met1?). One of the mutation was described in two patients before. A novel pathogenic variant was detected.

Frequency of Cystic Fibrosis in Children with Recurrent Respiratory Infections by Sweat Chloride Testing: A Hospital-Based Cross-sectional Study

Objective: This study was designed to find out the frequency of cystic fibrosis in children with recurrent respiratory infections by performing a sweat chloride test.Material and Methods: This cross-sectional study was carried out from 1st September 2015 to 28th February 2016 in the department of Pediatric Medicine at the Children’s Hospital and the Institute of Child Health, Lahore after ethical approval. A total of 300 cases of recurrent respiratory tract infections were included. The sweat chloride test was done by using pilocarpine-induced iontophoresis and measuring chloride levels on the forearm or thigh by sweat analyzer at the time of induction. Cystic fibrosis was labeled if sweat chloride level ranges above 60 mEq/L. Data was collected on Performa and SPSS version 23 was used to analyze the data. Results: Mean age of patients was 6.24 ± 2.7 years with 52.7% males and 47.3% females. Most patients (86.3%) have more than 5 episodes of respiratory infection in a year. Cystic fibrosis was diagnosed in 19 (6.3%) patients. There was no relationship between the frequency of respiratory infections in a year and cystic fibrosis (p-value 0.78).Conclusion: This hospital-based study showed quite a high incidence of cystic fibrosis in our population. So facilities including neonatal screening along with sweat chloride testing and genetic analysis should be increased.

Necrotizing paraproctitis in a 5-year-old child: a case report

Authors present a rare clinical case of successful treatment of a 5-year-old child with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency state.
 Clinical case. A 5-year-old boy became acutely ill, against the background of diarrhea with hyperthermia. An area of hyperemia, edema, and tissue infiltration appeared in the perianal region. In anamnesis, with frequent respiratory infections and dysfunction of the intestinal tract in the form of diarrhea. He was admitted to the Regional Childrens Hospital on the 10th day of illness from the regional hospital, where antibiotic treatment was started. Upon admission, the condition was serious in the perianal region with an extensive wound necrotic tissues and a plaque of fibrin. To create favorable conditions for wound healing, a preventive sigmostomy operation was performed. Multidrug-resistant Pseudomonas aeruginosa was found in the wound culture. Thus, courses of antibiotics treatment, infusion therapy, and surgical debridement of the perianal wound and its local treatment were performed. Upon immunological status examination, a primary immunodeficiency was revealed, for which drugs with immunoglobulin G were administered. As a result of the treatment, the wound healed by secondary intention, thus, an operation was performed to close the sigmostoma. The child was discharged in satisfactory condition under the supervision of an immunologist and a surgeon.
 Discussion. In this case, preventive sigmostomy is justified; however, authors limit themselves to surgical intervention on the perineum in other cases. Pseudomonas aeruginosa shows its pathogenicity in patients with impaired immunity. Therefore, courses of antibiotics, infusion therapy, and immunomodulatory therapy along with surgical treatment, favorable result were achieved.
 Conclusion. Children with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency should be hospitalized as early as possible in a specialized hospital.

Impact of adenotonsillectomy on acoustic parameters of voice using GRBAS scale in children

Adenoids and tonsils are pharyngeal lymphoid tissue aggregation. Adenotonsillar hypertrophy is usually seen in children. Enlarged adenoid and tonsillar tissue in children causes snoring, sleeping disorders, failure to thrive, frequent upper respiratory tract infections and abnormalities in maxillofacial development. Surgical treatment performed for their removal is termed as adenotonsillectomy. This is one of the most commonly performed surgical procedures in children. The present study was conducted to compare the voice change using the GRBAS scale before and after adenotonsillectomy. This is a prospective study conducted for three months at the Department of Otorhinolaryngology in our tertiary care center. Voice of 35 children with adenotonsillar hypertrophy is analyzed by GRBAS scale in three stages before the surgery, three weeks after surgery and six weeks after surgery. The resulting voice quality improvement is noted in these children after adenotonsillectomy. This study showed that surgical procedures of adenotonsillectomy do not induce drastic adjustments in sound quality and can be performed safely in children. Post-operative voice changes are a significant concern issue among the parents of the children.

Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society

This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.

Breastfeeding restored the gut microbiota in caesarean section infants and lowered the infection risk in early life

BackgroundThe initialization of the neonatal gut microbiota (GM) is affected by diverse factors and is associated with infant development and health outcomes.MethodsIn this study, we collected 207 faecal samples from 41 infants at 6 time points (1, 3, and 7 days and 1, 3, and 6 months after birth). The infants were assigned to four groups according to delivery mode (caesarean section (CS) or vaginal delivery (VD)) and feeding pattern (breastfeeding or formula milk).ResultsThe meconium bacterial diversity was slightly higher in CS than in VD. Three GM patterns were identified, including Escherichia/Shigella-Streptococcus-dominated, Bifidobacterium-Escherichia/Shigella-dominated and Bifidobacterium-dominated patterns, and they gradually changed over time. In CS infants, Bifidobacterium was less abundant, and the delay in GM establishment could be partially restored by breastfeeding. The frequency of respiratory tract infection and diarrhoea consequently decreased.ConclusionThis study fills some gaps in the understanding of the restoration of the GM in CS towards that in VD.

Limited Utility of Surveillance Echocardiograms in Pediatric Patients with Isolated Secundum Atrial Septal Defects

Atrial septal defects (ASDs) are the third most common form of congenital heart defects worldwide.1 Most otherwise healthy pediatric patients with hemodynamically significant ASDs remain asymptomatic throughout childhood. Pulmonary vascular disease or atrial arrhythmias associated with long-standing ASDs rarely occur before late adolescence or early adulthood.2 In the absence of failure to thrive or frequent respiratory infections, most patients undergo elective ASD repair in early childhood (2-5 years of age).