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Patient-centered communication promotes positive patient outcomes. This study examines the linguistic markers of two key dimensions of patient-centered communication (i.e., provider compassionate care and shared decision-making) and their mediating effects on patient perceived quality of and affective responses to the provider's treatment recommendations. Transcripts (N = 343) of provider talk from provider-patient interactions in medical visits for upper respiratory infection symptoms where patients were not prescribed with antibiotics were analyzed with the Linguistic Inquiry and Word Count (LIWC) dictionary. Results showed that providers' use of affiliation words positively predicted patients' perceptions of their providers' compassionate care. Providers' use of insight words negatively predicted patients' perceptions of provider shared decision-making. Meanwhile, providers' use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making. Patient perceived compassionate care and shared decision-making further increased patients' positive affect toward and perceived quality of non-antibiotic treatment recommendations. These perceptions also reduced their negative affect toward the recommendations. Implications of the findings are discussed with regard to patient-centered communication in relation to the promotion of antibiotic stewardship. [ABSTRACT FROM AUTHOR]

The aim of the research was to study the etiological structure of associated infectious rhinotracheitis in cats. It has been established that infectious rhinotracheitis is registered among cats in association with infectious diseases of bacterial aetiology. Materials and methods. The research was conducted based on a private veterinary clinic in the city of Kharkiv in 2021-2023. A total of 48 cats with signs of respiratory tract damage were examined in the clinic. Samples for laboratory diagnosis were obtained by oropharyngeal swab and transnasal lavage. To confirm the laboratory diagnosis of infectious rhinotracheitis in cats, we used the PCR method (using the Rynovir test system), as well as rapid IXA tests (FHV Ag) manufactured by ASAN PHARM (China) or ZRbio (China). To detect specific antibodies, the method of serological (retrospective) ELISA diagnostics was used using the immunoComb Feline VacciCheck device-free ELISA test system manufactured by Biogal, Israel. Bacteriological studies were carried out according to wellknown methods using special nutrient media for the selection and identification of associated bacterial microflora. The sensitivity of selected dominant cultures of bacteria to antibiotics was determined by diffusion in agar using discs containing antibiotics. Results. It was investigated that Bordetella bronchiseptica was determined as the dominant pathogen in the bacterial association - 52.0 %. Isolated cultures of Bordetella bronchiseptica were sensitive to cefamycin. The proposed science-based scheme for the treatment of infectious rhinotracheitis in association with feline bordetelliosis ensures high therapeutic efficiency. Conclusions. For the treatment of infectious respiratory diseases in cats, it is necessary to carry out individual complex etiotropic, pathogenetic and symptomatic therapy. Homoeopathic therapy relieves the symptoms of the disease, promotes faster recovery, and is an addition to the main methods of treatment. The main specific measure of disease prevention is timely vaccination (inoculation), the effectiveness of which, according to our research, ranges from 71 % to 100 %. [ABSTRACT FROM AUTHOR]

Purpose: To investigate antimicrobial use and primary and nosocomial infections in hospitalized COVID-19 patients to provide data for guidance of antimicrobial therapy. Methods: Prospective observational cohort study conducted at Charité–Universitätsmedizin Berlin, including patients hospitalized with SARS-CoV-2-infection between March and November 2020. Results: 309 patients were included, 231 directly admitted and 78 transferred from other centres. Antimicrobial therapy was initiated in 62/231 (26.8%) of directly admitted and in 44/78 (56.4%) of transferred patients. The rate of microbiologically confirmed primary co-infections was 4.8% (11/231). Although elevated in most COVID-19 patients, C-reactive protein and procalcitonin levels were higher in patients with primary co-infections than in those without (median CRP 110 mg/l, IQR 51–222 vs. 36, IQR 11–101, respectively; p < 0.0001). Nosocomial bloodstream and respiratory infections occurred in 47/309 (15.2%) and 91/309 (29.4%) of patients, respectively, and were associated with need for invasive mechanical ventilation (OR 45.6 95%CI 13.7–151.8 and 104.6 95%CI 41.5–263.5, respectively), extracorporeal membrane oxygenation (OR 14.3 95%CI 6.5–31.5 and 16.5 95%CI 6.5–41.6, respectively), and haemodialysis (OR 31.4 95%CI 13.9–71.2 and OR 22.3 95%CI 11.2–44.2, respectively). The event of any nosocomial infection was significantly associated with in-hospital death (33/99 (33.3%) with nosocomial infection vs. 23/210 (10.9%) without, OR 4.1 95%CI 2.2–7.3). Conclusions: Primary co-infections are rare, yet antimicrobial use was frequent, mostly based on clinical worsening and elevated inflammation markers without clear evidence for co-infection. More reliable diagnostic prospects may help to reduce overtreatment. Rates of nosocomial infections are substantial in severely ill patients on organ support and associated with worse patient outcome. [ABSTRACT FROM AUTHOR]

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Observational studies and randomized controlled studies propose that vitamin D plays a significant role in preventing acute respiratory tract infection (RTI); however, results are inconsistent and the optimal serum 25-hydroxyvitamin D (25-OH-D3) concentration remains unknown. This study explores the risk factors associated with acute RTI in patients with chronic kidney disease (CKD) and analyzes its correlation with serum 25-OH-D3 levels, to provide appropriate preventive treatment measures for CKD patients complicated with acute RTI. Seventy cases of CKD patients treated in the department of nephrology of Jiangxi Provincial People's Hospital are recruited as the research objects and divided into a control group (CKD without RTI) and an observation group (CKD with RTI), with 35 cases in each group. The laboratory indexes and serum 25-OH-D3 levels are compared between the two groups. The area under the receiver operating characteristic curve (ROC) of 25-OH-D3 in the diagnosis of CKD patients complicated with RTI is 0.892, and the standard error is 0.038. The glomerular filtration rates (GFR) are 48.32 ± 9.87 mL / min and 50.18 ± 20.71 mL / min in the control group and the experimental group, respectively, with no statistical significance between the two groups (P > 0.05). The serum 25-OH-D3 content in the control group (35.08 ± 6.2 nmol / L) is dramatically higher than that in the observation group (20.71 ± 5.87 nmol / L) (P < 0.05). The proportion of patients with diabetes mellitus (DM) in the control group and observation group is 25.71% and 68.57%, respectively, with a considerable difference (P < 0.05). In the control group and the experimental group, the proportion of patients with oral vitamin D receptor agonists is 54.29% and 11.43%, respectively, and the difference is significant (P < 0.05). Results show that the serum 25-OH-D3 level is highly correlated with the occurrence of RTI in CKD patients. In addition, it is related to patients' age, DM, and vitamin D receptor agonists. [ABSTRACT FROM AUTHOR]

Some nutraceuticals have been studied as supportive treatment for fighting upper respiratory tract infection and middle ear disease. Our study aims at evaluating the effect of a specific oral supplementation in the treatment of pediatric otits media. The subjects were randomly assigned by the physician (single-blinded study) to one of three groups: Control Group (CG), Treatment Group 1 (TG1), or Treatment Group 2 (TG2). Both TG were treated with Flogostop Duo (for 20 days—TG1 or 30 days—TG2) in combination with the standard treatment, while CG underwent standard treatment only. The standard treatment was nasal aerosol with Fluticasone and Mucolytic, and nasal washing with hypertonic solution. All patients were analyzed by otoscopy, impedance, fibroscopy, and pure auditory test at the baseline (T0), after 20 days (T1) and 35 days (T2). 120 children were included in the study, 40 in the CG, 40 in the TG1, and 40 in the TG2. Both TG1 and TG2 presented statistically significant differences with respect to controls in otoscopy, impedance, fibroscopy, and PTA at T2. The otoscopy improved at T2 with statistically significant value only in TG2. The impedance and fibroscopy improved at T1 both in TG1 and TG2 compared to CG. A statistically significant improvement was observed in TG2 at T2 in comparison to both CG and TG1. Statistically significant differences were observed in PTA at T2 only compared with controls. This study confirmed the efficacy of nutraceutical as supporting therapy in the upper respiratory tract infection in children. In particular, the supplement containing Boswellia serrata and Bromelain, which are molecules with strong anti-inflammatory and pain-control capacities, could add the benefit without the adverse effects which are related to NSAID use. [ABSTRACT FROM AUTHOR]

Background. Chest compresses with mustard (MU) or ginger (GI) are a complementary treatment option for respiratory tract infections. However, little is known about their specific thermogenic qualities. This study examines the short-term effects of MU, GI, and chest compresses with warm water only (WA) on measurable and self-perceived body warmth in healthy adults. Methods. This was a single-center, randomized controlled trial with cross-over design (WA versus MU versus GI). 18 participants (23.7 ± 3.4 years; 66.7% female) received MU, GI, and WA in a random order on three different days with a mean washout period of 13.9 days. Chest compresses were applied to the thoracic back for a maximum of 20 minutes. The primary outcome measure was skin temperature of the posterior trunk (measured by infrared thermography) immediately following removal of the compresses (t1). Secondary outcome measures included skin temperature of the posterior trunk 10 minutes later (t2) and several parameters of self-perceived warmth at t1 and t2 (assessed with the Herdecke Warmth Perception Questionnaire). Results. Skin temperature of the posterior trunk was significantly higher with MU compared to WA and GI at t1 (p < 0.001 for both, primary outcome measure) and t2 (WA versus MU: p = 0.04 , MU versus GI: p < 0.01). Self-perceived warmth of the posterior trunk was higher with MU and GI compared to WA at t1 (1.40 ≥ d ≥ 1.79) and remained higher with GI at t2 (WA versus GI: d = 0.74). The overall warmth perception increased significantly with GI (d = 0.69), tended to increase with MU (d = 0.54), and did not change with WA (d = 0.36) between t0 and t1. Conclusions. Different effects on warmth regulation were observed when ginger and mustard were applied as chest compresses. Both substances induced self-perceived warming of the posterior trunk, but measurable skin temperature increased only with MU. Further research is needed to examine the duration of these thermogenic effects and how chest compresses with ginger or mustard might be incorporated into practice to influence clinical outcomes in respiratory tract infections. [ABSTRACT FROM AUTHOR]

This review is aimed at assessing and compiling the different ethnomedicinal studies in different parts of Ethiopia used to treat respiratory diseases. The data were collected from different published research papers through searching the web sources such as PubMed, Science Direct, Google Scholar, and other related websites. The important search terminologies included ethnobotany, respiratory diseases, medicinal plants, and Ethiopia. For this, a total of 65 articles of recent publications (from 2000 to May 2021 years) that provided full information about the use of medicinal plant species to treat respiratory disorder diseases in Ethiopia were consulted. Based on this, a total of 96 medicinal plants belonging to 57 families were reviewed. The commonly recorded families used to manage respiratory problems were Asteraceae, Lamiaceae, Solanaceae, and Fabaceae. Herbs and shrubs were the dominant plant growth forms. Due to the easiest form of their preparation for treating respiratory disorders, leaves are the most cited plant parts followed by roots. Crushing and pounding are useful methods of remedy preparation to treat respiratory diseases. This review concluded that different medicinal plants have a significant contribution in combating serious respiratory problems in Ethiopia. Hence, the complied review of medicinal plants on the treatment of respiratory problems would play a great role in further pharmacological and phytochemical investigations in developing new drugs used for the treatment of respiratory problems and in the conservation of these important medicinal plants. [ABSTRACT FROM AUTHOR]

Respiratory tract infections are considered the major cause of pediatric hospitalization requiring direct supervision by a clinician. The use of antibiotics that are commonly used for treatment is sometimes associated with the development of antibiotic resistance and less than desirable treatment outcome. Despite limited clinical evidence, complementary and alternative medicine is widely used as an alternative to antibiotics worldwide for treatment of respiratory tract infections in children. Therefore, we decided to explore the parental attitude and awareness regarding the use of the complementary and alternative medicine for the management or prevention of respiratory tract infections in children in Aseer region, Saudi Arabia. Over a 4-month period during influenza season, 1,192 parents were administered two sets of seven questionnaires dealing with attitude and awareness about the complementary and alternative medicine use. The results show that parents who felt that respiratory tract infections in children do need antibiotics supported the use of the complementary and alternative medicine modalities. More than half of the participants agreed that the complementary and alternative medicine would produce fewer side effects on their children's immunity than antibiotics and produce less bacterial resistance. In conclusion, the complementary and alternative medicine use for the treatment of respiratory tract infections in children should be based only on reliable and evidence-based advice. [ABSTRACT FROM AUTHOR]

Kwashiorkor is a serious nutritional disease. The 7-month-old male patient presented with severe metabolic acidosis and elevated liver enzymes. His condition was similar to fatty acid oxidation defect. He was taken to the hospital on the previous day with complaints of poor sucking and difficulty breathing. Treatment of upper respiratory tract infection was provided and then he returned to his home. He was cyanotic in bed after 12 hours. The patient, who was taken to the hospital unconscious and not fed for 12 hours, was not given any food orally in the first health center. Until laboratory tests are done, only iv electrolyte and a fluid containing dextrose were given. When the laboratory results were found to be significantly pathological, he was urgently referred to our hospital 4 hours after the admission. The content of the iv treatment applied at the time of referral was not clearly written. Low electrolytes, uric acid, liver enzymes, urea and creatinine elevation were detected at an outer center. Ketosis, lactic acidosis and dibasic aciduria were detected in urine organic acid analysis. He was diagnosed with Kwashiorkor and refeeding syndrome according to the clinical and laboratory findings. His complaints improved with appropriate treatment. [ABSTRACT FROM AUTHOR]

Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs. Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of probiotic supplementation on upper respiratory tract infection (URTI) and inflammatory markers in elite athletes. We searched the PubMed, EBSCOhost, Scopus, and Web of Science databases using the following terms: probiotic OR probiotics AND exercise OR sport OR athletes AND URTI OR respiratory infection OR URTIs OR inflammation OR inflammatory OR cytokines. We screened the titles and abstracts of 2498 articles using our inclusion criteria. A total of 14 articles were selected for further analysis. For each study, 2 independent reviewers extracted the study design, participant characteristics, inclusion and exclusion criteria, intervention characteristics, outcome measures, and main results. We did not observe an effect of probiotic supplementation on the number of days of illness or the mean number or duration of URTI episodes but did note an effect of probiotic supplementation on the total symptom severity score (−0.65; 95% CI = −1.05, −0.25; P =.02). Lower levels of interleukin 6 (−2.52 pg/mL; 95% CI = −4.39, −0.66 pg/mL; P =.002) and tumor necrosis factor α (−2.31 pg/mL; 95% CI = −4.12, −0.51 pg/mL; P =.01) were also reported after supplementation. This meta-analysis provides evidence that probiotic supplementation, especially among professional athletes, is an effective way to decrease the total URTI symptom severity score. In addition, probiotic supplementation may decrease interleukin 6 and tumor necrosis factor α levels. More studies involving larger groups are needed to better assess this effect. The optimal timing, duration, composition, and dose of such supplementation need to be determined. [ABSTRACT FROM AUTHOR]

Background: Recurrent respiratory papillomatosis is a potentially life-threatening condition characterised by the growth of exophytic lesions within the larynx and trachea. The principal aim of management is maintenance of an adequate airway by surgical debulking. Several adjuvant therapies have been used to varying effect to reduce the burden of this disease and increase the interval between debulking procedures. The most severe cases present in children aged under three years, who are therefore most likely to need adjuvant therapies. The current evidence base on adjuvant treatments relating to children who present aged under three years has been reviewed. Methods: A literature review of articles in Cochrane, PubMed and Embase databases was carried out. Given the rarity of the condition in this age group, all the literature relates to case reports and case series. Results and conclusion: The following adjuvant therapies have been used in children who presented under three years of age: quadrivalent human papilloma virus vaccine, intralesional cidofovir, pegylated interferon, alpha-interferon, cimetidine and cetuximab. [ABSTRACT FROM AUTHOR]

Background. Respiratory tract infections (RTI s) constitute the most common reason for pediatric patients to report to primary care facilities. Additionally, RTI s are also a significant problem among hospitalized patients. Due to the lack of specificity in the observed symptoms, RTI s cause both diagnostic and therapeutic difficulties. Objectives. The aim of our study was to explain the causes of RTI s in the pediatric population and to provide guidelines to facilitate diagnosis. Material and methods. In the study, the authors analyzed available literature dealing with the possibility of laboratory diagnosis and the results of treatment used in children with RTI s. Results. In pediatric patients, RTI s are mainly caused by viruses and occur seasonally during the autumn-winter period. There are certain factors, such as physiological distinctness resulting from developmental immaturity of the body, genetically determined diseases and specific diseases occurring during childhood, which contribute to the incidence of RTI s. Moreover, factors depending on the mother and the growth environment also significantly affect the incidence of RTI s in children. Conclusions. Available knowledge concerning the seasonality of the occurrence of individual pathogens and the differences in symptoms may facilitate an initial diagnosis. However, lower respiratory tract infections, and severe infections in particular, require the use of specific diagnostic tests which allow for both the identification of the etiological factors and the implementation of targeted treatment. The COVID -19 pandemic has highlighted the difficulties in the diagnosis and therapy of RTI s in pediatric patients, as well as the need to develop more sensitive diagnostic tools and a more effective treatment. [ABSTRACT FROM AUTHOR]

Background: Essential oils are volatile and lipophilic liquid extracts made from plants as secondary metabolites that can be obtained by distillation. To date, several studies have investigated the direct antimicrobial activity of liquid essential oils. However, this study investigated the antimicrobial properties of the volatile substances present in various essential oils. Methods: A modified zone of inhibition protocol was developed using agar petri dishes with a center glass vial to allow evaporation and aerosolization of the potential active constituents from essential oils. In total, nineteen essential oils were tested against five Gram positive bacterial species, five Gram negative bacterial species and one fungi. Results: This study found potent antimicrobial activity from the volatile constituents of several essential oils. Rosemary, tea tree, and cassia volatiles were found to be the best broad-spectrum antibacterial agents, whereas clove volatiles had almost no antimicrobial activity. Conclusions: These results support the anecdotal historical evidence of the antimicrobial activity of the volatile constituents essential oils. Modern medical implications for this work may be related to the use of aromatic essential oils for respiratory or dermatological infections. [ABSTRACT FROM AUTHOR]

Introduction: Lower respiratory tract infections (LRTIs) are one of the leading cause of hospitalization and mortality in childhood worldwide. The aim of this study was to evaluate the characteristics of the patients hospitalized in the neonatal intensive care unit (NICU) with the diagnosis of viral LRTI, to reveal the viral agents and to investigate the risk factors. Materials and Methods: In this study; the characteristics and the respiratory tract viral panel results of the patients who were hospitalized in the NICU of a university hospital between January 2018 and March 2020 with the diagnosis of viral LRTI were examined retrospectively. The patients were divided into two groups as RSV (+) and non-RSV viral agents, and the groups were compared. Results: 24 patients were included in the study. RSV-A was detected in 6 (25%), RSV-B in 8 (33.3%), and non-RSV viral agents in 10 (41.6%) patients. There were no significant difference between the sociodemographic features of RSV (+) group and non-RSV group. However presence of infiltration on chest radiography (pneumonia) was more common, the rate of receiving respiratory or oxygen support was higher and hospitalization duration was longer in RSV (+) group compared to non-RSV group (p values 0.001, 0.001 and 0.017, respectively). There was a positively, moderate level correlation between hospitalization duration and C-reactive protein (r = 0.558, p=0.005). Conclusions: RSV was the most common agent in viral LRTI in NICU, it should be emphasized that the staff in the NICU should pay close attention to the hygiene rules and that the visitors should be taken into the NICU after they are educated on this issue. It is important to increase the access to viral tests and provide wider use in order to make early diagnosis and treatment in viral LRTI and to take the necessary measures for preventing spread of the disease. [ABSTRACT FROM AUTHOR]

Background: Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear.Aim: To develop symptom-based criteria to support parental medical help seeking for children with RTIs.Design and Setting: A research and development/University of California Los Angeles (RAND/UCLA) appropriateness study to obtain consensus on children's RTI symptoms appropriate for home, primary, or secondary health care in the UK.Method: A multidisciplinary panel of 12 healthcare professionals - six GPs, two pharmacists, two NHS 111 nurses, and two emergency paediatric consultants - rated the appropriateness of care setting for 1134 scenarios in children aged >12 months.Results: Panellists agreed that home care would be appropriate for children with ≤1 week of 'normal' infection symptoms (cough, sore throat, ear pain, and/or runny nose, with or without eating adequately and normal conscious level). The presence of ≥2 additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the emergency department was considered appropriate when ≥3 symptoms were present and included shortness of breath or wheezing.Conclusion: The authors have defined the RTI symptoms that parents might regard as 'normal' and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs. [ABSTRACT FROM AUTHOR]

Respiratory tract infections are one of the most common health problems among children during the winter season. Viruses are responsible for a vast majority of respiratory tract infections. Bacterial infections usually affect specific locations (for example, otitis media, nasal sinuses, lungs or, sometimes, throat) and are more frequent in risk groups, or they can complicate a previous viral infection. During the ongoing COVID-19 pandemic, it is essential to consider SARS-CoV-2 as a possible causative agent for any infectious disease affecting the respiratory tract. Recommendations aim to establish an optimal manner for management of respiratory infections. Any patient should be pre-screened by telephone consultation to reduce the risk to healthcare workers. Regardless of the infection's etiology and location, the top priority should be to determine the patient's general condition and the place of treatment and treatment method (hospital, home, symptomatic, antimicrobial). For epidemic reasons, it is advisable to exclude infection with the new coronavirus in the case of a doubtful clinical picture, as well as patients with SARS-CoV-2 infection. The primary purpose of any consultation is to choose the best treatment for the patient (ambulatory/hospital/symptomatic/antimicrobial), and it is not always crucial to know the exact etiology of the infection. Due to epidemiologic reasons, it is reasonable to exclude SARS-CoV-2 infection in every patient with atypical symptoms or after contact with a person infected with SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11 and is potentially preventable through vaccination. This study estimated the incidence of juvenile-onset RRP before the implementation of the national HPV vaccination program in Korea.Methods: We conducted a cohort study using claims data provided by a mandatory insurance program to estimate the incidence of RRP and associated healthcare use. Patients with juvenile RRP were defined as those aged ≤12 years with ≥2 admissions or ≥2 outpatient visits during which they received the International Classification of Diseases, 10th revision code for benign neoplasms of the larynx (D14.1).Results: During 2002-2014, 123 children (74 boys and 49 girls) were diagnosed with RRP. The patients had a mean of 6.5 person-years of follow-up. The incidence was estimated at 0.30/100,000 person-years. The median age at diagnosis was 4.0 years (mean, 4.3). Thirty-six (29.3%) patients underwent surgery, including 23 patients (18.7%) who underwent 2 or more surgical procedures. Severe disease, measured by more frequent surgical procedures and shorter time intervals between consecutive operations, was associated with a younger age at diagnosis.Conclusions: The estimated incidence of juvenile-onset RRP in Korea was similar to that reported in other countries. The RRP burden should continue to be monitored using National Health Insurance Service claims data. [ABSTRACT FROM AUTHOR]

We present here a novel system for contactless inhalation therapy of the upper respiratory tract based on the formation of therapeutic vortex ring aerosols. A mathematical model of the relationship between the extent of the zone of mixing of vortex ring aerosols with air and their initial speed was developed. An autonomous inhalation system allowing synchronization of drug administration into the respiratory tract with the patient's inhalation is described. The contactless inhalation system developed here provides a treatment procedure for small children and elderly people with maximum comfort and efficacy due to the absence of mechanical contact with the patient. [ABSTRACT FROM AUTHOR]

The emergence of highly pathogenic strains of influenza virus and coronavirus (CoV) has been responsible for large epidemic and pandemic outbreaks characterised by severe pulmonary illness associated with high morbidity and mortality. One major challenge for critical care is to stratify and minimise the risk of multi-organ failure during the stay in the intensive care unit (ICU). Epigenetic-sensitive mechanisms, including deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) methylation, histone modifications, and non-coding RNAs may lead to perturbations of the host immune-related transcriptional programmes by regulating chromatin structure and gene expression patterns. Viruses causing severe pulmonary illness can use epigenetic-regulated mechanisms during host-pathogen interaction to interfere with innate and adaptive immunity, adequacy of inflammatory response, and overall outcome of viral infections. For example, Middle East respiratory syndrome-CoV and H5N1 can affect host antigen presentation through DNA methylation and histone modifications. The same mechanisms would presumably occur in patients with coronavirus disease 2019, in which tocilizumab may epigenetically reduce microvascular damage. Targeting epigenetic pathways by immune modulators (e.g. tocilizumab) or repurposed drugs (e.g. statins) may provide novel therapeutic opportunities to control viral-host interaction during critical illness. In this review, we provide an update on epigenetic-sensitive mechanisms and repurposed drugs interfering with epigenetic pathways which may be clinically suitable for risk stratification and beneficial for treatment of patients affected by severe viral respiratory infections. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex virus type 1 (HSV-1) is frequently detected in the BAL fluid of patients on mechanical ventilation.Research Question: The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days.Study Design and Methods: This was a retrospective cohort study in four ICUs between January 2011 and December 2017. All adult patients on mechanical ventilation with a respiratory tract infection with positive polymerase chain reaction testing for HSV-1 in the BAL were included. Patients already receiving antiviral agents on the day BAL was performed were excluded. We performed uni- and multivariable Cox and logistic regression modeling.Results: Overall, 306 patients were included in the analysis. Among them, 177 patients (57.8%) received antiviral therapy (90.9% acyclovir, 6.2% ganciclovir, 2.9% both). The overall 30-day mortality rate was 42.4% (n = 75) in the antiviral treatment group and 50.4% (n = 65) in the control group. The adjusted hazard ratio (HR) for the primary outcome was 0.62 (95% CI, 0.44-0.87; P = .005), indicating better overall survival within 30 days for the antiviral-treated group than for the untreated group. This benefit was also present in the subgroup of patients without immunosuppression (n = 246; adjusted HR, 0.53; 95% CI, 0.36-0.78; P = .001). Overall, the median lengths of hospital stay (31 vs 24 days, P = .002) and ICU stay (24 vs 17 days, P < .001), and the duration of mechanical ventilation (18 vs 11 days, P < .001), were longer for patients with therapy. No evidence for the treatment-related deterioration of renal function was observed.Interpretation: These data suggest that detection of HSV-1 in the BAL of patients on mechanical ventilation may be of clinical significance and that specific antiviral treatment may improve clinical outcomes. However, this needs to be proven in multicenter randomized controlled trials before implementation into the clinical routine. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is among the most important causes of acute lower respiratory tract infection (ALRI) in young children. We assessed the severity of RSV-ALRI in children less than 5 years old with bronchopulmonary dysplasia (BPD).Methods: We searched for studies using EMBASE, Global Health, and MEDLINE. We assessed hospitalization risk, intensive care unit (ICU) admission, need for oxygen supplementation and mechanical ventilation, and in-hospital case fatality (hCFR) among children with BPD compared with those without (non-BPD). We compared the (1) length of hospital stay (LOS) and (2) duration of oxygen supplementation and mechanical ventilation between the groups.Results: Twenty-nine studies fulfilled our inclusion criteria. The case definition for BPD varied substantially in the included studies. Risks were higher among children with BPD compared with non-BPD: RSV hospitalization (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7-4.2; P < .001), ICU admission (OR, 2.9; 95% CI, 2.3-3.5; P < .001), need for oxygen supplementation (OR, 4.2; 95% CI, .5-33.7; P = .175) and mechanical ventilation (OR, 8.2; 95% CI, 7.6-8.9; P < .001), and hCFR (OR, 12.8; 95% CI, 9.4-17.3; P < .001). Median LOS (range) was 7.2 days (4-23) (BPD) compared with 2.5 days (1-30) (non-BPD). Median duration of oxygen supplementation (range) was 5.5 days (0-21) (BPD) compared with 2.0 days (0-26) (non-BPD). The duration of mechanical ventilation was more often longer (>6 days) in those with BPD compared with non-BPD (OR, 11.9; 95% CI, 1.4-100; P = .02).Conclusions: The risk of severe RSV disease is considerably higher among children with BPD. There is an urgent need to establish standardized BPD case definitions, review the RSV prophylaxis guidelines, and encourage more specific studies on RSV infection in BPD patients, including vaccine development and RSV-specific treatment. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is the most common viral pathogen associated with acute lower respiratory infections (ALRIs), with significant childhood morbidity and mortality worldwide. Estimates reporting RSV-associated ALRI (RSV-ALRI) severity in children with congenital heart disease (CHD) are lacking, thus warranting the need to summarize the available data. We identified relevant studies to summarize the findings and conducted a meta-analysis of available data on RSV-associated ALRI hospitalizations in children aged <5 years, comparing those with underlying CHD to those without CHD.Methods: We conducted a systematic search of existing relevant literature and identified studies reporting hospitalization of children aged <5 years with RSV-ALRI with underlying or no CHD. We summarized the data and conducted (where possible) a random-effects meta-analysis to compare the 2 groups.Results: We included 18 studies that met our strict eligibility criteria. The risk of severe RSV-ALRI (odds ratio, 2.2; 95% confidence interval [CI], 1.6-2.8), the rate of hospitalization (incidence rate ratio, 2.8; 95% CI, 1.9-4.1), and the case-fatality ratio (risk ratio [RR], 16.5; 95% CI, 13.7-19.8) associated with RSV-ALRI was higher among children with underlying CHD as compared to those without no CHD. The risk of admission to the intensive care unit (RR, 3.9; 95% CI, 3.4-4.5), need for supplemental oxygen therapy (RR, 3.4; 95% CI, .5-21.1), and need for mechanical ventilation (RR, 4.1; 95% CI, 2.1-8.0) was also higher among children with underlying CHD.Conclusion: This is the most detailed review to show more-severe RSV-ALRI among children aged <5 years with underlying CHD, especially hemodynamically significant underlying CHD, as compared those without CHD, supporting a need for improved RSV prophylactics and treatments that also have efficacy in children older than 1 year. [ABSTRACT FROM AUTHOR]

Purpose: Acute upper respiratory tract infections are the most common infections in infants and children. Saline nasal irrigation (SNI) is widely prescribed and recommended. We conducted a systematic review to assess the efficacy and safety of SNI in infants and children with acute rhinopharyngitis.Methods: We searched CENTRAL, Medline, Embase and clinicalTrials.gov. Two authors selected randomized control trials (RCTs), including infants ≥3 months and children ≤12 years, comparing the use of isotonic saline solutions, whatever their mode of administration, with one therapeutic abstention, or a therapy deemed less important for nasal lavage. Trial quality was assessed independently by two authors, who, with a third author, extracted and analysed data. Statistical analysis was conducted using Comprehensive Meta-Analysis software. The standard difference in means (SMD) between groups and its 95% confidence interval were estimated.Results: Four RCTs (569 participants) were included. The analysis showed a benefit of SNI for certain clinical rhinological symptoms (SMD = -0.29 [-0.45; -0.13]) but no significant improvement of respiratory symptoms (SMD = -0.19 [-0.70; 1.08]) or health status (SMD = -0.30 [-0.68; 0.07]). Its use appeared to limit the prescription of other treatments, whether local or systemic, and particularly antibiotics. Long-term use led to a decrease in the incidence of acute rhinosinusitis and its complications. SNI appeared to be a safe treatment.Conclusions: SNI is beneficial for rhinological symptoms but not respiratory symptoms. Further research is needed to address the full benefits/risks of this treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine whether ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) protect against lower-respiratory tract infections complicating type 2 diabetes.Research Design and Methods: Of 1,732 participants with diabetes recruited to the longitudinal observational Fremantle Diabetes Study Phase II (FDS2) between 2008 and 2011, 1,482 had confirmed type 2 diabetes (mean age 65.8 years and median diabetes duration 9.0 years; 51.6% were male). All were followed for hospitalizations for or with, or deaths from, pneumonia/influenza, ascertained from validated administrative data linkage from study entry to end of 2016. Cox regression and competing risk regression were used to identify independent predictors of this outcome.Results: Two-thirds of participants (n = 982) were taking an ACEi and/or ARB at study entry (498 [33.6%] ACEi, 408 [27.5%] ARB, 76 [5.1%] both). During 9,511 person-years of follow-up (mean ± SD 6.4 ± 2.0 years), 174 participants had incident pneumonia/influenza (156 hospitalizations and 18 deaths without hospitalization). In Cox regression analysis, baseline ACEi/ARB use was independently associated with a reduced risk of incident pneumonia/influenza (cause-specific hazard ratio [HR] 0.64 [95% CI 0.45, 0.89], P = 0.008). Allowing for the competing risk of death did not change this finding (subdistribution HR 0.67 [0.48, 0.95], P = 0.024), and similar reductions were seen for ACEi, ARB alone, and ACEi/ARB combination therapy. There was no significant change in use of ACEi/ARB during follow-up [interaction with ln(time), P = 0.70]. Other significant predictors of incident pneumonia/influenza were previously reported, clinically plausible variables.Conclusions: ACEi/ARB reduce the risk of pneumonia/influenza in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Children with Down's syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS. Methods: Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank–sum test was used to compare length of stay by RTI type and time-to-hospitalisation. Results: RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62–1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82–6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19–2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls. Conclusions: Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group. [ABSTRACT FROM AUTHOR]

Background: Recurrent respiratory infections (RRIs) are defined by the presence of at least one of the following criteria: (i) > 6 annual respiratory infections (RIs); (ii) > 1 monthly RIs involving the upper airways from September to April; (iii) > 3 annual RIs involving the lower airways represent a very common health problem in the first years of life. We conducted a multi-centre, prospective, single-open study to assess the efficacy and the safety of Streptococcus salivarius 24SMBc and Streptococcus oralis 89a in the prevention of upper respiratory tract infections (URTIs) in children. Methods: Ninety-one children (M:F = 47:44, mean age 7.4 ± 2.3 years) with RRIs were enrolled in the study between September and November 2018. At baseline, children received Streptococcus salivarius 24SMBc and Streptococcus oralis 89a as 2 puffs for nostril twice/day for 7 days/months. The treatment lasted for 3 consecutive months. Efficacy was expressed in terms of absence or presence of fever, cough, bronchospasm, rhinorrhea and otalgia, at 1 month (T1), and 3 (T3) months. Safety and tolerability of the probiotic were evaluated on the basis of the number and type of adverse events (AEs) recorded during the treatment. Results: Children treated with Streptococcus salivarius 24SMBc and Streptococcus oralis 89a showed a significant decrease of symptoms including episodes of fever, cough, bronchospasm, rhinorrhea, and otalgia (p < 0.001) compared to baseline. The treatment significantly reduced the number of episodes of fever, cough, bronchospasm, rhinorrhea, otalgia, and cough also in patients with positive familial history for atopy and in atopic children (p < 0.05). No significant differences in symptoms among children with negative familial history for atopy and children with positive familial history for atopy subgroups, not atopic and atopic children subgroups, and smoke-exposed and not smoke-exposed subgroups were observed (p > 0.05). Conducting a subgroup analysis according to the age, it has been reported that children aged 1–3 years old showed an improvement in all symptoms, however, they become statistically significant only at the end of the 3 months of treatment (p < 0.05). Conversely, in children aged 3–6 and 6–12 years old, the therapeutic efficacy was progressive and significant already from the first month of therapy (p < 0.05). None of the children were withdrawn from the study because of AEs, although 9 children experienced burning nose leading to interruption of therapy. Conclusions: Our findings suggest that Streptococcus salivarius 24SMBc and Streptococcus oralis 89a treatment is safe and seems to be effective on short-term in the treatment of RRIs. Studies involving a longer observation period are necessary to establish the real efficacy of the product for the treatment of pediatric patients affected by RRIs. [ABSTRACT FROM AUTHOR]

Objective. Respiratory tract infections (RTIs) are the most commonly treated acute problems in general practice. Instead of treatment with antibiotics, therapies from the field of integrative medicine play an increasingly important role within the society. The aim of the study was to evaluate whether mustard footbaths improve the symptoms of patients with RTIs. Methods. The study was designed as a pilot study and was carried out as an interventional trial with two points of measurement. Between November and December 2017, six practices were invited to participate. Two of them participated in the study. Patients were included who presented with an RTI at one of the involved primary care practices during February and April 2018. Participants in the intervention group used self-administered mustard seed powder footbaths at home once a day, to be repeated for six consecutive days. The improvement of symptoms was measured using the "Herdecke Warmth Perception Questionnaire" (HeWEF). A variance analysis for repeated measurements was performed to analyse differences between the intervention and control groups. Results. In this pilot study, 103 patients were included in the intervention group and 36 patients were included in the control group. A comparison of the intervention and control group before the intervention started showed nearly no difference in their subjective perception of warmth measured by the HeWEF questionnaire. Participants of the intervention group who used mustard seed footbaths for six consecutive days showed an improvement in four of the five subscales of the HeWEF questionnaire. Conclusions. This study could provide a first insight into a possible strategy to improve symptoms regarding RTI by using mustard seed footbaths. [ABSTRACT FROM AUTHOR]

Background: Little is known about the prescription, frequency and nature of airway clearance therapy (ACT) in children hospitalised with lower respiratory tract infections (LRTIs). Objectives: To describe the characteristics and outcomes of children hospitalised with LRTIs at a tertiary paediatric hospital in South Africa and to investigate the role and impact of ACT in these children. Method: A retrospective folder review of children hospitalised with LRTI between January and June 2015 was conducted, extracting data on demographic characteristics, health condition, ACT interventions and patient outcomes. Results: A total of 1208 individual cases (median [IQR] age 7.6 (2.8–19.0) months), in 1440 hospitalisations, were included. The majority of children were hospitalised primarily for the management of bronchiolitis. Comorbidities were present in 52.6% of patients during at least one of their hospitalisations. Airway clearance therapy was administered in 5.9% (n = 85) of admissions, most commonly conventional (manual) ACT. Transient oxyhaemoglobin desaturation was reported in six children, and one child developed lobar collapse an hour post-treatment. No other adverse events were reported. The median (IQR) duration of hospitalisation was 2.3 (1.5–5.0) days, and the overall mortality rate was 0.7%. Children hospitalised for presumed nosocomial infections and pneumonia had the longest length of stay, were more likely to receive ACT and had the highest mortality rate. Conclusion: Airway clearance therapy was infrequently used in this population and was more commonly applied in those with nosocomial LRTI and pneumonia. Clinical implications: Although ACT was generally well tolerated, safety has not been ascertained, and oxygen saturation should be carefully monitored during therapy. [ABSTRACT FROM AUTHOR]

Background: Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates.Methods: We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years.Findings: In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2).Interpretation: Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths.Funding: Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]

Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser. [ABSTRACT FROM AUTHOR]

Background: Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites. Methods: Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists. Results: The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs' self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P <.05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P <.05). Conclusions: HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients. Contact pattern of healthcare workers and patients during care activities for hospitalized patients with viral respiratory infections are described. Healthcare workers regularly contact environmental surfaces that may be contaminated with pathogens and their bodies, putting them at risk for acquiring infection of disseminating pathogens through the contact route. [ABSTRACT FROM AUTHOR]

Lower respiratory tract infections (LRTIs) remain a challenge in African healthcare settings and only few data are available on their aetiology in Cameroon. The purpose of this study was to access the bacterial cause of LRTIs in patients in Cameroon by two methods. Methods. Participants with LRTIs were enrolled in the referral centre for respiratory diseases in Yaoundé city and its surroundings. To detect bacteria, specimens were tested by conventional bacterial culture and a commercial reverse-transcriptase real-time polymerase chain reaction (RT-PCR) assay. One hundred forty-one adult patients with LRTIs were enrolled in the study. Among the participants, 46.8% were positive for at least one bacterium. Streptococcus pneumoniae and Haemophilus influenzae were the most detected bacteria with 14.2% (20/141) followed by Klebsiella pneumoniae, 9.2% (13/141), Staphylococcus aureus, 7.1% (10/141), and Moraxella catarrhalis, 4.3% (6/141). Bacterial coinfection accounted for 23% (14/61) with Haemophilus influenzae being implicated in 19.7% (12/61). The diagnostic performance of RT-PCR for bacteria detection (43.3%) was significantly different from that of culture (17.7%) (p< 0.001). Only Streptococcus pneumoniae detection was associated with empyema by RT-PCR (p<0.001). These findings enhance understanding of bacterial aetiologies in order to improve respiratory infection management and treatment. It also highlights the need to implement molecular tools as part of the diagnosis of LRTIs. [ABSTRACT FROM AUTHOR]

The article focuses on several treatment options for respiratory infections. These include Western herbal medicine, traditional Japanese herbal medicine, evidence-based yoga therapy, Ayurveda, and traditional Chinese medicine. It also suggests to choose healthy lifestyle to prevent respiratory diseases.

Background: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials.Methods: We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures.Results: A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use.Conclusions: We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results. [ABSTRACT FROM AUTHOR]

Cough is a forced expulsive manoeuvre, usually against a closed glottis and is associated with a characteristic sound that is easily recognised. It is a protective reflex against aspiration and to clear airway secretions. In children cough is extremely common and when prolonged it is often a cause for concern for parents, resulting in a high proportion of attendances to primary and secondary care. There are many causes of cough which may be divided into productive or non-productive in character. As there are many guidelines for the management of productive or 'wet' cough the focus of this paper will be to discuss some of the main causes, investigations and management options for 'dry' cough. Dry coughing suggests airway irritation and or inflammation (without excessive extra secretion formation) and is predominantly the result of an acute viral respiratory infection that may last up to 3-4 weeks. [ABSTRACT FROM AUTHOR]

Background: Recurrent respiratory papillomatosis is a benign condition caused by human papillomavirus (HPV). Surgery is the mainstay of treatment, but numerous adjuvant therapies have been applied to improve surgical outcome. Recently, HPV vaccination has been introduced, but only smaller studies of its effect have been published. The present meta-analysis is intended as a possible substitute for a proposed but not yet realized multicenter randomized controlled trial.Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed, Embase, and Cochrane were systematically searched. All retrieved studies (n = 593) were reviewed and qualitatively assessed. In addition, 2 previously unpublished data sets were included. The systematic review included 11 studies, comprising 133 patients, of whom 63 patients from 5 studies were eligible for meta-analysis. A random-effects meta-analysis was conducted for the mean difference in number of surgical procedures per month before and after vaccination.Results: The number of surgical procedures per month was significantly reduced after HPV vaccination compared with before vaccination (estimated mean, 0.06 vs 0.35). The mean intersurgical interval increased from 7.02 months (range, 0.30-45 months) before to 34.45 months (2.71-82 months) after HPV vaccination.Conclusion: The present study supports the continued use of the HPV vaccine as an adjuvant treatment for recurrent respiratory papillomatosis. [ABSTRACT FROM AUTHOR]

Objectives: To provide an up-to-date review of honey's effectiveness and potential applications in otorhinolaryngology. Methods: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. Results: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). Conclusions: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications. [ABSTRACT FROM AUTHOR]

Background: The impact of respiratory tract pathogens and infection on outcomes in patients with prolonged weaning is largely unknown. Objective: We studied predictors of weaning outcomes (death and failure to achieve spontaneous ventilation) in a population treated during a 3.5-year period in a specialized and certified weaning centre. Methods: Patient data were retrieved retrospectively from the clinical charts. Complete datasets were available in 173 patients. The following parameters were investigated as potential predictors of both endpoints: age; comorbidities; tracheobronchial pathogens; bacteraemia, pneumonia and number of pneumonias; and number of inhouse treatment cycles (none vs. ≥1). Results: Tracheobronchial pathogens, pneumonia, bacteraemia and the number of antibiotic cycles all significantly increased weaning duration and hospitalisation times. Independent predictors of death were atrial fibrillation (OR 2.6, 95% CI 1.2–5.8, p = 0.02) and tracheobronchial multiresistant Pseudomonas aeruginosa (OR 3.9, 95% CI 1.4–11.0, p = 0.01). Independent predictors of failure to achieve spontaneous ventilation included chronic obstructive pulmonary disease (OR 2.8, 95% CI 1.0–7.8, p = 0.045); neuromuscular disease (OR 8.3, 95% CI 1.2–27.2, p = 0.02); tracheobronchial P. aeruginosa (OR 3.3, 95% CI 1.3–9.3, p = 0.01); Stenotrophomonas maltophilia (OR 7.9, 95% CI 1.4–51.6, p = 0.02); and pneumonia (OR 4.4, 95% CI 1.5–10.9, p = 0.003). Conclusions: The impact of respiratory tract pathogens and infection on weaning outcomes was remarkable. Predictors of death and failure to achieve spontaneous ventilation differed considerably. A priority may be to investigate preventive strategies against colonisation and infection with respiratory pathogens, particularly P. aeruginosa. [ABSTRACT FROM AUTHOR]

The article discusses a 3-month-old female presented to the pediatric cardiology clinic for a routine murmur evaluation. Topics discussed include the murmur was consistent with peripheral pulmonic stenosis, confirmed by a normal cardiac echocardiogram study; mentions the gross pathology cardiac study revealed a light tan protuberant nodule below the membranous part of interventricular septum; and also mentions the exact etiology of Histiocytoid cardiomyopathy (HC) is uncertain.

In direct-to-consumer telemedicine, physicians treat patients through real-time audiovisual conferencing for common conditions such as acute respiratory infections. Early studies had mixed findings on the quality of care provided during direct-to-consumer telemedicine and were limited by small sample sizes and narrow geographic scopes. Using claims data for 2015-16 from a large national commercial insurer, we examined the quality of antibiotic management in adults with acute respiratory infection diagnoses at 38,839 direct-to-consumer telemedicine visits, compared to the quality at 942,613 matched primary care visits and 186,016 matched urgent care visits. In the matched analyses, we found clinically similar rates of antibiotic use, broad-spectrum antibiotic use, and guideline-concordant antibiotic management. However, direct-to-consumer telemedicine visits had less appropriate streptococcal testing and a higher frequency of follow-up visits. These results suggest specific opportunities for improvement in direct-to-consumer telemedicine quality. [ABSTRACT FROM AUTHOR]

Background Respiratory virus infections (RVIs) pose a threat to children undergoing hematopoietic stem cell transplantation (HSCT). In this era of sensitive molecular diagnostics, the incidence and outcome of HSCT recipients who are hospitalized with RVI (H-RVI) are not well described. Methods A retrospective observational cohort of pediatric HSCT recipients (between January 2010 and June 2013) was assembled from 9 US pediatric transplant centers. Their medical charts were reviewed for H-RVI events within 1 year after their transplant. An H-RVI diagnosis required respiratory signs or symptoms plus viral detection (human rhinovirus/enterovirus, human metapneumovirus, influenza, parainfluenza, coronaviruses, and/or respiratory syncytial virus). The incidence of H-RVI was calculated, and the association of baseline HSCT factors with subsequent pulmonary complications and death was assessed. Results Among 1560 HSCT recipients, 259 (16.6%) acquired at least 1 H-RVI within 1 year after their transplant. The median age of the patients with an H-RVI was lower than that of patients without an H-RVI (4.8 vs 7.1 years; P <.001). Among the patients with a first H-RVI, 48% required some respiratory support, and 14% suffered significant pulmonary sequelae. The all-cause and attributable case-fatality rates within 3 months of H-RVI onset were 11% and 5.4%, respectively. Multivariate logistic regression revealed that H-RVI onset within 60 days of HSCT, steroid use in the 7 days before H-RVI onset, and the need for respiratory support at H-RVI onset were associated with subsequent morbidity or death. Conclusion Results of this multicenter cohort study suggest that H-RVIs are relatively common in pediatric HSCT recipients and contribute to significant morbidity and death. These data should help inform interventional studies specific to each viral pathogen. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effects of ajowan essential oil (AjEO)/thymol and antibiotics combinations against three standard strains and six resistant clinical isolates of major respiratory bacteria (Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae). The broth microdilution method was conducted to determine the minimum inhibitory concentrations (MIC) of essential oil/thymol and antibiotics. The checkerboard method was used to investigate the interactions between the essential oil/thymol and antibiotics by means of the fractional inhibitory concentration index (FICI). The chemical composition of essential oil was also analysed by GC–MS and GC‐FID. Thymol (50·75%), γ‐terpinene (25·94%) and p‐cymene (18·31%) were identified as major constituents of the oil. The most sensitive organisms to ajowan volatile oil were Strep. pneumoniae bacteria (MIC = 0·125–0·5 mg ml−1). Synergistic effects were observed with AjEO/thymol and amoxicillin combinations on methicillin‐resistant Staph. aureus clinical isolates (FICI = 0·37–0·50) and with essential oil and ciprofloxacin combinations against P. aeruginosa ATCC 27853, Staph. aureus ATCC 25923 and penicillin (P)‐resistant Strep. pneumoniae bacteria (FICI = 0·37–0·50). Combination of thymol and ciprofloxacin produces synergistic effects only against P. aeruginosa ATCC 27853 and P‐resistant Strep. pneumoniae clinical isolate (FICI = 0·46–0·49). Significance and impact of the study: Multidrug‐resistant bacteria associated with infections of the lower respiratory tract have become a significant public health concern. Therefore, known antimicrobial agents derived from plants (e.g. essential oils) and their synergistic combinations with conventional antibiotics may overcome the antimicrobial resistance. In this respect, the antibacterial effects of ajowan essential oil, thymol and their combinations with antibiotics were assessed against some standard strains and drug‐resistant clinical isolates of major respiratory bacteria (Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae). [ABSTRACT FROM AUTHOR]

Abstract Administration of influenza vaccines via the respiratory tract has potential benefits over conventional parenteral administration, inducing immunity directly at the site of influenza exposure as well as being needle free. In this study, we investigated the suitability of Advax™, a stable particulate polymorph of inulin, also referred to as delta inulin, as a mucosal adjuvant for whole inactivated influenza vaccine (WIV) administered either as a liquid or dry powder formulation. Spray freeze-drying produced Advax-adjuvanted WIV powder particles in a size range (1–5 μm) suitable for inhalation. The physical and biological characteristics of both WIV and Advax remained unaltered both by admixing WIV with Advax and by spray freeze drying. Upon intranasal or pulmonary immunization, both liquid and dry powder formulations containing Advax induced significantly higher systemic, mucosal and cellular immune responses than non-adjuvanted WIV formulations. Furthermore, pulmonary immunization with Advax-adjuvanted WIV led to robust memory B cell responses along with an increase of lung localization factors i.e. CXCR3, CD69, and CD103. A less pronounced but still positive effect of Advax was seen on memory T cell responses. In contrast to animals immunized with WIV alone, all animals pulmonary immunized with a single dose of Advax-adjuvanted WIV were fully protected with no visible clinical symptoms against a lethal dose of influenza virus. These data confirm that Advax is a potent mucosal adjuvant that boosts vaccine-induced humoral and cellular immune responses both in the lung and systemically with major positive effects on B-cell memory and complete protection against live virus. Hence, respiratory tract immunization, particularly via the lungs, with Advax-adjuvanted WIV formulation as a liquid or dry powder is a promising alternative to parenteral influenza vaccination. Graphical abstract Unlabelled Image Highlights • Effective Advax-adjuvanted powder influenza vaccine formulation can be prepared. • Advax enhances B and T cell immune responses to influenza vaccine. • Complete protection with Advax-adjuvanted influenza vaccine by pulmonary route. • Advax elicits robust B and T cell memory responses upon pulmonary administration. • Advax is a potent mucosal adjuvant. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the 2015/16 NHS England Quality Premium (which provided a financial incentive for Clinical Commissioning Groups to reduce antibiotic prescribing in primary care) on antibiotic prescribing by General Practitioners (GPs) for respiratory tract infections (RTIs).Methods: Interrupted time series analysis using monthly patient-level consultation and prescribing data obtained from the Clinical Practice Research Datalink (CPRD) between April 2011 and March 2017. The study population comprised patients consulting a GP who were diagnosed with an RTI. We assessed the rate of antibiotic prescribing in patients (both aggregate and stratified by age) with a recorded diagnosis of uncomplicated RTI, before and after the implementation of the Quality Premium.Results: Prescribing rates decreased over the 6 year study period, with evident seasonality. Notably, there was a 3% drop in the rate of antibiotic prescribing (equating to 14.65 prescriptions per 1000 RTI consultations) (P < 0.05) in April 2015, coinciding with the introduction of the Quality Premium. This reduction was sustained, such that after 2 years there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued. There was also a concurrent 2% relative reduction in the rate of broad-spectrum antibiotic prescribing. Antibiotic prescribing for RTIs diagnosed in children showed the greatest decline with a 6% relative change 2 years after the intervention. Of the RTI indications studied, the greatest reductions in antibiotic prescribing were seen for patients with sore throats.Conclusions: Community prescribing of antibiotics for RTIs significantly decreased following the introduction of the Quality Premium, with the greatest reduction seen in younger patients. [ABSTRACT FROM AUTHOR]

Objectives: Early target attainment is the key factor influencing the outcome of antimicrobial therapy. The objective of the present study was to evaluate the relationship between azithromycin concentrations during the first 24-48 h of therapy and the clinical outcome in order to optimize antimicrobial therapy.Methods: All children with lower respiratory tract infections receiving intravenous azithromycin monotherapy were included. The relationship between azithromycin trough concentrations during the first 24-48 h and the effectiveness and safety was explored.Results: Data from 44 children [mean (SD) age = 5.25 (3.72) years] were available for final analysis. Children with trough concentrations >0.25 mg/L (n = 8) had a more significant improvement in antibacterial efficacy in terms of decreased C-reactive protein (P = 0.006) and the percentage of neutrophils (P = 0.043) compared with children with trough concentrations ≤0.25 mg/L (n = 36). No drug-related adverse events were shown to have a causal association with azithromycin therapy.Conclusions: Our study showed the clinical benefits of early target attainment of azithromycin therapy. A target trough concentration of 0.25 mg/L in the first 24-48 h of hospitalization was required to ensure better antibacterial efficacy. [ABSTRACT FROM AUTHOR]