History Of Respiratory Infection Research Articles

Diversity of Fungi and Bacteria Associated with Respiratory Infections among Commercial Bank Tellers in South-Eastern Nigeria

Introduction: Fungi - associated respiratory Infections are serious health challenges that have become inextricably linked with handling of paper currencies in some countries of the world Dermici et al., [1]. Given the quantity of Old-worn-out and mutilated Naira notes in circulation, and other prevailing circumstances in Nigerian banking halls, study was undertaken to evaluate the incidence and spread of fungi -associated respiratory infections among tellers from selected commercial Banks in South-Eastern Nigeria. Methods: A total of 504 Cash Bank Tellers; 196 Males and 308 females aged 25 – 48years (mean age 32.4 years) were evaluated for Fungi-associated infections using Sputum and Nasal secretions-smear Microscopy and Culture simultaneously. Twenty-Seven bacterial strains; Staphylococcus aureus (12), Streptococcus Pneumonia (7) and Klebsiella pneumoniae (8) were tested for their antibiogram Results: One hundred and fifty-nine (31.5%) of the 504 Bank Cash Tellers were diagnosed of respiratory infections due to Aspergillus Sp. (13.5%), Candida albicans (5.8%), Candida tropicalis 6(.4%), Staphylococcus aureus (2.4%), Streptococcus pneumoniae (1.4%), Klebsiella pneumoniae (1.6%), and Nocardia Sp. (0.6%). The yield of micro-pathogens appeared to rise from 18.8% to 55.6% as duration of currency note handling increased from ≤ 6months to 43 – 48 months respectively. Analysis of the differences of the Micro-Pathogens isolated among tellers from Bulk Rooms (42.9%) and those from open Halls (20.2%) was statistically significant (X2cal=68.3) P < 0.05. Forty-eight (88.9%), 26(123.8%), 41(44.6%) and 43(113.2%) Strains of micro-pathogens were isolated from Tellers who indicated with history of respiratory infections, smoking only, alcohol consumption only and smoking/alcohol consumption respectively. The proportions of the micro-pathogens isolated are shown in the Table 1, with Aspergillus sp. yield appearing highest. The antibiogram of the 27 strains of bacteria isolated in the study appeared relatively high; 92.6% for Ofloxacin and 66.7% for Gentamycin, while Streptomycin, Erythromycin, Cephalexin, Ampiclox, and Chloramphenicol responded poorly. Conclusion: The micro-pathogens isolated from this study are important agents of respiratory infections. The relatively high proportions (31.6%) of micro-pathogens isolated may serve as relevant indication that most Nigerian Currency notes in circulation are old, worn-out, mutilated, and are contaminated with micro-pathogens commonly linked with serious public health problems.

MORBIDITY PROFILE AND RISK FACTORS AMONG UNDER-FIVES AND HEALTH CARE SEEKING BEHAVIOURS OFTHEIR PARENTS

The present study investigated the morbidity profile and its risk factors amongunder-fivesand the health care seeking behavioursof their parents in a selectedPanchayat,Ernakulam.Theobjectivesofthestudyweretoassessthemorbidityprofileand its risk factors among under-fives and health care seeking behaviours of parentsand to find the association between morbidity and selected demographic variables andselectedriskfactors.Across-sectionalcommunity-baseddescriptivesurveydesignwasemployed.Thesamplewereselectedusingconveniencesamplingtechnique.Thetoolsweremorbidityprofileassessmentchecklist,riskfactorassessmentchecklistandhealthcare seeking behaviour checklist tool. The findings showed that 81% children hadmorbidityand19%hadnomorbidity.Themost commonmorbidconditionswerecoldand running nose (76%),followed by cough (73%),fever (64%) and hand foot andmouth disease(8%).With regard to a risk factors leading to morbidity, 27% were notgiven exclusive breast feeding, 25% did not start complimentary feeding at the end ofsix months, 14% did not wash their hands before feeding the children, 28% had nofamily history of respiratory tract infection, 20% had no proper ventilation at home,34% had no proper waste disposal, 67% were exposed to passive smoking, 52% ofchildrenweregoingtoAnganwadiand4%hadcongenitaldisorders.Presentstudyalsoshowsthat52%ofmothersreliedonallopathicsectorandequalpercentage(12%)usedAyurvedaandprevious medicationand14%madeuseofhomeremedyduringdiseaseconditions of their children. The findings also showed that there was no associationbetweenmorbidityandselecteddemographicvariables.Thefindingsshowedtherewasassociation between morbidity and using boiled water for drinking (p = 0.038), familyhistoryofrespiratory infections(p=0.05),child goingto day-care/Anganwadi.

Birth weight and asthma in young adults of a Brazilian birth cohort.

This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Brain abscess as an otorhinolaryngological complication

Introduction: A brain abscess can be fatal if not diagnosed or treated promptly. It is more common in children than in adults and has a high mortality rate. Respiratory infections, such as otitis and sinusitis, usually precede brain abscesses. In most cases, double treatment, antibiotics, and surgery are necessary. Complications can be fatal even with proper treatment. Clinical case: This was a 3-year-old girl with a history of respiratory infection. His parents took her to the emergency room due to a severe headache and a seizure episode. Clinical examination revealed left ear otalgia associated with pain and sensitivity to palpation of the mastoid region. Laboratory tests revealed leukocytosis of 18,770/MMC with neutrophilia, thrombocytosis of 628,000/MMC, elevated C-reactive protein of 8.35 mg/dl (average value 0.10-0.30 mg/dl) and elevated ferritin of 250.20 ng/dl (standard value 7-140 ng/dl). Due to the patient’s history and clinical findings, the skull's computed tomography (CT) was performed, revealing an image of evident hypodensity in the left hemisphere. MRI was also performed and revealed that the lesion was previously associated with left breast thrombosis. She received antibiotics and low-molecular-weight heparin with neurosurgical therapy, which produced good results. Evolution: Despite the extent of the injury, he had two episodes of seizures. He promptly received appropriate antibiotic therapy and surgical treatment, which produced good results. Three months later, during the follow-up, he looked normal and had no long-term complications. Conclusions: Complications of brain abscess, even with adequate treatment, can be severe and include epilepsy or death. Early treatment minimizes lethal risks.

Classification of common variable immunodeficiency through immunological and clinical phenotyping in Moroccan patients.

Objective: Common variable immunodeficiency (CVID) is a complex inborn error of humoral immunity with complications of both infectious and non-infectious origins. Classifications of CVID patients provide a clearer understanding of the pathogenesis, prediction, and management of non-infectious complications. This study aims to classify Moroccan CVID patients based on the European classification (EUROclass). Materials and Methods: We recruited 20 CVID patients meeting standard diagnostic criteria (5-6). After collecting clinical and demographic data, we used flow cytometry to analyze B-cell subsets and group patients and assess the relation of each group with clinical manifestations. Results: 90% of the patients in our cohort study had a history of respiratory infections. The noninfectious manifestations included splenomegaly, autoimmunity, lymphadenopathy, and granulomatous diseases diagnosed in 50%, 45%, 40%, and 25% of patients, respectively. We observed significant co-occurrence of splenomegaly with autoimmunity and granulomatous diseases to a lesser extent. Patients had a significant reduction in total, switched memory, marginal zone-like, plasma blasts, and a substantial increase in the percentage of activated B cells, suggesting a defect in the late phases of B-cell differentiation. This condition was linked with an increased occurrence of splenomegaly and granulomatous affections. Besides, patients also had an expansion of CD21low B-cells, which was strongly associated with splenomegaly. Conclusion: The classification of the first Moroccan cohort of CVID patients showed agreement with previous results. It suggests the possibility of adopting this approach on a global scale for better diagnosis and follow-up of CVID patients.

Risk factors for progression to severe pneumonia in children visiting the emergency department with pneumonia

To determine the risk factors for developing severe pneumonia in children under 5 years old with pneumonia. A case-control study was conducted 246 children with pneumonia between 2 and 59 months old who were admitted to the department of emergency of the Children's Hospital of Nanjing Medical University from May 2019 to May 2021 were enrolled. The children with pneumonia were screened according to the diagnostic criteria of the World Health Organization (WHO). Case information of the children was reviewed to obtain relevant socio-demographic, nutritional status and potential risk factors. The independent risk factors for severe pneumonia were analyzed by univariate analysis and multivariate Logistic regression respectively. Among the 246 patients with pneumonia, 125 were male and 121 were female. The average age was (21.0±2.9) months, 184 children with severe pneumonia. The results of population epidemiological characteristics showed that there were no significant differences in gender, age and place of residence between the severe pneumonia group and the pneumonia group. Prematurity, low birth weight, congenital malformation, anemia, length of intensive care unit (ICU) stay, nutritional support, treatment delay, malnutrition, invasive treatment, history of respiratory infection were all related factors affecting the occurrence of severe pneumonia (severe pneumonia group vs. pneumonia group: the proportion of premature infants was 9.52% vs. 1.23%, low birth weight was 19.05% vs. 6.79%, congenital malformation was 22.62% vs. 9.26%, anemia was 27.38% vs. 16.05%, length of ICU stay < 48 hours was 63.10% vs. 38.89%, enteral nutritional support was 34.52% vs. 20.99%, treatment delay was 42.86% vs. 29.63%, malnutrition was 27.38% vs. 8.64%, invasive treatment was 9.52% vs. 1.85%, respiratory tract infection history was 67.86% vs. 40.74%, all P > 0.05). However, breastfeeding, type of infection, nebulization, use of hormones, use of antibiotics, etc. were not risk factors affecting severe pneumonia. Multivariate Logistic regression analysis showed that history of premature birth, low birth weight, congenital malformation, treatment delay, malnutrition, invasive treatment, and history of respiratory infection were independent risk factors for severe pneumonia [history of premature birth: odds ratio (OR) = 2.346, 95% confidence interval (95%CI) was 1.452-3.785; low birth weight: OR = 15.784, 95%CI was 5.201-47.946; congenital malformation: OR = 7.135, 95%CI was 1.519-33.681; treatment delay: OR = 11.541, 95%CI was 2.734-48.742; malnutrition: OR = 14.453, 95%CI was 4.264-49.018; invasive treatment: OR = 6.373, 95%CI was 1.542-26.343; history of respiratory infection: OR = 5.512, 95%CI was 1.891-16.101, all P < 0.05]. Premature birth history, low birth weight, congenital malformation, delayed treatment, malnutrition, invasive treatment, and history of respiratory infection are independent risk factors for severe pneumonia in children under 5 years old.

Clinical and Swallowing Characteristics Related With Respiratory Infection in Parkinsonism Patients.

To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism. One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections. Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV-V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson's disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p<0.05). Regarding clinical characteristics, higher H&Y stage (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.226-8.216; p=0.017) and diagnosis of IPD (OR, 0.280, 95% CI, 0.111-0.706; p=0.007) were significantly related to respiratory infections in the multivariate analysis. Among VFSS findings, pyriform sinus residue (OR, 14.615; 95% CI, 2.257-94.623; p=0.005) and premature bolus loss (OR, 5.151; 95% CI, 1.047-25.338; p=0.044) were also significantly associated with respiratory infection. This study suggests that disease severity, diagnosis, pyriform sinus residue, and premature bolus loss observed in VFSS are associated with respiratory infection in patients with parkinsonism.

Nasopharyngeal colonization by Streptococcus pneumoniae in children and adults before the introduction of the 10-valent conjugate vaccine, Paraguay.

Streptococcus pneumoniae is a cause of invasive diseases such as pneumonia, meningitis, and other serious infections among children and adults in Paraguay. This study was conducted to establish S. pneumoniae baseline prevalence, serotype distribution, and antibiotic resistance patterns in healthy children aged 2 to 59 months and adults ≥60 years of age prior to the introduction of PCV10 in the national childhood immunization program in Paraguay. Between April and July 2012, a total of 1444 nasopharyngeal swabs were collected, 718 from children aged 2 to 59 months and 726 from adults ≥60 years of age. The pneumococcal isolation, serotyping, and antibiotic susceptibility testing were performed using standard tests. Pneumococcal colonization prevalence was 34.1% (245/718) in children and 3.3% (24/726) in adults. The most frequent pneumococcal vaccine-types (VT) detected in the children were 6B (42/245), 19F (32/245), 14 (17/245), and 23F (20/245). Carriage prevalence with PCV10 serotypes was 50.6% (124/245) and PCV13 was 59.5% (146/245). Among colonized adults, prevalence of PCV10 and PCV13 serotypes were 29.1% (7/24) and 41.6% (10/24), respectively. Colonized children were more likely to share a bedroom, have a history of respiratory infection or pneumococcal infection compared to non-colonized children. no associations were found in adults. However, no significant associations were found in children and neither in adults. Vaccine-type pneumococcal colonization was highly prevalent in children and rare in adults in Paraguay prior to vaccine introduction, supporting the introduction of PCV10 in the country in 2012. These data will be useful to evaluate the impact of PCV introduction in the country.

February 2023 Pulmonary Case of the Month: SCID-ing to a Diagnosis

History of Present Illness A 40-year-old man was referred for management of respiratory symptoms of cough, sputum production and shortness of breath. He has a history of respiratory infections that began in early childhood. Sputum cultures were positive for Pseudomonas. He is currently using oxygen at night and occasionally during the day. Past Medical History, Family History and Social History • Childhood diagnosis of asthma. • Multiple colds and pneumonias in the past. • No family history of a similar problem. • He has never smoked. • Denies any occupational exposure. Physical Examination • Vital Signs: O2 Sat 88% on RA • Chest: diminished breath sounds, no wheezes • Heart: regular rate and rhythm without murmur • Extremities: mild clubbing present, no edema Pulmonary Function Testing Pulmonary function testing (PFTs) was performed with results as below (Figure 1). Thoracic CT Scan A thoracic CT was performed (Figure 2). Which of the following is/are true? 1. PFTs show severe obstructive …

Clinical Significance of Decreased TIPE2 Expression in Peripheral Blood Mononuclear Cells of Patients with Psoriasis Vulgaris

Psoriasis is an immune system disorder induced by the interaction of the polygenic background and environmental factors. Tumor necrosis factor‐α (TNF‐α)‐induced protein 8‐like 2 (TNFAIP8L2, TIPE2), a regulator of immunity, is differentially expressed in tumors, inflammation, and autoimmune diseases. However, to our knowledge, no study has evaluated TIPE2 expression in patients with psoriasis vulgaris. The present case‐control study aimed to determine the expression levels of TIPE2 mRNA in the peripheral blood mononuclear cells (PBMCs) of patients with psoriasis vulgaris and analyze the correlation between TIPE2 and other inflammatory cytokine variations in the pathogenesis of psoriasis vulgaris. Thirty‐three patients with psoriasis vulgaris and thirty‐one healthy volunteers were enrolled from October 2021 to March 2022. The mRNA expression levels of TIPE2, RELA (NF‐κb p65), TNF‐α, IL‐10, IL‐6, and IL‐1β in PBMCs were determined using qPCR. The severity of psoriasis vulgaris was determined according to the Psoriasis Area and Severity Index (PASI) scores. TIPE2 mRNA expression significantly decreased, while the expression of RELA, TNF‐α, IL‐10, IL‐6, and IL‐1β increased in patients with psoriasis vulgaris compared with that in the healthy control group. In addition, the expression levels of TIPE2, RELA, TNF‐α, and IL‐1β positively correlated with the PASI score. TIPE2 mRNA expression negatively correlated with IL‐6 and positively correlated with TNF‐α. Moreover, TIPE2 mRNA expression was higher in the active stage than that in the stationary stage. Notably, TNF‐α expression levels were higher in patients with psoriasis vulgaris combined with a history of respiratory infection. TIPE2 may contribute to the pathogenesis of psoriasis and be a potential biomarker of psoriasis vulgaris.

Study on acute respiratory infection in children aged 1 year to 5 years-A hospital-based cross-sectional study.

Acute respiratory infections (ARIs) are the single greatest cause of death among children throughout the world. They are responsible every year for the deaths of 4.3 million children under 5 years of age worldwide. Community- or hospital-based surveys for finding out the prevalence and various factors associated with ARI are very few, especially in urban areas. Also, surveys to study the use of vaccines in preventing ARIs are scarce. Hence, we studied ARI in children aged 1 year to 5 years in a tertiary care hospital in Kerala. The aim was to determine the frequency of ARIs in the last 1 year in children aged 1 year to 5 years, attending the immunization clinic at Lourdes Hospital, Kochi, and assess the selected epidemiological, socio-demographic, nutritional and immunization factors associated with ARIs in the study group. Children attending the immunization clinic at a tertiary care hospital, Kochi, in the age group of 1 year to 5 years were selected. A brief introduction was given to the mother/caregiver of the child regarding the purpose of the study and was asked to fill out the questionnaire. Informed consent was taken. For the study, ARI is defined as the presence of one or more of the following: cough, running nose, blocked nose, sore throat, difficulty breathing, or ear problems; with or without fever. Results were analyzed. Mother was the caregiver in 67% of the cases. When the caregiver was the mother, ARI is found to be less. Among those mothers who had no formal education, 100% of their children got ARI. Children whose caregivers were 30 years and older had lesser ARI. The proportion of children with ARIs was more with a history of respiratory infection among family members (parents/siblings) compared to those with no such history. The occurrence of ARI was more frequent in rural compared to urban areas. There is a significant proportion of ARI in non-exclusively breastfed infants, bottle feeding, and early initiation of complementary feeding. Children with a history of exposure to cigarette smoke had an increased occurrence of ARI. Similar results followed for exposure to biomass fuel and exposure to cold and rain. Children who were not immunized to vaccines-pneumococcal, Hib, measles, vitamin A, showed a higher occurrence of ARI compared to immunization. The studies regarding factors influencing ARI are relatively rare in an urban setting, thus this calls for more studies in urban areas. Health education can change the healthcare-seeking behavior and attitude of parents for preventing ARI-related deaths. Family physicians can play a significant role by educating caregivers of children and giving timely services. Promoting and ensuring exclusive breastfeeding practices, timely weaning after 6 months, and avoidance of bottle feeds can dramatically decrease the episodes of ARI.

Rapidly and slowly progressive neuromuscular disease: differences in pulmonary function, respiratory tract infections and response to lung volume recruitment therapy (LVR)

IntroductionReduced lung volumes are a hallmark of respiratory muscle weakness in neuromuscular disease (NMD). Low respiratory system compliance (Crs) may contribute to restriction and be amenable to lung volume recruitment...

Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children

Objective: To describe the clinical characteristics of Mycoplasma pneumoniae infection and analyze the factors associated with co-infections with other pathogens in children, and provide evidence for improvement of community acquired pneumonia (CAP) prevention and control in children. Methods: Based on the surveillance of hospitalized acute respiratory infections cases conducted in Soochow University Affiliated Children's Hospital (SCH), the CAP cases aged <16 years hospitalized in SCH between 2018 and 2021 were screened. The pathogenic test results of the cases were obtained through the laboratory information system, and their basic information, underlying conditions, and clinical characteristics were collected using a standardized questionnaire. The differences in clinical characteristics between M. pneumoniae infection and bacterial or viral infection and the effect of the co-infection of M. pneumoniae with other pathogens on clinical severity in the cases were analyzed; logistic regression was used to analyze the factors associated with the co-infections with other pathogens. Results: A total of 8 274 hospitalized CAP cases met the inclusion criteria. Among them, 2 184 were positive for M. pneumoniae (26.4%). The M. pneumoniae positivity rate increased with age (P<0.001), and it was higher in girls (P<0.001) and in summer and autumn (P<0.001). There were statistically significant differences in the incidence of wheezing, shortness of breath, wheezing sounds and visible lamellar faint shadow on chest radiographs, as well as fever and hospitalization days among M. pneumoniae, bacterial, and viral infection cases (all P<0.05). In the cases aged <60 months years, co-infection cases had higher rates of wheezing, gurgling with sputum and stridor; and in the cases aged ≥60 months, co-infection cases had a higher rate of shortness of breath (all P<0.05). Multifactorial logistic regression analysis showed that being boys (aOR=1.38,95%CI:1.15-1.67), being aged <6 months (aOR=3.30,95%CI:2.25-4.89), 6-23 months (aOR=3.44,95%CI:2.63-4.51), 24-47 months (aOR=2.50,95%CI:1.90-3.30) and 48-71 months (aOR=1.77,95%CI:1.32-2.37), and history of respiratory infection within 3 months (aOR=1.28,95%CI:1.06-1.55) were factors associated with co-infections of M. pneumoniae with other pathogens. Conclusions: M. pneumoniae was the leading pathogen in children hospitalized due to CAP. M. pneumoniae infections could cause fever for longer days compared with bacterial or viral infections; M. pneumoniae was often co-detected with virus or bacteria. Being boys, being aged <72 months and history of respiratory infection within 3 months were associated factors for co-infections.

Co-carriage of Streptococcus pneumoniae and Moraxella catarrhalis among preschool children and its influencing factors.

To investigate the carriage status of Streptococcus pneumoniae (S.pneumoniae) and Moraxella catarrhalis (M. catarrhalis) in preschool children and the influencing factors for the carriage status. The stratified cluster sampling method was used to select 2 031 healthy children from seven kindergartens in Shunde District of Foshan in Guangdong, China. Nasal swabs were collected from all children for the isolation and identification of S. pneumoniae and M. catarrhalis. The carriage status of S. pneumoniae and M. catarrhalis was analyzed in terms of its association with demographic features and hospital- and community-related factors. The carriage rates of S. pneumoniae and M. catarrhalis were 21.81% and 52.44%, respectively among the children. The co-carriage rate of S. pneumoniae and M. catarrhalis was 14.87%. The correspondence analysis showed that the factors such as lower grade, non-local registered residence, living in rural areas, small living area, history of respiratory tract infection but no history of antibiotic use, allergic skin diseases, and no hospital-related exposure history were significantly associated with the co-carriage of S. pneumoniae and M. catarrhalis among the children (P<0.05). Co-carriage of S. pneumoniae and M. catarrhalis can be observed in preschool children. Young age, poor living environment, a history of respiratory tract infection but no history of antibiotic use, allergic skin diseases, and no hospital-related exposure history are important risk factors for the co-carriage of S. pneumoniae and M. catarrhalis in preschool children.

Influence of epidemiological factors on asthma phenotypes among asthma patients attending a tertiary care center – A cross-sectional study

Background: Asthma is a heterogeneous disease presenting with various phenotypes usually characterized by chronic airway inflammation. Aims and Objectives: The aim of the study was to identify epidemiology of bronchial asthma phenotypes in patients attending totertiary care center. Materials and Methods: This was a descriptive cross-sectional study involving 69 patients who are suspected to have asthma according to the Global Initiative for Asthma guidelines. The data of each patient were collected on a proforma specially designed for this study on demographic data, socioeconomic status, body mass index, exposure to environmental factors, and other history-related questions. Sputum cytology and absolute eosinophil count were also examined using coGuide and P&lt;0.05 was considered significant. Asthma phenotypes were the primary outcome and association of environmental factors with asthma phenotypes was the secondary outcome. Results: Out of 69, majority 26 (37.7%) were aged 31–40 years; 35 (50.7%) males and 34 (49.3%) were females. Fifty-eight (84.1%) were illiterate and 46 (66.7%) belonged to low class. Sputum cytology report showed that majority of them, 66.7%, had eosinophilia. The majority, 48 (69.6%), of the participants were triggered by weather and 55.1% had a history of respiratory tract infections. Thirty-three (47.83%) participants had obesity associate asthma, 34 (49.28%) had allergic asthma, and 20 (28.99%) had smoking-related asthma phenotypes. The difference in the proportion of few environment factor was significant for allergic and smoking-related asthma (P&gt;0.005). Conclusion: The factors associated with the asthma phenotypes will help us further in anticipating the clinical course and better management of the specific phenotypes.

Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19.

BackgroundPersistent respiratory symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults are frequent, and there can be long-term impairment of pulmonary function. To date, only preliminary evidence is available on persistent respiratory sequelae of SARS-CoV-2 in children and adolescents. Our objective was to examine the long-term effects of symptomatic and asymptomatic SARS-CoV-2 infections on pulmonary function in this age group in a single-center, controlled, prospective study.MethodsParticipants with serological or polymerase chain reaction-based evidence of SARS-CoV-2 infection were recruited from a population-based study of seroconversion rates. Multiple-breath washout (MBW), body plethysmography, and diffusion capacity testing were performed for children and adolescents. Participants were interviewed about their symptoms during the acute phase of infection and long-lasting symptoms. Cases were compared with SARS-CoV-2 seronegative controls from the same population-based study with and without history of respiratory infection within 6 months prior to assessment. Primary endpoints were differences in pulmonary function, including diffusion capacity and MBW, between participants with and without evidence of SARS-CoV-2 infection. Secondary endpoints included correlation between lung function and long-lasting symptoms as well as disease severity.FindingsIn total, 73 seropositive children and adolescents (5–18 years) were recruited after an average of 2.6 months (range 0.4–6.0) following SARS-CoV-2 infection. Among 19 patients (27.1%) who complained of persistent or newly emerged symptoms since SARS-CoV-2, 8 (11.4%) reported respiratory symptoms. No significant differences were detected in frequency of abnormal pulmonary function when comparing cases with 45 controls, including 14 (31.1%) with a history of previous infection (SARS-CoV-2: 12, 16.4%; controls: 12, 27.7%; odds ratio 0.54, 95% confidence interval 0.22–1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p = 0.012) in patients with severe SARS-CoV-2 infection.InterpretationPulmonary function is rarely impaired in children and adolescents after SARS-CoV-2 infection, except from those with severe infection, and did not differ between SARS-CoV-2 and other previous infections, suggesting that SARS-CoV-2 is not more likely to cause pulmonary sequelae than other infections. The discrepancy between persisting respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia.

BACKGROUNDGastroesophageal reflux (GER) affects up to 20% of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation. GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being. However, the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.AIMTo explore independent risk factors for the incidence and extent of GER during general anesthesia induction. METHODSA retrospective study was conducted, and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University. This study recruited a total of 601 adult patients undergoing general anesthesia, and the characteristics of patients and the incidence or extent of GER were recorded. The potential risk factors for the incidence of GER were explored using multivariate logistic regression, and the risk factors for the extent of GER were evaluated using multivariate linear regression.RESULTSThe current study included 601 adult patients, 82 patients with GER and 519 patients without GER. Overall, we noted significant differences between GER and non-GER for pharyngitis, history of GER, other digestive tract diseases, history of asthma, and the use of sufentanil (P < 0.05), while no significant differences between groups were observed for sex, age, type of surgery, operative time, body mass index, intraoperative blood loss, smoking status, alcohol intake, hypertension, diabetes mellitus, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, palliative strategies, propofol, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05). The results of multivariate logistic regression indicated that female sex [odds ratio (OR): 2.702; 95% confidence interval (CI): 1.144-6.378; P = 0.023], increased age (OR: 1.031; 95%CI: 1.008-1.056; P = 0.009), pharyngitis (OR: 31.388; 95%CI: 15.709-62.715; P < 0.001), and history of GER (OR: 11.925; 95%CI: 4.184-33.989; P < 0.001) were associated with an increased risk of GER, whereas the use of propofol could protect against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Finally, age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017) were significantly associated with GER time.CONCLUSIONThis study identified the risk factors for GER in patients undergoing general anesthesia including female sex, increased age, pharyngitis, and history of GER.

P7‐67: The association between history of respiratory infection in childhood and the incidence of COPD

P7‐67: The association between history of respiratory infection in childhood and the incidence of COPD

1640 Stridor in An Infant with Double Aortic Arch

Abstract An eleven-month-old infant presented to our casualty with stridor that had been noticed by the parents a few weeks earlier and became increasingly evident lately. They did not recall a specific event when the infant “chocked”, but they denied any recent history of respiratory tract infection. The infant had no relevant medical or surgical history, and he was born full term with normal vaginal delivery. Examination of the infant showed moderate biphasic stridor with both suprasternal and intercostal recessions. Oxygen saturation on room air was 94% and temperature was 37.1°. Chest auscultation revealed bilateral equal air entry, though decreased, with transmitted stridor. No lung crepitations were appreciated. Suspicion of unwitnessed foreign body aspiration arose, and a decision of diagnostic rigid bronchoscopy was taken. Rigid bronchoscopy revealed no foreign body along the tracheobronchial tree, but evident circumferential constriction of the lower trachea was noted with tendency of the tracheal wall to collapse upon withdrawal of the bronchoscope. Following recovery, computed tomography with contrast of the neck and chest was done and a vascular ring, consisting of double aortic arch, was found compressing and narrowing the trachea. Further follow up over the following 6 months showed marked improvement of his distress, and active observation was continued. Conclusions Although foreign body aspiration is the commonest cause of stridor in infants and young children, external compression of the trachea, particularly with vascular rings, should be considered in children with otherwise unexplained stridor.

Study on clinical symptoms and influencing factors of influenza-associated severe acute respiratory illness in children younger than 5 years old in Suzhou of China, 2011-2017

Objective: To study the influencing factors of influenza-associated severe acute respiratory illness (SARI) in children younger than 5 years of old in Suzhou, and to provide evidence to support the improvement of prevention and control strategies for influenza in children. Methods: We conducted a prospective influenza surveillance for hospitalized SARI and outpatient influenza-like illness (ILI) at Children's Hospital of Soochow University from April 2011 to March 2017. We compared the clinical and other characteristics of influenza-positive patients with SARI to those with ILI to find the differences and to identify influencing factors of influenza-associated SARI, using χ2 test and unconditional logistic regression. Results: We found 786 cases of influenza-associated ILI and 413 cases of influenza-associated SARI during the study period. Cough, runny nose, shortness of breath, asthma or wheezing were more common in influenza-associated SARI than in influenza-associated ILI (P<0.01). Univariate and multivariate logistic regression showed that the influencing factors which significantly associated with increased risk of influenza-associated SARI were as follows: younger age (<6 months OR=3.6, 6-23 months aOR=2.5), respiratory infection history within 3 months (aOR=4.5), chronic lung disease history (OR=3.4), fever above 39.0 ℃ (39.0-39.9 ℃ aOR=2.4, ≥40.0 ℃ aOR=6.0), and the presence of A/H1N1 (aOR=2.3), A/H3N2 (aOR=1.9). Conclusion: Children younger than 2 years old, with a history of chronic lung disease, a history of respiratory infection within 3 months, or with a fever peak above 39.0 ℃ should seek medical advice as soon as possible or receive annual influenza vaccination to reduce the incidence of influenza-associated serious outcomes.