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Wang B, Zhou J, He B, Shi H, Liang X, Zhang Z, Luo C, Bai C, Ao Y, Yu H, Gu X. Reveal the Patterns of Prescriptions for Recurrent Respiratory Tract Infections' Treatment Based on Multiple Illustrious Senior Traditional Chinese Medicine Practitioners. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:7982927. [PMID: 37275574 PMCID: PMC10234731 DOI: 10.1155/2023/7982927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 06/07/2023]
Abstract
Background Recurrent respiratory tract infections (RRTIs) are one of the most common diseases in children and adolescents. The causes of RRTIs are various. In addition to the factors related to infection, basic diseases such as respiratory system, immune system, and digestive system are also involved. The cost of patients' frequent medical treatment and hospitalization has been deemed to be a heavy burden to the society and family. In China, traditional Chinese medicine (TCM) is commonly used to treat RRTIs. TCM treatment has been appraised to be effective, for reducing the number of hospital stays. Illustrious senior TCM practitioners of pediatrics are recognized as a group of outstanding physicians with significantly better patient outcomes. However, different illustrious senior TCM practitioners can lead to differences in treatment strategies due to factors such as region, prescription theory, and individual differences of patients. This makes it difficult for the experience of illustrious senior TCM practitioners to be popularized. However, there have been no prescription mining studies for the treatment of RRTIs based on different and multiple illustrious senior TCM practitioners. We explored the core prescriptions and drug mechanisms through data mining based on the prescriptions of illustrious senior TCM practitioners treating RRTIs from different clinical settings. This is important to promote the effective treatment of RRTIs with TCM. The objective of this study is to reveal the strategies (core prescriptions) from the prescriptions of multiple illustrious senior TCM practitioners for the treatment of RRTIs. We hope that this core prescription can help all TCM pediatricians to improve RRTIs children's outcome. Meanwhile, it could provide a new way for researchers to study the treatment of RRTIs. Methods In this study, we prospectively collected 400 children's prescriptions with RRTIs receiving TCM treatment from four illustrious senior TCM practitioners in different hospitals. We described and analyzed the characteristics of TCM prescriptions. The prescription regularity was analyzed by hierarchical clustering and association rules. Network pharmacology methods has been used to reveal the pathway mechanism of core prescriptions which have been mined and visualized with the help of SymMap, Genecards, KEGG, Metascape databases, and R. The execution of all methods was completed in May 2022. Results According to RRTIs multiple clinical syndromes, five new prescriptions were obtained based on illustrious senior TCM practitioners. Among them, the prescription composed of Scutellariae radix (Huangqin), Armeniacae semen amarum (Kuxingren), Peucedani radix (Qianhu), and Pheretima (Dilong) is the core strategy for the treatment of RRTIs. Cold herbs and heat herbs in the core prescription are approximately equal. Scutellariae radix (Huangqin) was dominant, and other herbs exert synergistic effects. The core prescription covered 76 pathways and 226 herb-disease genes. It promotes the differentiation of Th1, Th2, and Th17 cells and the secretion of inflammatory factors through toll-like receptor signaling pathway in the immune system, T cell receptor signaling pathway, and PPAR signaling pathway in the endocrine system, thereby exerting immune regulation and anti-inflammation. Conclusion In this study, we revealed the prescription regularity of TCM in the treatment of RRTIs and analyzed the mechanism of core prescriptions, which provided new ideas for the treatment of RRTIs.
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Affiliation(s)
- Bochuan Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jiang Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Bing He
- Dongzhimeng Hospital Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Huiyang Shi
- The Second Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
| | - Xue Liang
- Jilin Academy of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Zhiqiang Zhang
- Beijing Tcmages Pharmaceutical Co., Ltd., Beijing, China
| | - Changyong Luo
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Bai
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yixuan Ao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - He Yu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Gu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Nora ME, Murni IK, Nugroho S, Noormanto N. Predictors of heart failure in children with congenital heart disease. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.6.2022.390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Heart failure continues to be a significant contributor to morbidity and mortality in children with congenital heart disease (CHD). Little is known about heart failure in children. Identifying predictors of heart failure in children with CHD can serve to guide preventive strategies to heart failure.
Objective To understand the predictors of heart failure of children with congenital heart disease.
Methods A nested, case-control study was performed using secondary data based on a prospective study previously conducted in Dr Sardjito Tertiary Hospital in Yogyakarta in years 2011-2013. We included children aged 1 month-18 years who had been diagnosed with CHD by echocardiography. Age, sex, type of CHD, CHD complexity, as well as presence of syndrome, no pulmonary obstruction, pneumonia, and malnutrition were analyzed as potential predictors of heart failure. Results are presented as odds ratios (OR) with 95% confidence intervals (95%CI).
Results A total of 2,646 children were hospitalized in Dr Sardjito Tertiary Hospital during the study period. Congenital heart disease was noted in 216 children (8.16%), 200 (7.5%) of whom met the inclusion criteria. The 100 children with heart failure had median age of 1.5 years and 15% died during hospitalization. Multivariate analysis revealed that acyanotic CHD (OR 2.69; 95%CI 1.45 to 5.00), no pulmonary obstruction (OR 3.05; 95%CI 1.33 to 6.99) and the presence of pneumonia (OR 2.04; 95%CI 1.03 to 4.06) were statistically significant as independent predictors of heart failure in children with CHD. However, sex, age, CHD complexity, as well as presence of a syndrome, and malnutrition were not significantly associated with heart failure in children with CHD.
Conclusion The predictors of heart failure in children with CHD were acyanotic CHD, no pulmonary obstruction, and presence of pneumonia.
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A Brief Review of Local Bacteriotherapy for Preventing Respiratory Infections. ALLERGIES 2022. [DOI: 10.3390/allergies2040013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Recurrent respiratory infections (RRIs) account for relevant economic and social implications and significantly affect family life. Local Bacteriotherapy (LB) represents an innovative option in preventing RRIs. Local bacteriotherapy consists of administering “good” and safe bacteria (probiotics) by nasal or oral route. In particular, two strains (Streptococcus salivarius 24SMB and Streptococcus oralis 89a) are commonly used. The present article presents and discusses the literature concerning LB. Infections of airways include the upper and lower respiratory tract. A series of clinical trials investigated the preventive role of LB in preventing upper and lower RIs. These studies demonstrated that LB safely reduced the prevalence and severity of RIs, the use of antibiotics, and absences from school. Therefore, Local Bacteriotherapy may be considered an interesting therapeutic option in RRI prevention.
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Parisi GF, Manti S, Papale M, Giallongo A, Indolfi C, Miraglia Del Giudice M, Salpietro C, Licari A, Marseglia GL, Leonardi S. Addition of a nutraceutical to montelukast or inhaled steroid in the treatment of wheezing during COVID-19 pandemic: a multicenter, open-label, randomized controlled trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022156. [PMID: 35546018 PMCID: PMC9171851 DOI: 10.23750/abm.v93i2.11958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background and aim: Recurrent wheezing is often triggered by viral respiratory infections. The aims of our study were: i) to evaluate whether the addition of a nutraceutical (Leucodif®), could improve the efficacy of montelukast or inhaled steroids (ICS) compared to the single treatment; ii) to verify whether a treatment is more effective than another. Our study was biased by the COVID-19 pandemic, which resulted in a lockdown of almost two months in Italy. Methods: The multicenter, open-label study enrolled 84 children aged 2–6 years diagnosed with recurrent wheezing and randomized them into four treatment arms for three months: ICS treatment; ii) montelukast; iii) montelukast + Leucodif; iv) ICS + Leucodif. Children were assessed at baseline and after one, two, and three months of treatment using the TRACK score for both the caregiver and the physician. Results: Out of the 84 patients, 18 patients received ICS therapy, 22 patients ICS + Leucodif, 24 patients montelukast, and 20 patients montelukast + Leucodif. All four treatments resulted in a significant reduction in symptoms with no differences among the various groups. Conclusions: Our study demonstrates that montelukast therapy appears to be equally effective as ICS therapy and that the addition of the nutraceutical Leucodif does not appear to improve the treatment outcome. However, in our opinion our study was strongly influenced and biased by the lockdown due to the COVID-19 pandemic, which inherently resulted in reduced exposure to the viruses that commonly cause respiratory infections in children. (www.actabiomedica.it)
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Affiliation(s)
| | - Sara Manti
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Maria Papale
- Department of Clinical and Experimental Medicine, University of Catania.
| | | | - Cristiana Indolfi
- Department of Woman, Child and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | | | - Carmelo Salpietro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatric, University of Messina, "G. Martino" Policlinic, Italy.
| | - Amelia Licari
- Pediatrics Department, Policlinico San Matteo, University of Pavia.
| | | | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania.
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Zhou B, Niu W, Liu F, Yuan Y, Wang K, Zhang J, Wang Y, Zhang Z. Risk factors for recurrent respiratory tract infection in preschool-aged children. Pediatr Res 2021; 90:223-231. [PMID: 33173178 DOI: 10.1038/s41390-020-01233-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/12/2020] [Accepted: 10/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to identify potential risk factors for recurrent respiratory tract infection among Chinese preschool-aged children, and further to construct a nomogram prediction model. METHODS This is a cross-sectional survey conducted in Beijing. Utilizing a stratified cluster random sampling strategy, a total of 7222 children from 20 kindergartens were enrolled. Data are analyzed by STATA software and R language. RESULTS Five independent factors were identified to be significantly associated with recurrent respiratory tract infection risk overall and by pathogenic sites. The significant odds of recurrent respiratory tract infection was 8.31 (95% confidence interval [CI]: 5.69-12.12, P < 0.001), 2.31 (2.06-2.58, P < 0.001), 1.72 (1.48-1.99, P < 0.001), 1.24 (1.08-1.43, P = 0.002), and 1.19 (1.09-1.31, P < 0.001) for asthma, allergy, initial use of antibiotics <6 months, breastfeeding duration <6 months, and maternal body mass index, respectively. Besides the leading role played by asthma, allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility. CONCLUSIONS We have identified five potential risk factors for the risk of recurrent respiratory tract infection from 7222 preschool-aged Chinese children. Notably, asthma plays a leading role, and allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility. IMPACT This is the first report of examining the joint contribution of multiple potential risk factors to recurrent respiratory tract infection among Chinese preschool-aged children. We have identified five potential risk factors for the risk of recurrent respiratory tract infection via analyzing survey data from 7222 preschool-aged Chinese children. Asthma plays a leading role, and allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility.
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Affiliation(s)
- Bo Zhou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,International Medical Services, China-Japan Friendship Hospital, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Fangyu Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,International Medical Services, China-Japan Friendship Hospital, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Kundi Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Yunfeng Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- International Medical Services, China-Japan Friendship Hospital, Beijing, China. .,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
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Di Pierro F, Sagheddu V, Galletti S, Forti M, Elli M, Bertuccioli A, Gaeta S. Antibacterial Activity of a Fractionated Pistacia lentiscus Oil Against Pharyngeal and Ear Pathogens, Alone or in Combination With Antibiotics. Front Microbiol 2021; 12:686942. [PMID: 34220777 PMCID: PMC8247648 DOI: 10.3389/fmicb.2021.686942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
Previous studies have clearly demonstrated that the addition of lentisk oil (LO) to streptococcal cultures makes it possible to differentiate Streptococcus spp. into three categories with Streptococcus mitis and Streptococcus intermedius sensitive, Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus mutans partially sensitive, and Streptococcus salivarius insensitive to the product. We have investigated here whether the winterization of LO, an easy and cheap procedure that removes some of the fatty substances contained within, resulted in a better antimicrobial effect on human pathogens affecting the pharyngeal mucosa and middle ear such as S. pyogenes, S. pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae, without affecting, or minimally affecting, S. salivarius strains, oral probiotics commonly used to reduce oral and middle ear infection recurrence, especially in children. Our results not only demonstrated a stronger antimicrobial action of winterized LO (WLO) on S. pyogenes, compared to what was seen with LO, but also demonstrated a strong antimicrobial action vs. S. pneumoniae and M. catarrhalis and a very limited effect on S. salivarius (strains K12 and M18). Moreover, WLO demonstrated a co-acting action when tested along with the antibiotics amoxicillin (A) and amoxicillin clavulanate (AC), effects clearly visible also on H. influenzae. Our results also showed that at least part of the antimicrobial effect observed was due to the presence of anacardic acids (AAs). Finally, WLO, when tested with human peripheral blood mononuclear cells (h-PBMCs), reduced the release of IL-6 and TNF-α and, in the case of cells stimulated by LPS, the release of IFN-γ. In conclusion, our study highlights an enhanced antimicrobial role for LO when winterized, suggests a co-acting effect of this when given with antibiotics, identifies AAs as possible active ingredients, and proposes a possible anti-inflammatory role for it.
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Affiliation(s)
- Francesco Di Pierro
- Velleja Research, Milan, Italy.,Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Mara Forti
- AAT-Advanced Analytical Technologies, Piacenza, Italy
| | - Marina Elli
- AAT-Advanced Analytical Technologies, Piacenza, Italy
| | | | - Simone Gaeta
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara, Italy
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Ciprandi G, La Mantia I, Damiani V, Passali D. Local Bacteriotherapy - a promising preventive tool in recurrent respiratory infections. Expert Rev Clin Immunol 2020; 16:1047-1052. [PMID: 33022191 DOI: 10.1080/1744666x.2021.1833720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the negative family impact. Local Bacteriotherapy is an attractive therapeutic strategy that could be potentially effective in preventing infections. The current article remarks on the existing evidence of preventing RRI by Local Bacteriotherapy. AREAS COVERED The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. Respiratory infections include rhino-pharyngitis, otitis media, rhinosinusitis, pharyngo-tracheitis, bronchitis, and pneumonia. Several studies were performed to investigate the effects of Local Bacteriotherapy in children with RRI. Both intranasal and oral Local Bacteriotherapy were evaluated. The findings showed that Local Bacteriotherapy significantly reduced the number of RI episodes, their severity, the use of antibiotics, and school absences. EXPERT OPINION Local Bacteriotherapy is a promising approach to RRI prevention and could be a profitable strategy to contrast infections in the future.
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Affiliation(s)
| | | | - Valerio Damiani
- Medical Department, Drugs Minerals and Generics , Pomezia, Italy
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8
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Koumbourlis AC, Belessis Y, Cataletto M, Cutrera R, DeBoer E, Kazachkov M, Laberge S, Popler J, Porcaro F, Kovesi T. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55:2713-2729. [PMID: 32716120 DOI: 10.1002/ppul.24982] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Mary Cataletto
- Division of Pediatric Pulmonary Medicine, New York University, Winthrop University Hospital, Mineola, New York
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Emily DeBoer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver, Children's Hospital Colorado Breathing Institute, Aurora, Colorado
| | - Mikhail Kazachkov
- Department of Pediatric Pulmonology, Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, New York
| | - Sophie Laberge
- Department of Pediatrics, Division of Respiratory Medicine, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Jonathan Popler
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Federica Porcaro
- Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Thomas Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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9
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Varricchio A, La Mantia I, Brunese FP, Ciprandi G. Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies. Ital J Pediatr 2020; 46:18. [PMID: 32039733 PMCID: PMC7008537 DOI: 10.1186/s13052-020-0782-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.
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Affiliation(s)
- Attilio Varricchio
- UOSD Video-Endoscopia delle VAS, P.O. San Gennaro - ASL Napoli 1-centro, Naples, Italy
| | | | | | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Via Boselli 5, 16146, Genoa, Italy.
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10
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Linares NA, Bouchard M, Gutiérrez NS, Colmenares M, Cantor-Garcia A, Gabaldon-Figueira JC, Bellorin AV, Rujano B, Peterson DL, Salmen S. Immunological features in pediatric patients with recurrent and severe infection: Identification of Primary Immunodeficiency Diseases in Merida, Venezuela. Allergol Immunopathol (Madr) 2019; 47:437-448. [PMID: 31371133 DOI: 10.1016/j.aller.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Primary immunodeficiency diseases (PIDs) are disorders associated mainly with recurrent and severe infection and an increase in susceptibility to autoimmune conditions and cancer. In Venezuela, PIDs are underdiagnosed and there is usually a delay in their diagnosis. Hence there are no data concerning the frequency and type of PIDs that occur. The aim of this study was to identify and quantify the types of PIDs that occur in Merida, a population within Venezuela. PATIENTS OR MATERIALS AND METHODS Following an informative program designed to alert local health professionals to the warning signs for PIDs, patients with a history of recurrent infections were referred to the Instituto de Inmunologia Clinica, Universidad de Los Andes. RESULTS AND CONCLUSIONS During the three-year period January 2014 to January 2017, thirty-two cases of PIDs were identified in pediatric patients, and 17 different types of PIDs, were identified. Predominantly antibody deficiencies were most frequent (40.6%), followed by immunodeficiencies affecting cellular and humoral immunity (21.8%), congenital defects of phagocyte (18.7%), CID with associated or syndromic features (9.3%), defects in intrinsic and innate immunity (6.4%) and diseases of immune dysregulation (3.2%). These results have important implications not only to the future approach for management of patients in our regions, but add important knowledge concerning PIDs in Latin America and worldwide.
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Affiliation(s)
- N A Linares
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - M Bouchard
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - N S Gutiérrez
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - M Colmenares
- Centro de Microscopía Electrónica "Dr Ernesto Palacios Prü". Universidad de Los Andes, Mérida, Venezuela
| | - A Cantor-Garcia
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - J C Gabaldon-Figueira
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - A V Bellorin
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela
| | - B Rujano
- Departamento de Pediatría, Instituto Autónomo Hospital Universitario de Los Andes, Merida, Venezuela
| | - D L Peterson
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA, USA
| | - S Salmen
- Instituto de Inmunología Clínica, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela.
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11
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Li X, Li Q, Wang X, Lu M, Shen J, Meng Q. Pidotimod in the treatment of pediatric recurrent respiratory tract infection. Pak J Med Sci 2019; 35:981-986. [PMID: 31372128 PMCID: PMC6659081 DOI: 10.12669/pjms.35.4.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To observe the clinical efficacy of pidotimod in the treatment of recurrent respiratory tract infection in children. Methods: One hundred thirty-two patients with recurrent respiratory tract infection who received treatment in Tianan City Central Hospital were selected and divided into an observation group and a control group using random number table, 66 in each group. Patients in the control group were given conventional treatment, while patients in the observation group were given conventional treatment and pidotimod treatment; the clinical efficacy of the two therapies was compared. The levels of IgG and IgM were measured after treatment. Results: The vital signs and the content of inflammatory mediator and Th1/Th2 in serum before and after treatment were compared, and the clinical efficacy of the two groups was evaluated. The fever, pulmonary rale, cough and antiadoncus of patients in the observation group disappeared earlier than those in the control group (P<0.05). The onset duration of respiratory tract infection and days of antibiotic application of the observation group were shorter than those of the control group after treatment (P<0.05). The times of infection of the observation group were less than that of the control group (P<0.05). Before treatment, the two groups had no significant difference in the content of inflammatory mediators and Th1/Th2 in the serum (P>0.05). The serum content of tumor necrosis factor (TNF)-α and interleukin (IL)-4 of the two groups one week after treatment was lower than that before treatment, and the content of interferon (IFN)-γ and IFN-γ/IL-4 were higher than that before treatment; moreover the observation group had lower serum content of TFN-α and IL-4 and lower content of IFN-γ and IFN-γ/IL-4 compared to the control group (P<0.05). The overall response rate of the observation group was 92.4%, much higher than 81.8% in the control group (P<0.05). Conclusion: Pidotimod has a remarkable efficacy in the treatment of pediatric recurrent respiratory tract infection because it can effectively inhibit the infection and optimize Th1/Th2 immune function.
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Affiliation(s)
- Xia Li
- Xia Li, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Qingfang Li
- Qingfang Li, Department of Pediatric Orthopedics, Taian City Central Hospital, Shandong, 271000, China
| | - Xudong Wang
- Xudong Wang, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Man Lu
- Man Lu, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Jingjing Shen
- Jingjing Shen, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Qingmei Meng
- Qingmei Meng, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
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Siebert JN, Hamann L, Verolet CM, Gameiro C, Grillet S, Siegrist CA, Posfay-Barbe KM. Toll-Interleukin 1 Receptor Domain-Containing Adaptor Protein 180L Single-Nucleotide Polymorphism Is Associated With Susceptibility to Recurrent Pneumococcal Lower Respiratory Tract Infections in Children. Front Immunol 2018; 9:1780. [PMID: 30131804 PMCID: PMC6090034 DOI: 10.3389/fimmu.2018.01780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/19/2018] [Indexed: 12/28/2022] Open
Abstract
Lower respiratory tract infections (LRTI) are often caused by Streptococcus pneumoniae (Spn) and can be recurrent in 8% of children older than 2 years of age. Spn is recognized by pattern-recognition receptors (PRRs) of the innate immune system, in particular toll-like receptors (TLRs) 2 and 4. To assess whether a defect somewhere along this TLR signaling pathway increases susceptibility to recurrent pneumococcal LRTI, we conducted a prospective case-control study with 88 healthy individuals and 45 children with recurrent LRTI aged 2-5 years old. We examined cell surface expression of TLR2 and TLR4, as well as eight genetic variants of these receptors or associated co-receptors TLR1 and TLR6. Interleukin-6 production was measured after whole blood stimulation assays with specific agonists and heat-killed Spn. Our findings reveal that single-nucleotide polymorphisms within toll-interleukin 1 receptor domain-containing adaptor protein (TIRAP) alone or in combination with TLR1 N248S, TLR1 I602S, or TLR6 S249P polymorphisms contributes to various degree of susceptibility to recurrent pneumococcal LRTI in children by modulating the inflammatory response. In that respect, carriage of the TIRAP S180L heterozygous trait increases the likelihood to protect against pneumococcal LRTI, whereas children carrying the mutant homozygous TIRAP 180L polymorphism might be more likely susceptible to recurrent pneumococcal LRTI.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology-Immunology and Pediatrics, Center for Vaccinology and Neonatal Immunology, Geneva Medical Center, Geneva, Switzerland
| | - Lutz Hamann
- Institute of Medical Microbiology and Hygiene, Charité-University Medical Center Berlin, Berlin, Germany
| | - Charlotte M Verolet
- Department of Pediatrics, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Cécile Gameiro
- Flow Cytometry Core Facility, Geneva University Medical Center, Geneva, Switzerland
| | - Stéphane Grillet
- Department of Pathology-Immunology and Pediatrics, Center for Vaccinology and Neonatal Immunology, Geneva Medical Center, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Department of Pathology-Immunology and Pediatrics, Center for Vaccinology and Neonatal Immunology, Geneva Medical Center, Geneva, Switzerland.,Department of Pediatrics, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Department of Pediatrics, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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de Oliveira TB, Klering EA, da Veiga ABG. Is recurrent respiratory infection associated with allergic respiratory disease? J Asthma 2018. [PMID: 29533102 DOI: 10.1080/02770903.2018.1445266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Respiratory infections cause high morbidity and mortality worldwide. This study aims to estimate the relationship between allergic respiratory diseases with the occurrence of recurrent respiratory infection (RRI) in children and adolescents. METHODS The International Study of Asthma and Allergies in Childhood questionnaire and a questionnaire that provides data on the history of respiratory infections and the use of antibiotics were used to obtain data from patients. The relationship between the presence of asthma or allergic rhinitis and the occurrence of respiratory infections in childhood was analyzed. RESULTS We interviewed the caregivers of 531 children aged 0 to 15 years. The average age of participants was 7.43 years, with females accounting for 52.2%. This study found significant relationship between: presence of asthma or allergic rhinitis with RRI, with prevalence ratio (PR) of 2.47 (1.51-4.02) and 1.61 (1.34-1.93), respectively; respiratory allergies with use of antibiotics for respiratory problems, with PR of 5.32 (2.17-13.0) for asthma and of 1.64 (1.29-2.09) for allergic rhinitis; asthma and allergic rhinitis with diseases of the lower respiratory airways, with PR of 7.82 (4.63-13.21) and 1.65 (1.38-1.96), respectively. In contrast, no relationship between upper respiratory airway diseases and asthma and allergic rhinitis was observed, with PR of 0.71 (0.35-1.48) and 1.30 (0.87-1.95), respectively. CONCLUSIONS RRI is associated with previous atopic diseases, and these conditions should be considered when treating children.
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Affiliation(s)
- Tiago Bittencourt de Oliveira
- a Departamento Ciências da Saúde , Universidade Regional Integrada do Alto Uruguai e das Missões-URI , Santo Ângelo , Rio Grande do Sul , Brazil.,b Programa de Pós-Graduação em Patologia , Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , Rio Grande do Sul , Brazil
| | - Everton Andrei Klering
- a Departamento Ciências da Saúde , Universidade Regional Integrada do Alto Uruguai e das Missões-URI , Santo Ângelo , Rio Grande do Sul , Brazil
| | - Ana Beatriz Gorini da Veiga
- b Programa de Pós-Graduação em Patologia , Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , Rio Grande do Sul , Brazil
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Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. Int J Mol Sci 2017; 18:ijms18020296. [PMID: 28146079 PMCID: PMC5343832 DOI: 10.3390/ijms18020296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Adele Corcione
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Ferrara P, Ianniello F, Bianchi V, Quintarelli F, Cammerata M, Quattrocchi E, Terranova GM, Miggiano GA, Casale M. Beneficial therapeutic effects of vitamin C on recurrent respiratory tract infections in children: preliminary data. Minerva Pediatr (Torino) 2016; 73:22-27. [PMID: 27854116 DOI: 10.23736/s2724-5276.16.04621-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to demonstrate whether supplementation of vitamin C has a beneficial effect in the prevention of recurrent respiratory tract infections (RTIs) in children. Moreover, we evaluate the main risk factors that predispose to the development of this disease. METHODS Sixty children have been enrolled in the study and randomized into two groups: the control group (G1 N.=33) and the group at risk of recurrent RTIs (G2 N.=27). To G2 group was administered every day 100% orange juice with the content of vitamin C 70 mg. RESULTS Significant reduction in the incidence rate of RTIs (episodes pre-treatment: 182-6.75 episodes/child, after-treatment: 71-2.62 episodes/child, P<0.05), were observed in G2 group. CONCLUSIONS The administration of vitamin C had a beneficial effect in our group of children with recurrent RTIs, reducing the number of infective episodes.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Sacred Heart Catholic University, Rome, Italy - .,Unit of Pediatrics, Campus Bio-Medico University, Rome, Italy -
| | | | - Virginia Bianchi
- Unit of Food Sciences and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | | | | | | | | | | | - Manuele Casale
- Unit of Otolaryngology, Campus Bio-Medico University, Rome, Italy
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16
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Patria MF, Longhi B, Lelii M, Tagliabue C, Lavelli M, Galeone C, Principi N, Esposito S. Children with recurrent pneumonia and non-cystic fibrosis bronchiectasis. Ital J Pediatr 2016; 42:13. [PMID: 26861259 PMCID: PMC4748602 DOI: 10.1186/s13052-016-0225-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent pneumonia (RP) is one of the most frequent causes of pediatric non-cystic fibrosis (CF) bronchiectasis (BE) and a consequent accelerated decline in lung function. The aim of this study was to analyse the clinical records of children with RP in attempt to identify factors that may lead to an early suspicion of non-CF BE. METHODS We recorded the demographic and clinical data, and lung function test results of children without CF attending our outpatient RP clinic between January 2009 to December 2013 who had undergone chest high-resolution computed tomography ≥ 8 weeks after an acute pneumonia episode and ≤ 6 months before enrolment. RESULTS The study involved 42 patients with RP: 21 with and 21 without non-CF BE. The most frequent underlying diseases in both groups were chronic rhinosinusitis with post-nasal drip and recurrent wheezing (81 % and 71.4 % of those with, and 85.7 % and 71.4 % of those without BE). FEV1 and FEF25-75 values were significantly lower in the children with non-CF BE than in those without (77.9 ± 17.8 vs 96.8 ± 12.4, p = 0.004; 69.3 ± 25.6 vs 89.3 ± 21.9, p = 0.048). Bronchodilator responsiveness was observed in seven children with BE (33.3 %) and two without (9.5 %; p = 0.13). CONCLUSIONS Reduced FEV1 and FEF25-75 values seem associated with an increased risk of developing non-CF BE in children with RP. This suggests a need for further studies to confirm the diagnostic usefulness use of spirometry in such cases.
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Affiliation(s)
- Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Benedetta Longhi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Marinella Lavelli
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy.
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
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Baptista V, Azevedo I, Rio G, Moreira C. Double aortic arch: a cause of stridor to remember. BMJ Case Rep 2015; 2015:bcr-2015-213038. [PMID: 26677157 DOI: 10.1136/bcr-2015-213038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Vera Baptista
- Department of Pediatrics, Hospital de Braga, Braga, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Faculty of Medicine, Centro Hospitalar S João, Oporto, Portugal
| | - Gisela Rio
- Department of Radiology, Hospital de Braga, Braga, Portugal
| | - Carla Moreira
- Department of Pediatrics, Hospital de Braga, Braga, Portugal
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18
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Onakpoya IJ, Hayward G, Heneghan CJ. Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under. Cochrane Database Syst Rev 2015; 2015:CD011530. [PMID: 26408070 PMCID: PMC10624245 DOI: 10.1002/14651858.cd011530.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) in young children account for 1.4 million deaths annually worldwide. Antibiotics could be beneficial in preventing LRTIs in high-risk children, and may also help prevent school absenteeism and work days missed by children and/or carers. While it is well documented that the efficacy of antibiotic prophylaxis for RTIs decreases over time, there are no reviews that describe the use of antibiotic prophylaxis to prevent LRTIs in high-risk children aged 12 years and under. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in the prevention of bacterial LRTIs in high-risk children aged 12 years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1) and the Database of Abstracts of Reviews of Effects (DARE), MEDLINE and MEDLINE In-Process (OvidSP) (1946 to 13 February 2015), EMBASE (OvidSP) (1974 to 12 February 2015), Science Citation Index Expanded (1945 to 13 February 2015) and Conference Proceedings Citation Index-Science (Web of Science Core Collection) (1990 to 13 February 2015). We searched for ongoing studies on ClinicalTrials.gov and the World Health Organization ICTRP. We handsearched the bibliographies of retrieved full texts of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral or intravenous antibiotics versus placebo or no treatment to prevent infections in high-risk children aged 12 years and under. We used a combination of the Centers for Disease Control and Prevention (CDC), National Health Service (NHS), American Academy of Paediatrics (AAP) and National Institute for Health and Care Excellence (NICE) guidelines to define conditions at higher risk of complications. Our primary outcome was the incidence of bacterial lower respiratory infections. Secondary outcomes included clinical function, hospital admission, mortality, growth, use of secondary antibiotics, time off school or parental work, quality of life and adverse events. DATA COLLECTION AND ANALYSIS We extracted data using a customised data extraction sheet, assessed the risk of bias of included studies using the Cochrane 'Risk of bias' criteria, and used the GRADE criteria to rate the quality of the evidence. We used a random-effects model for meta-analysis. We presented the results narratively where we could not statistically combine data. MAIN RESULTS We included 10 RCTs of high-risk children using antibiotics (azithromycin, ciprofloxacin, co-trimoxazole, isoniazid, oral penicillin V or vancomycin) to prevent LRTIs. Three studies included HIV-infected children (n = 1345), four cystic fibrosis (n = 429) and one each sickle cell disease (n = 219), cancer (n = 160) and low birth weight neonates with underlying respiratory disorders (n = 40). The study duration ranged from seven days to three years. The quality of the evidence from studies including children with HIV infection, cystic fibrosis or cancer was moderate. Due to inadequate data, we were unable to rate the quality of the evidence for two studies: one in children with sickle cell disease (low risk of bias), and another in low birth weight neonates with underlying respiratory disorders (high risk of bias).In HIV-infected children receiving continuous isoniazid prophylaxis, there was no significant difference in the incidence of pulmonary tuberculosis (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.32 to 1.29, I(2) statistic = 47%, P value = 0.21). There was no significant effect on mortality with co-trimoxazole or isoniazid prophylaxis (RR 0.82, 0.46 to 1.46, I(2) statistic = 76%, P value = 0.58); however, analysis of one study that used co-trimoxazole showed a significant reduction in mortality (RR 0.67, 95% CI 0.53 to 0.85, P value = 0.001). There was a significant decrease in the rates of hospital admission per child-year of follow-up with co-trimoxazole prophylaxis in one study (P value = 0.01). There was no evidence of increased adverse events due to antibiotic prophylaxis (RR 1.10, 95% CI 0.75 to 1.64, I(2) statistic = 22%, P value = 0.28); however, there was scant reporting of antibiotic resistance - the one study that did assess this found no increase.In two studies of children with cystic fibrosis receiving ciprofloxacin prophylaxis, there was no significant difference in Pseudomonas infections (RR 0.76, 0.44 to 1.31, I(2) statistic = 0%, P value = 0.33). In two studies assessing the benefit of azithromycin prophylaxis, there was a significant reduction in the frequency of pulmonary exacerbations (RR 0.60, 95% CI 0.48 to 0.76, I(2) statistic = 0%, P value < 0.0001). The effect of antibiotic prophylaxis on growth in children with cystic fibrosis was inconsistent across the studies. There was an increased risk of emergence of pathogenic strains with either azithromycin or ciprofloxacin prophylaxis in two studies reporting this outcome. There was no significant difference in the quality of life (one study). In three studies, there was no significant increase in the frequency of adverse events with prophylaxis with azithromycin (two studies) or ciprofloxacin (one study). There was no evidence of increased antibiotic resistance in two studies.In the one study of children with sickle cell disease, a significantly lesser proportion of children with pneumococcal septicaemia was reported with penicillin V prophylaxis (P value = 0.0025).In the one study of children with cancer there was a significant decrease in Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole prophylaxis (RR 0.03, 95% CI 0.00 to 0.47, P value < 0.01). There was no significant increase in the frequency of adverse events with antibiotic prophylaxis.In low birth weight children with underlying respiratory disorders, there was no significant difference in the proportion of children with pulmonary infection with vancomycin prophylaxis (P value = 0.18).No included studies reported time off school or carer time off work. AUTHORS' CONCLUSIONS There is inconclusive evidence that antibiotic prophylaxis in certain groups of high-risk children can reduce pneumonia, exacerbations, hospital admission and mortality in certain conditions. However, limitations in the evidence base mean more clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in children at high risk should be conducted. Specifically, clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in congenital heart disease, metabolic disease, endocrine and renal disorders, neurological disease or prematurity should be a priority.
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Affiliation(s)
- Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK, Oxon
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Zhu G, Zhu J, Song L, Cai W, Wang J. Combined use of biomarkers for distinguishing between bacterial and viral etiologies in pediatric lower respiratory tract infections. Infect Dis (Lond) 2015; 47:289-93. [PMID: 25712729 DOI: 10.3109/00365548.2014.987163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In clinical practice it is often troublesome to discriminate bacterial etiologies from viral etiologies in pediatric lower respiratory tract infections (LRTIs). The aim of this study was to develop an accurate analytic method to improve diagnostic determination for bacterial and viral etiologies in pediatric LRTIs. METHODS A total of 45 children with confirmed bacterial LRTIs and 51 children with viral LRTIs were finally included after assessment of the children visiting the emergency department with a suspected infection and identification of pathogens. C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), CD35, and CD64 were assessed and then the areas under receiver operating characteristic (ROC) curves (AUC) of PCT, IL-6, CD35, and CD64 in combination with CRP were compared to the AUC of CRP alone in all subjects. RESULTS The levels of CRP, PCT, IL-6, CD45, and CD64 observed in children with bacterial LRTIs were statistically higher than for viral infections. The AUC of CRP combined with CD53 (0.963, 95% confidence interval (CI) 0.921-1.002) or CD64 (0.952, 95% CI 0.907-0.998) or CD35/CD64 (0.971, 95% CI 0.932-1.004) increased compared with that of the single biomarker. CONCLUSIONS The combined analysis improved diagnostic accuracy in children with bacterial and viral LRTIs.
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Affiliation(s)
- Guoji Zhu
- Department of Internal Medicine, Soochow University Affiliated Children's Hospital , Soochow , China
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20
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Onakpoya IJ, Hayward G, Heneghan CJ. The use of antibiotics for preventing lower respiratory tract infections in at risk children less than 12 years old. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abolhassani H, Rezaei N, Mohammadinejad P, Mirminachi B, Hammarstrom L, Aghamohammadi A. Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children. Expert Rev Clin Immunol 2015; 11:289-302. [DOI: 10.1586/1744666x.2015.990440] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lemańska-Perek A, Polańska B, Krzyżanowska-Gołąb D, Kątnik-Prastowska I. Occurrence of soluble supra-molecular FN–fibrin complexes in the plasma of children with recurrent respiratory infection. Ann Clin Biochem 2014; 52:441-7. [DOI: 10.1177/0004563214556650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 11/16/2022]
Abstract
Objectives Fibronectin (FN) is able to bind fibrin and FN–fibrin complexes and is found in the plasma of some patients suffering from inflammatory disease. The present study was undertaken to determine whether soluble supra-molecular FN–fibrin complexes were present in the plasma of children with recurrent respiratory infections (RRI). Design and methods The frequency of occurrence and relative amounts of the supra-molecular FN–fibrin forms, concentrations of immunoglobulins and numbers of natural killer cells (NK) were determined in the plasma of children with recurrent respiratory infections. The frequencies of these parameters were compared with their frequencies in the plasma of children with acute respiratory infections and plasma from healthy children. Results SDS-agarose immunoblotting of patients’ plasma revealed the presence of several additional FN–fibrin bands, with decreasing electrophoretic mobilities and increasing molecular masses of 750 kDa, 1000 kDa, 1300 kDa, 1600 kDa and 1900 kDa. Such FN–fibrin complexes occurred with higher frequency and in larger amounts in the plasma of children with RRI and acute infection than they did in plasma from normal children. Moreover, bands above 1000 kDa were absent in most young healthy individuals. The occurrence of FN–fibrin complexes did not correlate with either immunoglobulin concentrations, or with the number of NK cells. Conclusions The occurrence of plasma supra-molecular FN–fibrin complexes is associated with acute and recurrent respiratory infections of children.
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Affiliation(s)
- Anna Lemańska-Perek
- Department of Chemistry and Immunochemistry, Wrocław University of Medicine, Wroclaw, Poland
| | - Bożena Polańska
- 3rd Department and Clinic of Paediatrics, Immunology and Rheumatology of Developmental Age, Wrocław University of Medicine, Wroclaw, Poland
| | | | - Iwona Kątnik-Prastowska
- Department of Chemistry and Immunochemistry, Wrocław University of Medicine, Wroclaw, Poland
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Santiago-Burruchaga M, Zalacain-Jorge R, Vazquez-Cordero C. Are airways structural abnormalities more frequent in children with recurrent lower respiratory tract infections? Respir Med 2014; 108:800-5. [PMID: 24709380 DOI: 10.1016/j.rmed.2014.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED We report bronchoscopic changes observed in children with recurrent lower airways infections (RLAI) and findings in control children undergoing bronchoscopy for causes other than RLAI. PATIENTS AND METHODS Retrospective case-control cohorts study. The clinical records of children who had fiberoptic bronchoscopy (FB) for a history of RLAI without any known underlying disorder between 2007 and 2013 and of control children who required FB for other causes were reviewed. Clinical features, bronchospic findings and bronchoalveolar lavage (BAL) results were assessed. RESULTS Cases were 62 (32 female) children aged 5 years (1-12) and controls 29 children aged 4.5 years (0.5-14). Airway malacia was observed in 32 (52%) vs. 4 (13%) (p = 0.001), profuse respiratory secretions in 34(55%) vs. 6 (20%) (p = 0.007). Endobronchial obstruction: 4 (6.4%) and tracheobronchomegaly were observed only in cases. In cases with profuse respiratory secretions there was a higher prevalence of airways malacia: 64.7% vs. 35.7% (p = 0.04) and of positive BAL cultures: 45.5% vs. 13.3% (p = 0.04). Isolated organisms in cases were non-typable Haemophilus influenzae and Streptococcus pneumoniae most frequently. Pneumocystiis jirovecii, Staphylococcus aureus, and Streptococcus mitis were isolated in controls. CONCLUSIONS Half of the children with RLAI had tracheo and/or bronchomalacia, their frequency being in keeping with previous reports and far higher than that observed in controls. It was associated with profuse respiratory secretions and with a higher frequency of positive BAL cultures mostly for non typable H. influenzae and S. pneumoniae which were not isolated in controls.
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Esposito S, Principi N. Pharmacological approach to wheezing in preschool children. Expert Opin Pharmacother 2014; 15:943-52. [PMID: 24611506 DOI: 10.1517/14656566.2014.896340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Wheezing disorders are very common during childhood (particularly among preschool children), and represent a significant burden for patients, their families, the healthcare system, and society as a whole. Identifying wheezing phenotypes, and recognizing the risk factors associated with each, may help to predict long-term outcomes, distinguish high-risk children who may benefit from secondary prevention measures, and ensure that the most effective therapy is prescribed for each case. AREAS COVERED The main aim of this review is to analyze the characteristics of the drugs currently used to treat wheezing in preschool children, and discuss the results obtained in children with different wheezing phenotypes. EXPERT OPINION The continuous or intermittent administration of various oral or inhaled drugs could theoretically be effective in preventing or controlling wheezing in preschool children. However, the optimal management of acute preschool wheezing episodes has not yet been determined mainly because of their phenotypical heterogeneity.
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Affiliation(s)
- Susanna Esposito
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Pediatric High Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Via Commenda 9, 20122 Milano , Italy +39 02 55032498 ; +39 02 50320206 ;
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Clinical profile of recurrent community-acquired pneumonia in children. BMC Pulm Med 2013; 13:60. [PMID: 24106756 PMCID: PMC3852007 DOI: 10.1186/1471-2466-13-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this case-control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients. METHODS The study involved 146 children with ≥2 episodes of radiographically confirmed CAP in DLA in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. ≤3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes). RESULTS Gestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP. CONCLUSIONS The diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients' history and clinical findings make it possible to limit diagnostic investigations.
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Saad K, Mohamed SA, Metwalley KA. Recurrent/Persistent Pneumonia among Children in Upper Egypt. Mediterr J Hematol Infect Dis 2013; 5:e2013028. [PMID: 23667726 PMCID: PMC3647710 DOI: 10.4084/mjhid.2013.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/10/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Recurrent/persistent pneumonia in children continues to be a major challenge for the pediatricians. The aim of our study was to establish the prevalence and underlying causes of recurrent/persistent pneumonia in children in Upper Egypt. SETTINGS Assiut University Children Hospital, Assiut, Egypt. PATIENTS AND METHODS Patients, admitted for pneumonia to the hospital during 2 years, were investigated with microbiological, biochemical, immunological and radiological tests in order to establish the prevalence of recurrent/persistent pneumonia and to find out its underlying causes. RESULTS 113 out of 1228 patients (9.2%) met the diagnosis of recurrent/persistent pneumonia. Identified causes were; aspiration syndrome (17.7%), pulmonary TB (14.0%), congenital heart disease (11.5%), bronchial asthma (9.7%), immune deficiency disorders (8.8%) and vitamin D deficiency rickets (7.0%). Other causes included; congenital anomalies of the respiratory tract, interstitial lung diseases, bronchiectasis, and sickle cell anemia. No predisposing factors could be identified in 15% of cases. CONCLUSION Approximately 1 out of 10 children with diagnosis of pneumonia in Assiut University Children Hospital had recurrent/persistent pneumonia. The most frequent underlying cause for recurrent/persistent pneumonia was aspiration syndrome, followed by pulmonary TB.
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Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Assiut University, Assiut 71516, Egypt
- Correspondence to: Khaled Saad, Department of Pediatrics, Faculty of medicine, University of Assiut, Assiut 71516, Egypt, Tel +20-106-080-182*, Fax +20-88-236-8371. E-mail:
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