Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study.

INTRODUCTION: Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway ('The Hague RTI Care Bridge') developed with the aim to treat and coordinate care for these patients outside the hospital. METHODS AND ANALYSIS: This is a prospective mixed methods study. Participants will be older adults (age≥65 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life. ETHICS AND DISSEMINATION: The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN68786381.

Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: A systematic review and narrative synthesis.

Background: Severe acute respiratory infections (SARIs) are the leading cause of paediatric death globally, particularly in low- and middle-income countries (LMICs). Given the potential rapid clinical decompensation and high mortality rate from SARIs, interventions that facilitate the early care are critical to improving patient outcomes. Through this systematic review, we aimed to evaluate the impact of emergency care interventions on improving clinical outcomes of paediatric patients with SARIs in LMICs. Methods: We searched PubMed, Global Health, and Global Index Medicus for peer-reviewed clinical trials or studies with comparator groups published before November 2020. We included all studies which evaluated acute and emergency care interventions on clinical outcomes for children (29 days to 19 years) with SARIs conducted in LMICs. Due to observed heterogeneity of interventions and outcomes, we performed narrative synthesis. We assessed bias using the Risk of Bias 2 and Risk of Bias in Non-Randomized Studies of Interventions tools. Results: We screened 20 583, 99 of which met the inclusion criteria. Conditions studied included pneumonia or acute lower respiratory infection (61.6%) and bronchiolitis (29.3%). Studies evaluated medications (80.8%), respiratory support (14.1%), and supportive care (5%). We found the strongest evidence of benefit for decreasing risk of death for respiratory support interventions. Results were inconclusive on the utility of continuous positive airway pressure (CPAP). We found mixed results for interventions for bronchiolitis, but a possible benefit for hypertonic nebulised saline to decrease hospital length of stay. Early use of adjuvant treatments such as Vitamin A, D, and zinc for pneumonia and bronchiolitis did not appear to have convincing evidence of benefit on clinical outcomes. Conclusions: Despite the high global burden of SARI in paediatric populations, few emergency care (EC) interventions have high quality evidence for benefit on clinical outcomes in LMICs. Respiratory support interventions have the strongest evidence for benefit. Further research on the use of CPAP in diverse settings is needed, as is a stronger evidence base for EC interventions for children with SARI, including metrics on the timing of interventions. Registration: PROSPERO (CRD42020216117).

Intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella: A case report.

RATIONALE: Hyponatremia is a common electrolyte disorder in elderly critically ill patients, and it may be associated with poor outcomes, higher morbidity, and mortality. Syndrome of inappropriate antidiuresis (SIAD) is one of the main causes of hyponatremia, with an insidious onset that is highly misdiagnosed. Primary empty sella lesions are specific, mostly asymptomatic, and easily overlooked. SIAD combined with empty sella is much rarer in clinic, this article focuses on the diagnosis and management of an elderly patient with intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella. PATIENT CONCERNS: An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia. DIAGNOSES: The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function. INTERVENTIONS: Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance. OUTCOMES: His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500-2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy. LESSONS: Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.

Effect of Electroacupuncture on the Treatment of Pneumonia in Patients with Hypertensive Intracerebral Hemorrhage.

OBJECTIVE: Pneumonia is a serious postoperative complication of hypertensive intracerebral hemorrhage (HICH), and there is no specific treatment for pneumonia. In this study, we conducted randomized controlled trials to evaluate the effects of electroacupuncture (EA) on the treatment of pneumonia in patients with HICH. METHODS: An equal number of patients with HICH complicated with pneumonia (n = 80 in total) were randomly placed in either the EA group (EA treatment and routine basic treatment) or the control group (routine basic treatment). After 14 days of treatment, clinical symptoms and signs, blood oxygen saturation, the level of inflammatory factors, the effective rate, the scores of the Barthel Index, National Institutes of Health Stroke Scale and Glasgow Coma Scale, the hospitalization time, and expenses were compared between the groups. RESULTS: The general information of the patients in the control and EA groups were similar. After 14 days of intervention, the patients in the EA group showed better symptom and sign scores, blood oxygen saturation levels, Barthel Index scores, Glasgow Coma Scale scores, and National Institutes of Health Stroke Scale scores than the patients in the control group. Furthermore, the EA treatment also lowered the levels of inflammatory factors and white blood cell count. Additionally, the patients in the EA group showed higher effective rates than those in the control group. CONCLUSIONS: EA benefits the treatment of pneumonia in patients with HICH.

Chest physiotherapy for pneumonia in adults.

BACKGROUND: Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia. This is an update of a review first published in 2010 and updated in 2013. OBJECTIVES: To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults. SEARCH METHODS: We updated our searches in the following databases to May 2022: the Cochrane Central Register of Controlled Trials (CENTRAL) via OvidSP, MEDLINE via OvidSP (from 1966), Embase via embase.com (from 1974), Physiotherapy Evidence Database (PEDro) (from 1929), CINAHL via EBSCO (from 2009), and the Chinese Biomedical Literature Database (CBM) (from 1978). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of chest physiotherapy for treating pneumonia in adults. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included two new trials in this update (540 participants), for a total of eight RCTs (974 participants). Four RCTs were conducted in the United States, two in Sweden, one in China, and one in the United Kingdom. The studies looked at five types of chest physiotherapy: conventional chest physiotherapy; osteopathic manipulative treatment (OMT, which includes paraspinal inhibition, rib raising, and myofascial release); active cycle of breathing techniques (which includes active breathing control, thoracic expansion exercises, and forced expiration techniques); positive expiratory pressure; and high-frequency chest wall oscillation. We assessed four trials as at unclear risk of bias and four trials as at high risk of bias. Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving mortality, but the certainty of evidence is very low (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.15 to 7.13; 2 trials, 225 participants; I² = 0%). OMT (versus placebo) may have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.43, 95% CI 0.12 to 1.50; 3 trials, 327 participants; I² = 0%). Similarly, high-frequency chest wall oscillation (versus no physiotherapy) may also have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.75, 95% CI 0.17 to 3.29; 1 trial, 286 participants). Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.93, 95% CI 0.56 to 1.55; 2 trials, 225 participants; I² = 85%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.60, 95% CI 0.29 to 1.23; 1 trial, 32 participants). OMT (versus placebo) may improve cure rate, but the certainty of evidence is very low (RR 1.59, 95% CI 1.01 to 2.51; 2 trials, 79 participants; I² = 0%). OMT (versus placebo) may have little to no effect on mean duration of hospital stay, but the certainty of evidence is very low (mean difference (MD) -1.08 days, 95% CI -2.39 to 0.23; 3 trials, 333 participants; I² = 50%). Conventional chest physiotherapy (versus no physiotherapy, MD 0.7 days, 95% CI -1.39 to 2.79; 1 trial, 54 participants) and active cycle of breathing techniques (versus no physiotherapy, MD 1.4 days, 95% CI -0.69 to 3.49; 1 trial, 32 participants) may also have little to no effect on duration of hospital stay, but the certainty of evidence is very low. Positive expiratory pressure (versus no physiotherapy) may reduce the mean duration of hospital stay by 1.4 days, but the certainty of evidence is very low (MD -1.4 days, 95% CI -2.77 to -0.03; 1 trial, 98 participants). Positive expiratory pressure (versus no physiotherapy) may reduce the duration of fever by 0.7 days, but the certainty of evidence is very low (MD -0.7 days, 95% CI -1.36 to -0.04; 1 trial, 98 participants). Conventional chest physiotherapy (versus no physiotherapy, MD 0.4 days, 95% CI -1.01 to 1.81; 1 trial, 54 participants) and OMT (versus placebo, MD 0.6 days, 95% CI -1.60 to 2.80; 1 trial, 21 participants) may have little to no effect on duration of fever, but the certainty of evidence is very low. OMT (versus placebo) may have little to no effect on the mean duration of total antibiotic therapy, but the certainty of evidence is very low (MD -1.07 days, 95% CI -2.37 to 0.23; 3 trials, 333 participants; I² = 61%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on duration of total antibiotic therapy, but the certainty of evidence is very low (MD 0.2 days, 95% CI -4.39 to 4.69; 1 trial, 32 participants). High-frequency chest wall oscillation plus fibrobronchoscope alveolar lavage (versus fibrobronchoscope alveolar lavage alone) may reduce the MD of intensive care unit (ICU) stay by 3.8 days (MD -3.8 days, 95% CI -5.00 to -2.60; 1 trial, 286 participants) and the MD of mechanical ventilation by three days (MD -3 days, 95% CI -3.68 to -2.32; 1 trial, 286 participants), but the certainty of evidence is very low. One trial reported transient muscle tenderness emerging after OMT in two participants. In another trial, three serious adverse events led to early withdrawal after OMT. One trial reported no adverse events after positive expiratory pressure treatment. Limitations of this review were the small sample size and unclear or high risk of bias of the included trials. AUTHORS' CONCLUSIONS: The inclusion of two new trials in this update did not change the main conclusions of the original review. The current evidence is very uncertain about the effect of chest physiotherapy on improving mortality and cure rate in adults with pneumonia. Some physiotherapies may slightly shorten hospital stays, fever duration, and ICU stays, as well as mechanical ventilation. However, all of these findings are based on very low certainty evidence and need to be further validated.

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China.

There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, which were sampled from 6 county hospitals in 3 counties of eastern China. The average proportion of recommended care delivered included stroke, pneumonia, and heart failure patients at 55.36%, 41.64%, and 49.56%, respectively. Great variation of QoC was detected not only across selected counties but between comprehensive county hospitals and traditional Chinese medicine county hospitals. We deny the widely-accepted assumptions that poor QoC should be blamed on defectively-equipped facilities or medicine and overwhelmed care providers. Instead, we speculate the low qualifications of medical workers, failed clinical knowledge translation, incorrect diagnosis, and a lack of electronic systems could be the reasons behind poor QoC. It is high time for China to put QoC as the national health priority.

[Acupoint selection rules of acupuncture and moxibustion for stroke-related pneumonia].

Using data mining technology, the rules of acupoint selection of acupuncture and moxibustion were explored in treatment of stroke-related pneumonia. The clinical articles of acupuncture and moxibustion in treatment of stroke-related pneumonia were retrieved from CNKI, SinoMed, Wanfang and VIP databases from their inception through to January l 2021, and then, the acupuncture-moxibustion prescription database was set up for stroke-related pneumonia. SPSS Modeler 18.0 Apriori algorithm was adopted to analyze the association rules of acupoints and draw complex network diagrams. SPSS26.0 was used in clustering analysis of acupoints. Finally, a total of 44 articles were included, with 51 acupoint prescriptions and 82 acupoints extracted. The total frequency of acupoints was 340 times. The high-frequency acupoints in treatment with acupuncture and moxibustion for stroke-related pneumonia were Feishu (BL 13), Fenglong (ST 40), Hegu (LI 4), etc. These acupoints were mainly distributed on the limbs and back and mostly from yang meridians. Of these extracted acupoints, the five-shu points, convergent points and back-shu points were selected specially. Regarding acupoint combination, the association of Quchi (LI 11) had the highest support with Hegu (LI 4) and Zusanli (ST 36). The core prescription of acupuncture-moxibustion treatment for stroke-related pneumonia could be composed of Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36), Fenglong (ST 40) and Taichong (LR 3).

Arsenicum albumas a treatment for pneumonia in snakes: three serial cases

two Python bivittatussnakes were received at Project Selva Viva, a zoo in Taubaté, Brazil, both presenting respiratory noises and oro-nasal discharge. A thoracic ultrasonographic examination was performed for evaluation on February 25th,2022, which diagnosed the presence of multiple vertical hyperechoic artifactsemerging from the pleural line, coalescing in some of the examined areas, and the presence a hypoechoic structure located in the subpleural region. Another serpent, from the Boa constrictor species, was apprehended and arrived at the same zoo without medical history, showing a low body score. During a thoracic ultrasonographic evaluation realized on April 1st,2022, B lines emerging from the pleural line were found. These vertical reverberating lines are a result of respiratory illness (SOLDATI et al., 2014).Methodology:The report was authorized by the owner of the zoo. All the patients received homeopathic therapy with 2 globules of Arsenicum album30 cH/ BID into the mouth, after being diagnosed with the respiratory condition by the ultrasonographic examination. The medication was chosen according to the similarity with the symptoms. The snakes had a runny nose and hissing breathing noise. Weekly ultrasound scans were performed on the Python bivittatus snakes to follow up on the respiratory condition. Results: On March 04th, it was observed that both snakes showed a reduction in respiratory noises and were more active. Ars 30 cH was maintained BID. On March 25th, both presented significant improvement in the ultrasound images, which showed only A lines, compatible with a healthy lung, and the treatment was suspended. Boa constrictor snake ́streatment started on April 1st. On April 8th, the ultrasonographic examination performed only presented A lines, which are characterized in ultrasound by parallel horizontal lines in the near field with the loss of image continuity in the far field, indicating improvement of the condition (LICHTENSTEIN et al., 2003). Conclusion:Given these results, the homeopathic treatment is an option to be considered for the treatment of respiratory symptoms in snakes, although the duration of the therapy varies based on the stage and chronicity of the disease.

Acupoint selection rules of acupuncture and moxibustion for stroke-related pneumonia / 中国针灸

Using data mining technology, the rules of acupoint selection of acupuncture and moxibustion were explored in treatment of stroke-related pneumonia. The clinical articles of acupuncture and moxibustion in treatment of stroke-related pneumonia were retrieved from CNKI, SinoMed, Wanfang and VIP databases from their inception through to January l 2021, and then, the acupuncture-moxibustion prescription database was set up for stroke-related pneumonia. SPSS Modeler 18.0 Apriori algorithm was adopted to analyze the association rules of acupoints and draw complex network diagrams. SPSS26.0 was used in clustering analysis of acupoints. Finally, a total of 44 articles were included, with 51 acupoint prescriptions and 82 acupoints extracted. The total frequency of acupoints was 340 times. The high-frequency acupoints in treatment with acupuncture and moxibustion for stroke-related pneumonia were Feishu (BL 13), Fenglong (ST 40), Hegu (LI 4), etc. These acupoints were mainly distributed on the limbs and back and mostly from yang meridians. Of these extracted acupoints, the five-shu points, convergent points and back-shu points were selected specially. Regarding acupoint combination, the association of Quchi (LI 11) had the highest support with Hegu (LI 4) and Zusanli (ST 36). The core prescription of acupuncture-moxibustion treatment for stroke-related pneumonia could be composed of Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36), Fenglong (ST 40) and Taichong (LR 3).

Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia.

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8-25%.

Effect of Bloodletting at Shaoshang and Shangyang Acupuncture Points on Outcome and Prognosis of Severe Community-Acquired Pneumonia in the Elderly.

OBJECTIVES: The aim of this study was to explore, whether treatment with bloodletting at Shaoshang and Shangyang acupuncture points would affect therapy outcome and prognosis for severe community-acquired pneumonia (SCAP) in the elderly. METHODS: A total of 62 patients, who met the diagnostic criteria for SCAP, were enrolled in the study and randomly divided into two groups, i.e., treatment group (n = 31) and control group (n = 31). All patients received a therapy according to the Chinese Clinical Practice and Expert Consensus of Emergency Severe Pneumonia from 2016. In addition to that, a bloodletting at Shaoshang (LU11) and Shangyang (LI1) acupuncture points was applied for the treatment group. This intervention was repeated for three times (ones daily), bloodletting a volume of 2-3 ml at each time point. Differences in a main index of clinical efficacy, body temperature (T), respiratory rate (RR), heart rate (Hr), white blood cell count (WBC), neutrophil percentage (N%), and C-reactive protein level (CRP) as well as different scores (CURB-65 score, SOFA score, and Apache II score) were compared between groups. Moreover, the 28-day mortality was compared between treatment and control group. The statistical methods involved in carrying out the current study include t-test, Wilcoxon test, and chi-square test. RESULTS: The clinical effective rate of the treatment group was 82.9%, which was significantly higher than the 17.1% in the control group (P < 0.05). After finishing the intervention, the treatment group showed significantly lower T (37.28 ± 0.54 vs. 37.82 ± 0.81), RR (20.06 ± 2.67 vs. 23.71 ± 6.85), Hr (81.71 ± 10.38 vs. 93.84 ± 15.39), CUBR-65 score (2.16 ± 0.74 vs. 3.03 ± 0.98), and SOFA score (5.84 ± 3.83 vs. 8.16 ± 4.2) compared to the control group (P < 0.05). The 28-day mortality rate of the treatment group was significantly lower than in the control group (12.9% vs. 45.2%, P = 0.05). CONCLUSIONS: Bloodletting at Shaoshang and Shangyang acupuncture points can support improving the clinical treatment efficacy for SCAP and reduce the 28-day mortality rate in the elderly.

The traditional herbal formulation, Jianpiyifei II, reduces pulmonary inflammation induced by influenza A virus and cigarette smoke in mice.

Chronic obstructive pulmonary disease (COPD) is a worldwide chronic inflammatory lung disease, and influenza A virus (IAV) infection is a common cause of acute exacerbations of COPD (AECOPD). Therefore, targeting viral infections represents a promising strategy to prevent the occurrence and development of inflammatory flare ups in AECOPD. Jianpiyifei II (JPYFII) is a traditional herbal medicine used in China to treat patients with COPD, and its clinical indications are not well understood. However, investigation of the anti-inflammatory effects and underlying mechanism using an animal model of smoking have been reported in a previous study by our group. In addition, some included herbs, such as Radix astragali and Radix aupleuri, were reported to exhibit antiviral effects. Therefore, the aim of the present study was to investigate whether JPYFII formulation relieved acute inflammation by clearing the IAV in a mouse model that was exposed to cigarette smoke experimentally. JPYFII formulation treatment during smoke exposure and IAV infection significantly reduced the number of cells observed in bronchoalveolar lavage fluid (BALF), expression of proinflammatory cytokines, chemokines, superoxide production, and viral load in IAV-infected and smoke-exposed mice. However, JPYFII formulation treatment during smoke exposure alone did not reduce the number of cells in BALF or the expression of Il-6, Tnf-a, and Il-1ß. The results demonstrated that JPYFII formulation exerted an antiviral effect and reduced the exacerbation of lung inflammation in cigarette smoke (CS)-exposed mice infected with IAV. Our results suggested that JPYFII formulation could potentially be used to treat patients with AECOPD associated with IAV infection.

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt: A randomized controlled trial.

BACKGROUND: Despite the well-recognized effect of vitamin D in metabolism and homeostasis, there is now growing interest in its probable association with pneumonia. This study aims to supply vitamin D3 (Cholecalciferol) (100,000 IU) to pneumonic children to minimize the duration of illness and improve their outcome. METHODS: A double-blinded, randomized, placebo-controlled trial was conducted in a Pediatric Cairo University affiliated hospital. An intervention arm (93 children) and a control arm (98 children), who had pneumonia with an insufficient or deficient level of vitamin D and whose parental permission was obtained, were enrolled in the trial. All children were treated with antibiotics according to WHO guidelines. Children were given a single injection of 1 mL of 100,000 IU of vitamin D3 or placebo. Clinical data were recorded every eight hours for all children. Outcomes were assessed 7 days after vitamin D injection.The primary outcome variable was the change in serum level of 25(OH)D, while the secondary outcomes were the medical state of the assigned cases (improvement or death) and duration between enrollment and hospital discharge for improved cases. RESULTS: In the supplementation group, the percentage of patients who suffered either deficient (38.7%) or insufficient levels (61.3%) of 25 (OH)D at day one had significantly decreased in the seventh day to (11.8%) and (52.7%), respectively. Kaplan--Meier plots highlighted that the median time to recover of the placebo group was significantly longer than that of the supplementation group (Log Rank P value < .001). CONCLUSION: VDD was detected in pediatric critical care children. In pneumonic children with high VDD, it is illustrated that Vitamin D supplementation is accompanied by lowered mortality risk and pSOFA scores, reduced time to recover, and improved PaO2/FiO2. TRIAL REGISTRATION: Trial Identifier number: NCT04244474. Registered on 27 January 2020- Retrospectively registered at ClinicalTrials.gov https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JXO&selectaction=Edit&uid=U0004UO8&ts=152&cx=9cceq6.

[Observation on Shao's five-needle therapy as adjuvant treatment for stroke-associated pneumonia].

OBJECTIVE: To compare the therapeutic effect between Shao 's five-needle therapy combined with conventional western medical treatment and the simple conventional western medical treatment on stroke-associated pneumonia. METHODS: A total of 80 patients were randomized into an observation group and a control group, 40 cases in each group. Conventional western medication treatment i.e. anti-infection combined with rehabilitation swallowing training were adopted in the control group. On the basis of the treatment in the control group, Shao 's five-needle therapy was applied at Feishu (BL 13), Dazhui (GV 14), Fengmen (BL 12), etc. in the observation group, once a day. The treatment was given for 10 days in the both groups. The levels of inflammatory indexes [white blood cell (WBC), C-reactive protein (CRP), percentage of neutrophil (N%)] before and after treatment, the disappearance time of main clinical symptoms and signs, the scores of National Institutes of Health Stroke scale (NIHSS) and the ability of daily living (ADL) were observed, and the clinical therapeutic effect was evaluated in the both groups. RESULTS: Compared before treatment, the levels of WBC, CRP, N% and the NIHSS scores after treatment were decreased (P<0.05), the ADL scores were increased in the both groups (P<0.05), and the improvement of above indexes in the observation group was superior to the control group (P<0.05). The recovery time of temperature and rale, the duration of cough in the observation group were shorter than those in the control group (P<0.05). The effective rate was 97.5% (39/40) in the observation group, which was superior to 85.0% (34/40) in the control group (P<0.05). CONCLUSION: Shao 's five-needle therapy combined with conventional western medical treatment can effectively improve the clinical symptoms in patients with stroke-associated pneumonia, down-regulate the inflammatory indexes and improve the quality of life, the therapeutic effect is superior to the simple conventional western medical treatment.

[Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children: a randomized controlled trial].

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children. METHODS: A total of 80 children with pneumonia of phlegm-heat blocking lung type were randomized into an observation group (40 cases, 1 case dropped off) and a control group (40 cases). In the control group, routine anti-infection and symptomatic and supportive treatment were given. On the basis of the treatment in the control group, acupuncture was applied at Sifeng (EX-UE 10) in the observation group, once every 2 days, 4 times were required. Before and after treatment, the score of clinical symptoms and signs and level of serum hypersensitive C-reactive protein (hs-CRP) were observed in the two groups. The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays were recorded, and the clinical therapeutic effect was evaluated in the two groups. RESULTS: After treatment, the scores of clinical symptoms and signs and levels of serum hs-CRP were reduced in the two groups (P<0.01), and the changes of scores of fever, cough and lung moist rale, secondary symptom score, total score of clinical symptoms and signs and level of serum hs-CRP in the observation group were larger than those in the control group (P<0.05, P<0.01). The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays in the observation group were shorter than those in the control group (P<0.05). The total effective rate was 87.2% (34/39) in the observation group, which was superior to 65.0% (26/40) in the control group (P<0.05). CONCLUSION: Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment can relieve clinical symptoms, shorten duration of antibacterial drugs and hospital stays for children with pneumonia of phlegm-heat blocking lung type.

Effect of traditional Chinese medicine injections on severe pneumonia: A protocol for systematic review and meta-analysis.

BACKGROUND: Traditional Chinese medicine injections (TCMJ) used in the treatment of severe pneumonia have been widely implemented in clinical practice, but their overall efficacy and safety remain unclear. This paper aims to evaluate the efficacy and safety of TCMJ in the treatment of severe pneumonia. METHODS: PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and the Chongqing VIP Chinese Science and Technology Periodical Database were all searched for randomized controlled trials focusing on the administration of TCMJ for severe pneumonia. Two researchers independently screened titles, abstracts, full texts, and extracted relevant data. The RevMan 5.3 software (The Cochrane Collaboration, Software Update, Oxford, UK) and Stata 14 software (STATA Corporation, College Station, TX) were used for statistical analysis. RESULTS: This study summarizes the related randomized controlled trials to assess the effect and safety of TCMJ in the treatment of severe pneumonia. CONCLUSION: This article provides theoretical support for the clinical application of TCMJ in the treatment of severe pneumonia. PROSPERO REGISTRATION NUMBER: CRD42020185072.

Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy.

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.

Factors affecting mothers' intentions to visit healthcare facilities before hospitalisation of children with pneumonia in Biliran province, Philippines: a qualitative study.

BACKGROUND AND OBJECTIVES: Despite a substantial reduction in the mortality rate of children under 5 years in the past 25 years, pneumonia remains the single-largest infectious cause of child deaths worldwide. This study explored the chronological order of visited healthcare facilities and practitioners, and the factors affecting mothers' intention to seek care before the hospitalisation of children with pneumonia. METHODS AND ANALYSIS: A qualitative research design was employed using theory of planned behaviour as a framework for the analysis. Using purposive sampling technique, 11 mothers, whose children under 5 years old were hospitalised with severe pneumonia, were recruited for individual semi-structured interviews. Their socio-demographic information was analysed using descriptive statistics. RESULTS: Mothers brought their sick children to multiple facilities, and 1 to 19 days had passed before hospitalisation. We identified four major factors determining mothers' intentions: (1) doing something useful for the sick child, (2) expecting the child to receive the necessary assessment and treatment, (3) accepting advice to visit a healthcare facility and be referred to a hospital and (4) considering issues and benefits associated with hospitalisation. Mothers noticed their children's unusual symptoms and monitored them while applying home remedies. They also took their children to traditional healers despite knowing that the treatments were not necessarily effective. Mothers expected children to be checked by health professionals and listened to advice from family members regarding the facilities to visit, and from healthcare staff to be referred to a hospital. Financial issues and the double burden of housework and caring for the hospitalised child were mothers' major concerns about hospitalisation. CONCLUSION: Children were hospitalised after several days because they visited multiple healthcare facilities, including traditional healers. Improving care quality at healthcare facilities and reducing financial and mothers' burden may reduce the hospitalisation delay for children with pneumonia.

Analysis of the incidence of acute respiratory diseases in the paediatric population in Poland in the light of the "Health Needs Map".

INTRODUCTION: Statistical data on the structure of acute respiratory diseases incidence in the paediatric population are still scarce. The demand for such data results mainly from the need to constantly implement new systemic and economic solutions. The aim of the study was to attempt to use reported data for an assessment of the incidence of acute respiratory diseases in various age groups. MATERIAL AND METHODS: An analysis of selected acute respiratory diseases was conducted in relation to diagnoses reported from 1 January to 31 December 2014 to the National Health Fund (NFZ, Narodowy Fundusz Zdrowia) in accordance with the codes of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The study was conducted under the Knowledge Education Development operational programme co-funded by the European Social Fund. RESULTS: A total of 101,000 children were hospitalised due to acute respiratory diseases, which amounted to 1,554 hospitalisa-tions per 100.000. The most common causes of hospitalisation were pneumonia and bronchitis/bronchiolitis. Boys were hospital-ised more often in each age group. The shortest average length of stay (ALOS) was 5.21 days and concerned hospitalisation due to bronchitis. The longest length of stay for children was due to tuberculosis (14.3 days). The highest age average of a child was recorded in pleural diseases (10.51 years) and the lowest in bronchitis (2.93 years). Rehospitalisation was necessary in children in whom tuberculosis or pleural diseases were diagnosed (1.43 vs 1.34). A total of 67 inpatient deaths were recorded, of which 19 were due to pneumonia or its complications. CONCLUSIONS: Epidemiological data reported to the National Health Fund (NFZ) seem quite reliable and do not differ significantly from those reported in other European countries. The analysed data may be useful in estimating health needs in paediatrics.