Episodes Of Respiratory Infections Research Articles

Vitamin D and upper respiratory tract infections in young active males exposed to cold environments.

Performing indoor and outdoor work in cold environments may result in various adverse effects on human health and may lead to increased risk of respiratory infection. The aim of this study was to determine the relation of vitamin D status to secretory immunoglobulin A concentration, leucocyte counts, cytokine concentrations and incidence of upper respiratory tract infection (URTI) episodes in young active men during an autumn-winter period. The effect of work in a cold microclimate was studied among 23 young active male ice hockey players during a 19-week study period. Blood and saliva samples were collected 7 times during the study period. Incidence of URTI was evaluated using WURSS 21. White blood cell, neutrophil, lymphocyte, monocyte, eosinophil and basophil counts, concentrations of 25(OH)D, C-reactive protein, cortisol, IL-1ra, IL-10, IL-1β and immunoglobulins A, M and G, were determined in the blood. Secretory immunoglobulin A, A1 and A2 and cortisol were analysed in saliva. Spearman's correlations were used to evaluate relationships between initial or final 25(OH)D concentration and URTI incidence, as well as the immune and endocrine markers. Differences in URTI episodes, immune and endocrine parameters between sufficient ( ≥20 ng·ml -1) and deficient (<20 ng ·ml -1) vitamin D status groups were compared with the Mann-Whitney test. There were no statistically significant correlations between mucosal and blood markers or URTI incidence and initial and final 25(OH)D concentrations. Immune, endocrine and URTI variables did not differ between deficient and sufficient vitamin D status groups. 25(OH)D concentration has no impact on mucosal and systemic immunity, nor on URTI episodes.

Gambaran Drug Related Problems (DRPs) Terapi Farmakologi Pasien ISPA Pediatrik di Rumah Sakit PKU Muhammadiyah Gamping Yogyakarta

Acute Respiratory Infection has become the major cause of death in children in developing countries. There were about 11.9 million episodes of severe acute lower respiratory infection that resulted in hospital admission in young children worldwide. The method of drug administered was the common Drug-Related Problems found in young children. Objectives: To evaluated Drug-Related Problems of Acute Respiratory Infection drug therapy in pediatric patients. Methods: Ninety-four pediatric patients were included in this study. Drug therapy data were obtained from medical records from January 2018 until July 2019, as this study was using a retrospective method. Drug-Related Problems of drug therapy were analyzed based on the Cipolle classification system. Results: Prevalence of female and male patients are in the same number (50%) with the highest prevalence on 2-11 years (72.34%) in young children. The number of Drug-Related Problems was found about 61.49% from 148 numbers of used drugs with improper drug selection as the major Drug Related Problems (51,65%) followed by drugs without indication and underdose by 23.08% and 15.38%, respectively.Keywords: acute respiratory infection, hospital, pediatrics, pharmacologic therapy

Антибиопленочные эффекты муколитических лекарственных средств

Муколитические лекарственные средства обладают способностью нарушать структуру матрикса и разрушать сформированные бактериальные биопленки. Наиболее изученным является N-ацетилцистеин. Впервые антибиопленочная активность N-ацетилцистеина была продемонстрирована Ciro Pérez-Giraldo и соавт. в 1997 году. Они показали, что вещество оказывает ингибирующее действие на рост бактерий и способствует диспергированию биопленок, образованных бактериями Staphylococcus epidermidis. В настоящее время установлено, что N-ацетилцистеин обладает выраженной активностью, направленной против биопленок, сформированных различными грамположительными и грамотрицательными бактериями, в том числе и антибиотикорезистентными бактериальными штаммами метициллинрезистентного золотистого стафилококка и хинолонрезистентных синегнойных палочек. N-ацетилцистеин способствует проникновению пенициллинов, полимиксинов, фторхинолонов в самые глубокие слои биопленки, преодолевая антибио­тикорезистентность причинно-значимых бактериальных агентов. N-ацетилцистеин может применяться как антибиопленочное лекарственное средство при хронических бактериально-ассоциированных заболеваниях, в частности при эпизодах респираторных инфекций у больных муковисцидозом, хроническом бронхите, хронической обструктивной болезни легких. Полагают, что N-ацетилцистеин обладает превосходным профилем безопасности и эффективности при лечении заболеваний, которые сопровождаются образованием бактериальных биопленок. N-ацетилцистеин и нанотехнологические лекарственные средства, в которых его молекулы скомбинированы с частицами галлия или серебра, могут стать средствами выбора, диспергирующими биопленки и усиливающими эффективность антибактериальной терапии, особенно при заболеваниях, вызванных антибиотикорезистентными штаммами микроорганизмов.

Уровень цинка и особенности течения атопического дерматита у детей

Актуальность. В поисках основных патогенетических механизмов атопического дерматита (АД) и улучшения вариантов профилактики и лечения все больше внимания уделяется обеспечению организма ребенка микроэлементами. Особая роль принадлежит цинку, который является одним из самых многофункциональных микроэлементов. Цель: изучить особенности клинического течения АД у детей в зависимости от содержания цинка в сыворотке крови. Материалы и методы. В работе представлены материалы клинического наблюдения, клинико-лабораторного и инструментального обследования 168 детей в возрасте от 7 до 18 лет с АД. Контрольную группу составили 60 практически здоровых детей. Содержание цинка в сыворотке крови определяли методом атомно-абсорбционной спектроскопии на спектрофотометре С-115-М1, согласно инструкциям, прилагаемым к прибору. Результаты. Более половины детей (55,6 %) имели очень низкий уровень цинка — 0,35 ± 0,11 мг/л, еще 22,2 % — крайне низкий (0,12 ± 0,02 мг/л). Отмечен ряд особенностей клинического течения АД: более частые эпизоды острых респираторных вирусных инфекций, преобладание среднетяжелого и тяжелого течения с периорбитальным, периоральным, перианальным дерматитом, дистрофическими изменениями и гиперкератозом ногтей, повышенной ломкостью волос, выраженной сухостью кожи (2,31 ± 0,73 балла против 1,92 ± 0,69 балла; p &lt; 0,01). Выявлены обратные корреляционные связи между концентрацией цинка в сыворотке крови и сухостью кожных покровов (р = 0,001; r = –0,67; t = –2,99), значением индекса SСORAD (р = 0,01; r = –0,49; t = –2,34) и длительностью течения АД (р = 0,001; r = –0,46; t = –2,13). Установлены достоверно более низкие показатели роста (p &lt; 0,05), особенно у детей с очень низким содержанием цинка (0,12 ± 0,02 мг/л). Выводы. У детей с атопическим дерматитом содержание цинка в плазме крови достоверно ниже, чем у здоровых детей. У детей с пониженным содержанием цинка в организме отмечен ряд особенностей клинического течения атопического дерматита (более тяжелое и затяжное течение с периорбитальной и перианальной локализацией, частые респираторные инфекции, выраженные дистрофические изменения придатков кожи, задержка роста).

Disparities in mothers\u2019 healthcare seeking behavior for common childhood morbidities in Ethiopia: based on nationally representative data

BackgroundChildhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their under five children.MethodsThe study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design.ResultsOnly 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI.ConclusionsThe findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.

Association between gastrointestinal heat retention syndrome and respiratory tract infections in children: A prospective cohort study

Abstract Objective To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections (RRTIs) in children. Methods A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital. Children without respiratory tract infections (RTIs) were consecutively recruited according to the selection criteria. A semi-structured questionnaire was used to record traditional Chinese medicine (TCM) symptoms and demographic and physiological characteristics. Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity. The participants were followed up for 12 months. Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months. Episodes of pneumonia and RTIs were recorded in detail. Results A total of 420 children were included. Of participants, 370 (88.10%) were followed up for 12 months. The mean number of RTI episodes per participant was 5.37 (95% CI: 5.14 to 5.60). In total, 186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the non-gastrointestinal heat retention syndrome group completed the 12-month follow-up period. The baseline of both groups was comparable. The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27 (95% CI: 1.01 to 1.59) times that in children without gastrointestinal heat retention syndrome. Logistic regression analysis revealed that abnormally increased appetite with frequent hunger, foul breath, dry stools, and dark red or purple fingerprints were positively correlated with the incidence of pneumonia. Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI. Conclusions Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children. Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.

Mandatory Mask-Wearing and Hand Hygiene Associated With Decreased Infectious Diseases Among Patients Undergoing Regular Hemodialysis: A Historical-Control Study.

Background: Infections are the second leading cause of death among patients undergoing hemodialysis. However, preventive measures against infectious diseases are limited and have not been made mandatory for patients.Objective: To investigate the incidence of infectious diseases before and during the coronavirus disease (COVID-19) pandemic.Design: A historical comparative study of a prospective cohort.Setting(s): February 1, 2015 to January 31, 2020 was defined as the period before the mitigative confrontation of the COVID-19 pandemic in China. The period from February 1 to June 29, 2020 was defined as the period of mitigative confrontation of the COVID-19 pandemic in China.Participants: A cohort of patients undergoing hemodialysis whose infectious disease episodes were documented prospectively in the hemodialysis unit of the Third Affiliated Hospital of Guangzhou Medical University since February 1, 2015.Methods: Mandatory mask-wearing and reinforced hand-hygiene education were implemented to prevent COVID-19 from January 23, 2020 in China. The incidence of infectious episodes, including catheter-related infection, digestive tract infection, upper respiratory tract infection (UTRI), pneumonia, and infection at other sites, were documented and compared in the periods before and during the pandemic.Results: The historical control group consisted of 157 patients, with 79 patients in the COVID-19 prevention group. The mask-wearing rate of patients increased from 1.5 to 100%. Hand sanitizer consumption increased significantly during the COVID-19 pandemic. The compliance rates of hand hygiene increased from 66, 75.5, to 55% in physicians, nurses, and other employees before the pandemic to 90.5, 92.5, and 76.5%, respectively. The incidences of UTRI and pneumonia decreased during the pandemic (p < 0.001). Notably, catheter-related and digestive tract infections also decreased during the pandemic (p = 0.003 and 0.034, respectively). A matched-pair study was conducted to further analyze the 79 individual changes in the incidences of infectious disease before and during the pandemic. As a result, the incidences of UTRI, pneumonia, catheter-related infections, digestive tract infections, and infections at other sites all decreased during the pandemic.Conclusions: The present study indicated an association between mandatory mask-wearing and reinforced hand hygiene education and decreased respiratory, catheter-related, and digestive tract infection episodes in the hemodialysis unit.

Oropharyngeal Probiotic ENT-K12 Prevents Respiratory Tract Infections Among Frontline Medical Staff Fighting Against COVID-19: A Pilot Study.

Healthcare workers at the frontline are facing a substantial risk of respiratory tract infection during the COVID-19 outbreak due to an extremely stressful work schedule and public health event. A well-established first-line defense on oropharyngeal microbiome could be a promising strategy to protect individuals from respiratory tract infections including COVID-19. The most thoroughly studied oropharyngeal probiotic product which creates a stable upper respiratory tract microbiota capable of preventing upper respiratory tract infections was chosen to evaluate the safety and efficacy on reducing episodes of upper respiratory tract infections for COVID-19 healthcare workers. To our knowledge to date, this is the very first study describing the beneficial effects of oropharyngeal probiotic been administered by healthcare workers during the COVID-19 pandemic. In this randomized controlled trial, we provided the probiotics to frontline medical staff who work in the hospitals in Wuhan and had been in close contact with hospitalized COVID-19 patients for prophylactic use on a daily basis. Our finding suggests that oropharyngeal probiotic administration significantly reduced the incidence of respiratory tract infections by 64.8%, reduced the time experiencing respiratory tract infections and oral ulcer symptoms by 78%, shortened the days absent from work by 95.5%, and reduced the time under medication where there is no record of antibiotic and anti-viral drug intake in the probiotic group. Furthermore, medical staff treated with Bactoblis experienced sustained protection from respiratory tract infections since the 10th day of oropharyngeal probiotic administration resulting in an extremely low incidence rate of respiratory tract infections.

Vitamin D Deficiency and Insufficiency Among University Students: Prevalence, Risk Factors, and the Association Between Vitamin D Deficiency and Episodes of Respiratory Tract Infections.

BackgroundVitamin D deficiency (VDD) and insufficiency (VDI) is a public health problem worldwide. Low blood levels of vitamin D have been associated with many illnesses, including respiratory tract infections (RTIs). This study aims to evaluate the prevalence of VDD and VDI among university students, assess the correlation with demographic and anthropometric factors, and determine the effect of VDD on the respiratory tract infection (RTI) incidence.MethodsA cross-sectional and prospective design was used. Our sample consisted of 287 students aged 18–24 years from the University of Sharjah-UAE. Participants were tested for serum 25(hydroxyvitamin)D levels, Body mass index (BMI) was calculated, and the survey was completed. The association between VDD, VDI with the participant’s characteristics, and the incidents of RTIs were examined.ResultsVDD and VDI were highly prevalent among 85% of the students. The median serum 25(OH) D level was 15.8 ng/dl (19.5±11.6). The mean BMI was (24.32±6.3) kg/m. The results showed a significant positive correlation between VDI and VDD with gender and students who were previously diagnosed with VDD (P < 0.05); however, they were not statistically significant (P < 0.05) with other factors. The tonsillitis incidents were significantly associated with VDD (P = 0.027), while no significant correlation with other incidences of RTIs was found.ConclusionVDD and VDI represent a significant problem across the university students specifically with the female gender. VDD is associated with tonsillitis infection incidence. Both the health and higher education authorities’ attention is needed, exploring the causes of VDD and VDI, regular 25(OH)D serum level examination, and educational programs on VDD risks are required.

ОЦЕНКА ПРОГНОСТИЧЕСКОЙ ЦЕННОСТИ ФАКТОРОВ РИСКА РАЗВИТИЯ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ У ДЕТЕЙ

The study aims to assess the prognostic value of risk factors for tuberculosis infection. Material and methods. A total of 310 children with and without tuberculosis infection are prospectively examined. A comparison of the risk factors for the development of tuberculosis, already used in practice, with the results of a specific study, is carried out. Results. The significance of biomedical risk factors for the development of tuberculosis at the stage of latent tuberculosis infection, such as past chickenpox, untimely vaccination, the presence of allergic diseases, respiratory diseases (bronchial asthma), and recurrent episodes of viral respiratory infections, has been established.

Vitamin C May Increase the Recovery Rate of Outpatient Cases of SARS-CoV-2 Infection by 70%: Reanalysis of the COVID A to Z Randomized Clinical Trial.

Interest in the potential effects of vitamin C for respiratory virus infections traces back to the 1940s (1–3). Numerous effects of vitamin C on the immune system have been demonstrated, which provide the rationale to investigate its effect on infections (4). The most comprehensive summary of the placebo-controlled trials on vitamin C and respiratory virus infections is the Cochrane review on vitamin C and the common cold (2). The Cochrane review identified 31 comparisons that examined the effect of regular vitamin C supplementation of at least 0.2 g/day on 9745 episodes of respiratory virus infections occurring during the supplementation period. In adults the duration of colds was reduced by 7.7% (95% CI 3.7% to 11.8%, P = 0.00018) and in children by 14.2% (95% CI 7.3% to 21.1%, P = 0.000053) [2; Analysis 2.1]. These findings indicate that vitamin C has physiological effects, though the review did not demonstrate treatment effects on virus infections that had already started (2). Based on two trials that compared two different vitamin C doses in separate trial arms (5, 6), a dose-response relationship for the effect of vitamin C was indicated, with a prediction that doses of 6-8 g/day may shorten viral upper respiratory infections by some 20% (2, 3, 7, 8). Given the previous research on vitamin C, we read with great interest the report on the COVID A to Z Randomized Clinical Trial (COVID A to Z trial) which investigated the effects of 8 g/day vitamin C on the recovery from outpatient SARS-CoV-2 infection (9). However, we unfortunately found several methodological shortcomings in the trial. Here we describe our major concerns and statistical reanalysis of the findings. In addition to the usual care and the vitamin C arms, the trial included zinc, and zinc with vitamin C arms. These two arms are not considered in this commentary, however, major problems in the zinc intervention are described in the Supplement .

IFN-\u03bb4 genetic variants influence clinical malaria episodes in a cohort of Kenyan children

BackgroundInterferon (IFN)- λ4, a type III IFN, production is controlled by a dinucleotide frameshift variant (rs368234815-dG/TT) within the first exon of the IFNL4 gene. Carriers of the IFNL4-dG allele but not the IFNL4-TT allele are able to produce the IFN-λ4 protein. Patients with hepatitis C virus that do not produce the IFN-λ4 protein have higher rates of viral clearance suggesting a potential inhibitory role of IFN-λ4 in liver-tropic infections.MethodsIn this study, it was investigated whether children infected with Plasmodium falciparum, which has a well-characterized liver stage infection, would be more susceptible to clinical malaria relative to their IFNL4-rs368234815 allele. A cohort of 122 children from a malaria holoendemic region of Kenya was analysed. Episodes of clinical malaria and upper respiratory tract infections (URTIs) were determined using information collected from birth to 2 years of age. The dinucleotide frameshift variant IFNL4-rs368234815-dG/TT was genotyped using a TaqMan assay.ResultsIn this cohort, 33% of the study participants had the dG/dG genotype, 45% had the dG/TT genotype, and 22% had TT/TT genotype. The number and time to first episode of clinical malaria and URTIs with respect to the IFNL4-rs368234815 allele was evaluated. It was found that children that carried the IFNL4-rs368234815-dG allele had an increased number of clinical malaria episodes. In addition, there was a significant association between earlier age of first malaria infection with carriers of the IFNL4-dG allele (p-value: 0.021).ConclusionThe results suggest that the ability to produce IFN-λ4 negatively affects host immune protection against P. falciparum malaria in Kenyan children.

Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa

BackgroundExclusive breastfeeding for 6 months and breastfeeding with complementary feeds until 12 months for HIV exposed and uninfected (HEU) infants or 24 months for HIV unexposed (HU) infants is the current World Health Organisation (WHO) recommendation for low and middle income countries (LMICs) to improve clinical outcomes and growth trajectories in infants. In a post-hoc evaluation of HEU and HU cohorts, we examine growth patterns and clinical outcomes in the first 9 months of infancy in association with breastfeeding duration.MethodsTwo cohorts of infants, HEU and HU from a low-socioeconomic township in South Africa, were evaluated from birth until 9 months of age. Clinical, anthropometric and infant feeding data were analysed. Standard descriptive statistics and regression analysis were performed to determine the effect of HIV exposure and breastfeeding duration on growth and clinical outcomes.ResultsIncluded in this secondary analysis were 123 HEU and 157 HU infants breastfed for a median of 26 and 14 weeks respectively. Median WLZ score was significantly (p < 0.001) lower in HEU than HU infants at 3, 6 and 9 months (− 0.19 vs 2.09; − 0.81 vs 0.28; 0.05 vs 0.97 respectively). The median LAZ score was significantly lower among HU infants at 3 and 6 months (− 1.63 vs 0.91, p < 0.001; − 0.37 vs 0.51, p < 0.01) and a significantly higher proportion of HU was classified as stunted (LAZ < -2SD) at 3 and 6 months (3.9% vs 44.9%, p < 0.001; 4.8% vs 20.9%, p < 0.001 respectively) independent of breastfeeding duration. A higher proportion of HEU infants experienced one or more episodes of skin rash (44.5% vs 12.8%) and upper respiratory tract infection (URTI) (30.1% vs 10.9%) (p < 0.0001). In a multivariable analysis, the odds of occurrence of wasting, skin rash, URTI or any clinical adverse event in HEU infants were 2.86, 7.06, 3.01 and 8.89 times higher than HU infants after adjusting for breastfeeding duration.ConclusionOur study has generated additional evidence that HEU infants are at substantial risk of infectious morbidity and decreased growth trajectories however we have further demonstrated that these adverse outcomes were independent of breastfeeding duration.

IFN-\u03bb4 is associated with increased risk and earlier occurrence of several common infections in African children

Genetic polymorphisms within the IFNL3/IFNL4 genomic region, which encodes type III interferons, have been strongly associated with clearance of hepatitis C virus. We hypothesized that type III interferons might be important for the immune response to other pathogens as well. In a cohort of 914 Malian children, we genotyped functional variants IFNL4-rs368234815, IFNL4-rs117648444, and IFNL3-rs4803217 and analyzed episodes of malaria, gastrointestinal, and respiratory infections recorded at 30,626 clinic visits from birth up to 5 years of age. Compared to children with the rs368234815-TT/TT genotype (IFN-λ4-Null), rs368234815-dG allele was most strongly associated with an earlier time-to-first episode of gastrointestinal infections (p = 0.003). The risk of experiencing an infection episode during the follow-up was also significantly increased with rs368234815-dG allele, with OR = 1.53, 95%CI (1.13–2.07), p = 0.005 for gastrointestinal infections and OR = 1.30, 95%CI (1.02–1.65), p = 0.033 for malaria. All the associations for the moderately linked rs4803217 (r2 = 0.78 in this set) were weaker and lost significance after adjusting for rs368234815. We also analyzed all outcomes in relation to IFN-λ4-P70S groups. Our results implicate IFN-λ4 and not IFN-λ3 as the primary functional cause of genetic associations with increased overall risk and younger age at first clinical episodes but not with recurrence or intensity of several common pediatric infections.

Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial

BackgroundIn children, up to 30% of viral respiratory tract infections (RTIs) develop into bacterial complications associated with pneumonia, sinusitis or otitis media to trigger a tremendous need for antibiotics. This study investigated the efficacy of Echinacea for the prevention of viral RTIs, for the prevention of secondary bacterial complications and for reducing rates of antibiotic prescriptions in children.MethodsEchinaforce® Junior tablets [400 mg freshly harvested Echinacea purpurea alcoholic extract] or vitamin C [50 mg] as control were given three times daily for prevention to children 4–12 years. Two × 2 months of prevention were separated by a 1-week treatment break. Parents assessed respiratory symptoms in children via e-diaries and collected nasopharyngeal secretions for screening of respiratory pathogens (Allplex® RT-PCR).ResultsOverall, 429 cold days occurred in NITT = 103 children with Echinacea in comparison to 602 days in NITT = 98 children with vitamin C (p < 0.001, Chi-square test). Echinacea prevented 32.5% of RTI episodes resulting in an odds ratio of OR = 0.52 [95% CI 0.30–0.91, p = 0.021]. Six children (5.8%) with Echinacea and 15 children (15.3%) with vitamin C required 6 and 24 courses of antibiotic treatment, respectively (reduction of 76.3%, p < 0.001). A total of 45 and 216 days of antibiotic therapy were reported in the two groups, respectively (reduction of 80.2% (p < 0.001). Eleven and 30 events of RTI complications (e.g., otitis media, sinusitis or pneumonia) occurred with Echinacea and vitamin C, respectively (p = 0.0030). Echinacea significantly prevented influenza (3 vs. 20 detections, p = 0.012) and enveloped virus infections (29 vs. 47 detections, p = 0.0038). Finally, 76 adverse events occurred with Echinacea and 105 events with vitamin C (p = 0.016), only three events were reported possibly related with Echinacea.ConclusionsOur results support the use of Echinacea for the prevention of RTIs and reduction of associated antibiotic usage in children.Trial registration clinicaltrials.gov, NCT02971384, 23th Nov 2016.

Respiratory viruses and clinical- epidemiological characteristics in episodes of acute respiratory infection.

The aim of the study was to determine the viral frequency and clinical-epidemiological characteristics in the episodes of acute respiratory infection in patients of the Instituto Nacional de Salud del Niño San Borja in Lima, the information of the episodes of patients who required at least one direct Immunofluorescence test from January 1, 2017 to December 31, 2018 was analyzed. 1153 episodes were identified in 707 patients. The median age was 1 year and 55% were male. The viral frequency was 13.4%; respiratory syncytial virus was identified in 10.7% of the episodies. The viral frequency was higher in children under 1 year of age (16.2%); in those with congenital disease respiratory (38.9%) and during the autumn (24.2%). The most common symptoms were cough (70.3%) and fever (53.4%); and the main diagnoses, viral pneumonia (31.8) and bronchiolitis (23.4%). It is concluded that the respiratory viral frequency was related to age, seasonality and pre-existing pathology.

Role of vitamin D in pre-school children’s health

Vitamin D has pleiotropic effects, including maintaining calcium and phosphate homeostasis, and affecting the immune and endocrine systems. The article summarizes data on the expected biological effects of vitamin D on children’s health. The results of randomized clinical trials evaluating the effect of vitamin D supplementation on the incidence of acute respiratory tract infections are reviewed in detail. It has been shown that daily intake of vitamin D at a dose of 10 to 25 mcg/day (400–1000 IU/day) compared with placebo leads to a significant decrease in the proportion of children and adolescents who have had at least one episode of acute respiratory infection. The criteria for the provision of calciferol and the gradation of the status of vitamin D deficiency and deficiency in different countries are discussed. It has been shown that in the interpretation of the 25 (OH) D results there is a consensus on two points: calcidiol levels below 12 ng/ml (30 nmol/L) are considered clearly insufficient, and levels above 30 ng/ml (75 nmol/L) are considered sufficient in all regions. The incidence of hypovitaminosis D has been reported in children aged 3 to 7 years, where the overall combined assessment, regardless of age group, ethnic composition and breadth of the studied populations, showed that 13% of European children had a serum calcidiol concentration of less than 12 ng/ml (&lt;30 nmol/L), and about 40% had a level of less than 30 ng/ml (&lt;75 nmol/L). The data on the physiological need and the recommended daily dose of vitamin D for preschool children have been analyzed. In each country, the recommended intake of vitamin D is set (from 400 to 4000 IU), depending on the target concentration of serum calcidiol, the level of insolation, and nutritional characteristics. The necessity of conducting clinical studies in the age group from 3 to 7 years to determine an adequate, effective and safe preventive dose of vitamin D for preschool children in the Russian Federation is emphasized.

Modern approaches to the treatment of rhinopharyngitis in the practice of a district pediatrician

Introduction. In outpatient practice, acute nasopharyngitis in children is one of the most common reasons for seeking medical attention. The local pediatrician, as a rule, is the first to examine the child and determine the tactics of treatment. A competent approach to the choice of drugs avoids polypharmacy.The article presents the published scientific evidence on the modern approach to the treatment, as well as the author’s own clinical observation.Objective. To study the effectiveness of modern methods for the treatment of rhinopharyngitis, including the use of silver proteinate to treat acute respiratory infections in a group of frequently ill children.Materials and methods. The study involved 38 children aged 3 to 4 years, included in the group of frequent illnesses. The children were divided into 3 groups. In the first group (12 people), for four months (October-December 2019), children received symptomatic treatment of an acute respiratory infection; between episodes of acute respiratory infection, daily prophylactic irrigation of the child’s nose and throat with saline was used. In the second group (13 people), symptomatic treatment and nasal instillation of a preparation of silver proteinate were used at each episode of acute respiratory infection. In the third group (13 people), children received only symptomatic treatment for acute respiratory infection.In the first and third groups, children received symptomatic treatment of an acute respiratory infection without the use of silver proteinate.Results. The chosen approach to the ARVI treatment such as nasal instillation of silver proteinate into the bilateral nasal cavities has shown its effectiveness without having to carry out preventive measures between episodes of the disease.Conclusion. The application of elimination and antiseptic therapy with the use of Sialor for each episode of ARVI in the group of frequently ill children can reduce polypharmacy and incidence of morbidity.

Acute Coronary Syndrome and Arrhytmia Induced by SARS-CoV-2 Infection in a Patient with Non-Significant LAD Lesion. A Case Report

Abstract Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis of an unprecedent effect. Clinical studies reported an association between COVID-19 and cardiovascular disease, whereas COVID-19 itself can induce myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Case summary: A patient diagnosed via screening coronary computed tomography angiography with non-obstructive coronary artery disease was hospitalized with non-ST elevation myocardial infarction and atrial flutter during a severe respiratory infection episode with SARS-CoV-2. After recovery from the infectious episode, fractional flow reserve-guided elective percutaneous coronary intervention with drug-eluting stent was performed. Conclusions: COVID-19 intercurrence in a cardiovascular patient with nonobstructive coronary artery disease triggered coronary plaque vulnerabilization with subsequent development of an acute coronary syndrome. SARS-CoV-2 proved to be involved via direct viral tissue involvement and concomitant mechanisms derived from systemic illness in the development of a severe supraventricular arrhythmic event.

Impact of determinants on nutritional status among children up to five years at tertiary care hospital, HIMS, Sitapur, Uttar Pradesh

Background: Malnutrition in children occurs as a complex interplay among various factors like maternal health, dietary practices, hand washing and other hygiene practices, low birth weight, episode of diarrhoea and acute respiratory infection within the last 6 months are often associated with undernutrition in most developing nations including India. Objective of the study were to assess the determinants of maternal and child health, hygienic practice, health services for underweight and their association among apparently healthy children. Methods: The present study was hospital based descriptive cross-sectional study conducted from June 2019 to December 2019. The sample size calculated was 410, and accounting for 10% nonresponsive, the sample size calculated was 451. The data obtained were compiled and entered in MS-excel 2010 and analysed by using institutional SPSS (22.0). Results: Mother’s age at marriage &lt;18 years belong to 68 (15.1%) children significantly low proportion as compared to marriage &gt;18 years 383 (84.9%) including underweight 41 (22.5%) and mother’s age at child birth &lt;18 years belong to 46 (10.2%) children significantly very low proportion in comparison to child birth &gt;18 years including underweight 30 (16.6%). Birth weight &lt;2.5 kg belongs to significantly 136 (30.1%) children including underweight 72 (39.8%) and significantly birth order &gt;2 belong to 135 (29.9%) children including underweight 39 (21.6%). Exclusive breast feeding belongs to 149 (33.0%) children including underweight 62 (34.2%)Conclusions: Health education and its reinforcement especially in the area of maternal &amp; child health care services is required.