Association between goal nutrition and intubation in patients with bronchiolitis on noninvasive ventilation: A retrospective cohort study.

BACKGROUND: Acute bronchiolitis causes many hospitalizations in children younger than 2 years. Early enteral nutrition is associated with improved outcomes in these patients. However, often nutrition is withheld when patients require noninvasive respiratory support because of the risk of aspiration worsening respiratory failure, possibly requiring intubation. We hypothesize that achieving goal energy intake is associated with a lower intubation rate in hospitalized children with bronchiolitis who require noninvasive ventilation. METHODS: This retrospective cohort study examined the association between goal enteral nutrition (60% of dietary reference energy intake) and intubation rates. We grouped patients by severity of illness and compared intubation rates in those who met goal energy to those who did not. We use stratified analysis methods (for both level of respiratory support and feeding route) to evaluate progression to intubation. RESULTS: Of the 272 patients, 215 met goal feeds. These groups had similar demographics, but the goal-feeds group started on higher respiratory support in the pediatric intensive care unit. We found that 4.65% of the patients who met goal feeds required intubation compared with 24.6% of patients who did not meet goal feeds (P < 0.0001), even after controlling for respiratory status at admission and time of feed initiation and feeding route. CONCLUSION: We observed when adjusting for severity, feeding route, and respiratory support, achieving goal energy intake remained associated with a lower rate of intubation, without higher rates of aspiration. Confounding factors include practice variation and difference in severity of illness that objective scoring may have missed.

Assessment of Salivary ABO Blood Group Antigens and Secretor Status in Sriganganagar, Rajasthan: A Correlational Analysis of 300 Samples.

Aim To estimate the ABO blood groups from saliva samples and to correlate with the secretor status. Materials and methods A sample size of 300 individuals was selected from the outpatient department of Surendera Dental College & Research Institute, Sriganganagar, India, and from dental camps organized by the college in the near vicinity. Informed consent was obtained from selected individuals to collect their blood and saliva samples. Salivary samples were evaluated for ABO blood groups by the absorption-inhibition method. The indicator erythrocytes were prepared after blood group confirmation from serum. It was used to identify the blood group antigens in saliva to confirm the secretor status. The results were tabulated and the Pearson's chi-squared test was performed for statistical analysis using SPSS 15.0 (SPSS Inc., Chicago, IL). Results The present study showed that 282 subjects (94%) were Rhesus positive and 18 subjects (6%) were Rhesus negative. Two-hundred-and-fifty subjects (83.3%) were secretors of antigens in saliva. Non-secretors were 50 subjects (16.7%). We identified that 250/300 were secretors and the majority were in AB & A group. Conclusion Blood groups could not be detected from the saliva of subjects who were non-secretors. In contrast, blood types could be accurately identified from the saliva of those subjects who were secretors of antigen.

Viral load drives disease in humans experimentally infected with respiratory syncytial virus.

RATIONALE: Respiratory syncytial virus (RSV) is the leading cause of childhood lower respiratory infection, yet viable therapies are lacking. Two major challenges have stalled antiviral development: ethical difficulties in performing pediatric proof-of-concept studies and the prevailing concept that the disease is immune-mediated rather than being driven by viral load. OBJECTIVES: The development of a human experimental wild-type RSV infection model to address these challenges. METHODS: Healthy volunteers (n = 35), in five cohorts, received increasing quantities (3.0-5.4 log plaque-forming units/person) of wild-type RSV-A intranasally. MEASUREMENTS AND MAIN RESULTS: Overall, 77% of volunteers consistently shed virus. Infection rate, viral loads, disease severity, and safety were similar between cohorts and were unrelated to quantity of RSV received. Symptoms began near the time of initial viral detection, peaked in severity near when viral load peaked, and subsided as viral loads (measured by real-time polymerase chain reaction) slowly declined. Viral loads correlated significantly with intranasal proinflammatory cytokine concentrations (IL-6 and IL-8). Increased viral load correlated consistently with increases in multiple different disease measurements (symptoms, physical examination, and amount of nasal mucus). CONCLUSIONS: Viral load appears to drive disease manifestations in humans with RSV infection. The observed parallel viral and disease kinetics support a potential clinical benefit of RSV antivirals. This reproducible model facilitates the development of future RSV therapeutics.

Comparison of Bone Healing in Immediate Implant Placement versus Delayed Implant Placement.

INTRODUCTION: Today, modern surgical and regenerative techniques with implant immediately placed into the prepared socket, predictable gap repair with bone substitutes and soft tissue grafts, have helped to eliminate concerns about bone deficiencies and allowed implant placement according to prosthodontic needs. MATERIALS AND METHODS: The present in vivo study was designed to evaluate and compare the implant healing after immediate implant placement with or without bone graft and implant healing after delayed implant placement with or without bone graft. Crestal bone levels were compared in both the groups at preoperatively and postoperatively on immediate postoperatively, at 3rd month, and at 6th month. RESULTS: Immediate implant group has more crestal bone level reduction at 3rd and 6th months as compared to the delayed implant group. Immediate implant with bone graft group has insignificant crestal bone level reduction at 3rd and 6th months as compared to immediate implant without bone graft group. Delayed implant with bone graft group has insignificant crestal bone level reduction at 3rd and 6th months as compared to delayed implant without bone graft group. CONCLUSION: It was concluded from this study that clinical and radiographical bone healing in the delayed implant group with or without bone graft (Group Y) appears to be better than the immediate dental implant group with or without bone graft (Group X).

The antiviral effects of RSV fusion inhibitor, MDT-637, on clinical isolates, vs its achievable concentrations in the human respiratory tract and comparison to ribavirin.

BACKGROUND: Respiratory syncytial virus (RSV) viral load and disease severity associate, and the timing of viral load and disease run in parallel. An antiviral must be broadly effective against the natural spectrum of RSV genotypes and must attain concentrations capable of inhibiting viral replication within the human respiratory tract. OBJECTIVES: We evaluated a novel RSV fusion inhibitor, MDT-637, and compared it with ribavirin for therapeutic effect in vitro to identify relative therapeutic doses achievable in humans. METHOD: MDT-637 and ribavirin were co-incubated with RSV in HEp-2 cells. Quantitative PCR assessed viral concentrations; 50% inhibitory concentrations (IC50 ) were compared to achievable human MDT-637 and ribavirin peak and trough concentrations. RESULTS AND CONCLUSIONS: The IC50 for MDT-637 and ribavirin (against RSV-A Long) was 1.42 and 16 973 ng/mL, respectively. The ratio of achievable peak respiratory secretion concentration to IC50 was 6041-fold for MDT-637 and 25-fold for aerosolized ribavirin. The ratio of trough concentration to IC50 was 1481-fold for MDT-637 and 3.29-fold for aerosolized ribavirin. Maximal peak and trough levels of oral or intravenous ribavirin were significantly lower than their IC50 s. We also measured MDT-637 IC50 s in 3 lab strains and 4 clinical strains. The IC50 s ranged from 0.36 to 3.4 ng/mL. Achievable human MDT-637 concentrations in respiratory secretions exceed the IC50 s by factors from hundreds to thousands of times greater than does ribavirin. Furthermore, MDT-637 has broad in vitro antiviral activity on clinical strains of different RSV genotypes and clades. Together, these data imply that MDT-637 may produce a superior clinical effect compared to ribavirin on natural RSV infections.