Upper Respiratory Tract Research Articles

Performance of rapid antigen tests to detect SARS-CoV-2 variant diversity and correlation with viral culture positivity: implication for diagnostic development and future public health strategies.

Despite the availability of vaccines, COVID-19 continues to be a major health concern, and antigen-based rapid diagnostic tests (Ag-RDTs) are commonly used as point-of-care or at-home diagnostic tests. In this study, we evaluated the performance of two commercially available Ag-RDTs and a research Ag-RDT to detect multiple SARS-CoV-2 variants using upper respiratory tract swab samples from clinical COVID-19 cases. Furthermore, we determined whether Ag-RDT results correlated with culture positivity, a potential proxy of viral transmissibility. Our results have important implications to inform future testing and response strategies during periods of high COVID-19 transmission with new variants.

TERAPI INHALASI SEDERHANA MENGGUNAKAN MINYAK KAYU PUTIH PADA PASIEN ISPA

ARIs is an infectious disease of the upper or lower respiratory tract that can cause a variety of illnesses ranging from mild infections to severe, life-threatening illnesses, depending on the causative pathogen. Deaths due to ARIs were 10 to 50 times more common in developing countries than in developed countries. The aim of this research was to find out whether simple inhalation therapy using eucalyptus oil can prevent acute respiratory infections. In this research, researchers used descriptive methods. The descriptive method is a method for describing the current situation of objects and based on phenomena and as it is without manipulation and the researcher analyzes the phenomenon. This research used a case study method and carries out a series of one group pretest-posttest designs. The results showed differences before and after administering simple inhalation therapy using eucalyptus oil and there were significant differences in people's understanding and knowledge regarding acute respiratory infections after carrying out the pre-test and post-test. The conclusion of this study was that giving simple inhalation therapy using eucalyptus oil can prevent symptoms of acute respiratory infections.

Identifying viral infections through analysis of head space volatile organic compounds

Volatile organic compounds (VOCs) produced by human respiratory cells reflect metabolic and pathophysiological processes which can be detected with the use of modern technology. Analysis of exhaled breath or indoor air may potentially play an important role in screening of upper respiratory tract infections such as COVID-19 or influenza in the future. In this experimental study, air samples were collected and analyzed from the headspace of anin vitrocell culture infected by selected pathogens (influenza A H1N1 and seasonal coronaviruses OC43 and NL63). VOCs were measured with a real-time proton-transfer-reaction time-of-flight mass spectrometer and a differential mobility spectrometer. Measurements were performed every 12 h for 7 d. Non-infected cells and cell culture media served as references. In H1N1 and OC43 we observed four different VOCs which peaked during the infection. Different, individual VOCs were also observed in both infections. Activity began to clearly increase after 2 d in all analyses. We did not see increased VOC production in cells infected with NL63. VOC analysis seems to be suitable to differentiate the infected cells from those which are not infected as well as different viruses, from another. In the future, this could have practical value in both individual diagnostics and indoor environment screening.

Evaluation of nasal mucociliary clearance in patients with psoriasis.

Psoriasis is an autoimmune pathology characterized by chronic inflammation with known multiorgan involvement. In the literature, there are few studies investigating the effects of psoriasis on upper respiratory tract mucosa. Our aim in our study was to investigate the possible effect of psoriasis disease severity and duration on nasal mucosa. A study group was formed from patients with psoriasis and disease duration, Psoriasis Area Severity Index (PASI) and Nasal Obstruction Symptom Evaluation (NOSE) scores of these patients were recorded. Demographic data were noted in all participants with the participation of control group patients, saccharin test was performed to evaluate the nasal mucosa and nasal mucociliary clearance (NMC) times were measured. Psoriasis patients with pathology that may cause nasal obstruction were excluded from the study. A total of 59 people (30 patients and 29 controls) aged 20-65 years were included in the study. There was no difference in age and gender distribution between the two groups. No statistically significant difference in the NMC time between two groups. In the patients group, a correlation was observed between the NMC time to the NOSE test, but no correlation was observed between the NMC time to the duration of the disease and the PASI score. In our study, no difference was observed in NMC time between the two groups and according to the duration or severity of the disease. In addition, NOSE score of patients was also relatively low. No significant impact of psoriasis on nasal functions was found.

Tuberculous meningitis in an intravenous drug user: A case report

Tubercle bacilli can cause tuberculous meningitis by hematogenous spread from a primary focus. A 49-year-old foreign national male patient was admitted to the emergency department with complaints of joint pains, fever, cough and malaise. He was diagnosed with a viral upper respiratory tract infection and discharged after treatment was organised. The patient was admitted again the next day with the complaint of inability to urinate, and suprapubic tenderness was also present on physical examination. The patient's laboratory values, different from the previous day, were determined as WBC:16000/µL CRP:115 mg/L, and he was discharged again after oral treatment. On his 3rd admission to the emergency department, he had complaints of weakness and numbness in the legs and spasm in the neck. It was learned that the patient had a history of intravenous substance use. Following the tests, the patient was initially diagnosed with atypical meningitis and was taken to the intensive care unit. As a result of advanced examinations performed here, the patient was diagnosed with tuberculous meningitis and treated. Patients who experience repeated hospitalisations and exhibit abnormal neurological symptoms should have a thorough physical examination, deeper anamnesis, and considered in the diagnosis that takes uncommon illnesses like atypical meningitis into account.

Therapeutic potential of oral tofacitinib in alopecia areata: a retrospective study

Background: Alopecia areata (AA), a prevalent autoimmune disorder, poses challenges in management, particularly in severe cases. Recent advancements highlight janus kinase (JAK) inhibitors-tofacitinib demonstrating promise. However, the literature reports conflicting information on its safety profile, especially at higher doses, necessitating a comprehensive evaluation. Methods: This retrospective analysis investigates the long-term efficacy and safety of oral tofacitinib in AA patients from January 2017 to October 2022. The study included 69 patients diagnosed with patchy multifocal AA (mfAA), alopecia totalis (AT), alopecia universalis (AU) or alopecia sub-totalis (AS). Data analysis incorporated demographic details, treatment history, autoimmune comorbidities, tofacitinib dosages, prior investigations, recurrence rates, and adverse effects. Efficacy was assessed using severity of alopecia tool (SALT) scores, with a grading system for percentage of hair regrowth. Results: The study comprising of 58% males and 42% females, exhibited varied alopecia types. Treatment response analyzed through percent change in SALT score revealed 46.5% showed very good response to tofacitinib treatment, while 4.3% had excellent response (100% change in SALT score). 44.9% of patients showed no recurrence. Adverse effects were minimal, including acneiform eruptions and upper respiratory tract infections. Pearson correlations revealed age negatively correlated with hair regrowth percentage, suggesting older individuals exhibited lower regrowth responses. Conclusions: Our findings endorse tofacitinib as a promising therapeutic option for the management of AA, with no serious side effects observed even during longer treatment durations. It can be regarded as the primary choice of treatment modality for moderate to severe forms of AA.

Patterns of Viral Pathogens Causing Upper Respiratory Tract Infections in Children Under 13 Years Old: A Retrospective Analysis

Background: Respiratory viral infections strain healthcare globally, accounting for 15% of encounters in the UAE. However, seasonal prevalence in the region remains unclear. This hospitalbased study aims to understand viral causes of upper respiratory tract infections (URTIs) in children under 13, focusing on influenza and RSV. Methods: We conducted a retrospective chart review at Hatta Hospital in Dubai, collecting data from pediatric patients under 13 years old with URTI diagnoses from 2022 to 2023. Nasopharyngeal aspirate samples were analyzed using a multiplex chain reaction (mPCR) assay to identify viral pathogens. Data were collected from the hospital’s emergency department, walk-in clinic, and admitted patients. Results: During the study period, 2714 samples were analyzed, with 1870 (69%) testing positive for any respiratory pathogen. Most infected individuals were males (56.7%), aged between 1 and 3 years (37.9%). Single viral infections were predominant (85.3%), with 27.3% attributed to Human Enterovirus/Rhinovirus, 26.6% to Influenza A, and 10.2% to respiratory syncytial virus (RSV). The RSV season was observed to span from August to December, peaking in October, while Influenza A had semi-seasonal peaks in June and October. Hospital admissions varied significantly between single (21%) and multiple viral infections (27%). Of 340 children hospitalized with single viral infections, 28.2% were infected with Human Enterovirus/Rhinovirus, 16.7% with RSV, and 13.5% with Influenza A. Conclusion: The study provides insights into viral epidemiology among children in the UAE, highlighting the high prevalence and seasonal peaks of viral pathogens. Awareness of these trends can reduce unnecessary streptococcal testing and antibiotic overuse. Understanding the seasonal patterns aids in optimizing prophylactic measures and vaccination strategies for RSV and influenza, benefiting high-risk infants and children.

SHR-1918, a monoclonal antibody against angiopoietin-like 3, in healthy subjects: a randomized, double-blind, placebo-controlled, phase 1 study

Abstract Background Low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) are important risk factors for atherosclerotic cardiovascular disease. Angiopoietin-like 3 (ANGPTL3) is involved in the regulation of lipid metabolism and can increase serum TG and LDL-C levels by reducing their clearance. SHR-1918 is an ANGPTL3 monoclonal antibody developed to inhibit ANGPTL3 activity, thereby reducing the level of TG and LDL-C. Purpose This phase 1 single ascending dose study aimed to assess the safety, tolerability, pharmacokinetics, pharmacodynamics, and immunogenicity of SHR-1918 in healthy subjects. Methods Six dose cohorts were planned, including 100, 300, 450, 750, 900 (optional), and 1200 (optional) mg. For each cohort, 12 healthy subjects were enrolled and randomized (9:3) to receive single subcutaneous SHR-1918 or placebo. Subjects were observed for seven days post-dose and followed up to Day 148 for the 100 mg cohort and Day 190 for the other dose cohorts. The primary endpoints were safety and tolerability. Results A total of 72 subjects were enrolled in the six dose cohorts from 100 to 1200 mg (SHR-1918, n = 54; placebo, n = 18). SHR-1918 was well-tolerated at tested doses. Treatment-emergent adverse events (TEAEs) were reported in 49 (90.7%) subjects in the SHR-1918 group and 17 (94.4%) subjects in the placebo group. The most common TEAEs were upper respiratory tract infection (25.9% with SHR-1918 vs. 27.8% with placebo), protein urine present (22.2% vs. 22.2%), and blood uric acid increased (16.7% vs. 16.7%). All TEAEs were mild or moderate in severity. There were no serious adverse events or TEAEs leading to death. Serum concentration of SHR-1918 generally increased with increasing doses. Maximum serum concentration was reached 8.0 to 10.0 days after injection, and mean t½ was 29.4 to 53.3 days across the dose range. SHR-1918 exposure exhibited in a slightly greater-than-dose-proportional manner from 100 to 1200 mg. Serum LDL-C and TG levels markedly and rapidly decreased in all SHR-1918 dose cohorts and remained under the baseline value up to the end of follow-up period for the higher doses, whereas those in the placebo group were above baseline at most follow-up visits (Figure 1 and 2). In the 750 to 1200 mg cohorts, the largest decline in LDL-C from baseline ranged from -46.5% to -49.1%, and the maximum decrease in TG ranged from -67.4% to -82.8%. On Day 85, there remained to be 36.9% to 39.0% reduction in LDL-C and 59.9% to 79.1% reduction in TG for the higher doses. Anti-drug antibody was not detected in SHR-1918-treated subjects. Conclusions SHR-1918 was well-tolerated and showed promising efficacy in healthy subjects. A phase 2 study has initiated to evaluate SHR-1918 in hyperlipidemic patients (NCT06109831).Serum LDL-C after SHR-1918 injectionSerum TG after SHR-1918 injection

Homo-harringtonine (HHT) is highly effective against SARS-CoV-2-A potential first-line defense in future coronavirus epidemics

Abstract As COVID-19 is the third coronavirus epidemic in this century, it would be desirable to have a treatment scheme in anticipation of a fourth one. We here present a scheme that could clear SARS-CoV-2 in 2-4 days post infection from the upper respiratory tract (URT), where the virions are initially concentrated. The scheme, applicable in large scale by nasal spray, is based on Homo-harringtonine (HHT) that has been approved for treating other diseases. HHT blocked protein elongation and repressed in vitro replication of all 4 coronaviruses (including SARS-CoV-2) tested at the nano-molar concentration, demonstrating its potential of broad effectiveness against coronaviruses. In animal models, HHT cleared SARS-CoV-2 in all treated mice in 3 days by daily nasal dripping of a small dose (40 ug). In December 2022, HHT was administered to 26 cancer patients by nebulization at 1 mg/day. On average, the viral load in the URT was reduced by 3/4 six hours after the nebulization. In the wavelet of May 2023, 11 patients without other medical conditions were administered HHT by repeated liquid nasal spray at the low, total daily-dose of 0.2 mg. Ten of the 11 patients were cleared of the virus in 2-4 days. In comparison, in large-cohort studies of participants in China during the same wave, most patients need 7-9 to turn negative. No adverse effects were detected in any patient in the two clinical trials. A short review of drugs approved for treating COVID-19 shows the many advantages of HHT. With continual development, it could become a first-line defense at the onset of future coronavirus epidemics.

Efficacy of Streptococcus salivarius Blis K12 in the Prevention of Upper Respiratory Tract Infections in Physically Active Individuals: A Randomized Controlled Trial

This study investigates the efficacy of Streptococcus salivarius K12 in preventing upper respiratory tract infections (URTIs) in healthy adults. URTIs are a common issue, particularly in physically active individuals, leading to significant disruptions in daily life. Probiotics, such as S. salivarius K12, have emerged as a potential preventive strategy for these infections. This research was conducted as a randomized, double-blind, placebo-controlled trial involving 112 participants aged between 19 and 25. Participants were randomly divided into two groups: one group received a daily dose of S. salivarius K12, marketed as Bactoblis®, while the other received a placebo. The trial lasted for four months, during which adherence to the treatment protocol was closely monitored. The primary goal was to measure the incidence of URTIs using the Jackson Scale and the Wisconsin Upper Respiratory Symptom Survey (WURSS-11). The results indicated that higher adherence to the S. salivarius K12 treatment was associated with an increased number of days without URTI symptoms. Although the overall severity of symptoms did not differ significantly between the treatment and control groups, those with high adherence to S. salivarius K12 (greater than 90%) reported more days free from illness. In conclusion, S. salivarius K12 demonstrated potential as a preventive measure against URTIs, especially in individuals who adhered strictly to the treatment regimen. However, further research involving larger populations and longer follow-up periods is needed to fully confirm these findings and better understand the role of S. salivarius K12 in preventing respiratory infections.

Interferon as an immunoadjuvant to enhance antibodies following influenza B infection and vaccination in ferrets

Despite annual vaccination, influenza B viruses (IBV) continue to cause significant morbidity and mortality in humans. We have found that IBV infection resulted in a weaker innate and adaptive immune response than influenza A viruses (IAV) in ferrets. To understand and overcome the weak immune responses to IBV in ferrets, we administered type-I or type-III interferon (IFN) to ferrets following infection or vaccination and evaluated their effects on the immune response. IFN signaling following viral infection plays an important role in the initial innate immune response and affects subsequent adaptive immune responses. In the respiratory tract, IFN lambda (IFNL) has regulatory effects on adaptive immunity indirectly through thymic stromal lymphopoietin (TSLP), which then acts on immune cells to stimulate the adaptive response. Following IBV infection or vaccination, IFN treatment (IFN-Tx) upregulated gene expression of early inflammatory responses in the upper respiratory tract and robust IFN, TSLP, and inflammatory responses in peripheral blood cells. These responses were sustained following challenge or vaccination in IFN-Tx animals. Serum IFNL and TSLP levels were enhanced in IFN-Tx animals following challenge/rechallenge over mock-Tx; however, this difference was not observed following vaccination. Antibody responses in serum of IFN-Tx animals following IBV infection or vaccination increased more quickly and to higher titers and were sustained longer than mock-Tx animals over 3 months. Following rechallenge of infected animals 3 months post treatment, antibody levels remained higher than mock-Tx. However, IFN-Tx did not have an effect on antibody responses following challenge of vaccinated animals. A strong direct correlation was found between TSLP levels and antibody responses following challenge-rechallenge and vaccination-challenge indicating it as a useful tool for predicting adaptive immune responses following IBV infection or vaccination. The effects of IFN on strengthening both innate and adaptive responses to IBV may aid in development of more effective treatments following infection and improved influenza vaccines.

The role of the microbiota in respiratory virus-bacterial pathobiont relationships in the upper respiratory tract.

The mechanisms by which respiratory viruses predispose to secondary bacterial infections remain poorly characterized. Using 2,409 nasopharyngeal swabs from 300 infants in Botswana, we performed a detailed analysis of factors that influence the dynamics of bacterial pathobiont colonization during infancy. We quantify the extent to which viruses increase the acquisition of Haemophilus influenzae , Moraxella catarrhalis , and Streptococcus pneumoniae . We provide evidence of cooperative interactions between these pathobionts while identifying host characteristics and environmental exposures that influence the odds of pathobiont colonization during early life. Using 16S rRNA gene sequencing, we demonstrate that respiratory viruses result in losses of putatively beneficial Corynebacterium and Streptococcus species that are associated with a lower odds of pathobiont acquisition. These findings provide novel insights into viral-bacterial relationships in the URT of direct relevance to respiratory infections and suggest that the URT bacterial microbiota is a potentially modifiable mechanism by which viruses promote bacterial respiratory infections.

Epidemiology of human metapneumovirus in Taiwan from 2013 to 2023

Human metapneumovirus (HMPV) is a member of the genus Metapneumovirus in the family Pneumoviridae of the order Mononegavirales that can cause upper and lower respiratory tract disease. This retrospective study describes the epidemiology of hMPV based on community viral surveillance results from sentinel sites across Taiwan from 2013 to 2023. A total of 114 hMPV strains were isolated and analyzed to assess viral evolution through sequencing of their fusion protein genes. This study revealed that hMPV cases occur almost year-round in Taiwan, with a peak occurring during spring (March to May). Of the 114 infected patients, 68.4% were children under 4 years old. The geographical distribution of hMPV positivity was highest in Penghu County, followed by Changhua County and Hsinchu County. The clinical symptoms of hMPV infection are nonspecific, with fever (56.1%), cough (44.7%), rhinorrhea (21.1%), and sore throat (14.9%) being the most common. However, a few patients also developed severe central nervous system symptoms (1.8%) or dyspnea (0.9%). Phylogenetic analysis revealed genetic diversity among the 114 isolated hMPV strains, with the A2 lineage (57.9%) being the most frequently observed, followed by the B2 lineage (33.3%), in the Taiwanese community from 2013 to 2023. In conclusion, hMPV causes a serious acute respiratory disease in Taiwan that should not be neglected. Further epidemiological surveillance and investigations of the clinical characteristics of hMPV should be performed continually for prevention and control of this virus.

Exploring Dual-Targeted Therapy in the Management of Moderate to Severe Inflammatory Bowel Disease: A Retrospective Study

Abstract Background Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), often results in significant morbidity among patients with moderate to severe forms. While biologics and small molecules are effective in inducing remission, many patients experience refractory disease or extra-intestinal manifestations. This study assesses the safety and efficacy of dual-targeted therapy in IBD patients treated at the Inflammatory Bowel Disease Center. Methods This retrospective cohort study examined 79 patients with UC or CD who received dual-targeted therapy at the University from October 2018 to August 2023. Data collected included demographics, disease characteristics, previous treatments, and clinical outcomes. Primary outcomes were endoscopic, radiographic, and patient-reported clinical improvements, with secondary outcomes focusing on safety profiles. Results Among the 79 patients (42 UC, 37 CD), 97 dual-targeted therapy cases were analyzed, primarily involving a biologic combined with a JAK inhibitor (90.7%). The median therapy duration was 39.1 weeks. Endoscopic improvement occurred in 69% of matched samples, with significant differences between pre- and post-dual-targeted therapy Mayo scores for UC (p = 0.002) and SES-CD scores for CD (p = 0.018). The median pre- and post-dual-targeted therapy Mayo scores across matched samples were 3 (range 1-3) and 1 (range 0-3) respectively, and for SES-CD scores were 12 (range 0-36) and 4 (range 0-20) respectively. Clinical improvement was reported by 73.2% of patients, with notable reductions in ESR (median 19 [range 2-124] mm/hr to 9 [range 0-116] mm/hr, p = 0.006), CRP (median 8.0 [range 0.2-78.5] mg/L to 3.0 [range 0.2-68.2] mg/L, p <0.001) , and albumin levels (4.0 [range 2.2-4.9] mg/dL to 4.2 [range 3.4-5.2], p < 0.001). Non-obesity was associated with both more endoscopic improvement (p = 0.002) and clinical improvement (p = 0.007). Adverse events occurred in 37 cases, predominantly upper respiratory tract infections and dermatologic issues, with no thromboembolic events reported. Discussion Dual-targeted therapy demonstrated efficacy in improving clinical and endoscopic outcomes in patients with severe, refractory IBD, and exhibited an acceptable safety profile. Despite the promising results, further research is needed to confirm these findings and determine optimal therapy combinations.

Drone-based infrared thermography to measure the intranasal temperature of baleen whales

ABSTRACT Traditional methods for quantifying the internal temperature of marine mammals require handling live animals, which is not practical for free-swimming baleen whales. Developing a less invasive, more repeatable method would significantly improve our understanding of whale health and thermal physiology. Infrared thermography (IRT) devices compatible with remotely piloted aircraft systems (RPAS) have facilitated qualitative assessments of heat signatures from marine mammals at sea, but absolute temperatures derived using this approach are rare. The goal of this study was to develop a precise empirical method for estimating intranasal temperatures of baleen whales using RPAS-based IRT. We conducted controlled field experiments and flights over North Atlantic right whales (Eubalaena glacialis, NARWs) to develop and test the methodology. Two approaches were evaluated to estimate intranasal temperatures from IRT sensor intensities: a three-point empirical line regression calibrated per flight using known-temperature objects and a generalized linear model incorporating environmental variables. Controlled field experiments demonstrated that the former approach had a median bias of −0.6°C (interquartile range: 1.5ºC), while the latter approach had unexplained negative proportional bias with increasing true temperature of the target object. After accounting for bias, the former approach yielded an average intranasal temperature of 26.9 ± 1.7°C for 21 unique NARWs. The anatomy of the mysticete upper respiratory tract and physiological heat conservation strategies may explain why estimates were low compared to internal temperatures measured from baleen whales using other techniques (30–39ºC). Variability within whales was less than ± 2°C, supporting the use of these methods to monitor the health of individuals over time. However, variability among whales was greater (up to 7ºC). Improvements in our understanding of whale physiology and respiratory mechanics and advancements in RPAS-based IRT calibrations could make this technology more reliable for assessing individual body temperatures and monitoring populations in the future.

Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach.

Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital.

Air quality disparities and respiratory health risks in critically polluted and relatively non-polluted areas: a prospective child health study.

Air pollution, a significant global health concern, notably impacts human well-being. Children, owing to their distinctive physiology and behavior, are particularly susceptible to its adverse effects. This prospective study examines air quality variations and respiratory risks in children residing in critically polluted areas (CPA) compared to relatively non-polluted areas (NPA), utilizing a prospective design to understand the impacts of air pollution on children's respiratory health, including measures like relative risk (RR) and attributable risk (AR). This prospective study tracked 739 students of 5th- 7th grade residing in CPA and NPA for one year, and measured the ambient and indoor air quality levels in both these areas. Throughout the study, based on the observed respiratory symptoms new episodes of upper and lower respiratory tract illnesses were recorded for each child on a weekly basis. Incidence rate, RR and AR for both the illnesses were compared. Statistical analysis was performed with SPSS 26.0. The study observes higher concentration for particulate matter and gaseous pollutants at CPA in comparison to NPA. Children living in CPA exhibited a notably greater weekly occurrence of both upper and lower respiratory tract illnesses compared to those in NPA, with RR of 1.26 (95% CI: 1.16-1.37) and 1.74 (95% CI: 1.34-2.27), respectively. The AR associated with air pollution for upper and lower respiratory tract illnesses among CPA students was found to be 20.7% and 42.7%, respectively. This research underscores the pressing need to address air pollution in critically polluted areas and its profound effects on children's respiratory health. Public health interventions, such as reducing emissions from industries and creating green spaces, should be prioritized. Furthermore, early respiratory health screening in schools within polluted areas could aid in the timely diagnosis and management of respiratory issues in children.

A "plus one" strategy impacts replication of felid alphaherpesvirus 1, Mycoplasma and Chlamydia, and the metabolism of coinfected feline cells.

Coinfections are known to play an important role in disease progression and severity. Coinfections are common in cats, but no coinfection studies have investigated the in vitro dynamics between feline viral and bacterial pathogens. In this study, we performed co-culture and invasion assays to investigate the ability of common feline bacterial respiratory pathogens, Chlamydia felis and Mycoplasma felis, to replicate in and invade into Crandell-Rees feline kidney cells. We subsequently investigated how coinfection of these feline cells with each bacterium (C. felis or M. felis) and the common feline viral pathogen, felid alphaherpesvirus 1 (FHV-1), affects replication of each agent in this cell culture system. We also investigated the metabolic impact of each co-pathogen using metabolomic analysis of infected and coinfected cells. C. felis was able to invade and replicate in CRFKs, while M. felis had little capacity to invade. During coinfection, FHV-1 replication was minimally affected by the presence of either bacterial pathogen, but bacterial replication kinetics were more affected, particularly in M. felis. Both C. felis and M. felis replicated to higher levels in the presence of a secondary pathogen. Coinfections resulted in reprogramming of the glycolysis pathway, the pentose phosphate pathway, and the tricarboxylic acid cycle. The distinct metabolic profiles of coinfected cells compared to those of cells infected with just one of these three pathogens, as well as the impact of coinfections on viral or bacterial load, suggest strong interactions between these three pathogens and possible synergistic mechanisms enhancing virulence that need further investigation.IMPORTANCEIn the natural world, respiratory pathogens coexist within their hosts, but their dynamics and interactions remain largely unexplored. Herpesviruses, mycoplasmas, and chlamydias are common and significant causes of acute and chronic respiratory and system disease in animals and people, and these diseases are increasingly found to be polymicrobial. This study investigates how coinfection of feline cells between three respiratory pathogens of cats impact each other as well as the host innate metabolic response to infection. Each of these pathogens have been implicated in the induction of feline upper respiratory tract disease in cats, which is the leading cause of euthanasia in shelters. Understanding how coinfection impacts co-pathogenesis and host responses is critical for improving disease management.

Unusual onset and course of Crohn’s disease in children

The purpose of the article is to demonstrate a clinical case of Crohn’s disease in an 8-year-old child. Materials and methods: The given clinical example is a case of a non-classical variant of the course of Crohn’s disease in an 8-year-old child who debuted with an upper respiratory tract lesion in combination with abdominal pain against the background of long courses of antibacterial therapy. Conclusion: This clinical case demonstrates the complexity of the diagnostic search, the need for careful history collection and differential diagnosis.

Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, in patients from China mainland, Taiwan, and South Korea with moderate to severe plaque psoriasis: a phase 3 randomized clinical trial.

Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in the United States, European Union, Japan, South Korea, China, and other countries for treatment of moderate-to-severe plaque psoriasis. To evaluate the efficacy and safety of deucravacitinib in Asian patients with moderate to severe plaque psoriasis. In the 52-week, blinded, phase 3 POETYK PSO-3 trial (NCT04167462), patients were randomized 1 : 2 to placebo (n = 74) or deucravacitinib 6 mg once daily (n = 146) for 16 weeks followed by deucravacitinib alone. Coprimary endpoints were achievement of ≥ 75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) and static Physician Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1) at Week 16. Efficacy and safety were evaluated throughout. At Week 16, significantly higher proportions of patients receiving deucravacitinib versus placebo achieved PASI 75 (68.8% vs. 8.1%; P < 0.0001) and sPGA 0/1 (55.6% vs. 6.8%; P < 0.0001). Response rates with deucravacitinib were maintained through Week 52. Common adverse events included upper respiratory tract infection and nasopharyngitis. Serious adverse event and discontinuation rates were low. Deucravacitinib was efficacious and well tolerated in Asian patients with moderate to severe plaque psoriasis.