Frequent Respiratory Infections Research Articles

On the Possibility of Using the Topical form of the Recombinant Interferon alpha-2b Drug in the Prevention of Acute Respiratory Viral Infections in Organized Groups

Relevance. Respiratory infections are an urgent problem for organized groups, including military ones, since the transmission of pathogens by airborne droplets and household contact routes, physical and psychological stress on adaptive mechanisms contribute to the development of the epidemic process. There is no doubt that vaccination makes a significant contribution to the prevention of respiratory infections, but the contingent remains vulnerable to other pathogens against which there are no vaccines. Therefore, the search for new methods of non-specific prevention is necessary in maintaining the health of persons permanently residing in collectives. Aim. Evaluation of the possibility of using the topical form of the recombinant interferon α-2b drug for the prevention of acute respiratory viral infections in organized groups. Materials and methods. The work was carried out according to the methodology of a multicenter (3 Centers) double-blind controlled trial involving 3,235 people aged 18 to 22 years, who were divided into three groups: 1 gy. - received a recombinant interferon α-2b (Grippferon) drug 3 drops in each nasal passage 2 times a day in for two weeks; 2 g. - saline solution intranasally according to the same scheme; 3 g. - the volunteers did not receive anything. The frequency of respiratory infections was studied. Results and discussion. Medical monitoring of the study participants, which was carried out for 2 months, showed that in the groups from the Center 1, the incidence of acute respiratory diseases for 2 months in the main group (gr. 1) was 2.3 times lower than in the control (gr. 2) and the comparison group (gr. 3). In the Center 2 The data corresponded to the dynamics of Center 1: the incidence values were 2.4-2.5 times lower in Group 1. In Center 3, the values were 2.0-2.1, respectively. The epidemic effect of intranasal administration of the topical form of the drug recombinant interferon α-2b is due to its effect on the factors of mucosal immunity, which contributes to non-specific protection and increased body resistance against respiratory infections. Conclusions. The presented advantages of the recombinant interferon α-2b drug make it possible to draw attention to the clinical feasibility of its use for preventive purposes in organized groups, including military ones, from the position of high epidemiological effectiveness, both pre-exposure and post-exposure prevention of acute respiratory viral infections.

Managing children with frequent respiratory infections and associated wheezing: a preliminary randomized study with a new multicomponent nasal spray.

Preschoolers frequently have respiratory infections (RIs), which may cause wheezing in some subjects. Type 2 polarization may favor increased susceptibility to RIs and associated wheezing. Non-pharmacological remedies are garnering increasing interest as possible add-on therapies. The present preliminary study investigated the efficacy and safety of a new multi-component nasal spray in preschoolers with frequent RIs and associated wheezing. Some preschoolers with these characteristics randomly took this product, containing lactoferrin, dipotassium glycyrrhizinate, carboxymethyl-beta-glucan, and vitamins C and D3 (Saflovir), two sprays per nostril twice daily for 3 months. Other children were randomly treated only with standard therapy. Outcomes included the number of RIs and wheezing episodes, use of medications, and severity of clinical manifestations. Preschoolers treated add-on with this multicomponent product experienced fewer RIs and used fewer beta-2 agonists than untreated children (P = 0.01 and 0.029, respectively). This preliminary study demonstrated that a multicomponent product, administered add-on as a nasal spray, could reduce the incidence of RIs and use of symptomatic drugs for relieving wheezing in children.

Cutting Edge: First Lung Infection Permanently Enlarges Lymph Nodes and Enhances New T Cell Responses.

Humans experience frequent respiratory infections. Immunology and vaccinology studies in mice are typically performed in naive specific pathogen-free animals responding to their very first respiratory challenge. We found that the first respiratory infection induces lifelong enlargement of the lung-draining mediastinal lymph nodes (medLNs). Furthermore, infection-experienced medLNs supported better naive T cell surveillance and effector responses to new unrelated infections that exhibited more biased accumulation and memory establishment within the lung. Moreover, we observed that weight loss induced by influenza infection was substantially reduced in mice that had recovered from a previous unrelated respiratory viral challenge. These data show that the lack of infectious history and corresponding medLN hypoplasia in specific pathogen-free mice alter their immune response to lung infections. Preclinical vaccination and immunology studies should consider the previous infectious experience of the model organism.

Do early-life allergic sensitization and respiratory infection interact to increase asthma risk?

Objective The ‘two-hit’ hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk. Methods We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6–7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported “cough, rattle, or wheeze” and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6–7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders. Results Odds of asthma were higher in sensitized compared to nonsensitized children at age 6–7 years (OR = 14.46; 95% CI 3.99–52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6–7 years in both sensitized (OR = 1.13; 95% CI 1.02–1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11–1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker. Conclusions Our findings do not support ‘two-hit’ interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma.

“You can feel the fresh air … ” Rural Alaska Native household perceptions of home air purifiers and health

ABSTRACT Alaska Native and American Indian children experience frequent respiratory illness. Indoor air quality is associated with the severity and frequency of respiratory infections in children. High efficiency particulate air (HEPA) purifiers effectively improve indoor air quality and may protect respiratory health. In 2019, the Yukon-Kuskokwim Health Corporation implemented a pilot programme that provided education and HEPA purifiers to households of children with chronic lung conditions. The team evaluated HEPA purifier acceptability and use by interviewing representatives from 11 households that participated in the pilot programme. All interviewees reported improvement in their child’s health, and some believed that the health of other household members was also improved because of the HEPA purifier. Interviewees reported that the HEPA purifiers were easy to use, quiet, and not expensive to run. Five of 11 households were still using the HEPA purifier at the time of the interview, which was about three years after receipt of the unit. The most common reasons for discontinuing use were equipment failure and lack of replacement filter, suggesting that programme support could increase sustainability. Our evaluation suggests that HEPA purifiers are acceptable and feasible for use in rural Alaska Native households.

Supply of vitamins (A, E, D, C, B6, B12) and mineral substances (ZN, FE, MG, CA, P) for children with recurrent respiratory infections and deficiency correction of their deficiency as a possibility to prevent frequent respiratory infections

Introduction. Recurrent respiratory infections in children are a pressing problem in pediatrics. To maintain and function the immune system in children, their provision of vitamins and minerals is important.Purpose. To assess the provision of children with recurrent respiratory infections with vitamins (A, E, D, C, B6, B12, folic acid) and minerals (Zn, Fe, Mg, Ca, P) and to correct their deficiency with a vitamin-mineral complex.Materials and methods. The study was conducted on 65 children aged 3 to 8 years in 2 groups of children: group 1, children with RID, n = 50; group 2 – control, n = 15). An outpatient examination, a parent survey and a blood test for vitamins (A, E, D, C, B6, B12, folic acid) and minerals (Zn, Fe, Mg, total Ca, Ca++, P) were carried out. 30 children with RID were prescribed the vitamin and mineral complex, 1 tablet 2 times a day, with an assessment of vitamin and mineral sufficiency and the frequency of respiratory infections after the end of the dose.Results. In all examined children, both in the main and control groups, the most common were deficiencies of fat-soluble vitamins D (69%), A (40%), E (35%) and the minerals Zn (70%) and Fe (44%). In children with RID, deficiency of vitamins D, A and Zn was more common than in the control group (p < 0.05), in 96% of cases it was combined, more often in the form of a combined deficiency of fat-soluble vitamins D, A, E and minerals Zn, Fe (66% of cases). Taking vitamin-mineral complex in the 2nd prophylactic dose for 1 month contributed to an improvement in vitamin and mineral sufficiency and a decrease in respiratory morbidity in the next 2 months after stopping the drug.Conclusion. Vitamin-mineral complex can be successfully used to maintain vitamin and mineral levels and reduce respiratory morbidity in children with recurrent respiratory infections.

High-dose vitamin D3 supplementation shows no beneficial effects on white blood cell counts, acute phase reactants, or frequency of respiratory infections

BackgroundVitamin D has been suggested to influence the immune system, and vitamin D metabolites and the vitamin D receptor (VDR) are generated and expressed in white blood cells (WBC). Moreover, vitamin D status has been associated with incidence and prognosis of some respiratory tract infections (RTI). Therefore, we investigated the effect of vitamin D3 supplementation on WBC, acute phase reactants (APR), and the risk of developing RTIs.MethodsA double-blinded, randomized, placebo-controlled clinical trial of 307 infertile men with multiple secondary immunological endpoints. The vitamin D3 group (n = 151) initially received 300,000 IU (7,500 µg) cholecalciferol once - followed by 1,400 IU (35 µg) daily for 150 days. The placebo group (n = 156) did not receive active ingredients.ResultsAt baseline, stratification into clinically relevant groups of vitamin D status (< 25; 25–50; 50–75; >75 nmol/L), showed an inverse association with total leucocyte concentrations (7.0 vs. 6.0 vs. 6.0 vs. 5.5 (109/L); p = 0.007), lymphocytes (2.4 vs. 2.1 vs. 2.0 vs. 2.0 (109/L); p = 0.048), CRP (2.0 vs. 1.7 vs. 1.2 vs. 1.2 (mg/L); p = 0.037), and orosomucoid (0.82 vs. 0.77 vs. 0.76 vs. 0.70 (g/L); p = 0.015). After 150 days, no differences were detected in WBC counts or APRs between the vitamin D3 and the placebo group. However, vitamin D3 treated men had a higher prevalence of self-reported RTIs compared with the placebo group (55% vs. 39%; p = 0.005).ConclusionsHigh-dose vitamin D3 supplementation did not alter WBCs or APRs, but a higher prevalence of respiratory infections was observed in the vitamin D3 group. Serum 25(OH)D3 was negatively correlated with most WBCs, indicating that vitamin D status may be linked with inflammation and WBC turnover, but not an important determinant of developing RTIs.Trial registrationNCT01304927 (ClinicalTrials.gov). Registered February 20, 2011.

Prevalence and Outpatient Clinical Diagnostic Approaches for Common Acute Respiratory Tract Infections in Children Under Five Years of Age: A Cross-Sectional Study.

Acute respiratory tract infections are among the leading causes of child morbidity and mortality worldwide. Although the diagnosis of acute respiratory tract infections requires simple outpatient medical techniques and care, it is still misdiagnosed among primary care physicians, leading to delayed treatment and increased mortality. This study described the prevalence of common acute respiratory tract infections and simple techniques that effectively detect and diagnose children presenting with acute respiratory symptoms to primary healthcare physicians in remote settings. This descriptive cross-sectional study was conducted at the pediatric outpatient clinic of a tertiary hospital in western Uganda in April, May and June 2019. A total of 896 children aged 2-59 months attending the clinic were recruited consecutively into the study and examined for the presence of acute respiratory infection. Participants' sociodemographic and clinical data were collected through history taking and clinical examination using a validated Uganda Ministry of Health Uganda outpatient clinical checklist (FORM 5). The outcome variable was the presence of an acute upper or lower respiratory condition. Data was analyzed using STATA version 13.0 (StataCorp, College Station, USA) and summarized using descriptive statistics. The overall period prevalence of acute respiratory tract infections among children aged 2 to 59 months was 36.9% (36,942 per 100,000 population). Upper respiratory tract infections with a prevalence of 24.8% were more common than lower respiratory tract infections. The most frequent upper respiratory tract infection in this setting was common cold (52%), followed by tonsillopharyngitis (10.7%), while pneumonia (26%) was the most frequent lower respiratory tract infection. Acute respiratory tract infections contribute to the high burden of disease in pediatric outpatient clinics. Simple, affordable, and approved diagnostic clinical techniques that involve physical examination of the upper and lower respiratory systems can precisely diagnose acute respiratory tract infections in resource-limited settings where there is no access to sophisticated diagnostic equipment.

Long-term clinical results of power-assisted adenoidectomy with torus tubarius correction

In patients with hypertrophy of the pharyngeal tonsil, hypertrophy of the lymphoid tissue of the torus tubarius is often observed. The application of power-assisted technologies allows for precise correction of the torus tubarius simultaneously with adenoidectomy. The purpose of the study was to investigate the clinical effectiveness of power-assisted endoscopic adenoidectomy with additional correction of the torus tubarius in the presence of its hypertrophy, based on postoperative survey results. For this purpose, we surveyed of 209 patients who underwent endoscopic power-assisted adenoidectomy. In 107 of them additional correction of torus tubarius hypertrophy was performed in case of its presence (main group), while in 102, only adenoidectomy was performed in all patients (control group). The prevalence of main group complaints before adenoidectomy and their dynamics were assessed based on a survey 12–24 months post-intervention. It was found that the additional removal of hypertrophied torus tuba­rius in children during power-assisted endoscopic adenoidectomy significantly reduces the risk of frequent upper respiratory tract infections and acute otitis media. The proportion of individuals who assessed the adenoidectomy effect as "significant improvement" in terms of "frequent upper respiratory tract infections" in the main group was 20.4% higher, and for "frequent acute otitis media" it was 41.3% higher. Conclusion: Endoscopic power-assisted adenoidectomy with torus tubarius correction is an effective and safe method for children with hypertrophy of the pharyngeal tonsil in combination with torus tubarius hypertrophy, especially in cases where indications for intervention include frequent upper respiratory tract infections and acute otitis media. Keywords: scoring system, tonsils hypertrophy, tonsil pharingeal, hypertrophy, otitis, inflammatory diseases of the nose and paranasal sinuses.

Calcium, phosphorus, magnesium levels in frequent respiratory tract infections

Background It was well documented that calcium (Ca), phosphorus (P), and magnesium (Mg) participate in many physiological processes. We aimed to study the changing trend of serum levels of Ca, P, and Mg in frequent respiratory tract infections (FRTI) in children. Methods A retrospective study was performed in our centre. A total of 213 FRTI cases and 33 controls were enrolled in our study. We analyzed the correlation between serum Ca/P/Mg levels and inflammatory indexes by using Spearman correlation analysis. Standard mean difference (SMD) was applied to test the differences of serum Ca/P/Mg levels between FRTI subgroups and controls. In terms of the findings of SMD between Ca/P/Mg status between FRTI subgroups and controls, receiver operating characteristics (ROC) curve analysis was further applied to test the association between serum Ca level and bronchitis, parainfluenza virus infection, influenza B virus infection and cytomegalovirus infection. Results Serum Ca level was significantly associated with white blood cell (WBC), platelet (PLT) and procalcitonin (PCT) (p = 0.006; p < 10−4; p = 0.004). Serum P level was markedly associated with eryhtrocyte sedimentation rate (ESR) and PCT (p = 0.018; p < 10−4). Controls showed significantly lower serum Ca level than that among bronchitis (p = 0.001), parainfluenza virus infection (p = 0.027), influenza B virus infection (p = 0.017), cytomegalovirus infection (p = 0.029), and two pathogens infected (p = 0.020). ROC curve analysis showed that serum Ca level was significantly associated with bronchitis (p = 0.047) and influenza B virus infection (p = 0.049). Conclusions Serum levels of Ca and P may reflect the inflammatory status in children with FRTI. Alteration of serum Ca level may predict the risk of bronchitis and influenza B virus infection. Keeping the homeostasis of Ca, P, and Mg may be important for the prevention and treatment of FRTI.

Hematological malignancies in children with primary immunodeficiency

Primary immunodeficiencies (PIDs) represent a heterogeneous group of congenital disorders, often associated with specific genetic mutations. They are characterized by a varied spectrum of clinical manifestations, malignant tumors being the second cause of death among patients with primary immunodeficiencies after infections. The article presents the clinical case of a 13-year-old patient with a history of severe ataxia, telangiectasias, frequent respiratory infections, and cervical and submandibular lymphadenopathy diagnosed with IDP Ataxia Telangiectasia based on ESID criteria. Against the background of IDP, he is also diagnosed with Non-Hodgkin’s lymphoma.

Prediction of frequent acute respiratory infections in the first year of life in children with cerebral ischemia, survivors of cytomegalovirus infection in the neonatal period

Objective: to develop prognostic criteria for frequent respiratory diseases in the first year of life in children with cerebral ischemia who had a cytomegalovirus infection in the neonatal period. Research methods: 73 children of the first year of life with cerebral ischemia, who underwent cytomegalovirus infection in the neonatal period, were deployed. All observed patients at the age of three months underwent a study of the population composition of peripheral blood T-lymphocytes using flow cytometry for the expression of membrane markers, taking into account the results on a Beckman Coulter Epics XL II laser flow cytometer. Typing of lymphocytes was carried out using monoclonal antibodies to differentiation clusters CD3+, CD3+CD69+, CD3+CD71+, CD3+CD95+ from Immunotech (France). The observation groups consisted of 30 children (41.1%) with frequent acute respiratory infections (4—5 episodes per year) in the first year of life and 43 people (58.9%) — children with no acute respiratory infection’sepisodes in the first-year life. Results. From the set of studied T-lymphocytes, statistically significant for the prognosis of frequent acute respiratory infections in the first year of life in children with cerebral ischemia who underwent cytomegalovirus infection in the neonatal period were found: CD3+ CD71+, CD3+ CD95+. It was revealed that in children with a reduced level of CD3+ CD71+ and an increased level of CD3+ CD95+ in blood serum at the age of 3 months, frequent acute respiratory infections occurred in the first year of life.

The Association between Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Respiratory Tract Infections in Preschool Children: A Wuhan Cohort Study.

This study investigates the association between prenatal exposure to per- and polyfluoroalkyl substances (PFASs) and the incidence and frequency of respiratory tract infections (RTIs) in preschool children. We selected 527 mother-infant pairs from Wuhan Healthy Baby Cohort (WHBC), China. Ten PFASs were measured in umbilical cord serum, and we collected data on common RTIs in preschool children aged 4 years through a questionnaire. Associations of single PFASs with the incidence and frequency of RTIs were analyzed via Logistic regression and Poisson regression, while the collective effect was assessed by weighted quantile sum (WQS) regression. Furthermore, stratified and interaction analyses were performed to evaluate if there were sex-specific associations. We found a positive correlation between perfluorododecanoic acid (PFDoDA) and the incidence of tonsillitis, with several PFASs also showing positive associations with its frequency. Moreover, perfluorotridecanoic acid (PFTrDA) showed a positive link with the frequency of common cold. The results of WQS regression revealed that after adjusting for other covariates, PFASs mixture showed a positive association with the incidence of tonsillitis, the frequency of common cold, and episodes. In particular, perfluoroundecanoic acid (PFUnDA), PFDoDA, PFTrDA, perfluorodecanoic acid (PFDA) and 8:2 chlorinated polyfluorinated ether sulfonic acid (8:2 Cl-PFESA) had the most significant impact on this combined effect. The results suggest that both single and mixed exposures to PFASs may cause RTIs in preschool children. However, there was no statistically significant interaction between different PFASs and sex.

A multifactorial impact on respiratory morbidity in people of reproductive age and effectiveness of natopherine- and andropherine-containing odorants regarding a non-specific resistance of the nasal mucosa and lowered morbidity of respiratory infections

Prevention of respiratory infections during epidemic periods is an important task of modern health care in Russia and worldwide. One of such approach may rely on use of volatile substances capable of activating nonspecific resistance of the nasal mucosa. Long-term application of synthetic analogues of female pheromones to young males leads to lowered morbidity of respiratory diseases, increased levels of secretory immunoglobulins, as well as decrease peripheral blood of eosinophilia levels in subjects with allergic diseases. Based on this, the aim of the study was set to study an impact of anamnesis factors and indicators reflecting the functioning of nasal mucosal immunity, its nonspecific resistance, on emerging frequent respiratory morbidity; as well as to evaluate effectiveness of natopherine- and andropherine-containing odorants regarding dynamics of such indicators and to reduce incidence of respiratory infections in young subjects. Materials and methods. There were examined 46 apparently healthy boys and girls aged 18 to 22 years. The frequency of respiratory morbidity, anamnesis factors, and the results of non-invasive studies (cytokine concentrations in the nasopharyngeal aspirate and rhinocytograms). Within 30 days, all young subjects were applied to the nasolabial fold synthetic analogues of male (andropherine) and female (natopherine) pheromones (andropherine for young female, natopherine for young male). A re-examination with the above mentioned studies was carried out on day 14 and day 30 of the study. The incidence of respiratory infections was reassessed one year after the onset. Results. The study showed identified a number of predictors and protectors of frequent and long-term respiratory morbidity in young subjects. The predictors of this condition were presented by catamnestics markers of allergic anomalies of the constitution, behavioral factors (smoking), as well as immune indicators of allergy (IL-4) and mucociliary clearance deficiency. A monthly course of odorant applications on the skin of the nasolabial fold using synthetic analogues of male and female pheromones (steranes) has a positive effect both on the nonspecific resistance of the nasal mucosa as well as on the immune parameters. After a month of using steranes, the nasal mucosa is completely decontaminated from coccal microorganisms, and over the next 12 months, the frequency of respiratory infections decreases. This indicates about a prominent clinical effect of the odorants applied.

Prevalence of antibiotic resistance genes in resistome of adult residents of Arkhangelsk with regard to the severity of COVID-19

Objective: to estimate the prevalence of antibiotic resistance genes in the resistome of adult residents of Arkhangelsk with regard to the severity of the novel coronavirus infection (COVID-19).Materials and methods. A cross-sectional study was conducted between October and November 2022 (2.5 years after the start of the COVID-19 pandemic) on a random sample (N=455) of Arkhangelsk population aged 42-76 years. The data collection involved a questionnaire survey, assessment of immunoglobulins G to S-, S2, N-proteins of SARS-CoV-2 and detection of antibiotic resistance genes in fecal samples by polymerase chain reaction.Results. Almost all participants (98.5%) had at least one antibiotic resistance gene, the resistance determinants to three classes of antibiotics simultaneously were detected in 5.6%. The prevalence of resistance genes to macrolides was 98.5%, to beta-lactams – 29.0%, and to glycopeptides – 16.0%. Antibiotic resistance genes to beta-lactams were more prevalent among participants who had previously been hospitalized for COVID-19 (44.8%) and among those having had frequent acute respiratory infections (50.0%). Individuals vaccinated against SARS-CoV-2 (26.6%) and participants with cardiovascular diseases (17.0%) were less likely to have beta-lactam resistance genes.Conclusion. The high prevalence of antibiotic resistance genes has been revealed in the resistome of adult residents of Arkhangelsk. We determined the association between resistance to beta-lactams and COVID-19 severity. The study results could be used to improve the protocols of antibiotic therapy and to guide a decision-making related to the antibiotic prescription in adults.

Can Scoliosis Help the Early Diagnosis of Congenital Myasthenic Syndrome?

Background Congenital myasthenic syndromes (CMS) are a group of hereditary diseases of the neuromuscular junction. CMS are extremely rare diseases that cause hypotonia; however, scoliosis may theoretically be helpful in early diagnosis of CMS. The objective of this studywas to emphasize the clinical features of the patients we followed up with the diagnosis of CMS and demonstrate that scoliosis is an important finding in the diagnosis of CMS in the presence of hypotonia/weakness. Materials and methods In this retrospective study, data were retrieved by examining the digital files of the patients who presented to Aydın Maternity and Children's Hospital and Elazığ Fethi Sekin City Hospital Pediatric Neurology Clinics between 2018 and 2023. The diagnosis of CMS was strongly supported by a combination of clinical characteristics, neurophysiological studies, genetic tests, AChR antibodies, and serum creatine kinase measurement. The presence of scoliosis was evaluated by an orthopedics and traumatology specialist. Results Eleven CMS patients with accompanying scoliosis were included in the study. The mean age of the patients was 69.4±39.28 months. The age of the patients at the time of diagnosis was 42.7±35.19 months. Among the patients, eight were males (72.7%), and three were females (27.2%). Seven patients (63.6%) had COLQ mutations. Electromyography was conducted on eight patients, with one of them showing no pathological findings, while seven exhibited decremental responses. All patients had ptosis, while six (54.5%) had bulbar signs. Ten patients (90.9%) had weakness. Nine patients (81.8%) experienced frequent recurrent lower respiratory tract infections. Both the patient with CHAT mutation and RAPSN mutation had arthrogryposis. Conclusion In this study, CMS stands out as an essential consideration in the differential diagnosis, particularly when scoliosis accompanies early-onset muscle weakness.

Associations of early life and childhood risk factors with obstructive sleep apnoea in middle-age.

Early-life risk factors for obstructive sleep apnoea (OSA) are poorly described, yet this knowledge may be critical to inform preventive strategies. We conducted the first study to investigate the association between early-life risk factors and OSA in middle-aged adults. Data were from population-based Tasmanian Longitudinal Health Study cohort (n = 3550) followed from 1st to 6th decades of life. Potentially relevant childhood exposures were available from a parent-completed survey at age 7-years, along with previously characterized risk factor profiles. Information on the primary outcome, probable OSA (based on a STOP-Bang questionnaire cut-off ≥5), were collected when participants were 53 years old. Associations were examined using logistic regression adjusting for potential confounders. Analyses were repeated using the Berlin questionnaire. Maternal asthma (OR = 1.5; 95% CI 1.1-2.0), maternal smoking (OR = 1.2; 1.05, 1.5), childhood pleurisy/pneumonia (OR = 1.3; 1.04, 1.7) and frequent bronchitis (OR = 1.2; 1.01, 1.5) were associated with probable OSA. The risk-factor profiles of 'parental smoking' and 'frequent asthma and bronchitis' were also associated with probable OSA (OR = 1.3; 1.01, 1.6 and OR = 1.3; 1.01-1.9, respectively). Similar associations were found for Berlin questionnaire-defined OSA. We found novel temporal associations of maternal asthma, parental smoking and frequent lower respiratory tract infections before the age of 7 years with adult OSA. While determination of their pathophysiological and any causal pathways require further research, these may be useful to flag the risk of OSA within clinical practice and create awareness and vigilance among at-risk groups.

Stunting is influenced by toddler and maternal characteristics, history of infectious disease, IYCF practices, and protein intake: case control study in Nabire coastal areas, Indonesia

Background: Stunting is one of the unresolved nutritional problems in Indonesia. The coastal areas of Nabire Regency have a high prevalence of stunting, which is more than 20%. This study aims to further analyze the risk factors for stunting in children aged 6-24 months in the coastal area of Nabire Regency. Methods: The research design used was a case-control study with matching age, gender, socioeconomics, and village monographs, performed in August 2022-June 2023. The number of samples in this study was 112 subjects (children’s 6-24 months). Collected by questionnaires, data of family characteristics, toddler characteristics, maternal characteristics, history of infectious diseases, IYCF practices, nutritional intake of toddlers, complete basic immunization status of toddlers, maternal anemia history, maternal SEZ history, and maternal ANC history. The risk of independent variables was analyzed by logistic regression test by SPSS 16. Results: The results showed that the risk factors for stunting were birth length (OR=6.38), birth weight (OR=6.73), current weight (OR: 15.59), history of anemia during pregnancy (OR=19.60), history of ANC during pregnancy (OR=41.88), frequency of respiratory infection (OR=39.00), frequency of diarrhea (OR=2.37), early initiation of breastfeeding (OR=0.33), exclusive breastfeeding (OR=0.41), 6-24 months breastfeeding (OR=0.39), complementary feeding practices (OR=2.60), protein intake (OR=6.75). Conclusions: Nabire Regency with its diversity of socio-cultural life, and unique geographical conditions, certainly has problems and determinants of stunting that are different from other parts of Indonesia. The most influential risk factor for stunting is the history of ANC during pregnancy and frequency of respiratory infections.

Immunodeficiency due to a novel variant in PIK3CD: a case report

BackgroundPrimary immunodeficiencies are immunological disorders caused by gene mutations involved in immune system development and activation. Recently, activated phosphoinositide 3-kinase delta syndrome (APDS) due to mutations in the phosphoinositide 3-kinase (PI3K), phosphatidylinositol-4, 5-bisphosphate 3-kinase, catalytic subunit delta gene (PIK3CD), and phosphoinositide 3-kinase regulatory subunit 1 (PIK3R1) genes have been reported to induce a combined immunodeficiency syndrome leading to senescent T cells, lymphadenopathy, and immunodeficiency. The exact diagnosis of these deficiencies is essential for treatment and prognosis. In recent years, targeted treatment with selective PI3Kd inhibitors has had a significant effect on controlling the symptoms of these patients.Case presentationIn this case report, we represent a 27-month-old girl with recurrent fever, an increased level of inflammatory markers, and erythema nodosum, who was referred to the rheumatology clinic. In the course of evaluations, because of the lack of clinical improvement with usual treatments, and a history of frequent respiratory infections, combined immunodeficiency was diagnosed in the immunological investigations. Moreover, whole-exome sequencing was performed for her.ConclusionThe genetic analysis found a novel variant of PIK3CD (c.1429 G > A) in the patient. Following daily antibiotic prophylaxis and monthly IV therapy, the patient’s frequent infections and fevers were controlled.

End-user acceptability of a prototype digital stethoscope to diagnose childhood pneumonia- a qualitative exploration from Sylhet, Bangladesh

BackgroundConsidering the high frequency of respiratory infections among children in low- and middle-income countries (LMICs), the World Health Organization (WHO) developed a pragmatic guideline for managing pneumonia in low-resource settings. The guideline’s low specificity leads to many false-positive pneumonia cases receiving antibiotic treatment. Integrating diagnostic technology to incorporate lung sounds into WHO guidelines could improve childhood pneumonia diagnosis and management. This qualitative study aimed to explore the acceptability of a prototype digital stethoscope device among potential end-users in Bangladesh.MethodsWe conducted four focus group discussions (FGDs) with beneficiaries and service providers who used a 2018 digital stethoscope prototype. The data collection was conducted in November 2020. The study was carried out at Zakiganj Upazila (sub-district) of Sylhet district of Bangladesh. A total of 34 respondents, including parents of under-5 children, Community Health Care Providers (CHCPs), and community leaders were enrolled. Two researchers (TJ and a research assistant (not a co-author of this manuscript) conducted the FGDs. Verbatim transcripts were prepared, and translations were completed. Coding was executed in Microsoft Excel, and relevant quotes were extracted to ascertain the emerging themes. To ensure validity, two researchers coded the dataset independently and inconsistencies were resolved through discussion.FindingsMothers were more aware of the digital stethoscope than fathers. Except for the female community leaders, male leaders were unaware of the stethoscopes. Most CHCPs had positive perceptions of the digital stethoscope. They appreciated stethoscope training as they learned about new technology and diagnostic approaches. The users mentioned several technical shortcomings of the prototype device. A few stakeholders expressed dissatisfaction with the level of community involvement and information sharing from the study. The use of the device plummeted during the COVID-19 pandemic for fear of infection, to counteract which the CHCPs cleaned the device with chlorhexidine after every application as a precaution.ConclusionOverall, device use was supported by stakeholders despite perceptions that the prototype had some technological limitations, community engagement was suboptimal, and the COVID-19 pandemic caused disruptions. Stronger community engagement, addressing technological issues, and further research on its health systems application would improve the acceptability and effective use of the digital stethoscope.