Symptoms Of Respiratory Infection Research Articles

Опыт использования синдромальных подходов к диагностике респираторных инфекций

Irrational or excessive use of antibiotics, the absence or insufficient use of rapid diagnostics tests at the point of care ("POC"), as well as insufficient infection control are key factors in the development of multi- and pan-resistance to antibiotics. The article presents the clinical experience of using the syndromic approach Patients and methods. The work was carried out on the basis of the Morozovskaya State children's hospital from February to June 2022 in accordance with the standards of medical care for patients with acute respiratory infections using multiplex PCR test (mPCR) – BioFire FilmArray respiratory panel (BioFire RP). The study included inpatient children (n = 40) with symptoms of acute respiratory infections and respiratory failure (DN) of different severity. Results. The analysis of the nosological structure showed that acute obstructive bronchitis/acute bronchitis (J20.9) was found in 47.5%, pneumonia (J18.9) in 20% of children, acute bronchiolitis (J21.9) at 7.5%, other viral lesions of the respiratory tract (J00-J06) – 25%. The standard PCR ARVI panel identified pathogens in 45% (n = 18), the BioFire RP panel in 55% (n = 22) of patients (p = 0.503). An important indicator is the speed of obtaining results. The median time from the moment of taking the smear to the moment of transmitting the result to the physician was 2.56 hours (CI: 1.91–3.62) when examined using the BioFire RP panel compared with 28.4 hours (CI: 9.64–33) when using standard PCR diagnostics for respiratory viruses (p < 0.001). Conclusion. Methods of rapid molecular diagnostics can reduce the time of hospitalization of patients. In the study, the duration of hospitalization is 1 day shorter compared to the analysis of retrospective indicators of hospitalization terms. This is due to the ability to quickly identify the agent of respiratory infection, which in turn affects the tactics of treatment, optimizes the appointment of antibiotics, which affects to the duration of hospitalization. Key words: respiratory infection, BioFire, PCR, virus, rapid diagnosis, etiotropic therapy

EFFECTIVENESS OF THE MAGNESIUM APPLICATION IN OBSTETRICAL PRACTICE.

The aim: Conducting an evaluation of the effectiveness and safety of the use of magnesium in pregnant women. Materials and methods: A comprehensive examination of 60 pregnant women was conducted, of which 30 were taking a magnesium preparation in a daily dose of 2473.72 mg of magnesium citrate and 40 mg of pyridoxine hydrochloride (the main group) and 30 pregnant women who were not taking a magnesium preparation (сomparison group). The analysis of the clinical course of the first half of the pregnancy with the determination the frequency and structure of complications, blood pressure levels, indicators of ultrasound, general and biochemical blood tests, urinalysis, lipid status and carbohydrarate metabolism. Results: The main complications of the first half of pregnancy were: threatening miscarriage, abortion in progress, early gestosis, anemia, respiratory viral infection, exacerbation of extragenital pathology, hypertension. During the analysis of carbohydrate and lipid metabolism increased atherogenic potential. Analyzing the results of ultrasound studies reliably earlier comes down the local hypertonus. Сonclusions: The correction of chronic magnesium deficiency, performed by the drug magnesium has allowed to reduce cases of threat of abortion, the abortion that was started, the symptoms of early preeclampsia, anemia of pregnant women, symptoms of respiratory viral infection, reduces the number of bed-days in the case of hospitalization. The use of magnesium helped to normalize blood pressure, carbohydrate and lipid metabolism, reduces hypertonus of the myometrium.

Проблемы и возможности лечения инфекций верхних дыхательных путей у детей на сегодняшний день

This article presents the resolution and materials of the Expert Council meeting held in Saint Petersburg on May 24, 2023. The meeting was devoted to topical issues of treatment of oropharyngeal infections in children. Leading infectious disease specialists, pediatricians and immunologists from Moscow, Saint Petersburg, Kazan, and other cities of Russia took part in the discussion. According to the resolution, today in the Russian Federation there is a high incidence of acute respiratory infections among children with a high frequency of complications, and fatal outcomes are registered. Numerous cases of active herpesvirus infections are recorded, especially among frequently ill children. The current clinical guidelines for the treatment of acute respiratory viral infections lack algorithms for differentiated therapeutic approaches that reduce disease duration, prevent the development of complications and recurrent episodes of respiratory infections. In clinical practice, there is excessive, often unjustified prescription of antimicrobial therapy, which aggravates intestinal disorders, reducing colonization and immune resistance, and provokes oral infections and inflammations caused by opportunistic pathogens. Based on the presented data, it is necessary to correct clinical recommendations for the treatment of acute respiratory viral infections in children with the introduction of indications for prescribing benzydamine in cases of tonsillitis, pharyngitis (tonsillopharyngitis) and stomatitis as a first-choice medication for sore mouth and throat. It also seems necessary to include data on the efficacy of inosine pranobex in symptoms of acute respiratory viral infections of various etiologies, including COVID-19 and active herpesvirus infections. Key words: benzydamine, herpesvirus infections, inosine pranobex, microbiome, acute respiratory viral infections, ARI, tonsillitis, tonsillopharyngitis, pharyngitis, COVID-19, SARS-CoV-2

COVID-19 Suspects Monitoring System Based on Symptom recognition using Deep Neural Network


 
 
 
 The outbreak of the Corona virus or COVID-19 was still a global concern even though it has been declared an endemic in several countries in the world, including Indonesia. However, with the emergence of new variants of this virus, preventive efforts continue to be made to prevent its spread. To prevent the spread of this virus, early detection was important, especially in knowing prospective clients who are positive and reactive to this virus, thus enabling early isolation measures for prospective patients who are taking action. This identification can be carried out in public areas that are the center of community activities. In this study, an intelligent system will be developed that can detect people suspected of COVID-19 through fever and breathing problem symptoms that can provide solutions to prevent the spread of this virus. Identify these symptoms through thermography-based image processing sourced from thermal camera sensors and then look for the possibility of suspected and reactive COVID19. Furthermore, the AI model was used by the early detection system of people suspected of being positive and reactive for COVID-19 using the Deep Neural Network method. This study aims to identify symptoms of fever and respiratory infection through image processing sourced from thermal camera sensors and further diagnose prospective patients who are suspected of being positive and reactive for COVID19 using the CNN method as an intelligent system for early detection of suspected positive and reactive COVID19 patientsIn the process of testing the classification training model, the performance results in the CNN classification process have an accuracy value of more than 88%. Furthermore, a comparison was made between the CNN classification and other classifications, such as SVM, Naive Bayes and Multi-Layer Perceptron (MLP). The results obtained from this comparison have an average percentage of accuracy above 80%. MLP has the lowest accuracy among its classification methods of 83.56%. CNN has the highest accuracy value compared to other methods of 88.68%. Therefore, CNN can be chosen to be the right one for use in the COVID-19 suspect detection system through the recognition of symptoms and respiratory disorders. Based on these performance measurements, the process of detecting COVID19 suspects indicated by health symptoms can be applied to real data.
 
 
 

Lopinavir/ritonavir for treatment of non-hospitalized patients with COVID-19: a randomized clinical trial

ObjectivesEffective and widely available therapies are still needed for outpatients with COVID-19. We aimed to evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) for early treatment of non-hospitalized individuals diagnosed with COVID-19. MethodsThis randomized, placebo (Plb)-controlled, double-blind, multi-site decentralized clinical trial enrolled non-hospitalized adults with confirmed SARS-CoV-2 infection and six or fewer days of acute respiratory infection symptoms who were randomized to either twice-daily oral LPV/r (400 mg/100 mg) or Plb for 14 days. Daily surveys on study days 1 through 16 and again on study day 28 evaluated symptoms, daily activities, and hospitalization status. The primary outcome was longitudinal change in an ordinal scale based on a combination of symptoms, activity, and hospitalization status through day 15 and was analyzed by use of a Bayesian longitudinal proportional odds logistic regression model for estimating the probability of a superior recovery for LPV/r over Plb (odds ratio >1). ResultsBetween June 2020 and December 2021, 448 participants were randomized to receive either LPV/r (n = 216) or Plb (n = 221). The mean symptom duration before randomization was 4.3 days (SD 1.3). There were no differences between treatment groups through the first 15 days for the ordinal primary outcome (odds ratio 0.96; 95% credible interval: 0.66 to 1.41). There were 3.2% (n = 7) of LPV/r and 2.7% (n = 6) of Plb participants hospitalized by day 28. Serious adverse events did not differ between groups. ConclusionLPV/r did not significantly improve symptom resolution or reduce hospitalization in non-hospitalized participants with COVID-19. Trial registrationClinicalTrials.gov Identifier: NCT04372628

Efficacy and safety of add-on Viola odorata L. in the treatment of COVID-19: A randomized double-blind controlled trial

Ethnopharmacological relevanceSevere Acute Respiratory Syndrome (SARS) due to the novel coronavirus has become the highest priority that threatens human health. This situation demands widespread vaccination and the innovation of new therapeutic methods. Despite drug discoveries, the need for approving new medicaments is felt because of adverse effects and lack of efficacy. Several medicinal plants including Viola odorata L. are recommended in traditional Persian medicine for alleviating respiratory infection symptoms. Recent studies showed anti-inflammatory, antioxidant, anti-asthmatic, antitussive, analgesic, and antibacterial activities of sweet violet. These enhance respiratory functions, reduce pulmonary inflammation, and decline mucous membrane edema. This study aimed to evaluate the efficacy of sweet violet syrup in alleviating the manifestations of COVID-19 infection. Material and methodsA randomized parallel-group double-blind controlled trial was conducted at Al-Zahra general hospital, Isfahan, Iran. A total of 108 outpatients were enrolled in the study. The patients were randomly allocated to intervention and placebo groups, with 54 patients in each group. The allocation was concealed using sealed opaque envelopes. The intervention group received violet syrup and the control group received placebo syrup, an add-on to the conventional treatment.The outcomes were COVID-19 manifestations, such as dyspnea, cough, myalgia, headache, and diarrhea, considered as outcomes of the study and were evaluated twice using a visual analog scale before the intervention and after 7 days, at the end of the study. Patients were followed daily by phone calls to monitor proper drug consumption and possible side effects. ResultsNo significant difference was between groups regarding demographic characteristics and vital signs before and after the treatment. Although all symptoms have improved significantly in both groups, patients who received violet syrup recovered faster and the mean severity scores of cough (P = 0.025), myalgia (P = 0.036), headache (P = 0.037), and diarrhea (P = 0.044) decreased greater in comparison to control group. ConclusionThis study, the first clinical trial on the effectiveness of Viola odorata on SARS-CoV-2 patients, showed that Viola odorata L. effectively controls prevalent manifestations of COVID-19 including cough, myalgia, headache, and diarrhea. Regarding this survey, the violet syrup can be mentioned as a complementary treatment for viral influenza-like infections in which cough, myalgia, headache, and diarrhea are prominent.

534. Evaluation of a Rapid Multiplex PCR Diagnostic Device for the Detection of Microorganisms from Nasopharyngeal and Throat Swab Specimens in the Near Patient Setting

Abstract Background Limited availability of multiplex molecular tests in the near-patient setting can impact the rapid diagnosis and treatment of patients experiencing symptoms of respiratory tract infections, including pharyngitis. The BioFire® Respiratory/Sore Throat (R/ST) Panel (bioMérieux, Salt Lake City, UT), designed for use with the BioFire® SpotFire System, is a PCR-based sample-to-answer diagnostic test that identifies four bacteria and 10 viruses (including SARS-CoV-2) from nasopharyngeal swab (NPS) or throat swab (TS) specimens in about 16 minutes. This study evaluated the performance of an Investigational Use Only (IUO) version of the BioFire R/ST Panel in the near patient setting. Methods NPS and TS specimens were prospectively enrolled from symptomatic consented/assented volunteers of all ages, or obtained as residual leftover specimens. Enrollment was conducted between December 2020 and September 2021 at five study sites in the US and UK (adult and pediatric emergency departments or urgent care clinics) with testing performed by personnel representative of the intended users (non-laboratory professionals). Several analytes that were not circulating during the COVID-19 pandemic were supplemented with archived specimens of known analyte composition. Performance was determined for both sample types by comparison to FDA cleared multiplex PCR tests or culture and PCR followed by sequencing of isolates (Streptococcus from throat swabs). Results A total of 1131 NPS and 452 TS prospectively collected specimens and 542 NPS and 128 TS archived specimens were tested with the BioFire R/ST Panel. For NPS specimens (prospective and archived) overall positive percent agreement (PPA) was 98.7% and negative percent agreement (NPA) was 99.1%, and for TS specimens (prospective and archived) overall PPA was 95.9% and NPA was 99.2%. Conclusion The BioFire R/ST Panel is a sensitive, specific, and robust test for rapid detection of a wide range of organisms in NPS and TS specimens in the near-patient setting. This test is expected to aid in the timely diagnosis and appropriate management of pharyngitis and other respiratory infections. Data presented are from assays that have not been cleared or approved for diagnostic use. Disclosures Jeffrey Bastar, PhD, MSCI, bioMerieux: Employee|bioMerieux: Stocks/Bonds Ashley Ky, MLS(ASCP), bioMérieux: Employee|bioMérieux: Stocks/Bonds Kristen Holmberg, n/a, bioMerieux: Employee Hana Bay, BS, Biomerieux: Employee|Biomerieux: Stocks/Bonds Daria Drobysheva, PhD, bioMerieux: Employee Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, F(AAM), BioFire: Grant/Research Support|Luminex: Grant/Research Support Virve Enne, BSc PhD, Biomerieux: Advisor/Consultant Cynthia Andjelic, PhD, bioMerieux: Employee.

1084. Comparison of Pediatric SARS-CoV-2 Infections During Spring 2020 and Spring 2021

Abstract Background Data is lacking regarding the clinical manifestations of children with SARS-CoV-2 infection during Spring 2021 and how that clinical presentation compares to children who presented during the early months of the pandemic. We sought to compare the presentation and severity of illness among children with a positive PCR test result for SARS-CoV-2 who presented during the Spring 2020 to those who presented for testing during Spring 2021. Methods We identified all patients < 18 years old who had a positive nasopharyngeal polymerase chain reaction (PCR) result for SARS-CoV-2 from 4/1/2020-6/30/2020 and from 4/1/2021-6/30/2021 through a laboratory-based database at a rural academic tertiary care medical center. Data collected included demographics; underlying medical comorbidities; symptoms at the time of SARS-CoV-2 testing; results of SARS-CoV-2 testing and other tests performed at the same time; treatments administered; imaging studies performed; need for hospitalization; and, for those requiring hospitalization, hospital length of stay, and respiratory support. We excluded patients who were hospitalized for reasons other than COVID-19 infection in our hospitalization statistics. Results We identified 331 children with a positive SARS-CoV-2 PCR result who met our inclusion criteria. Among children presenting during the Spring 2021 time period, upper respiratory tract infection (URI) symptoms were much less common than those presenting in Spring 2020 (2% vs 19%, p< 0.001). Additionally, fever and cough were more common among children presenting in Spring 2021 (34% vs 22%, p=0.01) (Table 1). Hospitalization for COVID-19 care occurred in 4% of children overall: 3% of children during the Spring 2020 era and 5% of children during Spring 2021, P=0.587 (Table 2). Self-reported symptoms among children with a positive SARS-CoV-2 polymerase chain reaction test, Spring 2020 vs. Spring 2021. Association of year, patient, and clinical characteristics with hospital admission for care of COVID-19. Conclusion Our study offers insights into the differences in the clinical presentation and outcomes of pediatric patients infected with SARS-CoV-2 during Spring 2020 and Spring 2021, respectively. We found that children infected during Spring 2021 had fever and cough more often and rhinorrhea and nasal congestion less often than children infected during the Spring 2020. Hospitalization was uncommon and was similar in both time periods. Most children requiring hospital admission had an underlying medical comorbidity. Disclosures Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant.

2156. Impact of Asymptomatic Upper Respiratory Viral Shedding in Pediatric Cardiothoracic Surgical Patients

Abstract Background Intraoperative and postoperative complications associated with symptomatic upper respiratory infections in young children are well-documented; however, asymptomatic upper respiratory viral shedding is frequent and may be prolonged. Necessary pediatric cardiac surgical procedures could be delayed with recognition of asymptomatic viral shedding. This study aimed to assess if a positive preoperative respiratory viral panel PCR (+ RVP) impacted postoperative length of stay in the pediatric intensive care unit (PICU) or hospital and assessed for an association among + RVP and adverse clinical events. Methods Patients < 3 years old presenting to a freestanding children’s hospital for cardiothoracic surgery from March 2018-March 2020 were enrolled. Within 24 hours before surgery, an RVP via nasopharyngeal swab for PCR was collected from subjects. Chart review was completed after hospital discharge. Mean difference between RVP status and length of stay for PICU and hospital was assessed with an independent, two group, sample t-test. Logistic regression was used to test association between RVP status and adverse clinical events (VAP, SSI, prolonged fever, ventilator use, or antibiotics), adjusted by complexity of surgical procedure using the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score. Results There were 95 subjects included, approximately 50% female, 75% Caucasian; 39% had + RVP (Table 1). There was no statistical association between RVP status and length of PICU (p=0.35) or hospital stay (p=0.28) (Table 2). Odds ratio for extubation in the operating room was significantly associated with +RVP, though small sample size and wide confidence intervals limit generalizability of this observation (Table 3). There were no clinically significant associations between RVP status and adverse events. Table 1.Subject DemographicsTable 2.Mean Difference in Length of Stay by RVP StatusTable 3.Odds Ratios of Clinical Adverse Events by RVP status Conclusion This limited, single-center study suggests that preoperative RVPs in pediatric cardiac surgery candidates identified asymptomatic viral shedding in 39%, though provided no detectable clinical benefit. Larger studies are needed to fully explore specific adverse clinical events and individual viral pathogen impacts. Institutional policies requiring preoperative RVP screening for pediatric cardiac surgery should be discouraged. Disclosures Kari Simonsen, MD, MBA, MedImmune: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support.

1068. Prior SARS-CoV-2 infection and risk of subsequent COVID-19-related hospitalization: a test negative design

Abstract Background Studies show that past SARS-CoV-2 infection provides a protective immune response against subsequent COVID-19, but the degree of protection from prior infection has not been determined. History of previous SARS-COV-2 Infection and Current SARS-COV-2 Infection Status at Admission. *Adjusted for chronic respiratory disease and prior COVID-19 vaccination Methods From May 2021 through Feb 2022, adults (≥ 18 years of age) hospitalized at Emory University Hospital and Emory University Hospital Midtown with acute respiratory infection (ARI) symptoms, who were PCR tested for SARS-CoV-2 were enrolled. A prior history of SARS-CoV-2 infection was obtained from patient interview and medical record review. Previous infection was defined as a self-reported prior SARS-CoV-2 infection or previous evidence of a positive SARS-CoV-2 PCR test ≥ 90 days before ARI hospital admission. We performed a test negative design to evaluate the protection provided by prior SARS-CoV-2 infection against subsequent COVID-19-related hospitalization. Effectiveness was determined using logistic regression analysis adjusted for patient sociodemographic and clinical characteristics and COVID-19 vaccination status. Results Of 1152 adults hospitalized for ARI, 704/1152 (61%) were SARS-CoV-2 positive. 96/1152 (8%) had a prior SARS-CoV-2 infection before hospital admission. Patients with a previous history of SARS-CoV-2 infection were less likely to test positive for SARS-CoV-2 upon admission for ARI compared to those who did not have evidence of prior infection (31/96 [32%] vs 673/1056 [64%]; adjusted OR: 0.25 [0.15, 0.41] (Table). Conclusion Reinfections represented a small proportion (< 10%) of COVID-19-related hospitalizations. Prior SARS-CoV-2 infection provided meaningful protection against subsequent COVID-19-related hospitalization. The durability of this infection-induced immunity, variant-specific estimates, and the additive impact of vaccination are needed to further elucidate these findings. Disclosures Laura A. Puzniak, PhD. MPH, Merck & Co., Inc.: Stocks/Bonds|Pfizer, Inc.: Stocks/Bonds Robin Hubler, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Srinivas Valluri, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Benjamin Lopman, PhD, Epidemiological Research and Methods, LLC: Advisor/Consultant Satoshi Kamidani, MD, NIH: His institution (Emory University) receives funds from Pfizer for his work as a co-investigator on clinical trials of Pfizer COVID-19 vaccine.|Pfizer: His institution (Emory University) receives funds from Pfizer for his work as a co-investigator on clinical trials of Pfizer COVID-19 vaccine. Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Merck, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur.: Grant/Research Support|Meissa Vaccines, Inc.: Co-inventor of RSV vaccine technology licensed to Meissa Vaccines, Inc.|NIH (Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines): Grant/Research Support John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc: Data Safety Monitoring Board|MedImmune: Grant/Research Support|Medscape: Advisor/Consultant|Merck: Grant/Research Support|Micron: Grant/Research Support|NIH: Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines|PaxVax: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data Adjudication and Data Safety Monitoring Boards|WCG and ACI Clinical: Data Adjudication Board.

1908. Social Risk Factors for COVID-19-Related Hospitalizations in Adults

Abstract Background During the COVID-19 pandemic, social interventions such as social distancing and mask wearing have been encouraged. Social risk factors for SARS-CoV-2 infection and subsequent hospitalization remain uncertain. Methods Adult patients were eligible if admitted to Emory University Hospital or Emory University Hospital Midtown with acute respiratory infection (ARI) symptoms (≤ 14 days) or an admitting ARI diagnosis from May 2021 – Feb 2022. After enrollment, an in-depth interview identified demographic and social factors (e.g., employment status, smoking history, alcohol use), household characteristics, and pandemic social behaviors. All patients were tested for SARS-CoV-2 using PCR. We evaluated whether these demographic and social factors were related to a positive SARS-CoV-2 test upon admission to hospital with ARI using a logistic regression model. Results 1141 subjects were enrolled and had SARS-CoV-2 PCR results available (700 positive and 441 negative). The median age was greater in the SARS-CoV-2 negative cohort than in the positive cohort (60 and 53 years, respectively; P< .0001). Those who tested positive were more likely to have had at least some college education compared to those who tested negative (64.3% vs 52.3%, P< .0001; adjusted odds ratio [aOR]: 1.4 [95%CI: 1.1, 2.0]). Compared to those who tested negative, those who were SARS-CoV-2 positive were also more likely to be employed (48.9% vs 26.5%, P< .0001; aOR: 1.7 [95%CI: 1.1, 2.3]), have children 5-17 yo at home (27.6% vs 17.9%, P=.0002; aOR: 1.5 [95%CI: 1.1, 2.1]). Those with COVID-19 were less likely to receive home healthcare (6.2% vs 13.3%, P< .0001; aOR: 0.5 [95%CI: 0.4, 0.9]) and to be a current or previous smoker (7.6% vs 17.7%, P< .0001; aOR: 0.3 [95%CI: 0.2, 0.5]). Conclusion Among adults admitted to the hospital for ARI, those who tested positive for SARS-CoV-2 were typically younger, more likely to care for school-aged children, more likely to work outside the home, but were less likely to receive home healthcare or smoke. Personal and public health strategies to mitigate COVID-19 should take into consideration modifiable social risk factors. Disclosures Laura A. Puzniak, PhD. MPH, Merck & Co., Inc.: Stocks/Bonds|Pfizer, Inc.: Stocks/Bonds Robin Hubler, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Srinivas Valluri, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Benjamin Lopman, PhD, Epidemiological Research and Methods, LLC: Advisor/Consultant Satoshi Kamidani, MD, NIH: His institution (Emory University) receives funds from Pfizer for his work as a co-investigator on clinical trials of Pfizer COVID-19 vaccine.|Pfizer: His institution (Emory University) receives funds from Pfizer for his work as a co-investigator on clinical trials of Pfizer COVID-19 vaccine. Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Merck, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur.: Grant/Research Support|Meissa Vaccines, Inc.: Co-inventor of RSV vaccine technology licensed to Meissa Vaccines, Inc.|NIH (Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines): Grant/Research Support John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc: Data Safety Monitoring Board|MedImmune: Grant/Research Support|Medscape: Advisor/Consultant|Merck: Grant/Research Support|Micron: Grant/Research Support|NIH: Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines|PaxVax: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data Adjudication and Data Safety Monitoring Boards|WCG and ACI Clinical: Data Adjudication Board.

Neurological complications of SARS-CoV-2 infection

SARS-CoV-2 virus was first identified in 2019 in Wuhan (China) and is responsible for the ongoing COVID-19 pandemic. Although the virus causes mild, transient symptoms of an upper respiratory tract infection in most cases, it can also lead to severe pneumonia, respiratory failure and/or death. Approximately 85% of patients experience central and peripheral neurological symptoms. In the acute phase of the disease, ischaemic strokes, intracranial haemorrhages, meningitis and encephalitis, acute demyelinating diseases and acute inflammatory polyneuropathies may occur. However, mild neurological symptoms that can persist for months and significantly affect daily functioning are much more common. These include headache and dizziness, olfactory and gustatory dysfunction, mild cognitive disturbances, as well as depressive, anxiety, and sleep disorders. Some of them are encompassed by popular terms “post-covid syndrome” and “brain fog.” The pathogenesis of neurological complications of SARS-CoV-2 infection is still not fully understood; overproduction of cytokines induced by viral infection may be of great importance. There is no causal treatment, while symptomatic treatment is of limited effectiveness. Primary prevention in the form of SARS-CoV-2 vaccinations is of great importance. In the following review, we would like to present the current knowledge on epidemiology, pathology, pathogenesis and treatment of neurological complications after SARS-CoV-2 infection. Further multi-centre, large-scale clinical studies are necessary to identify the exact pathogenetic mechanisms.

PENGARUH PAPARAN DEBU TSP DAN PENGGUNAAN APD TERHADAP GEJALA ISPA PENGGUNA TERMINAL

Symptoms of Acute Respiratory Infection (ARI) are complaints experienced by a person in the respiratory tract. Respiratory tract disease is the third leading cause of death in workers, which is 21%. Some of the causes of ARI are dust exposure and non-compliance with the use of personal protection equipment (PPE), especially those that are in direct contact with dust. This study uses an analytical observational design with a cross sectional approach. Sampling by simple random sampling a number of respondents 80 respondents. Measurement of dust in the work environment using a digital dust monitor, assessment of symptoms of ARI using a questionnaire from the Ministry of Health in 2002 and the use of PPE based on observation sheets. The result of this research is that the average dust concentration is 4.606 mg/m3. for symptoms of ARI the majority of respondents are in the moderate category. The results of the bivariate test showed that there was a significant relationship between dust levels and the use of PPE with ARI symptoms with a p value of 0.045 and 0,024. There is a strong and unidirectional significant relationship between exposure to TSP dust and the use of PPE with ARI symptoms so that terminal users are expected to obey the use of masks to reduce the risk of dust exposure. Keywords : Acute Respiratory Infection, Dust, PPE

C-reactive protein point of care testing in community pharmacy: Observational study of a Northern Ireland pilot.

Whether or not to prescribe an antibiotic is a key issue for clinicians treating respiratory tract infection (RTI) in the community. Measurement of C-reactive protein (CRP) in community pharmacy may help to differentiate viral and self-limiting infections from more serious bacterial infections. To pilot POC CRP testing for suspected RTI within community pharmacy in Northern Ireland (NI). POC CRP testing was piloted in 17 community pharmacies linked to 9 general practitioner (GP) practices in NI. The service was available to adults presenting to their community pharmacy with signs and symptoms of RTI. The pilot (between October 2019 and March 2020) was stopped early due to Coronavirus-19 (COVID-19). During the pilot period, 328 patients from 9 GP practices completed a consultation. The majority (60%) were referred to the pharmacy from their GP and presented with <3 symptoms (55%) which had a duration of up to 1 week (36%). Most patients (72%) had a CRP result of <20mg/L. A larger proportion of patients with a CRP test result between 20mg/L and 100mg/L and >100mg/L, were referred to the GP when compared to patients with a CRP test result of <20mg/L. Antimicrobial prescribing rates were studied in a subgroup (n=30) from 1 practice. Whilst the majority (22/30; 73%) had a CRP test result of <20mg/L, 50%, (15/30) of patients had contact with the GP in relation to their acute cough and 43% (13/30) had an antibiotic prescribed within 5 days. The stakeholder and patient survey reported positive experiences. This pilot was successful in introducing POC CRP testing in keeping with National Institute of Health and Care Excellence (NICE) recommendations for the assessment of non-pneumonic lower RTIs and both stakeholders and patients reported positive experiences. A larger proportion of patients with a possible or likely bacterial infection as measured by CRP were referred to the GP, compared to patients with a normal CRP test result. Although stopped early due to COVID-19, the outcomes provide an insight and learning for the implementation, scale up and optimization of POC CRP testing in community pharmacy in NI.

Incidence of Respiratory Pathogens in Naval Special Warfare Sea, Air, and Land Team Candidates With Swimming-Induced Pulmonary Edema

Swimming-induced pulmonary edema (SIPE) is a respiratory condition frequently seen among Naval Special Warfare (NSW) trainees. The incidence of positive respiratory panel (RP) findings in trainees with a diagnosis of SIPE currently is unknown. Does a significant difference exist in the incidence of respiratory pathogens in nasopharyngeal samples of NSW candidates with SIPE and a control group? Retrospective analysis of clinical information from NSW Sea, Air, and Land (SEAL) team candidates with a diagnosis of SIPE over a 12-month period. Candidates who demonstrated the common signs and symptoms of SIPE underwent a nasopharyngeal swab and RP test for common respiratory pathogens. SIPE diagnoses were supported by two-view chest radiography. RP tests were obtained for a selected control group of first-phase trainees without SIPE. Forty-five of 1,048 SEAL team candidates received a diagnosis of SIPE (4.3%). Five had superimposed pneumonia. Thirty-six of 45 showed positive results for at least one microorganism on the RP (80%). In the study group, human rhinovirus/enterovirus (RV/EV) was the most frequently detected organism (37.8%), followed by coronavirus OC43 (17.8%), and parainfluenza virus type 3 (17.8%). Sixteen of 68 candidates from the control group showed positive RP (24%) findings. Patients with SIPE and positive RP results reported dyspnea (94%), pink frothy sputum (44%), and hemoptysis (22%) more frequently than the control participants with positive RP results. Those who reported respiratory infection symptoms in both the study and control groups showed higher incidences of positive RP results (P= .046). We observed that 80%of trainees with a diagnosis of SIPE showed positive results on a point-of-care RP. This positivity rate was significantly higher than that of RP test results from the control cohort. These findings suggest an association between colonization with a respiratory pathogen and the development of SIPE in NSW candidates.

Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study

BackgroundAlthough there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa.MethodsWe analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children’s healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis.ResultThe overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37–0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49–1.79)], high community level women education [AOR = 1.51, 95% CI (1.39–1.66)], primary education [AOR = 1.62, 95% CI (1.45–1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71–2.32)], working mother [AOR = 1.33, 95% CI (1.20–1.48)], unmarried women [AOR = 1.15, 95% CI (1.04–1.27)], media access [AOR = 1.43, 95% CI (1.20–1.58)], richest [AOR = 1.39, 95% CI (1.29–1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02–1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60–1.95)], age of child 7–23 months [AOR = 1.59, 95% CI (1.39–1.82)], age of child 24–59 months [AOR = 1.24, 95% CI (1.09–1.41)] in comparison with children aged 0–6 months, family size > 10 [AOR = 1.53, 95% CI (1.22–1.92)].Conclusions and recommendationsThe overall prevalence of children’s healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.

Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries.

Respiratory syncytial virus (RSV) significantly impacts the health of older and high-risk adults (those with comorbidities). We aimed to synthesise the evidence on RSV disease burden and RSV-related healthcare utilisation in both populations. We searched Embase and MEDLINE for papers published between 2000 and 2019 reporting the burden and clinical presentation of symptomatic RSV infection and the associated healthcare utilisation in developed countries in adults aged ≥60 years or at high risk. We calculated pooled estimates using random-effects inverse variance-weighted meta-analysis. 103 out of 3429 articles met the inclusion criteria. Among older adults, RSV caused 4.66% (95% CI 3.34-6.48%) of symptomatic respiratory infections in annual studies and 7.80% (95% CI 5.77-10.45%) in seasonal studies; RSV-related case fatality proportion (CFP) was 8.18% (95% CI 5.54-11.94%). Among high-risk adults, RSV caused 7.03% (95% CI 5.18-9.48%) of symptomatic respiratory infections in annual studies, and 7.69% (95% CI 6.23-9.46%) in seasonal studies; CFP was 9.88% (95% CI 6.66-14.43%). Data paucity impaired the calculation of estimates on population incidence, clinical presentation, severe outcomes and healthcare-related utilisation. Older and high-risk adults frequently experience symptomatic RSV infection, with appreciable mortality; however, detailed data are lacking. Increased surveillance and research are needed to quantify population-based disease burden and facilitate RSV treatments and vaccine development.

Improving the clinical effectiveness of the treatment of acute inflammatory diseases of the upper respiratory tract in children with the use of silver-based medicines

Introduction. Acute respiratory viral infection (ARVI) is the most common reason for visits to the physician by both children and adults.The aim of the study was to analyse the features of the course of ARVIs in patients with different immune status, to evaluate the effectiveness of standard therapy for these groups of patients, as well as the use of silver-based medicines in the combination therapy of patients.Materials and methods. For the period from July to September 2022, 26 children (Group 1) without immunodeficiency conditions and 26 immunocompromised children (Group 2) were identified, all of them had symptoms of acute respiratory viral infections. In Group 1, 69.2% of children (n = 18) were classified as frequently ill children with ARVI rate of more than 8 times per year, 38.4% (n = 10) had allergic rhinitis, 7.7% (n = 2) had a concomitant bronchial asthma. In Group 2, the distribution of underlying immunocompromised disease was as follows: primary immunodeficiency – 7.7% (n = 2), Hurler syndrome after bone marrow transplantation – 11.5% (n = 3), acute lymphoblastic leukemia during specific therapy – 26.9% (n = 7), with graft versus host disease – 30.7% (n = 8) and currently in remission – 23% (n = 6). Among patients in this Group, only 7.7% of children (n = 2) had a history of allergic rhinitis.Results. The criterion for recovery in Group 1 was reversal of all clinical symptoms, in Group 2 – clinical improvement, normalization or significant decrease in C-reactive protein levels, improvement of paranasal sinuses pneumatization.Conclusion. During ARVI, post-viral rhinosinusitis often occurs, the ability of the mucosa to regenerate becomes disturbed, which makes it more vulnerable to adhesion of viruses, bacteria, and fungi. In this case, especially effective is the intranasal use of a silver-based medicine to form a protective protein film on the injured mucosa. The use of silver-based medicines in the combination therapy of patients with inflammatory pathologies of the nose, nasopharynx and paranasal sinuses can greatly increase the effectiveness of treatment, while shortening the duration of therapy and being safe.

Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians' Prescribing of Antibiotics at Medical Visits.

Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children's acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians' prescribing of antibiotics was significantly associated with caregivers' self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations.

An infant with congenital heart defects and proteinuria: a case report

BackgroundBranchio-Oto-Renal (BOR) Syndrome is a rare autosomal disorder with a wide variety of clinical manifestations and a high degree of heterogeneity. Typical clinical manifestations of BOR syndrome include deafness, preauricular fistula, abnormal gill slits, and renal malformations. However, atypical phenotypes such as congenital hip dysplasia, congenital heart anomaly or facial nerve paresis are rare in BOR syndrome, and this might be easily misdiagnosed with other congenital disorders.Case presentationWe report a 5-month-old boy of BOR syndrome with "congenital heart defects and proteinuria" as clinical features. Initially, as this case mainly presented with symptoms of recurrent respiratory infections and was found to be with congenital heart disease and proteinuria at the local hospital, but he only was diagnosed with congenital heart disease combined with pulmonary infection and anti-infective and supportive treatment was given. Subsequently, during the physical examination at our hospital, left side preauricular pit and branchial fistulae on the right neck were found. Subsequent evaluation of auditory brainstem response and distortion product otoacoustic emission were revealed sensorineural hearing impairment. Results of renal ultrasonography showed small kidneys. Genetic analysis revealed a microdeletion at chromosome 8q13.2-q13.3 encompassing EYA1 gene, this patient was finally diagnosed with BOR syndrome. Then, this patient received transcatheter patent ductus arteriosus closure and hearing aid treatment. Proteinuria, renal function and hearing ability are monitoring by nephrologist and otologist. The patient is currently being followed up until 3 months after discharge and his condition is stable.ConclusionCareful physical examination, detailed history and the implementation of diagnostic laboratory tests can reduce the incidence of misdiagnosis. Genetic sequencing analysis of patients is a key guide to the differential diagnosis of BOR syndrome.