History Of Respiratory Infection Research Articles

Acute viral myositis: profound rhabdomyolysis without acute kidney injury.

BackgroundAcute viral myositis (AVM) may be triggered by influenza A/B, enteroviruses and other viruses. Severe complications including rhabdomyolysis regularly lead to acute kidney injury (AKI). The aim of this short report was to discuss management and differential diagnosis of massive creatine kinase (CK) elevation.Patient, material and methodsHerein, we report on a 19-year-old Austrian male of African descent with a history of respiratory tract infections and whole-body pain. He further developed acute viral myositis and massive CK elevation up to 440,000 IU/L but without any signs of AKI. A literature search relating AVM, management and differential diagnosis of rhabdomyolysis was conducted in PubMed and UptoDate.ResultsA full panel of serological and autoimmune blood work-up including testing for human immunodeficiency virus (HIV), hepatitis, influenza A/B, Epstein-Barr virus (EBV), antinuclear antibodies (ANA) and autoantibodies against various extractable nuclear antigens (ENA) did not reveal evidence for viral originators or autoimmune diseases. This case indicates that in acute viral myositis associated with extreme CK elevation (>400,000 IU/L) AKI might be completely absent. Potential causes for this clinical phenotype, differential diagnosis and management are discussed.

A novel bi‐allelic loss‐of‐function mutation in STIM1 expands the phenotype of STIM1‐related diseases

STIM1, the stromal interaction molecule 1, is the key protein for maintaining calcium concentration in the endoplasmic reticulum by triggering the Store Operated Calcium Entry (SOCE). Bi-allelic mutations in STIM1 gene are responsible for a loss-of-function in patients affected with a CRAC channelopathy syndrome in which severe combined immunodeficiency syndrome (SCID-like), autoimmunity, ectodermal dysplasia and muscle hypotonia are combined. Here, we studied two siblings from a consanguineous Syrian family, presenting with muscle weakness, hyperlaxity, elastic skin, tooth abnormalities, dysmorphic facies, hypoplastic patellae and history of respiratory infections. Using exome sequencing, we have identified a new homozygous frameshift mutation in STIM1: c.685delT [p.(Phe229Leufs*12)], leading to a complete loss of STIM1 protein. In this study, we describe an unusual phenotype linked to STIM1 mutations, combining clinical signs usually observed in different STIM1-related diseases. In particular, we confirmed that the complete loss of STIM1 function is not always associated with severe immune disorders. Altogether, our results broaden the spectrum of phenotypes associated with mutations in STIM1 and opens new perspectives on the pathological mechanisms associated with a defect in the proteins constituting the SOCE complex.

Clinical Profile and Outcomes of Guillain-Barre Syndrome: A Four-Year Retrospective Study at a Tertiary Hospital in the Philippines

Guillain-Barre syndrome (GBS) is the leading cause of acute neuromuscular weakness in the developed world. In this retrospective study, a total of 34 patients were identified and diagnosed with GBS from January 2016 to December 2019. The Brighton criteria was used to classify the certainty and diagnosis of GBS. The clinical profile and outcomes were then determined. GBS was seen in all age groups with a mean age at 47.9 with a slightly male predominance. The majority(47%) of patients had a history of respiratory infection although almost 30% had no known triggering event. The most common presenting symptom was ascending paralysis followed by complaints of cranial nerve involvement. Younger age and less severe disease presentation at onset correlate with a more favorable outcome. Patients who presented earlier after the triggering event were noted to have a faster rate of progression of symptoms and a worse outcome. The common GBS variants in this study according to nerve conduction studies were AMSAN and MFS. Methylprednisolone and IVIG were both effective with no statistical significance noted. The in-hospital mortality rate was at 3%. Majority of patients had a good functional outcome.

Guillain-Barre syndrome during COVID-19 pandemic: experience from a referral healthcare center in Mexico.

To describe clinical characteristics and electrophysiological variants of GBS cases during the pandemic, we carried out a comparative analysis between SARS-CoV2 related GBS and non-SARS-CoV2 patients and then compared to the 2019 cases. We carried out a cross-sectional study of GBS patients diagnosed according to Asbury and Cornblath criteria. We collected information on clinical and paraclinical variables. We defined a SARS-CoV-2 related GBS case according to the description of Ellul et al. We used Hadden criteria to classify the electrophysiological variants. We performed a comparative analysis between groups. Fourty-two patients were diagnosed with GBS in 2020, men 64.2%, age 46 ± 17.4 years, patients with obesity/overweight 42.8%, previous diarrhea 31%, history of respiratory tract infection 14.2%. Guillain Barre Disability Scale = 3 points 71.4% and, cranial nerve involvement 69%. The most frequent electrophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 53.5%. Seven (16.6%) cases were SARS-CoV2 related, four men, age 43.4 ± 13.4 years. When comparing patients with GBS in 2020 vs patients in 2019, we observed a decrease in the previous infection history during 2020 (45.2% vs 73.3%, p-value = 0.005) and a decrease in previous respiratory infection (14.2% vs 33.3%, p = 0.045), as well as a higher frequency of cranial nerve involvement, and albuminocytologic dissociation. SARS-CoV2 virus infection preventive measures may be impacting the presentation of post-infectious diseases such as GBS. We did not observe an increase in GBS cases during 2020. Also, the AIDP variant were more frequent in our population in the COVID-19 pandemic.

A CASE REPORT OF TUBERCULAR TRANSVERSE MYELIT

INTRODUCTION Transverse myelitis (TM) is a focal inflammatory disorder of the spinal cord, often associated with infectious disease, which can lead to permanent paraplegia or quadriplegia. CASE REPORT: A 56-year-female ,presentedwithb/l lower limb weakness since 2 days,b/l lower limb loss of sensations since two days,inability to walk since one day,and urinary retention requiring catherisation and fecal incontinence since one day. By history there was also , intermittent fever and night sweats. There was past history of respiratory tract infection two weeks back which partially subsided with antibiotics.Patient is known hypertensive and hypotyroid. Vitals:-normal General physical examination showed moderate general condition, and presence of crackles in both lungs. Neurological examination :- arreflecticlowerlimbs,paraplegia inboth lower limbs (strength 0/5 according to the Medical Research Council grade), and a positive Babinski sign,loss of all sensations completely below umbilicus. CONCLUSION- Tuberculous transversal myelitis is rare but should be consid- ered in the differential diagnosis of non-compressive myelopa- thies, in high burden TB countries or in the presence of clinical symptoms suggestiveofTB

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Multidrug-resistant Staphylococcus aureus nasal carriage among HIV-positive outpatients in Guangzhou, China: Prevalence, risk factors, phenotypic and molecular characteristics

IntroductionData on comprehensive characterization of multidrug-resistant (MDR) Staphylococcus aureus (S. aureus) carriage in human immunodeficiency virus (HIV)-positive patients are limited. The objective of the present study is to determine the prevalence, risk factors, phenotypic and molecular characterization of MDR S. aureus isolated from HIV-positive population. MethodsA cross-sectional study was conducted to determine the characteristics of MDR S. aureus nasal carriage among HIV-positive outpatients in an HIV clinic from June to August 2017. Nasal swabs and risk factor data of the enrolled HIV-positive outpatients were collected. Phenotypic and molecular characteristics of MDR and non-MDR S. aureus isolates were analyzed. Risk factors for nasal carriage with MDR S. aureus were estimated by logistic regression. The relationship between phenotypic and molecular characteristics of S. aureus isolates was assessed by the correspondence analysis. ResultsOverall, 1001 HIV-positive outpatients were included. The prevalence of MDR S. aureus nasal carriage was 15.18% (152/1001), and the proportion of multidrug resistance among S. aureus isolates was 60.08% (152/253). Having a history of respiratory tract infection was the risk factor for MDR S. aureus nasal carriage (adjusted odds ratio = 1.90, 95% confidence interval: 1.25–2.89). Multidrug resistance of S. aureus isolates was in good corresponding relationships with clonal complex (CC)5, CC15, CC59 and CC398. ConclusionsWe found high burden of multidrug resistance among S. aureus isolated from HIV-positive outpatients, particularly in those who had upper respiratory tract infection. Moreover, CC59 and CC398 are highly related to multidrug resistance of S. aureus isolates.

TO STUDY OF LDH LEVEL IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease of the lungs characterized by structural changes such as emphysema, airflow limitation, dynamic hyperinflation, air trapping, and peribronchial fibrotic remodeling of the lungs with significant systemic inflammatory components, induced by chronic exposures to smoking and/or occupational or environmental sources.
 Methods: It is a case control study of 100 subjects divided into two groups including 50 healthy controls and 50 cases of COPD. Patients with history of respiratory infection, pneumonia, coronary heart disease, heart failure, and neuromuscular disease, renal and hepatic dysfunction were excluded.
 Results: The statistically significant increased value of serum lactate dehydrogenase in cases as compared to control group with p value<0.05.
 Conclusion-Rise in serum LDH levels, though known to occur in many respiratory conditions, has not been studied in depth. Based on our study results, we have proved that patients with COPD have raised serum LDH levels.
 Keywords: COPD, Lactate dehydrogenase, Smoking.

Síndrome de Guillain Barré en paciente con antecedente de infección respiratoria: reporte de un caso

Introducción: El síndrome de Guillain-Barré (SGB), es una polineuropatía inflamatoria aguda, de etiología autoinmune que causa inflamación en los nervios periféricos y sus raíces espinales, se presenta como una parálisis flácida, simétrica, ascendente, arrefléxica y con antecedentes de una infección respiratoria o gastrointestinal previa. 
 Objetivo: Describir un caso clínico de Guillain Barré, con antecedentes de infección respiratoria previa.
 Material y métodos Estudio descriptivo, retrospectivo, presentación de un caso clínico.
 Resultados: Se trata de una paciente femenina de 69 años sin antecedentes patológicos de interés, padeció una infección respiratoria viral hace dos semanas, acude a médico particular presentando dolor en extremidades, parestesias en miembros inferiores, se prescribe ketoprofeno 100 mg, tiocolchicócido 4 mg e ibuprofeno 400 mg en dosis únicas, con lo cual no hubo mejoría, agravándose el cuadro clínico. Doce días después acude con disminución de fuerza muscular y dificultad para la deambulación. Reflejos osteo-tendinosos ausentes y leve disminución de la sensibilidad en zona distal de ambos miembros inferiores. Entre los exámenes complementarios se observó disociación albumino-citológica en el líquido cefalorraquídeo (LCR) y una electromiografía compatible con Polineuropatía Aguda. Se diagnosticó SGB, brindándose tratamiento con inmunoglobulina humana endovenosa con una evolución y resultados favorables. Conclusiones: El SGB es una polirradiculoneuropatía aguda inflamatoria desmielinizante monofásica ascendente de origen inmunológico, cuyo diagnóstico es clínico, los exámenes complementarios ayudan a corroborar la patología y permiten clasificar la enfermedad, como tratamiento se sigue manteniendo el uso de plasmaféresis o inmunoglobulina humana intravenosa sin evidenciarse superioridad a favor de alguno de ellos.

Magnitude and Predictors of Pneumonia among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis.

Background Pneumonia is currently the leading cause of morbidity and mortality among under-five children in developing countries, including Ethiopia. Although these problems are easily preventable and treatable, it contributes to more than 18% of deaths of under-five children every year in Ethiopia. Regardless of these facts, there is a paucity of information regarding the magnitude and its predictors of pneumonia in Ethiopia. Therefore, the main objective of this review is to determine the pooled magnitude of pneumonia and its predictors among under-five children in Ethiopia. Methods The international databases such as MEDLINE/PubMed, EMBASE, Google Scholar, and Science Direct were scientifically explored. Articles were also searched by examining the gray literature on institutional databases and by reviewing reference lists of already identified articles. We considered all primary studies reporting the magnitude of pneumonia among under-five children and its predictors in Ethiopia. We retrieved all necessary data by using a standardized data extraction format spreadsheet. STATA 14 statistical software was used to analyze the data, and Cochrane's Q test statistics and I2 test were used to assess the heterogeneity between the studies. Significant variability was found between the studies in such a way that a random-effect model was used. Result The pooled magnitude of pneumonia among under-five children was 20.68% (I2 = 97.9%; P ≤ 0.001) out of 12 studies in Ethiopia. Children who have unvaccinated (OR = 2.45), food cooking in the main house (OR = 2.46), vitamin A supplementation status (OR = 2.85), malnutrition (OR = 2.98), mixed breastfeeding (OR = 2.46), and child history of respiratory tract infection (OR = 4.11) were potential determinates of pneumonia. Conclusion and Recommendations. This review showed that the magnitude of pneumonia was relatively high. Hence, appropriate intervention on potential determinates such as health education on exclusive breastfeeding and nutrition, place of food cooking, increased immunization and vitamin A supplementation, and early control of respiratory tract infection was recommended to prevent those risk factors.

Incidence and clinical characteristics of Guillain-Barré syndrome in Osona (Barcelona, Spain), 2003-2016

IntroductionAccording to most studies, the incidence of Guillain-Barré syndrome increases with age, with a peak incidence occurring between 70 and 80 years of age. The objective of this study is to describe the incidence (overall and by sex and age group) and clinical characteristics of Guillain-Barré syndrome in Osona (Barcelona, Spain). MethodsWe performed a retrospective, descriptive, population-based study covering the period 2003 to 2016. ResultsThe global incidence of Guillain-Barré syndrome is 2.07 cases per 100000 person-years. Incidence increases with age, except for small peaks during childhood and between 40 and 50 years, and reaches a maximum of 6.26 cases per 100000 person-years above the age of 80. The incidences of the different variants were: AIDP, 72.1%; AMAN, 16.3%; ANSAN, 4.7%; and Miller Fisher syndrome, 4.7%. A total of 41.9% of patients had a history of respiratory tract infections, and 20.9% had a history of gastrointestinal infections. Protein in the cerebrospinal fluid was found in 76.7%. EMG findings suggested demyelination in 73.7% of the patients and axonal degeneration in 26.3%. A total of 20.9% of patients needed ventilatory support. Six-month mortality was 9.3%. Variables associated with worse prognosis were age over 80 years, delay in admission, previous gastrointestinal infection, and AMAN variant. ConclusionsThe incidence observed in our study is in the upper range of estimated incidence rates reported in European and North American studies. The syndrome may be underdiagnosed in elderly patients; physicians must be vigilant to the possibility of the disease, which is associated with a high mortality rate if it is not treated early.

Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study

IntroductionThere are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14–16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors. Material and methodsFrom 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants’ through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used. ResultsThe participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found. ConclusionsAD incidence in our cohort was high and several risks factors were related to AD.

Quiste pulmonar congénito como causa de neumonías recurrentes. A propósito de un caso

Introducción: Un quiste pulmonar se define como un espacio de parénquima pulmonar que contiene aire o líquido; se presentan asintomáticos o con infecciones respiratorias recurrentes. Se desarrolla por la separación de un segmento de uno de los bronquios principales, como resultado de una gemación anómala del intestino primitivo, con predilección por los lóbulos pulmonares inferiores. Tiene una incidencia mundial baja y pocos casos reportados por la literatura. 
 Objetivo: Describir un caso clínico de Quiste pulmonar congénito como causa de neumonías recurrentes Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico. 
 Resultados: Se presenta el caso de una preescolar de 4 años con antecedente de infecciones respiratorias a repetición que es diagnosticada de quiste pulmonar congénito mediante hallazgos imagenológicos, durante el estudio de la patología respiratoria recurrente, tratada quirúrgicamente con lobectomía, con excelentes resultados.
 Conclusiones: Las infecciones respiratorias recurrentes es decir al menos 2 episodios en un año son la principal manifestación de los quistes pulmonares congénito en niños preescolares y escolares que requieren una investigación exhaustiva del aparato respiratorio del niño, ya que una de las principales causas son las malformaciones pulmonares, como es el quiste pulmonar

Analysis of Risk Factors of Fever among Inpatients in Rehabilitation Department Based on Lasso Regression Analysis

Purpose: To explore the fever-related risk factors of inpatients in Rehabilitation Department, and to provide reference for patients with high risk of fever to take corresponding nursing measures. Methods: The study was conducted on the Rehabilitation Department of The First Affiliated Hospital of Jinan University from July 2019 to December 2019. The fever group included 51 patients and the non-fever group included 49 patients without fever. The two groups of clinical data, comorbidities, related laboratory values, possible risk factors of fever were analyzed by case regression analysis, and the relevant risk factors were screened out by LASSO (least absolute shrinkage and selection operator) regression analysis. Results: According to the results of Lasso regression analysis, pressure sore or skin infection, history of hypertension, current history of respiratory tract infection, feeding patterns were the higher risk factors of fever in inpatients in Rehabilitation Department, while the first course of disease, main diagnosis, history of respiratory tract infection within half a year, kidney damage and hospitalization days were lower risk factors. Conclusion: This study is helpful to early identify the fever risk of inpatients in Rehabilitation Department, and provide reference basis for high-risk fever patients to take positive and effective nursing measures.

A predictive model of offspring congenital heart disease based on maternal risk factors during pregnancy: a hospital based case-control study in Nanchong City.

Objective: Based on epidemiological field data, this study was to develop a prediction model which can be used as a preliminary screening tool to identify pregnant women who were at high risk of offspring congenital heart disease (CHD) in Nanchong City, and be beneficial in guiding prenatal management and prevention.Methods: A total of 367 children with CHD and 367 children without congenital malformations aged 0 to 14 years old were recruited from the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital between March 2016 and November 2018. Using the SPSS 22.0 case-control matching module, the controls were matched to the cases at a rate of 1:1, according to the same gestational age of child (premature delivery or full-term), the maternal age of pregnancy (less than 1 year). 327 matched case-control pairs were analyzed by SPSS 22. Univariate and multivariate analysis were performed to find the important maternal influencing factors of offspring CHD. A logistic regression disease prediction model was constructed as the final predictors, and Hosmer-Lemeshow goodness of fit test and receiver operating characteristic (ROC) curve were used to evaluate the model.Results: 654 subjects (327 cases and 327 controls) were matched. The 25 variables were analysed. The logistic regression model established in this study was as follows: Logit(P)= -2.871+(0.686×respiratory infections)+(1.176×water pollution)+(1.019×adverse emotions during pregnancy) - (0.617×nutrition supplementation). The Hosmer-Lemeshow chi-square value was 7.208 (df = 6), with a nonsignificant p value of 0.302, which indicates that the model was well-fitted. The calibration plot showed good agreement between the bias-corrected prediction and the ideal reference line. Area under the ROC curve was 0.72 (95% CI: 0.681~0.759), which means that the predictive power of the model set fitted the data.Conclusion: In Nanchong city, more attention should be paid to mother who had a history of respiratory infections, exposure to polluted water, adverse emotions during pregnancy and nutritional deficiency. The risk model might be an effective tool for predicting of the risk of CHD in offspring by maternal experience during pregnancy, which can be used for clinical practise in Nanchong area.

Study on Influence Factors of Pressure Injury Risk in the Elderly Inpatients with Kidney Disease Based on LASSO Regression

Objective: This paper aims to explore clinical status and related influence factors of pressure injury (PI) in the elderly inpatients with kidney disease, so as to provide reference for the prevention and treatment of PI in the elderly inpatients with kidney disease. Methods: Retrospective collection method is adopted to collect 158 clinical cases of the elderly inpatients with kidney disease aged ≥ 60 in the Nephrology Department, the First Affiliated Hospital of Jinan University from January 2017 to December 2019, and then least absolute shrinkage and selection Operator (LASSO) regression analysis is used to analyze 17 possible influence factors; finally Logistic regression model is established to analyze and screen influence factors of risk. Results: 1) Among 158 elderly inpatients with medium and high risk of PI, the incidence of PI is 20.25%; the most common stage of injury is stage I (42.5%); sacrococcygeal (60%) is the high-risk site of pressure injury. 2) LASSO regression analysis shows that history of present respiratory infection/respiratory failure (β = 1.2714. P β = 0.4177. P < 0.05) are independent factors influencing PI risk in the elderly inpatients with kidney disease. Conclusion: The elderly patients with kidney disease and PI risk are the high incidence population of hospital acquired PI; for the elderly inpatients with kidney disease and having respiratory infection history or respiratory failure, prolonged hospitalization will significantly increase the risk of PI. Therefore, targeted preventive and control measures should be taken to reduce the incidence of PI.

Unexpected low frequency of respiratory symptoms in an HIV-positive urban sub-Saharan population compared to an HIV-negative control group.

BackgroundChronic respiratory illnesses and respiratory infections are common in HIV-positive populations. It seems reasonable that HIV-positive people experience more respiratory symptoms, such as coughing and breathlessness, than those who are HIV-negative.ObjectivesThis study aims to determine the frequency of respiratory symptoms in an urban African HIV-positive population.MethodA cross-sectional study was conducted in Johannesburg, South Africa, in 2016–2017. Four groups of participants were included: HIV-positive participants (1) not yet on antiretroviral therapy (ART), (2) on first-line ART, (3) on second-line ART and (4) age- and sex-matched HIV-negative controls. Data were collected on socio-demographics, respiratory risk factors and respiratory symptoms. A logistic regression analysis was performed to determine if respiratory symptoms differed between groups and to identify determinants associated with symptoms.ResultsOverall, 547 participants were included, of whom 62% were women, with a median age of 37 years. Of these patients, 63% (347) were HIV-positive, 26% were ART-naïve, 24% were on first-line ART and 50% were on second-line ART. Cough and/or productive cough was reported by 27 (5%), wheezing by 9 (2%) and breathlessness by 118 (22%) of the participants. The frequency of these symptoms did not differ by HIV status after adjustment for age and sex. Breathlessness was associated with age, female sex, obesity, a history of respiratory infection and a history of airway hyper-reactivity.ConclusionThe frequency of respiratory symptoms was low in our study population except for breathlessness. HIV-positive participants, whether or not on ART, did not experience more symptoms than HIV-negative participants.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Modifiable risk factors for community-acquired pneumonia in children under 5years of age in resource-poor settings: a case-control study.

Despite the availability of vaccines and antibiotics, pneumonia remains the leading cause of mortality among children under 5years of age. The objective of this study was to identify modifiable risk factors for community-acquired pneumonia (CAP) in children under 5years of age in a vaccinated population. A case-control study was conducted between January and December 2017. The cases included children aged 2-59months with X-ray-confirmed pneumonia, whereas the controls were children from the community with no history of respiratory infection. A multivariable logistic regression model was used to determine the modifiable risk factors for CAP. A total of 113 children with X-ray-confirmed pneumonia and 350 healthy children were enrolled in this study. The median ages for the cases and controls were 13.7 (IQR=7.2-25.3) and 13.4 (IQR=6.0-24.8)months respectively. One (0.9%) child died after the enrolment. The independent predictors of CAP included a lack of exclusive breastfeeding for 6months (aOR=1.7, 95% CI=1.0-2.9), underweight (aOR=2.1, 95% CI=1.0-4.5), unclean cooking fuel (aOR=1.8, 95% CI=1.0-3.3) and low income (aOR=2.9, 95% CI=1.6-5.4). No association was found between vaccination status and CAP. In addition to a lack of exclusive breastfeeding, children from families of low-economic status were at risk of contracting CAP. Since the risk factors are complex, the study results call for more concerted efforts by and collaboration among the health, agriculture and development sectors to address mortality caused by CAP.

MODERATE PERSISTENT ASTHMA IN CHILDREN;

Objective: The objective of this study is to compare the effects of inhaledbeclomethasone with oral montelukast in long term management of moderate persistent asthmain children. Design: Quasi experimental study. Period: 6 months, from July 20,2007 to January20, 2008. Settings: Out patient paediatric department at Fauji Foundation hospital, Rawalpindi.Material and Methods: 8o children between 5-12yrs of age presenting with moderate persistentasthma, divided in two groups of 40 each. Group A treated with beclomethasone inhaler whileGroup B was started on oral montelukast. Drugs effect was recorded on a 2 wkly proforma for 8weeks. Results: There were 54(67.5%) male and 26(33%) female. Most common triggeringfactor seen in 54(67.5%) patients was recent history of respiratory tract infection, exposure tocarpet dust in 43(53.75%), cigarette smoke in 42(52.5%),recent psychological stress in 28(35%) ,pollen allergy in 26 (32.5%) , pets exposure in 8 (10%) and to mite was noticed in 5(6.25%)children. Marked improvement was observed in day time cough in group A with 10(25%) patientsbeing free of cough with inhaler, while 20(50%) showed mild intermittent symptoms. 1(2.5%)showed mild persistent symptoms. In Group B 3(7.5%) patients were symptom free,23(57.5%)with mild intermittent and 4(10%) with mild persistant symptoms while 6(15%)continued to have moderate persistent symptoms. P value was 0.01. Regarding day timebreathlessness, P value was significant of 0.258. Similarly marked improvement was observed innight symptoms of breathlessness, cough and sleeplessness in both groups. P value was lessthan 0.05 in majority of the variables showing statistically significant improvement with inhaledbeclomethasone than with oral montelukast. Conclusions: Inhaled beclom