Upper Respiratory Symptoms Research Articles

Abstract 4124313: An unusual case of pericardial mass

A 30-year-old male electrician presented with two days of fever and positional left shoulder pain and was found to have elevated inflammatory markers and a large pericardial effusion with echocardiographic evidence of tamponade for which he underwent pericardiocentesis. He was discharged on a course of anti-inflammatory therapy with presumed diagnosis of idiopathic pericarditis based on negative cytology. He returned 6 months later with several weeks of upper respiratory infection symptoms as well as new abdominal discomfort and emesis. On presentation, his vital signs were notable for tachycardia to 113 and cardiac exam was notable for tachycardia, regular rhythm, no rubs or murmurs, nondisplaced precordial impulse, normal jugular venous pressure with Kussmaul sign, and pulsus paradoxus of 6. An electrocardiogram showed sinus tachycardia with diffuse ST segment changes (Figure A). His cardiac biomarkers were unremarkable (troponin 21). His labs revealed normocytic anemia with hemoglobin of 11 and erythrocyte sediment rate above assay. Echocardiogram demonstrated a circumferential complex pericardial effusion with echocardiographic evidence of early tamponade (Figure B, C). A pericardiocentesis was attempted with inability to advance wire within pericardial space. A malignancy workup was initiated. CT demonstrated multi-station thoracic and lower cervical lymphadenopathy, moderate left pleural effusion, and an intrapericardial mass with associated pericardial effusion (Figure D). Cardiac magnetic resonance imaging demonstrated a circumferential intrapericardial non-mobile mass measuring up to 22 mm in thickness posteriorly and the mass was isointense to myocardium indicating low-fat content (Figure E). A supraclavicular lymph node biopsy was obtained with immunohistochemical staining positive for WT1 and calretinin, consistent with metastatic epithelioid mesothelioma of pericardial versus pleural etiology (Figure F). A PET-CT subsequently showed a FDG-avid circumferential anterior pericardial mass and multiple pleural-based lesions concerning for metastatic mesothelioma. He was initiated on pemetrexed/carboplatin systemic chemotherapy. With systemic therapy, his disease has been stable for 6 months. Pericardial mesothelioma is a rare malignancy. This case underscores the diagnostic challenges associated with pericardial mesothelioma and the importance of cancer workup as part of the pericardial effusion workup.

Right Information, Right Care, Right Patient, Right Time: Community Preferences to Inform a Self-Management Support Tool for Upper Respiratory Symptoms.

During and after the COVID-19 pandemic, communities must cope with several conditions that cause similar upper-respiratory symptoms but are managed differently. We describe community reactions to a self-management toolkit for patients with upper respiratory symptoms to inform mobile e-health app development. The toolkit is based on the '4R' (Right Information, Right Care, Right Patient, Right Time) care planning and management model. The 4R Cold, Flu and COVID-19 Information Tool (4R-Toolkit) along with a brief evaluation survey were distributed in three ways: through a Bronx NY Allergy/Asthma clinic, through the Bronx Borough President's Office listserv, and through peer recruitment. The survey assessed respondents' perceptions of the 4R-Toolkit's accessibility, preferences for sharing symptoms with clinicians, social media use, and e-health literacy. We obtained a diverse sample of 106 Bronx residents, with 83% reporting personal or a social contact with symptoms suggestive of COVID-19. Respondents varied in the information sources they preferred: computer (39%); smart phone (28%); paper (11%) and no preference (22%). Most (67%) reported that social media had at least some impact on their healthcare decisions. Regardless of media preferences, respondents were positive about the 4R-Toolkit. Out of 106 respondents, 91% believed the 4R-Toolkit would help people self-manage upper respiratory symptoms and 85% found it easy to understand. Respondents strongly endorsed retention of all 4R-Toolkit content domains with 81% indicating that they would be willing to share symptoms with providers using a 4R-Toolkit smartphone app. The 4R-Toolkit can offer patients and community members accurate and up-to-date information on COVID-19, the common cold, and the flu. The user-friendly tool is accessible to diverse individuals, including those with limited e-health literacy. It has potential to support self-management of upper respiratory symptoms and promote patient engagement with providers.

A Scoping Review of the Respiratory Effects of Red Tide in Humans.

Algal blooms of Karenia brevis produce brevetoxins that lead to the natural phenomenon of red tide. Beyond monitoring the red tide concentration and forecasting future outbreaks, uncertainty exists in the field when examining these toxins in relation to physiologic aspect of humans. Contaminated air that results from outbreaks of K. brevis leads to inhalation of aerosolized brevetoxins, which directly impact the human respiratory system. This scoping review focused on the respiratory effects of red tide and was conducted by using a comparative method between 2 researchers. Relevant abstracts were collected, and full-text articles were reviewed by using PubMed, Science Direct, CINAHL Complete, and BioMed Central databases. Thirty articles were included in the final analysis and categorized by study design, location, and number and age of participants, and were also divided into assessment by respiratory effects, exposure, measurements of K. brevis, and asthma. The research indicates that respiratory health issues exist and can be compounded with exposure to red tide, specifically upper respiratory symptoms. Both symptomatic issues and pulmonary function tests were of concern when individuals were subjected to brevetoxin exposure. Even low levels of K. brevis resulted in negative respiratory health effects. Red tide is common in many areas of the world. The toxins released can cause adverse respiratory effects in humans. This article provides a comprehensive summary of the scholarly literature focused on the respiratory system and red tide produced by K. brevis.

Malignant Rhabdoid Tumor masquerading as Neuroblastoma: A rare Case-report

Abstract Introduction/Objective Malignant rhabdoid tumors (MRT) predominantly impact infants and young children, typically occurring around the age of 15 months. While they can emerge from soft tissues throughout the body, but commonly initiate in the kidneys. Neuroblastoma-like characteristics are seldom observed within the varied phenotypes of malignant rhabdoid tumors. Here, we present an exceptionally rare and distinctive subtype of malignant rhabdoid tumor exhibiting features akin to neuroblastoma localized within the unusal parapharyngeal space. Methods/Case Report A 2-month-old female presented to the ED with an enlarging right cervical neck mass. The mother reported a one-week history of upper respiratory tract symptoms and noticed an enlarging mass of her right neck. CT reported a “parapharyngeal abscess with airway compression”. The patient was started on Augmentin with no significant improvement. Repeat CT with contrast demonstrated an enlarging rim-enhancing 3 cm mass involving the right parapharyngeal space, trachea, and right carotid arteries. Laryngoscopy and incisional biopsy of right neck lymph nodes demonstrated a high-grade malignancy with prominent nucleoli, high N/C ratio and scant cytoplasm. The tumor tested positive for CD 99, synaptophysin, and neurofilament, leading to the initial diagnosis of neuroblastoma. However, molecular analysis uncovered the loss of INI-1 on 22q11.2, prompting a reevaluation and a final diagnosis of MRT with neuroblastoma-like characteristics was made. Results (if a Case Study enter NA) NA Conclusion A range of tumors displaying distinct “rhabdoid” cytological features are collectively termed as malignant rhabdoid tumors (MRTs). Conventional immunohistochemistry (IHC) staining for CD99, synaptophysin, neurofilament, and myogenin might suggest neuroblastoma, Ewing sarcoma, or rhabdomyosarcoma. However, the absence of INI-1 expression provides a definitive diagnosis. INI-1 loss, a purported tumor suppressor gene located on chromosome 22q11.2, solidifies the tumor’s classification as malignant rhabdoid tumor (MRT). Additionally, a positive neurofilament stain in MRT is crucial for diagnostic and therapeutic assessments. This differentiation is vital, given the dismal prognosis of MRT with a 5-year survival rate of less than 10%.

Sex, vaccination status, and comorbidities influence long COVID persistence

BackgroundThere is interest in the public health impact of Long COVID, defined as symptoms that persist or begin after SARS-CoV-2 infection. We aimed to identify demographic and clinical risk factors associated with Long COVID over time in an Upper Middle-Income Country (UMIC) and potential biomarkers predictive of symptom trajectory. MethodsProspective cohort study of adults with mild SARS-COV-2 during the Omicron period. We tracked symptom persistence and IgG antibody titers against the spike S1 subunit. ResultsOf 383 participants, 276 had confirmed SARS-CoV-2 infection. Long COVID persisted for ≥ two months in 21 % and ≥ 12 months in 5 %. The most common symptoms were fatigue, upper respiratory symptoms, and myalgia/arthralgia: 15 % had fatigue for ≥ one month, 10 % for ≥ two months, and 5 % ≥ three months. Upper respiratory symptoms lasted ≥ one month in 17 %, ≥ two months in 7 %, and ≥ three months in 3 %. Fully 9 % reported myalgia/arthralgia lasting ≥ one month, 6 % ≥ two months, and 4 % ≥ three months. Risk factors for symptom persistence included female sex, not being fully vaccinated, and comorbidities. Participants experiencing persistent fatigue had lower anti-S1 IgG titers. ConclusionsIn this population, symptom persistence declined after the acute phase, but 5 % of participants did not fully recover. Even in a population that was almost fully vaccinated, women, individuals with comorbidities, and the few remaining people who were unvaccinated were at greater risk for Long COVID. Immunoglobulins may have utility as a biomarker of Long COVID fatigue in this population.

6594 A Rare Case of Clomiphene Induced De Quervain’s Subacute Thyroiditis

Abstract Disclosure: A. Abdelhameed: None. M. Mortagy: None. A. Elsandouby: None. A. Ghaffar: None. Introduction: Clomiphene is a selective estrogen receptor modulator that stimulates LH release by inhibiting negative feedback on the hypothalamic-pituitary axis. De Quervain’s subacute granulomatous thyroiditis is usually caused by viral infections and less often is drug-induced. We present a case of possible subacute thyroiditis induced by clomiphene. To the best of ourknowledge, this association has not been reported before. Case presentation: A 35-year-old female with a past medical history of unexplained infertility presents to the general medicine clinic with severe neck pain for the last 5 days. Her neck pain started 2 days after the completion of the clomiphene course for induction of ovulation (50 mg daily for 5 days). She denied upper respiratory symptoms. She had an extremely tender thyroid with no palpable nodules. Throat was clear. She was clinically euthyroid with no rash or itching. TSH was 3.9 mIU/L (TSH was normal 6 months prior). ESR was 40 mm/hr. Thyroid ultrasound was unremarkable. She was treated with Ibuprofen for subacute thyroiditis. In the first 2 weeks, the patient complained of increased anxiety. In the next month, she had a missed menstrual cycle. Her pain and tenderness resolved after 50 days. Repeat TSH was 2.4 mIU/L. The patient was advised not to retake clomiphene. Discussion: This is a typical presentation of subacute thyroiditis as persistent thyroid pain and tenderness with elevated ESR. The patient didn’t have the classical symptoms of preceding viral infection. However, her symptoms began immediately after completion of clomiphene course suggesting a temporal relation. The patient didn’t have any history of thyroid problems. She had increased anxiety initially followed by a missed period which suggests clinical thyroid dysfunction.Clomiphene has been associated in the literature with an increased risk of thyroid cancer. Uncontrolled thyroid dysfunction is a contraindication for clomiphene use. This might suggest an interaction between clomiphene and thyroid homeostasis. Subacute thyroiditis could be caused by drugs (e.g., lithium and amiodarone). This suggests that other drugs could lead to subacute thyroiditis such as clomiphene in our case. Conclusion: Clinicians should be aware that clomiphene could be associated with thyroid disorders such as subacute thyroiditis. It is also important to note that thyroid dysfunction is a contraindication for clomiphene use. Presentation: 6/3/2024

Unravelling the role of secretory Immnuoglobulin-A in COVID-19: a multicentre study in nursing homes during the first wave

BackgroundThe function of mucosal secretory IgA (SIgA) seems to be paramount in the immune response against SARS-CoV-2 however, there are few studies addressing this issue specifically in the institutionalized older population. This study aims to determine the levels of secretory IgA against the S1 domain of the SARS-CoV-2 spike (SIgA-S1) in older people living in nursing homes (NH) and to investigate the differences in baseline characteristics, severity of COVID-19, duration of symptoms, 30-day mortality, and reinfection according to the levels of SIgA-S1.MethodsIn this multicentre longitudinal study, conducted in two NHs attended in coordination with a hospital-based Geriatric team, 305 residents (87.3 years, 74.4% female) were included. A massive collection of nasopharyngeal samples was carried out after the first wave of COVID-19 in May 2020 and an ELISA analysis of SIgA-S1 was performed on frozen samples in May 2023. Values of SIgA-S1 ≥ 57.6 U/mL (“cut-off point”) were considered “induced”. Resident medical records were reviewed to assess symptoms, comprehensive geriatric assessment (CGA), reinfection, and overall 30-day mortality.ResultsAt the time of sample collection, 274 residents (89.8%) exhibited “induced” SIgA-S1 levels (≥ 57.6 U/mL), 46 (15.1%) tested positive for PCR SARS-CoV-2, and 170 (57%) had experienced COVID-19 symptoms. “Induced” SIgA-S1 patients were more likely to be symptomatic (60.3% vs. 29%; p < 0.001) and exhibited upper respiratory tract symptoms more frequently (25.1% vs. 6.5%; p = 0.020) compared to “non-induced” patients. Patients with severe disease and duration of symptoms > 10 days had higher levels of SIgA-S1 than those with mild disease (252 vs.192.6 U/mL; p = 0.012) or duration ≤ 10 days (270.5 vs. 208.1 U/mL; p = 0.043), respectively. No significant differences were observed in age, sex, CGA, duration of symptoms, disease severity, overall 30-day-mortality, or reinfection between “induced” and “non-induced” residents.ConclusionsLevels of SIgA-S1 are associated with the duration and type of COVID-19 symptoms, along with the severity of infection. While these findings shed light on the knowledge of SIgA-S1, further interdisciplinary studies are warranted to better understand the immune response to SARS-CoV-2 infection.

Clinical Profile and Outcome of Bronchiolitis in Children With 1-24 Months of Age.

Introduction Bronchiolitis poses a significant challenge in pediatric critical care. It is an acute illness affecting the lower respiratory tract in children under the age of two. The most common cause of bronchiolitis is the seasonal respiratory syncytial virus, with influenza and adenovirus also notable contributors. It is characterized by various clinical symptoms and indicators, such as an upper respiratory prodrome, increased respiratory effort, and wheezing in younger children under two years old.This study primarily examines the clinical profile, risk factors, severity, and outcomes of bronchiolitis in children under two years, excluding the neonatal age group. Materials and methods Children under two years of age who presented with upper respiratory symptoms and their first episode of wheezing were evaluated. Those with pre-existing systemic conditions such as cardiac, respiratory, or immunodeficiency disorders were excluded. A detailed history was gathered using a questionnaire, and risk factors were analyzed. The severity of the condition was measured using the Wood-Downes-Ferres score. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The relationship between risk factors, severity, and outcomes was examined using the chi-squared test. A two-sided probability of p<0.05 was considered statistically significant for all tests. Results Among 54 children aged 1-24 months with bronchiolitis, the average age was 10.18 months, with a standard deviation of 4.8 months. The severity of the condition was greater in younger children (1-12 months) and tended to decrease with age. Bronchiolitis was more common in males (33 cases) than females (21 cases). Approximately 50 children (92.6%) exhibited signs of respiratory distress, and 45 children (83.3%) showed cough as an initial symptom. Severity was notably higher in children with a history of irritability, which was statistically significant (chi-squared value: 8.169; p-value: 0.017). Only 16 children (29.65%) had a history of poor feeding. Bronchiolitis was more prevalent among infants with a birth weight under 1500 grams (63%). Non-exclusive breastfeeding and early bottle feeding were significant risk factors for bronchiolitis and its severity (chi-squared values: 18.794; p-value: 0.000 and 7.795; p-value: 0.020, respectively). Only two children (3.7%) had been exposed to passive smoke, and the severity was slightly higher in these cases. There was also a statistically significant association between socioeconomic status and bronchiolitis (chi-squared value: 11.917; p-value: 0.018). Conclusion This study aims to raise awareness among parents and clinicians about the high-risk age group for bronchiolitis, its typical presentations, and predictors of severity. It underscores the impact of both biological and environmental risk factors, such as bottle feeding, non-exclusive breastfeeding, and socioeconomic status, on the severity of the condition.

Oral SARS-CoV-2 host responses predict the early COVID-19 disease course

Oral fluids provide ready detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host responses. This study sought to evaluate relationships between oral virus, oral and systemic anti-SARS-CoV-2-specific antibodies, and symptoms. Oral fluids (saliva/throat wash (saliva/TW)) and serum were collected from asymptomatic and symptomatic, nasopharyngeal (NP) SARS-CoV-2 RT-qPCR+ human participants (n = 45). SARS-CoV-2 RT-qPCR and N-antigen detection by immunoblot and lateral flow assay (LFA) were performed. RT-qPCR for subgenomic RNA (sgRNA) was sequence confirmed. SARS-CoV-2-anti-S protein RBD LFA and ELISA assessed IgM and IgG responses. Structural analysis identified host salivary molecules analogous to SARS-CoV-2-N-antigen. At time of enrollment (baseline, BL), LFA-detected N-antigen in 86% of TW and was immunoblot-confirmed. However, only 3/17 were saliva/TW qPCR+ . Sixty percent of saliva and 83% of TW demonstrated persistent N-antigen at 4 weeks. N-antigen LFA signal in three anti-spike sero-negative participants suggested potential cross-detection of 4 structurally analogous salivary RNA binding proteins (alignment 19–29aa, RMSD 1–1.5 Angstroms). At enrollment, symptomatic participants demonstrated replication-associated sgRNA junctions, were IgG+ (94%/100% in saliva/TW), and IgM+ (63%/54%). At 4 weeks, SARS-CoV-2 IgG (100%/83%) and IgM (80%/67%) persisted. Oral and serum IgG correlated 100% with NP+ PCR status. Cough and fatigue severity (p = 0.010 and 0.018 respectively), and presence of weakness, nausea, and composite upper respiratory symptoms (p = 0.037, 0.005, and 0.017, respectively) were negatively associated with saliva IgM but not TW or serum IgM. Throat wash IgM levels were higher in women compared to men, although the association did not reach statistical significance (median: 290 (female) versus 0.697, p = 0.056). Important to transmission and disease course, oral viral replication and persistence showed clear relationships with select symptoms and early oral IgM responses during early infection. N-antigen cross-reactivity may reflect mimicry of structurally analogous host proteins.

Distribution of Respiratory Infection Viruses in 2019-2020 Season and Determination of Oseltamivir Resistance of Influenza Viruses

Objective: This study aimed to determine the seasonal distribution of the factor data of viral agents determined by the multiplex PCR method in routine practice in patients admitted to the hospital with upper respiratory tract infection symptoms and to detect oseltamivir resistance in viruses that are positive for Influenza A (H1N1). Methods: Nasopharyngeal swab and bronchoalveolar lavage samples of 354 patients between the ages of 0-94 who were admitted to the Sakarya University Sakarya Training and Research Hospital with symptoms of upper respiratory tract infection between 12 September 2019 and 19 February 2020 were studied with the multiplex PCR method. Oseltamivir resistance was investigated in 11 samples selected from Influenza A (H1N1) positive samples by Sanger sequence analysis method. Results: One or more respiratory viruses were identified in 233 (66%) of 354 respiratory samples evaluated. Of these, 64 (27.5%) are Influenza A/H1N1, 4 (1.7%) are Influenza A/H3N2, 24 (10.3%) are Influenza B, 64 (27.5) are Respiratory. Syncytial Virus A/B (RSV A/B), 58 (24.9%) Rhinovirus/Enterovirus, 18 (7.7%) Adenovirus, 12 (5.2%) Human Metapneumo Virus (hMPV) ), 10 (4.3%) Bocavirus, 4 (1.7%) Parainfluenza 1, 7 (3%) Parainfluenza 3, 3 (1.3%) Parainfluenza 4, 5 (2.1%) were found to be Coronavirus HKU1 and 13 (5.6%) were found to be Coronavirus NL63. More than one factor was detected simultaneously in 45 of 233 positive samples (19.3%). Oseltamivir resistance was not found in any of the 11 influenza A/H1N1 positive samples. Conclusion: No oseltamivir resistance was observed in any of the Influenza A/H1N1 positive samples evaluated in this study. Periodic analysis of influenza A/H1N1 strains for oseltamivir resistance is necessary to guide empirical treatment.

Asymptomatic infection and disappearance of clinical symptoms of COVID-19 infectors in China 2022–2023: a cross-sectional study

To explore the clinical characteristics of patients infected with SARS-CoV-2 nationwide, especially the effect factors of asymptomatic infection and disappearance of clinical symptoms. A total of 66,448 COVID-19 patients in China who have been diagnosed by nucleic acid test or rapid antigen test were surveyed online (December 24, 2022 to January 16, 2023). Our cross-sectional study used descriptive analyses and binary Logistics regression model to assess the correlation between the clinical characteristics and relative factors, including age, gender, pre-existing conditions, reinfection, vaccination and treatment. A total of 64,515 valid questionnaires were collected. Among included participants, 5969 of which were asymptomatic. The symptoms were mainly upper respiratory symptoms, including dry and itchy throat (64.16%), sore throat (59.95%), hoarseness (57.90%), nasal congestion (53.39%). In binary Logistics regression model, we found that male, no pre-existing conditions, reinfection and vaccination have positive correlations with the appearance of asymptomatic COVID-19 patients. In Cox proportional-hazards regression model, considering all clinical symptoms disappeared in 14 days as outcome, we found that ≤ 60 years old, male, no pre-existing conditions, vaccination and adopted treatment have positive correlations with rapid amelioration of clinical symptoms in COVID-19 patients. The clinical symptoms of the participants were mainly upper respiratory symptoms which were according with the infection of Omicron variant. Factors including age, gender, pre-existing conditions and reinfection could influence the clinical characteristics and prognosis of COVID-19 patients. Importantly, vaccination has positive significance for the prevention and treatment of COVID-19. Lastly, the use of Chinese medicine maybe beneficial to COVID-19 patients, however, reasonable guidance is necessary.

Urticaria multiforme in Asian children.

Urticaria multiforme is an uncommon presentation of acute urticaria. It most commonly affects children and most often occurs secondary to an underlying viral infection. We performed a retrospective review of a cohort of Asian children with urticaria multiforme and reviewed the literature on the condition. We retrospectively reviewed the clinical notes of children and adolescents less than 16 years of age, diagnosed with urticaria multiforme at our tertiary paediatric hospital between January 2017 and December 2022. Data collected and analysed included age, gender, initial diagnosis, antecedent symptoms, recent immunisations and medications, results of diagnostic tests, treatment and outcome. A total of 20 children were identified, with median age of diagnosis of 1.9 years, with most patients (79%) 7 years of age or younger. Viral infections were the commonest triggers. The most common referring diagnoses were erythema multiforme and Stevens-Johnson syndrome. Common antecedent or concomitant symptoms were fever and upper respiratory symptoms. Blood investigations were generally unremarkable except for mildly increased white cell counts and other markers of infection. Outcomes were good in all patients, with resolution of symptoms within 6 weeks without sequelae. Urticaria multiforme is an uncommon presentation of acute urticaria. Despite its striking appearance, it is generally a benign, self-limiting condition. Extensive investigations are usually not required and management is largely supportive.

Indoor Air Quality and Sick Building Syndrome among Caretakers in Childcare Centers

Sick Building Syndrome (SBS) refers to the health-related symptoms of exposure to an unhealthy microenvironment, especially poor indoor air quality This study investigated the associations of indoor air quality including particulate matter (PM10 and PM2 5), Carbon Dioxide (CO2), Carbon Monoxide (CO), Total Volatile Organic Compounds (TVOCs), and childcare center environment with SBS symptoms among caretakers. SBS was assessed using a self-reported questionnaire The prevalence of SBS was 77 78% among caretakers PM10 negatively correlated with CO2 (r=0 -558; p&lt;0 01) PM10 levels were associated with any reported symptoms of SBS (OR=7 38; 95%CI 1 98 - 27 53), and upper respiratory symptoms (OR= 12 00; 95%CI 1 46 – 98 08) PM2 5 showed no association with SBS Using air refresher was associated with upper respiratory symptoms (OR=5 10; 95%CI 1 46 – 13 59), lower respiratory symptoms (OR=3 64; ; 95%CI 1.22 - 10.82).

Clinical characteristics of COVID-19 clusters in three schools in Beijing, China: A retrospective study

BackgroundThis retrospective analysis aims to investigate the clinical characteristics of students infected with the SARS-CoV-2 Omicron variant in three Beijing schools. Additionally, we explore the dynamic trends of nucleic acid cycle threshold values (Ct values) and serum antibody titers throughout the disease course. MethodsDemographic, clinical, nucleic acid Ct values, and antibody titer data were collected from cases in a COVID-19 cluster in Beijing Ditan Hospital, Capital Medical University, spanning from September 6 to October 1, 2022. ResultsA total of 107 students infected with Omicron (BA.5.2 and BA.2.76) were identified across three schools. Primary clinical manifestations included fever and upper respiratory symptoms (85/107, 79.4 %), with the majority being classified as mild cases (96/107, 89.7 %). Notably, middle school students in the second school exhibited a higher peak body temperature compared to college students in the first and third schools (39.5 °C vs. 38.4 °C, adjusted P = 0.005; 39.5 °C vs. 38.6 °C, adjusted P = 0.002). Analysis of dynamic changes in Ct values revealed the lowest median Ct value in nasopharyngeal swabs on the third day of illness, reaching 35 after 9–11 days. Oropharyngeal swab nucleic acid median Ct value reached 35 approximately 3–5 days post-onset. Serum antibody detection showed continuous negativity of IgM antibody titers from days 1–10, while IgG antibody titers were positive on the first day and increased rapidly after one week. ConclusionsThe three COVID-19 cluster school outbreaks primarily resulted from Omicron infections, with no severe or fatal cases observed. Clinically, the selection of different types of SARS-CoV-2 nucleic acid swabs for virus detection can be tailored based on the infection's course.

Effects of Chronic Barley Consumption on Upper Respiratory Tract Symptoms in Japanese Healthy Adults: A Randomized, Parallel-Group, Controlled Trial.

β-(1,3/1,4)-glucan is a major component of cereal grains, such as oats and barley. In this study, we investigated the effects of cooked waxy barley, which contains β-(1,3/1,4)-glucan, on upper respiratory tract physical symptoms and mood status by performing a randomized, parallel-group, comparative trial. The primary outcome was assessed using the Wisconsin Upper Respiratory Symptom Survey-21 and Profile of Mood States second edition. Twenty-seven healthy Japanese adult participants were supplemented with 100 g of cooked waxy barley (containing 1.8 g of β-glucan) or 100 g of cooked white rice daily for 8 weeks. Participants receiving cooked waxy barley reported a reduction in cumulative days of sneezing (p < 0.05) and feeling tired (p < 0.0001) compared with the control group. After the intervention period, there were significantly less severe nasal symptoms, such as runny nose, plugged nose, and sneezing (p < 0.05), and a significantly greater reduction of the Tension-Anguish score (p < 0.05) in the barley group than in the control group. This study suggests that supplementation of cooked waxy barley containing β-(1,3/1,4)-glucan prevents or alleviates nasal upper respiratory tract symptoms and improves mood status. The findings of this study should be confirmed by double-blind trials with a larger number of participants.

Predictors of radiographic pneumonia in febrile children with cancer presenting to the emergency department

BackgroundFever is a common presenting complaint to the pediatric emergency department (PED), especially among oncology patients. While bacteremia has been extensively studied in this population, pneumonia has not. Some studies suggest that chest X-ray (CXR) does not have a role in the investigation of neutropenic fever in the absence of respiratory symptoms, yet non-neutropenic pediatric oncology patients were excluded from these studies. ObjectiveWe aimed to determine the incidence of CXRs ordered for febrile pediatric oncology patients, irrespective of their absolute neutrophil count (ANC), and to evaluate the rates of radiographic pneumonia as well as predictors of the latter in this group. MethodThis study was conducted in the PED at the American University of Beirut Medical Center (AUBMC), an Eastern Mediterranean tertiary-care hospital. We conducted a retrospective cohort study of acutely febrile pediatric cancer patients, younger than 18 years, presenting to a tertiary center from 2014 to 2018. We included one randomly selected febrile visit per patient. Fever was defined as a single oral temperature ≥38 °C within 24 h of presentation. We collected data on patient characteristics and outcomes. Our primary outcome was radiographic pneumonia; our secondary outcome was whether a CXR was done or not. We defined radiographic pneumonia as a consolidation, pleural effusion, infiltrate, pneumonia, “infiltrate vs. atelectasis,” or possible pneumonia mentioned by the radiologist. SPSS was used for the statistical analysis. ResultsWe reviewed a total of 664 medical charts and included data from 342 febrile pediatric patients in our analysis. Of these, 64 (18.7%) had a CXR performed. Overall, 16 (25%) had radiographic pneumonia while 48 (75%) did not. Patients were significantly more likely to have a CXR performed if they presented with upper respiratory tract symptoms, cough (p < 0.001 for both), or abnormal lung auscultation at the bedside (p = 0.004). Patients were also less likely to have a CXR done if they were asymptomatic upon admission to the PED (p < 0.001). However, neither cough nor shortness of breath nor abnormal lung examinations were significant predictors of a positive CXR (p = 0.17, 0.43, and 0.669, respectively). Patients with radiographic pneumonia were found to be significantly younger (4.29 vs. 6 years, p = 0.03), with a longer time since their last chemotherapy (15 vs. 7 days, p = 0.005), and were given intravenous (IV) bolus in the PED (87.5% vs. 56.3%, p = 0.02). Interestingly, patients with higher white blood cell (WBC) counts were more likely to have radiographic pneumonia (4850 vs. 1750, p = 0.01). Having a cough and an abnormal lung examination on presentation increased the odds of having a CXR (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI]: 3.4–12.8 and aOR: 4.5; 95% CI: 1.1–18.3, respectively). Returning to the PED for the same complaint within 2 weeks was associated with lower odds of a CXR at the index visit (aOR: 0.3; 95% CI: 0.1–0.6). For every year the child is older, the odds of having radiographic pneumonia decreased by 0.8 (95% CI: 0.6–0.98). However, for every day since the last chemotherapy session, the odds increased by 1.1 (95% CI: 1.01–1.12). ConclusionIn our sample, CXR was not commonly performed in the initial assessment of febrile cancer patients in the PED, unless respiratory symptoms or an abnormal lung examination was noted. However, these were not significant predictors of radiographic pneumonia. Further studies are needed to identify better predictors of pneumonia in this high-risk population.

An Evaluation of the Prevalence of Respiratory and General Symptoms among Occupants of Households Affected by Flooding in Guyana: The Case of Cove &amp; John

This study attempted to determine the prevalence of respiratory symptoms amongst occupants of homes affected by flooding in Guyana focusing on the area of Cove &amp; John, East Coast Demerara. A total of 130 households representing 460 participants completed the questionnaire. This corresponds to a participation rate of 70% of households (n=130/185) and 82% of persons (n=460/562). The prevalence of upper respiratory symptoms stuffy nose, runny nose, sore or dry throat and sneezing was 5% amongst respondents. A positive association was found between the presence of less than 50% and more than 50% of mould inside the home and upper respiratory symptoms. There was an increased risk of stuffy nose odds ratio (OR): 3.86(1.34 – 11.17), itchy nose OR: 4.28(1.31 – 14.04), and sore throat OR: 6.15(2.35 – 16.15) for persons dwelling in homes with more than 50% coverage of mould compared to homes with less than 50%. A similar association was found between mould and lower respiratory symptoms; wheeze OR: 5.87(2.56 – 13.47), chest tightness OR: 4.72(1.59 – 13.97), shortness of breath OR: 4.55(2.02 – 10.23), and cough OR: 2.92(1.39 – 6.14). This study demonstrates statistically significant associations between home dampness and general symptoms and the presence of mould and upper and lower respiratory symptoms.

Prevalence of GIT Symptoms in Patients of Covid 19

Abstract Background In December 2019, a cluster of patients with pneumonia of undetermined etiology was recognized in Wuhan, Hubei, China. Subsequently, a novel coronavirus (SARS-CoV-2) was identified from lower respiratory tract samples obtained from affected patients. The clinical manifestation of COVID-19 is broad and ranges from asymptomatic and mild upper respiratory tract symptoms to severe illnesses with multiorgan failure and death. Furthermore, it is challenging to predict the clinical course or determine patients at risk of deterioration. Aim of the Work The aim of our study was to assess prevalence of GIT symptoms in patients of covid 19 infected patients Patients and Methods This study was conducted on 100 adult covid 19 patients recently diagnosed by polymerase chain reaction (PCR). All patients were submitted to clinical examination, laboratory testing for ESR, CRP, CBC, and D-dimer. Radiological investigations in the form of CT Chest were be reported by radiologist for all patients. High resolution computed tomography Parenchymal abnormalities on HRCT were assessed. Nasopharyngeal, oropharyngeal and rectal swabs were collected for COVID-19 (PCR) test. All patients received Covid-19 treatment according to protocols of WHO and ministry of health and population, Egypt. Results We found that GI symptoms are prevalent among COVID-19 Egyptian patients (64%). The most common GI symptoms were Nausea, vomiting and diarrhea. We observed that 25 patients (25%) had positive viral RNA in rectal swab. Conclusion Severe COVID-19 was more frequent in older age. Dyspnea and increased respiratory rate were associated with severity of covid 19 infection. Increased CRP and high serum levels of ferritin, d-dimer and lactate dehydrogenase were significantly associated with COVID-19 severity.

Case Report: Bell’s palsy: a neurological manifestation of COVID-19 infection

Background Coronavirus (COVID-19) is the causative agent of the most recent pandemic that hit the globe and has been the cause of a vast range of symptoms, including neurological symptoms. Bell’s palsy is an acute peripheral facial paralysis commonly associated with viral infections. Case presentation This case report describes a patient with incidental COVID-19 infection that led to acute unilateral peripheral facial paralysis, Bell’s palsy. Our patient is a 35-year-old male with no known comorbidities who was presenting with upper respiratory tract infection symptoms and was found to be positive for COVID-19. Soon after the onset of symptoms, he also developed right-sided facial weakness in association with his symptoms. A thorough examination revealed a peripheral neurological lesion. The diagnosis of Bell’s palsy secondary to COVID-19 virus infection was through the exclusion of other possible causes. Conclusions This case report suggests a potential link between Bell’s palsy and COVID-19, highlighting the importance of a comprehensive understanding of the neurological manifestations of COVID-19. Further research is essential to determine the significance of neuropathies in COVID-19 and enhance treatment strategies.

Pneumococcal Colonization in Children With Persistent Asthma: A Retrospective Cohort.

Asthma is the most common chronic medical condition among children ≥5 years of age with invasive pneumococcal disease. How asthma or its management affects pneumococcal colonization is not fully understood. Our objective was to compare pneumococcal colonization rates between children with persistent asthma and children without asthma, and to characterize the pneumococcal serotype distribution. We used nasal mid-turbinate samples obtained per routine care from 5- to 18-year-old children with upper respiratory symptoms from November to April (respiratory seasons) of 2017 to 2018 and 2018 to 2019 in Kansas City, United States. Pneumococcal immunization status, prior antibiotic use and other clinical data were collected. Samples were tested for pneumococcal colonization by real-time polymerase chain reaction targeting lytA gene. Positive samples underwent multiplex serotype-specific polymerase chain reaction assays to determine the serotype. Of 363 children (120 with persistent asthma and 243 without asthma), 87.6% were 5 to 10 years old, 50.1% were female and 74.1% received ≥3 doses of a pneumococcal conjugate vaccine. The pneumococcal colonization rate was lower in children with persistent asthma than in children without asthma (10% versus 18.9%, P = 0.03). The odds of colonization were lower in children with persistent asthma [OR 0.4 (95% confidence interval: 0.2-0.9)] after adjusting for demographic and clinical data. Pneumococcal serotype was confirmed in 77.6% of positive samples; 35.6% of those samples corresponded to PCV13 serotypes and 64.4% to non-PCV13 serotypes. The most common serotypes were 19F (15%), 3 (13%) and 6C/6D (11%). Children with persistent asthma had lower rates of pneumococcal colonization than children without asthma when seeking care for respiratory symptoms.