Recurrent Acute Respiratory Infections Research Articles

CATION COMPOSITION OF ORAL SECRETION IN PRIMARY SCHOOL-AGED CHILDREN

SUMMARY. Recurrent respiratory infections (RRIs) currently have the greatest medical and social burden among infectious diseases worldwide, with the highest prevalence and incidence rates of acute respiratory infections in children. Recent studies indicate the role of inadequate immune response and the development of recurrent acute respiratory infections (ARI) in children due to deficiencies in essential trace elements in the body, which are crucial for the proper functioning of physical barriers and the immune system. The hypothesis of our study assumed that, considering the recurrence of at least 6 episodes of ARI per year, children with RRIs may have changes in salivary ion levels, which could serve as a basis for local immune suppression of the upper respiratory mucosa. The aim – to investigate the levels of metals in the saliva of children of primary school age with recurrent respiratory infections in comparison with episodically ill peers and establish the relationship of these changes with the state of local immunity. Material and Methods. In the actual study, 40 children participated, with 30 of them (the main group) being children with recurrent respiratory infections and 10 other children who had episodic illnesses were assigned to the control group. The levels of metal cations in the saliva were examined using inductively coupled plasma atomic emission spectrometry, including essential metals such as copper, manganese, zinc, calcium, cobalt, potassium, magnesium, sodium, phosphorus, selenium, iron, chromium, and sulfur. Additionally, levels of conditionally essential metals like lithium, nickel, and boron were measured. The levels of secretory IgA and lysozyme in saliva were determined using the enzyme-linked immunosorbent assay method. Results. The main group was not homogeneous; therefore, we divided it into two clusters. Respondents in one cluster had significantly lower relative levels of essential ion content in saliva. Specifically, calcium was lower in 64 % (p=0.003), copper in 76.5 % (p=0.001), manganese in 41.1 % (p=0.008), magnesium in 64 % (p=0.02), and zinc in 58.8 % (p=0.027). This fact can be explained by their increased losses due to frequent inflammatory processes in the upper respiratory tract, resulting in higher daily replenishment needs compared to their peers. Correlation analysis revealed a connection between illness incidence and the levels of copper (p=0.008), sodium (p=0.00005), and phosphorus (p=0.028), indicating potential associations between saliva metal profiles and the frequency of ARI in children with RRIs. The presence of dental caries correlated with lithium (p=0.02), copper (p=0.032), and nickel levels (p=0.037). Integral indicators of local immunity, such as lysozyme and secretory IgA, exhibited correlations with metal levels in saliva (Li, Cu, Ni, Na, Co, P, Zn), confirming the hypothesis of their role in regulating immune reactions in the oral cavity. Conclusions. Cluster analysis of the metal profiles of the group of children with RRI shows its heterogeneity, 43 % of representatives of this cohort had significantly lower levels of calcium (p=0.003), copper (p=0.001), manganese (p=0.008), magnesium (p=0.02) and zinc (p=0.027) than the control group. Which may indicate the presence of deficient conditions in some children with PRI as a result of the increased need for their recovery. The presence of caries, the level of SIgA, lysozyme (clinical indicators of local immunity of the oral cavity) have certain relationships with the levels of essential and conditionally essential levels of salivary metals (Li, Cu, Ni, Na, Co, P, Zn), which indicates the benefit of the connection between the metal profile of saliva and the state of local immunity.

Prevalence of undernutrition and associated risk factors among under five children in rural Haldwani

Background: The foundation of any nation is children. Malnutrition in children is global issue that may have both short- and long-term irreversible negative health consequences and thus associated with morbidity and mortality. Aims and Objectives: The study aims to determine the prevalence and associated risk factors of under-nutrition among under-five children in rural area of Haldwani. Materials and Methods: A community-based cross-sectional study conducted on Four hundred children residing in the rural field practice area of the Department of Community Medicine, Government Medical College, Haldwani. Results: The prevalence of underweight, stunting, and wasting was 7.75%, 9.25%, and 4%, respectively among under five children. The risk factors found significantly associated with undernutrition and sociodemographic profile were family size, parent’s education, mother’s occupation, and the socioeconomic class. The maternal factors found significantly associated with undernutrition were intake of iron folic acid tablets during antenatal care and postnatal care period, duration of pregnancy, site of delivery. Prelacteal, colostrum given, exclusive breastfeeding, and age of introducing complementary feeding and occurrence of recurrent diarrhea, recurrent acute respiratory infection, and worm infestation were child characteristics and medical illness found significantly associated with undernutrition. Conclusion: In this study, 17.5% of children were found undernourished. Factors determining undernourishment were parents literacy, social class, type and size of family, iron folic acid taken during pregnancy, feeding practices, immunization status, history of recurrent diarrhea, and other infections in the past 1 year.

Childhood Anemia and Risk for Acute Respiratory Infection, Gastroenteritis, and Urinary Tract Infection: A Systematic Review

Abstract Objective Children younger than 5 years, particularly children below 2 years, are among the most vulnerable groups for developing anemia and infections. This review is intended to assess the association between anemia and childhood acute respiratory infections (ARTIs), acute gastroenteritis (AGE), and urinary tract infections (UTIs). Methods PubMed was searched for published articles from January 2000 to August 2021 in English using the following terms: anemia and acute respiratory tract infections in children; anemia and UTIs in children; anemia and AGE in children. The data extraction were conducted by two investigators using the same methodology. Using descriptive statistics, the data from different sources were synthesized, including medians and ranges. Results A total of 426 articles and 27 original articles and 1 systematic review were included. Iron deficiency anemia is common among children between 6 months and 3 years of age. This age group can be considered a highly susceptible age for contraction of ARTI and AGE. Children below 5 years suffer five to six episodes of acute ARTI per year on average, and pneumonia accounts for the highest number of deaths, which is around 1.1 million each year. When considered, the odds ratio of anemia to increase the susceptibility of contracting lower ARTI would range from 2 to 5.7. Also, anemic children were 10 times more susceptible to developing acute recurrent ARTI and 4 times more susceptible to contracting pneumonia. Respiratory syncytial virus is the commonest viral etiology. Anemia would increase the risk of diarrhea by 2.9-fold in toddlers, while mild anemia, moderate anemia, and severe anemia would increase the susceptibility to contract AGE by 1.6, 1.6, and 8.9 times, respectively. Rotavirus is the commonest etiology. Some studies observed a protective effect of mild to moderate iron-deficient anemia from respiratory infections. Conclusion Infectious disease imposes a heavy burden on the health sector in a country. The highest susceptibility for infections and the development of anemia would be due to inadequate nutrition supplementation to meet the demand during rapid body growth. Therefore, based on the available evidence, one can take the necessary steps to reduce the infectious disease burden by correcting the anemia status in children.

Experience in the phytotherapy use for rehabilitation of adolescents with recurrent respiratory diseases

Introduction. The state of modern Russian adolescents health is characterized by negative trends such as high level of morbidity, largely due to recurrent acute respiratory diseases (ARI). Recurrent acute respiratory infections negatively affect the health of adolescents, contributing to the development of chronic infection foci, having a negative impact on their physical development and psychoemotional status. Many approaches have been proposed for the rehabilitation of adolescents with recurrent acute respiratory infections, but in recent years phytotherapy has attracted the attention of researchers.Aim. The study is to analyze the experience of using phytotherapy in the rehabilitation of adolescents with recurrent respiratory diseases.Materials and methods. 124 adolescents aged 13–18 years with recurrent acute respiratory infections were examined. The control group consisted of 50 conditionally healthy adolescents. The artificial colonization of buccal epithelial cells, anti-adhesive activity of saliva and level of psychic adaptation were determined. In addition to the generally accepted measures, the herbal medicine was included in the rehabilitation complex for 51 adolescents. Statistical processing of the obtained data was carried out using the SPSS 12.0 program.Results. A decrease in oral mucosa adaptive stability in adolescents with recurrent respiratory diseases during the period of clinical well-being was found – such as decrease of anti-adhesive activity of saliva, increase artificial colonization of buccal epithelial cells index. The prevalence of persons with psychic desadaptation among adolescents with recurrent acute respiratory infections was revealed. The positive clinical effect of the herbal medicine in improving the health of adolescents with recurrent respiratory infections, manifested by the end of the course of therapy by an increase in the adaptive resistance of the oral mucosa in the most of patients, and at the follow-up period of 6 months – an increase in the immune resistance and psychic adaptation.Conclusions. The use of herbal medicine effectively restores the reserves of oral cavity mucosal protection, psychic adaptation and reduces the number of acute respiratory infections. The drug has good tolerability and can be recommended for use in a complex of recreational activities for adolescents with recurrent respiratory diseases.

Age-specific features of the absorptive and cytokine-inducing function of phagocytosis in children with recurrent acute respiratory infections

Background. The study of the absorbing and cytokine-inducing function of phagocytosis is a mandatory starting point in assessing the state of anti-infective protection in children who suffer from frequent respiratory infections. It is important to understand and compare the features of phagocytosis in these children depending on their age. The purpose: to improve the diagnosis of immune disorders in children aged 2–5 and 6–10 years, who often suffer from acute respiratory diseases, by means of a comparative analysis of phagocytosis parameters and serum levels of some cytokines. Materials and methods. Under observation, there were 60 children aged 2 to 10 years who often suffer from acute infectious diseases of the respiratory tract. Two groups were formed: 1) children aged 2–5 years (n = 30); 2) children aged 6–10 years (n = 30). Results. Among patients of the first group compared to those of group 2, an increase in the frequency of low indicators of the phagocytic number (by 36.7 %, p < 0.05), phagocytic index (by 46.7 %, p < 0.05), the index of completion of phagocytosis (by 66.6 %, p < 0.05) and the staphylococcus-stimulated nitroblue tetrazolium test (by 46.4 %, p < 0.05), an increase in the frequency of high serum levels of interleukin-1β (by 33.3 %, p < 0.05), interleukin-10 (by 27.7 %, p < 0.05), a decrease in the frequency of high levels of interleukin-6 (by 16.7 %, p < 0.05). In the children of group 2 compared to those in the first one, high index of completion of phagocytosis was more often registered (by 70.0 %, p < 0.05), as well as more than a twofold increase in the ratio of interleukin-6/interleukin-10. Conclusions. In children aged 6–10 years, more frequent morbidity is due to a cytokine imbalance that was reflected in a more than a twofold increase in interleukin-6/interleukin-10 ratio, which is a negative factor indicating an enhancement of pro-inflammatory processes and a longer damage to the cells of the immune microenvironment.

The Overview of the Nurse’s Discharge Planning Implementation in Children with ARI in Indonesia : Literature Review

Implementation of discharge planning in children with ARI (Acute Respiratory Infection) in Indonesia is one of the efforts to prevent recurrent ARI in children. This study aimed to identify the implementation of discharge planning in children with ARI in Indonesia. A literature review searched four databases (Google Scholar, Science Direct, PubMed, and Springer) for all studies design between 2016-2021. The Prisma checklist guided in this review, title, abstract, full-text, and methodology were assessed for the eligibility of studies. The researcher found ten studies that met inclusion criteria in the review. Included studies consist of three studies discussing the factors that cause ARI, five studies discussing the implementation of discharge planning, and two studies of both. The average number of participants is 95 and most of the study design in this study used cross-sectional. 1) the importance of knowledge about the risk factor of ARI for discharge planning; 2) the risk factors of ARI in children, such as nutrition status, birth weight, exclusive breastfeeding, parental smoking status, dwelling density, ventilation, and humidity; 3) the implementation of discharge planning in the pediatric room was unoptimally implemented; 4) factors that causing unoptimally implementation of discharge planning are knowledge, competency, and coordination of nurse. It is also the competency of parents, especially mothers, in caring for children with ARI in Indonesia.
  
 Keywords: Acute Respiratory Infection, Discharge Planning, Children

Бактериальные лизаты как ключевой медикаментозный компонент профилактики и лечения острых респираторных инфекций у детей

В статье описаны возможности управления системой врожденного и адаптивного иммунитета медикаментозными средствами, в частности путем использования бактериального лизата Бронхо-мунал®. Подробно представлена иммунорегулирующая роль бактериальных лизатов. Дано патогенетическое обоснование использования бактериального лизата Бронхо-мунал® для профилактики острых респираторных инфекций у детей, в том числе у часто болеющих острыми респираторными инфекциями.

Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season

BackgroundTraditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines.MethodsA hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR.ResultsNinety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected.ConclusionsHybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site.This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures.Trial registration2019–001186-33 (EudraCT).

Оптимізація комплексної терапії пневмоній у дітей, які часто хворіють на гострі респіраторні захворювання

Purpose — to improve the pathogenetic treatment of pneumonia in children with recurrent acute respiratory infections by combining of protocol therapy with a drug has antioxidant, antihypoxic and organoprotective effects. Materials and methods. The analysis of the results of clinical, laboratory and instrumental methods of examination of children with pneumonia at the age of 3–8 years which have recurrent acute respiratory infections has performed. Children have had received standard protocol treatment of pneumonia and combination with a drug has antioxidant, antihypoxic and organoprotective effects. Results. Optimization the protocol treatment of pneumonia in children with recurrent acute respiratory infections by supplementing pathogenetic therapy with this drug made possible to improve the efficiency of treatment, what confirmed by the rapid regression of clinical manifestations of pneumonia (intoxication — to 1.9±0.04 days, cough — to 2.1±0.08 days, respiratory failure — to 1.7±0.08 days, shortness of breath — to 1.3±0.04 days, disorders of microcirculation and hemodynamics — to 2.1±0.05 and 1.8, respectively ± 0.09 days). This approach calls the decrease of percentage of children with pneumonic infiltration according to the control X-ray examination of the lungs — to 30.0%, myocardial hypoxia according to the ECG results — 20.0%, which made possible to reduce the duration of the course of antibiotic therapy to 2.0±0.04 days, inpatient treatment — to 2.2±0.08 bed-days. The positive dynamics laboratories values, clinical signs and instrumental methods of examination of such children occurred due to an increasing levels of glutathione reductase and glutathione transferase in the blood serum to 4 and 3 times, respectively, and a decreasing the content of glutathione peroxidase and gamma$glutamyl transpeptidase to 2.6 and 1.6 times. Conclusions. Supplement the protocol therapy of pneumonia in children with recurrent acute respiratory infections with a drug has antioxidant, antihypoxic and organoprotective effects promoted a rapid regression of clinical manifestations due to the improvement of the functional activity of the oxidative system of glutathione, which made possible to reduce the duration of the course of antibiotic therapy and inpatient treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: children with recurrent acute respiratory infections, pneumonia, treatment.

Рекурентні епізоди гострого обструктивного ларингіту в дітей: можливі причини та підходи до профілактики

Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup. Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention. Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years. Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (>6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D>30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D>30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29). Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to >30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: recurrent episodes, viral croup, children, causes, prevention.

The Effect Of Environmental Factors On The Events Of Restricted Ardes In Age Children Under Five Years

Acute Respiratory Infection (ARI) is one of the health problems in developing and developed countries. The World Health Organization (WHO) states that under-five mortality is generally caused by infectious diseases, and two-thirds are caused by Acute Respiratory Tract Infection or ARI. Objective To find out the effect of environmental factors on recurrent ISPA occurrence in children under five years of age in the work area of ​​Baolan Health Center, Tolitoli District.
 The design used in this study is cross-sectional analytic. The population is all mothers who have children with a history of Ispa disease in the last 6 months without complications (asthma, pulmonary tuberculosis, pneumonia). The sample size is 75 respondents using the Simple Random Sampling technique. Independent Variables of research are Environmental Factors. Dependent variable is Repeated Ispa Event based on observation of Toddler Medical Record. Data was collected using a questionnaire, then the data were analyzed using the Logistic Regression test, with a significance level of α 5 0.05.
 The results showed that p <a with a value of <0.05, this can be seen in Overall Statistics with a significance value of (p) 0.001 which means that there are variables that affect the incidence of recurrent ARI, and when viewed (p) in each independent variables namely ventilation variable has a value (p) of 0.007 occupancy density variable has a value (p) of 0.009, mosquito repellent use variable has a value (p) of 0.038, cooking fuel type variable has a value (p) of 0.073, the variable habit of smoking family members has a value (p) of 0.003.
 The discussion of this study was ventilation factors, occupancy density, use of medicinal drugs, types of cooking fuel, smoking habits of family members affecting the incidence of recurrent ARI in children under five years of age in the work area of ​​the Baolan Community Health Center, Tolitoli district.

Acute tonsillitis and pediatric functional gastrointestinal disorders: the first result of a possible association analysis

Acute tonsillitis (AT) and functional disorders of the digestive system (FDDS) are widespread among children. There is insufficient information about whether FDDS affects the incidence and course of АT, or whether АT may predispose to the development of АT. The aim is to discover a possible relationship between acute exudative tonsillitis and FDDS in children in the context of clinical and medico-social assessment. Materials and Methods: An observational cross-sectional study was performed using the continuous sampling method. There were 137 patients under observation, aged from one to 18 years, hospitalized in a hospital with АT, proceeding with overlaps on the tonsils, including 44 children younger and 93 older than 4 years. Bacterial АT was diagnosed on the MacIsack scale (≥ 4 points) in combination with the determination of inflammatory markers (leukocytosis, CRP). Epstein-Barr viral etiology of АT was diagnosed based on the detection of anti-EBV-VCA IgM and/or anti-EBV-EA IgG in the absence of anti-EBV-NA IgG. The legal representatives of the children agreed to participate in the study and completed a developed questionnaire containing 41 questions to assess medical and social factors, health status and gastrointestinal symptoms. FDDS diagnosis was carried out according to Rome IV 2016 criteria. Stool character was assessed using the Bristol scale, and clinical symptoms of АT were also analyzed. Results: Bacterial АT was diagnosed in 51.1% (70) of patients and EBV tonsillitis — in 48.9% (67), namely with equal frequency. The incidence of FDDS was 41.6% (95% CI (confidence interval) (33.3, 50.3), including 38.7% in children from 1 to 4 years old (95% CI (24.4, 54.5) and over 4 years 43.0% (95% CI (32.8, 53.7). Functional constipation (25.0%) and functional diarrhea (13.6%) were found in young children, all children over the age of 4 years had abdominal pain (including irritable bowel syndrome with a predominance of constipation — 4.3%). In EBV-RT with FDDS, the incidence of hepatolienal syndrome was 33.3% higher (RR (relative risk) 2.40; 95% CI (1.02, 5.66) and OR (odds ratio) 5.46; 95% CI (1.39, 21.28). Children with FDDS are 22.4% more likely (RR 1.65; 95% CI (1.21, 2.24) and OR 4.1; 95% CI (1.39, 12.07) suffered from recurrent acute respiratory infections; their relatives were more likely to have gastroenterological diseases (RR 1.54; 95% CI (1.12, 2.13) and OR 2.99; 95% CI (1.22, 7.34). Perinatal hypoxic lesions of the central nervous system were more often recorded in patients with FDDS in the anamnesis (RR 1.99; 95% CI (1.25, 3.15) and OR 4.13; 95% CI (1.37, 12.42). Conclusion: The etiological role of EBV among children with exudative АT admitted to the hospital is high. FDDS is more common among children with exudative АT over 4 years of age than in the general pediatric population. The influence of FDDS on the clinical manifestations of EBV-RT is highly probable. It is advisable to continue the study to determine the significance of АT in the development of FDDS in children and adolescents; their results may be useful for clinical practice.

Increased Risk of Recurrent Acute Respiratory Infections in Children with Congenital Heart Disease: A Prospective Cohort Study

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD.METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population.RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% (p=0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p=0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p<0.001). The mean frequency of and median duration of ARI episodes was also higher in CHD compared to the non-CHD group, 3 vs. 1.5 episodes (p<0.001), and 7 vs. 5 days, respectively.CONCLUSION: Children with CHD are at an increased risk of ARI, with more episodes and longer duration compared to children without CHD.KEYWORDS: non-cyanotic CHD, left-to-right shunt, acute respiratory infections

Vitamin D supplementation in the prevention of recurrent acute respiratory tract infections in children aged <5 years

Background: Children with Vitamin D deficiency are at an increased risk for acute respiratory tract infections (ARTIs). Till now, few studies have been conducted on the use of Vitamin D against ARTIs, but the findings are conflicting and not conclusive. Aim: The aim was to study the effect of Vitamin D supplementation in the prevention of recurrent ARTIs in under-five children. Methods: In this prospective study, a total of 310 children aged between 1 and 5 years diagnosed with ARTI were included. They were randomized into two groups: Group A (oral Vitamin D 120,000 IU with standard treatment; n = 155) and Group B (placebo with standard treatment only; n = 155). Follow-up of the patient was done every month for a period of 6 months to document the recurrence of acute attacks of ARTI. R version 3.6.0 software was employed to analyze the data. Results: Twelve children (3.9%) in Group B were unable to follow-up, and hence, 143 were considered for statistical analyses in that group. Among the 298 children, 63.7% were males and majority (25.5%) of them were in the age group of 11–20 months. Cough (96%), fever (93%), and rhinitis (85.2%) were the commonly encountered symptoms. On day 4th (after Vitamin D supplementation), majority in Group A (40%) had recovered completely compared to Group B (5.6%). Within 5 days, Group A patients were 7 times (odds ratio: 6.97, Confidence interval: 3.5–13.8; P < 0.0001) more likely to have a high recovery rate compared to Group B patients. The proportion of patients with minimal attacks (three or four) of ARTI was significantly less in Group A (7.7%) compared to Group B (32.4%; P < 0.001). Conclusions: Children with Vitamin D supplementation had better and rapid recovery from ARTIs and reduced frequency of ARTI attacks.

Are functional gastrointestinal disorders a clinically significant comorbid factor for acute respiratory infection in children?

Rationale: Functional gastrointestinal disorders (FGID) are highly prevalent in children worldwide. Current concept of FGID pathophysiology implies contributions from various mechanisms. Information in the role of acute respiratory infections in the development of FGID in children is lacking.Aim: To determine the prevalence of FGID in children hospitalized to the department of infectious diseases with acute respiratory tract infections (ARTI) and their association with demographic, medical biological factors and clinical manifestations.Materials and methods: We performed observational and cross-sectional study with continuous patient sampling. The study included 180 ARTI patients, whose mothers agreed to fill in the proposed questionnaire of 41 items. The diagnosis of FGID during in-hospital stay was made based on clinical data in accordance with the Rome criteria IV (2016) and by standard collection of the information from the parents. The stool characteristics were assessed with the Bristol scale. The rate of recurrent ARTI was assessed by the resistance index of above 0.5. We considered clinical symptoms of ARTI at the admittance, the rates of bacterial complications and the need in antibacterial treatment.Results: The prevalence of FGID in hospitalized children with ARTI below 4 years of age (n = 134) was 35.1% (95% confidence interval [CI]) 27.0– 43.9); they had higher rates of functional diarrhea (14.9%, 95% CI 9.4–22.1) and constipation (14.2%, 95% CI 8.8–21.3). Among those above 4 years of age (n = 46), FGID were diagnosed in 50% (95% CI 34.9–65.1) of the cases; with most frequent symptoms being abdominal pain (39.1%, 95% CI 25.1–54.6) and irritable bowel syndrome (10.8%). Irrespective of their age, the children with FGID had higher rates of ARTI recurrence (by 34.0%, 95% CI 20.0–48.1; relative risk 1.98, 95% CI 1.47–2.69; odds ratio 4.13, 95% CI 2.18–7.85) and intestinal infections in their past history, compared to those without any gastrointestinal symptoms during the index hospitalization. In children with FGID, ARTI were more frequently complicated by otitis and they had higher requirement in antibiotics. The mothers of the infants and toddlers with FGID had lower educational level (smaller proportion of those with high school education) and were less satisfied with their home and living conditions, whereas their fathers were older and more frequently employed in vehicle operations and less frequently were occupied in communication-related professions.Conclusion: Acute respiratory infections, especially recurring, may plaу a significant role in the development and maintenance of FGID in children. Further studies are necessary, which may result in useful information for the development of tailored strategies to treatment and prevention.

An open labelled prospective clinical study to evaluate the efficacy, safety and cost analysis of Pidotimod as add-on drug for maintenance therapy in Paediatric Recurrent Acute Respiratory tract Infections.

Recurrent acute respiratory tract infections (ARTI) are the commonest form of infections affecting children irrespective of socioeconomic status and geographical limits. Immaturity of immune response involving neutrophils, NK cells, T and B cells, in the early childhood, is often cited as a reason for this RRTI. There is a comparatively high incidence of ARTI in South East Asian countries when compared with global statistics. The possibility of using immune stimulation as a method of reducing the recurrence of ARTI prompted the use of Pidotimod as an add on drug. We tried to explore the safety, efficacy and a cost benefit analysis of Pidotimod as add-on treatment for paediatric use. After registering for Clinical trial and getting IEC approval, we started an open labelled prospective single arm interventional study by recruiting 65 children between 2-12 years with ARTI to receive 800 mg daily for 15 days and 400 mg for 45 days and was followed up for 6 months. Study revealed a significant reduction in number and duration of RRTI as well as reduction in episodes requiring antibiotics and reduction in duration of treatment. The reduction in number of school days lost and treatment expenses were statistically significant. There was a significant increase in mean absolute count in CD45, CD3, CD4, CD8 and lymphocyte counts at 6 months follow-up. Hence, we conclude that 60day Pidotimod therapy has immunostimulatory activity preventing the RRTI in paediatric population when considered as an add-on therapy to standard treatment.

A Qualitative Study on Family Role in the Care and Prevention of Acute Respiratory Infection Among Children in Primary Health Care.

Background. Acute Respiratory Infection (ARI) is a common reason that parents seek help to primary health care. In 2016, almost 65% (64.4%) pneumonia and less than 36% (35.6%) non-pneumonia cases were found among the children in Malang. Members of families have important roles to play in individual’s health, especially the children. The aim of this study was to explore the roles of family members in the care and prevention of children with ARI. Method. This was a qualitative study, with a phenomenological approach involving 12 informants. An in-depth interview was conducted on each informant having children with recurrent ARI during a space of 3 months in the primary health care. Information collected from the interviews were transcribed and analyzed into different themes. Results. The 4 themes identified include ARI in children, parent roles, influences of family members, and family problems. Different styles of parenting were established between the fathers and mothers also between the mothers and grandmothers on preventing ARI. The behavior of other family members impact both on the risk and prevention of ARI. Some of the identified problems capable of affecting children’s health include inability to control the children, unstable income and the stressed condition of most mothers. Conclusion. Behavior of family members impacts on the prevention of ARI among the children. Problems within the family could affect the mothers’ or caregivers’ psychology, which might in turn impact on the care given to the children infected with ARI or in preventing it.

COVİD 19 VE İMMUNONÜTRİSYON

The global coronavirus outbreak (COVID-19) has posed a major threat to public health worldwide. To date, most patients infected with COVID-19 have developed mild symptoms such as dry cough, sore throat, and fever. In some cases, various fatal complications such as organ failure, septic shock, pulmonary edema, severe pneumonia and acute respiratory distress syndrome (ARDS) have developed. Coronaviruses are a group of single-stranded RNA viruses that are common among mammals and birds. There are four main subgroups of coronaviruses (?, ß, ? and ?). SARS-CoV-2 is also a coronavirus. The immune system consists of both innate (fast, non-antigen-specific) and adaptive (slower, antigen-specific) responses. Vitamin C has a range of activities that can contribute to the immune system. Antigen-containing cells required for initiation and maintenance of cell-mediated immune responses can be directly inhibited by vitamin D. Zinc is known to modulate antiviral and antibacterial immunity and regulate the inflammatory response. Iron deficiency is a risk factor for the development of recurrent acute respiratory infections. Copper plays a role in the functions of T cells, B cells, neutrophils, natural killer cells and macrophages. In recent years, probiotic strains have been increasingly recognized as an increasingly powerful ally in preventing and fighting respiratory infections. For those with viral respiratory disorders, more investment is required in immunonutrition and its applications.

RECURRENT RESPIRATORY DISEASES AND HUMORAL IMMUNE STATUS IN PRESCHOOL CHILDREN

Currently, acute respiratory infections (ARI) are obviously considered to be the most topical issue of pediatric practice. It is worth noted that the age peculiarities of immune system in preschool children stipulated their higher vulnerability to infections and less differentiated response against infection process compared to older children and adults. Research aim consisted in finding out significant factors which are closely associated with serum immunoglobulin (Ig) levels in preschool children against the background of recurrent ARI.

New approaches to the prevention of recurrent respiratory diseases in preschool age

Objective. To evaluate the effectiveness of the natural terpenoids complex in preschool children with recurrent acute respiratory infections (ARI).Material and methods. There were examined 7129 children of 3-7 years old, they were divided into 3 groups. In main group (n = 2400) there was endonasally (on the mucous membrane of the nasal cavity with cotton buds) used a complex of natural terpenoids 2 times a day (morning and evening) 5 days a week for 1 - 3 months. Prevention and treatment of children from the comparison group (n = 2,379) was carried out with dioxotetrahydroxy tetrahydronaphthalene. The control group consisted of children (n = 2,350), who received no therapy. Upon completion of the course of therapy, children were examined in dynamics.Results. The authors noted positive clinical effect of the natural terpenoid complex, as evidenced by a 1.6 times decrease in acute respiratory infections during the year and the duration of the acute episode of the disease by 2.5 days, as well as a positive effect on the elimination of Epstein Barr virusin frequently ill children when using drug for 65.51 ± 2.98 days. The authors observed a favorable clinical effect against the decrease in neutrophils and eosinophils in the rhinocytogram, as well as mixed flora and cocci, indicating a decrease in mucosal neutrophilic inflammation and prevention of bacterial complications.