Upper Respiratory Tract In Children Research Articles

Microbiota of the upper respiratory tract in children with chronic adenoiditis

Background. Routine application of the GC-MS method to assess the URT microbiota can potentially improve the efficacy and safety of treatment for chronic respiratory diseases.
 Aim. To perform a comparative analysis of the microbiota from the surface of the pharyngeal tonsil, from the deep parts of the nose, and saliva in children with chronic adenoiditis.
 Materials and methods. The study included 90 patients with chronic adenoiditis (CA) and/or pharyngeal tonsil hypertrophy (PTH). All study participants had swabs taken from the surface of the pharyngeal tonsil, from the deep parts of the nasal cavity, and saliva as a biological fluid of the oral cavity. Microorganisms were identified by specific fatty acids using GC-MS to assess the composition of the microbial community on the surface of the pharyngeal tonsil.
 Results. The study showed that the microbiota of the nasopharynx is identical in its qualitative composition to microorganisms from the deep parts of the nose. However, according to the results of the analysis of microbial markers of saliva, the oral microbiota showed significant differences in the quantitative and qualitative composition of microorganisms compared with the nasopharyngeal microbiota.
 Conclusion. The introduction of the GC-MS method for assessing the URT microbiota enables its monitoring in clinical practice for the treatment of chronic respiratory system diseases without disturbing the ecology of the mucous membranes and the whole body.

Клінічне значення деблокади носового дихання в дітей грудного і раннього віку на тлі гострих респіраторних вірусних інфекцій: переваги ізотонічного розчину морської води

Acute respiratory viral infections (ARVI) are an urgent problem in young children, which is due to their significant prevalence, they have a constant tendency to increase and occupy the first places in the structure of infectious diseases. Damage to the mucous membranes of the upper respiratory tract in children with ARVI lead to numerous problems that require adequate replacement of the main functions of the child’s body, which determined the relevance of our study. Purpose - to analyze the effectiveness of the use of isotonic dilution of sea water (Pshyk Mini medicine) for irrigation therapy in nasal congestion in infants and young children caused by acute respiratory infections. Materials and methods. A comprehensive examination of 100 infants and young children with influenza and other ARVI was conducted in the infectious diseases department of the Chernivtsi Regional Children’s Clinical Hospital. The children were randomly divided into 2 clinical groups: the Group I included 55 children (average age - 1.09±0.3 years, the proportion of boys - 58.1%), who, as part of complex standard therapy, received nasal irrigation using 2-3 drops of Pshyk mini medicine in each nostril 3 times/day. The Group II included 45 patients (average age - 1.15±0.2 years (p>0.05), the proportion of boys - 59.1% (p>0.05)), in whom isotonic sodium chloride solution was used for the purpose of the nasal sanitation. Results. The conducted studies showed that starting from the 3-4th day of hospitalization, a statistically significant decrease in catarrhal manifestations and the severity of nasal obstruction was noted in patients of the Group I who received Pshyk Mini in complex treatment. In particular, in relation to the results of the Group II, in the children of the Group I, on the 4th day of inpatient treatment, the chances of reducing the severity of catarrhal manifestations (estimated ≤2 points) increased: the absolute risk increase - 53.0%, the relative risk increase - 67.9% (95% CI: 57.8-76.9) with the minimum number of patients who need to be treated to obtain a positive result - 1.5. We also established that compared to the representatives of the Group II, children of the Group I had almost a 4-fold increase in the chances of restoring tolerance to feeding (estimation of feeding difficulties ≤2 points): attributive risk - 30.5%, relative risk - 1.6 (95% CI: 0.6-4.8), odds ratio - 3.9 (95% CI: 1.2-12.3). Conclusions. For the purpose of unblocking of nasal breathing in infants and children of early age at the background of acute respiratory viral infections, the use of an isotonic solution of sea water (Pshyk Mini medicine) has a number of significant advantages compared to the use of an isotonic solution of sodium chloride for this purpose. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Possibilities for increasing the effectiveness of treatment of respiratory infections of the upper respiratory tract in children of various age groups

The article discusses the experience of complex therapy of rhinitis and sinusitis in children of various age groups, confirming the effectiveness of the combined effects of local thermotherapy, pulsed red light and low-frequency magnetic field. This combination of physical factors has an anti-inflammatory, decongestant, stimulating local cellular activity effect and helps to increase the effectiveness and reduce the overall treatment time for these diseases. The purpose of the study is to evaluate the effectiveness of the combined use of heat, red spectrum phototherapy and magnetic field in the treatment of children with rhinitis and sinusitis. Materials and methods. The observation included 30 children with rhinitis and 40 children with sinusitis aged 2-18 years, receiving combined physiotherapy procedures as part of the main treatment. Results and its discussion. The positive effect of the combined effects of thermotherapy, pulsed light radiation in the red range and low-frequency magnetic field on clinical symptoms and functional indicators of nasal breathing in children with rhinitis and sinusitis has been confirmed. Conclusions. The use of a course of procedures combined with the effects of local thermotherapy, pulsed red light and low-frequency magnetic field against the background of the main treatment helps to increase the effectiveness of the treatment of respiratory infections of the upper respiratory tract in children of various age groups.

What do you get? Transmission of pneumococcal pneumonia.

Streptococcus pneumoniae is a polysaccharide encapsulated bacterium responsible for the majority of cases of community acquired pneumonia. The upper respiratory tract of children becomes colonized with pneumococci early in life, from the first weeks of life up to 18 months. Factors which influence timing of colonization include geographical localization, socio-economic circumstances, and household conditions. Pneumococcal pneumonia to a degree is a seasonal disease, peaking in the winter months. One of the epidemiological determinants is that viral infections (in particular influenza) predispose for pneumococcal pneumonia. The infectious nature of pneumococcal pneumonia was underscored during the COVID-19 pandemic. Due to societal restrictions imposed (face masks, social distancing) the incidence of invasive pneumococcal disease (IPD) dropped, and returned to pre-COVID-19 numbers after lifting of the restrictions. There are 100 different S. pneumoniae serotypes, based on differences in the capsular polysaccharide. Introduction of protein conjugated polysaccharide vaccines (PCV) has reduced the incidence of IPD in children. Because children are the reservoir for other risk groups, in particular the elderly, introduction of PCV has indirectly also reduced the burden of IPD in latter risk group. The first generation of PCV consisted of the seven most prevalent pneumococcal serotypes. After implementation, replacement colonization of the upper respiratory tract with non-vaccine serotypes was observed and also replacement disease. Upcoming 24-valent PCVs will have a much broader coverage, but whether replacement disease now has been eliminated remains to be seen.

Antimicrobial Resistance in the Upper Respiratory Tract of Children Compared with Adults

Abstract Background Antimicrobial resistance (AMR) is a growing global public health threat. In 2019, resistant bacterial infections and respiratory tract infections were a leading cause of death in children worldwide. While the gut is a known reservoir of AMR genes, there is little data on the AMR burden in the respiratory tract. We used metagenomic RNA next-generation sequencing (mNGS) to describe bacterial AMR genes detected in the upper respiratory tract of children and compare with adults. Methods We leveraged two established cohort studies of children and adults diagnosed with acute respiratory illnesses in the inpatient and outpatient setting in California and Colorado. Nasopharyngeal (NP) swabs were collected between March to September 2020. Specimens underwent RNA extraction and paired-end Illumina sequencing. AMR genes were detected using the ARG-ANNOT database and the CZID pipeline. Children ≤18 years of age and adults≥ 40 years of age were eligible for inclusion in the analysis. We described and compared AMR genes and AMR gene classes detected in children and adults. P-values were calculated using the Wilcoxon rank-sum test. A multiple logistic regression model was fitted to evaluate the association of age cohort (children vs adults) with presence of AMR genes, while accounting for possible confounding from sex and encounter setting. 95% confidence intervals (CI) were calculated using the Wald CI. Results NP swab mNGS data from 236 patients (82 children, 154 adults) were analyzed. Children were a median age of 4 years (range: 0-17 years), and adults were a median age of 62 years (range: 40-89 years). Both cohorts were 50% male. AMR genes were detected in 44 (54%) children and 109 (71%) adults. Genes conferring resistance to beta-lactams (n=112, 47%), macrolides (n=89, 38%), and tetracyclines (n=72, 31%) were the most frequently detected. Among children, children ages 0 to 2 years had a higher number of AMR genes than children of other age groups, particularly when compared with children ages 3 to 10 years (p-value: 0.031) (Figure 1A). When comparing children with adults, children had fewer AMR genes (p-value: 0.014) as well as fewer AMR gene classes (p-value: 0.031) (Figure 1B). In the multiple logistic regression model, children still had lower odds of any AMR genes detected compared with adults (odds ratio: 0.39, 95% CI: 0.21-0.71). Figure 1. Box plots of (A) the number of antimicrobial resistance (AMR) genes detected in children stratified by age, and (B) the number of AMR genes and AMR gene classes detected in children (n=82) and adults (n=154). The size of the individual data points within the box plots correlates with the number of patients at each data point. Conclusion Children had fewer AMR genes and gene classes than adults in their upper respiratory tract microbiome. Despite this, over half of the children had detectable resistance genes, and children 2 years and younger had more AMR genes than other children. Almost half of the children had resistance genes to beta-lactams, the most frequently prescribed antibiotics to children. These findings suggest that presence of AMR organisms in the airway is common even in children, and that continued efforts to reduce AMR burden in this population are essential.

Effect of synthetic folic acid surplus on neurological symptoms in offspring

Background. It has long been known about the need for folic acid for the vital activity of both macro-and microorganisms. It is necessary for the processes of methylation, nucleotide synthesis and also the formation of methionine and reducing the toxic effect of homocysteine. The addition of synthetic folic acid to the diet of pregnant women, as well as at the stage of pre-pregnancy preparation, significantly reduces the risks of fetal neural tube defects, heart defects, and possibly other organs and systems of the body. In addition, folic acid can help improve fertility potential. However, there is evidence of adverse effects of folic acid proficite on the health of older adults (hiding B12-deficient status) and the offspring of mothers taking high doses prescribed by medical specialists like a risks of infectious-inflammatory and allergic diseases of the upper respiratory tract in children, eczema, also disorders of psychomotor development and insulin resistance. In 1980, the direct excitatory effect of folic acid on synaptic transmission in the central nervous system was proved. This is due to the molecular structure, it contains L-glutamate.
 Therefore, the aim of the work was trying to prove the existing correlation data on probable neuropathologies, including a reduced threshold of seizures, a high risk of epilepsy in a model of offspring of Wistar rats with an increased dosage of folate throughout gestation and including at the stage of pre-gravidar preparation.
 Methods. We have determined the ability to the first convulsive act by introducing a 20% solution of caffeine at the rate of 100 mg/kg of weight intraperitoneally.
 Results. In the control group, the average clonus time was 1779.6 seconds, in the experimental group with a 1 mg/kg folic acid per diet dosage of 797.3 seconds, and in the second group with a 5 mg/kg folic acid per diet 439.7 seconds (p 0,01).
 Conclusion. The obtained results of the difference in the convulsive threshold may be due to changes in synaptic density as a result of an excess of synthetic folic acid during the formation of NT and subsequently during the differentiation of nervous tissue in the central nervous system (in particular, in the 3rd trimester with a massive appearance of glutamatergic receptors), which can affect the processes of neurogenesis and the formation of neural networks.

Порушення носового дихання в дітей: причини, наслідки, сучасні погляди на корекцію та профілактику (огляд літератури)

Purpose - to analyze data from scientific sources on the causes, consequences, and current views on the correction and prevention of nasal breathing disorders. The authors have provided and systematized information on the peculiarities of the structure and functioning of the upper respiratory tract in children of various ages. The causes and consequences of nasal breathing disorders have been established. From the standpoint of modern international recommendations, the principles of correction of nasal breathing disorders and expanded views on the possibilities of prevention of diseases of the upper respiratory tract are evaluated. Conclusions. Nasal obstruction in childhood is the most common problem that can lead to negative consequences, and the nasal mucosa in young children needs regular care and hygienic cleaning. The use of the new medical product PSHIK MINI allows for high-quality, effective and safe moisturizing and cleansing of the nasal mucosa of children as a preventive and, if necessary, therapeutic procedure. No conflict of interests was declared by the authors.

Diseases of the upper respiratory tract and their pathogenetic mechanisms in children living under conditions of chronic exposure to aldehydes and aromatic hydrocarbons

Introduction. The problem of diseases of the respiratory system in children in regions with technogenic atmospheric pollution by chemical agents is relevant. 
 The aim of the study was to study the features of the formation of the pathology of the upper respiratory tract, their pathogenetic mechanisms, and causal relationships of clinical, instrumental, and immunological disorders with toxic load in children living under conditions of chronic exposure to phenols and aromatic hydrocarbons of the industrial origin. 
 Materials and methods. one thousand one hundred fifty one 4–13 years children were examined, 883 people made up the observation group and lived in the territory with excess of hygienic standards in the air of phenol, formaldehyde, acrolein, o-xylene. The comparison group consisted of 268 children living in the territory of ecological well-being. The prevalence of pathology of the upper respiratory tract (URT), rhinomanometry, laboratory parameters were assessed, correlation-regression relationships of clinical and laboratory parameters and the concentration of chemicals in the blood were determined. 
 Results. The study established for the first time the relationship between the concentration of chemical compounds in the blood, laboratory and instrumental indicators in children with URT pathology, living in the territory with excess levels of phenol, formaldehyde, acrolein. The total nasal airflow in the observation group was 10-15% lower than in the comparison group and inversely related to the blood concentration of acrolein, o-xylene, phenol, formaldehyde, and the content of IgG specific to phenol, myelopyroxidase, total number of lymphocytes, subpopulations of CD3+CD25+ and CD3+CD95+, integral index of proliferation and frequency of cells with apoptotic bodies and circular notches of the nucleus. 
 Limitations. The results of the study can be extrapolated to 4-13 years children, boys and girls. The study did not include young children or adults. 
 Conclusion. Characteristic features of the pathology of the upper respiratory tract associated with increased levels of acrolein, o-xylene, phenol and formaldehyde in the blood are a decrease in nasal airflow against the background of specific immune-dependent and non-specific inflammation. To reduce the incidence of URT in children, it is necessary to develop programs that include measures aimed at improving the quality of the environment, therapeutic and preventive measures that increase adaptive capacity.

MRNA vaccination induces persistent pharyngeal mucosal B cell responses to SARS-CoV-2 in children

Abstract We recently reported that SARS-CoV-2 infection triggers robust, persistent adaptive immune responses in the tonsils and adenoids of children. However, whether mRNA vaccination induces similar immune responses and how this compares to natural infection in children are unknown. To evaluate these questions, we collected peripheral blood (PBMCs), tonsils, and adenoids from 30 children undergoing tonsillectomy/adenoidectomy primarily in 2022. From questionnaires and serology, we identified 12 vaccinated subjects who had not been infected and compared them to 24 COVID-19 convalescent children from our previous study collected in 2020–2021. We found SARS-CoV-2-specific germinal center and CD27 +switched memory B (B SM) cells, including cells recognizing the spike protein receptor binding domain (RBD) of the original WA-1 strain and RBD from Omicron, in pharyngeal tissues of vaccinated children. PBMCs trended towards having higher percentages of S1 +RBD +B cells post-vaccination than post-infection, while adenoids had more S1 +RBD +B cells post-infection. SARS-CoV-2-specific B SMcells were dominated by IgG isotypes in all tissues, but a higher proportion of IgA +cells were seen post-infection. Furthermore, S1 +RBD +B SMcells showed greater CXCR3 expression post-infection in all tissues. In contrast, S1 +RBD +B SMcells showed higher expression of activation and atypical markers post-vaccination, particularly in PBMCs, implying different characteristics of B cell memory depending on the type of exposure. Our results demonstrate tissue-specific immunity to SARS-CoV-2 in the upper respiratory tract of children after vaccination and provide further evidence that mRNA vaccination induces broad protective B cell memory. This work was supported in part by intramural funds of NIAID, NIH.

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Adaptive immune responses to SARS-CoV-2 persist in the pharyngeal lymphoid tissue of children.

Most studies of adaptive immunity to SARS-CoV-2 infection focus on peripheral blood, which may not fully reflect immune responses at the site of infection. Using samples from 110 children undergoing tonsillectomy and adenoidectomy during the COVID-19 pandemic, we identified 24 samples with evidence of previous SARS-CoV-2 infection, including neutralizing antibodies in serum and SARS-CoV-2-specific germinal center and memory B cells in the tonsils and adenoids. Single-cell B cell receptor (BCR) sequencing indicated virus-specific BCRs were class-switched and somatically hypermutated, with overlapping clones in the two tissues. Expanded T cell clonotypes were found in tonsils, adenoids and blood post-COVID-19, some with CDR3 sequences identical to previously reported SARS-CoV-2-reactive T cell receptors (TCRs). Pharyngeal tissues from COVID-19-convalescent children showed persistent expansion of germinal center and antiviral lymphocyte populations associated with interferon (IFN)-γ-type responses, particularly in the adenoids, and viral RNA in both tissues. Our results provide evidence for persistent tissue-specific immunity to SARS-CoV-2 in the upper respiratory tract of children after infection.

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.

Airways tissue expression of type I interferons and their stimulated genes is higher in children than adults

There is emerging evidence that age-dependent differences in susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) correlate with stronger innate immune response in the upper respiratory tract in children compared to adults. The efficient induction of interferon (IFN) alpha and beta (α and β) signaling, and interferon-stimulated genes (ISGs) is fundamental to the host antiviral response. In-silico transcriptomic analyses was conducted to determine the expression levels of IFN α/β pathway genes as well as 524 human ISGs in upper and lower airways of children and adults at baseline and post respiratory infections including coronavirus disease 2019 (COVID-19). To validate our in-silico analysis, we conducted qRT-PCR to measure ISGs levels in children and adult's nasal epithelial samples. At baseline, children had significantly higher levels of IFN α/β and ISGs genes compared to adults. More distinction was also seen in bronchial compared to nasal basal levels. Children nasal epithelial cells exhibited superior antiviral IFN α/β and associated ISGs response following ex-vivo poly (I:C) treatment model, and in clinical samples of SARS-CoV-2 infected patients. This was also confirmed in nasal epithelial samples using qRT-PCR validation. No gender-based difference in type I IFN levels across both age groups were observed. Understanding the biological basis for children resistance against severe COVID-19 is a challenge that has substantial clinical importance. More mechanistic studies are needed to carefully quantify how much of early IFN levels is needed to bypass the viral evasion mechanism and prevent its further replication and dissemination to lower airways and the rest of the body.

Sore throat in children: diagnosis, treatment, prevention

Introduction. Sore throat often accompanies acute pharyngitis and tonsillitis in both children and adults. Inflammation of the posterior pharyngeal wall, acute pharyngitis, almost never occurs in isolated form in children and is often accompanied by symptoms of acute adenoiditis and / or tonsillitis.Aim. To study the effectiveness of the treatment of exacerbation of chronic non-streptococcal tonsillitis with an antiseptic herbal product in childhood.Materials and methods. We examined 58 children diagnosed with exacerbation of chronic tonsillitis for the period from June 2018 to December 2019. The age of the children ranged from 6 years 4 months up to 14 years old, the average age was 8.3 + 2.4 years, the group included 32 boys (55%) and 26 girls (45%). The duration of the disease ranged from 1 to 5.5 years. The exacerbations of chronic tonsillitis occured 3-4 times a year. The patients included in the study received the antiseptic herbal product in the form of drops at a dose of 15 drops five times/day for 7 days, and then 15 drops three times/day for another 7 days. The course of therapy was 14 days.Results. The provided course of therapy resulted in the significant positive changes overtime: reduced intensity of complaints already at the second visit, significant reduction of complaints at the third visit and actual relief of complaints by the fourth visit in the patients receiving the monotherapy with antiseptic herbal product.Conclusions. Preservation of the normal microbiome of the upper respiratory tract in children maintains effective functioning of MALT and thereby reduces the risk of the development and chronification of inflammation in the oropharynx. The antiseptic herbal medicinal product may be regarded as the alternative to antibiotic therapy in children with exacerbation of chronic tonsillitis, as it has a multifunctional effect on the mucous membranes lining upper respiratory tract, stimulates innate and adaptive immunity, and increases the resistance of mucous membranes to the pathogens.

МЕТА-АНАЛИЗ РАСПРОСТРАНЕННОСТИ АЛЛЕРГИЧЕСКОГО РИНИТА СРЕДИ ДЕТЕЙ, ПРОЖИВАЮЩИХ В ПЯТИ РАЗЛИЧНЫХ ОБЛАСТЯХ ЦЕНТРАЛЬНОГО ФЕДЕРАЛЬНОГО ОКРУГА

Abstract. Allergic rhinitis (AR) is one of the most urgent problems of allergology and immunology, since, despite the improvement in diagnostic and treatment approaches, the number of patients suffering from allergic diseases of the respiratory tract remains very significant. AR is a common allergic disease of the upper respiratory tract in children living in the Moscow, Yaroslavl, Tver, Vologda and Vladimir regions, with a frequency of occurrence in 2021 from 1.472% to 2.684% (mean random effect 2.143 with CI: 1.599-2.763). There is an annual increase in patients with AR in each region, but at the same time, the heterogeneity of the samples allows us to state that in each specific region, the increase in AR occurs under the influence of various risk factors specific to a particular region, ignorance of which leads to an increase in the total number of patients with AR, the number children with late diagnoses, as well as a decrease in the quality of life of patients and their families, which has significant socio-economic consequences. At present, as far as we know, there have been no works devoted to a one-time analysis of statistical data on the assessment of the prevalence and incidence of AR in a multicenter study in Russia.

COVID-19-Associated Croup in Children.

As SARS-CoV-2 has evolved, so has its effects on the pediatric population.1 While early variants typically resulted in lower respiratory infections, the recently identified Omicron variant may exhibit a predilection for the upper airways.2 The relatively smaller upper respiratory tract in children compared to adults has been thought to predispose them to more severe clinical presentations resembling laryngotracheobronchitis, or croup. Caused by viral-induced subglottic airway inflammation, croup is classically characterized by sudden onset "barking cough", inspiratory stridor, and respiratory distress. Endemic coronaviruses have been linked to croup, however only sparse case reports have described croup specifically associated with SARS-CoV-2 and it remains unclear if croup cases constitute a causative relationship or result of co-infection with another virus.3-6 To address this knowledge gap, we performed a retrospective analysis of the incidence and clinical characteristics of croup associated with SARS-CoV-2 infection at a large freestanding children's hospital.

Predominant Bacterial and Viral Otopathogens Identified Within the Respiratory Tract and Middle Ear of Urban Australian Children Experiencing Otitis Media Are Diversely Distributed.

BackgroundOtitis media (OM) is one of the most common infections in young children, arising from bacterial and/or viral infection of the middle ear. Globally, Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are the predominant bacterial otopathogens. Importantly, common upper respiratory viruses are increasingly recognized contributors to the polymicrobial pathogenesis of OM. This study aimed to identify predominant bacteria and viruses in the nasopharynx, adenoids and middle ears of peri-urban/urban South-East Queensland Australian children, with and without clinical history of chronic otitis media with effusion (COME) and/or recurrent acute otitis media (RAOM).MethodsSixty children, 43 diagnosed with OM and 17 controls with no clinical history of OM from peri-urban/urban South-East Queensland community were recruited to the study. Respiratory tract bacterial and viral presence were examined within nasopharyngeal swabs (NPS), middle ear effusions (MEE) and adenoids, using real-time polymerase chain reaction (RT-PCR) and bacterial culture.ResultsAt least one otopathogen present was observed in all adenoid samples, 86.1% and 82.4% of NPS for children with and without OM, respectively, and 47.1% of the MEE from the children with OM. NTHi was the most commonly detected bacteria in both the OM and control cohorts within the adenoids (90.0% vs 93.8%), nasopharynx (67.4% vs 58.8%) respectively, and in the MEE (OM cohort 25.9%). Viruses were detected in all adenoid samples, 67.4% vs 47.1% of the NPS from the OM and control cohorts, respectively, and 37% of the MEE. Rhinovirus was the predominant virus identified in the adenoids (85.0% vs 68.8%) and nasopharynx (37.2% vs 41.2%) from the OM and control cohorts, respectively, and the MEE (19.8%).ConclusionsNTHi and rhinovirus are predominant otopathogens within the upper respiratory tract of children with and without OM from peri-urban and urban South-East Queensland, Australia. The presence of bacterial otopathogens within the middle ear is more predictive of concurrent URT infection than was observed for viruses, and the high otopathogen carriage within adenoid tissues confirms the complex polymicrobial environment in children, regardless of OM history.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF ENT PATHOLOGY IN CHILDREN

Relevance. The insufficiency of studies on the field study of the structure and level of ENT morbidity, which affects the quality and life expectancy of a person in all social and age-sex groups of the population, indicates the relevance of this work.
 Purpose of the study A retrospective analysis of the indicators of the appealability of pediatric patients with ENT pathology.
 Material and research methods. In accordance with the set goal and objectives, the study was conducted in the period 2015-2019. An assessment was made of the condition of the ENT organs in children.
 Results of researches. The obtained data of statistical analysis confirm the high incidence of patients with allergic and catarrhal rhinitis, chronic pharyngitis, sinusitis, inflammatory diseases of the tonsils and adenoid vegetations, etc. Along with the high prevalence of adenoid vegetations, an increase in chronic rhinosinusitis was also observed. On average for 5 years, such diseases of the paranasal sinuses as acute rhinosinusitis 20.7±1.40% and chronic rhinosinusitis 7.8±0.93% prevail. At the same time, the prevalence of injuries to the bones of the nose and nosebleeds decreased during the study period. The data obtained determine the need for timely detection of diseases of the upper respiratory tract in children at the early stages of their development and the organization of measures for systematic dispensary observation.
 Conclusions.
 
 The pathological incidence of ENT diseases in children, being high, nevertheless does not exceed the similar indicators recorded at the final stage of the research.
 In the structure of ENT pathology of preschool age, the leading place belongs to diseases of the ear.
 Considering that the lowest prevalence rates of ENT diseases fall on the last year of observation, further reorganization of ENT care for the children's population and periodic preventive medical examinations with the involvement of certain individuals in medical examinations are necessary.

Особливості перебігу гострих інфекційних захворювань верхніх дихальних шляхів у дитячому віці (огляд літератури)

Описано особливості етіології та клінічного перебігу гострих респіраторних інфекційних захворювань верхніх дихальних шляхів у дітей порівняно з дорослими, оцінено особливості їх клінічних проявів, диференціальної діагностики, тактики ведення та ускладнень у дитячому віці

Assessment of the population health risk under the impact of climatic factors in the territory of St Petersburg

In recent years, climate change has been considered one of the leading factors affecting the health of the population, one of the conditions for the implementation of this concept for specific risk factors in St Petersburg is the development and use of adequate methods. In this work, as a methodological basis for assessing the state of health of the population, taking into account climatic conditions, the methodology of MR 2.1.10.0057-12 “The state of health of the population in connection with the state of the environment and living conditions of the population. Assessing the risk and damage from climate change affecting the increase in morbidity and mortality in high-risk population groups. Guidelines” was used. The presence of statistically significant correlations between the effective air temperature in St Petersburg and the primary incidence of diabetes mellitus in people older than working age has been established (Spearman rank correlation coefficient –0.829, p = 0.042); primary incidence of acute respiratory infections of the upper respiratory tract in children 0–14 years old (Spearman rank correlation coefficient –0.886, p = 0.019); primary incidence of chronic obstructive pulmonary disease in children 15–17 years (Spearman rank correlation coefficient –0.943, р = 0.005). The presence of established direct and inverse statistically significant correlations can be explained logically based on modern ideas about the impact of climatic parameters on human health, however, in this case, the logical connection seems doubtful due to the highest deviation of the average annual air temperature from the norm in 2020 and the pandemic of a new coronavirus infection COVID-19. Therefore, a decrease in morbidity (in the case of a negative correlation) can be explained by a reduction in planned medical care.