Frequency Of Upper Respiratory Tract Infections Research Articles

Examining the role of patient-reported external factors and risk of relapse in anti-neutrophilic cytoplasmic autoantibody vasculitis

The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011–2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.

Six Weeks of Supplementation with Bovine Colostrum Effectively Reduces URTIs Symptoms Frequency and Gravity for Up to 20 Weeks in Pre-School Children.

Bovine colostrum is considered to provide anti-infective protection. Here, we present the first randomized controlled trial (RCT) aimed at assessing the preventive use of colostrum against upper respiratory tract infections (URTIs) in healthy pre-school children. We analyzed 57 children-35 in the colostrum (COL-dried bovine colostrum) and 22 in the placebo (PBO-dried whey) group, who received these substances as follows: first 15 days 2 × 500 mg and then 30 days 1 × 500 mg. The reporting on the children's health status, specifically on the frequency and gravity of URTI symptoms and abdominal side effects, was performed via an online survey. The influence of colostrum on the frequency of days with URTI symptoms remained significant until the 20th week of observation and reached 31% of median reduction. The median reduction reached 37% when the gravity of symptoms was analyzed. When we grouped symptomatic days into episodes of second gravity level, the reduction in their frequency was even larger (50%) and lasted until the end of the trial (21 weeks). No significant side effects, especially abdominal, were reported during the trial. Colostrum supplementation in pre-school children is well tolerated, safe and provides protection from frequency of URTIs and their gravity.

1463-P: Heterozygous Variant in NFKB1 Presenting with Autoantibody-Negative (AbNeg) Insulin-Dependent Diabetes (IDDM)

Due to its uncertain etiology and clinical management, AbNeg IDDM is a phenotype of interest for the NIH-funded Rare and Atypical Diabetes Network (RADIANT), which aims to identify and characterize people with unknown forms of diabetes (DM). We report a case of childhood-onset AbNeg IDDM found to have a likely pathogenic variant in NFKB1. A 17-year-old female presented with DM at age 7 with A1c 10.8%; random C-peptide 0.21 ng/ml; no diabetic ketoacidosis; negative GAD65, insulin, IA-2 and ZnT8 Ab; normal BMI%ile; no signs of insulin resistance; and negative genetic testing for monogenic DM. She has required continuous insulin therapy. Past medical history: IgA deficiency, vitamin D deficiency, orthostatic intolerance, neurocardiogenic pre-syncope and chronic migraine. Family history: Autoimmune adult-onset DM and hypothyroidism in mother, frequent upper respiratory infections in sisters, Addison’s disease in maternal grandfather, hemochromatosis in paternal grandmother and pericarditis at age 30 in paternal grandfather. Physical exam: Unremarkable. RADIANT Labs: Undetectable serum C-peptide. Negative Ab. Whole genome sequencing: Heterozygous likely pathogenic variant in NFKB1 impacting the canonical splice acceptor sequence (NM_003998.4:c.1753-1G>C). This is a case of youth-onset AbNeg IDDM found to have a likely pathogenic variant in NFKB1. Heterozygous loss-of-function variants in NFKB1 are associated with Common Variable Immunodeficiency (CVID) type 12 (OMIM #616576), characterized by incomplete penetrance and variable expressivity of immunodeficiency and autoimmunity, including features of IDDM. Immune dysregulation may explain lack of classic Ab. There are no prior reports of CVID first ascertained through a DM phenotype. Thus, this case represents a phenotype expansion of NFKB1-associated disease, and contributes to our understanding of the heterogeneity of AbNeg IDDM. Genetic testing of first-degree relatives is underway. Disclosure M.J.Redondo: None. A.Balasubramanyam: None. P.Liu: Other Relationship; Baylor Genetics. A.N.Alkanaq: None. M.Tosur: Advisory Panel; Provention Bio, Inc. N.Ram: None. R.J.Kreienkamp: None. E.A.Oral: Advisory Panel; Amryt Pharma Plc, Regeneron, Rejuvenate Bio, Third Rock Ventures, Consultant; Amryt Pharma Plc, Ionis Pharmaceuticals, Regeneron, Other Relationship; Amryt Pharma Plc, Research Support; Amryt Pharma Plc, Novo Nordisk, Fractyl Health, Inc., Ionis Pharmaceuticals, Regeneron, GI Dynamics, Rejuvenate Bio. C.Pihoker: None. J.Posey: None. Funding National Institutes of Health (U54DK118638)

Üniversite Hastanesine Başvuran Çocuklarda COVID-19 Pandemisi İlaç Dışı Müdahalelerin Üst Solunum Yolu Enfeksiyonlarına Etkisi

Aim: To determine effects of non-pharmaceutical COVID-19 precaution measures on the frequency of upper respiratory tract infection (URTI) in children aged 6-18. Materials And Methods: The research is of cross-sectional type. The sample size was calculated as 316 people. The participation rate is 84.81% (n= 268). The dependent variable of the study is URTI in the last year; The independent variables are sociodemographic characteristics, characteristics related to URTI, and measures taken regarding the COVID-19 pandemic. The data were collected from the people who applied to the university hospital pediatrics polyclinic. Results: The frequency of URTI in children in the study group in the last year is 36.6% and compared to the pre-pandemic period, the frequency of URTI has decreased by 71.3%. Previous history of hospitalization for any reason increases the status of having URTI in the last year by 1.9 times (95% CI 1.1- 3.3); mask usage in the child being rarely/occasionally increases the status of having URTI in the last year by 2.7 times (95% CI 1.2-6.1), mask usage never increasing status of having URTI in last one year by 6 times (%95 CI 1.5-23.8) increase. Conclusion: Compared to the pre-pandemic period, the frequancy of URTI in children decreased by 71.3% according to the data received from parents. In the study,it was determined that using only the masks from the public health measures applied during the COVID-19 pandemic was effective in reducing the frequency of upper respiratory tract infection and that the use of masks in the community, especially in children, should be encouraged. Children with a history of hospitalization should be provided with masks in public areas.

Multi-Omic Factors Associated with Frequency of Upper Respiratory Infections in Developing Infants.

Susceptibility to upper respiratory infections (URIs) may be influenced by host, microbial, and environmental factors. We hypothesized that multi-omic analyses of molecular factors in infant saliva would identify complex host-environment interactions associated with URI frequency. A cohort study involving 146 infants was used to assess URI frequency in the first year of life. Saliva was collected at 6 months for high-throughput multi-omic measurement of cytokines, microRNAs, transcripts, and microbial RNA. Regression analysis identified environmental (daycare attendance, atmospheric pollution, breastfeeding duration), microbial (Verrucomicrobia, Streptococcus phage), and host factors (miR-22-5p) associated with URI frequency (p < 0.05). These results provide pathophysiologic clues about molecular factors that influence URI susceptibility. Validation of these findings in a larger cohort could one day yield novel approaches to detecting and managing URI susceptibility in infants.

Clinical characteristics and analysis of IDS gene variant in a child with mucopolysaccharidosis type Ⅱ

To summarize the clinical features, laboratory examination and genetic analysis of a patient with mucopolysaccharidosis type Ⅱ (MPS Ⅱ). Clinical manifestations, results of urine glycosaminoglycans (GAGs) and dermatan sulfate assay, metabolites related to MPS in peripheral blood leukocytes were analyzed. Meanwhile, the child and his mother were subjected to next-generation sequencing and Sanger sequencing. The boy has presented with global development delay, coarse facies, frequent upper-respiratory infections, hearing loss, indirect inguinal hernia, hepatosplenomegaly, and skeletal deformities. His urine GAGs were significantly elevated, and the urinary dermatan sulfate (DS) was positive. Meanwhile, the activity of idose-2-sulfatase was extremely reduced. The patient was found to harbor a hemizygote c.676C>G (p. His226Asp) missense variant in exon 5 of IDS gene, for which his mother was heterozygous. The novel c.676C>G variant of the IDS gene probably underlay the MPS Ⅱ in this child. Genetic testing combined with enzymatic analysis can enable effective diagnosis and classification of MPS.

Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care

Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.

The use of osteopathic manipulative treatment in the newborn nursery and its effect on health in the first six months of life: A retrospective observational case-control study

BackgroundLimitations of traditional medicine and rising interest in complementary medicine call for a closer look at the potential relevance of manual medicine, specifically osteopathic manipulative treatment (OMT) in children. ObjectiveTo conduct a retrospective observational pilot study of babies who received OMT in the newborn nursery compared to those who did not, by quantifying their outpatient health issues in the first 6 months of life, and to determine the feasibility of further definitive randomized controlled trials of a similar nature. DesignRetrospective chart review of the first 6 months of life from pediatric clinic records of 58 case-matched pairs of children, half of whom received OMT as part of their routine newborn care by virtue of their physician “call” assignment to the author. The sample from which the case-matched control group was chosen were babies who had received routine allopathic newborn care without OMT. Both groups received their pediatric care in the same academic ambulatory clinic and received no further OMT. MethodsOutpatient paper chart review consisted of tabulation by points of the following variables: mention of spitting/vomiting, gassiness, food intolerance, irritability/sleeplessness, colic suggested or diagnosed, episodes of otitis media, frequency of antibiotics given, frequency of upper respiratory infections, frequency of lower respiratory problems, diarrhea, and rashes, separated by month of visit in which the variable was reported. ResultsExploratory analysis by Pearson Chi-square yielded a few statistically significant differences between the 2 groups, in favor of the OMT-treated group, including Month 2 food intolerance (Χ21 = 4.14, P = .04), Month 3 colic suggested (Χ21 = 4.14, P = .04), Month 5 spitting/vomiting (Χ21 = 8.59, P = .003), and Month 5 antibiotic usage (Χ21 = 6.33, P = .012). ConclusionsFindings point to the need for further research in this area based on the suggestion that OMT given to a newborn can positively affect that baby's short-term and quite possibly long-term health, specifically related to GI complaints and irritability. Other studies would benefit from a variety of methodologic changes, including correlation of timing of administration of OMT with possible symptoms and changes in those symptoms over longer periods of observation, as well as correlation of anatomic osteopathic findings with specific symptoms.

Assessment of cluster of differentiation 4 and 8 among children with trisomy 21

Background Down syndrome (DS) is the most common genetic disorder with more probability of recurrent infections.Aim This study aimed to determine the differences in lymphocyte subgroups (CD4 and CD8) between DS children and to study the pattern and likelihood for recurrent infections and hospital admission due to infection.Patients and methods This study was carried out in the Genetic Unit of Alexandria University Children’s Hospital, Egypt. The study enrolled 61 individuals with DS. They were assessed for recurrent infections [including otitis media, pneumonia, upper respiratory tract infections (URTIs), and gastroenteritis] and hospital admission due to infections. All patients were subjected to complete blood count and flow cytometric analysis for expression markers of T lymphocytes (CD4 and CD8).Results The authors found a statistically significant increase in the frequency of URTIs. In terms of the type of recurrent infection in DS, it was the highest for URTIs. A statistically significant decrease was found in CD4 in the DS patients. Nonsignificant correlations were found between CD markers and hospital admission.Conclusion An increase in the incidence and the recurrence of infections among children with DS, especially URTI, pneumonia and gastroenteritis, was reported in the present work. Children with DS showed decreased absolute CD4 and CD4/CD8 ratio less than normal values of similar children younger than 6 years of age. Also, normal or even increased levels of absolute CD8 were evident in children with DS.

Upper Respiratory Tract Infection and Mucosal Immunity in Young Ice Hockey Players During the Pretournament Training Period.

Orysiak, J, Witek, K, Malczewska-Lenczowska, J, Zembron-Lacny, A, Pokrywka, A, and Sitkowski, D. Upper respiratory tract infection and mucosal immunity in young ice hockey players during the pretournament training period. J Strength Cond Res 33(11): 3129-3135, 2019-The aim of this study was to determine the effects of 17 days of training during preparation for the Ice Hockey Under 18 World Championship of the Polish ice hockey national team on the mucosal immune function and monitor upper respiratory tract infection (URTI) incidence before, during, and after the competition. Twelve male ice hockey players (age, 17.7 ± 0.5 years) were recruited for this study. The first saliva and blood collection took place at the beginning of the training camp (without training at the training camp), the second one was collected on the 9th day of the training camp immediately after the intensification of training, and the third collection was performed on the 13th day of training (4 days before leaving for the World Championship) in the tapering phase. To assess the mucosal immune function, concentrations of secretory immunoglobulin A (sIgA), sIgA1, and sIgA2 were analyzed in saliva. Cortisol concentration and creatine kinase activity were determined in blood, as indicators of stress and muscle damage, respectively. The Wisconsin Upper Respiratory Symptom Survey-21 questionnaire was used to assess URTI symptoms. A significant increase in the sIgA1 and sIgA2 concentrations was observed in the third collection compared with the second time point (114.45 ± 33.00 vs. 77.49 ± 27.29 and 88.97 ± 25.33 vs. 71.65 ± 32.44 U, respectively). There were no statistically significant correlations between the URTI incidence and saliva variables. In conclusion, the tapering period positively affects the mucosal immune function, especially sIgA1 and sIgA2 concentrations, with no significant change in the frequency of URTI in young ice hockey players.

260 Use of antibiotics in preschool age predicts atopic and allergic skin diseases in adolescents: A retrospective cohort study

The prevalence of atopic and allergic skin diseases has increased rapidly worldwide; and the overuse of antibiotics in the treatment of upper respiratory infection (URI) has been observed in China. The current study aimed to investigate the associations of antibiotics use in preschool age (<7 years old) with the atopic and allergic skin diseases in adolescents in China. A retrospective cohort study was conducted in a group of newly-enrolled college students in five universities in different regions of China. The frequency of URI and the use of antibiotics in preschool age was inquired through the questionnaire survey. Skin diseases were diagnosed by dermatologists during the health examination. Study outcomes included: 1) atopic dermatitis; 2) hand eczema; 3) allergic skin diseases (chronic urticaria, allergic contact dermatitis, photoallergic reactions); and 4) atopic march (asthma, atopic dermatitis, allergic rhinitis). Two-level logistic models were used to estimate the associations, and adjusted relative risks (ARRs) were presented as the effect size. A total of 20138 participants were analyzed. The mean age was 18.0 ± 0.8, and 50.7% of the participants was male. The use of antibiotics in preschool age (rare, reference group; occasionally; often, administered orally; often, administered i.v.) was significantly associated with atopic dermatitis (ARR: 0.89, 1.10, 1.30; P=0.004), hand eczema (ARR: 0.86, 1.14, 1.10; P=0.043), allergic skin diseases (ARR: 1.09, 1.24, 1.37; P=0.026), and atopic march (ARR: 1.11, 1.43, 1.66; P<0.001), in a dose-response manner, after adjustments for demographic variables (age, gender, ethnicity, and family income). Interactions between the frequency of URI and use of antibiotics was also tested, and the results were consistent. Use of antibiotics in the treatment of URI in preschool age is associated with atopic and allergic skin diseases in adolescents.

Lactobacillus plantarum DR7 improved upper respiratory tract infections via enhancing immune and inflammatory parameters: A randomized, double-blind, placebo-controlled study

The aims of this study were to investigate the effects of Lactobacillus plantarum DR7 isolated from bovine milk against upper respiratory tract infections (URTI) and elucidate the possible mechanisms underlying immunomodulatory properties. The DR7 strain (9 log cfu/d) was administered for 12 wk in a randomized, double-blind, and placebo-controlled human study involving 109 adults (DR7, n = 56; placebo, n = 53). Subjects were assessed for health conditions monthly via questionnaires, and blood samples were evaluated for cytokine concentrations, peroxidation and oxidative stress, and gene expression in T cells and natural killer (NK) cells. The administration of DR7 reduced the duration of nasal symptoms (mean difference 5.09 d; 95% CI: 0.42-9.75) and the frequency of URTI (mean difference 0.32; 95% CI: 0.01-0.63) after 12 and 4 wk, respectively, compared with the placebo. The DR7 treatment suppressed plasma proinflammatory cytokines (IFN-γ, TNF-α) in middle-aged adults (30 to 60 yr old), while enhancing anti-inflammatory cytokines (IL-4, IL-10) in young adults (<30 yr old), accompanied by reduced plasma peroxidation and oxidative stress levels compared with the placebo. Young adults who received DR7 showed higher expression of plasma CD44 and CD117 by 4.50- and 2.22-fold, respectively, compared with the placebo. Meanwhile, middle-aged adults showed lower expression of plasma CD4 and CD8 by 11.26- and 1.80-fold, respectively, compared with the placebo, indicating less T-cell activation. In contrast, both young and middle-aged adults who received DR7 showed enhanced presence of nonresting and mature NK cells compared with those who received the placebo. We postulate that DR7 alleviated the symptoms of URTI by improving inflammatory parameters and enhancing immunomodulatory properties.

Effects of sex and early rearing condition on adult behavior, health, and well-being in captive chimpanzees (Pan troglodytes)

Scientific evaluation of management strategies for captive species is part of the establishment of best practices for animal welfare. Here we report the effects of sex, rearing, and a sex-by-rearing interaction on adult, captive chimpanzees’ (Pan troglodytes) behavior, health, well-being, personality, and orientation towards humans based on multiple methods (observation, animal records, and surveys). Chimpanzees raised in three conditions, mother-reared (MR), standard nursery (ST) and an experimental nursery (RC), were assessed approximately 20 years after their differential rearing experiences concluded. Sex had a significant effect on behavior towards conspecifics (aggression [M > F]; affiliation [F > M]), on abnormal behavior (rocking [M > F]), and on likelihood of incurring at least one injury (between ages 6 and 10 [M > F]). Rearing condition had a significant impact on behavior towards humans (negative solicitation [RC = ST > MR = ST]; neutral behavior [RC > ST > MR], yawning (RC = ST > MR = ST), subjective well-being (MR = ST > RC = ST), and on GI illness frequency (RC > ST = MR). Sex interacted with rearing on aggression towards humans (for males, RC > MR = ST), frequency of upper respiratory infection (URI: for males RC > MR = ST)) and likelihood of at least one URI between the ages of 11 and 15 (RC males > ST males). Our findings support the conclusion that there are long-term effects of both early rearing and sex on captive adult chimpanzee welfare.

Possible Risks and Protective Factors of Upper Respiratory Tract Infections in Healthy Japanese Office Workers

Objective: In order to determine the risks and protective factors of upper respiratory tract infections (URTIs) in healthy office workers, we conducted a preliminary epidemiological survey and analysis of saliva parameter levels. Methods: One hundred and forty-six (98 men, 48 women; aged 20-59 years) healthy, full-time office workers in Tokyo and its suburbs participated in a questionnaire survey on lifestyle habits and daily physical condition, including symptoms of URTIs, from October 2012 to March 2013. Salivary parameters (secretory IgA, beta-defensin 2, LL-37, granulysin, lysozyme, cortisol) levels were also measured to analyze the correlation to URTI incidence and lifestyle habits. Results: Both the incidence rate and frequency of URTIs per person during the investigation period were highest among participants in their 50s and lowest among participants in their 30s. Participants who lived with their family showed higher URTI incidence than those who lived alone, while those with exercise habits showed lower URTI incidence. Higher saliva cortisol levels significantly correlated with high URTI incidence, while higher salivary granulysin levels significantly correlated with low URTI incidence. Conclusions: The risk factors of URTI incidence among healthy, full-time office workers include not only aging, but also living with family and higher salivary cortisol levels, and the protective factors are exercise habits and higher salivary granulysin levels.

Nasopharyngeal microbiota composition of children is related to the frequency of upper respiratory infection and acute sinusitis.

BackgroundUpper respiratory infections (URI) and their complications are a major healthcare burden for pediatric populations. Although the microbiology of the nasopharynx is an important determinant of the complications of URI, little is known of the nasopharyngeal (NP) microbiota of children, the factors that affect its composition, and its precise relationship with URI.ResultsHealthy children (n = 47) aged 49–84 months from a prospective cohort study based in Wisconsin, USA, were examined. Demographic and clinical data and NP swab samples were obtained from participants upon entry to the study. All NP samples were profiled for bacterial microbiota using a phylogenetic microarray, and these data were related to demographic characteristics and upper respiratory health outcomes. The composition of the NP bacterial community of children was significantly related prior to the history of acute sinusitis (R2 = 0.070, P < 0.009). History of acute sinusitis was associated with significant depletion in relative abundance of taxa including Faecalibacterium prausnitzii and Akkermansia spp. and enrichment of Moraxella nonliquefaciens. Enrichment of M. nonliquefaciens was also a characteristic of baseline NP samples of children who subsequently developed acute sinusitis over the 1-year study period. Time to develop URI was significantly positively correlated with NP diversity, and children who experienced more frequent URIs exhibited significantly diminished NP microbiota diversity (P ≤ 0.05).ConclusionsThese preliminary data suggest that previous history of acute sinusitis influences the composition of the NP microbiota, characterized by a depletion in relative abundance of specific taxa. Diminished diversity was associated with more frequent URIs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40168-016-0179-9) contains supplementary material, which is available to authorized users.

Do probiotics decrease the frequency of upper respiratory infections (URIs) in young children?

Case During a well-child visit, the mother of a 5-year-old boy and a 3-year-old girl laments that her kids “are always getting colds during the winter,” and she wonders if there is a medicine she can give them “to help them catch colds less often.” What can you suggest?

Orbital Complications of Acute Sinusitis: Evaluation, Management, and Results

Introduction Even though orbital complications in acute rhinosinusitis are not very common, they can be very severe complications, with high mortality rates, due to infection spreading to orbital and intracranial tissues (1). Especially due to intracranial complications, acute rhinosinusitis is considered in the life-threatening disease group. As per Chandler et al. (2), orbital complications are classified into five groups according to the severity of complications: preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Although orbital complications are clinically rare, they are more common in children than in adults. Orbital septum acts as a barrier that prevents the spread of inflammation from the preseptal region towards the orbital space. Along with proptosis, limitation of eye movements, and decrease in vision, the presence of redness, edema, and local temperature increase in the eyelids, i.e., infectious pathology of orbital region, suggest intraorbital propagation. Especially in the childhood period, compared to adult age groups, infections in the preseptal region that did not receive proper treatment can spread easily in the orbits and cause serious complications such as brain abscess, meningitis, and cavernous sinus thrombosis (1-4). Although antibiotic use reduces the incidence of sinus infections and complications, acute sinusitis is still the leading cause of orbital inflammation and impaired vision. Particularly after frequent upper respiratory infections during the childhood, the infection that spreads easily to the nose and sinuses sets the ground for orbital complications (4-6). In our study, accompanied by diagnosis, treatment, and follow-up symptoms of 11 patients who developed orbital complications of rhinosinusitis, treatment and follow-up algorithm of orbital complications have been revised with literature data. 131

Analysis of Upper Respiratory Tract Infections In Mission Circumstances

During this research a specific partial data set of the UN database was analyzed from different aspects and evaluated in order to create an image about the prevalence and probable reasons of upper respiratory tract infections among soldiers serving in the operation area.The research indicates that the prevalence of upper respiratory tract infections (URTIs), and the previously performed tonsillectomies, was the highest in one contingent. The statistical data demonstrates that the tonsillectomies may influence the frequency of upper respiratory infections within the contingent.

Long‐term 4‐year safety of saxagliptin in drug‐naive and metformin‐treated patients with Type 2 diabetes

To evaluate the safety of saxagliptin ± metformin over 4 years in patients with Type 2 diabetes mellitus. Drug-naive (n = 401; study 11) or metformin-treated (n = 743; study 14) adults with HbA(1c) of 53-86 mmol/mol (7.0-10%) were enrolled in two randomized, placebo-controlled, double-blind trials of saxagliptin 2.5, 5 or 10 mg/day. Patients rescued during or completing 24 weeks of treatment could continue in a 42-month long-term blinded phase, for which the primary goal was assessment of safety and tolerability. Between-group efficacy was not evaluated in the long-term phase of study 11. Time to rescue or discontinuation because of inadequate glycaemic control, change from baseline in HbA(1c) and percentages of patients achieving HbA(1c) < 53 mmol/mol (< 7.0%) were assessed in study 14. No new safety findings were noted during the long-term phase. Most adverse events were mild or moderate, with slightly greater frequency of upper respiratory infections with saxagliptin. Hypoglycaemic event rates were similar with saxagliptin and placebo. In study 14, time to rescue or discontinuation because of inadequate glycaemic control was longer with saxagliptin plus metformin than for placebo plus metformin. From baseline to week 154, HbA(1c) decreased with saxagliptin but increased with placebo. Saxagliptin monotherapy or add-on to metformin is generally safe and well tolerated, with no increased risk of hypoglycaemia, for up to 4 years.

AB1216 Periodic fever syndromes in the czech republic: A single-centre experience

ObjectivesTo describe clinical and laboratory features and disease outcome in a cohort of patients referred for suspected periodic fever syndromes.MethodsWe reviewed our rheumatology patient database covering period of 1/2005-6/2011 in...