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Landguth EL, Knudson J, Graham J, Orr A, Coyle EA, Smith P, Semmens EO, Noonan C. Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States. Environ Health 2024; 23:40. [PMID: 38622704 PMCID: PMC11017546 DOI: 10.1186/s12940-024-01082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Evaluating while accounting for these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health is becoming more important. METHODS We explored short-term exposure to air pollution on children's respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated healthcare events. The main outcome measure included individual-based address located respiratory-related healthcare visits for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for ages 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis with distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 14 prior-days modified by temperature or season. RESULTS For asthma, increases of 1 µg/m3 in PM2.5 exposure 7-13 days prior a healthcare visit date was associated with increased odds that were magnified during median to colder temperatures and winter periods. For LRTIs, 1 µg/m3 increases during 12 days of cumulative PM2.5 with peak exposure periods between 6-12 days before healthcare visit date was associated with elevated LRTI events, also heightened in median to colder temperatures but no seasonal effect was observed. For URTIs, 1 unit increases during 13 days of cumulative PM2.5 with peak exposure periods between 4-10 days prior event date was associated with greater risk for URTIs visits that were intensified during median to hotter temperatures and spring to summer periods. CONCLUSIONS Delayed, short-term exposure increases of PM2.5 were associated with elevated odds of all three pediatric respiratory healthcare visit categories in a sparsely population area of the inter-Rocky Mountains, USA. PM2.5 in colder temperatures tended to increase instances of asthma and LRTIs, while PM2.5 during hotter periods increased URTIs.
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Affiliation(s)
- Erin L Landguth
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Jonathon Knudson
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Jon Graham
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
- Mathematical Sciences, University of Montana, Missoula, USA
| | - Ava Orr
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Emily A Coyle
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Paul Smith
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
- Pediatric Pulmonology, Community Medical Center, Missoula, MT, USA
| | - Erin O Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Curtis Noonan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
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Galli J, Sheppard SC, Caversaccio M, Anschuetz L, Beckmann S. Impact of COVID-19 pandemic: increase in complicated upper respiratory tract infections requiring ENT surgery? Eur Arch Otorhinolaryngol 2024; 281:1581-1586. [PMID: 38085305 PMCID: PMC10857962 DOI: 10.1007/s00405-023-08349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE This study investigates the impact of the COVID-19 pandemic on complicated upper respiratory tract infections requiring surgical intervention in a tertiary referral center. The aim is to understand the consequences of pandemic-related measures and their subsequent relaxation on the incidence and characteristics of upper respiratory tract infection-related complications. METHODS Patients who underwent surgery as a complication of upper respiratory tract infections between December 2014 to February 2023 were included. Demographic information, surgical procedures, microbiological findings, and clinical outcomes were assessed and analyzed comparing pre-pandemic, pandemic and post-pandemic groups. RESULTS 321 patients were enrolled, including 105 patients (32.7%) in the pediatric population. Comparison of pre-pandemic (n = 210), pandemic (n = 46) and post-pandemic periods (n = 65) revealed a statistically significant increase in complicated otologic infections requiring surgical intervention in the post-pandemic period compared to the pandemic period (p value = 0.03). No statistically significant differences in other surgical procedures or demographic parameters were observed. A statistically significant increase in urgent ear surgery in the pediatric population between the pandemic and the post-pandemic period (p value = 0.02) was observed. Beta-hemolytic group A streptococcal infections showed a statistically significant increase in the post-pandemic period compared with the pandemic period (p value = 0.02). CONCLUSIONS Relaxation of COVID-19-related restrictions was associated with an increase of upper respiratory tract infection-related otologic infections requiring surgical intervention with an increasing rate of beta-hemolytic group A streptococcal infections. These findings highlight the importance of considering the impact of the pandemic on upper respiratory tract infection complications and adapting management strategies accordingly.
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Affiliation(s)
- Jonas Galli
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sean C Sheppard
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Abdellatife OE, Makowsky MJ. Factors influencing implementation of point-of-care testing for acute respiratory infectious diseases in community pharmacies: A scoping review using the Consolidated framework for implementation research. Res Social Adm Pharm 2024:S1551-7411(24)00056-1. [PMID: 38431516 DOI: 10.1016/j.sapharm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infections diseases is beneficial, but not widely implemented. A theory-informed review to understand the factors influencing service implementation is lacking. OBJECTIVE To examine the extent, range, and nature of research available on enablers and barriers to POC testing implementation for infectious respiratory diseases in community pharmacies and identify their underpinning theoretical constructs using the Consolidated Framework for Implementation Research (CFIR). METHODS Scoping review guided by the JBI Manual for Evidence Synthesis. A comprehensive search from inception to June 28th, 2022 was conducted using Medline, Embase, CINAHL, Cochrane Library, and ProQuest dissertations without date or language restriction. Eligible articles investigated barriers and/or facilitators to strep throat, influenza, C-reactive protein, and COVID-19 POC testing in community pharmacies. Two reviewers independently performed title & abstract screening, full-text screening, and data extraction. Content analysis was conducted according to a pre-established framework and concepts were mapped to the CFIR. RESULTS Forty-three studies were included. Most originated from the USA (n = 24; 56%) and investigated strep throat. The majority were testing/initial implementation projects (n = 23; 54%) conducted in urban centers (n = 17; 40%). Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Only four studies (9%) used theory to guide their inquiry. The 124 identified implementation factors mapped onto 21 CFIR constructs, covering all 5 domains. The domain "Outer setting" (n = 35/43; 81%) was most prevalent as were the constructs "Patient needs and resources," (n = 21/43; 49%) "External policy & incentives," (n = 17/43; 40%) and "Relative advantage" (n = 17/43; 40%). CONCLUSION A large volume of research explores factors influencing the implementation of pharmacy-based respiratory infectious disease POC testing services, but few studies use qualitative or theory-informed methods. Knowledge of the wide range of facilitators and barriers identified can help pharmacy managers and researchers design strategies to support successful service implementation.
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Affiliation(s)
- Omar E Abdellatife
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9
| | - Mark J Makowsky
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9.
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Hong S, Li D, Wei Y, Zheng Y, Cai J, Zheng H, Zhang X, Deng Y, Han D, Wang J, Chen L, Li S, Qiu W, Ren M, Zou L. Epidemiology of respiratory pathogens in patients with acute respiratory tract infection in Xiamen, China: A retrospective survey from 2020 to 2022. Heliyon 2023; 9:e22302. [PMID: 38053876 PMCID: PMC10694312 DOI: 10.1016/j.heliyon.2023.e22302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023] Open
Abstract
Acute respiratory tract infections (ARTI) are caused by respiratory pathogens and range from asymptomatic infections to severe respiratory diseases. These diseases can be life threatening with high morbidity and mortality worldwide. Under the pandemic of coronavirus disease 2019 (COVID-19), little has been reported about the pathogen etiologies and epidemiology of patients suffering from ARTI of all age in Xiamen. Region-specific surveillance in individuals with ARTI of all ages was performed in Xiamen from January 2020 to October 2022. Here, we observed the epidemiological characteristics of thirteen pathogens within ARTI patients and further revealed the difference of that between upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI). In total 56.36 % (2358/4184) of the ARTI patients were positive for at least one respiratory pathogen. Rhinovirus (RVs, 29.22 %), influenza A (FluA, 19.59 %), respiratory syncytial virus (RSV, 18.36 %), metapneumovirus (MPV, 13.91 %), and adenovirus (ADV, 10.31 %) were the five leading respiratory pathogens. Respiratory pathogens displayed age- and season-specific patterns, even between URTI and LRTI. Compared with other groups, a higher proportion of FluA (52.17 % and 68.75 %, respectively) infection was found in the adult group and the elder group, while the lower proportion of RVs (14.11 % and 11.11 %) infection was also observed in them. Although ARTI cases circulated throughout the year, RVs, FluB, and BoV peaked in autumn, and FluA circulated more in summer. Besides, the co-infectious rate was 8.7 % with the most common for RVs. Logistic regression analyses revealed the correlations between respiratory pathogens and disease types. These results are essential for replenishing epidemiological characteristics of common respiratory pathogens that caused ARTI in Xiamen during the epidemic of COVID-19, and a better understanding of it might optimize the local prevention and clinical control.
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Affiliation(s)
- Shan Hong
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Dan Li
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang, China
| | - Yanli Wei
- Department of General Practice, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Yilin Zheng
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Jiading Cai
- Department of General Practice, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Heping Zheng
- Department of Intensive Care Unit, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Xuan Zhang
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang, China
| | - Yulin Deng
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Dandan Han
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Jia Wang
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Linlin Chen
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Shujing Li
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Weiping Qiu
- Department of General Practice, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Min Ren
- Department of Pediatrics, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Liangneng Zou
- Department of General Practice, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
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Katundu DR, Hannink G, Lyimo JG, Rovers M, van Heerbeek N. Usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy in northern Tanzania. Pan Afr Med J 2023; 46:59. [PMID: 38223875 PMCID: PMC10787135 DOI: 10.11604/pamj.2023.46.59.41190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Antimicrobial Resistance (AMR) is a growing concern globally, mostly being contributed by a limited understanding of antibiotic utilization as a result of inappropriate acquisition and prescription. Parental awareness is essential in optimizing their usage and preserving the effectiveness of these crucial medications. The current study investigates the usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy ((A)TE) in Northern Tanzania. Methods a cross-sectional survey was conducted among parents/caregivers of children who underwent (A)TE in Northern Tanzania. A modified and well-structured questionnaire, which was adapted from a World Health Organization (WHO) questionnaire and used to assess the parents´ knowledge of antibiotics and antibiotic use. Results the study included 157 participants. About 54% of the children under the age of 5 years. As of 88% of children had already received antibiotics prior to surgery, 92% of the used antibiotics were prescribed by a clinician, and 5% of parents to used leftovers antibiotics for their children. While 88% of the parents reported adhering to prescriptions, 8% of reported buying the same antibiotic (as prescribed before) without consulting a clinician again when their children are sick. Conclusion the use of antibiotics, including broad-spectrum antibiotics, was found to be high in our study group. Parents demonstrate a relatively good understanding of antibiotic usage. It is plausible to speculate that a higher prevalence of non-insured, unemployed, and less educated parents may lead to an increased incidence of misuse and misinterpretation of antibiotics.
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Affiliation(s)
- Denis Robert Katundu
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Otolaryngology, Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Jesca Godlisten Lyimo
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Maroeska Rovers
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Niels van Heerbeek
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Otolaryngology, Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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Kitazawa T, Wada H, Onuki K, Furuya R, Miyakawa M, Zhu Q, Ueda Y, Sato S, Kameda Y, Nakano H, Gozal D, Tanigawa T. Snoring, obstructive sleep apnea, and upper respiratory tract infection in elementary school children in Japan. Sleep Breath 2023:10.1007/s11325-023-02932-y. [PMID: 37837496 DOI: 10.1007/s11325-023-02932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Both obstructive sleep apnea (OSA) and the common cold are disorders of the upper respiratory tract, and may be associated. However, studies on the association between OSA and upper respiratory tract infections (URTI) in children are scarce. The aim of this study was to investigate possible associations between snoring, the severity of OSA, and URTI in elementary school children. METHODS This was a cross-sectional study in a community cohort of elementary school children (first and second graders) in Japan. Information on sleep habits, history of URTI, and OSA risk was obtained from a parental questionnaire. Children underwent overnight tracheal sound recordings from which apnea-hypopnea index was estimated. Multivariable logistic analysis was employed to define the association between snoring, OSA, and URTI ≥ 3 episodes over six months. RESULTS Of the 922 potential enrollees, 653 children and their parents (71%) agreed to participate in the study. Multivariable-adjusted ORs for URTI were 1.73 (95%CI: 1.16 to 2.59) in children who snored 1 to 4 nights per week and 2.82 (95%CI: 1.26 to 6.28) in snoring ≥ 5 nights per week compared with never snoring (reference). Likewise, subjectively reported louder snoring, as well as objectively defined louder sound levels, were significantly associated with URTI. In addition, OR for URTI in children with an estimated apnea-hypopnea index ≥ 2.0 events/hour was 2.65 (95%CI: 1.32 to 5.31) compared to children with apnea-hypopnea index less than 1.0 events/hour (reference). CONCLUSIONS Snoring and severity of OSA as measured by nocturnal tracheal sound recordings were associated with increased susceptibility to URTI in elementary school children.
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Affiliation(s)
- Takayuki Kitazawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keisuke Onuki
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ritsuko Furuya
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mariko Miyakawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Qinye Zhu
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuito Ueda
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Setsuko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yoshihito Kameda
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroshi Nakano
- Sleep Disorders Centre, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru Minami-Ku, Fukuoka, 811-1394, Japan
| | - David Gozal
- Dean of the Joan C. Edwards School of Medicine and Vice President of Health Affairs at Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
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Choo ELW, Janhavi A, Koo JR, Yim SHL, Dickens BL, Lim JT. Association between ambient air pollutants and upper respiratory tract infection and pneumonia disease burden in Thailand from 2000 to 2022: a high frequency ecological analysis. BMC Infect Dis 2023; 23:379. [PMID: 37280547 DOI: 10.1186/s12879-023-08185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND A pertinent risk factor of upper respiratory tract infections (URTIs) and pneumonia is the exposure to major ambient air pollutants, with short term exposures to different air pollutants being shown to exacerbate several respiratory conditions. METHODS Here, using disease surveillance data comprising of reported disease case counts at the province level, high frequency ambient air pollutant and climate data in Thailand, we delineated the association between ambient air pollution and URTI/Pneumonia burden in Thailand from 2000 - 2022. We developed mixed-data sampling methods and estimation strategies to account for the high frequency nature of ambient air pollutant concentration data. This was used to evaluate the effects past concentrations of fine particulate matter (PM2.5), sulphur dioxide (SO2), and carbon monoxide (CO) and the number of disease case count, after controlling for the confounding meteorological and disease factors. RESULTS Across provinces, we found that past increases in CO, SO2, and PM2.5 concentration were associated to changes in URTI and pneumonia case counts, but the direction of their association mixed. The contributive burden of past ambient air pollutants on contemporaneous disease burden was also found to be larger than meteorological factors, and comparable to that of disease related factors. CONCLUSIONS By developing a novel statistical methodology, we prevented subjective variable selection and discretization bias to detect associations, and provided a robust estimate on the effect of ambient air pollutants on URTI and pneumonia burden over a large spatial scale.
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Affiliation(s)
- Esther Li Wen Choo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - A Janhavi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Joel Ruihan Koo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Steve H L Yim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- Earth Observatory of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Huang Y, Chen CL, Cen LJ, Li HM, Lin ZH, Zhu SY, Duan CY, Zhang RL, Pan CX, Zhang XF, Zhang XX, He ZF, Shi MX, Zhong NS, Guan WJ. Sputum pathogen spectrum and clinical outcomes of upper respiratory tract infection in bronchiectasis exacerbation: A prospective cohort study. Emerg Microbes Infect 2023; 12:2202277. [PMID: 37038356 PMCID: PMC10167879 DOI: 10.1080/22221751.2023.2202277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Upper respiratory tract infection (URTI) is common in humans. We sought to profile sputum pathogen spectrum and impact of URTI on acute exacerbation of bronchiectasis (AE). Between March 2017 and December 2021, we prospectively collected sputum from adults with bronchiectasis. We stratified AEs into events related (URTI-AE) and unrelated to URTI (non-URTI-AE). We captured URTI without onset of AE (URTI-non-AE). We did bacterial culture and viral detection with polymerase chain reaction, and explored the pathogen spectrum and clinical impacts of URTI-AE via longitudinal follow-up. Finally, we collected 479 clinically stable samples, 170 AE samples (89 collected at URTI-AE) and 113 URTI-non-AE samples. The viral detection rate was significantly higher in URTI-AE (46.1%) than in non-URTI-AE (4.9%) and URTI-non-AE (11.5%) (both P<0.01). Rhinovirus [odds ratio (OR): 5.00, 95% confidence interval (95%CI): 1.06-23.56, P=0.03] detection was independently associated with URTI-AE compared with non-URTI-AE. URTI-AE tended to yield higher viral load and detection rate of rhinovirus, metapneumovirus and bacterial shifting compared with URTI-non-AE. URTI-AE was associated with higher initial viral loads (esp. rhinovirus, metapneumovirus), greater symptom burden (consistently higher scores of three validated questionnaires) and prolonged recovery compared to those without. Having experienced URTI-AE predicted greater risk of future URTI-AE (OR: 10.90, 95%CI: 3.60-33.05). In summary, URTI is associated with a distinct pathogen spectrum and aggravates bronchiectasis exacerbation, providing the scientific rationale for the prevention of URTI to hinder bronchiectasis progression.
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Affiliation(s)
- Yan Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Geriatrics, National Key Clinical Specialty, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Chun-Lan Chen
- Department of Respiratory and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lai-Jian Cen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hui-Min Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen-Hong Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Si-Yu Zhu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Ri-Lan Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cui-Xia Pan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao-Fen Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao-Xian Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen-Feng He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ming-Xin Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Senior author
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Respiratory and Critical Care Medicine, Foshan Second People's Hospital, Affiliated Foshan Hospital of Southern Medical University, Foshan, Guangdong, China
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Anibasa FO, Abuba T, Dankyau M. Effect of Honey on Cough Symptoms in Children with Upper Respiratory Tract Infection: A Randomised Controlled Trial. West Afr J Med 2022; 39:928-934. [PMID: 36126325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Cough from URTI is common, leads to discomfort, sleep loss and stress in caregivers, leading to use of ineffective and potentially harmful over-the-counter medications. Honey is cost-effective and safe for children above one year of age. It is readily available and is a potentially valuable demulcent for treatment of childhood cough. The study aimed to determine the effect of honey on cough frequency and severity among children with URTI in outpatient setting. METHODS A single-blind randomised control trial involving children presenting with cough from URTI attending the GOPC of FMC Keffi. Eighty-four children presenting with cough from URTI were recruited, randomised into two groups of 42 and administered Honey (intervention) and Diphenhydramine (control) in three consecutive bedtime doses. Socio-demographic and clinical data including cough frequency, severity and impact on children and caregivers was collected using Paediatric Cough Questionnaire and Kingston Caregiver Stress Scale tool. Data was analysed using SPSS version 25. A p<0.05 was considered statistically significant. RESULTS Majority (56.0%) of the participants were males, with a mean age +SD of 4±1.47 years. Median cough frequency score for intervention and control groups pre and post intervention decreased (5.00 and 0.00 vs 5.00 and 3.00, p<0.001). Median cough severity score decreased (4.00 and 0.00 vs 4.00 and 3.00, p<0.001), Post intervention pooled caregivers' burden significantly reduced, (5.00 and 11.00 for intervention and control respectively) and sleep pattern improved among children and caregivers (0.00, 2.00 p<0.001; and 0.00, 2.00 p<0.001, for children and caregivers respectively. CONCLUSION Night-time honey doses given to children with cough from URTI significantly reduces symptoms and improves children and caregivers sleep compared to Diphenhydramine DPH.
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Affiliation(s)
- F O Anibasa
- Department of Family Medicine, Federal Medical Centre, Keffi, Nasarawa State, Nigeria
| | - T Abuba
- Department of Family Medicine, Federal Medical Centre, Keffi, Nasarawa State, Nigeria
| | - M Dankyau
- Department of Family Medicine, Bingham University, Karu, Nasarawa State, Nigeria
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10
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Xu G, Shu Y, Xu Y. Metabolomics analyses of traditional Chinese medicine formula Shuang Huang Lian by UHPLC-QTOF-MS/MS. Chin Med 2022; 17:62. [PMID: 35637516 PMCID: PMC9150355 DOI: 10.1186/s13020-022-00610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Shuang Huang Lian (SHL) is a traditional Chinese medicine (TCM) formula made from Lonicerae Japonicae Flos, Forsythiae Fructus, and Scutellariae Radix. Despite the widespread use of SHL in clinical practice for treating upper respiratory tract infections (URTIs), the complete component fingerprint and the pharmacologically active components in the SHL formula remain unclear. The objective of this study was to develop an untargeted metabolomics method for component identification, quantitation, pattern recognition, and cross-comparison of various SHL preparation forms (i.e., granule, oral liquid, and tablet). Methods Ultra-high-performance liquid chromatography and quadrupole time-of-flight tandem mass spectrometry (UHPLC-QTOF-MS/MS) together with bioinformatics were used for chemical profiling, identification, and quantitation of SHL. Multivariate data analyses such as principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were performed to assess the correlations among the three SHL preparation forms and the reproducibility of the technical and biological replicates. Results A UHPLC-QTOF-MS/MS-based untargeted metabolomics method was developed and applied to analyze three SHL preparation forms, consisting of 178 to 216 molecular features. Among the 95 common molecular features from the three SHL preparation forms, quantitative analysis was performed using a single exogenous reference internal standard. Forty-seven of the 95 common molecular features have been identified using various databases. Among the 47 common components, there were 17 flavonoids, 7 oligopeptides, 5 terpenoids, 2 glycosides, 2 cyclohexanecarboxylic acids, 2 spiro compounds, 2 lipids, 2 glycosylglycerol derivatives, and 8 various compounds such as alkyl caffeate ester, aromatic ketone, benzaldehyde, benzodioxole, benzofuran, chalcone, hydroxycoumarin, and purine nucleoside. Five of the 47 common components were designated by the Chinese Pharmacopoeia as the quality markers of medicinal plants of SHL, and 15 were previously reported to have pharmacological activities. Distinct patterns of the three SHL preparation forms were observed in the PCA and PLS-DA plots. Conclusions The developed method is reliable and reproducible, which is useful for the profiling, component identification, quantitation, quality assessment of various SHL preparation forms and may apply to the analysis of other TCM formulas. Supplementary Information The online version contains supplementary material available at 10.1186/s13020-022-00610-x.
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Affiliation(s)
- Gang Xu
- Department of Chemistry, Cleveland State University, Cleveland, OH, 44115, USA
| | - Yachun Shu
- Department of Pharmacy, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yan Xu
- Department of Chemistry, Cleveland State University, Cleveland, OH, 44115, USA.
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11
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Albayrak A, Karakaş NM, Karahalil B. Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: a cross-sectional study in Turkey. BMC Pediatr 2021; 21:554. [PMID: 34872522 PMCID: PMC8647354 DOI: 10.1186/s12887-021-03020-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/19/2021] [Indexed: 08/30/2023] Open
Abstract
Background Upper respiratory tract infections (URTIs) are common in children. Antibiotics still continue to be prescribed although most URTIs are of viral origin. This is inappropriate use and this unnecessary administration contributes or may cause antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries. This study aims to evaluate the knowledge and attitudes of parents of children with upper respiratory tract infections regarding antibiotic use and their antibiotic administration practices in a tertiary care hospital in Turkey. Methods Our study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics. Results Five hundred fifty-four parents responded to the questionnaire (93.2% rate of response). A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. While 28% of the parents who thought that the use of inappropriate antibiotics would not change the effect and resistance of the treatment, 41% thought that new antibiotics could be developed continuously. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection. Conclusion According to the results of our study of parents’ lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and practices. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.
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Affiliation(s)
- Aslınur Albayrak
- Faculty of Pharmacy, Department of Clinical Pharmacy, Gazi University, Ankara, Turkey.
| | - Nazmi Mutlu Karakaş
- Faculty of Medicine Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Bensu Karahalil
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Gazi University, Ankara, Turkey
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12
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Makary CA, Purnell PR, O'Brien D, Chaiban R, Demirdağ YY, Ramadan H. Antibody deficiencies are more common in adult versus pediatric recurrent acute rhinosinusitis. Am J Otolaryngol 2021; 42:103004. [PMID: 33812207 DOI: 10.1016/j.amjoto.2021.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the frequency and types of humoral immunodeficiencies (HID) in pediatric and adult patients with recurrent (RARS). Patients with HID commonly present with upper respiratory tract infections. Their pathophysiology in children is different than adult counterparts. It is unknown how HID affects those two age groups. MATERIALS AND METHODS We performed a retrospective chart review of pediatric (<18 years old) and adult (18 years and older) patients who were evaluated in our pediatric and adult rhinology clinic between July 2010 and December 2020 and had the diagnosis of recurrent (>3 times/year) rhinosinusitis. Patients with cystic fibrosis, Aspirin Exacerbated Respiratory Disease (AERD), and ciliary dyskinesia were excluded. Demographic data and associated conditions were reviewed. Immunologic evaluation included complete blood cell count (CBC) with differential, serum immunoglobulin G, A, and M levels, and baseline and post-vaccination pneumococcal antibody titers. RESULTS There were 135 patients who met the inclusion criteria. 86 patients (63.7%) were children, 49 patients (36.3%) were adults. 46.5% of the pediatric patients and 45% of the adult patients were female. 17.4% of children had abnormal immunologic findings: 8 had hypogammaglobulinemia (p < 0.0001), 2 had specific antibody deficiency (SAD), and 5 had selective IgA deficiency. 32.7% of adults (p < 0.0001) had abnormal immunologic findings: 4 had hypogammaglobulinemia, 11 had SAD (p < 0.0001), and 1 patient had both IgA deficiency and SAD. CONCLUSION Humoral immunodeficiency, specifically SAD, seems to be more common in adult versus pediatric RARS that is refractory to treatment.
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Zhong D, Zhang N, Qin XQ, Tan Y, Yang Y, Tu J, Zhang L. A Cross-Sectional Survey of Family Care Behaviors for Children with Upper Respiratory Tract Infections in China: Are There Opportunities for Improvement? J Pediatr Nurs 2021; 60:146-53. [PMID: 33965739 DOI: 10.1016/j.pedn.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe family care behaviors for children with upper respiratory tract infections (URTIs) and explore related factors. DESIGN AND METHODS Parents of children with URTIs were included in this cross-sectional study. Family care behaviors, disease-related knowledge, and parental self-efficacy were evaluated with validated measures. RESULTS Among the 419 participants, 73.80% recognized diseases based on their children's abnormal presentation. Self-medication was the main home care measure (36.28% used only self-medication; 27.92% used both self-medication and physical cooling methods), and 36.5% received suggestions from medical professionals. All the participants took their children to the hospital, and 28.20% did so two or three times. The proportions of visits to level II or III hospitals were 49.64% and 83.87% for first and third hospital visits, respectively. Parents who had less disease knowledge and assessed children' diseases as more serious took their children to the hospital more often (p < 0.05); those whose nearest medical institution was a community health center were more likely to visit such centers (p < 0.001). CONCLUSIONS Most of the parents recognized symptoms of URTIs and provided home care but lacked enough knowledge and professional support to take reasonable measures. Hospital visits were their primary choice. PRACTICAL IMPLICATIONS Family care behaviors for children with URTIs could be improved through health education, and an internet nursing service or family doctor system is suggested. A hierarchical medical system is necessary to reduce hospital visits, as are more community health centers with pediatric services.
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Gökçe Ş, Dörtkardeşler BE, Yurtseven A, Kurugöl Z. Effectiveness of Pelargonium sidoides in pediatric patients diagnosed with uncomplicated upper respiratory tract infection: a single-blind, randomized, placebo-controlled study. Eur J Pediatr 2021; 180:3019-28. [PMID: 34304301 DOI: 10.1007/s00431-021-04211-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Upper respiratory tract infections (URTIs) are a condition characterized by upper airway inflammation often caused by viruses in humans. The present study aimed to assess the effectiveness of the liquid herbal drug preparation from the root extracts of Pelargonium sidoides in improving symptoms of uncomplicated URTIs. One hundred sixty-four patients with URTI were randomized and given either verum containing the root extracts of Pelargonium sidoides (n = 82) or a matching placebo (n = 82) in a single-blind manner for 7 days. The median total scores of all symptoms (TSS) showed a significant decreasing trend in the group treated with the root extracts derived from Pelargonium sidoides compared to the placebo group from day 0 to day 7 (TSS significantly decreased by 0.85 points in the root extract group compared to a decrease of 0.62 points, p = 0.018). "Cough frequency" showed a significant improvement from day 0 to day 3 (p = 0.023). There was also detected a significant recovery in "sneezing" on day 3 via Brunner-Langer model, and it was detected that the extract administration given in the first 24 h onset of the symptoms had provided a significant improvement in day 0 to day 3 (difference of TSS 0.18 point, p = 0.011).Conclusion: The findings of the study revealed that the Pelargonium sidoides extracts are effective in relieving the symptom burden in the duration of the disease. It may be regarded as an alternative option for the management of URTIs. What is Known: • Upper respiratory tract infections (URTIs), an inflammation on the upper airways, are the most common infectious disease in children. • Pelargonium sidoides, a traditional medicinal plant native to South Africa, is one of the ornamental geraniums that is thought to be effective in treating URTIs What is New: • It may be revealed that the dried root extract of Pelargonium sidoides compared with placebo might be an alternative treatment in improving the symptoms such as dry cough, sneezing, and relieving cough frequency. • The administration of the root extract at the onset of URTIs' signs may be regarded as an adjunctive option for the management of URTIs due to its effectiveness in decreasing the symptom burden of the disease.
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15
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Parsel SM, McCoul ED. Corticosteroid utilization among otolaryngologists for the treatment of acute upper respiratory tract infections. Am J Otolaryngol 2021; 42:102930. [PMID: 33550026 DOI: 10.1016/j.amjoto.2021.102930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the effects of knowledge and practice variations on prescribing patterns of systemic corticosteroids (SC) for acute upper respiratory tract infections (URTI). MATERIALS AND METHODS A cross-sectional evaluation of practicing otolaryngologists in the United States through the use of a 16-question Knowledge, Attitude, and Practice survey. The survey was self-administered through email delivery to practicing members of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS Of 349 respondents, the majority were attending physicians in private practice and used SC 25% to 50% of the time. There was a higher rate of SC use by clinicians in the Southeast United States (adjusted odds ratio [aOR], 2.10; 95% confidence intervals [95% CI], 1.18-3.72) and by those in private practice (aOR, 2.67; 95% CI, 1.63-4.37). Levels of SC knowledge did not vary across respondents; however, knowledge was associated with increased use of SC. Only 62.8% of respondents answered all 4 Knowledge questions correctly and this was associated with a 3.5-fold decrease in SC use (aOR, 0.29; 95% CI, 0.19-0.44). Attitudes toward SC use reflected prescribing practices and were also linked to levels of knowledge, as respondents with less knowledge were more likely to have a favorable outlook toward use of SC. CONCLUSION Use of SC for treatment of acute URTI is associated with clinician demographics and knowledge. Otolaryngologists are more likely to use SC for acute URTI in the Southeast United States and in private practice. Knowledge and provider education are key factors in prescribing patterns.
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16
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Ness V, Currie K, Reilly J, McAloney-Kocaman K, Price L. Factors associated with independent nurse prescribers' antibiotic prescribing practice: a mixed-methods study using the Reasoned Action Approach. J Hosp Infect 2021; 113:22-29. [PMID: 33864894 DOI: 10.1016/j.jhin.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of nurse prescribers is increasing, yet little evidence exists about their antibiotic prescribing behaviour. AIM To measure nurse independent prescribers' (NIPs) intention to manage patients, presenting with an upper respiratory tract infection (URTI) for the first time, without prescribing an antibiotic and to examine the determinants of this behaviour. METHODS This was a mixed-method study using the Reasoned Action Approach (RAA). Content analysis of data from 27 telephone interviews with NIPs informed the development of a questionnaire which was tested for validity and reliability and used in a national survey of NIPs across Scotland. Descriptive and inferential statistical analysis was carried out to determine intention to manage patients without prescribing an antibiotic and the significant influences on this intention. FINDINGS From 184 participants it was found that NIPs intended to manage patients, presenting with a URTI for the first time, without prescribing an antibiotic. Key determinants were perceived norm, perceived behavioural control, and moral norm. Significant beliefs were positive social influence from other non-medical prescribers (P = 0.007) and nurse prescribers (P = 0.045), the enablers of prescriber experience and confidence (P ≤ 0.001), and the barrier of pressure from patients/carers (P = 0.010). CONCLUSION The findings provide reassurance that NIPs intend to prescribe appropriately. The identification of nurse-specific barriers and enablers to this intention should be acknowledged and targeted in future interventions to manage this behaviour.
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Affiliation(s)
- V Ness
- Glasgow Caledonian University, Glasgow, UK.
| | - K Currie
- Glasgow Caledonian University, Glasgow, UK
| | - J Reilly
- Glasgow Caledonian University, Glasgow, UK; NHS National Services Scotland, Glasgow, UK
| | | | - L Price
- Glasgow Caledonian University, Glasgow, UK
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17
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Cai X, Xu Q, Zhou C, Yin T, Zhou L. Serum β2-microglobulin may be a viral biomarker by analyzing children with upper respiratory tract infections and exanthem subitum: a retrospective study. PeerJ 2021; 9:e11109. [PMID: 33868812 PMCID: PMC8034339 DOI: 10.7717/peerj.11109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Due to the lack of effective and feasible viral biomarkers to distinguish viral infection from bacterial infection, children often receive unnecessary antibiotic treatment. To identify serum β2-microglobulin that distinguishes bacterial upper respiratory tract infection from viral upper respiratory tract infection and exanthem subitum in children. Methods This retrospective study was conducted from January 1, 2019 to September 30, 2020 in Yancheng Third People’s Hospital. Children with upper respiratory tract infection and exanthem subitum were recruited. The concentration of serum β2-microglobulin in the viral and bacterial infection groups were statistically analyzed. Results A total of 291 children included 36 with bacterial upper respiratory tract infection (median age, 13 months; 44.4% female), 197 with viral upper respiratory tract infection (median age, 12 months; 43.7% female) and 58 with exanthem subitum (median age, 13 months; 37.9% female). When the concentration of β2-microglobulin was 2.4mg/L, the sensitivity to distinguish viral from bacterial upper respiratory tract infection was 81.2% (95% CI [75.1–86.4%]), and the specificity was 80.6% (95% CI [64.0–91.8]%). When the cutoff was 2.91 mg/L, the sensitivity of β2-microglobulin to distinguish exanthem subitum from bacterial upper respiratory tract infection was 94.8% (95% CI [85.6–98.9]%), and the specificity was 100% (95% CI [90.3–100]%). Conclusions Serum β2-microglobulin may be a significant biological indicator in children with upper respiratory tract infection and exanthem subitum.
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Affiliation(s)
- Xulong Cai
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China.,Department of Pediatrics, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - Qiaolan Xu
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China.,Department of Pediatrics, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - Chenrong Zhou
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China.,Department of Pediatrics, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - Tongjin Yin
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China.,Department of Pediatrics, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - Li Zhou
- Department of Pediatrics, Yancheng Third People's Hospital, Yancheng, China.,Department of Pediatrics, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
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18
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Lin L, Harbarth S, Hargreaves JR, Zhou X, Li L. Large-scale survey of parental antibiotic use for paediatric upper respiratory tract infections in China: implications for stewardship programmes and national policy. Int J Antimicrob Agents 2021; 57:106302. [PMID: 33588014 DOI: 10.1016/j.ijantimicag.2021.106302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inappropriate use of antibiotics for upper respiratory tract infections (URTIs) in Chinese children is rampant. Parents' decision-making processes with respect to treatment choices and antibiotic use for paediatric URTIs were investigated to identify key constructs for effective interventions that target the public. METHODS Data were collected between June 2017 and April 2018 from a random cluster sample of 3188 parents of children aged 0-13 years across three Chinese provinces, representing different stages of economic development. Risk factors of parents' treatment choices and antibiotic use for paediatric URTIs were assessed using binary and multinomial logistic regressions, adjusting for socio-demographic characteristics. RESULTS A total of 1465 (46.0%) children of the 3188 parents who self-diagnosed their children with a URTI were given antibiotics, with or without prescription. Among these children, 40.5% were self-medicated with antibiotics by their parents and 56.1% obtained further antibiotic prescriptions at healthcare facilities. About 70% of children (n=2197) with URTI symptoms sought care; of these, 54.8% obtained antibiotic prescriptions and 7.7% asked for antibiotic prescriptions, with 79.4% successfully obtaining them. Those perceiving antibiotics as effective for treating the common cold and fever (adjusted odds ratio [aOR]=1.82[95% confidence interval, 1.51-2.19] and 1.77[1.47-2.13], respectively), who had access to non-prescription antibiotics (aOR=5.08[4.03-6.39]), and with greater perceived severity of infection (aOR=2.01[1.58-2.56]), were more likely to use antibiotics. CONCLUSIONS Multifaceted, context-appropriate interventions are vital to untangle the perpetual problem of self-medication, over-prescription and ill-informed demands for antibiotics. The findings in this study emphasise the need to prioritise interventions that enhance clinical training, neutralise the pressure from patients for antibiotics, educate on appropriate home care, discourage antibiotic self-medication and improve antibiotic dispensing.
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Abstract
Upper respiratory tract infections are one of the most common challenges in ambulatory medicine. Effective evaluation involves identification, primarily through the history, of the dominant set of patient symptoms leading to accurate diagnosis. Certain more morbid illnesses that mimic common upper respiratory symptoms can also be excluded with this approach. Treatment should address patient preferences through an understanding of the limited utility of antibiotics and through tailored advisement of the numerous pharmacologic options for symptom relief.
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Affiliation(s)
- Fred N Pelzman
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY 10021, USA.
| | - Judy Tung
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY 10021, USA. https://twitter.com/JudyTungMD
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Wang S, Liu L, Liu J, Miao L, Zhuang Q, Guo N, Zhao J, Li Q, Ren G. Characteristics of prescriptions and costs for acute upper respiratory tract infections in Chinese outpatient pediatric patients: a nationwide cross-sectional study. BMC Complement Med Ther 2020; 20:346. [PMID: 33198719 DOI: 10.1186/s12906-020-03141-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy. This study aims to provide evidence on these issues that was in short supply. METHODS We conducted a retrospective cross-sectional study based on data from National Engineering Laboratory of Application Technology in Medical Big Data. All outpatient pediatric patients aged 0-14 years with an uncomplicated AURI from 1 January 2015 to 31 December 2017 in 138 hospitals across the country were included. We reported characteristics of patients, the average number of medications prescribed per encounter, the categories of medication used and their percentages, the cost per visit and prescription costs of drugs. For these measurements, discrepancies among diverse groups of age, regions, insurance types, and AURI categories were compared. Kruskal-Wallis nonparametric test and Student-Newman-Keuls test were performed to identify differences among subgroups. A multinomial logistic regression was conducted to examine the independent effects of those factors on the prescribing behavior. RESULTS A total of 1,002,687 clinical records with 2,682,118 prescriptions were collected and analyzed. The average number of drugs prescribed per encounter was 2.8. The most frequently prescribed medication was Chinese traditional patent medicines (CTPM) (36.5% of overall prescriptions) followed by antibiotics (18.1%). It showed a preference of CPTM over conventional medicines. The median cost per visit was 17.91 USD. The median drug cost per visit was 13.84 USD. The expenditures of antibiotics and CTPM per visit (6.05 USD and 5.87 USD) were among the three highest categories of drugs. The percentage of out-of-pocket patients reached 65.9%. Disparities were showed among subgroups of different ages, regions, and insurance types. CONCLUSIONS The high volume of CPTM usage is the typical feature in outpatient care of AURI pediatric patients in China. The rational and cost-effective use of CPTM and antibiotics still faces challenges. The reimbursement for child AURI cases needs to be enhanced.
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Anderson DE, Sivalingam V, Kang AEZ, Ananthanarayanan A, Arumugam H, Jenkins TM, Hadjiat Y, Eggers M. Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease. Infect Dis Ther 2020; 9:669-675. [PMID: 32643111 PMCID: PMC7341475 DOI: 10.1007/s40121-020-00316-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION As of 22 June 2020, Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV)-2 has infected more than 8.95 million people worldwide, causing > 468,000 deaths. The virus is transmitted through respiratory droplets and physical contact from contaminated surfaces to the mucosa. Hand hygiene and oral decontamination among other measures are key to preventing the spread of the virus. We report the in vitro virucidal activity of topical and oral povidone-iodine (PVP-I) products against SARS-CoV-2. METHODS Suspension assays were used to assess the virucidal activity of PVP-I against SARS-CoV-2. Products were tested at a contact time of 30 s for virucidal activity. Viral titres were calculated using the Spearman-Kärber method and reported as median tissue culture infectious dose (TCID50)/mL. RESULTS All four products [antiseptic solution (PVP-I 10%), skin cleanser (PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and throat spray (PVP-I 0.45%)] achieved ≥ 99.99% virucidal activity against SARS-CoV-2, corresponding to ≥ 4 log10 reduction of virus titre, within 30 s of contact. CONCLUSION This study provides evidence of rapid and effective virucidal activity of PVP-I against SARS-CoV-2. PVP-I-based products are widely available for medical and personal use for hand hygiene and oral decontamination, and could be readily integrated into coronavirus disease, COVID-19, infection control measures in hospital and community settings.
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Affiliation(s)
- Danielle E Anderson
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - Velraj Sivalingam
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Adrian Eng Zheng Kang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | | | - Harsha Arumugam
- Mundipharma Singapore Holding Pte. Limited, Singapore, Singapore
| | | | - Yacine Hadjiat
- Mundipharma Singapore Holding Pte. Limited, Singapore, Singapore
| | - Maren Eggers
- Labor Prof. Dr. G. Enders MVZ GbR, Stuttgart, Germany.
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Bae S, Kim MC, Kim JY, Cha HH, Lim JS, Jung J, Kim MJ, Oh DK, Lee MK, Choi SH, Sung M, Hong SB, Chung JW, Kim SH. Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2: A Controlled Comparison in 4 Patients. Ann Intern Med 2020; 173:W22-W23. [PMID: 32251511 PMCID: PMC7153751 DOI: 10.7326/m20-1342] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Seongman Bae
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Min-Chul Kim
- Chung-Ang University Hospital, Seoul, South Korea (M.K., M.L., S.C., J.C.)
| | - Ji Yeun Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Hye-Hee Cha
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Joon Seo Lim
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.S.L.)
| | - Jiwon Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Min-Jae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Dong Kyu Oh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Mi-Kyung Lee
- Chung-Ang University Hospital, Seoul, South Korea (M.K., M.L., S.C., J.C.)
| | - Seong-Ho Choi
- Chung-Ang University Hospital, Seoul, South Korea (M.K., M.L., S.C., J.C.)
| | - Minki Sung
- Sejong University, Seoul, South Korea (M.S.)
| | - Sang-Bum Hong
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
| | - Jin-Won Chung
- Chung-Ang University Hospital, Seoul, South Korea (M.K., M.L., S.C., J.C.)
| | - Sung-Han Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.B., J.Y.K., H.C., J.J., M.K., D.K.O., S.H., S.K.)
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Weissman GE, Crane-Droesch A, Chivers C, Luong T, Hanish A, Levy MZ, Lubken J, Becker M, Draugelis ME, Anesi GL, Brennan PJ, Christie JD, Hanson CW, Mikkelsen ME, Halpern SD. Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic. Ann Intern Med 2020; 173:21-28. [PMID: 32259197 PMCID: PMC7153364 DOI: 10.7326/m20-1260] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic challenges hospital leaders to make time-sensitive, critical decisions about clinical operations and resource allocations. OBJECTIVE To estimate the timing of surges in clinical demand and the best- and worst-case scenarios of local COVID-19-induced strain on hospital capacity, and thus inform clinical operations and staffing demands and identify when hospital capacity would be saturated. DESIGN Monte Carlo simulation instantiation of a susceptible, infected, removed (SIR) model with a 1-day cycle. SETTING 3 hospitals in an academic health system. PATIENTS All people living in the greater Philadelphia region. MEASUREMENTS The COVID-19 Hospital Impact Model (CHIME) (http://penn-chime.phl.io) SIR model was used to estimate the time from 23 March 2020 until hospital capacity would probably be exceeded, and the intensity of the surge, including for intensive care unit (ICU) beds and ventilators. RESULTS Using patients with COVID-19 alone, CHIME estimated that it would be 31 to 53 days before demand exceeds existing hospital capacity. In best- and worst-case scenarios of surges in the number of patients with COVID-19, the needed total capacity for hospital beds would reach 3131 to 12 650 across the 3 hospitals, including 338 to 1608 ICU beds and 118 to 599 ventilators. LIMITATIONS Model parameters were taken directly or derived from published data across heterogeneous populations and practice environments and from the health system's historical data. CHIME does not incorporate more transition states to model infection severity, social networks to model transmission dynamics, or geographic information to account for spatial patterns of human interaction. CONCLUSION Publicly available and designed for hospital operations leaders, this modeling tool can inform preparations for capacity strain during the early days of a pandemic. PRIMARY FUNDING SOURCE University of Pennsylvania Health System and the Palliative and Advanced Illness Research Center.
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Affiliation(s)
- Gary E Weissman
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Andrew Crane-Droesch
- University of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C., M.E.D.)
| | - Corey Chivers
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - ThaiBinh Luong
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Asaf Hanish
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael Z Levy
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Jason Lubken
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael Becker
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael E Draugelis
- University of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C., M.E.D.)
| | - George L Anesi
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Patrick J Brennan
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Jason D Christie
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - C William Hanson
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Mark E Mikkelsen
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Scott D Halpern
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
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Chen C, Gao G, Xu Y, Pu L, Wang Q, Wang L, Wang W, Song Y, Chen M, Wang L, Yu F, Yang S, Tang Y, Zhao L, Wang H, Wang Y, Zeng H, Zhang F. SARS-CoV-2-Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19. Ann Intern Med 2020; 172:832-834. [PMID: 32227141 PMCID: PMC7133055 DOI: 10.7326/m20-0991] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Chen Chen
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Guiju Gao
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Yanli Xu
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Lin Pu
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Qi Wang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Liming Wang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Wenling Wang
- NHC Key Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China (W.W., L.Z., H.W.)
| | - Yangzi Song
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Meiling Chen
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Linghang Wang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Fengting Yu
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Siyuan Yang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Yunxia Tang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Li Zhao
- NHC Key Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China (W.W., L.Z., H.W.)
| | - Huijuan Wang
- NHC Key Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China (W.W., L.Z., H.W.)
| | - Yajie Wang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Hui Zeng
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China (C.C., G.G., Y.X., L.P., Q.W., L.W., Y.S., M.C., L.W., F.Y., S.Y., Y.T., Y.W., H.Z., F.Z.)
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25
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Khan EA, Raja MH, Chaudhry S, Zahra T, Naeem S, Anwar M. Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections. Pak J Med Sci 2020; 36:642-646. [PMID: 32494248 PMCID: PMC7260936 DOI: 10.12669/pjms.36.4.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The objective of the study was to assess the outcome of upper respiratory tract infections (URTI) in healthy children. Methods This descriptive study was conducted on 314 children aged 3-36 months in the paediatric outpatient clinic and emergency department with symptoms of URTI (fever, cough, rhinorrhoea) for ≤5 days. Patient's demographics, clinical features, laboratory data and outcome were recorded. Follow up phone calls were made to parents on day 7 (response 93.6%) and day 14 (response 94.6%) to record outcome. Results A total of 314 children with URTIs were included. Majority (57.6%) were males and <1year of age (40%). Common manifestations of URTI were fever (89%), cough (79%), rhinorrhoea (62%), pharyngitis (79%) and conjunctivitis (46%). More than half (53%) had history of contact with URTI in a family member. Mean duration of symptoms was 2.7±1.3 days. Majority (93%) of children were given supportive treatment and only 6.7% received antibiotics initially. Most of children (76%) recovered within one week and 91.8% within two weeks with supportive care only. Only 4% children were hospitalized and 12% required follow up visit of which 16% needed oral antibiotics. Complications or deaths did not occur. Conclusions Majority of URTIs in healthy children resolved with supportive treatment and do not require antibiotics. Antibiotic stewardship in simple URTIs should be practiced using awareness and advocacy campaigns.
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Affiliation(s)
- Ejaz Ahmed Khan
- Ejaz Ahmed Khan, MBBS, MD. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mazhar Hussain Raja
- Mazhar Hussain Raja, MRCP, MRCPC. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shehla Chaudhry
- Shehla Chaudhry, FCPS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Tehreem Zahra
- Tehreem Zahra, MBBS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Salman Naeem
- Salman Naeem, MBBS. Department of Emergency Medicine, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Masuma Anwar
- Masuma Anwar, MBBS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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26
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Cheng MP, Papenburg J, Desjardins M, Kanjilal S, Quach C, Libman M, Dittrich S, Yansouni CP. Diagnostic Testing for Severe Acute Respiratory Syndrome-Related Coronavirus 2: A Narrative Review. Ann Intern Med 2020; 172:726-734. [PMID: 32282894 PMCID: PMC7170415 DOI: 10.7326/m20-1301] [Citation(s) in RCA: 398] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing to identify persons infected with severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection is central to control the global pandemic of COVID-19 that began in late 2019. In a few countries, the use of diagnostic testing on a massive scale has been a cornerstone of successful containment strategies. In contrast, the United States, hampered by limited testing capacity, has prioritized testing for specific groups of persons. Real-time reverse transcriptase polymerase chain reaction-based assays performed in a laboratory on respiratory specimens are the reference standard for COVID-19 diagnostics. However, point-of-care technologies and serologic immunoassays are rapidly emerging. Although excellent tools exist for the diagnosis of symptomatic patients in well-equipped laboratories, important gaps remain in screening asymptomatic persons in the incubation phase, as well as in the accurate determination of live viral shedding during convalescence to inform decisions to end isolation. Many affluent countries have encountered challenges in test delivery and specimen collection that have inhibited rapid increases in testing capacity. These challenges may be even greater in low-resource settings. Urgent clinical and public health needs currently drive an unprecedented global effort to increase testing capacity for SARS-CoV-2 infection. Here, the authors review the current array of tests for SARS-CoV-2, highlight gaps in current diagnostic capacity, and propose potential solutions.
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Affiliation(s)
- Matthew P Cheng
- McGill University Health Centre and McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Quebec, Canada (M.P.C.)
| | - Jesse Papenburg
- McGill Interdisciplinary Initiative in Infection and Immunity and Montreal Children's Hospital, Montreal, Quebec, Canada (J.P.)
| | - Michaël Desjardins
- Brigham and Women's Hospital, Boston, Massachusetts, and Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (M.D.)
| | - Sanjat Kanjilal
- Brigham and Women's Hospital, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.K.)
| | - Caroline Quach
- CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada (C.Q.)
| | - Michael Libman
- McGill University Health Centre, McGill Interdisciplinary Initiative in Infection and Immunity, and McGill University, Montreal, Quebec, Canada (M.L., C.P.Y.)
| | - Sabine Dittrich
- Foundation of Innovative New Diagnostics, Malaria and Fever Program, Geneva, Switzerland, and University of Oxford, Oxford, United Kingdom (S.D.)
| | - Cedric P Yansouni
- McGill University Health Centre, McGill Interdisciplinary Initiative in Infection and Immunity, and McGill University, Montreal, Quebec, Canada (M.L., C.P.Y.)
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27
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Muraki Y, Kusama Y, Tanabe M, Hayakawa K, Gu Y, Ishikane M, Yamasaki D, Yagi T, Ohmagari N. Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections. BMC Health Serv Res 2020; 20:399. [PMID: 32393267 PMCID: PMC7212615 DOI: 10.1186/s12913-020-05288-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2018, the Japanese medical reimbursement system was revised to introduce a fee for the implementation of an antimicrobial stewardship (AS) fee for pediatric patients. The purpose of this study was to evaluate physicians' prescription behavior following this revision. METHODS We conducted a retrospective observational study from January 1, 2017 to September 30, 2018 of pediatric (< 15 years) outpatients with upper respiratory tract infections (URIs). To assess the pattern of antibiotic prescription for the treatment of pediatric URIs before and after the introduction of the AS fee, we extracted data on pediatric URIs, diagnosed during the study period. Patients were divided based on whether medical facilities claimed AS fees. We defined antibiotic use as the number of antibiotics prescribed, and evaluated the proportion of each class to the total number of antibiotics prescribed. We also recorded the number of medical facilities that each patient visited during the study period. RESULTS The frequency of antibiotic prescription decreased after AS fee implementation, regardless of whether the facility claimed the AS fee, but tended to be lower in facilities that claimed the fee. Additionally, the frequency of antibiotic prescription decreased in all age groups. Despite the reduced frequency of antibiotic prescription, consultation behavior did not change. CONCLUSIONS The AS fee system, which compensates physicians for limiting antibiotic prescriptions, helped to reduce unnecessary antibiotic prescription and is thus a potentially effective measure against antimicrobial resistance.
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Affiliation(s)
- Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5, Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto-shi, Kyoto, 607-8414 Japan
| | - Yoshiki Kusama
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaki Tanabe
- Department of Infection Control and Prevention, Mie University Hospital, Mie, Japan
| | - Kayoko Hayakawa
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Gu
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Yamasaki
- Department of Infection Control and Prevention, Mie University Hospital, Mie, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ohmagari
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Mortazhejri S, Hong PJ, Yu AM, Hong BY, Stacey D, Bhatia RS, Grimshaw JM. Systematic review of patient-oriented interventions to reduce unnecessary use of antibiotics for upper respiratory tract infections. Syst Rev 2020; 9:106. [PMID: 32384919 PMCID: PMC7210679 DOI: 10.1186/s13643-020-01359-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antibiotics are prescribed frequently for upper respiratory tract infections (URTIs) even though most URTIs do not require antibiotics. This over-prescription contributes to antibiotic resistance which is a major health problem globally. As physicians' prescribing behaviour is influenced by patients' expectations, there may be some opportunities to reduce antibiotic prescribing using patient-oriented interventions. We aimed to identify these interventions and to understand which ones are more effective in reducing unnecessary use of antibiotics for URTIs. METHODS We conducted a systematic review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), CINAHL, and the Web of Science. We included English language randomized controlled trials (RCTs), quasi-RCTs, controlled before and after studies, and interrupted time series (ITS) studies. Two authors screened the abstract/titles and full texts, extracted data, and assessed study risk of bias. Where pooling was appropriate, a meta-analysis was performed by using a random-effects model. Where pooling of the data was not possible, a narrative synthesis of results was conducted. RESULTS We included 13 studies (one ITS, one cluster RCTs, and eleven RCTs). All interventions could be classified into two major categories: delayed prescriptions (seven studies) and patient/public information and education interventions (six studies). Our meta-analysis of delayed prescription studies observed significant reductions in the use of antibiotics for URTIs (OR = 0.09, CI 0.03 to 0.23; six studies). A subgroup analysis showed that prescriptions that were given at a later time and prescriptions that were given at the index consultation had similar effects. The studies in the patient/public information and education group varied according to their methods of delivery. Since only one or two studies were included for each method, we could not make a definite conclusion on their effectiveness. In general, booklets or pamphlets demonstrated promising effects on antibiotic prescription, if discussed by a practitioner. CONCLUSIONS Patient-oriented interventions (especially delayed prescriptions) may be effective in reducing antibiotic prescription for URTIs. Further research is needed to investigate the costs and feasibility of implementing these interventions as part of routine clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016048007.
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Affiliation(s)
- Sameh Mortazhejri
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Patrick Jiho Hong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Ashley M Yu
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Brian Younho Hong
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, Turner JE, Walsh NP. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev 2020; 26:8-22. [PMID: 32139352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Multiple studies in humans and animals have demonstrated the profound impact that exercise can have on the immune system. There is a general consensus that regular bouts of short-lasting (i.e. up to 45 minutes) moderate intensity exercise is beneficial for host immune defense, particularly in older adults and people with chronic diseases. In contrast, infection burden is reported to be high among high performance athletes and second only to injury for the number of training days lost during preparation for major sporting events. This has shaped the common view that arduous exercise (i.e. those activities practiced by high performance athletes/ military personnel that greatly exceed recommended physical activity guidelines) can suppress immunity and increase infection risk. However, the idea that exercise per se can suppress immunity and increase infection risk independently of the many other factors (e.g. anxiety, sleep disruption, travel, exposure, nutritional deficits, environmental extremes, etc.) experienced by these populations has recently been challenged. The purpose of this debate article was to solicit opposing arguments centered around this fundamental question in the exercise immunology field: can exercise affect immune function to increase susceptibility to infection. Issues that were contested between the debating groups include: (i) whether or not athletes are more susceptible to infection (mainly of the upper respiratory tract) than the general population; (ii) whether exercise per se is capable of altering immunity to increase infection risk independently of the multiple factors that activate shared immune pathways and are unique to the study populations involved; (iii) the usefulness of certain biomarkers and the interpretation of in vitro and in vivo data to monitor immune health in those who perform arduous exercise; and (iv) the quality of scientific evidence that has been used to substantiate claims for and against the potential negative effects of arduous exercise on immunity and infection risk. A key point of agreement between the groups is that infection susceptibility has a multifactorial underpinning. An issue that remains to be resolved is whether exercise per se is a causative factor of increased infection risk in athletes. This article should provide impetus for more empirical research to unravel the complex questions that surround this contentious issue in the field of exercise immunology.
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Affiliation(s)
- Richard J Simpson
- Departments of Nutritional Sciences, Pediatrics and Immunobiology, University of Arizona, Tucson, AZ, USA
| | - John P Campbell
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY. UK
| | - Maree Gleeson
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Giessen, Giessen, Germany
| | - David C Nieman
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2617, Australia
| | - James E Turner
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY. UK
| | - Neil P Walsh
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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30
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Ali A, Lopardo G, Scarpellini B, Stein RT, Ribeiro D. Systematic review on respiratory syncytial virus epidemiology in adults and the elderly in Latin America. Int J Infect Dis 2020; 90:170-180. [PMID: 31669592 PMCID: PMC7110494 DOI: 10.1016/j.ijid.2019.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The present study provides a comprehensive review of the recently published data on RSV epidemiology in adults and the elderly in Latin America. METHODS A systematic literature search was carried out in Medline, Scielo, Lilacs, and Cochrane Library. The search strategy aimed at retrieving studies focusing on RSV prevalence, burden, risk factors, and the routine clinical practice in the prevention and management of RSV infections in Latin American countries. Only articles published between January 2011 and December 2017 were considered. RESULTS Eighteen studies were included. Percentages of RSV detection varied highly across included studies for adult subjects with respiratory infections (0% to 77.9%), influenza-like illness (1.0% to 16.4%) and community-acquired pneumonia (1.3% to 13.5%). Considerable percentages of hospitalization were reported for RSV-infected adults with influenza-like illness (40.9% and 69.9%) and community-acquired pneumonia (91.7%). CONCLUSIONS Recent RSV data regarding adult populations in Latin America are scarce. RSV was documented as a cause of illness in adults and the elderly, being identified in patients with acute respiratory infections, influenza-like illness and community-acquired pneumonia. The studies suggest that RSV infections may be a significant cause of hospitalization in adult populations in Latin America, including younger adults.
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Affiliation(s)
- Abraham Ali
- Fundación Neumológica Colombiana, Carrera 13B # 161- 85 Piso 2, Postal Code 110131, Bogotá, Colombia.
| | - Gustavo Lopardo
- Department of Infectious Diseases at FUNCEI and Hospital Bernardo Houssay, French 3085, (1425) Buenos Aires, Argentina.
| | - Bruno Scarpellini
- Real World Evidence Department, Medical Affairs Latin America, Janssen Cilag Farmacêutica, Avenida Presidente Juscelino Kubitschek, 2041 - Vila Nova Conceição, 04543-011, São Paulo, Brazil.
| | - Renato T. Stein
- Pontifícia Universidade Católica do RGS (PUCRS), ReSViNET Executive Committee member, Centro Clinico PUCRS, Av. Ipiranga, 6690, conj.420. Porto Alegre, RS, CEP 90610-000, Brazil
| | - Diogo Ribeiro
- CTI Clinical Trial & Consulting Services, Rua Tierno Galvan, Torre 3, Piso 16, 1070-274 Lisboa, Portugal.
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Singh N, Kamble D, Mahantshetti NS. Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children. Indian J Pediatr 2019; 86:1105-1111. [PMID: 31346969 DOI: 10.1007/s12098-019-03025-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effect of vitamin D supplementation in the prevention of recurrent pneumonia in under-five children. METHODS The present one year 8 months longitudinal, community-based randomized controlled study included a total of 100 under-five children with pneumonia. Children were divided into two groups: intervention group (Group I: standard treatment with vitamin D 300,000 IU; n = 50) and control group (Group C: standard treatment only; n = 50). As nine samples were hemolyzed, groups I and C comprised of 46 and 45 children, respectively. The children were followed up for 1 y and signs of upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), vitamin D deficiency, and vitamin D toxicity were recorded. RESULTS The male to female ratio in group C and I was 1.27:1 and 1.5:1, respectively (P = 0.420). Age, gender, birth, anthropometric and clinical characteristics, and feeding habits were not statistically significant (P > 0.05) between both the cohorts (Group C and I). Children with reduced vitamin D levels were high in group C (25) when compared to the group I (15). During all the follow-ups, the URTI and LRTI episodes, severity of pneumonia, number of hospital admissions, complications, mean episodes of LRTI, and mean duration of LRTI were comparable between group I and group C (P > 0.05). CONCLUSIONS Overall, the present study highlights that oral vitamin D (300,000 IU bolus dose quarterly) has some beneficial effect in the prevention of recurrent pneumonia in under-five children, although, not to a significant degree. Hence, it is recommended that further studies are required to demonstrate a significant effect of vitamin D in the prevention of pneumonia.
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Affiliation(s)
- Neha Singh
- Department of Pediatrics, KAHER'S JN Medical College, Nehru Nagar, Belagavi, Karnataka, 590010, India.
| | - Dnyanesh Kamble
- Department of Pediatrics, KAHER'S JN Medical College, Nehru Nagar, Belagavi, Karnataka, 590010, India.
| | - N S Mahantshetti
- Department of Pediatrics, KAHER'S JN Medical College, Nehru Nagar, Belagavi, Karnataka, 590010, India
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Eccles R, Mallefet P. Observational study of the effects of upper respiratory tract infection on hydration status. Multidiscip Respir Med 2019; 14:36. [PMID: 31695912 PMCID: PMC6823947 DOI: 10.1186/s40248-019-0200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background A frequent treatment recommendation during acute respiratory infection is to increase fluid intake. This is the first study to investigate whether upper respiratory tract infections (URTIs) such as common cold can lead to dehydration, as commonly believed by the public. Methods This was an exploratory, noninterventional, observational, single-center study. Subjects made 2 visits to a UK study center for assessments of dehydration, once during URTI and then 2–3 weeks later when fully recovered. The primary endpoint was a comparison of serum osmolality during vs after URTI. Complete blood count, serum urea, serum electrolytes, urine parameters (eg, osmolality, specific gravity, color), body weight/BMI, subjective assessment of thirst, and physician assessment of dehydration were additional outcomes. Only descriptive statistics and shift tables were used. Results Fifty-five otherwise healthy adults with moderate to severe URTI of < 120 h in duration were enrolled (63.6% female, 94.5% white, mean [SD] age 21.0 [6.8] years). There was no evidence of dehydration based on serum osmolality (mean [SD] 287.63 [4.83] mosm/kg during URTI; 288.60 [5.99] mosm/kg after recovery). With only a few exceptions, complete blood count, serum urea, serum electrolytes, urine specific gravity, urine color, and physician ratings of hydration remained stable. Body weight decreased > 1% in 34.0% of subjects and increased > 1% in 17.0% between visits, with similar changes in BMI. Urine osmolality varied: 14 subjects showed a decrease and 5 showed an increase, resulting in a higher mean [SD] urine osmolality during URTI (700.50 [231.59] vs 618.47 [320.29] mosm/kg). Subjects perceived greater thirst during URTI. Conclusions In this pilot observational study, we found no evidence that URTIs such as common cold are associated with dehydration, contrary to popular belief.
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Affiliation(s)
- Ronald Eccles
- 1Cardiff School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff, CF10 3AX UK
| | - Pascal Mallefet
- GSK Consumer Healthcare Company, Route de l'Etraz 2, 1260 Nyon, Switzerland
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Abstract
PURPOSE OF REVIEW To examine the relationship between vitamin D and otitis media. RECENT FINDINGS Vitamin D deficiency has been associated with several respiratory diseases, including otitis media. Vitamin D supplementation may reduce the risk of otitis media. This relationship may be explained by vitamin D supporting the immune system by upregulating antimicrobial peptides which are effective against otopathogens and biofilm formation, supporting a less inflammatory immune response, or promoting beneficial commensal bacteria. This review will explore risk factors of both otitis media and vitamin D deficiency, the evidence of vitamin D being beneficial for various forms of otitis media, and possible mechanisms of action.
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Seifert G, Brandes-Schramm J, Zimmermann A, Lehmacher W, Kamin W. Faster recovery and reduced paracetamol use - a meta-analysis of EPs 7630 in children with acute respiratory tract infections. BMC Pediatr 2019; 19:119. [PMID: 31014293 PMCID: PMC6477747 DOI: 10.1186/s12887-019-1473-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Fever is a very common adaptive immune response in acute respiratory tract disorders during infancy. Antipyretic / analgesic drugs such as paracetamol (acetaminophen) are widely used to improve the comfort of the child but may cause medically unneeded antipyresis and rare but potentially serious side effects. We assess whether treatment with Pelargonium sidoides extract EPs 7630 reduces the administration of paracetamol in children with acute tonsillopharyngitis (ATP) or acute bronchitis (AB). DESIGN Meta-analysis of randomised, placebo-controlled clinical trials. METHODS We searched clinical trial registries (ISRCTN, ClinicalTrials.gov ) and medical literature (MEDLINE, EMBASE), for randomised, placebo-controlled trials investigating the administration of EPs 7630 to children with ATP or AB and reporting the co-administration of paracetamol. Based on the individual participant data of the eligible trials, study populations were characterized according to sex and age, and meta-analyses were performed for cumulative paracetamol use and ability to attend school at treatment end. RESULTS Six trials including a total of 523 children aged 6-10 years (EPs 7630: 265; placebo: 258) and suffering from non-β-hemolytic streptococcal ATP (3 trials) or from AB (3 trials) were identified and eligible. Children received EPs 7630 or placebo for 6 (ATP) or 7 days (AB). Compared to placebo, EPs 7630 reduced the cumulative dose of paracetamol in 5 out of the 6 trials, by an average of 244 mg (Hedges' g; - 0.28; 95% confidence interval: [- 0.53; - 0.02]; p < 0.03). At treatment end, 30.2% (EPs 7630) and 74.4% (placebo) of the children were still unable to attend school (risk ratio: 0.43; 95% confidence interval: [0.29; 0.65]; p < 0.001). CONCLUSIONS In children aged 6-10 years with AB or ATP, EPs 7630 alleviated the symptom burden and accelerated recovery. Although EPs 7630 has no known antipyretic effect, concomitant use of paracetamol was reduced.
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Affiliation(s)
- Georg Seifert
- Charité - Universitätsmedizin Berlin, Clinic for Paediatrics, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Andrea Zimmermann
- Clinical Research Department, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Walter Lehmacher
- Emeritus -; University of Cologne, Institute of Medical Statistics, Informatics und Epidemiology, Cologne, Germany
| | - Wolfgang Kamin
- Clinic for Paediatrics, Evangelic Hospital Hamm, Hamm, Germany.,Faculty of Medicine, Pomeranian Medical University, Szczecin, Poland
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Keohavong B, Vonglokham M, Phoummalaysith B, Louangpradith V, Inthaphatha S, Kariya T, Saw YM, Yamamoto E, Hamajima N. Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR. Trop Med Health 2019; 47:16. [PMID: 30858755 PMCID: PMC6394019 DOI: 10.1186/s41182-019-0143-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background The irrational use of antibiotics has been identified as a major problem in healthcare, and it can lead to antimicrobial resistance, treatment failure, and increased healthcare costs. Although many studies worldwide have focused on the irrational use of drugs, reports on prescription practice in Lao PDR remained limited. This study aimed to examine the patterns of antibiotic prescription for under-fives with common cold or upper respiratory tract infection (URTI) at pediatric outpatient divisions. Methods One provincial hospital (PH) at Kaisone Phomvihane and four district hospitals (DHs) at Songkhone, Champhone, Atsaphangthong, and Xepon in Savannakhet Province were selected. Healthcare providers at these hospitals were interviewed and medical records of under-fives from 2016 were examined. Results Of the 54 healthcare providers interviewed, 85.2% had seen the standard treatment guideline, 77.8% adhered to this guideline, and 90.7% knew about antimicrobial resistance, while 18.5% participated in antimicrobial resistance activities. Medical records of 576 outpatients (311 boys and 265 girls) with common cold or URTI were examined, 154 at the PH and 422 at the DHs. Although antibiotics prescription proportions were similar between facilities at both levels (68.8% and 70.9% at the PH and DHs, respectively), antibiotics were exclusively prescribed for URTIs (96.4%), not for common cold (4.9%). First-line antibiotics recommended by WHO Model List of Essential Medicines for Children the 6th List were prescribed for 81.5% of patients; mainly, beta-lactam antibiotics were prescribed (87.2% of prescribed antibiotics). There were no cases in which two or more antibiotics were prescribed. The correct dose according to the National STG was 31.9% as a whole. The difference in the correct dose between the PH (52.8%) and the DHs (24.4%) was significant (p < 0.001). Conclusions This study demonstrated the patterns of antibiotic prescription for under-fives with common cold or URTI among healthcare providers from two different levels of facilities. Although an appropriate number of generic first-line antibiotics in the essential drug list were prescribed, the dosage and duration of antibiotic use were not appropriate. In order to further improve antibiotic prescription practices, regulation by the government is necessary; this could also decrease antimicrobial resistance and improve treatment outcomes.
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Affiliation(s)
- Bounxou Keohavong
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,2Food and Drug Department, Ministry of Health, Simuang road, Vientiane Capital, Lao People's Democratic Republic
| | - Manithong Vonglokham
- 3Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Bounfeng Phoummalaysith
- 4National Health Insurance Bureau, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Viengsakhone Louangpradith
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,Mittaphab Hospital, Phonsavang V, Chanthabouly D, Vientiane Capital, Lao People's Democratic Republic
| | - Souphalak Inthaphatha
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Tetsuyoshi Kariya
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yu Mon Saw
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Eiko Yamamoto
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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Saleh Faidah H, Haseeb A, Yousuf Lamfon M, Mohammad Almatrafi M, Abdullah Almasoudi I, Cheema E, Hassan Almalki W, E Elrggal M, M A Mohamed M, Saleem F, Mansour Al-Gethamy M, Pervaiz B, Khan TM, Azmi Hassali M. Parents' self-directed practices towards the use of antibiotics for upper respiratory tract infections in Makkah, Saudi Arabia. BMC Pediatr 2019; 19:46. [PMID: 30717737 PMCID: PMC6360761 DOI: 10.1186/s12887-019-1391-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 01/02/2019] [Indexed: 11/29/2022] Open
Abstract
Background Excessive and inappropriate antimicrobial use in the community is one risk factor that can result in the spread of antimicrobial resistance. Upper respiratory tract infections are most frequently reported among children and mainly of viral origin and do not require antibiotics. We have conducted Knowledge, Attitude and Perception (KAP) survey of parents to explore the parent’s knowledge, attitude & perception of Saudi parents. Methods A knowledge attitude perception questioner was adopted from a previous study conducted in Greece by Panagakou et al. Raosoft online sample size calculator calculated the sample size by adding the total estimated Makkah population of 5,979,719 with a response rate of 30%, 5% margin of error and 99% confidence interval. Based on the described criteria five hundred & fifty-eight was the required sample size of the study. Incomplete questioners were excluded from the statistical analysis. SPSS version 21 was used to analyse data and to produce descriptive statistics. Results Most of the mothers (95%) responded among parents. 67% had no health insurance to cover medications costs. Most of them (74%) were related to medium income level. Seventy per cent of the parents believed physicians as a source of information for judicious antibiotics use. Interestingly, only 8% were agreed that most of the upper respiratory tract infections are caused by viral reasons. Majority of Saudi parents (53%) expect pediatricians to prescribe antimicrobials for their children for symptoms like a cough, nose discharge, sore throat and fever. Moreover, most the parents had the poor knowledge to differentiate commonly used OTC medications for URTI and antibiotics like Augmentin (Co-amoxiclav), Ceclor (cefaclor) and Erythrocin (Erythromycin). While comparing males and female’s knowledge level, few males have identified Amoxil (Amoxicillin). Similarly, parents of age 20–30 years have good knowledge about the antibiotics. Conclusions Majority of Saudi parents believe in pediatricians and use antibiotics on physician’s advice. Most of them expect antibiotics from their physicians as a primary treatment for upper respiratory tract infections. There is need for more educational activities to parents by the pharmacists to prevent antibiotics overuse among children.
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Affiliation(s)
- Hani Saleh Faidah
- Department of Medical Microbiology, Al-Noor Specialist Hospital, Ministry of Health, Makkah, Kingdom of Saudi Arabia.,Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah, Kingdom of Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. .,Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Majd Yousuf Lamfon
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Dan Al-Majd Pharmacy, Makkah, Kingdom of Saudi Arabia
| | - Malak Mohammad Almatrafi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Imtinan Abdullah Almasoudi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ejaz Cheema
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Institute of Clinical Sciences, University of Birmingham, Birmingham, England
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mahmoud E Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mahmoud M A Mohamed
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT) , Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Manal Mansour Al-Gethamy
- Adult Infectious Disease Consultant and Infection Prevention and Control Programme Director, Al Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia
| | - Beenish Pervaiz
- Lady Reading Hospital, Medical Teaching Institute, Peshawar, Pakistan
| | - Tahir Mehmood Khan
- School of pharmacy, Monash University Malaysia, Selangor, Malaysia.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Tang J, Chen J, He T, Jiang Z, Zhou J, Hu B, Yang S. Diversity of upper respiratory tract infections and prevalence of Streptococcus pneumoniae colonization among patients with fever and flu-like symptoms. BMC Infect Dis 2019; 19:24. [PMID: 30616564 PMCID: PMC6323860 DOI: 10.1186/s12879-018-3662-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Many upper respiratory pathogens cause similar symptoms. In China, routine molecular tests for upper respiratory pathogens are not widely performed and antibiotics abuse in treating upper respiratory tract infections (URTIs) is a major public health concern. METHODS We performed qualitative real-time PCR tests to detect common upper respiratory tract pathogens including 9 viruses and 3 bacteria in 1221 nasopharyngeal swabs from patients with fever and influenza-like symptoms in a Chinese city. A quantitative real-time PCR was also performed to measure the bacterial density of the colonizing Streptococcus pneumoniae in these samples. RESULTS We found very diverse pathogens including 81.7% viruses, 11.6% bacteria and 6.7% mixed viruses and bacteria. S. pneumoniae colonization was found in 8.0% of the cases but most of them had low bacterial density (Mean = 3.9 log cfu/ml). We also discovered an increase of S. pneumoniae colonization frequency (but not the density) in patients with detectable upper respiratory tract pathogens, in a pathogen variety-dependent manner. CONCLUSIONS Our study provided strong evidence against empiric antibiotic use for treating URTIs, and highlighted a strong need for improving the diagnostic capacity for URTIs by using more molecular testing in China.
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Affiliation(s)
- Jialiang Tang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Jinkun Chen
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Tingting He
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Zhuojing Jiang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Jiale Zhou
- IngeniGen XunMinKang Biotechnology Inc. Shaoxing, Zhejiang, China
| | - Bin Hu
- IngeniGen XunMinKang Biotechnology Inc. Shaoxing, Zhejiang, China
| | - Shangxin Yang
- Zhejiang-Californina International Nanosystems Institute, Zhejiang University, Zhejiang, Hangzhou, China. .,Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, University of California Los Angeles, 11633 San Vicente Blvd, Los Angeles, CA, 90049, USA.
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Conde Diez S, Viejo Casas A, Garcia Rivero JL, Lopez Caro JC, Ortiz Portal F, Diaz Saez G. Impact of a homeopathic medication on upper respiratory tract infections in COPD patients: Results of an observational, prospective study (EPOXILO). Respir Med 2018; 146:96-105. [PMID: 30665525 DOI: 10.1016/j.rmed.2018.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which airflow is obstructed. Viral or bacterial upper respiratory tract infections (URTIs) may lead to exacerbations. Homeopathic medication administration to COPD patients during the influenza-exposure period may help to reduce the frequency of common URTIs. METHODS This prospective, observational, multicenter study was carried out in Cantabria, Spain. Patients with COPD were divided into two groups: group 1 received conventional treatment + homeopathic medication (diluted and dynamized extract of duck liver and heart; Boiron) (OG); group 2 received conventional treatment only (CG). The primary endpoint was the number of URTIs between the 4-5 months follow up (mean 4.72 ± 0.96) from basal to last visit. Secondary endpoints included the duration of URTIs, number and duration of COPD exacerbations, use of COPD drugs, changes in quality of life (QoL), compliance, and adverse events (AEs). RESULTS 219 patients were analyzed (OG = 109, CG = 110). There was a significant reduction in mean number of URTIs during the follow-up period in OG compared to CG (0.514 ± 0.722 vs. 1.037 ± 1.519, respectively; p = 0.014). Logistic regression analysis showed a 3.3-times higher probability of suffering ≥2 URTI episodes in CG (p = 0.003, n = 72). OG patients having ≥1 URTI also had a significant reduction in mean URTI duration per episode (3.57 ± 2.44 days OG vs. 5.22 ± 4.17 days CG; p = 0.012). There was no significant difference in mean number of exacerbations, mean duration of exacerbations, or QoL between OG and CG. There was a greater decrease in proportion of patients using corticosteroids for exacerbations between baseline and visit 2 in OG compared to CG (22.1% vs. 7.5% fewer respectively, p = 0.005). Exacerbator phenotype patients had a significant decrease in number of URTIs (0.54 ± 0.72 vs. 1.31 ± 1.81; p = 0.011), and fewer COPD exacerbations (0.9 ± 1.3 vs. 1.5 ± 1.7; p = 0.037) in OG vs. CG, respectively. CONCLUSIONS Homeopathic medication use during the influenza-exposure period may have a beneficial impact at reducing URTIs' number and duration in COPD patients and at reducing the number of COPD exacerbations in patients with the exacerbator phenotype. Further studies are needed to confirm the effects observed in this study.
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Affiliation(s)
- Susana Conde Diez
- Centro de Salud José Barros (Camargo), Avda. Bilbao S/n. Muriedas, 39600, Cantabria, Spain.
| | - Ana Viejo Casas
- Centro de Salud Pisueña-Cayón, C/El Ferial S/n. 39620 Sarón, Cantabria, Spain.
| | | | | | | | - Gualberto Diaz Saez
- Former Medical Director, BOIRON SIH, Madrid, Spain; CEDH (Centro Enseñanza y Desarrollo Homeopatía), Alcobendas, Spain.
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Komano Y, Shimada K, Naito H, Fukao K, Ishihara Y, Fujii T, Kokubo T, Daida H. Efficacy of heat-killed Lactococcus lactis JCM 5805 on immunity and fatigue during consecutive high intensity exercise in male athletes: a randomized, placebo-controlled, double-blinded trial. J Int Soc Sports Nutr 2018; 15:39. [PMID: 30071871 PMCID: PMC6090876 DOI: 10.1186/s12970-018-0244-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/29/2018] [Indexed: 02/07/2023] Open
Abstract
Background Lactococcus lactis JCM 5805 (LC-Plasma) is a unique lactic acid bacteria (LAB) which activates plasmacytoid dendritic cells (pDC). We aimed to evaluate the effect of LC-Plasma on dendritic cell (DC) activity and subjective indices of upper respiratory tract infections (URTI) and fatigue in athletes under high intensity exercise. Methods We conducted a randomized, placebo-controlled, double-blinded trial. Fifty-one male subjects belonging to a university sports club were randomized into placebo (n = 25) and LC-Plasma (n = 26) groups. Individuals ingested placebo capsules containing cornstarch or LC-Plasma capsules containing 100 billion cells of heat-killed LC-Plasma per day for 13 days. During the intervention period, subjects performed high intensity exercise according to their sports club training regime. Blood and saliva sampling were obtained at days 1 and 14, and physical conditions were recorded in a diary. We investigated expression of maturation markers on DCs, muscle damage and stress markers and used student’s t test adjusted by Bonferoni’s method for multiple comparison between groups. These data were presented as mean ± SD. We also investigated cumulative days of symptoms regarding infections and fatigue and used Chi-square test for comparison between groups. These data were presented as cumulative number. Results CD86 as maturation marker on pDC was significantly increased in the LC-Plasma group at day 14 (Placebo: 296 ± 70 vs. LC-Plasma: 365 ± 115; Mean Fluorescent Intensity; p = 0.013). Cumulative days of URTI were significantly lower in the LC-Plasma group (Placebo: URTI positive 56, URTI negative 256 vs. LC-Plasma: URTI positive 39, URTI negative 299; days; p = 0.028) and symptoms like sneeze or running nose were significantly lower in the LC-Plasma group (Placebo: Symptom positive 52, Symptom negative 258, vs. LC-Plasma: Symptom positive 36, Symptom negative 301; days; p = 0.032). Moreover, the cumulative days of fatigue were significantly fewer in the LC-Plasma group (Placebo: Symptom positive 128, Symptom negative 182, vs. LC-Plasma: Symptom positive 110, Symptom negative 225; days; p = 0.032). Markers of muscle damage and stress markers were not significantly different between groups. Conclusion We consider that heat-killed LC-Plasma supplementation relieves morbidity and symptoms of URTI via activation of pDC and decreases fatigue accumulation during consecutive high intensity exercise in athletes. However, LC-Plasma ingestion did not affect markers of muscle damage and stress. Trial registration UMIN-CTR, UMIN000020372. Registered 28 December 2015.
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Affiliation(s)
- Yuta Komano
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan. .,Research Laboratories for Health Science & Food Technologies, Kirin Co., Ltd., Yokohama, Kanagawa, Japan.
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Yoshihiko Ishihara
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan.,Department of humanities and Social Sciences, School of Science and Technology for Future Life, Tokyo Denki University, Adachi-ku, Tokyo, Japan
| | - Toshio Fujii
- Research Laboratories for Health Science & Food Technologies, Kirin Co., Ltd., Yokohama, Kanagawa, Japan
| | - Takeshi Kokubo
- Research Laboratories for Health Science & Food Technologies, Kirin Co., Ltd., Yokohama, Kanagawa, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Frickmann H, Hagen RM, Geiselbrechtinger F, Hoysal N. Infectious diseases during the European Union training mission Mali (EUTM MLI) - a four-year experience. Mil Med Res 2018; 5:19. [PMID: 29848381 PMCID: PMC5977544 DOI: 10.1186/s40779-018-0166-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The European Union Training Mission Mali (EUTM MLI) is a multinational military training deployment to the Western African tropical nation of Mali. Based on routinely collected disease and non-battle injury surveillance data, this study quantifies the true impact of infectious diseases for this tropical mission and potential seasonal variations in infectious disease threats. METHODS Categorized health events during the EUTM MLI mission and associated lost working days were reported using the EpiNATO-2 report. Infection-related health events were descriptively analyzed for a 4-year period from the 12th week in 2013 to the 13th week in 2017. Aggregated EpiNATO-2 data collected from all missions other than EUTM MLI were used as a comparator. RESULTS Among the infectious diseases reported by EUTM MLI, non-severe upper respiratory infections and gastrointestinal diseases dominated quantitatively, accounting for 1.65 and 1.42 consultations per 100 person-weeks, respectively. The number of recorded infectious disease-associated lost working days during the whole study interval was 723. Seasonal changes in disease frequency were detectable. More gastrointestinal infections were seen in the rainy season, and more respiratory infections occurred in the dry season; these were associated with peaks of more than 2.5 consultations per 100 person-weeks for both categories. CONCLUSIONS Despite initial concerns focused on tropical infectious diseases during this mission in tropical Mali, upper respiratory tract and gastrointestinal infections predominate. The relatively low number of reported lost working days may indicate that these infections are at the milder end of the spectrum of infectious diseases despite a likely reporting bias.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. .,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany.
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Neuherbergstraße 11, 80937, Munich, Germany
| | - Florian Geiselbrechtinger
- NATO Center of Excellence for Military Medicine (MilMedCOE), Deployment Health Surveillance Capability (DHSC), Dachauer Str. 128, 80637, Munich, Germany.,Institute of Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchionini-Str. 15, 81377, Munich, Germany
| | - Nagpal Hoysal
- NATO Center of Excellence for Military Medicine (MilMedCOE), Deployment Health Surveillance Capability (DHSC), Dachauer Str. 128, 80637, Munich, Germany
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Piltcher OB, Kosugi EM, Sakano E, Mion O, Testa JRG, Romano FR, Santos MCJ, Di Francesco RC, Mitre EI, Bezerra TFP, Roithmann R, Padua FG, Valera FCP, Lubianca Neto JF, Sá LCB, Pignatari SSN, Avelino MAG, Caixeta JADS, Anselmo-Lima WT, Tamashiro E. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel. Braz J Otorhinolaryngol 2018; 84:265-279. [PMID: 29588108 PMCID: PMC9449220 DOI: 10.1016/j.bjorl.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. OBJECTIVES To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. METHODS A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. RESULTS Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. CONCLUSIONS Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.
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Affiliation(s)
- Otávio Bejzman Piltcher
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Eduardo Macoto Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Oftalmologia, Campinas, SP, Brazil
| | - Olavo Mion
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil
| | - José Ricardo Gurgel Testa
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Otorrinolaringologia, São Paulo, SP, Brazil; Hospital Infantil Sabará, Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco Cesar Jorge Santos
- Hospital Paranaense de Otorrinolaringologia (IPO), Instituto Paranaense de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Renata Cantisani Di Francesco
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Edson Ibrahim Mitre
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Thiago Freire Pinto Bezerra
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Divisão de Otorrinolaringologia, Recife, PE, Brazil
| | - Renato Roithmann
- Universidade Luterana do Brasil, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Francini Greco Padua
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil; Hospital Albert Einstein, São Paulo, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Leonardo Conrado Barbosa Sá
- Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Ciências Médicas, Disciplina de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Shirley Shizue Nagata Pignatari
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Melissa Ameloti Gomes Avelino
- Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil; Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | | | - Wilma Terezinha Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
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Kukwa W, Guilleminault C, Tomaszewska M, Kukwa A, Krzeski A, Migacz E. Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. Int J Pediatr Otorhinolaryngol 2018; 107:37-41. [PMID: 29501308 DOI: 10.1016/j.ijporl.2018.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep. METHODS A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015. RESULTS 4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p < 0.0001 for each parameter). CONCLUSIONS Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.
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Gestro M, Condemi V, Bardi L, Fantino C, Solimene U. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. Int J Biometeorol 2017; 61:1749-1764. [PMID: 28466414 DOI: 10.1007/s00484-017-1356-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
AbstractOtitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0-18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose-response models (DLNM-final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0-3, CI 1.11-1.88 (lag time 0-1 days) and RR 1.43, CI 1.05-1.94 (lag time 0-3 days). The hourly model confirms a specific dose-response effect for T with RR 1.20, CI 1.04-1.38 (lag time range from 0 to 11 to 0-15 h) and for NO2 with RR 1.03, CI 1.01-1.05 (lag time range from 0 to 8 to 0-15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.
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Affiliation(s)
- Massimo Gestro
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
| | - Vincenzo Condemi
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy.
| | - Luisella Bardi
- Cuneo Department, Environmental Protection Agency of Piedmont, Turin, Italy
| | - Claudio Fantino
- S. Croce and Carle Hospital of Cuneo, SOC ORL Unit, Cuneo, Italy
| | - Umberto Solimene
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
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Ocan M, Aono M, Bukirwa C, Luyinda E, Ochwo C, Nsambu E, Namugonza S, Makoba J, Kandaruku E, Muyende H, Nakawunde A. Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years) in Kampala city, Uganda. BMC Public Health 2017; 17:732. [PMID: 28934933 PMCID: PMC5609015 DOI: 10.1186/s12889-017-4770-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city. METHODS This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection. RESULTS The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68). CONCLUSION Children are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Mary Aono
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Clare Bukirwa
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Emmanuel Luyinda
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Cathy Ochwo
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Elastus Nsambu
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Stella Namugonza
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joseph Makoba
- Department of Pharmacy, College of Health Sciences, Makerere University, P. O. Box, 7072, Kampala, Uganda
| | - Enock Kandaruku
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Hannington Muyende
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Aida Nakawunde
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Glenn H, Friedman J, Borecki AA, Bradshaw C, Grandjean-Thomsen N, Pickup H, Yin MY, Jun C, Abdel-Latif ME. Patient Demographic and Clinician Factors in Antibiotic Prescribing for Upper Respiratory Tract Infections in the Australian Capital Territory from 2006-2015. J Clin Diagn Res 2017; 11:FC01-FC05. [PMID: 28969150 DOI: 10.7860/jcdr/2017/25539.10395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/26/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION National antibiotic stewardship programs aim to mitigate rising antimicrobial resistance and associated healthcare costs by promoting safe and appropriate antibiotic prescribing. AIM This study aimed to analyse patient and clinician demographic factors that may influence antibiotic prescribing for Upper Respiratory Tract Infections (URTIs). Trends in antibiotic prescribing patterns were also analysed over the study period. MATERIALS AND METHODS This retrospective cross-sectional study analysed data from the Australian National University Medical School Clinical Audit Project database, comprising data collected by students during patient encounters over a two week period each April-May between 2006 and 2015 (excluding 2013). Data was collected via standardised survey in multiple healthcare settings and locations in the Australian Capital Territory (ACT) and Southeast New South Wales. (NSW) URTI diagnosis and symptomatology were defined using the International Classification of Disease (ICD-10) and International Classification of Primary Care, version 2 PLUS (ICPC-2+) criteria. RESULTS URTI accounted for 5.6% (n=698) of total patient encounters (n=12,468), and of these, 42.7% (n=289) were prescribed an antibiotic intervention. Antibiotics were significantly more likely to be prescribed in the hospital setting (44.2%; n=237) compared to community GP (32.1%; n=52; p<0.05) and for patients presenting with localised symptoms (65.9%; n=109) compared to generalised symptoms (33.7%; n=122; p<0.01). No significant association was observed for age, rurality, patient gender, clinical gender or Indigenous status. The most frequently prescribed antibiotic was penicillin (67.8%; n=196). Over the decade of study, antibiotic prescribing for URTIs showed decreasing trend both overall (R2=0.204) and with respect to all demographic factors assessed. CONCLUSION This study supports the effectiveness to-date of antibiotic stewardship programs in Australia. While continued efforts are required to further mitigate antibiotic resistance, this study suggests target areas may include improving clinician resistance to patient demand for antibiotics and increasing confidence in prescribing for special populations such as Indigenous peoples and the extremes of age.
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Affiliation(s)
- Hannah Glenn
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Justin Friedman
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Alexander A Borecki
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Camilla Bradshaw
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Nicolas Grandjean-Thomsen
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Harrison Pickup
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Michelle Yue Yin
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Catherine Jun
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, ACT, Australia
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Alrafiaah AS, Alqarny MH, Alkubedan HY, AlQueflie S, Omair A. Are the Saudi parents aware of antibiotic role in upper respiratory tract infections in children? J Infect Public Health 2017; 10:579-585. [PMID: 28283368 DOI: 10.1016/j.jiph.2017.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022] Open
Abstract
Upper respiratory tract infection (URTI) is considered to be the most common reason for children's visits to emergency departments or outpatient clinics. The misuse and overuse of antibiotics are currently major public health problems worldwide. This study aimed to assess Saudi parents' knowledge, attitude, and practice (KAP) regarding the use of antibiotics in URTIs in children. This cross-sectional study was conducted in Saudi Arabia using a previously validated questionnaire, which was distributed using Twitter. A total of 385 individuals completed the questionnaire. For the majority of the participants (77%), physicians were the primary source of information regarding the use of antibiotics. Forty-four percent of parents agreed that most URTIs are caused by viruses, and 81% were aware that inappropriate use of antibiotics leads to the development of antibiotic resistance. Fever was the primary symptom (27%) that led parents to ask for prescriptions for antibiotics. Although women had a higher attitude score (p=0.01), there was no difference between genders regarding knowledge and practice. Older participants (41 years or more) had a lower attitude score (p=0.02). Furthermore, participants with five children or more had lower attitude and practice scores (p=0.006, 0.04, respectively). Participants who lived in large cities had greater knowledge compared to the inhabitants of small cities (p=0.01). In conclusion, the findings of this study demonstrated that most of the participants were educated but lacked knowledge regarding antibiotic use in URTIs in children. This lack of knowledge led to inappropriate attitude and practice. Thus, launching public educational campaigns and encouraging physicians to educate parents regarding the proper use of antibiotics are recommended.
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Affiliation(s)
- Abdulaziz S Alrafiaah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Meaad H Alqarny
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Haneen Y Alkubedan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sulaiman AlQueflie
- Department of Pediatric, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Aamir Omair
- Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Walker RE, Bartley J, Flint D, Thompson JMD, Mitchell EA. Determinants of chronic otitis media with effusion in preschool children: a case-control study. BMC Pediatr 2017; 17:4. [PMID: 28056905 PMCID: PMC5217332 DOI: 10.1186/s12887-016-0767-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/21/2016] [Indexed: 02/17/2023] Open
Abstract
Background Chronic otitis media with effusion (COME) is a prevalent upper airway infection resulting in hearing loss. The aim of this research was to determine risk factors for COME in preschool children. Methods A case–control design was conducted in Auckland, New Zealand from May 2011 until November 2013. The cases were children aged 3 and 4 years referred for tympanostomy tube placement due to a diagnosis of COME (n = 178). The controls were a random sample of healthy children aged 3 and 4 years from primary care practices (n = 209). The children’s guardians completed an interviewer-administered questionnaire that covered topics including socio-demographic information, pregnancy and birth, infant feeding practices, home environment, and respiratory health. In addition, skin prick tests for atopy were performed. Odds ratios (OR) estimating the risk of COME independently associated with the exposures were calculated using a logistic regression model. Results Children with COME frequently had nasal obstruction (OR: 4.38 [95% CI: 2.37–8.28]), always snored (OR: 3.64 [95% CI: 1.51–9.15]) or often snored (OR: 2.45 [95% CI: 1.04–5.96]), spent more hours per week in daycare (OR per hour/week: 1.03 [95% CI: 1.00–1.05]), had frequent colds (OR: 2.67 [95% CI: 1.59–4.53]), had siblings who had undergone tympanostomy tube placement (OR: 2.68 [95% CI: 1.22–6.02]), underwent long labour (OR: 2.59 [95% CI: 1.03–6.79]), and had early introduction of cow’s milk (OR: 1.76 [95% CI: 1.05–2.97]). Asian ethnicity (OR: 0.20 [95% CI: 0.07–0.53]) and having older siblings (OR: 0.54 [95% CI: 0.31–0.93]) were inversely associated with COME. Conclusion COME in preschool children was associated with pathogen exposure, respiratory infection, and nasal obstruction. Strategies to prevent pathogen transmission warrant investigation. The novel findings of long labour and early cow’s milk introduction require replication in future studies.
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Affiliation(s)
- Rebecca E Walker
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Jim Bartley
- Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Manukau SuperClinic™, PO Box 98743, Manukau City, Auckland, 2241, New Zealand
| | - David Flint
- Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Manukau SuperClinic™, PO Box 98743, Manukau City, Auckland, 2241, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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Gergova RT, Petrova G, Gergov S, Minchev P, Mitov I, Strateva T. Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014. Balkan Med J 2016; 33:675-680. [PMID: 27994923 DOI: 10.5152/balkanmedj.2016.150116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 01/07/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Across the globe, upper respiratory tract infections (URTIs) are the most prevalent cause of morbidity in childhood. AIMS The aim of our study is to analyze the incidence and etiology of bacterial URTIs in Bulgarian children, as well as the increasing antimicrobial resistance to the most common etiologic agents over a period of 17 years. STUDY DESIGN Retrospective study. METHODS The study material comprised the data from 4768 patients (aged 1-16 years) with URTI during the period from 1998-2014. Specific microbiology agent detection was performed by culture examination. Susceptibilities to the investigated pathogens were determined by the disk diffusion method and minimal inhibitory concentration according to the criteria of the Clinical and Laboratory Standards Institute (CLSI). Polymerase chain reaction was used to detect the presence of β-lactam resistance genes. RESULTS We identified the following as the most common URTI bacterial pathogens: Streptococcus pneumoniae (40.94%), Streptococcus pyogenes (34.16%), Haemophilus influenzae (44.23%), Moraxella catarrhalis (39.19%) and Staphylococcus aureus (23.88%). In more than 70% of cases, a polymicrobial etiology was found. The most commonly affected individuals were pre-school-aged children, which accounted for more than 36% of all patients. During the study period, a dramatic increase in resistance to antibiotic agents was observed. The most frequent types of resistance were the enzymatic inactivation of penicillins and cephalosporins (close to 100% in staphylococci and moraxellae) and inducible macrolide-lincozamide resistance (about 20% of Gram-positive cocci). CONCLUSION Due to mandatory immunization against pneumococci and H. influenzae in Bulgaria and the vast expanding resistance to the most popular antimicrobial agents changes in the etiology of URTI have recently been noted. Regular analysis of this etiological dynamic and the antimicrobial resistance of respiratory pathogens is important for choosing the correct therapy and successful treatment.
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Affiliation(s)
- Raina Tzvetanova Gergova
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
| | - Guergana Petrova
- Pediatric Cilinic, UMHAT "Alexandrovska" Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Gergov
- Department of Otolaryngology, National Medical Center of Oncology, Sofia, Bulgaria
| | - Petko Minchev
- Pediatric Pulmonogy Clinic, USHATLD "Sveta Sofia", Sofia, Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
| | - Tanya Strateva
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
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Jong MC, Buskin SL, Ilyenko L, Kholodova I, Burkart J, Weber S, Keller T, Klement P. Effectiveness, safety and tolerability of a complex homeopathic medicinal product in the prevention of recurrent acute upper respiratory tract infections in children: a multicenter, open, comparative, randomized, controlled clinical trial. Multidiscip Respir Med 2016; 11:19. [PMID: 27186371 PMCID: PMC4868034 DOI: 10.1186/s40248-016-0056-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/23/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The present study was initiated to investigate the effectiveness, safety and tolerability of complex homeopathic CalSuli-4-02 tablets on prevention of recurrent acute upper respiratory tract infections (URTIs) in children, in comparison to another complex homeopathic product. METHODS The study was designed as a prospective, multicenter, randomized, open, clinical trial with two parallel treatment groups at four outpatient pediatric clinics in Russia. Children aged ≤ 6 years with susceptibility to acute URTIs (≥ three occasions during the last 6 months) were randomized to receive either CalSuli-4-02 or a comparator homeopathic product (control group) for 3 weeks. Primary outcome was the frequency of acute URTIs after 3 and 6 months post-treatment follow-up. Secondary endpoints were changes in complaints and symptoms (total and individual scores), treatment satisfaction, antibiotic use, safety and tolerability. RESULTS The intention-to-treat analysis involved 200 children (CalSuli-4-02: N = 99, CONTROL: N = 101). In both treatment groups, the median number of acute URTIs was one for 3 months and two, respectively, for the full 6 months post-treatment (Relative Risk: 0.86 (95 %-CI: 0.72-1.03), p = 0.1099). Seasons had no influence on the outcome. At the end of study, CalSuli-4-02 had overall higher odds of getting lower complaints severity total score (Odds ratio: 1.99 (95 %-CI: 1.31-3.02), p = 0.0012) and showing symptom improvement (Odds ratio: 1.93 (95 %-CI: 1.25-3.00), p = 0.0033). Specifically, the complaint "appetite disorder" and the symptom "child's activities" significantly improved more in the CalSuli-4-02 group (p = 0.0135 and p = 0.0063, respectively). Antibiotic use was decreased in both treatment groups at the study end. Overall assessment for satisfaction with and tolerability of treatment was higher with CalSuli-4-02. A low number of non-serious adverse drug reactions was reported (CalSuli-4-02: N = 4, CONTROL: N = 1). CONCLUSIONS Both complex homeopathic products led to a comparable reduction of URTIs. In the CalSuli-4-02 group, significantly less URTI-related complaints and symptoms and higher treatment satisfaction and tolerability were detected. The observation that the use of antibiotics was reduced upon treatment with the complex homeopathic medications, without the occurrence of complications, is interesting and warrants further investigations on the potential of CalSuli-4-02 as an antibiotic sparing option. CLINICAL TRIAL REGISTRATION NUMBER Roszdravnadzor: Study No 164-563.
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Affiliation(s)
- Miek C Jong
- Department Nutrition & Health, Louis Bolk Institute, Hoofdstraat 24, 3972 LA Driebergen, The Netherlands ; Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden ; National Information and Knowledge Center on Integrative Medicine (NIKIM), Amsterdam, The Netherlands
| | - Stephen L Buskin
- International Health Center of the Hague, The Hague, The Netherlands
| | | | | | - Julia Burkart
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
| | | | | | - Petra Klement
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
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50
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Nocerino R, Paparo L, Terrin G, Pezzella V, Amoroso A, Cosenza L, Cecere G, De Marco G, Micillo M, Albano F, Nugnes R, Ferri P, Ciccarelli G, Giaccio G, Spadaro R, Maddalena Y, Berni Canani F, Berni Canani R. Cow's milk and rice fermented with Lactobacillus paracasei CBA L74 prevent infectious diseases in children: A randomized controlled trial. Clin Nutr 2015; 36:118-125. [PMID: 26732025 DOI: 10.1016/j.clnu.2015.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/24/2015] [Accepted: 12/10/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIM Fermented foods have been proposed for the prevention of infectious diseases. We evaluated the efficacy of fermented foods in reducing common infectious diseases (CIDs) in children attending daycare. METHODS Prospective randomized, double-blind, placebo-controlled trial (registered under Clinical Trials.gov identifier NCT01909128) on healthy children (aged 12-48 months) consuming daily cow's milk (group A) or rice (group B) fermented with Lactobacillus paracasei CBA L74, or placebo (group C) for three months during the winter season. The main study outcome was the proportion of children who experienced at least one CID. All CIDs were diagnosed by family pediatricians. Fecal concentrations of innate (α- and β-defensins and cathelicidin LL-37) and acquired immunity biomarkers (secretory IgA) were also evaluated. RESULTS 377 children (193 males, 51%) with a mean (SD) age of 32 (10) months completed the study: 137 in group A, 118 in group B and 122 in group C. Intention-to-treat analysis showed that the proportion of children who experienced at least one CID was lower in group A (51.8%) and B (65.9%) compared to group C (80.3%). Per-protocol analysis showed that the proportion of children presenting upper respiratory tract infections was lower in group A (48.2%) and group B (58.5%) compared with group C (70.5%). The proportion of children presenting acute gastroenteritis was also lower in group A (13.1%) and group B (19.5%) compared with group C (31.1%). A net increase of all fecal biomarkers of innate and acquired immunity was observed for groups A and B compared to group C. Moreover, there was a negative association between fecal biomarkers and the occurrence of CID. CONCLUSION Dietary supplementation with cow's milk or rice fermented with L. paracasei CBA L74 prevents CIDs in children attending daycare possibly by means of a stimulation of innate and acquired immunity.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Gianluca Terrin
- Department of Gynecology-Obstetrics and Perinatal Medicine, University of Rome "La Sapienza", Rome, Italy
| | - Vincenza Pezzella
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Antonio Amoroso
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Linda Cosenza
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Gaetano Cecere
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giulio De Marco
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Maria Micillo
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Fabio Albano
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Nugnes
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Pasqualina Ferri
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Ciccarelli
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giuliana Giaccio
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Raffaella Spadaro
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Ylenia Maddalena
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | | | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy; European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples "Federico II", Naples, Italy; CEINGE - Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy.
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