Airway Research Articles

Association between narrow palate and respiratory function in children: a literature review

Changes in the airways and dentoalveolar system are one of the most challenging aspects of modern practical and theoretical dentistry. Nasal breathing is essential for the normal development of the maxillofacial area. During a child’s growth, the respiratory tract and facial skull development are closely linked. The main stage of dentoalveolar system development occurs during preschool and elementary school years. Nasal breathing disorders are currently widespread in this age group. Dental professionals are frequently the first to detect these disorders. A dental professional can then inform parents on the potential causes and consequences of habitual mouth breathing, justify the need for treatment and prevention of this pathology, and refer a child to an ENT specialist. The review examines the association between narrow palate and respiratory function in children. Domestic and international studies addressing the association between dentoalveolar system pathologies and respiratory patterns and functional parameters were analyzed. The studies present a variety of opinions: some authors confirm the association between narrow palate and mouth breathing, while others refute it. Moreover, changes in respiratory function parameters following rapid palatal expansion have been analyzed, emphasizing the importance of timely orthodontic treatment to improve breathing.

Wybrane aspekty przeciwwirusowej aktywności flawonoidów względem SARS-CoV-2

Coronaviruses cause diseases of the respiratory tract, gastrointestinal tract and central nervous system, which threaten human health and contribute to economic losses. Innovative production technologies make it possible to use bioactive compounds as antiviral agents. Most fruits, vegetables and plant products contain flavonoids. Numerous studies have demonstrated the health-promoting effect of this group of compounds resulting from their antioxidant potential. The activity of an antioxidant in the body is the result of many factors that modulate the reactivity and physicochemical properties, among which the chemical structure is the most important. Bioinformatics tools using molecular modeling often precede research using in vitro and in vivo methods. The aim of this review is to present the mechanism of antiviral action of flavonoids against SARS-CoV-2, responsible for COVID-19. Studies using virtual molecular docking models were collected to test the affinity of flavonoids for key proteins of the SARS-CoV-2 virus replication cycle. Among the flavonoids with antiviral activity, the most active were apigenin, luteolin, isorhamnetin, kaempferol, myricetin, quercetin, hesperetin, naringenin and genistein. Food products with a high content of these compounds are indicated.

Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents’ infections and improving staff infection control competency in a nursing home

Abstract Background Nursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO’s core components in an NH. Methods The IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention. Results Analysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30–0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before. Conclusions WHO’s core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.

Preoperative Challenges for Pediatric Ambulatory Surgery

The demand for ambulatory anesthesia in pediatric surgery has been increasing, reflecting a significant shift over recent decades toward performing a growing number of procedures in an outpatient setting.1 The growing shortage of pediatric anesthesiologists, coupled with an increase in pediatric ambulatory surgery volumes, will require general anesthesiologists to deliver anesthesia care to children. Children with prematurity, hypotonia, upper respiratory tract infections (URTI), obesity, and congenital heart disease (CHD) are frequently encountered in the ambulatory setting and present significant challenges for ambulatory anesthesiologists. In addition, the management of preoperative fasting, pregnancy testing, and perioperative anxiety further complicates the care of a pediatric patient. This review will examine the existing evidence and provide guidance for ambulatory anesthesiologists on preoperative considerations for pediatric patients undergoing ambulatory surgical procedures.

DIABETES MELLITUS TIPO 2 COMO FATOR DE RISCO PARA O AGRAVO DA COVID-19 NA POPULAÇÃO BRASILEIRA: UMA REVISÃO SISTEMÁTICA

INTRODUCTION: The novel coronavirus, named SARS-CoV-2, is the etiological agent of COVID-19, a highly contagious infectious disease that primarily affects the lower respiratory tract. Type 2 diabetes mellitus may be a factor worsening this condition. OBJECTIVE: To identify the prevalence of diabetes mellitus as a risk factor for COVID-19 in Brazil from 2019 to 2023, assess the severity of cases in different states, analyze the sociodemographic factors affecting prognosis, and clarify the role of pharmacists in monitoring and managing the therapy of these patients. METHODOLOGY: This is a systematic review study using the PRISMA method, divided into four stages. The first stage involved searching for scientific works to answer the question about the frequency of worsening COVID-19 cases associated with type 2 diabetes mellitus in Brazil. The databases consulted were Scielo, PubMed, and the Virtual Health Library (BVS), using keywords such as “Diabetes mellitus,” “COVID-19,” “Brazil,” “Worsening,” and “Death.” RESULTS: Seveteen articles that met the inclusion criteria were selected. The studies indicate that diabetes mellitus is a significant risk factor for the severity and mortality of COVID-19 in Brazil, with mortality rates between 40% and 55% among diabetic patients. Additionally, the disease is associated with other comorbidities, such as hypertension and obesity, contributing to the need for ICU admissions and longer hospital stays. CONCLUSION: Type 2 diabetes mellitus is a significant risk factor for complications and mortality in COVID-19 patients, resulting in higher ICU admission rates and deaths, highlighting the need for rigorous glycemic control. The pharmacist's role is essential in monitoring glycemic levels and educating patients about treatment, contributing to reducing complications and improving clinical outcomes.

Insights into respiratory microbiome composition and systemic inflammatory biomarkers of bronchiectasis patients

ABSTRACT The human microbiomes, including the ones present in the respiratory tract, are described and characterized in an increasing number of studies. However, the composition and the impact of the healthy and/or impaired microbiome on pulmonary health and its interaction with the host tissues remain enigmatic. In chronic airway diseases, bronchiectasis stands out as a progressive condition characterized by microbial colonization and infection. In this study, we aimed to investigate the microbiome of the lower airways and lungs of bronchiectasis patients together with their serum cytokine and chemokine content, and gain novel insights into the pathogenesis of bronchiectasis. The microbiome of 47 patients was analyzed by sequencing of full-length 16S rRNA gene using amplicon sequencing Oxford Nanopore technologies. Their serum inflammatory mediators content was quantified in parallel. Several divergently composed microbiome groups were identified and characterized, the majority of patients displayed one dominant bacterial species, whereas others had a more diverse microbiome. The analysis of systemic immune biomarkers revealed two distinct inflammatory response groups, i.e., low and high response groups, each associated with a specific array of clinical symptoms, microbial composition, and diversity. Moreover, we have identified some microbiome compositions associated with high inflammatory response, i.e., high levels of pro- and anti-inflammatory cytokines, whereas other microbiomes were in correlation with low inflammatory responses. Although bronchiectasis pathogenetic mechanisms remain to be elucidated, it is clear that addressing microbiome composition in the airways is a valuable resource not only for diagnosis but also for personalized disease management. IMPORTANCE The population of microorganisms on/in the human body resides in distinct local microbiomes, including the respiratory microbiome. It remains unclear what defines a healthy and a diseased respiratory microbiome. We investigated the respiratory microbiome in chronic pulmonary infectious disease, i.e., bronchiectasis, and researched correlations between microbiome composition, systemic inflammatory biomarkers, and disease characteristics. The bronchoalveolar microbiome of 47 patients was sequenced, and their serum inflammatory mediators were quantified. The microbiomes were grouped based on their content and diversity. In addition, patients were also grouped into low- and high-response groups according to their inflammatory biomarkers’ levels. Certain microbiome compositions, mainly single-species dominated, were associated with high levels of inflammatory cytokines, whereas others correlated with low inflammatory response and remained diverse. We conclude that respiratory microbiome composition is a valuable resource for the diagnostics and personalized management of bronchiectasis, which may include preserving microbiome diversity and introducing possible probiotics.

ACE2-independent sarbecovirus cell entry can be supported by TMPRSS2-related enzymes and can reduce sensitivity to antibody-mediated neutralization

The COVID-19 pandemic, caused by SARS-CoV-2, demonstrated that zoonotic transmission of animal sarbecoviruses threatens human health but the determinants of transmission are incompletely understood. Here, we show that most spike (S) proteins of horseshoe bat and Malayan pangolin sarbecoviruses employ ACE2 for entry, with human and raccoon dog ACE2 exhibiting broad receptor activity. The insertion of a multibasic cleavage site into the S proteins increased entry into human lung cells driven by most S proteins tested, suggesting that acquisition of a multibasic cleavage site might increase infectivity of diverse animal sarbecoviruses for the human respiratory tract. In contrast, two bat sarbecovirus S proteins drove cell entry in an ACE2-independent, trypsin-dependent fashion and several ACE2-dependent S proteins could switch to the ACE2-independent entry pathway when exposed to trypsin. Several TMPRSS2-related cellular proteases but not the insertion of a multibasic cleavage site into the S protein allowed for ACE2-independent entry in the absence of trypsin and may support viral spread in the respiratory tract. Finally, the pan-sarbecovirus antibody S2H97 enhanced cell entry driven by two S proteins and this effect was reversed by trypsin while trypsin protected entry driven by a third S protein from neutralization by S2H97. Similarly, plasma from quadruple vaccinated individuals neutralized entry driven by all S proteins studied, and availability of the ACE2-independent, trypsin-dependent pathway reduced neutralization sensitivity. In sum, our study reports a pathway for entry into human cells that is ACE2-independent, can be supported by TMPRSS2-related proteases and may be associated with antibody evasion.

Imaging of Aspiration: When to Suspect Based on Imaging of Bacterial Aspiration, Chemical Aspiration, and Foreign Body Aspiration

AbstractAspiration-related syndromes comprise a broad spectrum of diseases affecting the airways and lung parenchyma resulting from inadvertent entry of oropharyngeal or gastric contents into the respiratory tract. The diagnosis can be challenging given lack of self-reported symptoms and unwitnessed or silent aspiration events. Aspiration is a common finding in healthy individuals suggesting that host defenses play a critical role in the pathophysiology. In the absence of strict criterion, a high index of suspicion is necessary based on recognition of established risk factors and identification of characteristic imaging findings. Conditions predisposing to altered levels of consciousness and neuromuscular weakness can lead to dysphagia, impaired cough reflux, and subsequent aspiration. The most salient feature on imaging is the anatomic location of the abnormalities, with the superior segments of the lower lobes and posterior segments of upper lobes involved in the recumbent position, and basilar segments of lower lobes in the upright position. Acute syndromes include pneumonia, pneumonitis, and foreign body aspiration. In the more indolent form of aspiration, bronchiectasis, diffuse bronchiolitis, and interstitial lung disease can develop. A detailed understanding of associated radiographic findings for these syndromes can help to implicate aspiration as the cause for imaging abnormalities and ultimately optimize patient management.

Bacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology

AbstractAspiration pneumonia refers to the process of alveolar inflammation induced by the inhalation of oropharyngeal secretions into the lower respiratory tract. Predisposing factors comprise swallowing dysfunction, impaired cough reflex, and degenerative neurological diseases. Accumulating evidence projects a fading contribution of anaerobic bacteria in aspiration pneumonia at the expense of Gram-negative bacilli, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, becoming the predominant organisms recovered from respiratory specimens. Aspiration of oropharyngeal secretions colonized with respiratory pathogens induces a profound disequilibrium of the lung microbiota resulting in a state of dysbiosis. Understanding this complex temporal variability between microbiome–host associations was only made possible with the introduction of metagenomic sequencing. In this narrative review, we summarize existing knowledge and elaborate on the evolving microbiology of aspiration pneumonia including the link between oral microbiome and pulmonary aspiration. We also highlight the progress and challenges in instituting microbiome-targeted strategies for preventing and treating the sequelae of aspiration pneumonia.

Burden and Risk Factors for Coinfections in Patients with a Viral Respiratory Tract Infection

Which patients should be monitored for coinfections or should receive empirical antibiotic treatment, in patients with an acute viral respiratory infection, is largely unknown. We evaluated the prevalence, characteristics, outcomes of coinfected patients, and risk factors associated with a coinfection among patients with an acute viral infection. A retrospective, single-center study recruited consecutive patients from October 2022 to March 2023 presenting to the emergency department with signs of a respiratory tract infection. Patients were screened for respiratory viruses and bacterial/fungal secondary infections according to local standard procedures. Outcomes included severe disease, in-hospital complications, all-cause in-hospital and ICU-related mortality, time to death, time to discharge, and time to coinfection. The analysis included 652 patients. A viral infection and a secondary bacterial/fungal infection were detected in 39.1% and 40% of cases. Compared with the rest of the cohort, coinfected patients had more frequently severe disease (88.3%, p < 0.001; 51% in patients with SARS-CoV-2) and higher in-hospital mortality (16.5%, p = 0.010). Nephropathy (OR 3.649, p = 0.007), absence of COVID-19 vaccination (OR 0.160, p < 0.001), SARS-CoV-2 infection (OR 2.390, p = 0.017), and lower blood pressure at admission (OR 0.980, p = 0.007) were independent risk factors for coinfection. Multidrug-resistant pathogens were detected in 30.8% of all coinfections. Patients with a viral infection are at high risk of bacterial coinfections, which carry a significant morbidity and mortality burden.

Contagious Bovine Pleuropneumonia: A Review

Contagious bovine pleuropneumonia (CBPP) is a bacterial disease, the causative agent of which is Mycoplasma mycoides subsp. Mycoides. The CBPP disease is one of important disease to be given attention because it is causing heavy mortality in bovines all over the world with African continent being hardly hit due to vagaries of bacteria. Air droplets is primary source of infection. Colonization in lower respiratory tract, Mmm invades arteries cause vasculitis. Many pathways of Mmm organism to cause destruction in host animal, presence of Gts ABC is one such mechanism. In CBPP we see pulmonary sequestra in chronic cases, severe fibrinous bronchopneumonia and pleural effusion during the acute to subacute phases. For confirmatory diagnosis, laboratory investigation and use of molecular techniques is recommended. Isolation of causative agent is also optimal method for diagnosis. The use of danofloxacin, tetracycline, flufenicol etc have been documented with varying degree of efficiency. Control over movement of bovine species, adequate space (where droplet spread is prevented) for each animal and vaccination are recommendatory steps. Though India has been declared CBPP free in 2007 we still need cautious approach and continue surveillance because north east of India seems very vulnerable to CBPP. Also, the fact that animal husbandry and agriculture drive economy of some of our most populous states it is all the more important that we give due consideration and focus on CBPP.

Hardware treatment of diseases of the upper respiratory tract in acute respiratory viral infections

Acute respiratory viral infections are among the most common diseases affecting the health of the population and often leading to complications from the upper respiratory tract. Medical treatment of acute respiratory viral infection is often complemented by hardware therapies that help reduce the risk of complications and accelerate recovery. This paper describes modern hardware methods for the treatment of acute respiratory viral infections, including low-frequency ultrasound cavitation, photochromotherapy, ultraviolet irradiation and UHF therapy. The clinical efficacy was evaluated in comparison with drug-based approaches. The possibilities of using these methods both in medical institutions and at home using the MULTILOR device were also investigated. Data analysis has shown that the use of hardware treatment methods significantly reduces the severity of symptoms of acute respiratory viral infections, shortens the duration of the disease and reduces the risk of complications. It is important to note that devices such as MULTILOR allow for treatment at home, increasing the availability of therapy. Hardware treatment of acute respiratory viral infections (ARVI) of the upper respiratory tract is a promising direction in modern medical practice, due to its proven effectiveness, safety and variety of technologies used. The inclusion in therapeutic regimens of such methods as low-frequency ultrasonic cavitation, ultraviolet irradiation (UVF), as well as UHF therapy, allows not only to significantly accelerate the regression of clinical symptoms, but also prevents the development of complications often associated with acute respiratory viral infections. The combined effect of these methods contributes to a significant reduction in symptoms, improvement of the condition of the mucous membranes and prevention of disease recurrence.

Respiratory tract bacteria distribution and transmission patterns among individuals in close contact

Respiratory tract bacteria distribution and transmission patterns among individuals in close contact

Recombinant chimeric horsepox virus (TNX-801) is attenuated relative to vaccinia virus strains in both in vitro and in vivo models

ABSTRACT Recombinant chimeric horsepox virus (TNX-801) is a preclinical vaccine in development against mpox and smallpox. In this report, we investigated the potential phenotypic differences in in vitro and in vivo models between TNX-801 and older vaccinia virus (VACV)-based vaccine strains (VACV-Lis and VACV-NYCBH) used in the eradication of smallpox as well as VACV-WR, VACV-IHD, and MVA. TNX-801 displayed a small plaque phenotype (~1–2 mm) in BSC-40 and Vero-E6 cells. Multi-step replication kinetics in immortalized nonhuman primate cell lines, and human primary cells from dermal and respiratory tracts yielded >10- to 100-fold lower infectious titers than the VACV strains. In addition, the infectious particle-to-genome copy ratio data suggests that TNX-801 genome packaging is ~10- to 100-fold less efficient than the VACV strains and the potential mechanism of TNX-801 attenuation is at the packaging/egress stage. Lastly, the susceptibility to VACV and TNX-801 infection of three new immunocompromised murine models (C56BL/6 Ifnar −/− , C56BL/6 Ifngr −/− , and C56BL/6 Ifnar −/− / Ifngr −/− ) was investigated. VACV strains were able to produce severe disease including decrease in body weight and temperature, as well as lethality in murine models via the intraperitoneal or intranasal routes. In contrast to VACV strains, TNX-801 was unable to produce any disease in murine models. These data demonstrate that TNX-801 is >10- to 1,000-fold more attenuated compared to older VACV-based smallpox vaccine strains in human primary cell lines and immunocompromised mice. IMPORTANCE Variola and monkeypox viruses are medically important pathogens that can cause fatal human disease. The two FDA-approved vaccines, ACAM-2000 and JYNNEOS, have important advantages and disadvantages. ACAM-2000 offers durable immunity; however, it has high adverse event rates. In contrast, JYNNEOS has a safer profile but requires two doses 4-weeks apart to achieve comparable immunity. Consequently, there is a need for vaccines offering durable immunity via single immunization with minimal adverse events. TNX-801 is a preclinical stage vaccine that can stimulate potent immunity via a single dose and provides protection against lethal mpox disease in the nonhuman primate model. Here, we show that TNX-801 is >10- to 1,000-fold attenuated in in vitro and in vivo models including human primary cells and immunocompromised murine models than vaccine strains utilized in smallpox eradication. The natural attenuation of TNX-801 and its ability to induce protective immunity via a single vaccination are promising and warrants further development.

Longitudinal 1H NMR-Based Metabolomics in Saliva Unveils Signatures of Transition from Acute to Post-Acute Phase of SARS-CoV-2 Infection

COVID-19 can range from a mild to severe acute respiratory syndrome and also could result in multisystemic damage. Additionally, many people develop post-acute symptoms associated with immune and metabolic disturbances in response to viral infection, requiring longitudinal and multisystem studies to understand the complexity of COVID-19 pathophysiology. Here, we conducted a 1H Nuclear Magnetic Resonance metabolomics in saliva of symptomatic subjects presenting mild and moderate respiratory symptoms to investigate prospective changes in the metabolism induced after acute-phase SARS-CoV-2 infection. Saliva from 119 donors presenting non-COVID and COVID-19 respiratory symptoms were evaluated in the acute phase (T1) and the post-acute phase (T2). We found two clusters of metabolite fluctuation in the COVID-19 group. Cluster 1, metabolites such as glucose, (CH3)3 choline-related metabolites, 2-hydroxybutyrate, BCAA, and taurine increased in T2 relative to T1, and in cluster 2, acetate, creatine/creatinine, phenylalanine, histidine, and lysine decreased in T2 relative to T1. Metabolic fluctuations in the COVID-19 group were associated with overweight/obesity, vaccination status, higher viral load, and viral clearance of the respiratory tract. Our data unveil metabolic signatures associated with the transition to the post-acute phase of SARS-CoV-2 infection that may reflect tissue damage, inflammatory process, and activation of tissue repair cascade. Thus, they contribute to describing alterations in host metabolism that may be associated with prolonged symptoms of COVID-19.

An Optimised Live Attenuated Influenza Vaccine Ferret Efficacy Model Successfully Translates H1N1 Clinical Data

Between 2013 and 2016, the A/H1N1pdm09 component of the live attenuated influenza vaccine (LAIV) produced instances of lower-than-expected vaccine effectiveness. Standard pre-clinical ferret models, using a human-like vaccine dose and focusing on antigenic match to circulating wildtype (wt) strains, were unable to predict these fluctuations. By optimising the vaccine dose and utilising clinically relevant endpoints, we aimed to develop a ferret efficacy model able to reproduce clinical observations. Ferrets were intranasally vaccinated with 4 Log10 FFU/animal (1000-fold reduction compared to clinical dose) of seven historical LAIV formulations with known (19–90%) H1N1 vaccine efficacy or effectiveness (VE). Following homologous H1N1 wt virus challenge, protection was assessed based on primary endpoints of wt virus shedding in the upper respiratory tract and the development of fever. LAIV formulations with high (82–90%) H1N1 VE provided significant protection from wt challenge, while formulations with reduced (19–32%) VE tended not to provide significant protection. The strongest correlation observed was between reduction in wt shedding and VE (R2 = 0.75). Conversely, serum immunogenicity following vaccination was not a reliable indicator of protection (R2 = 0.37). This demonstrated that, by optimisation of the vaccine dose and the use of non-serological, clinically relevant protection endpoints, the ferret model could successfully translate clinical H1N1 LAIV VE data.

Abstract 4119470: ST-Elevation Myocardial Infarction as a Complication of Granulomatosis with Polyangiitis

Description of Case: A 19-year-old female with history of granulomatosis with polyangiitis (GPA) presented to the emergency department after a syncopal episode at a concert. She reported a prodrome of feeling hot and dizzy prior to the event, followed by epigastric discomfort, nausea, and vomiting after regaining consciousness. She had been diagnosed with GPA one year prior to presentation based on serology and biopsy results. Because her disease was felt to be well-controlled on azathioprine, she had been tapered off of prednisone one month prior to presentation. Initial vitals included blood pressure of 90/60 mmHg, and heart rate of 94 bpm. A 12-lead EKG revealed ST segment elevation in leads I, II and aVF with T wave inversions in the lateral leads ( Figure 1 ). Initial bloodwork was notable for troponin I of 0.11ng/mL (upper limit of normal 0.034 ng/mL). A diagnosis of inferior ST-elevation myocardial infarction was made. She was treated with oral aspirin and prasugrel load as well as intravenous heparin and taken urgently to the catheterization laboratory. Diagnostic coronary angiography was significant for single vessel coronary artery disease (CAD) of the right coronary artery (RCA), with acute complete occlusion of the mid-RCA ( Figure 2A-B ). She was treated successfully with primary percutaneous coronary intervention and implant of two overlapping drug eluting stents in the mid-RCA ( Figure 2C ). Discussion: GPA is a systemic necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) that predominantly affects small to medium sized vessels in the respiratory tract and kidneys. Cardiovascular manifestations in GPA are uncommon, but include pericarditis, myocarditis, and coronary arteritis. GPA can affect the coronary arteries either primarily through inflammatory changes in the arterial wall or via systemic inflammation leading to accelerated atherosclerosis. No standardized criteria exist to establish the diagnosis of coronary arteritis and to differentiate it from accelerated atherosclerosis. Long-term treatment of vasculitis patients with coronary involvement is also poorly supported by evidence. Optimization of cardiovascular risk factors is advocated as per standard of care, and vasculitis control may slow disease progression. This case not only raises awareness of cardiac complications in GPA, but highlights the current lack of evidence surrounding secondary prevention in young patients with vasculitis and cardiac complications.

The Coexistence of Klebsiella pneumoniae and Candida albicans Enhanced Biofilm Thickness but Induced Less Severe Neutrophil Responses and Less Inflammation in Pneumonia Mice Than K. pneumoniae Alone

Due to the possible coexistence of Klebsiella pneumoniae (KP) and Candida albicans (CA), strains of KP and CA with biofilm production properties clinically isolated from patients were tested. The production of biofilms from the combined organisms (KP+CA) was higher than the biofilms from each organism alone, as indicated by crystal violet and z-stack immunofluorescence. In parallel, the bacterial abundance in KP + CA was similar to KP, but the fungal abundance was higher than CA (culture method), implying that CA grows better in the presence of KP. Proteomic analysis was performed to compare KP + CA biofilm to KP biofilm alone. With isolated mouse neutrophils (thioglycolate induction), KP + CA biofilms induced less prominent responses than KP biofilms, as determined by (i) neutrophilic supernatant cytokines (ELISA) and (ii) neutrophil extracellular traps (NETs), using immunofluorescent images (neutrophil elastase, myeloperoxidase, and citrullinated histone 3), peptidyl arginine deiminase 4 (PAD4) expression, and cell-free DNA. Likewise, intratracheal KP + CA in C57BL/6 mice induces less severe pneumonia than KP alone, as indicated by organ injury (serum creatinine and alanine transaminase) (colorimetric assays), cytokines (ELISA), bronchoalveolar lavage fluid parameters (bacterial culture and neutrophil abundances using a hemocytometer), histology score (H&E stains), and NETs (immunofluorescence on the lung tissue). In conclusion, the biofilm biomass of KP + CA was mostly produced from CA with less potent neutrophil activation and less severe pneumonia than KP alone. Hence, fungi in the respiratory tract might benefit the host in some situations, despite the well-known adverse effects of fungi.

Correlation Between Feeding Pattern and Duration of Hospital Stay in Pneumonia of Infants Below 6 Months of Age

<i>Introduction</i>: Pneumonia is the most common respiratory disorder among infants and one of the leading causes of hospital admission. Various feeding patterns have multiple impacts on pneumonia and recovery from it. Breast milk provides some protective properties against respiratory tract and gastrointestinal illness to protect infants during the first year of life. This study aimed to find an association between feeding patterns and duration of hospital stay due to pneumonia in infants below 6 months of age. <i>Methodology</i>: This cross-sectional study was conducted in the Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from February, 2019 to August, 2020. In our study, 200 infants below 6 months of age admitted with pneumonia in the Department of Paediatrics in Shaheed Suhrawardy Medical College Hospital, Dhaka were enrolled according to selection criteria. <i>Result</i>: Maximum incidence was seen in the 3 to 4 months of age, e.g.40.0% & 36.30% in girls and boys respectively, mean age of the pneumonia patient was 2.9±1.5 months. Out of 200 cases, 55.0% cases were male and 45.0% were female. Among all infants 93.75% of exclusively breastfed infants needed ≤10 days, and 27.88% of non-exclusive breastfed infants needed>10 days in the hospital for recovery from pneumonia. In both cases, the p-value was 0.001. <i>Conclusion</i>: Exclusive breastfed infants have shorter and non-exclusive breastfed infants have longer hospital stays due to pneumonia below 6 months of age.

Antimicrobial Peptides: A Promising Alternative to Conventional Antimicrobials for Combating Polymicrobial Biofilms

AbstractPolymicrobial biofilms adhere to surfaces and enhance pathogen resistance to conventional treatments, significantly contributing to chronic infections in the respiratory tract, oral cavity, chronic wounds, and on medical devices. This review examines antimicrobial peptides (AMPs) as a promising alternative to traditional antibiotics for treating biofilm‐associated infections. AMPs, which can be produced as part of the innate immune response or synthesized therapeutically, have broad‐spectrum antimicrobial activity, often disrupting microbial cell membranes and causing cell death. Many specifically target negatively charged bacterial membranes, unlike host cell membranes. Research shows AMPs effectively inhibit and disrupt polymicrobial biofilms and can enhance conventional antibiotics' efficacy. Preclinical and clinical research is advancing, with animal studies and clinical trials showing promise against multidrug‐resistant bacteria and fungi. Numerous patents indicate increasing interest in AMPs. However, challenges such as peptide stability, potential cytotoxicity, and high production costs must be addressed. Ongoing research focuses on optimizing AMP structures, enhancing stability, and developing cost‐effective production methods. In summary, AMPs offer a novel approach to combating biofilm‐associated infections, with their unique mechanisms and synergistic potential with existing antibiotics positioning them as promising candidates for future treatments.