A new view of treatment for bronchiolitis / 中国实用儿科杂志

Bronchiolitis is a common lower respiratory tract infection in infants and young children, mostly caused by respiratory syncytial virus. At present, the treatment mainly includes oxygen therapy, control of wheezing, maintenance of internal environment stability and so on. Most cases of bronchiolitis still lack specific antimicrobial agents. To explore a new treatment method for bronchiolitis is helpful to improve the symptoms, shorten hospitalization days,and improve the prognosis of children with moderate to severe bronchiolitis, especially those younger than 6 months with high risk factors.

Montelukast Inhibits the Inflammation of Human Bronchial Epithelial Cells Infected by Respiratory Syncytial Virus / 中山大学学报(医学科学版)

[Objective]To investigate the pharmacological mechanism of montelukast in the inhibition of inflammation.[Meth-ods]Respiratory syncytial virus-infected human bronchial epithelial cell(16HBEC)inflammatory cell model was established,and mRNA and protein expressions of Nuclear factor NF-E2 related factor(Nrf2),heme oxygenase(HO-1),quinone oxidoreductase (NQO-1),and glutathione transferase (GST) were determined by qPCR and Western-blot ,and production of cellular reactive oxygen species(ROS)was measured by DCFH-DA fluorescent probe method. Nrf2 siRNA was further synthesized to reduce the expression of Nrf2 ,to investigate the chang of inflammatory index.[Results]Montelukast significantly reduced the expressions of inflammatory cytokines IL-6,TNF-α,and IL-1β(P<0.05)on respiratory syncytial virus-infected 16HBEC,and the ROS level in inflammatory cell model was decreased(P<0.05),increased the mRNA and protein expressions of Nrf2,HO-1,NQO-1 and GST (P < 0.05),with a more significant effect at higher dose. After the down-regulation of Nrf2,the expressions of inflammatory cyto-kines IL-6,TNF-α,and IL-1βwere increased(P<0.05),and ROS level was significantly increased(P<0.05),mRNA and pro-tein expressions of Nrf2,HO-1,NQO-1 and GST were decreased(P<0.05).[Conclusion]Montelukast inhibits the inflammation of human bronchial epithelial cells infected by respiratory syncytial virus (RSV),and the potential mechanism may involve its ef-fect on the Nrf2/ARE signaling pathway.

Aumento de interleuquinas proinflamatorias y de cortisol plasmático en bronquiolitis por virus respiratorio sincicial: relación con la gravedad de la infección / Levels of inflammatory cytokines and plasma cortisol in respiratory syncytial virus bronchiolitis

Background: An increased inflammatory innate response may play a role in pathogenesis of respiratory syncytial virus (RSV) infection. Aim: To quantify pro-inflammatory cytokines (IL-6-IL-8, ÍL-2-P and TNF-a) in nasopharyngeal aspirate (NPA) and plasma, and plasma cortisol in previously healthy infants with RSV bronchiolitis. Patients and Methods: We studied 49 infants aged less than one year of age with RSV bronchiolitis and 25 healthy controls. Severity was defined using a previously described modified score. We quantified interleukins in NPA and plasma by flow cytometry and plasma cortisol by radioimmunoanalysis. Results: Among patients with RSV bronchiolitis, 25 were classified as severe and 24 as moderate or mild. Significantly higher levels ofIL-6 and IL-8 in NPA and plasma and IL-lfi in NPA were found in children classified as severe, when compared to those with moderate or mild disease and controls. There was a positive correlation between IL-6 and cortisol in plasma (r = 0,55; p < 0,0001) and both were correlated with the severity of the disease. Conclusions: RSV bronchiolitis severity was associated with higher levéis of inflammatory interleukins and plasma cortisol.

Estudio temporal de diabetes mellitus tipo 1 en Chile: asociación con factores ambientales durante el período 2000-2007 / Association of the incidence of type 1 diabetes mellitus with environmental factors in Chile during the period 2000-2007

Background: Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. Aim: To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15years, and environmental factors, such as air pollution and viruses. Material and Methods: Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. Results: Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. Conclusions: These results show that environmental factors could be related to peaks of type 1 diabetes incidence.

Diagnóstico virológico de la infección por virus sincitial respiratorio / Virological diagnosis of respiratory syncytial virus

La enfermedad respiratoria aguda se define como un conjunto de infecciones del tracto respiratorio que pueden ser causadas por una gran variedad de microorganismos tanto virales como bacterianos, y que constituyen un importante problema de salud pública en el mundo. La infección por Virus Sincitial Respiratorio (VSR) está catalogada como una de las principales causas de enfermedad respiratoria aguda, presentándo se especialmente en niños menores de dos años. La falta de diagnóstico confiable de la etiología en las infecciones respiratorias, da como resultado un manejo inadecuado de los pacientes, lo cual puede originar varios tipos de complicaciones. Por tal razón, en esta revisión de la literatura nos enfocamos en presentar un panorama general de la situación de las infecciones respiratorias debidas a VSR en Latinoamérica y las principales dificultades que se presentan al realizar el diagnostico virológico. Para el caso puntual del VSR debido a que todos los agentes etiológicos producen signos y síntomas similares, estos no pueden ser tomados como referencia para distinguir el agente etiológico asociado, así que, en este trabajo se describen las estrategias para realizar el diagnostico de VSR como por ejemplo los que se encargan de detectar anticuerpos específicos en el suero y también los métodos de detección del virus directamente en la muestra de secreción respiratoria, es decir el aislamiento viral en cultivo celular, la detección de antígenos por fluorescencia y la detección de ácidos nucleicos.

Acute respiratory disease is defined as a set of respiratory tract infections that can be caused by a variety of both viral and bacterial microorganisms, which constitute a major public health problem in the world. Respiratory Syncytial Virus (RSV) infection is listed as a major cause of acute respiratory disease, occurring especially in children less than two years old. The lack of accurate diagnosis of respiratory infections etiology, results in an inadequate management of patients, which can cause lots of complications. Thus, this review is focused on presenting an overview of the status of respiratory infections due to RSV in Latin America and the main difficulties related with performing the virological diagnosis. For the specific case of RSV, since all etiologic agents produce similar symptoms, clinical signs cannot be taken as a reference to distinguish the etiological agent of the disease, so, in this paper we describe strategies for diagnosis of RSV such as those that detects specific antibodies in serum and also methods that directly detects the virus in the respiratory secretion sample, in other words, the viral isolation in cell culture, antigens and nucleic acid detection.