Symptoms Of Upper Respiratory Infection Research Articles

The impact of pre-transplant respiratory virus detection on post-transplant outcomes in children undergoing hematopoietic cell transplantation.

Pre-transplant respiratory virus (RV) infections have been associated with negative transplant outcomes in adult hematopoietic cell transplantation (HCT) recipients. In the era of HCT delay due to high-risk RVs, we examined the impact of pre-transplant RV detection on transplant outcomes in a pediatric HCT recipients. This retrospective cohort study included myeloablative allogeneic HCT recipients from 2010 to 2019. All patients were screened for RV at least once within 90 days before HCT using RT-PCR, regardless of symptoms. Post-transplant outcomes included days alive and out of hospital (DAOH) and progression to lower respiratory tract infection (LRTI). Among 310 patients, 134 had a RV detected in the 90 days prior to HCT. In univariable analysis, transplant factors including younger age, total body irradiation, umbilical cord blood transplantation, lymphocyte count less than 100/mm3, and HCT comorbidity index score ≥3, and viral factors including symptomatic infection, human rhinovirus (HRV) as a virus type, and symptomatic pre-transplant upper respiratory tract infection (URTI) were associated with fewer DAOH. In multivariable analysis, transplant factors remained significant, but not viral factors. There was a higher incidence of progression to post-transplant LRTI with the same pre-transplant RV if the last positive PCR before HCT was ≤30 days compared to >30 days (p=0.007). In the setting of recommending HCT delay for high-risk RVs, symptomatic URTI, including HRV infections, may lead to increased duration of hospitalization and early progression to LRTI when transplantation is performed within 30 days of the last positive PCR test.

Use, failure, and non-compliance of respiratory personal protective equipment and risk of upper respiratory tract infections-A longitudinal repeated measurement study during the COVID-19 pandemic among healthcare workers in Denmark.

Upper respiratory tract infections (URTI) are common and a common cause of sick-leave for healthcare workers, and furthermore pose a threat especially for patients susceptible to other diseases. Sufficient use of respiratory protective equipment (RPE) may protect both the workers and the patients. The COVID-19 pandemic provided a unique opportunity to study the association between use of RPE and URTI in a real-life setting. The aim of this study was to examine if failure of RPE or non-compliance with RPE guidelines increases the risk of non-COVID-19 URTI symptoms among healthcare workers. In a longitudinal cohort study, we collected self-reported data daily on work tasks, use of RPE, and URTI symptoms among healthcare workers with patient contact in 2 Danish Regions in 2 time periods during the COVID-19 pandemic. The association between failure of RPE or non-compliance with RPE guidelines and URTI symptoms was analyzed separately by generalized linear models. Persons tested positive for severe acute respiratory syndrome coronavirus 2 were censored from the analyses. The 2 waves of data collection were analyzed separately, as there were differences in recommendations of RPE during the 2 waves. We found that for healthcare workers performing work tasks with a risk of transmission of viruses or bacteria, failure of RPE was associated with an increased risk of URTI symptoms, RR: 1.65[0.53-5.14] in wave 1 and RR: 1.30[0.56-3.03] in wave 2. Also non-compliance with RPE guidelines was associated with an increased risk of URTI symptoms compared to the use of RPE in wave 1, RR: 1.28[0.87-1.87] and wave 2, RR: 1.39[1.01-1.91]. Stratifying on high- versus low-risk tasks showed that the risk related to failure and non-compliance was primarily associated with high-risk tasks, although not statistically significant. The study was conducted during the COVID-19 pandemic and thus may be affected by other preventive measures in society. However, this gave the opportunity to study the use of RPE in a real-life setting, also in departments that did not previously use RPE. The circumstances in the 2 time periods of data collection differed and were analyzed separately and thus the sample size was limited and affected the precision of the estimates. Failures of RPE and non-compliance with RPE guidelines may increase the risk of URTI, compared to those who reported use of RPE as recommended. The implications of these findings are that the use of RPE to prevent URTI could be considered, especially while performing high-risk tasks where other prevention strategies are not achievable.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

NON-COVID-19 UPPER RESPIRATORY INFECTION DECREASES DURING THE COVID-19 PANDEMIC

Abstract During the Covid 19 pandemic, the Vista on 5th Assisted Living Facility in New York City instituted a wide variety of pharmacological and non-pharmacological interventions (NPIs) to control the spread of the disease. Before and after vaccines were available for Covid 19, this combination of approaches reduced the usual seasonal variation of non-Covid upper respiratory infections (URIs). Almost all residents of the 127-bed facility were seen by the on-site physician with the onset of URI symptoms. Almost all those with symptoms were give an anti-histamine and cough syrup for relief. The single off-site pharmacy which supplied these medications tabulated the total amount of medications dispensed over the four years of 2019 to 2022. During December of 2019, normally the peak month for URIs at the facility, and the last month before significant Covid infections occurred, 67 prescriptions of these two types were dispensed. During 2020 NPIs and these medications kept new Covid 19 infections to about one dozen over the year. Medications being dispensed for all URIs in December of 2020 decreased by 69% to 21. Similar low rates of URI symptoms were seen in December 2021 and 2022 with only 18 prescriptions written in both months. Although some variation from month to month occurred because of other syndromes, the overall burden of URIs during the normally peak respiratory infection season was greatly reduced probably from the strict imposition of NPIs.

Identifying Causes of Unscheduled Healthcare Interactions and Changes to Patient Disposition in Individuals Receiving Outpatient Commercial Bispecific Antibody Therapy in Relapsed/Refractory Multiple Myeloma (RRMM)

Introduction: Teclistamab is a BCMA targeting bispecific antibody that was FDA approved for treating relapsed/refractory multiple myeloma (RRMM) based off the results of the MajesTEC-1 trial (Usmani S, et al. Lancet 2021, Moreau P, et al. N Engl J Med 2022), and is the first bispecific antibody approved for myeloma treatment. While patients included in the MajesTEC-1 study were monitored closely per trial protocols, little is known about what patient-reported care concerns and education gaps may exist outside of a trial setting with standard of care teclistamab and whether these gaps lead to a high number of unscheduled healthcare interactions. Methods: We retrospectively analyzed patient reported symptom concerns for commercial teclistamab patients at Memorial Sloan Kettering Cancer Center (MSKCC) via review of the electronic health record for a 4-month observation period following treatment initiation. Patients were included in the study if they had a response to teclistamab (per IMWG criteria), remained on treatment for at least 4 months as of our data cut-off (07/20/2023), and did not have evidence of disease progression during the observation period. Collected data included all unscheduled healthcare visits, including urgent care visits, emergency room visits, and hospital admissions. We also evaluated all outpatient communications, including telephone calls to physicians' offices and messages sent to physicians' offices through MSKCC's online patient portal. The total observation period included the first 4 months of therapy, during which patients were scheduled to receive treatment weekly and be seen by their physicians at regular 4-week intervals. Results: We identified 52 patients treated with teclistamab at our center as of the data cut-off, 19 of which met our inclusion criteria. Of note, this population had poorer performance status (89% vs 67% ECOG ≥1) and had more heavily pretreated disease (6 vs 5 median prior lines of therapy) when compared to the MajesTEC-1 population, with the majority not being eligible for MajesTEC-1 per its criteria. Within this population, 79% of patients communicated with their physicians' offices outside of their scheduled monthly appointments, with an average of 2.3 (0-8) communications sent per patient during the 4-month observation period. The most common reason for communication was upper respiratory tract infection (URI) symptoms, accounting for 24% of all communications. Other notable reasons included gastrointestinal (GI) symptoms (20%), disease related pain (13%), injection site reactions (9%) and symptoms of volume overload (9%). Unscheduled visits included 8 urgent care (UC) visits, and 20 emergency department (ED) visits involving 11/19 patients. The 20 ED visits led to 16 inpatient admissions, not including planned admissions for step-up dosing (data summarized in Figure 1), with a median length of stay of 4 days (2-24 days). URI symptoms triggered 50% of UC visits and 40% of the ED visits not leading to inpatient admission, but only accounted for 6% of hospital admissions. The most common cause of hospital admission was a non-URI acute infection (29%). Conclusions: Our data suggest that RRMM patients being treated with outpatient teclistamab have frequent unscheduled healthcare interactions. The high prevalence of URIs in our population indicates that infection rates in this frequently hypogammaglobulinemic patient population may be underreported. However, these do not frequently lead to inpatient admissions or to significant morbidity/mortality. Overall, teclistamab patients would likely benefit from improved patient education with regards to expected side effects of therapy, with pre-existing management plans in place for URIs, GI symptoms, and injection site reactions. Applying these principles may limit excessive healthcare visits for patients, particularly in those with heavily relapsed/refractory myeloma with poor disease prognosis. Data from additional patients, including patients receiving step-up dosing as outpatients as part of a pilot study, will be presented at the meeting.

1687. Unprecedented Outbreak of Invasive group A Streptococcus Infections in Children - Colorado, October 2022 to March 2023

Abstract Background Since the fall of 2022, we have observed a sharp rise in pediatric invasive group A Streptococcus (iGAS) hospitalizations in Colorado, similar to trends reported in other countries. Methods From October 2022 – March 2023, iGAS cases were prospectively identified in patients hospitalized at Children’s Hospital Colorado and medical charts were systematically reviewed. iGAS was defined as isolation of GAS from a sterile site (confirmed case) or a non-sterile site with clinically consistent disease (probable). Using laboratory specimen records, we compared the number of patients with sterile site GAS-positive cultures across three time periods: Pre-COVID-19 (Jan 2015 – Mar 2020), COVID-19 pandemic (Apr 2020 – Sep 2022), and Outbreak (Oct 2022 – Mar 2023). Results Among the 81 iGAS cases identified during the outbreak (Table 1), median age was 6 years old; 64% of patients were male and 69% were previously healthy. 33% of patients required pediatric intensive care unit (PICU) admission, and two patients died. iGAS was more commonly associated with upper respiratory infection (URI) symptoms (63%) than isolated sore throat (5%) or trauma/skin findings (15%). The most common clinical manifestations were head and neck infections (37%), musculoskeletal infections (32%) and pneumonia (20%). 11% had toxic shock syndrome and 4% had necrotizing fasciitis. Lab findings associated with PICU admission were bandemia, leukopenia and higher CRP values. Disease severity and treatment varied by clinical manifestation (Table 2). There were more iGAS cases during the outbreak (average 10.0/month) compared to pre-pandemic years (3.8/month over the same period) and during the pandemic (1.2/month over the same period) (Figure 1). Conclusion We report an unprecedented outbreak of iGAS in pediatric patients in Colorado, with case numbers close to triple the pre-pandemic baseline at our hospital. The timing and high proportion of cases with associated URI symptoms suggest a link to the recent surges in respiratory viruses, although iGAS cases have continued to persist past the peak of respiratory season. Invasive GAS can be severe and evolve rapidly; there are important clinical and laboratory features that may help in earlier identification of children who are critically ill. Disclosures Samuel R. Dominguez, MD, PhD, Biofire Diagnostics: Advisor/Consultant|Biofire Diagnostics: Grant/Research Support|Cobio Diagnostics: Board Member|Karius: Advisor/Consultant|Pfizer: Grant/Research Support

The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial.

Upper respiratory tract infections (URTIs) are caused by bacteria or viruses, with the most common causes being the common cold and influenza. The high occurrence of URTI means therapies that are effective with minimal side effects are in constant demand. Palmitoylethanolamide (PEA) is a signaling lipid previously shown to be effective in improving the incidence of URTIs. The aim of this study was to assess the effectiveness of PEA (Levagen+) on URTI incidence, duration, and severity. Participants (n = 426) consumed either 300 mg of Levagen+ or a placebo (maltodextrin) twice daily for 12 weeks. Participants completed the Wisconsin Upper Respiratory Symptom Survey 24 questionnaire daily upon the commencement of symptoms until symptoms subsided. The Levagen+ group reported fewer URTI episodes (39 vs. 64) compared to the placebo group. The Levagen+ group reported a significant reduction in the median severity score of URTI symptoms for scratchy throat (3 vs. 7) and cough (2 vs. 7) compared to the placebo group. The results of this study show Levagen+ to be safe and effective in reducing the incidence and symptoms associated with URTIs.

Impact of SARS-CoV-2 and Other Upper Respiratory Tract Viral Infections on Reproductive Parameters in Young Healthy Men with Mild Symptoms of Disease

Data regarding excretion of SARS-CoV-2 in semen are inconclusive and counseling regarding risk of sexual transmission is still challenging. Our knowledge on the effect of upper respiratory tract infections (URTI) on male reproductive system is also scarce. Apart from negative effect of fever on spermatogenesis virtually no study has been able to compare reproductive parameters in men with COVID-19 or other URTI with predisease data. Eleven men who developed symptoms of URTI during the first and second wave of COVID-19 pandemic and who had preexistent fertility and hormonal data, participated in the study leaving sperm and blood samples. Three additional subjects were recruited among proven SARS-CoV-2 positive male hospital workers (without previous data). SARS-CoV-2 RNA was present in the ejaculate from 2 of 5 (40%) young men with mild COVID-19. In one of them viral particles could be detected in the semen sample 2 weeks after the first sampling. Men with any URTI showed higher LH ( p = 0.02 ), lower sperm concentration ( p = 0.047 ), and free testosterone ( p = 0.008 ) when compared to their samples delivered 10 years earlier. When SARS-CoV-2 positive subjects were compared to subjects with other URTIs, no difference in levels of reproductive parameters or inflammatory markers was seen. In conclusion, SARS-CoV-2 RNA can be present in the ejaculate but does not seem to affect reproductive parameters any more than other viruses. However, mild URTI was shown to affect the sperm concentration, LH, and free testosterone negatively.

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.

Ingredients of Vicks VapoRub inhibit rhinovirus-induced ATP release.

Over-the-counter therapies, such as Vicks VapoRub, are frequently used in the management of upper respiratory tract infection symptoms. Of these, acute cough is the most bothersome; however, the mechanisms involved have not been fully elucidated. The temperature-sensitive transient receptor potential (TRP) channels, including TRPA1, TRPV1, TRPM8 and TRPV4, are potential candidates. TRPV4 is also thought to be involved in cough through the TRPV4-ATP-P2X3 pathway. Here, we hypothesise that Vicks VapoRub ingredients (VVRIs) modulate the TRP cough channels. Stably transfected HEK cells expressing TRP channels were challenged with VVRIs, individually or in combination, and the agonist and antagonist effects were measured using calcium signalling responses. In addition, rhinovirus serotype-16 (RV16)-infected A549 airway epithelial cells were pre-incubated with individual or combinations of VVRIs prior to hypotonic challenge and extracellular ATP release analysis. Calcium signalling reconfirmed some previously defined activation of TRP channels by specific VVRIs. The combined VVRIs containing menthol, camphor and eucalyptus oil activated TRPV1, TRPV4, TRPM8 and untransfected wild-type HEK293 cells. However, pre-incubation with VVRIs did not significantly inhibit any of the channels compared with the standard agonist responses. Pre-incubation of RV16-infected A549 cells with individual or combined VVRIs, except menthol, resulted in a 0.45-0.55-fold reduction in total ATP release following hypotonic stimulation, compared with infected cells not treated with VVRIs. These findings suggest that some VVRIs may reduce symptoms associated with upper respiratory tract infection by modulating specific TRP receptors and by reducing RV16-induced ATP release.

The anti-infective effect of β-glucans in children.

Background: β-glucans are bioactive β-D-glucose polysaccharides of natural origin, presenting antimicrobial and immunomodulation properties, with a low risk of toxicity. Objectives: This scoping review aims to present the current knowledge on the anti-infective properties of β-glucans in the pediatric population. Methods: We used the PRISMA Extension for Scoping Reviews Checklist to prepare this review. Studies were identified by electronic searches of Pubmed, Embase, and Cochrane databases up to May 2021. Results: The primary search allowed us to find 6232 studies, twelve of which were finally included in the analysis. Eight studies were designed as randomized, placebo-controlled trials, while in four studies the intervention outcome was compared with the pre-intervention period in the same group. The type of preparation and doses varied between studies: in five trials pleuran was administered (in dose 10 mg/5 kg of body weight/day), and in one study baker's yeast β-glucan was used (in two doses: 35mg/day and 75 mg/day). In six other studies, the analyzed preparation comprised β-glucan and other substances. The shortest study lasted seven days, while the most prolonged intervention lasted six months, followed by six months of follow-up. Ten out of twelve trials demonstrated the effectiveness of β-glucans in reducing respiratory tract infection incidence or alleviation of upper respiratory tract infection symptoms. Ten out of twelve studies have reported a good tolerance and safety profile. Conclusions: Good tolerance of β-glucans shows a favorable benefit-risk ratio of this type of intervention. Nevertheless, further monitoring of their efficacy and safety in high-quality research is necessary.

Antibiotic-Prescribing Patterns Among Patients With Respiratory Symptoms in the Eastern Province, Kingdom of Saudi Arabia.

Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests(RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.

Six Weeks of Supplementation with Bovine Colostrum Effectively Reduces URTIs Symptoms Frequency and Gravity for Up to 20 Weeks in Pre-School Children.

Bovine colostrum is considered to provide anti-infective protection. Here, we present the first randomized controlled trial (RCT) aimed at assessing the preventive use of colostrum against upper respiratory tract infections (URTIs) in healthy pre-school children. We analyzed 57 children-35 in the colostrum (COL-dried bovine colostrum) and 22 in the placebo (PBO-dried whey) group, who received these substances as follows: first 15 days 2 × 500 mg and then 30 days 1 × 500 mg. The reporting on the children's health status, specifically on the frequency and gravity of URTI symptoms and abdominal side effects, was performed via an online survey. The influence of colostrum on the frequency of days with URTI symptoms remained significant until the 20th week of observation and reached 31% of median reduction. The median reduction reached 37% when the gravity of symptoms was analyzed. When we grouped symptomatic days into episodes of second gravity level, the reduction in their frequency was even larger (50%) and lasted until the end of the trial (21 weeks). No significant side effects, especially abdominal, were reported during the trial. Colostrum supplementation in pre-school children is well tolerated, safe and provides protection from frequency of URTIs and their gravity.

Nonpharmacological home remedies for upper respiratory tract infections: a cross-sectional study of primary care patients in Switzerland and France.

Many patients might be tempted to use nonpharmacological home remedies (NPHRs) to relieve upper respiratory tract infection (URTI) symptoms. However, primary care physicians (PCPs) rarely recommend NPHRs due to a lack of knowledge in this field. We conducted a questionnaire-based survey among primary care patients in Switzerland and France to explore which NPHRs they use and consider effective for 3 common URTI symptoms: sore throat/cough/common cold. Using official physician registries, we randomly selected 50 PCPs in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants were involved in the recruitment of consecutive patients from the waiting rooms of these PCPs (20-25 patients per practice). Patients were asked to complete a paper-based questionnaire to assess the use and perceived effectiveness of 72 NPHRs for URTI symptoms. The list of NPHRs was developed by our research team with the help of 97 patients. Remedies were considered effective if patients reported that they were effective/very effective. Data were analysed descriptively. Of the 1,198 eligible patients, 1,012 agreed to participate (84.5%). The 4 most frequently used NPHRs were honey/lemon/thyme/herbal teas. Most patients using these NPHRs considered them as effective (between 77% of patients for onion syrup for cough and 94% of patients for thyme inhalations for common colds). Many patients reported using honey/lemon/thyme/herbal teas for URTI symptoms, and generally considered these treatments to be effective. Future research should explore the extent to which these remedies can be safely proposed as alternatives for the symptomatic treatment of ear/nose/throat complaints in primary care.

Looking Back to Move Forward: The Current State of Research on the Clinical Applications of Camphor- and Menthol-Containing Agents.

Topically appliedcompounds containing camphor and mentholhave been used to alleviate pain, cold symptoms, and pruritus, historically predominantlyin East Asia. Being not studied well, they are less recognized in Western medicine. Given the commonality of pain, pruritus, and cold symptoms in addition to the growing need for non-opioid treatment options, the authors investigated clinical applications of such compounds for their over-counter usage. The purpose was to analyze current clinical research and applications regarding the use of these topical agents. This study involved a bibliometric analysis of peer-reviewed articles, published in English and indexed in PubMed from 2010 to 2022, pertaining to camphor- and menthol-containingcompounds. There were 103 results, of which 15 (14.6%) articles were related to the treatment of disorders related to health, such as upper respiratory infection, pain, and pruritus. Excluded were "non-research" articles (e.g., letters to the editor), articles that do not involve human subjects, reports of improper application or misuse (e.g., ingestion), and articles pertaining to intraoral, intranasal, and ophthalmic agents. Of these articles, the originating journals, respective journal impact factor scores, publication years, study designs, and study topics were identified. Underlying trends and themes regarding clinically relevant research on these compounds were subsequently discerned. Based on this analysis, topical agentscontaining camphor and mentholare potentially effective at treating pain, upper respiratory infection symptoms, and pruritus in addition to potentially functioning as an antimicrobial. However, with a limited number of studies addressing these compounds' uses in each application, no definitive recommendation can be made regarding their use. Given the promising results of earlier studies, the authors recommend that more primary research, particularly randomized, double-blind controlled studies, be done regarding clinical applications of thesesubstances.

Probiotics with low dose vitamin C reduce antibiotic prescriptions in children: A secondary analysis of a multicentre randomised double-blind placebo-controlled trial

As part of a randomised, double-blind, placebo-controlled study in children looking at the impact of a combination of a multistrain probiotic and vitamin C on upper respiratory tract infection symptoms, we have explored antibiotic prescription during the study. Antibiotic usage in children for acute respiratory tract infections is quite widespread. In this study the incidence rates for oral antibiotic prescriptions were significantly reduced in the Lab4 probiotic/vitamin C group compared to the placebo; children had a lower risk of being prescribed antibiotics (Risk Ratio: 0.60, 95 % CI: 0.39, 0.94, P = 0.0239, per protocol; Risk Ratio: 0.72, 95 % CI: 0.49, 1.05, P = 0.0890, intention to treat, respectively). These data suggest that supplementation with the probiotic/vitamin C may help to reduce antibiotic prescriptions in children.

Healthy adults supplemented with a nutraceutical formulation containing Aloe vera gel, rosemary and Poria cocos enhances the effect of influenza vaccination in a randomized, triple-blind, placebo-controlled trial.

The study objective was to examine the role of a formulation, UP360, containing rosemary and Poria cocos extracts and Aloe vera gel powder, in healthy adults on supporting immune function with influenza vaccination. A 56-day randomized, triple-blind, placebo-controlled, parallel study consisted of a 28-day pre-vaccination period, an influenza vaccination on Day 28 and a 28-day post-vaccination period. Men and women ages 40-80 who had not yet been vaccinated for the flu were randomized to UP360 or Placebo (n = 25/group). At baseline, Days 28 and 56, blood lymphocyte populations, immunoglobulins (Ig), and cytokines were measured, and quality of life (QoL) questionnaires administered. The Wisconsin Upper Respiratory Symptom Survey (WURSS)-24 was completed daily by participants to measure incidence of upper respiratory tract infection (URTIs). In the post-vaccination period, TCR gamma-delta (γδ+) cells, known as γδ T cells, increased with UP360 supplementation compared to Placebo (p < 0.001). The UP360 group had a 15.6% increase in influenza B-specific IgG levels in the post-vaccination period (p = 0.0006). UP360 significantly increased the amount of circulating glutathione peroxidase (GSH-Px) from baseline at Day 28 (p = 0.0214), an enzyme that is important for neutralizing free radicals. While UP360 supplementation initially decreased levels of anti-inflammatory cytokine IL-1RA in the pre-vaccination period, IL-1RA levels were increased in the post-vaccination period (p ≤ 0.0482). Levels of IL-7 increased from baseline at Day 56 with UP360 supplementation (p = 0.0458). Despite these changes in immune markers, there were no differences in URTI symptoms or QoL between UP360 and Placebo. These results suggest UP360 supplementation was beneficial in eliciting a healthy, robust immune response in the context of vaccination. No changes in subjective measures of URTI illness or QoL demonstrated that participants' QoL was not negatively impacted by UP360 supplementation. There were no differences in clinical chemistry, vitals or adverse events confirming the good safety profile of UP360. The trial was registered on the International Clinical Trials Registry Platform (ISRCTN15838713).

Potential therapeutic effects of adjunct osteopathic manipulative treatments in SARS-CoV-2 patients.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects various human organ systems, including the lymphatic, pulmonary, gastrointestinal, and neurologic systems. The utilization of osteopathic manipulative treatment (OMT) techniques has been clinically effective in the alleviation of various upper respiratory infection symptoms. Consequently, the use of osteopathic manipulative medicine (OMM) in SARS-CoV-2 patients as adjunct treatment can be beneficial in promoting overall recovery. This paper attempts to address the pathophysiology of SARS-CoV-2 infection at the cellular level and its downstream effects. Subsequently, osteopathic principles were investigated to evaluate potential therapeutic effects, providing a holistic approach in the SARS-CoV-2 treatment. Although the association between the benefits of OMT on clinical improvement during the 1918 Spanish influenza pandemic can be seen, further investigation is required to establish a direct correlation between OMT and symptom management in SARS-CoV-2.

Severe Acute Respiratory Syndrome Coronavirus 2 in Infants Younger Than 90 Days Presenting to the Pediatric Emergency Department: Clinical Characteristics and Risk of Serious Bacterial Infection.

There are scant data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in infants younger than 90 days. This study was designed to characterize COVID-19 presentation and clinical course in this age group and evaluate the risk of serious bacterial infection. Data on all SARS-CoV-2-polymerase chain reaction-positive infants presenting to the pediatric emergency department (PED) were retrospectively collected, followed by a case-control study comparing those infants presenting with fever (COVID group) to febrile infants presenting to the PED and found to be SARS-CoV-2 negative (control group). Of the 96 PCR-positive SARS-CoV-2 infants who met the inclusion criteria, the most common presenting symptom was fever (74/96, 77.1%) followed by upper respiratory tract infection symptoms (42/96, 43.8%). Four (4.2%) presented with symptoms consistent with brief resolved unexplained event (4.2%).Among the febrile infants, the presenting symptoms and vital signs were similar in the COVID and control groups, with the exception of irritability, which was more common in the control group (8% and 26%; P < 0.01). The SARS-CoV-2-positive infants had decreased inflammatory markers including: C-reactive protein (0.6 ± 1 mg/dL vs 2.1 ± 2.7 mg/dL; P < 0.0001), white blood cell count (9.3 ± 3.4 × 10 9 /L vs 11.8 ± 5.1 × 10 9 /L; P < 0.001), and absolute neutrophils count (3.4 ± 2.4 × 10 9 /L vs 5.1 ± 3.7 × 10 9 /L; P < 0.001). The rate of invasive bacterial infection was similar between groups (1.4% and 0%; P = 0.31). No mortality was recorded. Although not significantly different, urinary tract infections were less common in the COVID group (7% and 16%; P = 0.07). The SARS-CoV-2 infection in infants aged 0 to 90 days who present to the PED seems to be mostly mild and self-limiting, with no increased risk of serious bacterial infection.

Characterization of viral pathogens associated with symptomatic upper respiratory tract infection in adults during a low COVID-19 transmission period.

The epidemiology of respiratory tract infections (RTI) has dramatically changed over the course of the COVID-19 pandemic. A major effort in the clinical management of RTI has been directed toward diagnosing COVID-19, while the causes of other, common community RTI often remain enigmatic. To shed light on the etiological causes of RTI during a low COVID-19 transmission period in 2021, we did a pilot study using molecular testing for virologic causes of upper RTI among adults with respiratory symptoms from Almaty, Kazakhstan. Adults presenting at two public hospitals with respiratory symptoms were screened using SARS-CoV-2 PCR on nasopharyngeal swabs. A subset of RTI+, COVID-19-negative adults (n = 50) was then tested for the presence of common RTI viruses and influenza A virus (IAV). Next generation virome sequencing was used to further characterize the PCR-detected RTI pathogens. Of 1,812 symptomatic adults, 21 (1.2%) tested SARS-CoV-2-positive. Within the COVID-19 negative outpatient subset, 33/50 subjects (66%) had a positive PCR result for a common community RTI virus, consisting of human parainfluenza virus 3-4 (hPIV 3-4) in 25/50 (50%), rhinovirus (hRV) in 2 (4%), hPIV4-hRV co-infection in four (8%) and adenovirus or the OCR43/HKU-1 coronavirus in two (4%) cases; no IAV was detected. Virome sequencing allowed to reconstruct sequences of most PCR-identified rhinoviruses and hPIV-3/human respirovirus-3. COVID-19 was cause to a low proportion of symptomatic RTI among adults. Among COVID-negative participants, symptomatic RTI was predominantly associated with hPIV and hRV. Therefore, respiratory viruses other than SARS-CoV-2 should be considered in the clinical management and prevention of adult RTI in the post-pandemic era.