The changing epidemiology of pulmonary infection in children and adolescents with cystic fibrosis: an 18-year experience.

The impact of evolving treatment regimens, airway clearance strategies, and antibiotic combinations on the incidence and prevalence of respiratory infection in cystic fibrosis (CF) in children and adolescents remains unclear. The incidence, prevalence, and prescription trends from 2002 to 2019 with 18,339 airway samples were analysed. Staphylococcus aureus [- 3.86% (95% CI - 5.28-2.43)] showed the largest annual decline in incidence, followed by Haemophilus influenzae [- 3.46% (95% CI - 4.95-1.96)] and Pseudomonas aeruginosa [- 2.80%95% CI (- 4.26-1.34)]. Non-tuberculous mycobacteria and Burkholderia cepacia showed a non-significant increase in incidence. A similar pattern of change in prevalence was observed. No change in trend was observed in infants < 2 years of age. The mean age of the first isolation of S. aureus (p < 0.001), P. aeruginosa (p < 0.001), H. influenza (p < 0.001), Serratia marcescens (p = 0.006) and Aspergillus fumigatus (p = 0.02) have increased. Nebulised amikacin (+ 3.09 ± 2.24 prescription/year, p = 0.003) and colistin (+ 1.95 ± 0.3 prescriptions/year, p = 0.032) were increasingly prescribed, while tobramycin (- 8.46 ± 4.7 prescriptions/year, p < 0.001) showed a decrease in prescription. Dornase alfa and hypertonic saline nebulisation prescription increased by 16.74 ± 4.1 prescriptions/year and 24 ± 4.6 prescriptions/year (p < 0.001). There is a shift in CF among respiratory pathogens and prescriptions which reflects the evolution of cystic fibrosis treatment strategies over time.

Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services.

During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.

Simulating accurate and effective solutions of some nonlinear nonlocal two-point BVPs: Clique and QLM-clique matrix methods.

This research work deals with two spectral matrix collocation algorithms based on (novel) clique functions to solve two classes of nonlinear nonlocal elliptic two-points boundary value problems (BVPs) arising in diverse physical models. The nonlinearity together with nonlocality makes the models so difficult to solve numerically. In both matrix methods by expanding the unknown solutions in terms of clique polynomials the nonlocality in the models is handled. In the first and direct technique, the clique coefficients are determined in an accurate way through solving an algebraic system of nonlinear equations. To get rid of the nonlinearity of the models and in order to gain efficacy, the quasilinearization method (QLM) is utilized in the second approach. In the latter algorithm named QLM-clique procedure, the first directly clique collocation method is applied to a family of linearized equations in an iterative manner. In particular, we show that the series expansion of clique polynomials is convergent exponentially in a weighted L2 norm. Numerous numerical simulations validate the performance of two matrix collocation schemes and demonstrate the accuracy as well as the gain in computational efficiency in terms of elapsed CPU time. The proposed matrix algorithms for computation are easy to implement and straightforward, and provide more accuracy compared to other available computational values in the literature.

Factors influencing treatment response of pulmonary exacerbation in children with cystic fibrosis.

BACKGROUND: Pulmonary exacerbations in cystic fibrosis (CF) significantly impact morbidity and mortality. This study aimed to assess treatment response rates and identify contributing factors towards treatment response. METHODS: In this single-center, retrospective, longitudinal study spanning four years, we analyzed all pulmonary exacerbation admissions. We compared lung function at baseline, admission, end of treatment, and 6-week follow-up. Treatment response was defined as ≥95% recovery of baseline FEV1%. RESULTS: There were 78 children who required a total of 184 admissions. The mean duration of treatment was 14.9±2.9 days. FEV1% returned to 95% of baseline in 59% following treatment. The magnitude of the decline in lung function on admission in children who did not respond to treatment was 21.7±15.2% while the decline in children who responded to treatment was 8.3±9.4%, P<0.001. Children who experienced a decline in FEV1% greater than 40% exhibited an 80% reduced likelihood of returning to their baseline values (OR -0.8, 95% CI -0.988; -0.612). Similarly, those with FEV1% reductions in the ranges of 30-39% (OR -0.63, 95% CI -0.821; -0.439), 20-29% (OR -0.52, 95% CI -0.657; -0.383), and 10-19% (OR -0.239, 95% CI -0.33; -0.148) showed progressively lower odds of returning to baseline. Fourty-eight children required readmission within 7.7±5.4 months, children who responded to treatment had a longer time taken to readmission (8.9±6.4 months) versus children who did not respond to treatment (6.4±3.5 months), (OR: -0.20, 95% CI -0.355; -0.048). CONCLUSIONS: A greater decline in lung function on admission and readmission within 6 months of the initial admission predicts non-response to treatment. This highlights the importance of re-evaluating follow-up strategies following discharge.

A systematic review on the use of bacteriophage in treating Staphylococcus aureus and Pseudomonas aeruginosa infections in cystic fibrosis.

BACKGROUND: Respiratory infections caused by Staphylococcus aureus and Pseudomonas aeruginosa are a major concern for cystic fibrosis (CF) patients due to increasing antibiotic resistance. Bacteriophages, which are viruses that selectively target and kill bacteria, are being studied as an alternative treatment for these infections. This systematic review evaluates the safety and effectiveness of bacteriophages for the treatment of CF-related infections caused by S. aureus and/or P. aeruginosa. We conducted a search for original, published articles in the English language up to March 2023. Studies that administered bacteriophages via intravenous, nebulised, inhaled, or intranasal routes were included, with no comparators required. In vitro and in vivo studies were eligible for inclusion, and only animal in vivo studies that utilised a CF transmembrane conductance regulator (CFTR) animal model were included. Bacteriophage treatment resulted in a decrease in bacterial load in both humans and animals infected with P. aeruginosa. Complete eradication of P. aeruginosa was only observed in one human subject. Additionally, there was a reduction in biofilm, improvement in resistance profile, and reduced pulmonary exacerbations in individual case reports. Evidence suggests that bacteriophage therapy may be a promising treatment option for CF-related infections caused by P. aeruginosa and S. aureus. However, larger and more robust trials are needed to establish its safety and efficacy and create necessary evidence for global legislative frameworks.

Single-arm, open-labelled, safety and tolerability of intrabronchial and nebulised bacteriophage treatment in children with cystic fibrosis and Pseudomonas aeruginosa.

INTRODUCTION: Cystic fibrosis (CF) is a multisystem condition that is complicated by recurrent pulmonary infections requiring aggressive antibiotic treatment. This predisposes the patient to complications such as sensorineural hearing loss, renal impairment, hypersensitivity and the development of antibiotic resistance. Pseudomonas aeruginosa is one of the more common organisms which cause recurrent infections and result in greater morbidity and mortality in people living with CF. Bacteriophages have been identified as a potential alternative or adjunct to antibiotics. We hypothesise that bacteriophage therapy is a safe and well-tolerated treatment in children with CF infected with P. aeruginosa infection in their airways. METHODS: This single-arm, open-labelled, non-randomised trial will run for a maximum period of 36 months with up to 10 participants. Adolescents (≥12 years and <18 years of age) who continue to shed P.aeruginosa (within 3 months of enrolment) despite undergoing eradication therapy previously, will be considered for this trial. Non-genetically modified bacteriophages that have demonstrated obligate lytic activity against each of the study participants' P. aeruginosa strains will be selected and prepared according to a combination of established protocols (isolation, purification, sterility testing and packaging) to achieve close to good manufacturing practice recommendations. The selected bacteriophage will be administered endo-bronchially first under direct vision, followed by two times a day nebulisation for 7 days in addition to standard CF treatment (intravenous antibiotics, physiotherapy to be completed as inpatient for 10-14 days). Safety and tolerability will be defined as the absence of (1) fever above 38.5°C occurring within 1 hour of the administration of the nebulised bacteriophage, (2) a 10% decline in spirometry (forced expiratory volume in 1 s %) measured preadministration and postadministration of the first dose of nebulised bacteriophage. Clinical reviews including repeat sputum cultures and spirometry will be performed at 3, 6, 9 and 12 months following bacteriophage treatment. ETHICS AND DISSEMINATION: Our clinical trial is conducted in accordance with (1) good clinical practice, (2) Australian legislation, (3) National Health and Medical Research Council guidelines for the ethical conduct of research. TRIAL REGISTRATION NUMBER: Australia and New Zealand Clinical Trial Registry (ACTRN12622000767707).

The management of upper airway obstruction in Pierre Robin Sequence.

Pierre Robin Sequence (PRS) is defined by a constellation of characteristics including micrognathia, glossoptosis and airway obstruction. PRS can occur in isolation or can be associated with syndromes and another anomalies. Airway obstruction and feeding difficulties are the major presenting issues, and the severity of the condition ranges from mild, with minimal to no symptoms, to severe, with overt obstruction resulting in apnoeas, severe respiratory distress and cyanosis. The presence of airway obstruction can result in obstructive sleep apnoea and abnormalities in gas exchange, as well as exacerbation of already present feeding difficulties and failure to thrive, secondary to mismatch of caloric intake to energy usage associated with increased effort of breathing. Management of airway obstruction for infants with PRS varies between centres. This paper explores the surgical and non-surgical management options available, their effectiveness and pitfalls in children with PRS. Despite the pros and cons of each management option, it is evident that resource availability and multidisciplinary clinical support are key factors to successful management.

Polysomnography in infants with clinical suspicion of sleep-related breathing disorders.

STUDY OBJECTIVES: Limited data exist concerning the indications, parameters, utility of daytime polysomnography, and treatment of infants with suspected sleep-related breathing disorders. METHODS: We retrospectively reviewed all polysomnography undertaken in a quaternary pediatric hospital for term infants up to 6 months of age between January 2017 and December 2019. Outcomes were evaluated, including a comparison among diagnostic groups. RESULTS: Of 161 infants (58% male), 77 (48%) were ≤ 2 months old, and 103 (61%) were referred for either craniofacial abnormalities or an airway malformation. Daytime (n = 100) vs nighttime (n = 61) studies showed no differences in sleep architecture or treatment rates. Apnea-hypopnea index was > 10 events/h in 137 (85%) and was similar across different diagnostic groups, and 97 (78%) were prescribed noninvasive ventilation, with a mean treatment duration of 13.4 ± 9 months. Of the infants who were commenced on noninvasive ventilation 75% did not require it beyond 24 months. CONCLUSIONS: Polysomnographic sleep parameters and the number of treatments prescribed were equivalent whether the polysomnography was performed during daytime or nighttime. Treatment with noninvasive ventilation was required in the short term for most infants with sleep-related breathing disorders, regardless of the indication for referral. CITATION: Singh J, Yeoh E, Castro C, Uy C, Waters K. Polysomnography in infants with clinical suspicion of sleep-related breathing disorders. J Clin Sleep Med. 2022;18(12):2803-2812.

Total shoulder arthroplasty vs. hemiarthroplasty in patients with primary glenohumeral arthritis with intact rotator cuff: meta-analysis using the ratio of means.

BACKGROUND: Glenohumeral arthritis is a degenerative disease of the shoulder joint. There is limited evidence in the literature in superiority of outcomes between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for patients when the rotator cuff is intact. The purpose of this systematic review was to compare patient-reported outcome measures (PROMs) and rate of complication between these 2 interventions in patients with primary glenohumeral arthritis and an intact rotator cuff. Previous systematic reviews have focused only on results from randomized controlled trials, demonstrating mixed outcomes in PROMs and no difference in postoperative complications or rate of revision. Our study is the first, to our knowledge, to assess all comparative studies including prospective and retrospective observational studies, assessing a combined 1317 patients. Using the ratio of means, data from different PROMs were pooled to analyze and compare the total combined relative effect change following intervention. METHODS: We undertook literature review of the reference databases until March 2021. We included randomized controlled trials in addition to comparative observational studies and case series (more than 10 patients). Study participants were adults who had primary glenohumeral arthritis with an intact rotator cuff. Meta-analysis was performed by the ratio of means for PROMs and risk ratio for revision and complication data. RESULTS: Comparing clinical outcome of TSA against HA from 10 studies, meta-analyses using ratio of means demonstrated an 8% significantly improved relative increase in the postoperative PROMs in the TSA cohort (ratio of means 1.08, 95% confidence interval [CI] 0.04-1.12, P < .01). The TSA cohort additionally demonstrated a significantly lower revision rate (relative risk 1.84, 95% CI 1.05-3.24, P = .03). Although the risk of complication was nonsignificant, pooling revision and complications data revealed a 2-fold increased risk in the HA group compared with TSA (relative risk 2.09, 95% CI 1.17-3.74, P = .01). CONCLUSIONS: In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, TSA is favored to HA in terms of clinical outcome, risk of revision surgery, and postoperative complications.

Cheyne-stokes respiration in children with heart failure.

Cheyne-Stokes respiration (CSA-CSR) is a form of central sleep apnea characterized by alternating periods of hyperventilation and central apneas or hypopneas. CSA-CSR develops following a cardiac insult resulting in a compensatory increase in sympathetic activity, which in susceptible patients causes hyperventilation and destabilizes respiratory control. The physiological changes that occur in CSA-CSR include hyperventilation, a reduced blood gas buffering capacity, and circulatory delay. In adults, 25% to 50% of patients with heart failure are reported to have CSA-CSR. The development of CSA-CSR in this group of patients is considered a poor prognostic sign. The prevalence, progression, and treatment outcomes of CSA-CSR in children remain unclear with only 11 children being described in the literature. The lack of data is possibly not due to the paucity of children with severe heart failure and CSA-CSR but because they may be under-recognized, compounded by the absence of routine polysomnographic assessment of children with moderate to severe heart failure. Building on much broader experience in the diagnosis and management of CSA-CSR in adult sleep medicine and our limited experience in a pediatric quaternary center, this paper will discuss the prevalence of CSA-CSR, its' treatment options, outcomes in children, and the potential future direction for research in this understudied area of pediatric sleep medicine.

Transition to adult care in cystic fibrosis: The challenges and the structure.

In developed countries, it is projected that there will be a 70% increase in the number of adults living with Cystic Fibrosis (CF) between 2010 and 2025. This shift in demographics highlights the importance of high-quality transition programmes with developmentally appropriate integrated health care services as the individual moves through adolescence to adulthood. Adolescents living with CF face additional and unique challenges that may have long-term impacts on their health, quality of life and life-expectancy. CF specific issues around socially challenging symptoms, body image, reproductive health and treatment burden differentiate people with CF from their peers and require clinicians to identify and address these issues during the transition process. This review provides an overview of the health, developmental and psychosocial challenges faced by individuals with CF, their guardians and health care teams considering the fundamental components and tools that are required to build a transition programme that can be tailored to suit individual CF clinics.

A fractional-order model of coronavirus disease 2019 (COVID-19) with governmental action and individual reaction.

The deadly coronavirus disease 2019 (COVID-19) has recently affected each corner of the world. Many governments of different countries have imposed strict measures in order to reduce the severity of the infection. In this present paper, we will study a mathematical model describing COVID-19 dynamics taking into account the government action and the individuals reaction. To this end, we will suggest a system of seven fractional deferential equations (FDEs) that describe the interaction between the classical susceptible, exposed, infectious, and removed (SEIR) individuals along with the government action and individual reaction involvement. Both human-to-human and zoonotic transmissions are considered in the model. The well-posedness of the FDEs model is established in terms of existence, positivity, and boundedness. The basic reproduction number (BRN) is found via the new generation matrix method. Different numerical simulations were carried out by taking into account real reported data from Wuhan, China. It was shown that the governmental action and the individuals' risk awareness reduce effectively the infection spread. Moreover, it was established that with the fractional derivative, the infection converges more quickly to its steady state.

Spectropolarimeter on board the Aditya-L1: polarization modulation and demodulation.

One of the major science goals of the Visible Emission Line Coronagraph (VELC) payload aboard the Aditya-L1 mission is to map the coronal magnetic field topology and quantitative estimation of longitudinal magnetic field on a routine basis. The infrared channel of VELC is equipped with a polarimeter to carry out full Stokes spectropolarimetric observations in the Fe xiii line at 1074.7 nm. The polarimeter is in a dual-beam setup with a continuously rotating wave plate as the polarization modulator. Detection of circular polarization due to the Zeeman effect and depolarization of linear polarization in the presence of a magnetic field due to the saturated Hanle effect in the Fe xiii line require a high signal-to-noise ratio (SNR). Due to the limited number of photons, long integration times are expected to build the required SNR. In other words, signals from a large number of modulation cycles are to be averaged to achieve the required SNR. This poses several difficulties. One is the increase in data volume and the other is the change in the modulation matrix in successive modulation cycles. The latter effect arises due to a mismatch between the retarder's rotation period and the length of the signal detection time in the case of the VELC spectropolarimeter. It is shown in this paper that by appropriately choosing the number of samples per half rotation, the data volume can be optimized. A potential solution is suggested to account for modulation matrix variation from one cycle to another.

Analysis of fractional model of guava for biological pest control with memory effect.

Introduction: Fractional operators find their applications in several scientific and engineering processes. We consider a fractional guava fruit model involving a non-local additionally non-singular fractional derivative for the interaction into guava pests and natural enemies. The fractional guava fruit model is considered as a Lotka-Volterra nature. Objectives: The main objective of this work is to study a guava fruit model associated with a non-local additionally non-singular fractional derivative for the interaction into guava pests and natural enemies. Methods: Existence and uniqueness analysis of the solution is evaluated effectively by using Picard Lindelof approach. An approximate numerical solution of the fractional guava fruit problem is obtained via a numerical scheme. Results: The positivity analysis and equilibrium analysis for the fractional guava fruit model is discussed. The numerical results are demonstrated to prove our theoretical results. The graphical behavior of solution of the fractional guava problem at the distinct fractional order values and at various parameters is discussed. Conclusion: The graphical behavior of solution of the fractional guava problem at the distinct fractional order values and at various parameters shows new vista and interesting phenomena of the model. The results are indicating that the fractional approach with non-singular kernel plays an important role in the study of different scientific problems. The suggested numerical scheme is very efficient for solving nonlinear fractional models of physical importance.

Surfactant protein disorders in childhood interstitial lung disease.

Surfactant, which was first identified in the 1920s, is pivotal to lower the surface tension in alveoli of the lungs and helps to lower the work of breathing and prevents atelectasis. Surfactant proteins, such as surfactant protein B and surfactant protein C, contribute to function and stability of surfactant film. Additionally, adenosine triphosphate binding cassette 3 and thyroid transcription factor-1 are also integral for the normal structure and functioning of pulmonary surfactant. Through the study and improved understanding of surfactant over the decades, there is increasing interest into the study of childhood interstitial lung diseases (chILD) in the context of surfactant protein disorders. Surfactant protein deficiency syndrome (SPDS) is a group of rare diseases within the chILD group that is caused by genetic mutations of SFTPB, SFTPC, ABCA3 and TTF1 genes.Conclusion: This review article seeks to provide an overview of surfactant protein disorders in the context of chILD. What is Known: • Surfactant protein disorders are an extremely rare group of disorders caused by genetic mutations of SFTPB, SPTPC, ABCA3 and TTF1 genes. • Given its rarity, research is only beginning to unmask the pathophysiology, inheritance, spectrum of disease and its manifestations. What is New: • Diagnostic and treatment options continue to be explored and evolve in these conditions. • It is, therefore, imperative that we as paediatricians are abreast with current development in this field.

A new analysis for fractional rumor spreading dynamical model in a social network with Mittag-Leffler law.

Rumor plays a key role in social interaction, and its spreading has a notable influence on human lives. In this work, we study the rumor spreading dynamical model in a social network associated with the Atangana-Baleanu derivative of non-integer order. A deterministic model of the rumor spreading is studied. The solution of the rumor spreading dynamical model is obtained by employing an iterative scheme. Additionally, existence and uniqueness of the solution are discussed by employing the Picard-Lindelöf scheme. The effect of the order of AB fractional derivative on ignorants, spreaders, and stiflers is analyzed. Finally, to represent the obtained results, some numerical simulations are shown via graphs.

An Efficient Computational Technique for Fractal Vehicular Traffic Flow.

In this work, we examine a fractal vehicular traffic flow problem. The partial differential equations describing a fractal vehicular traffic flow are solved with the aid of the local fractional homotopy perturbation Sumudu transform scheme and the local fractional reduced differential transform method. Some illustrative examples are taken to describe the success of the suggested techniques. The results derived with the aid of the suggested schemes reveal that the present schemes are very efficient for obtaining the non-differentiable solution to fractal vehicular traffic flow problem.

On the analysis of chemical kinetics system pertaining to a fractional derivative with Mittag-Leffler type kernel.

The pivotal aim of this paper was to analyze a new fractional model of chemical kinetics system related to a newly discovered Atangana-Baleanu derivative with fractional order having non-singular and non-local kernel. The numerical solution is derived by making use of the iterative scheme. The existence of the solution of chemical kinetics system of arbitrary order is examined by implementing the fixed-point theorem. The uniqueness of the special solution of the studied model is shown. The effect of different variables and order of arbitrary ordered derivative on concentrations is demonstrated in tabular and graphical forms. The numerical results for chemical kinetics system pertaining to the newly derivative with fractional order are compared with the chemical kinetics system involving classical derivative.