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2.
Ann Neurol ; 89(3): 610-616, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33377539

RESUMO

There is emerging evidence for multifarious neurological manifestations of coronavirus disease 2019 (COVID-19), but little is known regarding whether they reflect structural damage to the nervous system. Serum neurofilament light chain (sNfL) is a specific biomarker of neuronal injury. We measured sNfL concentrations of 29 critically ill COVID-19 patients, 10 critically ill non-COVID-19 patients, and 259 healthy controls. After adjusting for neurological comorbidities and age, sNfL concentrations were higher in patients with COVID-19 versus both comparator groups. Higher sNfL levels were associated with unfavorable short-term outcome, indicating that neuronal injury is common and pronounced in critically ill patients. ANN NEUROL 2021;89:610-616.


Assuntos
/sangue , Proteínas de Neurofilamentos/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , /terapia , Estudos de Casos e Controles , Estado Terminal , Feminino , Escala de Resultado de Glasgow , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/terapia , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Edema Pulmonar/sangue , Edema Pulmonar/terapia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/sangue , Insuficiência Respiratória/terapia , Infecções Respiratórias/sangue , Infecções Respiratórias/terapia , Choque Cardiogênico/sangue , Choque Cardiogênico/terapia
3.
Orv Hetil ; 161(52): 2179-2187, 2020 12 27.
Artigo em Húngaro | MEDLINE | ID: mdl-33361503

RESUMO

Összefoglaló. Bevezetés, célkituzés: Az influenzaszezonban fellépo, elsosorban virális megbetegedések jelentos morbiditási és mortalitási teherrel rendelkeznek. Célunk volt az influenzaszeru betegséggel (ILI) és akut légúti betegséggel (ARI) kórházba felvett felnott betegek mikrobiológiai és klinikai karakterisztikájának leírása. Módszerek: Egycentrumos, obszervációs kohorszvizsgálatunk során a 2018/2019. évi légúti szezonban a Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet Infektológiai Osztályára ILI/ARI diagnózissal felvett betegek eseteit dolgoztuk fel a kórház elektronikus adatbázisának segítségével. Bevonásra azon betegek kerültek, akiknél légúti PCR-vizsgálat történt. A bevont betegeket alcsoportokra osztottuk: klinikai ILI/ARI, PCR-pozitív ILI/ARI influezavírussal, PCR-pozitív ILI/ARI más vírussal. Elsodleges kimenetelnek a komplikált betegséglefolyást, másodlagos kimenetelnek a kórházi összhalálozást, az intenzív osztályos (ICU-) felvételt, az osztályos ápolás hosszát (LOS) és az ICU LOS-t választottuk. Statisztikai összehasonlításra a Mann-Whitney-féle U-próbát, a Fisher-féle egzakt tesztet használtuk. Eredmények: A bevont 112 eset 42,8%-ában igazolódott influenza A- vagy B-vírus, 7,1%-ban egyéb légúti vírus, második leggyakrabban az RSV etiológiai szerepe. Megelozo kórházi ellátás szignifikánsan gyakrabban fordult elo PCR-pozitív ILI/ARI esetekben (23,2% vs. 42,8%; p = 0,04); ugyanezen betegek körében a panaszok kezdetétol a diagnózisig eltelt ido kb. 1 nappal rövidebb volt (3,0 ± 4,0 vs. 4,0 ± 5,0 nap; p = 0,02). A komplikációk gyakoriságát hasonló nagyságúnak találtuk (46,4% vs. 51,8%; p = 0,72), a leggyakoribb szövodmény a tüdogyulladás volt (45,5%). ICU-felvételre az esetek 5,4%-ában volt szükség, a kórházi összhalálozás 3,6%-nak adódott. A medián LOS 8,5 ± 8,0 nap, a medián ICU LOS ideje 20,5 ± 30,5 nap volt. Következtetés: A vizsgált légúti szezonban ILI/ARI diagnózissal felvett betegek jelentos részében influenza-, kisebb hányadban egyéb légúti vírusok voltak felelosek a klinikumért. A leggyakoribb szövodmény a pneumonia volt. A légúti PCR-vizsgálat lehetoséget nyújthat az etiológia tisztázására. Orv Hetil. 2020; 161(52): 2179-2187. SUMMARY: Introduction, objectives: A significant burden of morbidity and mortality is caused by seasonal outbreaks of respiratory viruses. Our aim was to identify clinical and microbiological differences among adult patients hospitalized with acute respiratory infection (ARI) or influenza-like illness (ILI). METHODS: A single-center observational cohort study was conducted at South Pest Central Hospital, National Institute of Hematology and Infectious Diseases during the 2018/2019 influenza season. Patients were identified using the hospital database, and included in the study if respiratory PCR sampling was done during hospital stay. Subgroups were created according to the identified etiology: clinical ILI/ARI (no PCR positivity), PCR positive ILI/ARI with influenza, PCR positive ILI/ARI with other virus(es). Primary outcome was the occurrence of any complication, secondary outcomes were in-hospital all-cause mortality, intensive care unit (ICU) admission, length of stay (LOS) and ICU LOS. For statistical analysis, Mann-Whitney and Fisher's tests were used. RESULTS: From 112 identified cases, 42.8% were caused by influenza A or B, 7.1% by other viruses, notably RSV. PCR positivity frequently associated with prior hospitalization (23.2% vs. 42.8%; p = 0.04), and shorter time from symptom onset to diagnosis (3.0 ± 4.0 vs. 4.0 ±5.0 days, p = 0.02). Complication rates were similar among subgroups (46.4% vs. 51.8%; p = 0.72), with pneumonia as a leading complication (45.5%). ICU admission was necessary in 5.4%, in-hospital all-cause mortality was 3.6%. Median LOS and ICU LOS were 8.5 ± 8.0 and 20.5 ± 30.5 days, respectively. CONCLUSION: During the 2018/2019 season, most ILI/ARI cases were caused by influenza, but other respiratory viruses could also be detected in lower rates. Pneumonia was the most common complication. Respiratory PCR sampling might provide a feasible way of etiology identification. Orv Hetil. 2020; 161(52): 2179-2187.


Assuntos
Hospitalização/estatística & dados numéricos , Influenza Humana/epidemiologia , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia , Doença Aguda , Adulto , Estudos de Coortes , Humanos , Estações do Ano
5.
Molecules ; 25(21)2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105830

RESUMO

Inflammation is a biological response to the activation of the immune system by various infectious or non-infectious agents, which may lead to tissue damage and various diseases. Gut commensal bacteria maintain a symbiotic relationship with the host and display a critical function in the homeostasis of the host immune system. Disturbance to the gut microbiota leads to immune dysfunction both locally and at distant sites, which causes inflammatory conditions not only in the intestine but also in the other organs such as lungs and brain, and may induce a disease state. Probiotics are well known to reinforce immunity and counteract inflammation by restoring symbiosis within the gut microbiota. As a result, probiotics protect against various diseases, including respiratory infections and neuroinflammatory disorders. A growing body of research supports the beneficial role of probiotics in lung and mental health through modulating the gut-lung and gut-brain axes. In the current paper, we discuss the potential role of probiotics in the treatment of viral respiratory infections, including the COVID-19 disease, as major public health crisis in 2020, and influenza virus infection, as well as treatment of neurological disorders like multiple sclerosis and other mental illnesses.


Assuntos
Infecções por Coronavirus/terapia , Influenza Humana/terapia , Transtornos Mentais/terapia , Esclerose Múltipla/terapia , Pneumonia Viral/terapia , Probióticos/uso terapêutico , Infecções Respiratórias/terapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Encéfalo/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/microbiologia , Infecções por Coronavirus/virologia , Microbioma Gastrointestinal/imunologia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/microbiologia , Humanos , Imunomodulação , Influenza Humana/imunologia , Influenza Humana/microbiologia , Influenza Humana/virologia , Pulmão/imunologia , Transtornos Mentais/imunologia , Transtornos Mentais/microbiologia , Consórcios Microbianos/imunologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/microbiologia , Orthomyxoviridae/efeitos dos fármacos , Orthomyxoviridae/patogenicidade , Orthomyxoviridae/fisiologia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/microbiologia , Pneumonia Viral/virologia , Infecções Respiratórias/imunologia , Infecções Respiratórias/microbiologia , Simbiose/imunologia
6.
J Biomed Nanotechnol ; 16(4): 399-418, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32970974

RESUMO

Exosomes are small extracellular vesicles of 30-150 nm diameter secreted by almost all cells. In recent years, with continuous deeper understanding of exosomes physiological functions, different reports have proven that exosomes can facilitate cell-to-cell communication by binding to target cells and transferring their contents, together with RNAs, DNAs, proteins, and lipids between cells and tissues. With advantages that exosomes can be involved in various types of physiological processes, such as blood coagulation, cellular homeostasis, inflammation, immune surveillance, stem cell differentiation, neuroprotection, and tissue regeneration and angiogenesis. Exosomes have been demonstrated that they can be applied in identification and treatment of multiple disorders such as cancers, cerebral ischemia, and respiratory infectious diseases. Importantly, researchers utilize application of exosomes in the treatment of various respiratory infectious diseases that have made some breakthrough progress. However, with the global pandemic of Coronavirus Disease 2019 (COVID-19), we have focused on applications of exosomes in respiratory infectious diseases and their serious complications, including influenza, TB, ARDS and sepsis. In this review, we explain the use of exosomes in various respiratory infectious diseases and their serious complications, and hope to provide new ideas for the treatment of new coronavirus infections.


Assuntos
Infecções por Coronavirus/terapia , Exossomos , Pneumonia Viral/terapia , Infecções Respiratórias/terapia , Betacoronavirus , Comunicação Celular , Humanos , Pandemias
9.
Br J Anaesth ; 125(6): 1002-1017, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32828489

RESUMO

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.


Assuntos
Infecções por Coronavirus/genética , Infecções por Coronavirus/terapia , Epigênese Genética , Predisposição Genética para Doença/genética , Influenza Humana/genética , Influenza Humana/terapia , Pneumonia Viral/genética , Pneumonia Viral/terapia , Infecções Respiratórias/genética , Infecções Respiratórias/terapia , Betacoronavirus/genética , Humanos , Pandemias
10.
Medicine (Baltimore) ; 99(30): e21320, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791725

RESUMO

BACKGROUND: Assessing the effectiveness and safety of traditional Chinese medicine (TCM) for symptoms of upper respiratory tract of coronavirus disease 2019 is the main purpose of this systematic review protocol. METHODS: The following electronic databases will be searched from inception to Sep 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, TCM, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Search dates: from inception dates to June 2020. Language: English. Publication period: from inception dates to June 2020. The primary outcome is the time and rate of appearance of main symptoms (including coughing, pharyngalgia, and nasal obstruction). The secondary outcome is the length of hospital stay. Two independent reviewers will conduct the study selection, data extraction and assessment. RevMan V.5.3 will be used for the assessment of risk of bias and data synthesis. RESULTS: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: The conclusion of our study will provide an evidence to judge whether TCM is effective and safe for the patients with symptoms of upper respiratory tract of coronavirus disease 2019. ETHICS AND DISSEMINATION: This protocol will not evaluate individual patient information or affect patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports. PROSPERO REGISTRATION NUMBER: CRD42020187422.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicina Tradicional Chinesa/métodos , Pneumonia Viral/terapia , Infecções Respiratórias/terapia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Humanos , Metanálise como Assunto , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Sistema Respiratório/virologia , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
11.
PLoS One ; 15(8): e0237769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817718

RESUMO

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean ß (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.


Assuntos
Asma/terapia , Exercício Físico , Pulmão/fisiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Asma/etiologia , Asma/fisiopatologia , Peso Corporal/fisiologia , Dieta , Feminino , Volume Expiratório Forçado/fisiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fumantes , Fumar/efeitos adversos , Capacidade Vital/fisiologia , Adulto Jovem
12.
Asia Pac J Public Health ; 32(6-7): 310-319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32729324

RESUMO

Our study examined factors associated with the utilization of health services in children younger than 5 years with acute respiratory infections (ARIs) symptoms in Indonesia. Data were derived from the 2012 and 2017 Indonesia Demographic and Health Survey. Information from 1408 children younger than 5 years showing ARI symptoms in the past 2 weeks before the survey was analyzed using logistic regression analyses. Around 25% of children younger than 5 years with ARI symptoms did not receive medical care. The odds of receiving care increased in mothers from rich households. The odds reduced in children aged 2 or more years; children of mothers not assisted by trained delivery attendants; mothers attending none or <4 antenatal visits; mothers delivering at home, and mothers reporting that permission to visit health services was a problem. Efforts to improve care-seeking behavior are required. Health promotion strategies and interventions to improve access to reach community not regularly exposed to health services are important.


Assuntos
Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infecções Respiratórias/terapia , Adulto , Pré-Escolar , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Indonésia , Lactente , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
13.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662615

RESUMO

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Abscesso/cirurgia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Betacoronavirus , Colecistectomia Laparoscópica , Comorbidade , Infecções por Coronavirus/terapia , Surtos de Doenças , Drenagem , Feminino , Herniorrafia , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Insuficiência Respiratória/terapia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
14.
Curr Protoc Stem Cell Biol ; 54(1): e118, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640120

RESUMO

The normal development of the pulmonary system is critical to transitioning from placental-dependent fetal life to alveolar-dependent newborn life. Human lung development and disease have been difficult to study due to the lack of an in vitro model system containing cells from the large airways and distal alveolus. This article describes a system that allows human embryonic stem cells (hESCs) and induced pluripotent stem cells (hiPSCs) to differentiate and form three-dimensional (3D) structures that emulate the development, cytoarchitecture, and function of the lung ("organoids"), containing epithelial and mesenchymal cell populations, and including the production of surfactant and presence of ciliated cells. The organoids can also be invested with mesoderm derivatives, differentiated from the same human pluripotent stem cells, such as alveolar macrophages and vasculature. Such lung organoids may be used to study the impact of environmental modifiers and perturbagens (toxins, microbial or viral pathogens, alterations in microbiome) or the efficacy and safety of drugs, biologics, and gene transfer. © 2020 Wiley Periodicals LLC. Basic Protocol: hESC/hiPSC dissection, definitive endoderm formation, and lung progenitor cell induction.


Assuntos
Infecções por Coronavirus/patologia , Pulmão/citologia , Organoides/citologia , Pneumonia Viral/patologia , Infecções Respiratórias/patologia , Betacoronavirus , Técnicas de Cultura de Células , Diferenciação Celular , Infecções por Coronavirus/terapia , Endoderma/citologia , Células-Tronco Embrionárias Humanas/citologia , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Pulmão/crescimento & desenvolvimento , Pulmão/fisiologia , Modelos Biológicos , Pandemias , Modelagem Computacional Específica para o Paciente , Pneumonia Viral/terapia , Infecções Respiratórias/terapia , Imagem com Lapso de Tempo
15.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32699026

RESUMO

According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide. The coronavirus disease that emerged in 2019 in China and now in many other countries has brought viral sepsis back into the vision of physicians and researchers worldwide. Although the current understanding of the pathophysiology of sepsis has improved, the differences between viral and bacterial sepsis at the level of pathophysiology are not well understood. Diagnosis methods that can broadly differentiate between bacterial and viral sepsis at the initial stage after the development of sepsis are limited. New treatments that can be applied at clinics for sepsis are scarce and this situation is not consistent with the growing understanding of pathophysiology. This review aims to give a brief summary of current knowledge of the epidemiology, pathophysiology, diagnosis and treatment of viral sepsis.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Sepse/diagnóstico , Sepse/epidemiologia , Causas de Morte , China/epidemiologia , Consenso , Coronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Vírus Sinciciais Respiratórios/isolamento & purificação , Infecções Respiratórias/terapia , Medição de Risco , Sepse/terapia , Choque Séptico/diagnóstico , Choque Séptico/epidemiologia , Choque Séptico/terapia , Análise de Sobrevida
16.
Pediatr Pulmonol ; 55(8): 2150-2155, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32492284

RESUMO

BACKGROUND: Children who require chronic positive pressure ventilation (CPPV) are frequently hospitalized with acute respiratory infections. Although respiratory viral testing is often performed, it is unclear how positive results impact antibiotic use. We sought to assess the impact of respiratory viral testing on antibiotic use in hospitalized children on CPPV. METHODS: This retrospective cohort study included hospitalized children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. Primary exposure was a positive RVP result; primary outcome was antibiotic de-escalation, defined as discontinuation of antibiotics or narrowing of antimicrobial spectra. To determine the independent association of positive RVP and antibiotic de-escalation, a generalized linear mixed effect model was used to account for within patient clustering and confounders defined a priori (blood and respiratory cultures, leukocytosis, bandemia, chest radiograph findings, aspiration risk, and recent admission). RESULTS: A total of 200 admissions representing 118 patients were included. A viral pathogen was identified in 46.5% (93/200) of admissions; rhinovirus was most frequently identified (61.5% of positive RVPs). Antibiotic de-escalation occurred in 33% of admissions (35.5% of RVP-positive admissions vs 30.8% of RVP-negative admissions; P = .49). In adjusted analysis, there was no association between positive RVP and antibiotics de-escalation (adjusted OR: 0.86; 95% confidence interval: 0.32-2.26). CONCLUSION: This single center cohort study suggests that respiratory viral testing may not impact antibiotic prescribing for hospitalized children on CPPV. There is need for improved stewardship of both diagnostic testing and antimicrobial use in this population.


Assuntos
Antibacterianos/uso terapêutico , Reação em Cadeia da Polimerase , Respiração com Pressão Positiva , Infecções Respiratórias/diagnóstico , Viroses/diagnóstico , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Masculino , Padrões de Prática Médica , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Viroses/terapia , Viroses/virologia , Vírus/genética
17.
Int J Infect Dis ; 96: 688-695, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32413607

RESUMO

BACKGROUND: Acute respiratory infection (ARI) leads to morbidity and mortality among under-fivechildren in developing countries, especially in rural settings. ARI ranks among the top 10 diseases in under-five children in Legambo District, South Wollo Zone, Ethiopia. The aim of this study was to evaluate determinant factors for ARI in Legambo District in 2019. MATERIALS AND METHODS: A community-based matched case-control study was conducted, involving 139 cases and 278 controls under 5 years of age, from mid-January to mid-February 2019. Data were collected using a structured questionnaire. Bivariate and multivariable conditional logistic regression analyses were performed. From the multivariable conditional logistic regression analysis, variables with a significance level of p < 0.05 were taken as significantly associated with ARI among under-five children. RESULT: ARI among children under 5 years of age was significantly associated with age of the mother/caregiver being ≥35 years, occupation of mother/caregiver being housewife, the family being of medium wealth status, the type of stove used in the house, carrying the child while preparing food, absence of windows in the house, and nutritional status of the child. CONCLUSION: The occurrence of ARI could be reduced by improving economic status, stove use, and nutrition of children, and by increasing community awareness regarding indoor air pollution and ventilation.


Assuntos
Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Adulto , Estudos de Casos e Controles , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Mães , Estado Nutricional , Infecções Respiratórias/economia , População Rural , Fatores Socioeconômicos , Adulto Jovem
18.
Am J Geriatr Psychiatry ; 28(8): 812-819, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32425471

RESUMO

The elderly are at high risk of contracting respiratory infectious diseases, including COVID-19 infection. The recent pandemic has the potential to cause significant physical and mental damage in older adults. Similarly to other mind-body exercises in Traditional Chinese medicine, Qigong features regulation of breath rhythm and pattern, body movement and posture, and meditation. Given these traits, Qigong has the potential to play a role in the prevention, treatment, and rehabilitation of respiratory infections, such as COVID-19. Potential mechanisms of action include stress reduction, emotion regulation, strengthening of respiratory muscles, reduction of inflammation, and enhanced immune function. Three forms of Qigong; abdominal breathing, Ba Duan Jin and Liu Zi Jue, all of which are gentle, smooth, and simple for the elderly to practice, are recommended in this context.


Assuntos
Infecções por Coronavirus , Terapias Mente-Corpo/métodos , Pandemias , Pneumonia Viral , Qigong , Infecções Respiratórias , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/reabilitação , Infecções por Coronavirus/terapia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/reabilitação , Infecções Respiratórias/terapia
19.
J Glob Health ; 10(1): 010422, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32426122

RESUMO

Background: The primary cause of death in Burkina Faso is lower respiratory tract infections, accounting for 1 in 7 deaths. The Ministry of Health is building surveillance for severe acute respiratory infections (SARI) in four districts. This study sought to determine the catchment area of the Boussé district hospital and to describe disease burden of individuals hospitalized for SARI. Methods: Data were collected from hospital log books to identify individuals with a SARI diagnosis during 2015 and 2016. Residence of SARI patients was recorded to determine the catchment area of the hospital. Population data were used to estimate SARI incidence rates. Results: Investigators reviewed logs for 3034 hospital admissions; 885 SARI cases were identified. Five communes were identified as the hospital catchment area, with 770 SARI patients residing in these communes. The SARI incidence rate (IR) for all ages was 136 (95% confidence interval (CI) = 115, 161) and 266 (95% CI = 236, 300) cases per 100 000 population for 2015 and 2016, respectively. Children <1 (RI = 1111 cases per 100 000, 95% CI = 1047, 1178, and RI = 2425 cases per 100 000, 95% CI = 2330, 2524) and adults ≥65 years old (RI = 377 cases per 100 000, 95% CI = 341, 417, and RI = 816 cases per 100 000, 95% CI = 762, 874) had the highest burden of disease for 2015 and 2016, respectively. Conclusion: Our analysis found high rates of SARI, especially among children <1 year of age, and marked variation in incidence between the years studied. These baseline data and the method developed will be useful for the new SARI surveillance system.


Assuntos
Área Programática de Saúde , Hospitais de Distrito/estatística & dados numéricos , Vigilância da População , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Idoso , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Complement Ther Clin Pract ; 39: 101171, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379696

RESUMO

BACKGROUND: Acute respiratory tract infection (ARTI) is a prevalent condition associated with serious health and economic implications. A range of strategies is used to manage ARTI in children, including complementary and alternative medicines (CAM). There has been little investigation into this area, and this study aims to address this knowledge gap. METHODS: Primary carers of children aged from 0 to 12 years that utilised CAM for ARTI were invited to participate in the online survey in 2019. Survey data were analysed descriptively. RESULTS: The 246 surveyed parents specified the types of CAM frequently used to manage ARTI in their children were home-remedies. Reasons parents reported using CAM were personal-beliefs and positive past-experience with CAM practitioners. Information sources that parents consulted when decision-making were education, naturopaths, and journals. CONCLUSION: Parents utilised diverse interventions, with home-remedies dominating the choice. Parents were most likely well-informed. Notably, parents indicated a preference for an integrative healthcare approach.


Assuntos
Doença Aguda/terapia , Terapias Complementares/métodos , Terapias Complementares/psicologia , Grupos de Populações Continentais/psicologia , Pais/psicologia , Infecções Respiratórias/terapia , Adulto , Austrália/epidemiologia , Criança , Pré-Escolar , Terapias Complementares/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Infecções Respiratórias/epidemiologia , Inquéritos e Questionários
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