Lower Respiratory Tract Research Articles

Comparison of the effectiveness of dornase alfa in chronic rhinosinusitis with nasal polyposis using different types of drug delivery

Introduction. When using the drug dornase alfa in children with cystic fibrosis (CF) in the form of inhalations through a compressor inhaler with a pulsating aerosol supply, a high concentration of aerosol is achieved in the nasal cavity and paranasal sinuses, which reduces the severity of rhinological pathology, namely chronic rhinosinusitis, including those with nasal polyposis. There is also a positive effect on the function of external respiration, due to a decrease in the negative impact of rhinological pathology on the respiratory tract, primarily due to descending infection.Aim. To evaluate the effect of intranasal dornase alfa therapy as part of a complex treatment on lung function and indicators of physical development in children with CF.Materials and methods. The study compared the effectiveness of the drug dornase alfa for chronic rhinosinusitis with nasal polyposis using different types of drug delivery in children who did not receive targeted therapy for CF. A group of children who received two inhalations of dornase alfa (n = 43), information about patients in this group was taken from the 2020 register, and a group of children who received inhalation of dornase alfa only in the lower respiratory tract were compared (n = 28), information about patients in this group was taken from the 2016 register.Results. The effect of additional intranasal inhalation of the drug dornase alfa was observed in the form of an increase in FEV and FVC. In addition, there was an improvement in body weight and height in the group of patients receiving intranasal inhalations, but the identified difference did not reach significant values.Conclusion. The results obtained in the form of an increase in FEV1 and FVC allow us to draw a conclusion about the effectiveness of prescribing additional intranasal inhalation of the drug dornase alfa.

Omalizumab: a quarter of a century in the fight against T2-inflammatory diseases of upper and lower respiratory tract

T2 inflammation underlies diseases such as bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. These diseases often have a severe course and often accompany each other, which leads to a significant decrease in the quality of life of patients. Studying the mechanisms of inflammation at the molecular level has made it possible to develop immunobiological drugs aimed at different stages of pathogenesis. One of the targets of immunobiological therapy for T2 inflammation, which can be affected by monoclonal antibodies, is immunoglobulin E. The purpose of the scientific review is to summarize the data accumulated over the past 25 years from randomized clinical trials and studies of real clinical practice on the effectiveness and safety of the original anti-IgE drug – “omalizumab”, including in comorbid patients. Clinical trials have shown that the use of omalizumab in patients with severe bronchial asthma reduces the frequency of exacerbations and severe exacerbations of asthma, reduces the number of hospitalizations and emergency room visits due to asthma exacerbations, reduces oral and inhaled glucocorticosteroids doses, improves respiratory function and improves quality of life. Omalizumab reduces the severity of nasal and ocular symptoms and reduces the need for antihistamines in patients with severe allergic rhinitis. Omalizumab effectiveness in patients with chronic rhinosinusitis with nasal polyps is manifested by decrease in nasal symptoms (nasal congestion, rhinorrhea), improvement in the sense of smell, decrease in polyps size, and the need for systemic glucocorticosteroids and surgical interventions. Omalizumab showed good tolerability and safety profile comparable to placebo in both clinical trials and routine practice.

Circulating monocytes expressing senescence-associated features are enriched in COVID-19 patients with severe disease.

Accurate biomarkers for predicting COVID-19 severity have remained an unmet need due to an incomplete understanding of virus pathogenesis and heterogeneity among patients. Cellular senescence and its pro-inflammatory phenotype are suggested to be a consequence of SARS-CoV-2 infection and potentially drive infection-dependent pathological sequelae. Senescence-associated markers in infected individuals have been identified primarily in the lower respiratory tract, while little is known about their presence in more easily accessible bio-specimens. Here, we measured the abundance of senescence-associated signatures in whole blood, plasma and peripheral blood mononuclear cells (PBMCs) of COVID-19 patients and patients without an infection. Bulk transcriptomic and targeted proteomic assays revealed that the level of senescence-associated markers, including the senescence-associated secretory phenotype (SASP), is predictive of SARS-CoV-2 infection. Single-cell RNA-sequencing data demonstrated that a senescence signature is particularly enriched in monocytes of COVID-19 patients, partially correlating with disease severity. Our findings suggest that monocytes are prematurely induced to senescence by SARS-CoV-2 infection, might contribute to exacerbating a SASP-like inflammatory response and can serve as markers and predictors for COVID-19 and its sequelae.

Preclinical evaluation of RQ3013, a broad-spectrum mRNA vaccine against SARS-CoV-2 variants

The global emergence of SARS-CoV-2 variants has led to increasing breakthrough infections in vaccinated populations, calling for an urgent need to develop more effective and broad-spectrum vaccines to combat COVID-19. Here we report the preclinical development of RQ3013, an mRNA vaccine candidate intended to bring broad protection against SARS-CoV-2 variants of concern (VOCs). RQ3013, which contains pseudouridine-modified mRNAs formulated in lipid nanoparticles, encodes the spike (S) protein harboring a combination of mutations responsible for immune evasion of VOCs. Here we characterized the expressed S immunogen and evaluated the immunogenicity, efficacy, and safety of RQ3013 in various animal models. RQ3013 elicited robust immune responses in mice, hamsters, and nonhuman primates (NHP). It can induce high titers of antibodies with broad cross-neutralizing ability against the wild-type, B.1.1.7, B.1.351, B.1.617.2, and the newly emerging Omicron variants. In mice and NHP, two doses of RQ3013 protected the upper and lower respiratory tract against infection by SARS-CoV-2 and its variants. Furthermore, our safety assessment of RQ3013 in NHP showed no observable adverse effects. These results provide strong support for the evaluation of RQ3013 in clinical trials and suggest that it may be a promising candidate for broad protection against COVID-19 and its variants.

Higher Levels of SARS-CoV-2 Genetic Variation in Immunocompromised Patients: A Retrospective Case-Control Study.

A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection lasts longer in immunocompromised hosts than in immunocompetent patients. Prolonged infection is associated with a higher probability of selection for novel SARS-CoV-2 mutations, particularly in the spike protein, a critical target for vaccines and therapeutics. From December 2020 to September 2022, respiratory samples from 444 immunocompromised patients and 234 health care workers positive for SARS-CoV-2, diagnosed at 2 hospitals in Paris, France, were analyzed using whole-genome sequencing using Nanopore technology. Custom scripts were developed to assess the SARS-CoV-2 genetic diversity between the 2 groups and within the host. Most infections were SARS-CoV-2 Delta or Omicron lineages. Viral genetic diversity was significantly higher in infections of immunocompromised patients than those of controls. Minor mutations were identified in viruses sequenced from immunocompromised individuals, which became signature mutations for newer SARS-CoV-2 variants as the epidemic progressed. Two patients were coinfected with Delta and Omicron variants. The follow-up of immunocompromised patients revealed that the SARS-CoV-2 genome evolution differed in the upper and lower respiratory tracts. This study found that SARS-CoV-2 infection in immunocompromised patients is associated with higher genetic diversity, which could lead to the emergence of new SARS-CoV-2 variants with possible immune evasion or different virulence characteristics.

DETERMINAN FAKTOR PERILAKU MEROKOK TERHADAP KEJADIAN ISPA PADA BALITA DI WILAYAH KERJA PUSKESMAS AEK HABIL KOTA SIBOLGA TAHUN 2023

Acute Respiratory Infection (ARI) is an infection that occurs in the respiratory tract, both upper and lower respiratory tract which is often found in children, especially children under five yearof age. This infection can cause symptoms of cough, runny nose, and fever that last up to 14 days. The purpose of this study was to determine the relationship between smoking behavior and the incidence of Acute Respiratory Infection (ARI) in children under five year in the working area of the Aek Habil Community Health Center, Kota Sibolga. The type of study used quantitative research with a cross sectional approach. The sample collection technique was carried out using simple random sampling method. The number of samples taken was 88 respondents. This study used statistical test with Chi Square.The results of the study:Shown that there is a relationship between knowledge and the incidence of ARI in children under five year in the work area of the Aek Habil Community Health Center (p=0.004), there is an attitude relationship with the incidence of ARI in children under five year in the work area of the Aek Habil Community Health Center (p=0.001), there is a relationship between action and the incidence of ARI in children under five year in the working area of the Aek Habil Community Health Center (p=0.002). It is hoped that the Community Health Center can provide information to the public, especially parents in order to reduce the incidence of ARI in children under five year and provide counseling about the dangers of smoking which can cause ARI in children under five year by reducing the use of cigarettes around children under five year.

Changes in clinical, demographic, and outcome patterns of children hospitalized with non-SARS-CoV-2 viral low respiratory tract infections before and during the COVID pandemic in Rome, Italy.

We performed this study aiming to evaluate changes in epidemiology, clinical presentation and outcomes of children hospitalized for viral lower respiratory tract infections (LRTI). We performed a retrospective study of children younger than 18 years of age hospitalized for LRTIs with a positive respiratory viral testing from 2018 to 2022. We compared need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018-2019) and covid (2020-2022) period. A total of 523 were included in the analysis. In the pandemic period, the detection of influenza was 95% less likely to occur (odds ratio [OR]: 0.05; 95% confidence interval [95% CI]: 0.02-0.12; p < .001), likewise the detection of adenovirus was 77% less likely to occur (OR: 0.23; 95% CI: 0.10-0.51; p < .001). In the pandemic period, the number of codetections increased from 15.52% in 2018 to 57.25% in 2022, resulting in a significantly increasing trend (p < .001). The odds of transfer to PICU was more than five times greater during the pandemic period (OR: 5.31; 95% CI: 1.78-15.86; p = .003). We found that the pattern of LRTI in children during COVID-19 pandemic significantly changed in terms of etiologies and increased severity.

Clinical characteristics of hospitalized patients with Nocardia genus detection by metagenomic next generation sequencing in a tertiary hospital from southern China

ObjectiveAs an opportunistic pathogen, Nocardia often occurring in the immunocompromised hosts. As the unspecifc clinical presentation and low identification rate of the culture dependent methods, Nocardia infection may be under-diagnosis. Recent study have reported physicians could benefit from metagenomic next-generation sequencing (mNGS) in Nocardia diagnosis. Herein, we present patients with a positive detection of nocardiosis in mNGS, aiming to provide useful information for an differential diagnosis and patients management.MethodsA total of 3756 samples detected for mNGS from March 2019 to April 2022 at the Fifth Affifiliated Hospital of Sun Yat-sen University, were screened. Clinical records, laboratory finding, CT images and mNGS results were reviewed for 19 patients who were positive for Nocardia genus.ResultsSamples from low respiratory tract obtained by bronchoscope took the major part of the positive (15/19). 12 of 19 cases were diagnosis as Nocardiosis Disease (ND) and over half of the ND individuals (7/12) were geriatric. Nearly all of them (10/12) were immunocompetent and 2 patients in ND group were impressively asymptomatic. Cough was the most common symptom. Nocardia cyriacigeorgica (4/12) was more frequently occurring in ND, followed by Nocardia abscessus (3/12). There are 3 individuals detected more than one kind of Nocardia species (Supplementary table 1). Except one with renal failure and one allergic to sulfamethoxazole, all of them received co-sulfonamide treatment and relieved eventually.ConclusionOur study deciphered the clinical features of patients with positive nocardiosis detected by mNGS. Greater attention should be paid to the ND that occurred in the immunocompetent host and the geriatric. Due to the difficulties in establishing diagnosis of Nocardiosis disease, mNGS should play a much more essential role for a better assessment in those intractable cases. Co-sulfonamide treatment should still be the first choice of Nocardiosis disease.

Immunogenicity and Efficacy of TNX-1800, A Live Virus Recombinant Poxvirus Vaccine Candidate, against SARS-CoV-2 Challenge in Nonhuman Primates.

TNX-1800 is a synthetically derived live recombinant chimeric horsepox virus (rcHPXV) vaccine candidate expressing Wuhan SARS-CoV-2 spike (S) protein. The primary objective of this study was to evaluate the immunogenicity and efficacy of TNX-1800 in two nonhuman primate species challenged with USA-WA1/2020 SARS-CoV-2. TNX-1800 vaccination was well tolerated with no serious adverse events or significant changes in clinical parameters. A single dose of TNX-1800 generated humoral responses in African Green Monkeys and Cynomolgus Macaques, as measured by the total binding of anti-SARS-CoV-2 S IgG and neutralizing antibody titers against the USA-WA1/2020 strain. In addition, a single dose of TNX-1800 induced an interferon-gamma (IFN-γ)-mediated T-cell response in Cynomolgus Macaques. Following challenge with SARS-CoV-2, African Green and Cynomolgus Macaques exhibited rapid clearance of virus in the upper and lower respiratory tract. Future studies will assess the efficacy of TNX-1800 against newly emerging variants and demonstrate its safety in humans.

Long COVID Explained: The Ultimate Guide For Kids!

COVID-19 is caused by SARS-CoV-2, a virus that affects the upper and lower respiratory tracts. Most kids who get COVID-19 do not get sick at all, or only feel sick for a short time. But sometimes children who have had COVID-19 can feel unwell for several weeks or months after the infection. They continue to feel exhausted, have shortness of breath, and have trouble doing daily tasks. This is called long COVID, and doctors are trying to understand it and find ways to protect people. In this article, we will explain what can happen when kids get COVID-19, what long COVID is, and what might cause long COVID to happen in a number of infected people.

Abstract 17 — Overall Infection Risks of Tofacitinib in Patient with Rheumatoid Arthritis: A Meta-Analysis of Randomized Clinical Trials

Background There is an ongoing controversy surrounding whether tofacitinib increases the risk of infections in patients with rheumatoid arthritis (RA). To address this issue, we conducted a meta-analysis using data from randomized clinical trials (RCTs) to assess the overall risk of infection in these patients. Methods We conducted a comprehensive systematic search in EMBASE, MEDLINE, and CENTRAL from their inception until December 2022 to identify relevant RCTs reporting the occurrence of infections in patients with RA who were treated with the standard clinical therapeutic dosage of tofacitinib (5mg twice daily orally). The primary outcomes of the included studies in this review focused on the incidence of total infections, serious infections, non-serious infections, and opportunistic infections (including herpes zoster and tuberculosis). Additionally, we examined secondary outcomes related to the incidence of various sites of infections, including the upper respiratory tract, lower respiratory tract, gastrointestinal tract, hepatobiliary system, urinary tract, skin and soft tissue, blood, dental and oral soft tissue, genital, reproductive tract, bone and joint, and central nervous system infections. Due to the expected anticipation of clinical and methodological heterogeneity across studies, the effect estimate was pooled with a random-effects model, to obtain the RRs and 95% CIs, using Mantel-Haenszel statistical method. Results Twelve eligible RCTs, involving a total of 6,056 patients, were included in the analysis. In comparison to the control group (placebo and other active treatments), tofacitinib exhibited a significant increase in the risk of total infections (RR, 1.21; 95% CI, 1.07-1.37; I2, 28%), serious infections (RR, 1.23; 95% CI, 1.02-1.48; I2, 0%), non-serious infections (RR, 1.20; 95% CI, 1.05-1.36; I2, 29%), and opportunistic infections (RR, 1.66; 95% CI, 1.40-1.97; I2, 0%). Secondary outcomes analyses revealed a significant increase in the risk of lower respiratory infections with tofacitinib (RR, 1.27; 95% CI, 1.10–1.47; I2, 0%). Conclusion Compared with placebo and other active treatments, tofacitinib significantly increased the overall risk of infections (total infections, serious infections, non-serious infections, and opportunistic infections). These findings can help clinicians assess the risk of infections in RA patients treated with tofacitinib.

Identification of repurposable drug targets in Mycoplasma pneumoniae using subtractive genomics, molecular docking and dynamics simulation

Mycoplasma pneumoniae is a significant causative agent of community-acquired pneumonia, causing acute inflammation in the upper and lower respiratory tract as well as extrapulmonary syndromes. In particular, the elderly and infants are at greater risk of developing severe, life-threatening pneumonia caused by M. pneumoniae. Yet, the global increase in antimicrobial resistance against antibiotics for the treatment of M. pneumoniae infection highlights the urgent need to explore novel drug targets. To this end, bioinformatics approaches, such as subtractive genomics, can be employed to identify specific metabolic pathways and essential proteins unique to the pathogen that could be potential targets for new drugs. In this study, we implemented a subtractive genomics approach to identify 61 metabolic pathways and 42 essential proteins that are unique to M. pneumoniae. A subsequent screening in the DrugBank database revealed three druggable proteins with similarity to FDA-approved small-molecule drugs, and finally, the compound CHEBI:97093 was identified as a promising novel putative drug target. These findings can provide crucial insights for the development of highly effective drugs that selectively inhibit the pathogen-specific metabolic pathways, leading to better management and treatment of M. pneumoniae infections.

A national antimicrobial guide with local, customizable versions: how is it used? A two-year analysis.

Guideline adherence is one of the most important objectives for antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) developed an online national guide (SWAB-ID) in 2006. Every Dutch hospital is offered the opportunity to customize the national version to their local context and distribute it through an independent website. We studied user data to see how often the guidelines on therapy, prophylaxis and medication are used. Data on usage between 19 June 2020 and 30 June 2022 were extracted through Google Analytics for the national site and the 53 hospitals using a customized version of the national guide. User data were divided into three main groups: users of the national guide SWAB-ID, and users of the sites of general hospitals and university hospitals. A total of 1 837 126 searches were analysed, of which 1 393 681 (75.9%) concerned therapy, 111 774 (6.1%) prophylaxis and 331 671 (18%) medication. Of these searches, 456 854 (24.9%) were performed on the national site, 950 887 (51.8%) by general hospitals and 429 385 (23.4%) by university hospitals. The most commonly searched tracts among all user groups were lower respiratory tract (21.8%), kidney and urinary tract (16.6%) and skin and soft tissues (11.8%). The most commonly searched conditions were community-acquired pneumonia (15.3%), cystitis (13.5%) and sepsis (11.3%). The top ranked pages on medication differed for the three categories of users. The SWAB-ID antimicrobial guide is used extensively by both general and university hospitals. The online guide can help in prescribing therapy according to the guideline.

Exertional Dyspnea; Just an Untrained Child? Two Case Reports Analyzing the Role of Lung Function Testing

Background: Dyspnea is a common symptom that afflicts many patients with pulmonary disease and may be the primary manifestation of not only lung disease but also myocardial dysfunction, anemia, neuromuscular disorders, obesity, etc. Dyspnea can be induced by physical activity, which is referred to as exercise-induced dyspnea (EID). It can be caused by various etiologies, sometimes concomitant. In pediatrics, the three most common causes of exertional dyspnea are exercise-induced bronchoconstriction, inducible laryngeal obstruction, and being physically untrained Case presentation: We report two cases of adolescents who developed EID and their management approach. The first patient had an inducible laryngeal obstruction (EILO), while the second had an exercise-induced bronchoconstriction (EIB). Discussion: The diagnosis of EIB is based on clinical symptoms (e.g., exercise-related symptoms of dyspnea, cough, or wheezing) and lung function testing (LFT). This test shows a reversible airflow limitation in response to exercise. A decrease in FEV1 ≥ 10% is considered positive. A major goal is to ensure that patients with EIB continue physical activity. Therapy is based on non-pharmacologic and pharmacologic measures. Conclusion: Our aim is to add our experience to the available knowledge on the diagnosis of EID. In conclusion, when faced with a child with exertional dyspnea, before declaring that he is not trained, it is always necessary to collect an accurate medical history, examination and carry out LFT, excluding pathologies of the upper and lower respiratory tract, such as EILO and EIB.

Chronic Rhinosinusitis with Nasal Polyposis in People with Cystic Fibrosis

Cystic fibrosis (CF) is an autosomal recessive disorder that results in deranged ion transport and affects multiple organ systems, including the upper and lower respiratory tracts. People with CF (PwCF) often develop chronic rhinosinusitis (CRS) with or without nasal polyposis. CRS can significantly decrease quality of life for PwCF and can lead to more frequent pulmonary exacerbations. The management of CRS in PwCF is different from that in individuals without CF. Novel therapies have emerged in the last several years that have drastically altered the progression of both pulmonary and sinonasal disease in people with CF. It is critical for providers who manage CF-related CRS to understand the unique characteristics and challenges that coincide with this disease process. This review article aims to provide readers with an overview of the pathophysiology of CF and to summarize best practice strategies for the management of CF-related CRS.

Susceptibility to antimicrobial preparations of Klebsiella pneumoniae strains isolated from patients in a multidisciplinary hospital

Introduction. The extraordinary genetic potential of microorganisms has benefited from human overuse antibiotics to develop multiple resistance mechanisms. The large size and heterogeneity of the Russian population, the presence of territories with significant differences in demographic, cultural, and socio-economic indicators, the features of the management and availability of medical care are significant factors influencing the spread of resistance genes to antibacterial therapy of some strains of microorganisms.&#x0D; Materials and methods. Susceptibility to twenty one antimicrobial agents of one hundred twenty eight Klebsiella pneumoniae isolates, isolated from various loci of patients in a multidisciplinary hospital, including 16% of strains from the lower respiratory tract, 44% from wounds and wound discharge, and 40% from urine, was assessed.&#x0D; Results. Among isolates from urine, 20% of isolates were found to have the multidrug resistance (MDR) phenotype, 42% had the extreme resistance phenotype (XDR). Among the isolates of Kl. pneumoniae from purulent wounds, 18% had the MDR phenotype, and 43% had the XDR phenotype. Among the isolates of Kl. Рneumoniae from the lower respiratory tract, 37% had the MDR phenotype, 40% had the XDR phenotype. There are no pan-resistant strains in all groups. &#x0D; The presence of genes for metallo-beta-lactamase (VIM, IMP, NDM groups) and serine carbapenemase (bovine and OXA-48) in molecular genetic study by real-time PCR of isolated Kl. pneumoniae was found in 73.4% of cases. &#x0D; The results of determining the sensitivity of the isolates revealed a low activity of amoxicillin / clavulanic acid, III and IV generation cephalosporins (ceftazidime, cefotaxime, cefepime). 86.7% of isolates are resistant to drugs of the aminoglycoside group (amikacin), and 100% to gentamicin. Of the group of carbapenems, meropenem showed the highest activity – 26.6%, about 7% were sensitive to ertapenem. From the group of fluoroquinolones, sensitivity ranged from 20 to 30%. The highest activity of all drugs was shown by ticarcillin/clavulanate – 33.3%.&#x0D; Limitations. The criteria for inclusion in the group of examination and selection of biomaterial were the presence of previous massive antibacterial therapy in the anamnesis, the presence of catheters, drains, etc.&#x0D; Conclusions. There was established a high proportion of strains Kl. pneumoniae with the phenotype of multiple antibiotic resistance.

Hubungan Perilaku Merokok Orang Terdekat Dengan Kejadian Ispa Pada Balita Di Puskesmas Sungai Tutung

ABSTRACT&#x0D; One of the things that influences the emergence of acute respiratory infections is air pollution and includes cigarette smoke. Cigarette smoke as one of the factors that causes ARI is a disease that can kill the third after coronary heart disease and cancer. ARI is a disease of the upper or lower respiratory tract, usually a disease It is contagious and can cause a wide spectrum of illnesses ranging from asymptomatic or mild infections to severe and fatal illnesses.This type of research is analytical research. This research uses a quantitative approach carried out at the Sungai Tutung Community Health Center, which is located at Jalan Raya Simpang Empat Village, Baru Sungai Tutung Village. This research was carried out at the Sungai Tutung Community Health Center 07 - 15 August 2023. The sample in this research is The entire population is 52 people with a sampling technique, namely total sampling.The results of this study, using the chi square test, obtained a p-value of 0.00, which is smaller than the significance level, namely 0.05, thus there is a significant relationship between the smoking behavior of people closest to the incidence of ISPA in toddlers at the Tutung River Community Health Center. namely smoking behavior 61.5% and ARI in toddlers 53.8%. &#x0D;

Hubungan Kepadatan Hunian dan Pencahayaan Kamar dengan Kejadian ISPA pada Balita di Wilayah Kerja UPTD Puskesmas Babelan 1

Acute Repiratory Infections (ARI) is a health problem that occurs due to respiratory infections that attack both the upper and lower respiratory tract and is usually common and mostly experienced by toddlers. Bekasi Regency has the second highest number of cases of ARI among toddlers in 2018 with 560 cases (9.03%) at the Babelan 1 Health Center in the last three years there has been an increase in ARI cases in toddlers aged 12-59 months, in 2020 there were 17 cases increasing in 2021 to 28 cases and increasing to 40 cases in 2022. This study aims to determine the relationship between occupancy density and room lighting with the incidence of ARI in toddlers in the Babelan 1 Puskesmas Working Area. This study used a case control design. The population in this study were all toddlers aged 12-59 months who lived in the Working Area of UPTD Puskesmas Babelan 1 in 2023. The population in the case group consisted of all toddlers who suffered from ARI from January-December 2022 at the MTBS Poly and the control population consisted of all toddlers who had never been reported to have ARI. The sample in this study were 40 cases and 40 controls. This study was conducted from November 2022-July 2023. The results of bivariate analysis showed there was a significant relationship between room occupancy density (pvalue = 0.003) and room lighting (pvalue = 0.006) with the incidence of ARI in toddlers. Mothers with children under the age of five are encouraged to actively consult with healthcare workers during educational sessions. This is aimed at increasing awareness among mothers with toddlers about the importance of considering factors such as family behavior and the physical condition of their homes.

Microbiological Profiles and Inflammatory Biomarkers of Bacteremia in Children in a Teaching Hospital in Kuwait: An 8-Year Retrospective Study

Objectives: The objectives of this study were to determine the bacterial profiles and prevalence of antibiotic resistance patterns of bacteria causing bacteremia in febrile children and to compare levels of inflammatory markers between children with and without bacteremia in Kuwait from 2015 to 2022. Materials and Methods: Isolates from all episodes of significant bacteremia (n = 96) during the study period were recorded and evaluated. Microorganisms were identified using standard microbiological methods. Antimicrobial susceptibility testing was carried out using the VITEK2 system and Etest method. Extended-spectrum β-lactamase (ESBL) production by Enterobacterales was detected by the double-disk diffusion method and VITEK2 system. Patient age, gender, and inflammatory markers were collected at admission and compared between patients with and without bacteremia. Results: A majority of the patients were infants (37, 40%) and newborns (13, 14%). The main ports of entry were the lower respiratory tract, the genitourinary tract, and the gastrointestinal tract. Streptococcus pneumoniae was the most common pathogen (16, 16.7%) followed by Escherichia coli (12, 12.5%), Staphylococcus aureus (10, 10.4%), and Streptococcus agalactiae (9, 9.4%). High rates of resistance to ampicillin, cefuroxime, ciprofloxacin, and trimethoprim-sulfamethoxazole were observed among the Enterobacterales. The prevalence of ESBL-producing E. coli and K. pneumoniae were 45% and 29%, respectively. The prevalence of methicillin-resistant S. aureus was 30%. Patients with bacteremia had significantly higher white blood cell (WBC) counts, absolute neutrophil count (ANC), C-reactive protein (CRP), and neutrophil-lymphocyte ratio (NLR). Conclusion: Continuous surveillance of the prevalence and antimicrobial susceptibility patterns of blood isolates is imperative for the formulation of antibiotic policy. WBC, ANC, CRP, and NLR could be valuable indicators of bacteremia in febrile children.

CONFIRMATION OF DIAGNOSIS AND TREATMENT FOR A RHINITIS ALLERGY CASE IN A DOG

Rhinitis is a state of irritation and inflammation in the nasal area precisely in the nasal mucous membrane caused by allergic or non-allergic reactions. The case study aims to find out the appropriate diagnosis and therapy techniques for rhinitis cases. An examination was performed on a dog with complaints of sneezing and unilateral epistaxis for 10 days. Physical examination showed bilateral serous discharge mixed with blood from the nose and increased respiration frequency. X-rays of the thoracic region showed no significant abnormalities in the upper or lower respiratory tract. Cytological examination of nasal discharge revealed coccobacillus and simonsiela bacteria. Hematology examination results showed an increase in mean corpuscular volume (MCV) and a decrease in mean corpuscular hemoglobin concentration (MCHC). The therapy given to the case dog was causative, symptomatic, and supportive. Causative therapy was given in the form of antihistamine chlorpheniramine maleate® 4 mg in the amount of 4 mg/dog given orally twice a day for seven days. Symptomatic therapy was given antibiotics doxycycline hyclate® 100 mg in capsule form with the amount of 10 mg/kg BW given orally once a day for seven days and anti-inflammatory methylprednisolone® 4 mg in the amount of 0.3 mg/kg BW given orally twice a day for seven days. Supportive therapy was given caviplex 60 ml multivitamin with the amount of 1 mL once a day for seven days. As well as local hemostatic epinephrine is only given when the case dog has a blood-tinged discharge by inserting it into the nasal cavity using an iv catheter. The results of treatment for seven days showed an improvement in the condition characterized by no epistaxis, nasal discharge, and normal respiration in the case dog.