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Corsello A, Milani GP, Picca M, Buzzetti R, Carrozzo R, Gambino M, Chiaffoni G, Marchisio P, Mameli C. Recurrent upper respiratory tract infections in early childhood: a newly defined clinical condition. Ital J Pediatr 2024; 50:30. [PMID: 38365783 PMCID: PMC10873936 DOI: 10.1186/s13052-024-01600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/27/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Recurrent Upper Respiratory Tract Infections (R-URTIs) pose a significant challenge in pediatric healthcare, affecting both children and their families. This study aimed to investigate the prevalence, risk factors, and clinical implications of R-URTI in children aged 0-5 years. METHODS This observational study involved a sample of 483 children aged 0-5 years, focusing on establishing a practical and dynamic definition of R-URTI. Family pediatricians prospectively collected socio-demographic information, medical history, and recorded the occurrence of URTI episodes. Children were followed from recruitment until March 2021, predating the COVID-19 outbreak. RESULTS A substantial prevalence of R-URTIs was found, estimating it at 5-10% among this age group. To define R-URTI, a practical and dynamic criterion was proposed: children experiencing a minimum of four URTI episodes, each lasting four days or more, within a six-month period, with intervals of well-being in between. CONCLUSIONS The study highlighted that specific risk factors for R-URTI were elusive, suggesting that this condition may affect children regardless of their family or clinical history. Moreover, the study's stratification by age group and times of observation facilitated patient-specific clinical decision-making. The proposed definition may represent a valuable tool for clinicians in diagnosing and addressing R-URTI cases.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Picca
- Italian Primary Care Paediatrics Society (SICuPP), Lombardy, Italy
| | | | - Romeo Carrozzo
- Italian Primary Care Paediatrics Society (SICuPP), Lombardy, Italy
| | - Mirko Gambino
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Giovanni Chiaffoni
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Milan, Italy
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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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Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, Bloom DE, Cannon JW. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. EClinicalMedicine 2022; 48:101458. [PMID: 35706486 PMCID: PMC9124702 DOI: 10.1016/j.eclinm.2022.101458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Contemporary data for the global burden of sore throat and group A Streptococcus (Strep A) pharyngitis are required to understand the frequency of disease and develop value propositions for Strep A vaccines. METHODS We used Clarivate Analytics' Web of Science platform to search WoS core collection, PubMed, Medline, data citation index, KCI-Korean Journal Database, Russian Science Citation Index, and the SciELO Citation Index for articles published between Jan 1, 2000, and Feb 15, 2021, from any country and in any language. The risk of bias was assessed using the JBI critical appraisal checklist. We used random-effects meta-analyses to pool sore throat and Strep A sore throat incidence rates from community-based studies. Our study was registered with PROSPERO (CRD42020181103). FINDINGS Of 5,529 articles identified by the search strategy, 26 studies met the inclusion criteria, but only two included data to determine incidence among adults. The pooled incidence rate, calculated for children only, was 82.2 episodes per 100 child-years (95% CI 25.2-286.3, I2 = 100%) for sore throat (7 studies; 7,964 person years) and 22.1 episodes per 100 child-years (95% CI 14.7-33.1, I2 = 98%) for Strep A sore throat (9 studies; 15,696 person years). The pooled cumulative incidence rate of sore throat from five studies was 31.9 per 100 children. There was significant methodological and statistical heterogeneity among studies, and five of 26 studies had a risk of bias score less than five (range: nine [maximum score] to one). INTERPRETATION Strep A sore throat has a considerable global burden. However, methodologically standardised studies are required to quantify that burden, analyse differences in rates between populations, and evaluate the likely impact of future Strep A vaccines. FUNDING This study was funded by Wellcome Trust 215,490/Z/19/Z.
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Affiliation(s)
- Kate M. Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Corresponding author.
| | - Jonathan R. Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Daniel Cadarette
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica N. Daw
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey W. Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Zhang L, Wang X, Wang D, Guo Y, Zhou X, Yu H. Adjuvant treatment with yupingfeng granules for recurrent respiratory tract infections in children: A systematic review and meta-analysis. Front Pediatr 2022; 10:1005745. [PMID: 36619520 PMCID: PMC9811950 DOI: 10.3389/fped.2022.1005745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Yupingfeng granules (YPFG) contribute to various chronic respiratory infections. Several clinical studies have evaluated its efficacy and safety in treating recurrent respiratory tract infections (RRTIs) in children. However, the evidence for its use has not been conclusively proven. OBJECTIVE The aim of this study was to demonstrate the efficacy and safety of YPFG in the adjuvant treatment of RRTIs in children. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, Chinese Clinical Trial Registry, Sinomad, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Scientific Journals Database (VIP) for randomized controlled trials (RCTs) of YPFG adjuvant therapy for children with RRTIs as of September 1, 2022. We screened the literature for inclusion and exclusion criteria, assessed the quality of each included literature, and then extracted data from each study for this systematic review and meta-analysis. RESULTS A total of 17 RCTs were included. Data analysis showed that the total clinical response rate in the YPFG group was significantly higher than that in the control group [risk ratio (RR) = 1.18, 95%CI (1.12, 1.24), I 2 = 39%, P < 0.00001]. Compared with the control group, three serum immunoglobulin levels were significantly increased in the YPFG group: IgA level [standardized mean difference (SMD) = 1.23, 95%CI (0.68, 1.78), I 2 = 95%, P < 0.0001]; IgM level [SMD = 0.85, 95%CI (0.35, 1.35), I 2 = 93%, P = 0.0009]; IgG level [SMD = 1.06, 95%CI (0.65, 1.47), I 2 = 91%, P < 0.00001]. The TNF-α level was significantly lower in the YPFG group [SMD = -1.03, 95%CI (-1.55, -0.51), I 2 = 84%, P = 0.0001] compared with the control group. CONCLUSIONS In summary, adjuvant YPFG therapy improves clinical efficacy and immunity in children with RRTIs. However, the effectiveness and safety of YPFG remain to be further verified. SYSTEMATIC REVIEW REGISTRATION [https://inplasy.com/inplasy-2022-3-0150/], identifier [INPLASY202230150].
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Affiliation(s)
- Lu Zhang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuqiong Wang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dong Wang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yinling Guo
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinying Zhou
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haiyan Yu
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Georgountzou A, Kokkinou D, Taka S, Maggina P, Lakoumentas J, Papaevangelou V, Tsolia M, Xepapadaki P, Andreakos E, Papadopoulos NG. Differential maturation trajectories of innate antiviral immunity in health and atopy. Pediatr Allergy Immunol 2021; 32:1843-1856. [PMID: 34288122 DOI: 10.1111/pai.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The maturation of innate immune responses in health and atopy is still incompletely understood. METHODS We aimed to evaluate age-related trajectories of the TLR3 and TLR7/8 pathways from birth to adulthood and whether these differ between healthy and atopic individuals. Peripheral blood mononuclear cells (PBMCs) were isolated from 39 otherwise healthy, atopic and 39 non-atopic subjects, aged 0-45 years. Selected cytokines involved in antiviral responses were measured by Luminex in culture supernatants of poly(I:C)- and R848-stimulated PBMCs. The non-parametric correlation between age and cytokine expression and differences in developmental trajectories between healthy and atopic subjects were estimated. Patterns of cytokine development were identified with principal component analysis. RESULTS Normal innate immune maturation entails significant and progressive age-related changes in the production of IL-1β, TNF-α, MIP-1β, MCP-3, IP-10, IL-10, IL-12p70, and IFN-γ upon TLR3 and/or TLR7/8 stimulation. Individual cytokines made small contributions to the observed variability; chemokines MCP-3 and IP-10 were key contributors. The development of these pathways deviated in atopic subjects with significant differences observed in the trajectories of IL-1β, MIP-1β, and IL-10 syntheses. CONCLUSION TLR3 and TLR7/8 pathways mature during childhood, while atopy is associated with an abnormal maturation pattern. Suboptimal responses in Th1, inflammatory cytokine, and chemokine production may be implicated in poor antiviral immunity in atopics. Moreover, the deficient maturation of IL-10 synthesis may be implicated in the breaking of tolerance, characterizing the onset of atopic disease.
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Affiliation(s)
- Anastasia Georgountzou
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Kokkinou
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Stella Taka
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Maggina
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lakoumentas
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Athens, Greece
| | - Maria Tsolia
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Paraskevi Xepapadaki
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Evangelos Andreakos
- Department of Immunology, Center for Translational and Clinical Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy and Clinical Immunology Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Inflammation and Respiratory Medicine, University of Manchester, Manchester, UK
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Ear Infection Trajectories and Academic, Behavioral, and Quality-of-Life Outcomes: A Population-Based Longitudinal Study. J Dev Behav Pediatr 2021; 42:588-596. [PMID: 34518499 DOI: 10.1097/dbp.0000000000000931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate (1) typical trajectories of parent-reported ear infections throughout childhood and (2) their associations with child outcomes. METHOD Design and participants: Two parallel cohorts assessed biennially from 2004 to 2014 spanning ages 0-1 to 10-11 years (B cohort, n = 3721) and ages 4-5 to 14-15 years (K cohort, n = 3489) in the Longitudinal Study of Australian Children. Ear infection: Parent-reported ongoing ear infections (B: waves 1-6; K: waves 1, 2, 4, and 5). Outcomes (wave 6): National academic standardized test, teacher-reported learning, parent- and teacher-reported behavior, and self-reported quality of life. Analysis: Latent class models identified ear infection trajectories. Linear regression quantified associations between trajectories and outcomes. RESULTS Four probability trajectories of ear infections emerged in both cohorts: "consistently low" (B 86.2%, K 87.0%), "moderate to low" (5.5%, 9.7%), "low to moderate" (7.0%, 1.5%), and "consistently high" (1.4%, 1.8%). In K cohort, the "consistently high" group had the worst outcomes (effect sizes 0.2-0.8 SDs), with effect sizes largest for psychosocial and language outcomes. "Moderate to low" and "low to moderate" groups showed marginal to no academic associations, although behavior and quality-of-life scores were 0.2 to 0.3 SDs poorer than the "consistently low" group. Similar but attenuated associations were seen in B cohort. CONCLUSION Sizable adverse adolescent outcomes follow parent reports of persistent ongoing ear infections throughout childhood. Despite a possibility of reverse causation, this suggests that cumulative rather than age-specific ear infections are most important to outcomes. Clinicians may generally be reassuring about ongoing ear infections limited to either early or middle childhood but should proactively identify and manage the small subgroup whose early infections persist throughout the elementary school years.
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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: 13] [Impact Index Per Article: 4.3] [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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Adeyemo A, Ogunkeyede S, Dania O. Hearing healthcare gaps in LMICS: snapshot from a semi-urban community in Nigeria. Afr Health Sci 2021; 21:912-918. [PMID: 34795751 PMCID: PMC8568223 DOI: 10.4314/ahs.v21i2.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Low and middle-income countries (LMICs) have high prevalence of hearing loss which are mainly due to preventable causes. While urban communities in LMICs are likely to have functional hearing healthcare delivery infrastructure, rural and semi-urban communities may have different reality. OBJECTIVES This study aimed to provide: (i) a snapshot of the burden of ear diseases and (ii) a description of available hearing healthcare resources in a semi-urban Nigerian community. METHODS A cross-sectional study of households selected by multistage random sampling technique. Seventy-four participants: 39 males and 35 females with mean age of 34 years ± 5.24 were recruited and answered a structured questionnaire. In addition, the availability of hearing healthcare services in 15 health centers within the community were determined. RESULTS All participants reported recent occurrence of ear complaints or gave similar history in a household member. Common complaints were ear discharge, ear pain and hearing loss. Medical intervention was sought from patent medicine stores, hospitals and traditional healers. None of the assessed hospitals within the study site was manned by an ENT surgeon or ENT trained nurse. CONCLUSION Despite the heavy burden of ear complaints there is inadequate hearing healthcare delivery in a typical LMIC community. This highlights the need for urgent improvement of hearing healthcare.
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Affiliation(s)
- Adebolajo Adeyemo
- University of Ibadan, Institute of Child Health
- University College Hospital, Department of Otorhinolaryngology
| | - Segun Ogunkeyede
- University College Hospital, Department of Otorhinolaryngology
- University of Ibadan, Department of Otorhinolaryngology
| | - Oluyinka Dania
- University College Hospital, Department of Community Medicine
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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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Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review. Curr Allergy Asthma Rep 2020; 20:68. [PMID: 32889648 PMCID: PMC7474513 DOI: 10.1007/s11882-020-00967-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Purpose of the Review We provide a systematic review of experimental and clinical evidences linking allergy to acute, including common cold, and chronic rhinosinusitis in children. Furthermore, we questioned if anti-allergy treatment may prevent the occurrence of rhinosinusitis or improve outcomes of its specific management. Recent Findings Allergic rhinitis is a common childhood disease in industrialized countries that is responsible for a major impact on quality of life and healthcare resources. Over the years many authors tried to correlate allergy with comorbidities and in particular to the onset of rhinosinusitis including common cold, even though conflicting results are frequently reached. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 7103 that were finally screened. This resulted in 25 publications of which the full texts were assessed and included in a qualitative analysis per different phenotypes of rhinosinusitis. Summary The evidence suggests that allergy may lead to overall impairment of mechanical and immunological defense function of the nasal mucosa against viruses and that anti-allergy treatment may significantly decrease the number and severity of upper respiratory tract infections including common colds in children. It was not possible to perform the analysis for allergy and post-viral acute rhinosinusitis, bacterial acute rhinosinusitis, and recurrent acute rhinosinusitis because of paucity and heterogeneity of data. Although there is no definitive proof of causation linking allergy to chronic rhinosinusitis, studies lead to suppose that anti-allergy treatment may improve outcomes of specific CRS treatments.
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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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Norbäck D, Lu C, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Qian H, Sun Y, Sundell J, Wang J, Liu W, Deng Q. Lifetime-ever pneumonia among pre-school children across China - Associations with pre-natal and post-natal early life environmental factors. ENVIRONMENTAL RESEARCH 2018; 167:418-427. [PMID: 30121466 DOI: 10.1016/j.envres.2018.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/04/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Biomass burning is associated with childhood pneumonia but few studies exist on other indoor factors. AIM To study pneumonia in relation to pre-natal and post-natal exposure among children across China. METHODS Children (3-6 y) (n = 39,782) from randomized day care centres in seven cities in China. Information on pneumonia and pre-natal and post-natal exposure to home environment factors were assessed by a parental questionnaire. Life-time outdoor temperature and GDP per capita were assessed on city level. Associations were calculated by multilevel logistic regression adjusting for fourteen co-variates. RESULTS Totally 32.0% had ever had pneumonia diagnosed by a physician. Children of farmer mothers (OR = 0.65), with breastfeeding (OR = 0.91) and living in rural (OR = 0.85) or suburban (OR = 0.90) areas had less pneumonia. Buying new furniture one year before conception (OR = 1.11) and after first year of life (OR = 1.10) increased the risk. Redecoration one year before conception (OR = 1.20), during pregnancy (OR = 1.18) and after first year of life (OR = 1.17) increased pneumonia risk. Children with mould (OR = 1.17), window pane condensation (WPC) (OR = 1.20) and mould odour (OR = 1.15) at home at birth only had a higher risk of pneumonia. Similar associations were seen for dampness and mould in the current home. Children in the oldest and newest homes had less pneumonia. Cockroaches (OR = 1.08), mosquitos or flies in the current home (OR = 1.18), an exhaust fan in the bathroom (OR = 1.10) and higher economic development level, measured as GDP per capita on city level (OR 1.11 per 10,000 RMB/year) were associated with childhood pneumonia. CONCLUSIONS Perinatal and postnatal exposure to mould, mould odour and window pane condensation at home can be early life risk factors for childhood pneumonia in China. Moreover, pre-natal and post-natal exposure to chemical emissions from new furniture and renovation could increase the risk of childhood pneumonia. Breastfeeding, farm exposure, and living in rural or suburban areas could be protective.
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Affiliation(s)
- Dan Norbäck
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Chan Lu
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XingYa School of Public Health, Central South University, Changsha, Hunan, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy & Environment, Southeast University, Nanjing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Juan Wang
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Qihong Deng
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XingYa School of Public Health, Central South University, Changsha, Hunan, China.
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Liu W, Huang C, Wang X, Cai J, Hu Y, Zou Z, Weschler LB, Shen L, Sundell J. Multimorbidities of asthma, allergies, and airway illnesses in childhood: Chance or not chance? J Asthma 2016; 54:687-698. [PMID: 27880051 DOI: 10.1080/02770903.2016.1263648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We investigated patterns of multimorbidities among asthma, allergies, and respiratory illnesses in preschool children. We investigated multimorbidities of lifetime asthma, allergic rhinitis, eczema, food allergy, pneumonia, and ear infections; and multimorbidities of current (in the last year before the survey) wheeze, dry cough, rhinitis, eczema, and common cold during childhood. We further analyzed whether prevalences of these multimorbidities were due to chance. METHODS A cross-sectional study was conducted in 72 kindergartens of Shanghai, China. Parents of preschool children were surveyed with a modified ISAAC questionnaire. Observed prevalences (OPs), expected prevalences (EPs), absolute excess comorbidities (AECs), and relative excess comorbidities (RECs) of various combinations of illnesses were calculated to indicate whether the combined illnesses were related. RESULTS We analyzed questionnaires for children aged 4-6 years, whose 13,335 questionnaires were the majority of the total 15,266 returned questionnaires (response rate: 85.3%). The studied illnesses were common. For children who had more than three lifetime or current illnesses, OPs tended to be higher than EPs. Most OPs and EPs were higher in boys than in girls, and were higher in children with a family history of atopy (FHA) than in children without FHA. AECs and RECs between boys and girls as well as between children with and without FHA were substantially different. CONCLUSIONS Our findings suggest that multimorbidities among childhood asthma, allergies, and respiratory illnesses are likely not random, but rather share etiology. Specific patterns of childhood asthma multimorbidities perhaps differ between boys and girls and between children with and without FHA.
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Affiliation(s)
- Wei Liu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Chen Huang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Xueying Wang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jiao Cai
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Yu Hu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Zhijun Zou
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | | | - Li Shen
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jan Sundell
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China.,c Department of Building Science , Tsinghua University , Beijing , China
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Yenigun A, Dogan R, Ozturan O, Meric Hafiz A. RGB Measurements From Endoscopic Photography as a New and Objective Diagnostic Method for Chronic Tonsillitis. Clin Ther 2016; 38:625-30. [PMID: 26895768 DOI: 10.1016/j.clinthera.2016.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study assessed the diagnostic role of a digital photographic assessment of chronic tonsillitis. This study was performed at a tertiary referral center. METHODS Three cohorts of children were studied based on their diagnoses: current chronic tonsillitis (before tonsillectomy), previous chronic tonsillitis (3 months after tonsillectomy), and healthy children (control group). Oropharyngeal regions of all subjects were examined and photographed endoscopically. Red/green/blue (RGB) values of particular oropharyngeal points were then measured. FINDINGS The current chronic tonsillitis group differed significantly from the other 2 groups. The RGB values of the current chronic tonsillitis group were significantly higher than those of the previous chronic tonsillitis group (3 months after tonsillectomy) and the control group (P = 0.018 (red), P = 0.024 (green), and P = 0.004 (blue)). The RGB values did not differ significantly between the previous chronic tonsillitis group and the control group (P = 0.684 [red], P = 0.890 [green], and P = 0.672 [blue]). The RGB values of the previous chronic tonsillitis group decreased significantly 3 months after tonsillectomy (P = 0.015 [red], P = 0.033 [green], and P = 0.001 [blue]). Sensitivity was 80%, specificity was 90%, the positive predictive value was 59%, the negative predictive value was 96%, and the general power of the test was 88.6% regarding the power and competence of the RGB test in the diagnosis of chronic tonsillitis. IMPLICATIONS Measuring RGB values may be an inexpensive and simple way to quickly provide objective and corroborative information on hyperemia of the anterior pillars in diagnosing chronic tonsillitis in conjunction with subjective methods.
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Affiliation(s)
- Alper Yenigun
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey.
| | - Remzi Dogan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
| | - Aysenur Meric Hafiz
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
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Mameli C, Pasinato A, Picca M, Bedogni G, Pisanelli S, Zuccotti GV. Pidotimod for the prevention of acute respiratory infections in healthy children entering into daycare: A double blind randomized placebo-controlled study. Pharmacol Res 2015; 97:79-83. [DOI: 10.1016/j.phrs.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/18/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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Oguonu T, Adaeze Ayuk C, Edelu BO, Ndu IK. Pattern of respiratory diseases in children presenting to the paediatric emergency unit of the University of Nigeria Teaching Hospital, Enugu: a case series report. BMC Pulm Med 2014; 14:101. [PMID: 24916799 PMCID: PMC4088915 DOI: 10.1186/1471-2466-14-101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Respiratory diseases are one of the causes of childhood morbidity and mortality as well as hospitalization globally. The patterns of different respiratory illnesses in several parts of the world have been reported but there are few on the combined burden of the diseases. Determination of the burden of respiratory diseases as a group will help ascertain their collective impact on the health systems in order to develop intervention measures. METHODS Data from case notes of children with respiratory diseases admitted to the University of Nigeria Teaching Hospital Enugu, Nigeria over a six year period were extracted. Age, gender, admission rates, types of respiratory illness, duration of admission, season of presentation and outcome were analysed. Descriptive and inferential (Chi square) statistics were used to describe the various disease types and ascertain association of the disease outcome, seasonal pattern with the types of diseases. RESULTS Of the total of 8974 children admissions, 2214 (24.7%) were due to respiratory diseases. The mean age of all the children with respiratory diseases was 3.3 years (SD 3.9). Communicable diseases were the common cause of admission cases throughout the seasons, p < 0.001. The highest admission rates were for pneumonia, (34.0%), acute bronchial asthma, (27.7%) and rhinosinusitis (14.6%) p < 0.001. The frequency of respiratory disease decreases with age and children less than five years of age and of low socio-economic status were commonly affected, p=0.01. The median duration of hospital stay was two days [range 1 to 8 days], children less than five years old and those of low socio-economic status, spent more than four days (p=0.01 and p < 0.001 respectively). The all-cause mortality was 0.5% (11/2214) of which 81.8% (9/11) was due to pneumonia. CONCLUSIONS Respiratory diseases constitute a significant burden of childhood illnesses in our centre. Efforts are required to reduce the impact as part of the steps towards the achievement of the Millennium Development Goals.
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Affiliation(s)
- Tagbo Oguonu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | | | - Ikenna Kingsley Ndu
- Department of Paediatrics, Enugu State University of Technology Teaching Hospital Enugu, Enugu, Nigeria
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Altuğ H, Gaga EO, Döğeroğlu T, Brunekreef B, Hoek G, Van Doorn W. Effects of ambient air pollution on respiratory tract complaints and airway inflammation in primary school children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 479-480:201-9. [PMID: 24561926 DOI: 10.1016/j.scitotenv.2014.01.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/25/2014] [Accepted: 01/30/2014] [Indexed: 05/13/2023]
Abstract
Respiratory health effects of ambient air pollution were studied in 605 school children 9 to 13 years in Eskişehir, Turkey. Each child performed a fractional exhaled nitric oxide (FENO) measurement and a lung function test (LFT). Self-reported respiratory tract complaints (having cold, complaints of throat, runny nose and shortness of breath/wheezing) in the last 7 days and on the day of testing were also recorded. As acute health outcomes were investigated, weekly average ambient concentrations of ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2) were determined by passive sampling in the school playgrounds simultaneously with the health survey. Effects of air pollution on respiratory tract complaints and exhaled NO/lung function were estimated by multivariate logistic regression and multivariate linear mixed effects models, respectively. Upper respiratory tract complaints were significantly (p<0.05) associated with weekly average O3 concentrations during the health survey (adjusted odds ratios (OR) of 1.21 and 1.28 for a 10 μgm(-3) increment for having cold and a runny nose on day of testing, respectively). FENO levels were significantly (p<0.05) increased in children with various upper respiratory tract complaints (ratio in FENO varied between 1.16 and 1.40). No significant change in FENO levels was detected in association with any of the measured pollutants (p ≥ 0.05). Lung function was not associated with upper respiratory tract complaints and FENO levels. Peak Expiratory Flow (PEF) levels were negatively associated with weekly average O3 levels for children without upper respiratory tract complaints. In summary, elevated levels of air pollutants increased respiratory tract complaints in children.
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Affiliation(s)
- Hicran Altuğ
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Eftade O Gaga
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Tuncay Döğeroğlu
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Bert Brunekreef
- IRAS Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
| | - Gerard Hoek
- IRAS Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
| | - Wim Van Doorn
- Royal Haskoning, Business line Industry and Energy, P.O. Box 151, 6500 AD Nijmegen, The Netherlands.
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Khattab A, Shaheen M, Kamel T, El Faramay A, El Rahman SA, Nabil D, Gouda M. Burden of pediatric influenza A virus infection post swine-flu H1N1 pandemic in Egypt. ASIAN PAC J TROP MED 2014; 6:693-8. [PMID: 23827145 DOI: 10.1016/s1995-7645(13)60120-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/15/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection - post swine flu pandemic era - using rapid influenza diagnostic tests. METHODS During two years (2010 & 2011), 1 200 children with influenza like illness or acute respiratory tract infections (according to World Health Organization criteria) were recruited. Their ages ranged from 2-60 months. Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test. RESULTS Influenza A virus rapid test was positive in 47.5% of the children; the majority (89.6%) were presented with lower respiratory tract infections. Respiratory rate and temperature were significantly higher among positive rapid influenza test patients. CONCLUSIONS Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children. It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.
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Affiliation(s)
- Adel Khattab
- Influenza Advisory Board, Egyptian Ministry of Health, Cairo, Egypt
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19
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Abstract
At the end of 1990s, acute respiratory tract infections (ARTIs) were called the 'forgotten pandemic’, with a clear dichotomy between developing and industrialised countries in mortality and morbidity, the main outcomes associated with ARTIs. This definition still applies 20 years later, when the introduction of new and safe antibiotics and vaccines has certainly contributed to controlling the most life-threatening ARTIs, but has not had a major impact on viral ARTIs in paediatric age. One functional approach to preventing and treating ARTIs is non-specifically increasing the immune response or enhancing the children’s innate defence mechanisms. Different kinds of biologically active substances – called immunostimulants – of natural and synthetic origins and with different mechanisms of action have been introduced in some countries for the prevention of ARTIs in children. Recently, research focused on one of these compounds, Pidotimod, has attempted to better clarify and define its mechanisms of action both in vitro and in vivo. In this paper, we critically examine the most recent findings on Pidotimod. Certainly the improvement of research methodology in the last 20 years and the acquired knowledge in various fields of clinical immunology should be the starting point for research on Pidotimod. Preclinical research will be essential to better understand the mechanisms of action of this compound. However, in vivo studies, especially randomised control trials, will be necessary to establish the real efficacy of Pidotimod in the prevention of ARTIs in paediatric age.
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Affiliation(s)
- Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Via GB Grassi 74, 20157, Milan, Italy.
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20
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Kim JH, Moon BJ, Gong CH, Kim NH, Jang YJ. Detection of respiratory viruses in adult patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol 2013; 111:508-11. [PMID: 24267360 PMCID: PMC7111117 DOI: 10.1016/j.anai.2013.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/16/2013] [Accepted: 08/25/2013] [Indexed: 11/18/2022]
Abstract
Background The symptoms of allergic rhinitis may be worsened by a viral respiratory infection. However, there are few data on the presence of respiratory virus in patients with allergic rhinitis. Objective To evaluate whether patients with allergic rhinitis have an increased frequency of respiratory virus detection in a prospective case–control study. Methods Fifty-eight adult patients diagnosed with perennial allergic rhinitis were evaluated from September 2011 through June 2012. A control group of 61 adult patients without allergy was included. Multiplex polymerase chain reaction was used to detect respiratory viruses in nasal lavage samples. Results Respiratory viruses were detected in 25 of 58 patients (43.1%) with perennial allergic rhinitis, but in only 15 of 61 control patients (24.6%). In virus-positive samples, multiple viruses were detected in 9 of 25 patients (36.0%) with perennial allergic rhinitis but in only 2 of 15 control patients (12.5%). Rhinovirus was the most common virus in patients without allergy and those with allergic rhinitis. There were significant differences in the detection rates of overall and multiple respiratory viruses and rhinovirus between the 2 groups (P < .05). However, in patients with allergic rhinitis, there was no statistically significant association between the detection of respiratory viruses and symptom scores. Conclusion This study shows that there is a high prevalence of respiratory viruses, especially rhinovirus, in patients with allergic rhinitis. Subsequent studies are needed to determine the clinical significance of highly prevalent respiratory viruses in patients with allergic rhinitis.
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Affiliation(s)
- Ji Heui Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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21
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Abstract
The placement of myringotomy tubes remains an effective treatment of recurrent acute otitis media and chronic otitis media with effusion. Infants and young children are prone to these entities because of their immature anatomy and immunology. Several host, pathogenic, and environmental factors contribute to the development of these conditions. The identification and modification of some these factors can preclude the need for intervention. The procedure continues to be one of the most common outpatient pediatric procedures. Close vigilance and identification of potential complications is of utmost importance in the ongoing management of the child with middle ear disease.
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Affiliation(s)
- Elton Lambert
- Department of Otorhinolaryngology, University of Texas-Houston School of Medicine, Houston, TX 77030, USA
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22
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Ear infection and its associated risk factors, comorbidity, and health service use in Australian children. Int J Pediatr 2013; 2013:963132. [PMID: 23840224 PMCID: PMC3690237 DOI: 10.1155/2013/963132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/30/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
This study investigates and identifies risk factors, comorbidity, and health service use related to ear infection in Australian children. Two cross-sectional analyses of the Longitudinal Study of Australian Children (LSAC) involved 4,983 children aged 4 to 5 years in 2004 and aged 10 to 11 years in 2010. Odds ratios (ORs) were analysed using bivariate logistic regression. The prevalence of parent-reported ear infection was 7.9% (394) among children aged 4 to 5 years and 3.3% (139) at 10 to 11 years. Our study found that risk factors associated with ear infection were indigenous status, not being breastfed, mother or father smoking at least once a day, and father's school completion at year 9 or lower. By age 10 to 11 years significantly reported comorbidities were tonsillitis (OR 4.67; P < 0.001), headache (OR 2.13; P = 0.006), and asthma (OR 1.67; P = 0.003) and ear infection was found to be associated with the use of pediatrician (OR 1.83; P = 0.031), other specialist (OR 2.12; P < 0.001), and early intervention services (OR 3.08; P = 0.010). This empirical evidence can be used to inform the development of intervention and management programs for ear infection.
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Hoving MFP, Brand PLP. Causes of recurrent pneumonia in children in a general hospital. J Paediatr Child Health 2013; 49:E208-12. [PMID: 23438187 DOI: 10.1111/jpc.12114] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/27/2022]
Abstract
AIM Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. METHODS We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. RESULTS In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. CONCLUSION The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children.
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Affiliation(s)
- M F Paulien Hoving
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands
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Yiengprugsawan V, Hogan A, Strazdins L. Longitudinal analysis of ear infection and hearing impairment: findings from 6-year prospective cohorts of Australian children. BMC Pediatr 2013; 13:28. [PMID: 23432915 PMCID: PMC3616953 DOI: 10.1186/1471-2431-13-28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background Middle ear infection is common in childhood. Despite its prevalence, there is little longitudinal evidence about the impact of ear infection, particularly its association to hearing loss. By using 6-year prospective data, we investigate the onset and impact over time of ear infection in Australian children. Methods We analyse 4 waves of the Longitudinal Study of Australian Children (LSAC) survey collected in 2004, 2006, 2008, and 2010. There are two age cohorts in this study (B cohort aged 0/1 to 6/7 years N=4242 and K cohort aged 4/5 to 10/11 years N=4169). Exposure was parent-reported ear infection and outcome was parent-reported hearing problems. We modelled ear infection onset and subsequent impact on hearing using multivariate logistic regressions, reporting Adjusted Odds Ratios (AOR) and Confidence Intervals (95% CI). Separate analyses were reported for indigenous and non-indigenous children. Results Associations of ear infections between waves were found to be very strong both among both indigenous and non-indigenous children in the two cohorts. Reported ear infections at earlier wave were also associated with hearing problems in subsequent wave. For example, reported ear infections at age 4/5 years among the K cohort were found to be predictors of hearing problems at age 8/9 years (AOR 4.0, 95% CI 2.2-7.3 among non-indigenous children and AOR 7.7 95% CI 1.0-59.4 among indigenous children). Number of repeated ear infections during the 6-year follow-up revealed strong dose–response relationships with subsequent hearing problems among non-indigenous children (AORs ranged from 4.4 to 31.7 in the B cohort and 4.4 to 51.0 in the K cohort) but not statistically significant among indigenous children partly due to small sample. Conclusions This study revealed the longitudinal impact of ear infections on hearing problems in both indigenous and non-indigenous children. These findings highlight the need for special attention and follow-up on children with repeated ear infections.
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Affiliation(s)
- Vasoontara Yiengprugsawan
- The Australian National University, National Centre for Epidemiology and Population Health, Acton, Canberra ACT 2601, Australia.
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Abstract
We review the limited available evidence on underlying causes of recurrent pneumonia in children, supplemented by our own clinical experience. Diagnosing recurrent pneumonia in children is difficult. Diagnostic confusion is possible with recurrent upper respiratory tract infections and asthma. In our series of children with recurrent pneumonia, we never identified asthma as an underlying cause. Because the frequency or severity of recurrent pneumonia does not always justify additional invasive investigations, the diagnostic work-up may be incomplete in a number of cases. This may help to explain why an underlying cause for recurrent pneumonia cannot be found in approximately 30% of cases. Finally, the paradigm that recurrent pneumonia in the same lung lobe has a differential diagnosis different from those recurring in multiple lobes was not borne out in our case series. A stepwise and pragmatic approach to evaluating children with recurrent lower respiratory tract infections is recommended.
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Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Clinic, Isala Klinieken, PO Box 10400, 8000 GK Zwolle, the Netherlands.
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Ting PJ, Lin CH, Huang FL, Lin MC, Hwang KP, Huang YC, Chiu CH, Lin TY, Chen PY. Epidemiology of acute otitis media among young children: a multiple database study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:453-8. [PMID: 22823943 DOI: 10.1016/j.jmii.2012.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 08/01/2011] [Accepted: 08/31/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Acute otitis media (AOM) is a common complication of upper respiratory tract infection (URTI) among children. The purpose of this study was to evaluate the epidemiology of AOM among young children in Taiwan, including the age incidence and seasonality by combining multiple databases. METHODS Two country-based questionnaire survey studies had been conducted to evaluate the experience of otitis media (OM) among young children: one in 2007 and the other between 2005 and 2010. The number of OM cases (5% of population younger than 7 years) in 2005 and annual visiting rates for URTI from 2005 to 2010 obtained from the National Health Insurance Research Database of Taiwan were collected and comprised the third database. The fourth database comprised ambulatory visits of children with OM to a medical center in central Taiwan between 2005 and 2010. RESULTS Data from a total of 1099 questionnaires were entered into Database I in 2007, and data from 9705 questionnaires between 2005 and 2010 comprised Database II. There were 86,702 children (younger than 7 years, representing 5% of the whole population for this age group) retrieved from Database III in 2007, and 5,904 cases of OM in children between 2005 and 2010 in a hospital. In Database I, 7.46% children experienced at least one episode of AOM compared with 9.21% in Database II for children aged 5 years and younger. In Database III, 13.2% children younger than 7 years had AOM in 2005. The peak season of AOM among children was from March to May (Databases III and IV). CONCLUSION AOM was thought to be a very common disease among children; however, this comparative analysis showed that the overall prevalence of AOM among children younger than 5 years was only 20%, much lower than in other countries. AOM was more prevalent during the spring season, and still was similarly common after age 2 years.
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Affiliation(s)
- Pei-Ju Ting
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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Moore HC, de Klerk N, Richmond P, Lehmann D. A retrospective population-based cohort study identifying target areas for prevention of acute lower respiratory infections in children. BMC Public Health 2010; 10:757. [PMID: 21138593 PMCID: PMC3004840 DOI: 10.1186/1471-2458-10-757] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 12/07/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute lower respiratory infections (ALRI) are a major cause of hospitalisation in young children. Many factors can lead to increased risk of ALRI in children and predispose a child to hospitalisation, but population attributable fractions for different risk factors and how these fractions differ between Indigenous and non-Indigenous children is unknown. This study investigates population attributable fractions of known infant and maternal risk factors for ALRI to inform prevention strategies that target high-risk groups or particular risk factors. METHODS A retrospective population-based data linkage study of 245,249 singleton births in Western Australia. Population attributable fractions of known maternal and infant risk factors for hospitalisation with ALRI between 1996 and 2005 were calculated using multiple logistic regression. RESULTS The overall ALRI hospitalisation rate was 16.1/1,000 person-years for non-Aboriginal children and 93.0/1,000 for Aboriginal children. Male gender, being born in autumn, gestational age <33 weeks, and multiple previous pregnancies were significant risk factors for ALRI in both Aboriginal and non-Aboriginal children. In non-Aboriginal children, maternal smoking during pregnancy accounted for 6.3% (95%CI: 5.0, 7.6) of the population attributable fraction for ALRI, being born in autumn accounted for 12.3% (10.8, 13.8), being born to a mother with three or more previous pregnancies accounted for 15.4% (14.1, 17.0) and delivery by elective caesarean accounted for 4.1% (2.8, 5.3). In Aboriginal children, being born to a mother with three or more previous pregnancies accounted for 16.5% (11.8, 20.9), but remote location at birth accounted for 11.7% (8.5, 14.8), maternal age <20 years accounted for 11.2% (7.8, 14.5), and being in the most disadvantaged socio-economic group accounted for 18.4% (-6.5, 37.4) of the population attributable fraction. CONCLUSIONS The population attributable fractions estimated in this study should help in guiding public health interventions to prevent ALRI. A key risk factor for all children is maternal smoking during pregnancy, and multiple previous pregnancies and autumnal births are important high-risk groups. Specific key target areas are reducing elective caesareans in non-Aboriginal women and reducing teenage pregnancies and improving access to services and living conditions for the Aboriginal population.
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Affiliation(s)
- Hannah C Moore
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Nicholas de Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Peter Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Princess Margaret Hospital for Children, Perth, Australia
| | - Deborah Lehmann
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
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Fisk WJ, Eliseeva EA, Mendell MJ. Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta-analysis. Environ Health 2010; 9:72. [PMID: 21078183 PMCID: PMC3000394 DOI: 10.1186/1476-069x-9-72] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 11/15/2010] [Indexed: 05/18/2023]
Abstract
BACKGROUND Dampness and mold have been shown in qualitative reviews to be associated with a variety of adverse respiratory health effects, including respiratory tract infections. Several published meta-analyses have provided quantitative summaries for some of these associations, but not for respiratory infections. Demonstrating a causal relationship between dampness-related agents, which are preventable exposures, and respiratory tract infections would suggest important new public health strategies. We report the results of quantitative meta-analyses of published studies that examined the association of dampness or mold in homes with respiratory infections and bronchitis. METHODS For primary studies meeting eligibility criteria, we transformed reported odds ratios (ORs) and confidence intervals (CIs) to the log scale. Both fixed and random effects models were applied to the log ORs and their variances. Most studies contained multiple estimated ORs. Models accounted for the correlation between multiple results within the studies analyzed. One set of analyses was performed with all eligible studies, and another set restricted to studies that controlled for age, gender, smoking, and socioeconomic status. Subgroups of studies were assessed to explore heterogeneity. Funnel plots were used to assess publication bias. RESULTS The resulting summary estimates of ORs from random effects models based on all studies ranged from 1.38 to 1.50, with 95% CIs excluding the null in all cases. Use of different analysis models and restricting analyses based on control of multiple confounding variables changed findings only slightly. ORs (95% CIs) from random effects models using studies adjusting for major confounding variables were, for bronchitis, 1.45 (1.32-1.59); for respiratory infections, 1.44 (1.31-1.59); for respiratory infections excluding nonspecific upper respiratory infections, 1.50 (1.32-1.70), and for respiratory infections in children or infants, 1.48 (1.33-1.65). Little effect of publication bias was evident. Estimated attributable risk proportions ranged from 8% to 20%. CONCLUSIONS Residential dampness and mold are associated with substantial and statistically significant increases in both respiratory infections and bronchitis. If these associations were confirmed as causal, effective control of dampness and mold in buildings would prevent a substantial proportion of respiratory infections.
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Affiliation(s)
- William J Fisk
- Indoor Environment Department, Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road 90R3058, Berkeley, CA, USA
| | - Ekaterina A Eliseeva
- Indoor Environment Department, Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road 90R3058, Berkeley, CA, USA
| | - Mark J Mendell
- Indoor Environment Department, Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road 90R3058, Berkeley, CA, USA
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Daly KA, Hoffman HJ, Kvaerner KJ, Kvestad E, Casselbrant ML, Homoe P, Rovers MM. Epidemiology, natural history, and risk factors: panel report from the Ninth International Research Conference on Otitis Media. Int J Pediatr Otorhinolaryngol 2010; 74:231-40. [PMID: 19836843 DOI: 10.1016/j.ijporl.2009.09.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 09/03/2009] [Indexed: 11/19/2022]
Abstract
The 2007 Recent Advances in Otitis Media Research Conference Panel Report provides an update on otitis media (OM) research published from 2003 to 2007. This report summarizes important trends in disease incidence and prevalence, describes established and newly identified risk factors for acute and chronic OM and OM with effusion, and conveys information on newly discovered genetic factors. In this report, researchers have described declining rates of OM diagnosis, antibiotic prescriptions, offices visits for OM, and middle ear surgery since the licensure and routine use of pneumococcal conjugate vaccine in infants. The panel report also recommends short and long term goals for current and future OM research.
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Affiliation(s)
- Kathleen A Daly
- Department of Otolaryngology and Division of Epidemiology, University of Minnesota, Minneapolis, MN 55435, USA.
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Karvonen AM, Hyvärinen A, Roponen M, Hoffmann M, Korppi M, Remes S, von Mutius E, Nevalainen A, Pekkanen J. Confirmed moisture damage at home, respiratory symptoms and atopy in early life: a birth-cohort study. Pediatrics 2009; 124:e329-38. [PMID: 19651571 DOI: 10.1542/peds.2008-1590] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Most previous studies on the association between moisture or mold problems in the home and respiratory symptoms in children were cross-sectional and based on self-reported exposure. The aim of this study was to evaluate the impact of objectively observed moisture damage and visible mold in the homes on early-life respiratory morbidity and atopic sensitization in a birth cohort. METHODS Building inspection was performed by building engineers in the homes of 396 children, and the children were followed up with questionnaires from birth to the age of 18 months. Specific immunoglobulin E levels were measured at the age of 1 year. RESULTS Doctor-diagnosed wheezing was associated with the severity of moisture damage in the kitchen and with visible mold in the main living area and especially in the bedroom of the child. The risk for parent-reported wheezing apart from cold increased with the severity of moisture damage in the kitchen. Moisture damage in the bathrooms or other interior spaces had no significant association with wheezing. No significant associations were observed for other end points, such as cough, or respiratory infections. There was a suggestion for an increased risk for sensitization to cat dander linked with moisture and mold exposure. CONCLUSIONS This birth-cohort study supports previous observations that moisture mold problems in the kitchen and in the main living area increase the risk for wheezing in early childhood. The results underline the importance of assessing separately the health effects of moisture and mold problems in different areas of the home.
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Affiliation(s)
- Anne M Karvonen
- Environmental Health Department, National Institute for Health and Welfare, Kuopio, Finland.
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Surgery for otitis media and infectious susceptibility in 10-year old school children. Int J Pediatr Otorhinolaryngol 2009; 73:603-6. [PMID: 19167763 DOI: 10.1016/j.ijporl.2008.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Assess infectious susceptibility in children previously operated for otitis media and evaluate reliability of parental reported otitis media surgery in the same group of children. METHODS Population based, cross-sectional survey of 10-year olds in the city of Oslo, Norway studying otitis media and surgical intervention in n=3406 with reliability assessments in a subset of n=2027. RESULTS Ten percent of children had otitis media surgery. Peak age was 2.5 years for adenoidectomy and tympanostomy tubes and 3 years for myringotomy. The crude odds ratio (cOR) with 95% confidence interval (95% CI) for one or more episodes of otitis media at 10 years in children with previous otitis media surgery was 3.4 (2.7-4.4). Intervention after the child was 4 years increased the risk further, crude odds ratio 4.2 (2.9-6.1). Kappa coefficients for agreement in answers to questions on otitis media surgery performed in children between 0 and 4 years were 0.9 for adenoidectomy, 1.0 for tympanostomy tubes, and 0.6 for myringotomy. CONCLUSION Otitis media in 10-year old children was associated with previous surgical intervention, particularly when performed after 4 years of age. Parental reports of tympanostomy tubes and adenoidectomy in early childhood were found reliable.
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Early onset otitis media: risk factors and effects on the outcome of chronic suppurative otitis media. Eur Arch Otorhinolaryngol 2007; 265:765-8. [PMID: 18046567 DOI: 10.1007/s00405-007-0544-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
Abstract
The onset of early otitis media (EOM), in the first few months of life has been reported to predict later chronic otitis media (CSOM), although the prevalence rates are increasing little is known about specific risk factors. In this survey we examined the hypothesis that higher risk factors is associated with the development of OM within 1 year compared to later onset and early onset otitis media (OM) has potential for negative outcome of CSOM. This is a survey of the age at onset of otorrhoea and associated risk factors in children with CSOM, in five sites spread in two sub-urban cities in two states in Nigeria. Questionnaires were administered on the informants followed by examination of the children. EOM was seen in 136/189 (70%) with CSOM, the age range was 1-150 months, mean of 59.25 (SD = 44.55). Of the 85 CSOM subjects with hearing loss, EOM accounted for 49 (57.7%) while 36 (42.4%) was later onset, On multivariate analysis (OR = 0.276, CI = 0.133-0.572, P = 0.001) revealing EOM was significant in the development of hearing loss however there was no correlation with the frequency of attack of otorrhoea (OR = 1.025, CI = 0.88-1.19, P = 0.75). Low socioeconomic status seen in 110/136 EOM (P = 0.000), allergy (P = 0.030) and number of people >10 in household (OR = 4.13, CI = 1.81-9.39, P = 0.001) constituted the significant risk for EOM compared to later onset. Bottlefeeding, adenoiditis/adenoid hypertrophy, indoor cooking and upper respiratory infection were not found to have statistical significance in early onset OM compared to later onset OM. This study found correlation between EOM and hearing loss and identified allergy, low social status and chronic exposure to overcrowding through increased number of children in the household significant risk factors for future research focus. This may help in controlling the prevalence of hearing loss accompanying CSOM.
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Abstract
Respiratory infections (RI) are one of the major complaints in children and adolescents, and represent a demanding challenge for the pediatrician. It has been estimated that at least 6% of Italian children younger than 6 yr of age present recurrent respiratory infections (RRI). Children with RRI are not affected by severe alterations of the immune system. RRI represent essentially the consequence of an increased exposure to infectious agents during the first years of life, when immune functions are still largely immature. Several social and environmental factors, such as day-care attendance, family size, air pollution, parental smoking, and home dampness, represent important risk factors for airway diseases and may contribute in various degrees to determine the incidence of RRI. The main problem for the pediatrician is to discriminate normal children with high RI frequency related to an augmented exposure to environmental risk factors from children affected by other underlying pathological conditions (immunological or not), predisposing to infectious diseases. When RRI diagnosis has been formulated, removal of environmental risk factors (i.e. precocious day-care attendance, smoking in the household) must first be suggested.
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Affiliation(s)
- M de Martino
- Department of Paediatrics, University of Florence, Anna Meyer Children's Hospital, Florence, Italy.
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Kamtsiuris P, Atzpodien K, Ellert U, Schlack R, Schlaud M. [Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:686-700. [PMID: 17514453 DOI: 10.1007/s00103-007-0230-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.
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Bentdal YE, Karevold G, Nafstad P, Kvaerner KJ. Early acute otitis media: predictor for AOM and respiratory infections in schoolchildren? Int J Pediatr Otorhinolaryngol 2007; 71:1251-9. [PMID: 17559950 DOI: 10.1016/j.ijporl.2007.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 04/24/2007] [Accepted: 04/25/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It has been reported that acute otitis media (AOM) and respiratory infectious morbidity still are common in schoolchildren. However, the significance of early initiation of AOM on later respiratory infections is not known. The aim of the study was to assess whether early initiation of AOM is a predictor for AOM and other respiratory infections in schoolchildren, and if environmental exposures and host factors in early life predict later AOM. METHODS A population-based, prospective study of 3754 children born in Oslo in 1992/93, of which 2549 children were followed from birth to 10 years. Main outcome measures were questionnaire-based information on AOM and other respiratory infections at ages 6 months, 1 year and 10 years. RESULTS Of the 190 (5.3%) children with one or more episodes of AOM before 6 months, 97 (51.1%) remained susceptible the next 6 months. The total number of children with one or more episodes of AOM from 6 to 12 months was 812 (25.1%). Of the 336 (13.2%) with AOM at 10, 95 (28.3%) also had AOM the first year of life. One or more episodes of tonsillopharyngitis or lower respiratory infections were experienced in 624 (24.4%) of the children at 10 years. There was a predominance of boys with AOM the first year of life, while girls were more prone to AOM at age 10. AOM the first year of life was not strongly associated with AOM at age 10 with crude and adjusted odds ratios 1.3 (95% CI 1.0-1.6) and 1.2 (95% CI 0.9-1.5), respectively. A corresponding tendency was found for other respiratory infections (tonsillopharyngitis or lower respiratory infections) at age 10. Tobacco smoke exposure at birth, early life atopic eczema and otitis media surgery increased the risk of AOM at age 10. CONCLUSIONS We found no strong association between early AOM and AOM and other respiratory infections in schoolchildren. Parental smoking at birth, early life atopic eczema and female gender were only weakly associated with AOM in 10-year olds while otitis media surgery was strongly associated with AOM in schoolchildren.
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Affiliation(s)
- Yngvild E Bentdal
- Faculty Division of Akershus University Hospital, Department of Otorhinolaryngology, University of Oslo, Norway.
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Bentdal YE, Nafstad P, Karevold G, Kvaerner KJ. Acute otitis media in schoolchildren: allergic diseases and skin prick test positivity. Acta Otolaryngol 2007; 127:480-5. [PMID: 17453473 DOI: 10.1080/00016480600895128] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS Single and repeated episodes of acute otitis media (AOM) in 10-year-old children were associated with reported allergic disease. Further, skin prick test (SPT)-negative children with reported asthma and allergic rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment of allergic symptoms may have an effect on AOM in school children. OBJECTIVE The objective of the study was to estimate associations between AOM, allergic diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS Population-based cross-sectional study of 3406 10-year-old children living in Oslo. Main outcome measures were questionnaire-based information on AOM and reported physician-diagnosed allergic diseases with symptoms during the last year. In addition, 2657 children were skin prick tested. Logistic regression analyses were performed to estimate associations and control for potential confounders. RESULTS One or more episodes of AOM were present in 13.8% (n=470) of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or more infections. We found a statistically significant association between AOM and reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95% confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single and two or more episodes of AOM, respectively. The risk for AOM was increased in asthmatic SPT-negative children compared with asthmatic SPT-positive children, the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same tendency was found for allergic rhinoconjunctivitis.
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Affiliation(s)
- Yngvild E Bentdal
- Department of Otorhinolaryngology, Faculty Division of Akershus University Hospital, University of Oslo, Sykehusvagen 27, 1478 Lørenskog, Norway.
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van Gageldonk-Lafeber AB, van der Sande MAB, Heijnen MLA, Peeters MF, Bartelds AIM, Wilbrink B. Risk factors for acute respiratory tract infections in general practitioner patients in The Netherlands: a case-control study. BMC Infect Dis 2007; 7:35. [PMID: 17466060 PMCID: PMC1871593 DOI: 10.1186/1471-2334-7-35] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 04/27/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory tract infections (ARTI) are an important public health problem. Improved identification of risk factors might enable targeted intervention. Therefore we carried out a case-control study with the aim of identifying environmental risk factors for ARTI consultations in the Dutch general population. METHODS A subset of patients visiting their GP in the period of 2000-2003 with an ARTI (cases) and age-matched controls (visiting for other complaints) were included in a case-control study. They were asked to complete a questionnaire about potential risk factors. Conditional logistic regression was used to calculate odds ratio's (OR) and 95% confidence intervals (CI) to estimate the independent effect of potential risk factors. RESULTS A total of 493 matched pairs of case and control subjects were enrolled. Exposure to persons with respiratory complaints, both inside and outside the household, was found to be an independent risk factor for visiting a GP with an ARTI (respectively ORadj = 1.9 and ORadj = 3.7). Participants exposed to dampness or mould at home (ORadj=0.5) were significantly less likely to visit their GP. In accordance with the general risk of consultations for ARTI, participants with a laboratory-confirmed ARTI who were exposed to persons with respiratory complaints outside the household were also significantly more likely to visit their GP (ORadj=2.5). CONCLUSION This study confirmed that heterogeneity in the general population as well as in pathogens causing ARTI makes it complicated to detect associations between potential risk factors and respiratory infections. Whereas it may be difficult to intervene on the risk posed by exposure to persons with respiratory complaints, transmission of ARTI in the general population might be reduced by improved hygienic conditions.
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Affiliation(s)
- Arianne B van Gageldonk-Lafeber
- National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and surveillance, Bilthoven, The Netherlands
| | - Marianne AB van der Sande
- National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and surveillance, Bilthoven, The Netherlands
| | - Marie-Louise A Heijnen
- National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and surveillance, Bilthoven, The Netherlands
- Netherlands Association for Community Health Services, Utrecht, The Netherlands
| | | | - Aad IM Bartelds
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Berry Wilbrink
- National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netherlands
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Farchi S, Forastiere F, Cesaroni G, Perucci CA. Environmental exposures and hospitalisation for respiratory conditions in children: a five year follow up study in Rome, Italy. Occup Environ Med 2006; 63:573-6. [PMID: 16551757 PMCID: PMC2078128 DOI: 10.1136/oem.2005.023556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Farchi
- Department of Epidemiology, Rome E Health Authority, Rome, Italy.
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