Incidence Of Respiratory Infections Research Articles

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.

An association between PM2.5 components and respiratory infectious diseases: A China's mainland-based study

The particulate matter with diameter of less than 2.5 µm (PM2.5) is an important risk factor for respiratory infectious diseases, such as scarlet fever, tuberculosis, and similar diseases. However, it is not clear which component of PM2.5 is more important for respiratory infectious diseases. Based on data from 31 provinces in mainland China obtained between 2013 and 2019, this study investigated the effects of different PM2.5 components, i.e., sulfate (SO42−), nitrate (NO3−), ammonium (NH4+), and organic matter (OM), and black carbon (BC), on respiratory infectious diseases incidence [pulmonary tuberculosis (PTB), scarlet fever (SF), influenza, hand, foot, and mouth disease (HFMD), and mumps]. Geographical probes and the Bayesian kernel machine regression (BKMR) model were used to investigate correlations, single-component effects, joint effects, and interactions between components, and subgroup analysis was used to assess regional and temporal heterogeneity. The results of geographical probes showed that the chemical components of PM2.5 were associated with the incidence of respiratory infectious diseases. BKMR results showed that the five components of PM2.5 were the main factors affecting the incidence of respiratory infectious diseases (PIP>0.5). The joint effect of influenza and mumps by co-exposure to the components showed a significant positive correlation, and the exposure-response curve for a single component was approximately linear. And single-component modelling revealed that OM and BC may be the most important factors influencing the incidence of respiratory infections. Moreover, respiratory infectious diseases in southern and southwestern China may be less affected by the PM2.5 component. This study is the first to explore the relationship between different components of PM2.5 and the incidence of five common respiratory infectious diseases in 31 provinces of mainland China, which provides a certain theoretical basis for future research.

Correlation of DNA load, genotyping, and clinical phenotype of Mycoplasma pneumoniae infection in children.

This study aimed to investigate the correlation between Mycoplasma pneumoniae (MP)-DNA load in the bronchoalveolar lavage fluid (BALF) of children with MP pneumonia (MPP) and its subtypes, relevant laboratory data, imaging, extrapulmonary complications in infected children, and its clinical significance in evaluating the disease. Children hospitalized with MPP at Tianjin Children's Hospital between December 2017 and December 2020 were selected for the study, excluding those with mixed viral, bacterial, and fungal infections. Children were divided into low- and high-load groups according to the MP DNA load in BALF using real-time quantitative fluorescence polymerase chain reaction (PCR). After a successful MP culture, positive specimens were subjected to PCR-Restriction fragment length polymorphism and Multiple-locus variable number tandem repeat analysis typing. Basic data, clinical information, laboratory data, and radiological results were collected from all children included in the study. The PI-I type dominated the different load groups. Children in the low-load group had more wheezing and shortness of breath; however, children in the high-load group had a higher length of hospitalization, maximum fever temperature, higher chills/chilliness, incidence of abdominal pain, and higher C-reactive protein (CRP), procalcitonin (PCT) and aspartate aminotransferase (AST) levels. Children in the high-load group were more likely to have imaging changes such as pleural effusion, and the incidence of respiratory infections and extrapulmonary complications was higher than that of those in the low-load group. We applied Spearman's correlation analysis to clarify the relationship between MP DNA load and the clinical severity of MPP. We found that MP DNA load was positively correlated with length of hospitalization, maximum fever temperature, CRP, PCT, Interleukin-6 (IL-6), and AST levels, and negatively correlated with fever and cough durations, white blood cell count (WBC), and proportion of monocytes (MONO). The degree of correlation was as follows: length of hospitalization > IL-6 > cough duration > AST > fever duration > PCT > WBC > proportion of MONO > maximum fever temperature > CRP levels. MP DNA load was not correlated with MP typing but was significantly correlated with the children's clinical phenotype. Therefore, the MP DNA load helps in the early diagnosis of infection and can better predict disease regression.

Efficacy and safety of low-dose corticosteroids combined with leflunomide for progressive IgA nephropathy: a systematic review and meta-analysis

Background and objectiveThe effectiveness of immunosuppressive and corticosteroid treatments for Immunoglobulin A (IgA) nephropathy (IgAN) remains thoroughly evaluated. We undertook a meta-analysis to investigate the efficacy and safety of low-dose corticosteroids plus leflunomide for progressive IgA nephropathy.MethodsEligible studies were obtained from PubMed, Embase, and Cochrane Library databases. We also searched the references of the included studies. Our protocol followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were defined using a PICOS framework.ResultsOur study included three articles presenting 342 patient cases. Findings revealed that low-dose corticosteroids combined with the leflunomide group were effective in relieving urine protein excretion (UPE) [mean difference (MD) = -0.35, 95% confidence interval (CI): -0.41 to -0.30, P < 0.00001] compared with the full-dose corticosteroids group. Regarding serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate, there was no difference between the groups (p > 0.05). Regarding safety, low-dose corticosteroids combined with leflunomide significantly reduced the risk of serious adverse events [odds ratio (OR): 0.11, 95% CI: 0.01 to 0.91, P = 0.04]. Besides, no significant differences were observed between the two groups in the incidence of respiratory infection, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infection (P > 0.05).ConclusionsLow-dose corticosteroids combined with leflunomide are a safe and effective treatment for progressive IgA nephropathy.Trial registrationThe PROSPERO registration number is CRD42022361883.

Incidence of respiratory infections and SARS-CoV-2 is higher during contact phases in student rugby players – Lessons learnt from COVID-19 risk mitigation strategies–AWARE V

The incidence of acute respiratory infections (ARinf), including SARS-CoV-2, in unvaccinated student rugby players during phases from complete lockdown during the COVID-19 pandemic to returning to competition is unknown. The aim of the study was to determine the incidence of ARinf (including SARS-CoV-2) during non-contact and contact phases during the COVID-19 pandemic to evaluate risk mitigation strategies. In this retrospective cohort study, 319 top tier rugby players from 17 universities completed an online questionnaire. ARinf was reported during 4 phases over 14 months (April 2020–May 2021): phase 1 (individual training), phase 2 (non-contact team training), phase 3 (contact team training) and phase 4 (competition). Incidence (per 1 000 player days) and Incidence Ratio (IR) for ‘All ARinf’, and subgroups (SARS-CoV-2; ‘Other ARinf’) are reported. Selected factors associated with ARinf were also explored. The incidence of ‘All ARinf’ (0.31) was significantly higher for SARS-CoV-2 (0.23) vs. ‘Other ARinf’ (0.08) (p ​< ​0.01). The incidence of ‘All ARinf’ (IR ​= ​3.6; p ​< ​0.01) and SARS-CoV-2 (IR ​= ​4.2; p ​< ​0.01) infection was significantly higher during contact (phases 3 ​+ ​4) compared with non-contact (phases 1 ​+ ​2). Demographics, level of sport, co-morbidities, allergies, influenza vaccination, injuries and lifestyle habits were not associated with ARinf incidence. In student rugby, contact phases are associated with a 3–4 times higher incidence of ARinf/SARS-CoV-2 compared to non-contact phases. Infection risk mitigation strategies in the contact sport setting are important. Data from this study serve as a platform to which future research on incidence of ARinf in athletes within contact team sports, can be compared.

Epidemiological characteristics and outcome of viral respiratory tract infections in the first year after allogeneic hematopoietic cell transplantation.

Adverse outcomes of viral respiratory tract infections (RTI) have been reported in recipients of allogeneic hematopoietic cell transplantation. Using a laboratory-developed multiparameter PCR in a consecutive series of 242 patients, we found the highest incidence of viral RTI in the pre-engraftment phase. The occurrence of multiple episodes of viral RTI or viral pneumonia was significantly associated with a higher hazard of non-relapse mortality in the first year after transplantation. We observed a 90-day mortality of 19.7% after viral RTI, which was significantly different between patient groups stratified according to the ISI score.

Vitamin D supply, respiratory viral infections and persistent wheezing in children: how significant is the relationship?

The review discusses the multifaceted effect of vitamin D on antiviral immunity, induction of antimicrobial peptides, functional activity of immunocompetent cells, autophagy processes, clearance of viruses and viral fragments. The relationship between vitamin D and allergic inflammatory cells, its modulating and tolerogenic potential is considered. The inhibitory effect of vitamin D on eosinophils, mast cells, the production of pro-inflammatory and proallergic mediators, and the synthesis of IgE has been shown. The protective role of vitamin D in the development of remodeling and hyperresponsiveness of the respiratory tract has been established by reducing the number of goblet cells, mucus hypersecretion, and the expression of metalloproteinases. The effects of vitamin D on the replication of respiratory viruses and experimental resistance to them through the induction of antimicrobial peptides and other mechanisms have been demonstrated. Data from clinical studies on the preventive effect of vitamin D on the incidence of respiratory infections and episodes of persistent wheezing in children are presented. Children with respiratory syncytial infection and vitamin D deficiency were more likely to require respiratory support and mechanical ventilation. The preventive role of vitamin D in the development of obstructive bronchitis in children and severe bronchiolitis in infants has been shown. It has been established that normal levels of 25(OH)D in the mother significantly reduce the risk of developing bronchial obstruction in the child. Alternative data that do not support a protective effect of vitamin D on respiratory morbidity and wheezing in children are discussed. Further monitoring studies that take into account geographic location and analysis of the dose of cholecalciferol used to assess its preventive role in the development of wheezing and bronchial asthma in children are advisable.

MV130 in the Prevention of Recurrent Respiratory Tract Infections: A Retrospective Real-World Study in Children and Adults.

Respiratory tract infections (RTIs) are among the most common and important problems in clinical medicine, making antibiotics the gold standard therapeutic option regardless of their frequent viral etiology. Their excessive and inappropriate use contributes to the rapid rise of antibiotic resistance and underscores the need for alternative strategies, especially when dealing with recurrent RTIs. Prevention is the ideal alternative, but specific vaccines targeting a wide range of respiratory pathogens are scarce. MV130 is a sublingual bacterial vaccine that induces trained immunity and provides non-specific protection against respiratory pathogens in various clinical settings according to the concept of TIbV (Trained Immunity-based Vaccine). A retrospective real-world study (RWS) was conducted to evaluate the annual incidence of RTIs and the consumption of antibiotics before and after the administration of MV130, using data sourced from the medical records of 599 patients (186 children and 413 adults) who suffered from recurrent RTIs. The median number of infectious episodes in children was significantly reduced by more than 70% from 5 episodes (interquartile range (IQR) 4.0-6.0) to 1 (IQR, 0.0-2.0) (p < 0.001) after MV130. Similarly, in adults, the median number of episodes before MV130 immunization was 5 (IQR, 4.0-6.0), which dropped by more than 80% to 1 (IQR, 0.0-1.0) during the year following MV130 immunization (p < 0.001). The median number of antibiotic courses also significantly decreased for both children and adults by over 80% (p < 0.001). This RWS showed that MV130 is an effective strategy for the prevention of respiratory infections and the reduction of associated antibiotic consumption.

EPIDEMIOLOGICAL COMPARISON OF INFLUENZA, ARI AND COVID-19 PREVALENCE IN BULGARIA FOR THE PERIOD 2017-2022

Introduction: The report presents a comparison of the incidence of respiratory infections - influenza, other acute respiratory infections and COVID-19 for the period 2017-2022. A comparative analysis of the epidemiological dynamics in different areas of the country is made and factors such as demography and vaccine coverage are also analyzed. Materials and Methods: A comparative analysis of the prevalence of Influenza/ARI, and COVID-19 was made for the years of the studied period. Regional values were compared to the country total in order to rank regions according to the experienced disease incidence burden at a regional level. The percentile method was used to identify and filter the regions where Influenza/ARI waves appeared with the highest intensity in the country. To compare intensity of COVID-19 waves between the selected regions we used the maximal weekly incidence values per 100 000 population reached for the different periods of the pandemic. Information on the age structure of the population in the respective regions and the vaccine uptake was retrieved and compared. Results: The regions of Blagoevgrad, Montana, Haskovo, Razgrad, Kardzhali, Sliven and Targovishte were filtered among all regions as the ones with the most intensive Influenza waves for the period 2017-2022.  Blagoevgrad and Sliven were the regions with higher maximal COVID-19 incidence values before the Delta circulation and during the Omicron predominance. When the Delta variant was predominant, Blagoevgrad and Montana surpassed the incidence recorded for the country. No data supporting the initial hypothesis that demographic structure at regional level determines intensity of spread of the two viral respiratory infections was found. However, the regions with higher COVID-19 vaccines coverage were found to have the lowest incidence levels of the infection. Conclusion: Although COVID-19 and Influenza/ARI are both respiratory infections, they differ in their epidemiology and no specific pattern can be found. We recommend that anti-epidemic measures should be followed to limit incidence regardless of the circulating respiratory pathogen.

The use of a train-the-trainer model to educate non-dental healthcare professionals for oral care

Background: Associations between oral health and systemic conditions have been well established in recent literature. Improvements in oral hygiene have consistently shown to significantly reduce the incidence of respiratory infections, which has high morbidity and mortality rates in the frail elderly. However, the simple low-cost intervention of good oral care remains overlooked in healthcare institutions and nursing homes, due to limited awareness and knowledge. Previous efforts for oral care training of non-dental healthcare professionals have been largely sporadic, with little impact and reach to the medical fraternity. Purpose: To overcome these challenges, we utilized a train-the-trainer model, where seven senior nurses from the long-term stay wards of a public community hospital were educated on the importance of good oral health and trained to administer a comprehensive oral care protocol in patients requiring assistance. The Oral Health Education Programme (OHEP) consisted of a full-day workshop on Common Dental Conditions, Oral Health Assessment Technique (OHAT), and oral hygiene instruction for normal and assisted tooth brushing in independent and mechanically ventilated patients respectively. Results: Majority of the nurses felt that the training was effective and applicable to their work. The number of patients with chronic respiratory infections in the wards were reduced after commencement of OHEP. Conclusion: This interprofessional education collaboration using the train-the-trainer model provides a standardized curriculum, while allowing autonomy for the trainers to customize modules relevant to their respective institutions. This partnership model between medical nurses and oral health professionals allows for better sustainability of the programme.

Efficacy and safety of belimumab in patients with lupus nephritis: a real-world retrospective observational study.

To evaluate the differences in efficacy and safety between Lupus Nephritis (LN) patients who received belimumab plus standard therapy and those who received only standard therapy in real world practice. Patients diagnosed with LN at the First Affiliated Hospital of Wenzhou Medical University from November 2012 to July 2023 were identified, and eligible cases were divided into two groups according to whether they received additional treatment with belimumab during the course of the disease. A total of 1,169 LN patients were identified from our follow-up database. 112 patients receiving add-on treatment with belimumab (BLM group) and 112 control patients matched for relevant baseline characteristics were enrolled in this study. The median duration of treatment with belimumab was 13.82 [7.24, 20.29] months. Compared with the control group, the BLM group had more significant improvement in disease activity indicators such as serum albumin and complement levels, significantly lower B cell count, immunoglobulin, and earlier first attainment of renal remission, but there was no significant improvement in renal function and kidney-related events or death during the 2-year follow-up period. In the BLM group, the treatment effect of belimumab was more prominent in patients with lower levels of proteinuria. The safety profile of belimumab treatment was favorable, with a lower incidence of respiratory tract infection in the BLM group than in the control group during the follow-up period (p= 0.015). This real-world study revealed that add-on treatment with belimumab provided better disease remission, and the therapeutic effect was more significant in patients with lower proteinuria levels. In addition, it had a favorable safety profile and reduced the risk of respiratory tract infection.

Mangifera indica L., By-Products, and Mangiferin on Cardio-Metabolic and Other Health Conditions: A Systematic Review.

Mango and its by-products have traditional medicinal uses. They contain diverse bioactive compounds offering numerous health benefits, including cardioprotective and metabolic properties. This study aimed to explore the impact of mango fruit and its by-products on human health, emphasizing its metabolic syndrome components. PUBMED, EMBASE, COCHRANE, and GOOGLE SCHOLAR were searched following PRISMA guidelines, and the COCHRANE handbook was utilized to assess bias risks. In vivo and in vitro studies have shown several benefits of mango and its by-products. For this systematic review, 13 studies met the inclusion criteria. The collective findings indicated that the utilization of mango in various forms-ranging from fresh mango slices and mango puree to mango by-products, mango leaf extract, fruit powder, and mangiferin-yielded many favorable effects. These encompassed enhancements in glycemic control and improvements in plasma lipid profiles. Additionally, mango reduces food intake, elevates mood scores, augments physical performance during exercise, improves endothelial function, and decreases the incidence of respiratory tract infections. Utilizing mango by-products supports the demand for healthier products. This approach also aids in environmental conservation. Furthermore, the development of mango-derived nanomedicines aligns with sustainable goals and offers innovative solutions for healthcare challenges whilst being environmentally conscious.

Bone Marrow Versus Peripheral Blood in HLA-Matched Sibling Transplantation: Does the Stem Cell Source Matter in Severe Aplastic Anemia?

Background Selecting a graft source is critical in HLA-matched sibling donor hematopoietic stem cell transplantation (MSD-HCT) for severe aplastic anemia (SAA). Since graft-versus-host-disease (GVHD) is the major cause of mortality after MSD-HCT, and SAA patients do not need the graft-versus-leukemia effect, the selection of a suitable source of stem cells becomes critical. Although bone marrow (BM) is the preferable stem cell source based on the registry-based studies, mobilized peripheral blood stem cells (PBSC) may offer faster engraftment with rapid immune reconstitution. Moreover, the recent advances in conditioning regimens have significantly reduced transplantation-related complications. Here, we compared the long-term outcomes of BM vs PBSC as a graft source in adult patients with SAA who received MSD-HCT with the reduced intensity conditioning (RIC) regimen. Method We conducted a retrospective analysis of 171 consecutive SAA adult patients who received MSD-HCT with Flu6/Cy2/ATG4 RIC regimen (Flu, 30 mg/m 2 IV for 6 days: Cy, 50 mg/kg IV for 2 days; rabbit ATG, 2.5 mg/kg IV for 4 days) or total nodal irradiation (TNI) of 750 cGy combined with ATG as GVHD prophylaxis (TNI-750/ATG) from March 2002 to March 2021 at Seoul St. Mary's Hospital, Seoul, Korea. BM was the primary graft source, but PBSC was used in donors who refused BM harvest, were unsuitable for general anesthesia, or received TNI-750/ATG conditioning. The primary endpoint of this study was to compare the overall survival (OS), and the secondary endpoints included speed of hematologic recovery, primary or secondary graft failure (GF), and failure-free survival (FFS) between the BM and PBSC group. Results The median patient age in the BM group was 38 years (range, 15 - 59) and 44 years (range, 19 - 64) in the PBSC group (p=0.005). There were no differences of baseline characteristics between the two groups except for a donor-to-recipient sex discrepancy (female to male, BM vs. PBSC; 16.4% vs. 30.9%, p=0.029). The majority of BM group (114/116, 98.2%) received the Flu6/Cy2/ATG4 RIC regimen, while 38.2% (21/55) of PBSC group received TNI-750/ATG for the conditioning (p&amp;lt;0.001). The PBSC contained a median 4.71 (range, 1.22 - 17.03) x 10 6/kg CD34 + cells and 368.82 (range, 25.12 - 1234.70) x 10 6/kg CD3 + cells which were about 1.7-fold (BM 2.80 x 10 6/kg CD34 + cells; range, 0.25 - 10.05) and 10-fold (BM 39.61 x 10 6/kg CD3 + cells; range, 1.34 - 463.68) higher than the BM graft (p&amp;lt;0.001). Consequently, the PBSC group exhibited faster engraftment of neutrophils (median 13 vs. 11 days, p&amp;lt;0.001) and platelets (median 18 vs. 12 days, p=0.012). However, there were no differences in the incidence of secondary GF (19.0% vs. 12.7%, p=0.386) and donor-type aplasia (4.3% vs. 10.9%, p=0.178) between two groups. Furthermore, the incidence of acute grade I-II (8.6% vs. 10.9%, p=0.619) and moderate to severe chronic graft-versus-host disease (GVHD) (3.5% vs. 5.5%, p=0.542) were also not significantly different between two groups. However, the BM group has shown more CMV reactivation (44.0% vs. 24.9%, p=0.005), and higher incidence of respiratory infection (14.7% vs. 3.6%, p=0.037) than those of the PBSC group. The incidences of transplantation-related complications between the BM and PBSC group are summarized in Table. The 10-year OS (93.8% vs. 98.1%, p=0.246) and FFS (65.7% vs. 69.0%, p=0.455) were comparable (Figure). Moreover, there was no significant difference in FFS between BM and PBSC group by potential risk factors of patient and donor age at MSD-HCT, sex incompatibility, ABC mismatch, PNH clone presence, HCT-CI ≥3, infused CD34 + cell count, interval from diagnosis to transplant, prior IST history, heavy transfusion before allo-HCT, or severity of AA. Conclusions Our results suggest that survival outcomes of MSD-HCT showed no difference between BM and PBSC as graft sources, and using PBSC may be an efficient alternative offering faster engraftment without significant difference in graft failure or transplantation-related adverse events such as GVHD, and survival. Current analysis and results were drawn from the Asian population with a fludarabine-based conditioning regimen and therefore, need to validate in the Western population. In addition, well-designed prospective studies in a larger cohort are required to confirm our findings.

2322. Challenges Faced by Perinatally-Infected Young People Living with HIV in Kenya During the COVID-19 Pandemic

Abstract Background Understanding challenges experienced by young people living with HIV (YPLWH) during the COVID-19 pandemic could guide care during public health crises, particularly in resource-limited settings. Methods Surveys utilizing validated and self-reported measures were administered to perinatally-infected YPLWH receiving care at four clinics at the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya between February 2021 and July 2022. Reported psychological, physical, and socioeconomic challenges were summarized overall and across viral load (VL) thresholds (virologic failure VL &amp;gt;40 copies/mL; treatment failure VL &amp;gt;1000 copies/mL). COVID-19-related events, restrictions, and interventions in Kenya from the beginning of the pandemic through the entirety of the study period were compiled into a pandemic timeline and temporal patterns of the evaluated challenges within this timeline were assessed using generalized additive models. Results Among 442 participants (median age 17 years, IQR 14-19; 49% female), 89% reported any challenge (mean 2.92 of the 23 challenges estimated; SD=2.14); 48% psychological, 66% physical, and 62% socioeconomic. Major psychological challenges included moderate to severe depression (36%) and anxiety (29%) symptoms. Major physical challenges included recent illness (31%), and recent symptoms of cough (34%), congestion (25%), and fatigue (23%). Major socioeconomic challenges included food insecurity (31%), household income loss (27%), and departure from usual residence (20%). Participants with virologic or treatment failure experienced more challenges compared to those suppressed. Trends of challenges over time were stable for all but physical challenges, which decreased in parallel with the reduced incidence of respiratory infections as masking and social distancing measures were implemented. Conclusion The vast majority of Kenyan YPLWH experienced significant wellness challenges during the COVID-19 pandemic, conceivably due to pandemic-imposed travel restrictions and mitigation measures, and possibly impacting HIV care. This knowledge could guide intervention opportunities in this vulnerable population for current and future pandemics. Disclosures All Authors: No reported disclosures

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.

Effects of prenatal alcohol exposure on infant lung function, wheeze, and respiratory infections in Australian children.

Prenatal alcohol exposure (PAE) is a known risk factor for a range of adverse outcomes, such as facial dysmorphism, adverse birth outcomes, and neurodevelopmental changes. Preclinical research shows that PAE also inhibits lung development, lowers surfactant protein expression, has detrimental effects on alveolar macrophages, and decreases both T and B cell numbers. However, clinical evidence of respiratory impacts from PAE is limited. This study explored whether lung function, wheeze, and incidence of respiratory infections differ in children with PAE compared with unexposed children. Data from the Barwon Infant Study (n = 1074) were examined. PAE data were extracted from maternal questionnaires at trimesters 1 and 2 (combined), and trimester 3, and included as "total standard drinks" during each trimester and total pregnancy intake, a binary yes/no for PAE, and binge drinking (>5 standard drinks in one session). Respiratory outcomes were parent-reported wheeze, lung function (measured by multiple breath washout), and parent report and medical record indicators of health service attendances for respiratory conditions. Linear and logistic regressions were performed to quantify relationships between PAE and respiratory outcomes, controlling for socioeconomic status, birthweight, sex, gestational age, and maternal smoking. Binge drinking was associated with increased health service attendance for respiratory condition(s) in the first 12 months of life (OR = 5.0, 95% CI (1.7, 20.7), p = 0.008). We did not find a relationship between binary PAE and binge drinking with lung function at 4 weeks of age or wheeze at 12 months. The number of standard drinks consumed in trimester two was associated with a lower lung clearance index (β = -0.011 turnovers, 95% CI (-0.0200, -0.0013), p = 0.03), and a small increase in functional residual capacity (β = 0.34 mL, 95% CI (0.02, 0.66), p = 0.04). We found an association between binge drinking and health service utilization for respiratory conditions in infancy, but no evidence that low-level PAE was associated with adverse respiratory outcomes.

Impact of the covid-19 pandemic on GP contacts for respiratory infections in children under 5 years

Abstract Background Social distancing measures to reduce transmission of SARS-CoV-2 during the covid-19 pandemic also impacted the transmission of many other respiratory pathogens. We describe the impact of the covid-19 pandemic on general practitioner (GP) contact rates for respiratory tract infections (RTIs) that may have been affected by social distancing in children &amp;lt;5 years in England. Methods Trends analysis from 1 April 2016 to 31 March 2021 using electronic health records from a nationally representative primary care database. We included all children aged &amp;lt;5 years registered with a primary care practice during the study period. Our main outcome was GP contact rates for transmissible RTIs including otitis media, tonsillitis, and pneumonia. We also calculated the rates of urinary tract infections as an index non-transmissible condition. We calculated annual rates for each year of age (&amp;lt;1, 1-&amp;lt;2, 2-&amp;lt;3, 3-&amp;lt;4, 4-&amp;lt;5) by summing the GP contacts divided by the number of days each child was registered with the GP practice. Results There were 415 622 RTIs among 1 955 946 children &amp;lt;5 years over the study period. From 2016-2020 GP contact rates for RTIs were falling steadily by ∼14%/ year in all age bands, with rates of otitis media, tonsillitis and pneumonia declining by 5-11% per year. However, in 2021 marked falls of around 80% occurred for all RTIs, otitis media, tonsillitis, and pneumonia. By contrast, trends for GP contact rates for urinary tract infections before and during the covid-19 pandemic steadily declined by ∼5%/year. Conclusions Our study shows major reductions in the incidence of RTIs in under 5s during the pandemic, probably a result of SARS-CoV-2 containment measures. The impact of reduced exposure to RTIs during childhood on long term respiratory health is unknown. At the conference, we will report results up to March 2023. Key messages • GP contacts for respiratory infections in under 5s fell during the covid-19 pandemic in England. • Fewer respiratory infections in childhood may impact future health service use and requires monitoring.

Health, environment, current knowledge of the heads of household and acute respiratory infection in toddlers

Background: The ten patrons of disease at the Moni Health Center, the highest acute respiratory infection (ARI) of all cases, the second highest ARI in toddlers (62.90%) in Ende District. ARI can inhibit oxygenation of the body, causing decreased cell metabolism, thereby inhibiting growth and development, can contribute to morbidity and mortality in infants. Toddlers are still fully cared for by the family, which is the front line to prevent toddlers from getting sick.Purpose: Determine the effect of knowledge and family home environment on the incidence of respiratory infections in toddlers.Method: The research design is a mix of methods and approaches cross sectional. The sample size was calculated based on the Slovin formula of 164 respondents. Sampling using purposive dan accidental sampling. Data collected by interview, observation. The instrument used is the standard instrument. Bivariate Analysis Who Square to examine the effect of family tasks on the incidence of ARI. Logistic regression test to analyze the strength of the influence of knowledge and family home environment on the incidence of ARI at the 95% confidence level and significance limit p ≤0,05.Results: Bivariate test increases the risk, namely family knowledge OR=1.950 (95% CI: 1.571-2.421; p=0.000), maintenance of the home environment, OR = 94.53 (95%) CI: 4.120 - 21.690p - value = 0.000 ), In the multivariate analysis, it was found that the most dominant variable influencing increased risk was the maintenance of the home environment. There is a need for periodic health counseling and promotion related to efforts to prevent and control ARI, further research needs to use other methods.Conclusion: The most dominant variable that influences increasing risk is the maintenance of the home environment.  There is a need for periodic health counseling and promotion related to efforts to prevent and control respiratory  infections, further research needs to use other methods.

The anti-infective effect of β-glucans in children.

Background: β-glucans are bioactive β-D-glucose polysaccharides of natural origin, presenting antimicrobial and immunomodulation properties, with a low risk of toxicity. Objectives: This scoping review aims to present the current knowledge on the anti-infective properties of β-glucans in the pediatric population. Methods: We used the PRISMA Extension for Scoping Reviews Checklist to prepare this review. Studies were identified by electronic searches of Pubmed, Embase, and Cochrane databases up to May 2021. Results: The primary search allowed us to find 6232 studies, twelve of which were finally included in the analysis. Eight studies were designed as randomized, placebo-controlled trials, while in four studies the intervention outcome was compared with the pre-intervention period in the same group. The type of preparation and doses varied between studies: in five trials pleuran was administered (in dose 10 mg/5 kg of body weight/day), and in one study baker's yeast β-glucan was used (in two doses: 35mg/day and 75 mg/day). In six other studies, the analyzed preparation comprised β-glucan and other substances. The shortest study lasted seven days, while the most prolonged intervention lasted six months, followed by six months of follow-up. Ten out of twelve trials demonstrated the effectiveness of β-glucans in reducing respiratory tract infection incidence or alleviation of upper respiratory tract infection symptoms. Ten out of twelve studies have reported a good tolerance and safety profile. Conclusions: Good tolerance of β-glucans shows a favorable benefit-risk ratio of this type of intervention. Nevertheless, further monitoring of their efficacy and safety in high-quality research is necessary.

Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study.

Postoperative pulmonary complications (PPCs) are among the most common complications after cardiovascular surgery. This study aimed to explore the real incidence of and risk factors for PPC in patients with acute type A aortic dissection (ATAAD) who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR + FET). In total, 305 ATAAD patients undergoing TAR + FET from January 2021 to August 2022 in a single-center were divided into PPCs or non-PPCs group. The incidence of PPCs was calculated, risk factors of PPCs were analyzed, and postoperative outcomes were compared between these 2 groups. The incidence of any PPC was 29.2%. And the incidence of respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, acute respiratory distress syndrome, aspiration pneumonitis, pulmonary edema and bronchospasm was 23.0%, 12.5%, 10.5%, 1.0%, 0.7%, 1.0%, 0%, 0.7%, 0%, respectively. The logistic regression analysis revealed that the history of diabetes, history of renal dysfunction, preoperative SpO2 <90%, cardiopulmonary bypass duration, fresh frozen plasma volume and platelet concentrates volume were independent risk factors for PPCs. Among 2 groups, postoperative ventilation duration, postoperative length of stay in intensive care unit and hospital were (73.5 ± 79.0 vs 24.8 ± 35.2 hours; P < .001), (228.3 ± 151.2 vs 95.2 ± 72.0 hours; P < .001) and (17.9 ± 8.8 vs 11.5 ± 6.2 days; P < .001). There was no difference between 2 groups of in-hospital mortality rate. Additionally, other short-term outcomes were also significantly poorer in patients with PPCs. PPCs are common in ATAAD patients undergoing TAR + FET, and could be multifactorial. PPCs occurrence are associated with poor patient outcomes postoperatively and worth further investigation.