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Milani GP, Alberti I, Abodi M, Lakoumentas J, Konstantinou GN, Papadopoulos NG, Pop RM, Bocsan IC, Cassimos D, Kull I, Bettocchi S, Corsello A, Cugliari M, Ciliberti L, Spolidoro GCI, Agostoni C, Vlieg Boerstra B, Venter C, O'Mahony L, Vassilopoulou E. A systematic review and meta-analysis on nutritional and dietary interventions for the treatment of acute respiratory infection in pediatric patients: An EAACI taskforce. Allergy 2024; 79:1687-1707. [PMID: 38174413 DOI: 10.1111/all.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
Acute respiratory infections are a major cause of morbidity and mortality in children worldwide. Dietary and nutritional interventions, including minerals and vitamin supplementation, have been explored as potential treatments for these infections. However, the evidence on their efficacy is limited and inconclusive. This systematic review and meta-analysis aim to provide a comprehensive summary of the available evidence on the effectiveness of dietary and nutritional interventions for treating acute respiratory tract infections in children. A systematic review was conducted according to the PRISMA 2020 guidelines in April 2022 and updated in April 2023. Clinical trials focusing on dietary or nutritional interventions, including supplementations, in children with acute respiratory tract infections were included. The selection of interventions and outcomes was based on biological plausibility. Data were extracted using a standardized form, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using random-effect models. A total of 50 studies were included in the review. Four trials were conducted in low, 32 in lower-middle, 12 in upper-middle, and only two in high-income countries. The studies evaluated various dietary interventions, including zinc, vitamin A, vitamin E, vitamin D, and probiotics. The results of individual studies on the efficacy of these interventions were mixed, with some showing positive effects on clinical outcomes such as duration of symptoms, while others showed no significant impact. Meta-analysis was conducted for zinc supplementation in children with pneumonia, and the pooled results suggested a potential limited benefit in terms of reduced hospital length of stay but not time to recovery. Meta-analyses on vitamin D did not show any effect in children with pneumonia. This systematic review fills a critical gap in the literature by synthesizing the available evidence on the efficacy and safety of nutritional or dietary interventions for acute respiratory tract infections in children. The findings indicate no dietary or nutritional intervention can currently be recommended for the routine treatment of respiratory tract infections in children based on single supplement studies. The metanalysis suggests that zinc supplementation might have a beneficial effect on length of hospitalization in children with pneumonia. New studies are needed to establish more conclusive evidence for pediatric acute respiratory diseases especially for children living in a context of high-income countries.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Ilaria Alberti
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Abodi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | | | - Raluca M Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ioana C Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dimitrios Cassimos
- Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Silvia Bettocchi
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Marco Cugliari
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Letizia Ciliberti
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulia C I Spolidoro
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Berber Vlieg Boerstra
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
- Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Emilia Vassilopoulou
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
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Briassoulis G, Briassoulis P, Ilia S, Miliaraki M, Briassouli E. The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis. Antioxidants (Basel) 2023; 12:1942. [PMID: 38001795 PMCID: PMC10669546 DOI: 10.3390/antiox12111942] [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: 09/23/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Zinc is a structural component of proteins, functions as a catalytic co-factor in DNA synthesis and transcription of hundreds of enzymes, and has a regulatory role in protein-DNA interactions of zinc-finger proteins. For many years, zinc has been acknowledged for its anti-oxidative and anti-inflammatory functions. Furthermore, zinc is a potent inhibitor of caspases-3, -7, and -8, modulating the caspase-controlled apoptosis and necroptosis. In recent years, the immunomodulatory role of zinc in sepsis and COVID-19 has been investigated. Both sepsis and COVID-19 are related to various regulated cell death (RCD) pathways, including apoptosis and necroptosis. Lack of zinc may have a negative effect on many immune functions, such as oxidative burst, cytokine production, chemotaxis, degranulation, phagocytosis, and RCD. While plasma zinc concentrations decline swiftly during both sepsis and COVID-19, this reduction is primarily attributed to a redistribution process associated with the inflammatory response. In this response, hepatic metallothionein production increases in reaction to cytokine release, which is linked to inflammation, and this protein effectively captures and stores zinc in the liver. Multiple regulatory mechanisms come into play, influencing the uptake of zinc, the binding of zinc to blood albumin and red blood cells, as well as the buffering and modulation of cytosolic zinc levels. Decreased zinc levels are associated with increasing severity of organ dysfunction, prolonged hospital stay and increased mortality in septic and COVID-19 patients. Results of recent studies focusing on these topics are summarized and discussed in this narrative review. Existing evidence currently does not support pharmacological zinc supplementation in patients with sepsis or COVID-19. Complementation and repletion should follow current guidelines for micronutrients in critically ill patients. Further research investigating the pharmacological mechanism of zinc in programmed cell death caused by invasive infections and its therapeutic potential in sepsis and COVID-19 could be worthwhile.
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Affiliation(s)
- George Briassoulis
- Postgraduate Program “Emergency and Intensive Care in Children, Adolescents, and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Panagiotis Briassoulis
- Second Department of Anesthesiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Stavroula Ilia
- Postgraduate Program “Emergency and Intensive Care in Children, Adolescents, and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece;
- Paediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece;
| | - Marianna Miliaraki
- Paediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece;
| | - Efrossini Briassouli
- Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Ekyaruhanga P, Nantanda R, Aanyu HT, Mukisa J, Ssemasaazi JA, John M, Aceng P, Rujumba J. Delay in healthcare seeking for young children with severe pneumonia at Mulago National Referral Hospital, Uganda: A mixed methods cross-sectional study. PLoS One 2023; 18:e0291387. [PMID: 37816023 PMCID: PMC10564236 DOI: 10.1371/journal.pone.0291387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Globally, pneumonia is the leading infectious cause of under-five mortality, and this can be reduced by prompt healthcare seeking. Data on factors associated with delays in seeking care for children with pneumonia in Uganda is scarce. OBJECTIVES The study aimed to determine the prevalence, factors associated with delay, barriers, and facilitators of prompt healthcare seeking for children under five years of age with severe pneumonia attending Mulago National Referral Hospital (MNRH) Uganda. METHODS A mixed methods cross-sectional study was conducted among 384 caregivers of children with severe pneumonia at MNRH. Quantitative data was collected using interviewer-administered structured questionnaires and qualitative data through focus group discussions with caregivers. Descriptive statistics were used to determine the prevalence of delay in care seeking. Logistic regression analysis was used to determine the factors that were independently associated with delay in seeking healthcare. Content thematic analysis was used to analyze for barriers and facilitators of prompt healthcare seeking. RESULTS The prevalence of delay in seeking healthcare was 53.6% (95% CI: 48.6-58.6). Long distance to a hospital (AOR = 1.94, 95% CI 1.22-3.01, p value = 0.003), first seeking care elsewhere (AOR = 3.33, 95% CI 1.85-6.01, p value = 0.001), and monthly income ≤100,000 UGX (28 USD) (AOR = 2.27,95% CI 1.33-3.86, p value = 0.003) were independently associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed referrals, self-medication, and low level of education were barriers to prompt healthcare seeking while recognition of symptoms of severe illness in the child, support from spouses, and availability of money for transport were key facilitators of early healthcare seeking. CONCLUSION This study showed that more than half of the caregivers delayed seeking healthcare for their children with pneumonia symptoms. Caregivers who first sought care elsewhere, lived more than 5 km from the hospital, and earned less than 28 USD per month were more likely to delay seeking healthcare for their children with severe pneumonia. Limited knowledge of symptoms of pneumonia, self-medication, and delayed referral hindered prompt care-seeking. Key facilitators of prompt care-seeking were accessibility to health workers, support from spouses, and recognition of symptoms of severe illness in children. There is a need for programs that educate caregivers about pneumonia symptoms, in children less than five years.
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Affiliation(s)
- Phiona Ekyaruhanga
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hellen T. Aanyu
- Department of Paediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Mukeere John
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Palma Aceng
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Wilkes C, Bava M, Graham HR, Duke T. What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review. J Glob Health 2023; 13:05003. [PMID: 36825608 PMCID: PMC9951126 DOI: 10.7189/jogh.13.05003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background Knowledge of the risk factors for and causes of treatment failure and mortality in childhood pneumonia is important for prevention, diagnosis, and treatment at an individual and population level. This review aimed to identify the most important risk factors for mortality among children aged under ten years with pneumonia. Methods We systematically searched MEDLINE, EMBASE, and PubMed for observational and interventional studies reporting risk factors for mortality in children (aged two months to nine years) in low- and middle-income countries (LMICs). We screened articles according to specified inclusion and exclusion criteria, assessed risk of bias using the EPHPP framework, and extracted data on demographic, clinical, and laboratory risk factors for death. We synthesized data descriptively and using Forest plots and did not attempt meta-analysis due to the heterogeneity in study design, definitions, and populations. Findings We included 143 studies in this review. Hypoxaemia (low blood oxygen level), decreased conscious state, severe acute malnutrition, and the presence of an underlying chronic condition were the risk factors most strongly and consistently associated with increased mortality in children with pneumonia. Additional important clinical factors that were associated with mortality in the majority of studies included particular clinical signs (cyanosis, pallor, tachypnoea, chest indrawing, convulsions, diarrhoea), chronic comorbidities (anaemia, HIV infection, congenital heart disease, heart failure), as well as other non-severe forms of malnutrition. Important demographic factors associated with mortality in the majority of studies included age <12 months and inadequate immunisation. Important laboratory and investigation findings associated with mortality in the majority of studies included: confirmed Pneumocystis jirovecii pneumonia (PJP), consolidation on chest x-ray, pleural effusion on chest x-ray, and leukopenia. Several other demographic, clinical and laboratory findings were associated with mortality less consistently or in a small numbers of studies. Conclusions Risk assessment for children with pneumonia should include routine evaluation for hypoxaemia (pulse oximetry), decreased conscious state (e.g. AVPU), malnutrition (severe, moderate, and stunting), and the presence of an underlying chronic condition as these are strongly and consistently associated with increased mortality. Other potentially useful risk factors include the presence of pallor or anaemia, chest indrawing, young age (<12 months), inadequate immunisation, and leukopenia.
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Affiliation(s)
- Chris Wilkes
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Mohamed Bava
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Hamish R Graham
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
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Zinc in Human Health and Infectious Diseases. Biomolecules 2022; 12:biom12121748. [PMID: 36551176 PMCID: PMC9775844 DOI: 10.3390/biom12121748] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
During the last few decades, the micronutrient zinc has proven to be an important metal ion for a well-functioning immune system, and thus also for a suitable immune defense. Nowadays, it is known that the main cause of zinc deficiency is malnutrition. In particular, vulnerable populations, such as the elderly in Western countries and children in developing countries, are often affected. However, sufficient zinc intake and homeostasis is essential for a healthy life, as it is known that zinc deficiency is associated with a multitude of immune disorders such as metabolic and chronic diseases, as well as infectious diseases such as respiratory infections, malaria, HIV, or tuberculosis. Moreover, the modulation of the proinflammatory immune response and oxidative stress is well described. The anti-inflammatory and antioxidant properties of zinc have been known for a long time, but are not comprehensively researched and understood yet. Therefore, this review highlights the current molecular mechanisms underlying the development of a pro-/ and anti-inflammatory immune response as a result of zinc deficiency and zinc supplementation. Additionally, we emphasize the potential of zinc as a preventive and therapeutic agent, alone or in combination with other strategies, that could ameliorate infectious diseases.
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Saied A, El Borolossy RM, Ramzy MA, Sabri NA. Effect of zinc versus vitamin A supplementation on pediatric patients with community-acquired pneumonia. Front Pharmacol 2022; 13:933998. [PMID: 36110532 PMCID: PMC9468708 DOI: 10.3389/fphar.2022.933998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Community-acquired pneumonia (CAP) is one of the most common infectious diseases affecting the respiratory tract and is responsible for a high mortality rate in children less than 5 years of age. The mortality rate due to CAP is much higher in low/middle-income countries than in high-income countries due to malnutrition and different micronutrient deficiencies that weaken the immune system. Aim: The aim of this study was to compare the effects of zinc and vitamin A, as two elements of micronutrient agents, on the recovery rate of children suffering from CAP aged from 6 months to 5 years. The length of hospital stays was also investigated. Method: A comparative, randomized, open-label, controlled, interventional study was carried out among children less than 5 years of age in the pediatric intensive care unit (PICU) diagnosed with CAP who were randomly divided into three groups. In addition to the standard therapy, group 1 was given zinc, group 2 was given vitamin A, and group 3 was the control group, given the standard therapy only. We compared the three groups in terms of recovery rate and hospital stay. Result: The duration of hospitalization following zinc and vitamin A supplementation was reduced by an average of 3.21 days (95% CI: 5.01–1.41, p = 0.01) and 2.43 days (95% CI: 4.29–0.57, p = 0.01), respectively, compared to the control group. In addition, the two groups of vitamin A and zinc supplementation were associated with a shorter duration of pneumonic effusion (p < 0.001) in comparison to the control group. Additionally, there was no significant difference between the effects of zinc and vitamin A when compared to each other in terms of duration of hospital stay and pneumatic effusion. Conclusion: The administration of zinc or vitamin A supplementation proved to be useful as an add-on therapy in community-acquired pneumonia, where it reduced the length of hospital stay and the duration of pneumonic effusion in pneumonic children less than 5 years of age.
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Affiliation(s)
- Aya Saied
- Clinical Pharmacist, Al Galaa Military Medical Complex, Cairo, Egypt
- *Correspondence: Aya Saied,
| | | | | | - Nagwa A. Sabri
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Hume-Nixon M, Graham H, Russell F, Mulholland K, Gwee A. Review of the role of additional treatments including oseltamivir, oral steroids, macrolides, and vitamin supplementation for children with severe pneumonia in low- and middle-income countries. J Glob Health 2022; 12:10005. [PMID: 35993199 PMCID: PMC9393748 DOI: 10.7189/jogh.12.10005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Pneumonia is a major cause of death in children aged under five years. As children with severe pneumonia have the highest risk of morbidity and mortality, previous studies have evaluated the additional benefit of adjunctive treatments such as oseltamivir, oral steroids, macrolides, and vitamin supplementation that can be added to standard antibiotic management to improve clinical outcomes. The study reviewed the evidence for the role of these additional treatments for children with severe pneumonia in low- and middle-income countries (LMICs). Methods Four electronic databases were searched for English-language articles between 2000 to 2020. Systematic reviews (SRs) with meta-analyses, comparative cohort studies, and randomised controlled trials (RCTs) from LMICs that reported clinical outcomes for children with severe pneumonia aged between one month to 9 years who received adjunct treatment in addition to standard care were included. Risk of bias of included SRs was assessed using AMSTAR 2, and of individual studies using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results Overall, the search identified 2147 articles, 32 of which were eligible, including 7 SRs and 25 RCTs. These studies evaluated zinc (4 SRs, 17 RCTs), Vitamin D (1 SR, 4 RCTs), Vitamin A (3 SRs, 1 RCT), Vitamin C (1 SR, 2 RCTs) and micronutrients (1 RCT). Most studies reported clinical outcomes of time to improvement, length of stay, and treatment failure (including mortality). No studies of oseltamivir, steroids, or macrolides fulfilling the inclusion criteria were identified. For zinc, pooled analyses from SRs showed no evidence of benefit. Similarly, a Cochrane review and one RCT found that Vitamin A did not improve clinical outcomes. For Vitamin D, an RCT evaluating a single high dose of 100 000 international units (IU) of vitamin D found a reduction in time to improvement, with 38%-40% documented vitamin D deficiency at baseline. However, two other studies of 1000 IU daily did not show any effect, but vitamin D status was not measured. For vitamin C, two studies found a reduction in time to symptom resolution in those with severe disease, with one reporting a shorter length of hospital stay. However, both studies were of weak quality. Most studies excluded malnourished children, and studies which included these children did not report specifically on the effect of micronutrients. Conclusions This review found that adjunctive zinc and vitamin A, in addition to standard care, does not improve clinical outcomes in children with severe pneumonia in LMICs (strong evidence). However, a reduction in time to symptom resolution was reported with high dose vitamin D supplementation in children with documented vitamin D deficiency (strong evidence from one study) and vitamin C (weak evidence), although further research is needed, especially in underweight children.
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Affiliation(s)
- Maeve Hume-Nixon
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Hamish Graham
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Royal Children's Hospital Melbourne, Flemington Road, Parkville, Victoria, Australia
| | - Fiona Russell
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kim Mulholland
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amanda Gwee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Royal Children's Hospital Melbourne, Flemington Road, Parkville, Victoria, Australia
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Khoshnevisasl P, Sadeghzadeh M, Kamali K, Ardalani A. A randomized clinical trial to assess the effect of zinc and vitamin D supplementation in addition to hypertonic saline on treatment of acute bronchiolitis. BMC Infect Dis 2022; 22:538. [PMID: 35692038 PMCID: PMC9190165 DOI: 10.1186/s12879-022-07492-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Bronchiolitis, the most common cause of hospitalization in infancy has not yet a definitive treatment. This study was conducted to assess the effect of Zinc and vitamin D on treatment of infants with bronchiolitis. Methods In this double blind, randomized clinical trial, 94 infants aged 2 to 23 months, admitted in Mousavi Hospital in Zanjan, Iran, with the diagnosis of acute bronchiolitis were randomly assigned into 3 groups. The control group was only treated with hypertonic saline. The two case groups received either 100 unit/kg/day of Vitamin D or 20 mg/day of zinc in addition to hypertonic saline. Wheezing, duration of hospital stay, cough, cyanosis, respiratory distress and the respiratory rate in the first, third and seventh day of hospitalization were evaluated. Results There was no significant difference between groups in terms of age, sex, weight, passive smoking, wheezing, oxygen saturation, cyanosis and type of delivery. On the third day of hospitalization, the respiratory rate/min in the control group, the groups receiving vitamin D and zinc were 45.2 ± 10.7, 37.8 ± 3.9 and 41.1 ± 9.1 respectively and the result of repeated measure analysis didn’t show any significant difference between the 3 groups (P = 0.562). Duration of hospitalization in the group receiving Vitamin D or zinc and in controls were 4.2 ± 2.6, 4.4 ± 2.2 and 5.1 ± 2.4 days respectively and this difference was not significant. Zinc receiving patients did not differ from the control group regarding to respiratory rate, cyanosis and wheezing. Conclusion Vitamin D or zinc administration was not effective in reducing respiratory rate in children with bronchiolitis. Trial registration This project was approved by the Institutional Ethics Committee (IR, ZUMS.REC.1396.50), and registered on IRCT (IRCT20131217015835N7).
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Affiliation(s)
- Parisa Khoshnevisasl
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mansour Sadeghzadeh
- Metabolic Disease Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Koorosh Kamali
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Armita Ardalani
- Department of Pediatrics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Rahman AE, Hossain AT, Nair H, Chisti MJ, Dockrell D, Arifeen SE, Campbell H. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2022; 10:e348-e359. [PMID: 35180418 PMCID: PMC8864303 DOI: 10.1016/s2214-109x(21)00586-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. METHODS We conducted a systematic review using the following key concepts "children under five years of age" AND "pneumonia" AND "hypoxaemia" AND "low- and middle-income countries" by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO2 <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. FINDINGS We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26-36; 101 775 children) among all children with WHO-classified pneumonia, 41% (33-49; 30 483 children) among those with very severe or severe pneumonia, and 8% (3-16; 2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5-8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high τ2 (ie, 0·17), indicating a high level of heterogeneity between studies, and a high I2 value (ie, 99·6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. INTERPRETATION The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. FUNDING UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109).
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Affiliation(s)
- Ahmed Ehsanur Rahman
- The University of Edinburgh, Edinburgh, UK; International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Nantanda R, Bwanga F, Najjingo I, Ndeezi G, Tumwine JK. Prevalence, risk factors and outcome of Mycoplasma pneumoniae infection among children in Uganda: a prospective study. Paediatr Int Child Health 2021; 41:188-198. [PMID: 34743675 PMCID: PMC8791631 DOI: 10.1080/20469047.2021.1980698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND : Atypical bacteria cause 10-40% of all childhood pneumonia.. Data on the burden of atypical pneumonia in sub-Saharan Africa are limited. AIM : To determine the prevalence, associated factors, and outcome of Mycoplasma pneumoniae infection in children with respiratory symptoms at Mulago National Referral Hospital, Kampala. METHODS : Children aged 2 months to 12 years with cough and/or difficult breathing and fast breathing were recruited. A clinical history and physical examination were undertaken. Blood samples for Mycoplasma pneumoniae IgM antibodies were taken at enrolment and Day 21 and induced sputum for DNA-PCR. Admitted participants were followed for a maximum of 7 days or until discharge or death, whichever came first. RESULTS : A total of 385 children were enrolled, and, of these, 368 (95.6%) were <5 years. Overall, 60/385 (15.6%) participants tested positive for M. pneumoniae IgM and/or DNA-PCR. Of these, 56/60 (93.3%) were <5 years of age. Wheezing was present in 21/60 (35.0%) of the children with atypical pneumonia and in 128/325 (39.4%) with typical pneumonia. The factors associated with M. pneumonia were female sex (AOR 1.94, 95% CI 1.22-3.08, p < 0.001), age ≥12 months (AOR 2.73, 95% CI 1.53-4.87, p = 0.01) and a history of prematurity (AOR 2.07, 95% CI 1.23-3.49, p = 0.01). Mortality was 17/352 (4.8%) and, of these, 4/17 (23.5%) had M. pneumonia. CONCLUSION : M. pneumonia is common in young children , especially females above 2 years and those with history of prematurity. It presents with severe symptoms. The results of the study highlight the importance of considering atypical bacteria in under-5s with the symptoms of pneumonia.
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Affiliation(s)
- Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Freddie Bwanga
- Department of Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Najjingo
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Effect of zinc supplementation on mortality in under 5-year children: a systematic review and meta-analysis of randomized clinical trials. Eur J Nutr 2021; 61:37-54. [PMID: 34120246 DOI: 10.1007/s00394-021-02604-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several clinical trials evaluated the effect of zinc supplementation on mortality in children, but the results were inconsistent. We aimed to conduct a systematic review and meta-analysis on the impact of zinc supplementation on mortality in under 5-year children. METHODS A comprehensive search was conducted using the electronic (PubMed, Scopus, Web of Science) databases, and Google Scholar, up to June 2020. Randomized clinical trials (RCTs) that reported the effect of zinc supplementation on death incidence in under 5-year children were included in the analysis. Screening was performed based on title/abstract and full-text. A random effects model was applied to calculate the summary relative risk (SRR). Risk of Bias 2.0 tool was used to rate the quality of trials. The body of evidence was assessed by the GRADE approach. RESULTS Combining 30 RRs from 28 RCTs including 237,068 participants revealed that zinc supplementation has significantly reduced the risk of all-causes mortality by 16% in children (SRR: 0.84, 95% CI: 0.74, 0.96). A follow-up duration of less than 1 year after supplementation resulted in 54% reduced risk of mortality (0.46; 0.33, 0.63) with no heterogeneity between investigations. Subgroup analysis by zinc dosage showed that assigning ≥ 10 mg/d zinc to under five children and duration of less than 11 months of intervention decreased the risk of all-cause mortality by 44% (0.56; 0.42, 0.75) and 48% (0.52; 0.38, 0.72), respectively. In low birth weight (LBW) infants, zinc supplementation was reduced all-cause mortality by 52% (0.48; 0.23, 1.00). Zinc supplementation significantly reduced the risk of death from pneumonia (0.70: 0.64, 0.98) and infection (0.54; 0.39, 0.76), also changed the risk of mortality from diarrhea by 15% (0.85; 0.70, 1.03) and sepsis by 57% (0.43; 0.18, 1.02). CONCLUSION This meta-analysis on RCTs revealed that zinc supplementation in under 5-year children has significantly reduced the risk of all-cause mortality. Notable decreases were found in trials with a dose of 10 mg/d or more zinc supplementation, a maximum of 11 months of supplementation, a follow-up less than one year and especially in LBW infants.
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12
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Chinni V, El-Khoury J, Perera M, Bellomo R, Jones D, Bolton D, Ischia J, Patel O. Zinc supplementation as an adjunct therapy for COVID-19: Challenges and opportunities. Br J Clin Pharmacol 2021; 87:3737-3746. [PMID: 33742473 PMCID: PMC8250380 DOI: 10.1111/bcp.14826] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 01/19/2023] Open
Abstract
An outbreak of a novel coronavirus (COVID‐19 or 2019‐CoV) infection has posed significant threats to international health and the economy. Patients with COVID‐19 are at risk of cytokine storm, acute respiratory distress syndrome (ARDS), reduced blood oxygenation, mechanical ventilation, and a high death rate. Although recent studies have shown remdesivir and dexamethasone as treatment options, there is an urgent need to find a treatment to inhibit virus replication and to control the progression of the disease. Essential biometal zinc has generated a lot of excitement as one of the promising candidates to reduce the severity of COVID‐19 infection. Several published observations outlined in the review are the reasons why there is a global enthusiasm that zinc therapy could be a possible therapeutic option. However, the biggest challenge in realising the therapeutic value of zinc is lack of optimal treatment modalities such as dose, duration of zinc supplementation and the mode of delivery. In this review, we discuss the regulatory mechanism that hinges upon the bioavailability of zinc. Finally, we propose that intravenous zinc could circumvent the confounding factors affecting the bioavailability of zinc and allow zinc to achieve its therapeutic potential. If successful, due to advantages such as lack of toxicity, low cost and ease of availability, intravenous zinc could be rapidly implemented clinically.
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Affiliation(s)
- Vidyasagar Chinni
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - John El-Khoury
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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13
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Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients 2020; 12:E3198. [PMID: 33092041 PMCID: PMC7589163 DOI: 10.3390/nu12103198] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022] Open
Abstract
Viral infections are a leading cause of morbidity and mortality worldwide, and the importance of public health practices including handwashing and vaccinations in reducing their spread is well established. Furthermore, it is well known that proper nutrition can help support optimal immune function, reducing the impact of infections. Several vitamins and trace elements play an important role in supporting the cells of the immune system, thus increasing the resistance to infections. Other nutrients, such as omega-3 fatty acids, help sustain optimal function of the immune system. The main aim of this manuscript is to discuss of the potential role of micronutrients supplementation in supporting immunity, particularly against respiratory virus infections. Literature analysis showed that in vitro and observational studies, and clinical trials, highlight the important role of vitamins A, C, and D, omega-3 fatty acids, and zinc in modulating the immune response. Supplementation with vitamins, omega 3 fatty acids and zinc appears to be a safe and low-cost way to support optimal function of the immune system, with the potential to reduce the risk and consequences of infection, including viral respiratory infections. Supplementation should be in addition to a healthy diet and fall within recommended upper safety limits set by scientific expert bodies. Therefore, implementing an optimal nutrition, with micronutrients and omega-3 fatty acids supplementation, might be a cost-effective, underestimated strategy to help reduce the burden of infectious diseases worldwide, including coronavirus disease 2019 (COVID-19).
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Affiliation(s)
| | | | | | | | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (F.P.); (A.A.); (C.N.)
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14
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Brown N, Kukka AJ, Mårtensson A. Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Paediatr Open 2020; 4:e000662. [PMID: 32685705 PMCID: PMC7359381 DOI: 10.1136/bmjpo-2020-000662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active. METHODS Systematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed. RESULTS We identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions. CONCLUSION There is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs. TRIAL REGISTRATION NUMBER CRD42019141602.
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Affiliation(s)
- Nick Brown
- IMCH, Kvinno och barnhälsa, Uppsala Universitet, Uppsala, Sweden
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15
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Skalny AV, Rink L, Ajsuvakova OP, Aschner M, Gritsenko VA, Alekseenko SI, Svistunov AA, Petrakis D, Spandidos DA, Aaseth J, Tsatsakis A, Tinkov AA. Zinc and respiratory tract infections: Perspectives for COVID‑19 (Review). Int J Mol Med 2020; 46:17-26. [PMID: 32319538 PMCID: PMC7255455 DOI: 10.3892/ijmm.2020.4575] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
In view of the emerging COVID‑19 pandemic caused by SARS‑CoV‑2 virus, the search for potential protective and therapeutic antiviral strategies is of particular and urgent interest. Zinc is known to modulate antiviral and antibacterial immunity and regulate inflammatory response. Despite the lack of clinical data, certain indications suggest that modulation of zinc status may be beneficial in COVID‑19. In vitro experiments demonstrate that Zn2+ possesses antiviral activity through inhibition of SARS‑CoV RNA polymerase. This effect may underlie therapeutic efficiency of chloroquine known to act as zinc ionophore. Indirect evidence also indicates that Zn2+ may decrease the activity of angiotensin‑converting enzyme 2 (ACE2), known to be the receptor for SARS‑CoV‑2. Improved antiviral immunity by zinc may also occur through up‑regulation of interferon α production and increasing its antiviral activity. Zinc possesses anti‑inflammatory activity by inhibiting NF‑κB signaling and modulation of regulatory T‑cell functions that may limit the cytokine storm in COVID‑19. Improved Zn status may also reduce the risk of bacterial co‑infection by improving mucociliary clearance and barrier function of the respiratory epithelium, as well as direct antibacterial effects against S. pneumoniae. Zinc status is also tightly associated with risk factors for severe COVID‑19 including ageing, immune deficiency, obesity, diabetes, and atherosclerosis, since these are known risk groups for zinc deficiency. Therefore, Zn may possess protective effect as preventive and adjuvant therapy of COVID‑19 through reducing inflammation, improvement of mucociliary clearance, prevention of ventilator‑induced lung injury, modulation of antiviral and antibacterial immunity. However, further clinical and experimental studies are required.
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Affiliation(s)
- Anatoly V. Skalny
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
- Yaroslavl State University, 150003 Yaroslavl, Russia
| | - Lothar Rink
- Institute of Immunology, Medical Faculty, RWTH Aachen University, D-52062 Aachen, Germany
| | - Olga P. Ajsuvakova
- Yaroslavl State University, 150003 Yaroslavl, Russia
- Federal Research Centre of Biological Systems and Agro-technologies of the Russian Academy of Sciences, 460000 Orenburg, Russia
| | - Michael Aschner
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Viktor A. Gritsenko
- Institute of Cellular and Intracellular Symbiosis, Russian Academy of Sciences, 460000 Orenburg
| | - Svetlana I. Alekseenko
- I.I. Mechnikov North-Western State Medical University, 191015 St. Petersburg
- K.A. Rauhfus Children's City Multidisciplinary Clinical Center for High Medical Technologies, 191000 St. Petersburg, Russia
| | - Andrey A. Svistunov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71409 Heraklion, Greece
| | - Jan Aaseth
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
- Research Department, Innlandet Hospital Trust, 3159894 Brumunddal, Norway
| | - Aristidis Tsatsakis
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
- Center of Toxicology Science and Research
| | - Alexey A. Tinkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow
- Yaroslavl State University, 150003 Yaroslavl, Russia
- Institute of Cellular and Intracellular Symbiosis, Russian Academy of Sciences, 460000 Orenburg
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Serum Zinc Levels in Children 1 - 59 Months of Age with Pneumonia: A Single-Center Surveillance in India from 2014 to 2016. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.98735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Hamed AMM, Kassem YT, Fayed HK, Solaiman AM. Serum zinc levels in hospitalized children with pneumonia: a hospital-based case–control study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_30_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Case fatality rate and viral aetiologies of acute respiratory tract infections in HIV positive and negative people in Africa: The VARIAFRICA-HIV systematic review and meta-analysis. J Clin Virol 2019; 117:96-102. [PMID: 31272038 PMCID: PMC7106531 DOI: 10.1016/j.jcv.2019.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/04/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022]
Abstract
This first meta-analysis compare CFR between HIV(+) and HIV(-) with ARTI in Africa We found higher rate of mortality in HIV(+) people compared to HIV(-) In subgroup analysis, the CFR was higher in HIV + children <5 compared to people >5 Viral aetiologies of ARTI were not different between HIV(+) and HIV(-)
Background To set priorities for efficient control of acute respiratory tract infection (ARTI) in Africa, it is necessary to have accurate estimate of its burden, especially among HIV-infected populations. Objectives To compare case fatality rate (CFR) and viral aetiologies of ARTI between HIV-positive and HIV-negative populations in Africa. Study design We searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, and Global Index Medicus to identify studies published from January 2000 to April 2018. Random-effect meta-analysis method was used to assess association (pooled weighted odds ratios (OR) with 95% confidence interval (CI)). Results A total of 36 studies (126,526 participants) were included. CFR was significantly higher in patients with HIV than in HIV-negative controls (OR 4.10, 95%CI: 2.63–6.27, I²: 93.7%). The risk was significantly higher among children ≤5 years (OR 5.51, 95%CI 2.83–10.74) compared to people aged >5 years (OR 1.48, 95%CI 1.17–1.89); p = 0.0002. There was no difference between children (15 years) and adults and between regions of Africa. There was no difference for viral respiratory aetiologies (Enterovirus, Adenovirus, Bocavirus, Coronavirus, Metapneumovirus, Parainfluenza, Influenza, and Respiratory Syncytial Virus) of ARTI between HIV-positive and HIV-negative people, except for Rhinovirus where being HIV-negative was associated with Rhinovirus (OR 0.70; 95%CI 0.51–0.97, I²: 63.4%). Conclusions This study shows an increased risk of deaths among HIV-infected individuals with ARTI, however with no difference in viral aetiologies compared to HIV-negative individuals in Africa. ARTI deserves more attention from HIV health-care providers for efficient control. Specific strategies are needed for HIV-positive children under 5.
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Acevedo-Murillo JA, García León ML, Firo-Reyes V, Santiago-Cordova JL, Gonzalez-Rodriguez AP, Wong-Chew RM. Zinc Supplementation Promotes a Th1 Response and Improves Clinical Symptoms in Fewer Hours in Children With Pneumonia Younger Than 5 Years Old. A Randomized Controlled Clinical Trial. Front Pediatr 2019; 7:431. [PMID: 31803694 PMCID: PMC6874056 DOI: 10.3389/fped.2019.00431] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Pneumonia caused 704,000 deaths in children younger than 5 years in 2015. Zinc is an important micronutrient due to its role in immune function. Since 2004, WHO recommends zinc supplementation for children with diarrhea to shorten the duration and decrease severity. Zinc supplementation for children with pneumonia is controversial. Methods: A randomized controlled clinical trial was conducted, and 103 children 1 month to 5 years old with pneumonia were included. Zinc or placebo was given during hospitalization. Clinical symptoms were recorded, and a blood draw was obtained to determine serum zinc levels, lymphoproliferation, and cytokines at hospitalization and at discharge of the patient; a nasal wash was obtained to detect viral or bacterial pathogens by multiplex RT-PCR. Results: Zinc supplementation improved in fewer hours the clinical status (76 ± 7 vs. 105 ± 8, p = 0.01), the respiratory rate (37 ± 6 vs. 57 ± 7, p = 0.04), and the oxygen saturation (53 ± 7 vs. 87 ± 9, p = 0.007) compared to the placebo group. An increase in IFNγ and IL-2 after treatment in the zinc group was observed. Conclusions: Zinc supplementation improved some clinical symptoms in children with pneumonia in fewer hours and induced a cellular immune response. Clinical Trial Registration: The trial was retrospectively registered in ClinicalTrials.gov, identifier NCT03690583, URL https://clinicaltrials.gov/ct2/show/NCT03690583?term=zinc+children&cond=Pneumonia&draw=2&rank=1.
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Affiliation(s)
| | - Miguel Leonardo García León
- Laboratorio de Investigación en Enfermedades Infecciosas, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Verónica Firo-Reyes
- Servicio de Pediatría, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Jorge Luis Santiago-Cordova
- Laboratorio de Investigación en Enfermedades Infecciosas, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Pamela Gonzalez-Rodriguez
- Laboratorio de Investigación en Enfermedades Infecciosas, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosa María Wong-Chew
- Laboratorio de Investigación en Enfermedades Infecciosas, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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20
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Saleh NY, Abo El Fotoh WMM. Low serum zinc level: The relationship with severe pneumonia and survival in critically ill children. Int J Clin Pract 2018; 72:e13211. [PMID: 29855123 DOI: 10.1111/ijcp.13211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/30/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Zinc deficiency is common among children in developing countries; but, there is still conflicting evidence on whether the alteration in zinc metabolism is the predictive of disease severity in the setting of critical illness. OBJECTIVES To assess serum zinc levels in children admitted with pneumonia, and also to study the relationship between zinc levels and severity and mortality from pneumonia. METHODS In a prospective cohort study, we enrolled 320 critically ill children admitted to the paediatric intensive care unit (PICU) with severe pneumonia (group 1) in addition to 160 children admitted into wards with pneumonia (group 2). Serum zinc measured in all patients on admission. RESULTS Serum zinc level was significantly lower among patients admitted to PICU (group 1) compared with patients admitted to wards (group 2) (P < .001). There was a highly statistically significant decrease in zinc level in critically ill children complicated by sepsis, mechanically ventilated cases and those who died. Regarding the diagnosis of sepsis, zinc had an area under the curve (AUC) of 0.81 while C-reactive protein (CRP) had an AUC of 0.83. Regarding the prognosis, zinc had an AUC of 0.649 for prediction of mortality, whereas the AUC for Pediatric risk of mortality (PRISM), Pediatric index of mortality2 (PIM2) and CRP were 0.83, 0.82 and 0.78, respectively. The combined zinc with PRISM and PIM2 has increased the sensitivity of zinc for mortality from 86.5% to 94.9%. CONCLUSION Zinc has both a diagnostic and a prognostic value for children with pneumonia.
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Affiliation(s)
- Nagwan Yossery Saleh
- Department of Pediatrics, Faculty of Medicine, Menoufia University Hospital, Shebin El-Kom, Egypt
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21
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Howie S, Bottomley C, Chimah O, Ideh R, Ebruke B, Okomo U, Onyeama C, Donkor S, Rodrigues O, Tapgun M, Janneh M, Oluwalana C, Kuti B, Enwere G, Esangbedo P, Doherty C, Mackenzie G, Greenwood B, Corrah T, Prentice A, Adegbola R, Zaman S. Zinc as an adjunct therapy in the management of severe pneumonia among Gambian children: randomized controlled trial. J Glob Health 2018; 8:010418. [PMID: 29713463 PMCID: PMC5908397 DOI: 10.7189/jogh.08.010418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The benefit of zinc as an adjunct therapy for severe pneumonia is not established. We assessed the benefit of adjunct zinc therapy for severe pneumonia in children and determined whether the study children were zinc deficient. Methods This was a randomized, parallel group, double-blind, placebo-controlled trial with an allocation ratio of 1:1 conducted in children with severe pneumonia to evaluate the efficacy of daily zinc as an adjunct treatment in preventing 'treatment failure' (presence of any sign of severe pneumonia) on day-5 and day-10 and in reducing the time to resolution of signs of severe pneumonia. Six hundred and four children 2-59 months of age presenting with severe pneumonia at six urban and rural health care facilities in The Gambia were individually randomised to receive placebo (n = 301) or zinc (n = 303) for seven days. To determine if the study children were zinc deficient, supplementation was continued in a randomly selected subgroup of 121 children from each arm for six months post-enrolment, and height-gain, nutritional status, plasma zinc concentrations, and immune competence were compared. Results Percentage of treatment failure were similar in placebo and zinc arms both on day 5 (14.0% vs 14.1%) and day 10 (5.2% vs 5.9%). The time to recovery from lower chest wall indrawing and sternal retraction was longer in the placebo compared to zinc arm (24.4 vs 23.0 hours; P = 0.011 and 18.7 vs 11.0 hours; P = 0.006 respectively). The time to resolution for all respiratory symptoms of severity was not significantly different between placebo and zinc arms (42.3 vs 30.9 hours respectively; P = 0.242). In the six months follow-up sub-group, there was no significant difference in height gain, height-for-age and weight-for-height Z-scores, mid upper arm circumference, plasma zinc concentrations, and anergy at six months post-enrolment. Conclusions In this population, zinc given as an adjunct treatment for severe pneumonia showed no benefit in treatment failure rates, or clinically important benefit in time to recovery from respiratory symptoms and showed marginal benefit in rapidity of resolution of some signs of severity. This finding does not support routine use of zinc as an adjunct treatment in severe pneumonia in generally zinc replete children. Trial registration ISRCTN33548493.
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Affiliation(s)
- Stephen Howie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Readon Ideh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Bernard Ebruke
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Uduak Okomo
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Simon Donkor
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Mary Tapgun
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Marie Janneh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Bankole Kuti
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Godwin Enwere
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Conor Doherty
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Tumani Corrah
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Andrew Prentice
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Syed Zaman
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
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22
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Bagri NK, Bagri N, Jana M, Gupta AK, Wadhwa N, Lodha R, Kabra SK, Chandran A, Aneja S, Chaturvedi MK, Sodhi J, Fitzwater SP, Chandra J, Rath B, Kainth US, Saini S, Black RE, Santosham M, Bhatnagar S. Efficacy of Oral Zinc Supplementation in Radiologically Confirmed Pneumonia: Secondary Analysis of a Randomized Controlled Trial. J Trop Pediatr 2018; 64:110-117. [PMID: 28575379 DOI: 10.1093/tropej/fmx036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effect of zinc as an adjuvant therapy in radiologically confirmed pneumonia in children 2-24 months of age. PATIENTS AND METHODS We analyzed data of 212 children with pneumonia for whom chest X-ray films were available at enrollment and at least two radiologists agreed on the diagnosis of pneumonia. We compared the time to recovery in the two groups (n = 121, zinc group and n = 91, placebo group) using a Cox proportional hazards regression model. RESULTS Time to recovery was similar in both groups [median interquartile range: zinc, 84 h (64, 140 h); placebo, 85 h (65, 140 h)]. The absolute risk reduction for treatment failure was 5.2% (95% confidence interval: -4.8, 15.1) with zinc supplementation. CONCLUSION There was no significant beneficial effect of zinc on the duration of recovery or risk of treatment failure in children with radiologically confirmed pneumonia.
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Affiliation(s)
- Narendra Kumar Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Bagri
- Mahajan Imaging, Defence Colony, New Delhi 110024, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitya Wadhwa
- Department of Pediatrics, All India Institute of Medical Sciences, Centre for Diarrheal Diseases and Nutrition Research, New Delhi 110029, India.,Pediatric Biology Centre, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aruna Chandran
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Department of Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Satinder Aneja
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Mona K Chaturvedi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jitender Sodhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sean Patrick Fitzwater
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Jagdish Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Bimbadhar Rath
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Udaypal S Kainth
- Department of Pediatrics, Deen Dayal Upadhyay Hospital, New Delhi 110064, India
| | - Savita Saini
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Department of Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Shinjini Bhatnagar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.,Department of Pediatrics, All India Institute of Medical Sciences, Centre for Diarrheal Diseases and Nutrition Research, New Delhi 110029, India
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23
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Wang L, Song Y. Efficacy of zinc given as an adjunct to the treatment of severe pneumonia: A meta-analysis of randomized, double-blind and placebo-controlled trials. CLINICAL RESPIRATORY JOURNAL 2017; 12:857-864. [PMID: 28488366 DOI: 10.1111/crj.12646] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/09/2017] [Accepted: 05/02/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pneumonia is a major cause of morbidity and mortality of children. Zinc is known to play a central role in the immune system. The deficiency of zinc increased susceptibility to infectious diseases. OBJECTIVE To investigate the clinical efficacy of zinc given as an adjunct therapy to the treatment of severe pneumonia. METHODS The PubMed, Embase, MEDLINETM and the Cochrane Central Register of Controlled Trials were searched to identify all randomized, double-blind and placebo-controlled (DBPC) trials which evaluated the clinical efficacy of zinc given as an adjunct in the treatment of severe pneumonia and published between January 1966 and October 2015. RESULTS Six randomized DBPC trials including 2216 patients with severe pneumonia were eligible. The results suggested that zinc given as an adjunct therapy to the treatment of severe pneumonia had no significant improvement of treatment failure (RR = 0.97, P = .71) and change of antibiotic therapy (RR = 1.09, P = .52). We also found a favorable trend for clinical deterioration of severe pneumonia but with no statistical significance (RR = 0.88, P = .55). Zinc produced a significant reduction in mortality caused by severe pneumonia (RR = 0.43, P = .01). CONCLUSIONS Zinc given as an adjunct to the treatment of severe pneumonia is effective in reducing the mortality of severe pneumonia, and has no significant effects on treatment failure and change of antibiotic therapy.
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Affiliation(s)
- Linlin Wang
- Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Public Health Clinical Center, Shanghai, 201508, China.,Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, 201700, China
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24
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Newberry L, O'Hare B, Kennedy N, Selman A, Omar S, Dawson P, Stevenson K, Nishihara Y, Lissauer S, Molyneux E. Early use of corticosteroids in infants with a clinical diagnosis of Pneumocystis jiroveci pneumonia in Malawi: a double-blind, randomised clinical trial. Paediatr Int Child Health 2017; 37:121-128. [PMID: 28145162 DOI: 10.1080/20469047.2016.1260891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pneumocystis jiroveci pneumonia (PJP) is the most common opportunistic infection in infants with vertically acquired HIV infection and the most common cause of death in HIV-infected infants. OBJECTIVES To determine whether early administration of adjuvant corticosteroids in addition to standard treatment reduces mortality in infants with vertically acquired HIV and clinically diagnosed PJP when co-infection with cytomegalovirus and other pathogens cannot be excluded. METHODS A double-blind placebo-controlled trial of adjuvant prednisolone treatment in HIV-exposed infants aged 2-6 months admitted to Queen Elizabeth Central Hospital, Blantyre who were diagnosed clinically with PJP was performed. All recruited infants were HIV-exposed, and the HIV status of the infant was confirmed by DNA-PCR. HIV-exposed and infected infants as well as HIV-exposed but non-infected infants were included in the study. The protocol provided for the addition of prednisolone to the treatment at 48 h if there was clinical deterioration or an independent indication for corticosteroid therapy in any patient not receiving it. Oral trimethoprim-sulfamethoxazole (TMP/SMX) therapy and full supportive treatment were provided according to established guidelines. Primary outcomes for all patients included survival to hospital discharge and 6-month post-discharge survival. RESULTS It was planned to enroll 200 patients but the trial was stopped early because of recruitment difficulties and a statistically significant result on interim analysis. Seventy-eight infants were enrolled between April 2012 and August 2014; 36 infants (46%) were randomised to receive corticosteroids plus standard treatment with TMP/SMX, and 42 infants (54%) received the standard treatment plus placebo. In an intention-to treat-analysis, the risk ratio of in-hospital mortality in the steroid group compared with the standard treatment plus placebo group was 0.53 [95% CI 0.29-0.97, p = 0.038]. The risk ratio of mortality at 6 months was 0.63 (95% CI 0.41-0.95, p = 0.029). Two children who received steroids developed bloody stools while in hospital. CONCLUSION In infants with a clinical diagnosis of PJP, early use of steroids in addition to conventional TMP/SMX therapy significantly reduced mortality in hospital and 6 months after discharge.
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Affiliation(s)
- Laura Newberry
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Bernadette O'Hare
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi.,c Global Health Implementation Group , University of St Andrews , Fife , Scotland
| | - Neil Kennedy
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi.,d Department of Paediatrics , Queen's University Belfast , Belfast , Northern Ireland
| | - Andrew Selman
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Sofia Omar
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Pamela Dawson
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Kim Stevenson
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Yo Nishihara
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Samantha Lissauer
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Elizabeth Molyneux
- a College of Medicine, University of Malawi , Blantyre , Malawi.,b Queen Elizabeth Central Hospital , Blantyre , Malawi
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Hasanzadeh Kiabi F, Alipour A, Darvishi-Khezri H, Aliasgharian A, Emami Zeydi A. Zinc Supplementation in Adult Mechanically Ventilated Trauma Patients is Associated with Decreased Occurrence of Ventilator-associated Pneumonia: A Secondary Analysis of a Prospective, Observational Study. Indian J Crit Care Med 2017; 21:34-39. [PMID: 28197049 PMCID: PMC5278588 DOI: 10.4103/0972-5229.198324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. SUBJECTS AND METHODS This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death. RESULTS Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86-25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138-0.732]; P < 0.0001). CONCLUSION The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
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Affiliation(s)
- Farshad Hasanzadeh Kiabi
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Aily Aliasgharian
- Student Research Committee, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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26
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Effect of Nutrition Supplementation in Children Living with HIV at ART Centre. Indian J Pediatr 2016; 83:232-7. [PMID: 26337450 DOI: 10.1007/s12098-015-1873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the benefits of nutrition supplementation in children living with HIV (CLHIV). METHODS A prospective observational study was carried out at antiretroviral therapy (ART)/pediatric centre of excellence (PCOE), Niloufer hospital for a period of one year in CLHIV (N = 164) aged 1 to 18 y referred to ART/PCOE. Nutrition supplementation was given in the form of Ready to Use Food (About 350 kcal and 12 g of protein per day) supplementation to assess improvement in Height for age Z (HAZ), Weight for Age Z (WAZ), Weight for Height Z (WHZ) and Body Mass Index for age Z (BMIZ) scores over a period of one year. RESULTS At baseline, 65.5 % and 57.5 % of children below and above 5 y respectively were stunted. 24.1 % and 45.3 % children below and above 5 y respectively were wasted/thin (as assessed by BMI for age). Mean BMIZ score significantly improved in both the age groups (0.96 Z score, P < 0.001) in below and above 5 (0.37 Z score, P < 0.001) respectively at the end of 12 mo. Mean HAZ score also significantly improved in children above 5 y (0.09 Z score, P < 0.05) with non-significant improvement below 5 y (0.14 Z score, P < 0.57) by the end of 12 mo. CONCLUSIONS Nutrition supplementation over one year resulted in moderate improvement in the nutritional status of CLHIV. However, it is unclear, whether the improvement in nutritional status was due to regular visits to ART centre that may have resulted in better adherence to treatment or an additional benefit of nutrition intervention. This warrants a well-designed randomized controlled trial to examine the benefits of nutrition supplementation in CLHIV attending ART centre.
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27
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Zinc as an adjunct to antibiotics for the treatment of severe pneumonia in children <5 years: a meta-analysis of randomised-controlled trials. Br J Nutr 2016; 115:807-16. [PMID: 26811108 DOI: 10.1017/s0007114515005449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effect of Zn, as an adjunct to antibiotics, on the treatment of severe pneumonia in young children is still under debate; therefore, we performed a meta-analysis to evaluate the therapeutic role of Zn for severe pneumonia in children younger than 5 years. PubMed, Cochrane library and Embase databases were systematically searched from inception until October 2015 for randomised-controlled trials (RCT) that assessed the effect of Zn as an adjunct to antibiotics for severe pneumonia. Random-effects model was used for calculating the pooled estimates, and intention-to-treat principle was also applied. Nine RCT involving 2926 children were included. Overall, the pooled results showed that adjunct treatment with Zn failed to reduce the time to recovery from severe pneumonia (hazard ratios (HR)=1·04; 95% CI 0·90, 1·19; I(2)=39%; P=0·58), hospital length of stay (HR=1·04; 95% CI 0·83, 1·33; I(2)=57%; P=0·74), treatment failure (relative risk (RR)=0·95; 95% CI 0·79, 1·14; I(2)=20%; P=0·58) or change of antibiotics (RR=1·07; 95% CI 0·79, 1·45; I(2)=44%; P=0·67). In addition, continuous outcomes were consistent while meta-analysed with standard mean difference, and all outcomes remained stable in intention-to-treat analysis. No significant differences were observed in the two groups between death rate, adverse events or recovery times of severe pneumonia indicators. Our results suggested that adjunct treatment with Zn failed to benefit young children in the treatment of severe pneumonia. Considering the clinical heterogeneity, baseline characteristics of children, definition of severe pneumonia and Zn supplement way should be taken into consideration in future research. This study was registered at PRESPERO as CRD42015019798.
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28
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Sears D, Mpimbaza A, Kigozi R, Sserwanga A, Chang MA, Kapella BK, Yoon S, Kamya MR, Dorsey G, Ruel T. Quality of inpatient pediatric case management for four leading causes of child mortality at six government-run Ugandan hospitals. PLoS One 2015; 10:e0127192. [PMID: 25992620 PMCID: PMC4437786 DOI: 10.1371/journal.pone.0127192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/12/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care. METHODS All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression. RESULTS A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea. CONCLUSIONS Appropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality improvement initiatives should target deficiencies in care unique to each health facility, and interventions should focus on the simultaneous management of multiple diagnoses.
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Affiliation(s)
- David Sears
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States of America
| | - Arthur Mpimbaza
- Uganda Malaria Surveillance Project, Kampala, Uganda
- Child Health & Development Centre, Makerere University, Kampala, Uganda
| | - Ruth Kigozi
- Uganda Malaria Surveillance Project, Kampala, Uganda
| | | | - Michelle A. Chang
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Bryan K. Kapella
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Steven Yoon
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- United States President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States of America
| | - Theodore Ruel
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States of America
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29
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Chamberlain S, Stolz U, Dreifuss B, Nelson SW, Hammerstedt H, Andinda J, Maling S, Bisanzo M. Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes. PLoS One 2015; 10:e0122559. [PMID: 25849960 PMCID: PMC4388510 DOI: 10.1371/journal.pone.0122559] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 02/23/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.
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Affiliation(s)
- Stacey Chamberlain
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Uwe Stolz
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Bradley Dreifuss
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Sara W. Nelson
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, United States of America
| | - Heather Hammerstedt
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Idaho Emergency Physicians, Boise, Idaho, United States of America
| | - Jovita Andinda
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Karoli Lwanga Hospital, Nyakibale, Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Bisanzo
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts, United States of America
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30
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King JC, Brown KH, Gibson RS, Krebs NF, Lowe NM, Siekmann JH, Raiten DJ. Biomarkers of Nutrition for Development (BOND)-Zinc Review. J Nutr 2015; 146:858S-885S. [PMID: 26962190 PMCID: PMC4807640 DOI: 10.3945/jn.115.220079] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 07/29/2015] [Accepted: 12/29/2015] [Indexed: 12/17/2022] Open
Abstract
Zinc is required for multiple metabolic processes as a structural, regulatory, or catalytic ion. Cellular, tissue, and whole-body zinc homeostasis is tightly controlled to sustain metabolic functions over a wide range of zinc intakes, making it difficult to assess zinc insufficiency or excess. The BOND (Biomarkers of Nutrition for Development) Zinc Expert Panel recommends 3 measurements for estimating zinc status: dietary zinc intake, plasma zinc concentration (PZC), and height-for-age of growing infants and children. The amount of dietary zinc potentially available for absorption, which requires an estimate of dietary zinc and phytate, can be used to identify individuals and populations at risk of zinc deficiency. PZCs respond to severe dietary zinc restriction and to zinc supplementation; they also change with shifts in whole-body zinc balance and clinical signs of zinc deficiency. PZC cutoffs are available to identify individuals and populations at risk of zinc deficiency. However, there are limitations in using the PZC to assess zinc status. PZCs respond less to additional zinc provided in food than to a supplement administered between meals, there is considerable interindividual variability in PZCs with changes in dietary zinc, and PZCs are influenced by recent meal consumption, the time of day, inflammation, and certain drugs and hormones. Insufficient data are available on hair, urinary, nail, and blood cell zinc responses to changes in dietary zinc to recommend these biomarkers for assessing zinc status. Of the potential functional indicators of zinc, growth is the only one that is recommended. Because pharmacologic zinc doses are unlikely to enhance growth, a growth response to supplemental zinc is interpreted as indicating pre-existing zinc deficiency. Other functional indicators reviewed but not recommended for assessing zinc nutrition in clinical or field settings because of insufficient information are the activity or amounts of zinc-dependent enzymes and proteins and biomarkers of oxidative stress, inflammation, or DNA damage.
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Affiliation(s)
- Janet C King
- Children’s Hospital Oakland Research Institute, Oakland, CA
- University of California, Davis, Davis, CA
| | - Kenneth H Brown
- University of California, Davis, Davis, CA
- Bill & Melinda Gates Foundation, Seattle, WA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Aurora, CO
| | - Nicola M Lowe
- University of Central Lancashire, Preston, United Kingdom; and
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Basnet S, Mathisen M, Strand TA. Oral zinc and common childhood infections--An update. J Trace Elem Med Biol 2015; 31:163-6. [PMID: 24906347 DOI: 10.1016/j.jtemb.2014.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/07/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.
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Affiliation(s)
- Sudha Basnet
- Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; Centre for International Health, University of Bergen, Bergen, Norway.
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway
| | - Tor A Strand
- Centre for International Health, University of Bergen, Bergen, Norway; Division of Laboratory Medicine, Sykehuset Innlandet, Lillehammer, Norway
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Nantanda R, Ostergaard MS, Ndeezi G, Tumwine JK. Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study. BMC Pediatr 2014; 14:285. [PMID: 25431036 PMCID: PMC4254222 DOI: 10.1186/s12887-014-0285-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/23/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Little attention has been paid to asthma in 'under-fives' in Sub-Saharan Africa. In 'under-fives', acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality associated with acute respiratory diseases in Uganda is high but improving, dropping from 24% in 2004 to 11.9% in 2012. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality. METHODS We enrolled 614 children aged 2 to 59 months with acute respiratory symptoms presenting at the emergency paediatric unit of Mulago hospital. Clinical histories, physical examination, blood and radiological tests were done. Children with asthma and bronchiolitis were collectively referred to as 'Asthma syndrome'. Hospitalized children were monitored every 12 hours for a maximum of 7 days. Survival analysis was done to compare outcome of children with asthma and pneumonia. Cox regression analysis was done to determine factors associated with prolonged hospitalization and mortality. RESULTS Overall mortality was 3.6%. The highest case fatality was due to pneumocystis jirovecii pneumonia (2/4) and pulmonary tuberculosis (2/7). None of the children with asthma syndrome died. Children with 'asthma syndrome' had a significantly shorter hospital stay compared to those with pneumonia (p<0.001). Factors independently associated with mortality included hypoxemia (HR = 10.7, 95% CI 1.4- 81.1) and severe malnutrition (HR = 5.7, 95% CI 2.1- 15.8). Factors independently associated with prolonged hospitalization among children with asthma syndrome included age less than 12 months (RR = 1.2, 95% CI 1.0-1.4), hypoxemia (RR = 1.4, 95% CI 1.2-1.7), and severe malnutrition (RR = 1.5 95% CI 1.3-1.8). Similar factors were associated with long duration of hospital stay among children with pneumonia. CONCLUSION This study identified a sharp decline in acute respiratory mortality compared to the previous studies in Mulago hospital. This may be related to focus on and treatment of asthma in this study, and will be analysed in a later study. Bacterial pneumonia is still associated with high case fatality. Hypoxemia, severe malnutrition, and being an infant were associated with poor prognosis among children with acute asthma and pneumonia and need to be addressed in the management protocols.
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Affiliation(s)
- Rebecca Nantanda
- />Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marianne S Ostergaard
- />The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grace Ndeezi
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K Tumwine
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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McHenry MS, Apondi E, Vreeman RC. The importance of nutritional care in HIV-infected children in resource-limited settings. Expert Rev Anti Infect Ther 2014; 12:1423-6. [PMID: 25371264 DOI: 10.1586/14787210.2014.979155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Renewed efforts to provide proper nutritional care are essential for appropriate pediatric HIV management. Current studies support the use of vitamin A and macronutrients that increase caloric and protein intake. With additional research on key issues such as the needed composition and timing for nutritional supplementation, we can determine the best strategies to support the growth and development of HIV-infected children in resource-limited settings. Malnutrition among children is common in the resource-limited settings where HIV infection is most prevalent. While malnutrition is associated with higher morbidity and mortality for HIV-infected children, there is only limited evidence to guide the use of nutritional support for HIV-infected children. The best studied is vitamin A, which is associated with improved mortality and clinical outcomes. Zinc and multivitamin supplementation have not consistently been associated with clinical benefits. Limited research suggests macronutrient supplementation, which typically uses enriched formulas or foods, improves key anthropometrics for HIV-infected children, but the optimal composition of nutrients for supplementation has not been determined. More research is needed to understand the most efficient and sustainable ways to ensure adequate nutrition in this vulnerable population.
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Affiliation(s)
- Megan S McHenry
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA
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Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, Lam KBH, Mortimer K, Asante KP, Balakrishnan K, Balmes J, Bar-Zeev N, Bates MN, Breysse PN, Buist S, Chen Z, Havens D, Jack D, Jindal S, Kan H, Mehta S, Moschovis P, Naeher L, Patel A, Perez-Padilla R, Pope D, Rylance J, Semple S, Martin WJ. Respiratory risks from household air pollution in low and middle income countries. THE LANCET RESPIRATORY MEDICINE 2014; 2:823-60. [PMID: 25193349 DOI: 10.1016/s2213-2600(14)70168-7] [Citation(s) in RCA: 516] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
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Affiliation(s)
- Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Nigel G Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Om P Kurmi
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin-bong Hubert Lam
- Institute of Occupational and Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kwaku Poku Asante
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Michael N Bates
- Divisions of Epidemiology and Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Buist
- Oregon Health and Science University, Portland, OR, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Deborah Havens
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Sumi Mehta
- Health Effects Institute, Boston, MA, USA
| | - Peter Moschovis
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Luke Naeher
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
| | | | | | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sean Semple
- University of Aberdeen, Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - William J Martin
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
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Fink G, Heitner J. Evaluating the cost-effectiveness of preventive zinc supplementation. BMC Public Health 2014; 14:852. [PMID: 25128210 PMCID: PMC4143582 DOI: 10.1186/1471-2458-14-852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. METHODS Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplementation in a representative low-income country. We then computed the cost and cost-effectiveness for three delivery mechanisms: the direct distribution of zinc supplements, the distribution of micronutrient biscuits including zinc, and the distribution of zinc through water filtration systems. RESULTS Combining all health outcomes and impact estimates, we find that systematic zinc supplementation among children of ages one to five would avert 1.423 DALYs per 100 households and year in least developed countries. The estimated cost per DALY is US$ 606 for pill supplementation, US$ 1211 for micronutrient biscuits, and US$ 879 per DALY saved for water filtration systems. CONCLUSIONS Preventive zinc supplementation to children of ages 1-5 appears to be a highly cost-effective intervention in typical developing country settings. More research will be needed to determine the most effective mechanism to deliver zinc to this target population.
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Affiliation(s)
- Günther Fink
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA USA
| | - Jesse Heitner
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA USA
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McHenry MS, Dixit A, Vreeman RC. A Systematic Review of Nutritional Supplementation in HIV-Infected Children in Resource-Limited Settings. J Int Assoc Provid AIDS Care 2014; 14:313-23. [PMID: 24943654 DOI: 10.1177/2325957414539044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In resource-limited settings, malnutrition is the major cause of death in young children, but the precise benefits of nutritional supplementation for HIV-infected children are not well understood. METHODS Two researchers reviewed studies conducted in low- or middle-income countries that involved macro- and micronutrient supplementation in HIV-infected individuals ≤18 years. RESULTS Fifteen studies focused on micronutrients, including vitamin A, zinc, multivitamins, and multiple-micronutrient supplementation. The 8 macronutrient studies focused on ready-to-use foods (4 studies), spirulina, whey protein, general food rations, and F75 and F100 starter formulas. Vitamin A was associated with improved mortality rates, ranging from 28% to 63%. Multiple-micronutrient supplementations were not associated with improvement of measured health outcomes. Ready-to-use foods were associated with improvement in certain anthropometrics. CONCLUSION Periodic vitamin A supplementation is associated with reduced mortality. Macronutrient supplementation is linked to improved anthropometrics. More research is needed to determine how nutritional supplementation benefits this particularly vulnerable population.
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Affiliation(s)
- Megan S McHenry
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Avika Dixit
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel C Vreeman
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Fataki MR, Kisenge RR, Sudfeld CR, Aboud S, Okuma J, Mehta S, Spiegelman D, Fawzi WW. Effect of zinc supplementation on duration of hospitalization in Tanzanian children presenting with acute pneumonia. J Trop Pediatr 2014; 60:104-11. [PMID: 24194421 PMCID: PMC3967446 DOI: 10.1093/tropej/fmt089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Zinc supplementation prevents incident pneumonia in children; however, the effect for pneumonia treatment remains unclear. METHODS A randomized, double-blind, placebo-controlled trial of zinc supplements (daily 25 mg) adjunct to antibiotic treatment of radiology-confirmed acute pneumonia was conducted among hospitalized children (6-36 months) in Dar es Salaam, Tanzania. RESULTS The trial was stopped early due to low enrollment, primarily owing to exclusion of children outside the age range and >3 days of prior illness. Among children enrolled (n = 94), zinc supplementation indicated no beneficial effect on the duration of hospitalization (IRR: 0.69; 95% CI 0.45-1.06; p = 0.09) or the proportion of children who were hospitalized for <3 days (RR: 0.85; 95% CI: 0.57-1.25; p = 0.40) or <5 days (RR: 1.01; 95% CI: 0.83-1.23; p = 0.92) (IRRs and RRs >1.0 favor zinc). CONCLUSIONS Although underpowered, this randomized trial provided no evidence for a beneficial effect of zinc supplementation adjunct to antibiotics for hospitalized children.
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Affiliation(s)
- Maulidi R. Fataki
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick R. Kisenge
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James Okuma
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA
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Maslove DM, Wong HR. Gene expression profiling in sepsis: timing, tissue, and translational considerations. Trends Mol Med 2014; 20:204-13. [PMID: 24548661 DOI: 10.1016/j.molmed.2014.01.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 01/15/2023]
Abstract
Sepsis is a complex inflammatory response to infection. Microarray-based gene expression studies of sepsis have illuminated the complex pathogen recognition and inflammatory signaling pathways that characterize sepsis. More recently, gene expression profiling has been used to identify diagnostic and prognostic gene signatures, as well as novel therapeutic targets. Studies in pediatric cohorts suggest that transcriptionally distinct subclasses might account for some of the heterogeneity seen in sepsis. Time series analyses have pointed to rapid and dynamic shifts in transcription patterns associated with various phases of sepsis. These findings highlight current challenges in sepsis knowledge translation, including the need to adapt complex and time-consuming whole-genome methods for use in the intensive care unit environment, where rapid diagnosis and treatment are essential.
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Affiliation(s)
- David M Maslove
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hector R Wong
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Selvaraj K, Chinnakali P, Majumdar A, Krishnan IS. Acute respiratory infections among under-5 children in India: A situational analysis. J Nat Sci Biol Med 2014; 5:15-20. [PMID: 24678190 PMCID: PMC3961922 DOI: 10.4103/0976-9668.127275] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Emergence of newer pathogenic organisms, reemergence of disease previously controlled, wide spread antibiotic resistance, and suboptimal immunization coverage even after many innovative efforts are major factors responsible for high incidence of ARI. Drastic reduction in the burden of ARI by low-cost interventions such as hand washing, breast feeding, availability of rapid and feasible array of diagnostics, and introduction of pentavalent vaccine under National Immunization Schedule which are ongoing are necessary for reduction of ARI.
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Affiliation(s)
- Kalaiselvi Selvaraj
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Palanivel Chinnakali
- Dept of Community medicine, Indira Gandhi Medical College and Research Institute, Puducherry, Puducherry, India
| | - Anindo Majumdar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Iswarya Santhana Krishnan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Nantanda R, Tumwine JK, Ndeezi G, Ostergaard MS. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: evidence of under-diagnosis of asthma. PLoS One 2013; 8:e81562. [PMID: 24312321 PMCID: PMC3843700 DOI: 10.1371/journal.pone.0081562] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. Methods We enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis according to the study criteria. Results Of the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids. Conclusion Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.
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Affiliation(s)
- Rebecca Nantanda
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - James K. Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marianne S. Ostergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Blood zinc levels in children hospitalized with pneumonia: A cross sectional study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; 382:452-477. [PMID: 23746776 DOI: 10.1016/s0140-6736(13)60996-4] [Citation(s) in RCA: 1548] [Impact Index Per Article: 140.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal undernutrition contributes to 800,000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches--ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets--they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.
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Affiliation(s)
| | - Jai K Das
- Aga Khan University, Karachi, Pakistan
| | | | | | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Wadhwa N, Chandran A, Aneja S, Lodha R, Kabra SK, Chaturvedi MK, Sodhi J, Fitzwater SP, Chandra J, Rath B, Kainth US, Saini S, Black RE, Santosham M, Bhatnagar S. Efficacy of zinc given as an adjunct in the treatment of severe and very severe pneumonia in hospitalized children 2-24 mo of age: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2013; 97:1387-94. [PMID: 23636236 DOI: 10.3945/ajcn.112.052951] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of death; in India, an estimated 370,000 children die of pneumonia each year. Zinc has multiple influences on the immune response to infections. Zinc supplementation has been shown to prevent diarrhea and pneumonia in children. However, zinc's therapeutic effect on respiratory infections is less clear. OBJECTIVE We evaluated the role of zinc as an adjunct to antibiotics in the treatment of children hospitalized for severe or very severe pneumonia. DESIGN In this randomized, double-blind, placebo-controlled trial, we enrolled 550 children aged 2-24 mo with severe or very severe pneumonia. Within each hospital and pneumonia-severity stratum, children were randomly assigned to receive zinc (20 mg elemental zinc/d) or a placebo in addition to antibiotics and supportive care. RESULTS The time to recovery from severe or very severe pneumonia was similar in both groups (HR: 0.98; 95% CI: 0.82, 1.17). In the stratified analysis, zinc was shown to be efficacious in reducing the time to recovery in children with very severe pneumonia (HR: 1.52; 95% CI: 1.03, 2.23); however, the effect was no longer statistically significant after adjustment for differences in severely underweight children in the 2 groups. CONCLUSIONS This study showed no overall benefit of the addition of zinc to antibiotics in reducing the time to recovery from pneumonia but showed a possible benefit of zinc supplementation in a subgroup of children with very severe pneumonia. Additional research is needed in specific subgroups such as children with very severe pneumonia. This trial was registered at http://www.controlled-trials.com as ISRCTN48954234.
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Affiliation(s)
- Nitya Wadhwa
- Centre for Diarrheal Diseases and Nutrition Research, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Abstract
For nearly a decade, our research group has had the privilege of developing and mining a multicenter, microarray-based, genome-wide expression database of critically ill children (≤10 y of age) with septic shock. Using bioinformatic and systems biology approaches, the expression data generated through this discovery-oriented, exploratory approach have been leveraged for a variety of objectives, which are reviewed here. Fundamental observations include widespread repression of gene programs corresponding to the adaptive immune system and biologically significant differential patterns of gene expression across developmental age groups. The data have also identified gene expression-based subclasses of pediatric septic shock having clinically relevant phenotypic differences. The data have also been leveraged for the discovery of novel therapeutic targets, as well as for the discovery and development of novel stratification and diagnostic biomarkers. Almost a decade of genome-wide expression profiling in pediatric septic shock is now demonstrating tangible results. The studies have progressed from an initial discovery-oriented and exploratory phase to a new phase in which the data are being translated and applied to address several areas of clinical need.
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Affiliation(s)
- Hector R. Wong
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center and Cincinnati Children’s Hospital Research Foundation, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Birbeck G. Medicine for global health: can "simple interventions" improve the worldwide burden of disease? BMC Med 2013; 11:72. [PMID: 23496983 PMCID: PMC3621694 DOI: 10.1186/1741-7015-11-72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 01/21/2023] Open
Abstract
Improvements to medical practice and delivery of treatment has been the focus of many international collaborations aiming to address the delivery of appropriate health care in low- and middle-income countries. However, this is compounded by various social, cultural as well as resource allocation issues. This Editorial marks the launch of an article collection on Medicine for Global Health (http://www.biomedcentral.com/bmcmed/series/medicine_for_global_health), and here, guest editor Gretchen Birbeck discusses the challenges, importance and increasing relevance of global health.
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Duke T, Enarson PM, Graham SM. Child pneumonia: beyond pneumococcal vaccine and 2015. Public Health Action 2012; 2:43. [PMID: 26392947 PMCID: PMC4463042 DOI: 10.5588/ijtld.pha.12.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- T Duke
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - P M Enarson
- Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia ; Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris, France
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Affiliation(s)
- Christa L Fischer Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Brodwall K. [Zinc supplements and pneumonia in children]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:811. [PMID: 22629551 DOI: 10.4045/tidsskr.12.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Kristoffer Brodwall
- Avdeling for internasjonalt samarbeid, Haukeland universitetssykehus, Norway.
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