A Study to Assess the Effectiveness of Balloon Therapy on Lung Capacity of Patients with Lower Respiratory Tract Infections in Selected Hospital of Chitrakoot U.P.

As per 2019 report of the National Health Portal of India, 41,996,260 cases and 3,740 deaths from respiratory infections were recorded across India in 2018. The main aim of the study was to assess the effectiveness of balloon therapy on increased level of oxygenation of patients with lower respiratory tract disorders. Quasi experimental design was used for this study. Balloon therapy improves pulmonary functions. Daily practice of blowing up balloon, once a day, 10 times per day for 10 days will steadily increase lung capacity. The data pertaining to lung capacity was collected using self-administered questionnaire. Respiratory assessment viz Vital, Tidal and Lung capacity were measured using balloon therapy. The pre-test mean and SD were 6.83 & 1.30 respectively where as posttest mean & SD were 7.16 & 1.26, with t-test value of 6.12. These reading indicate the effectiveness of Balloon therapy on lung capacity in patients with lower respiratory tract infections. The result of this study guides that regular practice of balloon therapy can improve the lung capacity to a greater extent among patients with lower respiratory tract infection. Off course, large sample size is recommended for generalization.

Epidemiological study of pathogens in hospitalized children with lower respiratory tract infection in a single center of Shanghai from 2015 to 2019 / 中华传染病杂志

Objective:To analyze common respiratory pathogens epidemiology in hospitalized children with lower respiratory tract infection (LRTI) in a single center in Shanghai, and to provide the basic data support for clinical diagnosis and treatment of children with LRTI in Shanghai.Methods:Children with LRTI in Children′s Hospital of Fudan University were enrolled from January 1, 2015 to December 31, 2019, and respiratory samples were collected and tested by direct immunofluorescence assay and real time polymerase chain reaction. The epidemiological characteristics of different respiratory pathogens were analyzed. Chi-square test was used for statistical analysis.Results:A total of 18 716 children were included, the total detection rate of respiratory pathogens was 36.96% (6 918/18 716), and the most frequent detected pathogen was Mycoplasma pneumoniae (MP) (15.31%(2 866/18 716)), followed by respiratory syncytial virus (RSV) (10.40%(1 946/18 716)) and parainfluenza virus Ⅲ (PIV-Ⅲ) (4.65%(871/18 716)). The detection rate of pathogens in female was significantly higher than that in male (38.48%(2 936/7 630) vs 35.92%(3 982/11 086), χ2=12.72, P<0.001). RSV and influenza virus A (Flu-A) infections peaked in winter. The detection rates of influenza virus B (Flu-B) and human metapneumovirus (MPV) were higher in winter and spring. PIV-Ⅲ infection peaked in spring and summer. The peak of PIV-Ⅱ infection occurred in summer and autumn. The infections of adenovirus (ADV), MP, Chlamydia trachomatis (CT) and PIV-Ⅰ were prevalent throughout the year without significant seasonality. The detection rate of RSV declined with age, while the detection rate of MP increased with age. The co-infection rate was 1.65%(309/18 716), and the predominant co-infection type was MP and RSV (0.37%(70/18 716)). Conclusions:A variety of pathogens lead to children′s LRTI in Shanghai from 2015 to 2019, with the common infection of MP, RSV and PIV-Ⅲ. Different pathogens showed different epidemiological characteristics in age and season distributions.

Safety, tolerability and efficacy of LEGA-Kid® mechanical percussion device versus conventional chest physiotherapy in children: a randomised, single-blind controlled study

INTRODUCTION@#Chest physiotherapy (CPT) may benefit children aged below five years who suffer from lower respiratory tract infection (LRTI). However, its effects depend on the technique used. This study aimed to determine whether mechanical CPT using the LEGA-Kid® mechanical percussion device is superior to manual CPT in children with LRTI.@*METHODS@#Children aged five months to five years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid. Outcomes measured before intervention and two hours after intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.@*RESULTS@#All 30 enrolled patients showed significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.@*CONCLUSION@#Children receiving both manual and mechanical CPT showed improvements in respiratory distress symptoms, with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements in moderately severe respiratory distress. The LEGA-Kid mechanical CPT method is superior to manual CPT in reducing the RR.

Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age

Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for the first time were included in the study and divided into two groups i.e. with and without clinical signs of rickets. Disease profile was studied in both groups. Incidence of lower respiratory tract infection was compared between two groups.  Children with clinicoradiological signs of rickets were also investigated for biochemical abnormalities.Results: During the one year study period a total of 393 children were admitted, 65 were found to have rickets constituted as study group and 328 were without rickets were included the controls. Rickets incidence was 16.5% of which majority (74.6%) were males and most rachitic children (64.6%) were below six months of age. Acute lower respiratory tract infection (64.6%) was commonest in study group and acute gastroenteritis (24.4%) in the controls. The rate of ALRTI was nearly three times in study group.  Frontal bossing (67.7%) was most common sign of rickets and increased alkaline phosphatase (93.8%) was the commonest biochemical abnormality.Conclusions: Nutritional rickets, a multifactorial disease, is easily preventable. The present study has revealed the high incidence of rickets i. e., 16.5% and also show the strong statistically significant association of nutritional rickets with acute lower respiratory tract infections.

Risk factors responsible for lower respiratory tract infections in children aged under five: a hospital based study

Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.

Detection of respiratory syncytial virus & Mycoplasma pneumoniae in paediatric lower respiratory tract infections

Background & objectives: Respiratory syncytial virus (RSV) and Mycoplasma pneumoniae are considered common cause of lower respiratory tract infections (LRTIs) in children. The present study was conducted to detect M. pneumoniae and RSV in paediatric LRTIs employing serology, polymerase chain reaction (PCR) and reverse transcriptase PCR (RT-PCR) analysis. Methods: Seventy five children aged one month to five years with acute LRTIs were investigated for M. pneumoniae antibodies and RSV antigen using immunochromatographic test, RT-PCR for RSV and M. pneumoniae by PCR on nasopharyngeal aspirates. Results: RSV infection was observed in 33 (44%) and M. pneumoniae was positive in 26 (35%) children. No significant difference in infection was noted between male and female children. Clinical and radiological features among RSV and M. pneumoniae positive and negative cases were similar. Considering RT-PCR for RSV as gold standard, RSV antigen immunochromatography was 90.90 per cent sensitive and 100 per cent specific. Interpretation & conclusions: Our study showed the presence of RSV and M. pneumoniae infection in 44 and 35 per cent children, respectively with community-acquired LRTIs and aged less than five years.

Social dilemma and vitamin D deficiency: a cross-sectional study of nutritional rickets in children ages 6 months to 24 months

Background: In developing countries, malnutrition's is one of the challenges that still need to be addressed. Undernutrition is usually a result of the unavailability of food and/or repeated infections in children. Countries with comparatively lower per-capita incomes as well as those with middle per-capita income have its increased prevalence in younger age. Social dilemma of mothers, like exclusively breastfeeding, heavy clothing's and practice of keeping babies inside the doors, lead vitamin D deficiency and ultimately into nutritional rickets. The objective of this study was to determine the frequency of factors leading to nutritional rickets in children ages 6 months to 24 months.Methods: This cross-sectional study was conducted at Department of Pediatrics, Ayub Teaching Hospital, Abbottabad, Pakistan from March to December 2017. After inclusion/exclusion criteria, total 160 patients of rickets were observed. Detailed history followed by vitamin D level (<15 ng/ml) was measure. Data was analyzed by SPSS-22 and all documents were locked with principal author.Results: Present study showed that 62% children were in age ranged 6-12 months and 38% children were in age range 13-24 months. Mean age was 12 months with SD'2.16. Seventy nine percent children were male, and 21% children were females. More over 52% children had exclusive breast feeding, and 48% children did not have exclusive breast feeding. Similarly, 15% children had limited sun-light exposure and 85% children did not have limited sun-light exposure.Conclusions: Present study concluded that a lack of health education and sunlight exposure and exclusive breastfeeding were the significant risk factors contributed to nutritional rickets among children of Abbottabad, Pakistan.

Prevalence of vitamin D deficiency in children with lower respiratory tract infection

Background: Vitamin D has a role in lung growth, preserving lung function, and preventing pulmonary infection.Methods: Hospital based cross sectional prospective study was done for a period of one year from January 2017 to December 2017, at the AJ Institute of Medical Sciences, Mangalore. A total of 69 patients were admitted with LRTI during the duration of 1 year, which includes pneumonia and bronchiolitis. Out of 69 patients admitted with LRTI, 10 were excluded from the study as they were not fulfilled the criteria.Results: A total 59 children were enrolled in the study with LRTI, out of which 50 (84.7%) were vitamin D deficiency 6 (10.1%) were insufficiency and only 3 (5.08%) had normal vitamin D values, which was statistically highly significant with p value <0.05. Vitamin D deficiency is more common in less than 1 year and also in male child. Vitamin D deficiency is also common among preterm babies who were not on Vitamin D supplements, exclusively breast fed babies and among lower socio economic status especially in class 4. Authors found that 13 (22.03%) members were having a history of previous LRTI out of which 11 (84.6%), 2 (15.3%) had Vitamin D deficiency and insufficiency respectively. Among study group, 16 (27.11%) were diagnosed to have bronchiolitis, out of which 10 (62.5%), 4 (25%), 2 (12.5%) patients were found to have Vitamin D deficiency, insufficiency and normal values respectively. Children who diagnosed as pneumonia were 43 (72.88%), out of them 40 (93%), 2 (4.6%), 1 (2.3%) were having deficiency, insufficiency and normal values of Vitamin D respectively.Conclusions: Vitamin D deficiency is common in children with LRTI especially among exclusively breastfed, born preterm and children from lower socio economic status. Early recognition and treatment of Vitamin D deficiency can prevent morbidity associated with rickets and possibly frequent LRTI.

Rapid detection of respiratory syncytial virus in community-acquired lower respiratory tract infections in children by chromatographic assay

Respiratory syncytial virus (RSV) is the single most important viral agent causing pediatric lower respiratory tract infections (LRTIs) worldwide. To evaluate the role of RSV in pediatric LRTIs, we studied 85 children <2 years of age hospitalized for community-acquired LRTIs. Nasopharyngeal aspirates were obtained on admission for the detection of RSV antigen by immunochromatographic assay. Demographic, clinical, and radiological findings for RSV antigen were compared. Data analysis was performed by Chi-square test. A relatively higher number of RSV-infected children 32 (60.4%) were below 6 months of age. Clinical and radiological findings in both RSV-positive and RSV-negative groups were comparable. RSV antigen was positive in 53 (62.4%) with immunochromatography. Our study confirms that RSV plays a significant role in community-acquired LRTIs in children.

Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections

Lower respiratory tract infections are considered a common cause responsible for morbidity and mortality among children, and Mycoplasma pneumoniae is identified to be responsible for up to 40 per cent of community-acquired pneumonia in children greater than five years of age. Extrapulmonary manifestations have been reported either due to spread of infection or autoimmune mechanisms. Infection by M. pneumoniae has high incidence and clinical importance but is still an underrated disease. Most widely used serologic methods are enzyme immunoassays for detection of immunoglobulin M (IgM), IgG and IgA antibodies to M. pneumoniae, though other methods such as particle agglutination assays and immunofluorescence methods are also used. Detection of M. pneumoniae by nucleic acid amplification techniques provides fast, sensitive and specific results. Utilization of polymerase chain reaction (PCR) has improved the diagnosis of M. pneumoniae infections. Besides PCR, other alternative amplification techniques include (i) nucleic acid sequence-based amplification, (ii) Q? replicase amplification, (iii) strand displacement amplification, (iv) transcription-mediated amplification, and (v) ligase chain reaction. Macrolides are used as the first-line treatment in childhood for M. pneumoniae infections; however, emergence of macrolide-resistant M. pneumoniae is a cause of concern. Development of a safe vaccine is important that gives protective immunity and would be a major step in reducing M. pneumoniae infections.

Clinical characteristics of hospitalized infants with acute lower respiratory tract infections induced wheezing and their changes in lung function / 中华实用儿科临床杂志

Objective To determine the clinical characteristics of acute lower respiratory tract infections (ALRIs)induced wheezing,and to explore the impact of wheezing ALRIs on the subsequent respiratory diseases and lung function. Methods A total of 1726 hospitalized infants who were diagnosed with ALRIs in Children′s Hospital of Fudan University between March 2011 and February 2012 were enrolled and classified into wheezing group and non -wheezing group. Data were collected regarding demographic characteristics,family status,clinical presentations,respira-tory pathogens,and pulmonary function tests (PFTs). Subjects were followed up with questionnaires in 6 months and 1 year after discharge. PFTs were performed in 50 wheezing infants at 6 months after discharge. Results In the 1726 hospitalized infants,471 cases had a wheezing episode (27. 3％). The majority (262 / 471 cases,55. 6％)of infants with wheezing were reported with a family history of atopy. The total detection rate of viruses in wheezing group was 73. 7％ . The detection rate of respiratory syncytial virus (RSV)in wheezing group was higher than that of non-whee-zing group (68. 6％ vs. 47. 0％),and the difference was significant (P < 0. 001). For infants less than 3 months,the wheezing group had less time to peak tidal expiratory flow as a percentage of total expiratory time (TPTEF/ TE)and volume to peak tidal expiratory flow as a percentage of total expiratory volume (VPTEF/ VE),compared with the non -wheezing group [(22. 9 ± 9. 8)％ vs. (29. 2 ± 12. 3)％ and (25. 7 ± 8. 0)％ vs. (29. 8 ± 9. 6)％,respectively],and the differences were significant (all P < 0. 05). After 6 months,the wheezing group increased TPTEF/ TE and VPTEF/VE [(24. 0 ± 9. 0)％ vs. (19. 9 ± 6. 7)％,(25. 8 ± 7. 0)％ vs. (23. 2 ± 5. 0)％,respectively],and the differences were significant (all P < 0. 05),but still below normal level. Patients with wheezing were more likely to develop subse-quent wheezing during the following 1 year (20. 0％ vs. 10. 6％),and the difference was significant (P < 0. 001). Conclusion Wheezing in infants with ALRIs is related to family history of atopy and viral infections,especially to RSV. Hospitalization for wheezing ALRIs is associated with impaired lung function and a higher frequency of subsequent wheezing.

Simultaneous Detection of 13 Key Bacterial Respiratory Pathogens by Combination of Multiplex PCR and Capillary Electrophoresis / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Lower respiratory tract infections continue to pose a significant threat to human health. It is important to accurately and rapidly detect respiratory bacteria. To compensate for the limits of current respiratory bacteria detection methods, we developed a combination of multiplex polymerase chain reaction (PCR) and capillary electrophoresis (MPCE) assay to detect thirteen bacterial pathogens responsible for lower respiratory tract infections, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Mycoplasma pneumoniae, Legionella spp., Bordetella pertussis, Mycobacterium tuberculosis complex, Corynebacterium diphtheriae, and Streptococcus pyogenes.</p><p><b>METHODS</b>Three multiplex PCR reactions were built, and the products were analyzed by capillary electrophoresis using the high-throughput DNA analyzer. The specificity of the MPCE assay was examined and the detection limit was evaluated using DNA samples from each bacterial strain and the simulative samples of each strain. This assay was further evaluated using 152 clinical specimens and compared with real-time PCR reactions. For this assay, three nested-multiplex-PCRs were used to detect these clinical specimens.</p><p><b>RESULTS</b>The detection limits of the MPCE assay for the 13 pathogens were very low and ranged from 10-7 to 10-2 ng/μL. Furthermore, analysis of the 152 clinical specimens yielded a specificity ranging from 96.5%-100.0%, and a sensitivity of 100.0% for the 13 pathogens.</p><p><b>CONCLUSION</b>This study revealed that the MPCE assay is a rapid, reliable, and high-throughput method with high specificity and sensitivity. This assay has great potential in the molecular epidemiological survey of respiratory pathogens.</p>

Epidemiological and clinical features of enteroviral acute lower respiratory tract infections in hospitalized paediatric patients in a Malaysian tertiary center

Background: Human enteroviruses (HEVs) have been recognized to cause a significant number of respiratory tract infections in many regions. Previous studies conducted to analyse enteroviral respiratory tract infections focused on outbreaks. Data in the Southeast Asian region is still rather limited to date. Objectives: We conducted a prospective analysis to understand the epidemiological characteristics of enteroviral lower respiratory tract infections (LRTIs) among paediatric patients admitted to Hospital Ampang, a tertiary hospital in Malaysia. Methodology: Nasopharyngeal aspirates for common respiratory viruses and throat swabs for enteroviruses were obtained for rtPCR analyses. All positive enteroviral results were then cultured for species identification. Results and conclusion: Of the total 211 recruited patients, enteroviral LRTIs made up 8%. The clinical features of enteroviral infections are mostly clinically indistinguishable from that of respiratory syncytial virus (RSV) infections. However, RSV appears to be more lymphocytosis causing than enteroviruses (EV). We found a higher asthma incidence within the enteroviral group compared to RSV group. Enteroviral infections continue to play an important role in LRTIs in children beyond infancy and up to school age. Among the enteroviral strains, EV71 contributes a major role in enteroviral LRTIs in our center. Routine testing for enterovirus would certainly help identify a significant proportion of unexplained viral LRTIs among paediatric patients. However, further cost analyses studies would be helpful to determine if incorporating testing for enteroviruses into routine respiratory viruses panel tests is economically feasible.

Epidemiological investigation on human coronovirus infection in hospitalized children with lower respiratory tract infection in Shanghai / 中华传染病杂志

Objective To investigate the epidemiological and clinical characteristics of human coronovirus (HCoV ) infection in hospitalized children with acute lower respiratory tract infection (ALRTI)in Shanghai.Methods A retrospective cohort study was conducted between October 2009 and September 2012.Five hundred and fifty-four cases of ALRTI in children under 5 years were enrolled. HCoV and other respiratory viruses in archival nasopharyngeal aspirate specimens were detected by a commercial Seeplex RV12 ACE detection kit.HCoV pan-family reverse transcription polymerase chain reaction (PCR)was performed to screen all known six HCoV,including HCoV-229E,HCoV-OC43, severe acute respiratory syndrome (SARS)-CoV,HCoV-NL63,HCoV-HKU1 ,and real-time PCR was performed to screen Middle East respiratory syndrome (MERS)-CoV.MEGA5 .0 software was used to perform sequence alignment and phylogenetic tree analysis.Results In 554 samples,at least one virus was identified in 273 cases (48.56%)and HCoV was detected in 18 cases (3.25 %),among which 13 were HCoV-OC43/HKU1 positive,5 HCoV-229E/NL63 positive.No high pathogenic MERS-CoV and SARS-CoV were detected.The median age of 18 children with HCoV infection was 18 months (1 -48 months)with 12 boys and 6 girls.Seventeen cases had fever,11 cough,9 tachypenea and 1 wheeze. Seven received oxygen therapy,and 6 were admitted to intensive care unit for treatment.Two who was in ordinary ward were coinfected with adenovirus and human rhinovirus.All 18 cases recovered or improved on discharge.Six was infected in autumn,5 in winter,3 in spring and 4 in summer.Of 8 HCoV-positive samples which were sequenced,each 3 samples belonged to HKU1 and 229E subtypes,respectively,and each 1 belonged to OC43 and NL63 subtypes,respectively.Conclusions HCoV is a relatively common viral pathogen among hospitalized young children with ALRTI in Shanghai.No high pathogenic MERS-CoV is detected.HCoV can cause severe infection with favorable outcome.

Management of lower respiratory tract infections (LRTI's): clinical microbiologists' perspective.

In the era of emergence and re-emergence of newer and existing microorganisms, clinical and laboratory diagnosis of LRTI’s requires regular evaluation. Elaborating on possible predisposing factors will be critical to health care workers in the better management of patients suffering with Lower Respiratory Tract Infections (LRTI’s). Microbiologist’s role becomes crucial in deciding the culture methods to be employed to isolate the suspected causative microorganism and identification of the probable pathogen among mixed growth of the isolated bacteria/fungi. Antimicrobial therapy should necessarily be guided by the susceptibility patterns of various antibiotics against different microorganisms from a given geographical region, which should be regularly updated.

Lower respiratory tract in patients with malignant tumor of fermentation bacteria infection of bacterial drug resistance analysis / 国际检验医学杂志

Objective To understand the drug resistance in cancer patients with secondary non-fermenting bacterial lower respir-atory tract infection in order to provide a basis for clinical rational use of antibacterial drugs.Methods The lower respiratory tract specimens were collected from the patients with malignant tumor and identified by the fully automated microbial identification sys-tem,the drug susceptibility test was performed by using K-B method and the drug susceptibility test results were judged according to CLSI 2012 standard.The data were analyzed by the WHONET 5.6 software.Results 172 strains of non-fermenting bacteria were isolated from the lower respiratory tract specimens in the patients with malignant tumors,in which Pseudomonas aeruginosa was maximum,accounted for 45.9%,followed by Acinetobacter baumannii and Stenotrophomonas maltophilia ,accounted for 36. 0% and 10.5 % respectively.The drug susceptibility test showed that five kinds of non-fermenter demonstrated the high resistance or multi-resistance to multiple antibacterial drugs.Conclusion Non-fermenting bacterial multi-drug resistant phenomenon is seri-ous,clinic should pay attention to non-fermenting bacterial infection and drug resistance monitoring,antibacterial drugs should be rationally used according to the drug susceptibility test results in order to reduce the generation of drug-resistant strains.

Efficacy and Tolerability of Meroplan S (Meropenem 1 g and Sulbactam 0.5 g) (ETIOS) in the Management of Lower Respiratory Tract Infections caused by Gram-negative Pathogens in Adults: A Post Marketing Observational Study.

Background: The rapid and ongoing spread of antimicrobial-resistant bacteria throughout all healthcare institutions is considered a critical medical and public health issue. Gram-negative bacteria are resistant to multiple drugs and are increasingly resistant to most available antibiotics. Given the high mortality rates caused by drug-resistant Gram-negative bacteria such as Klebsiella, Acinetobacter, Pseudomonas aeruginosa and Escherichia coli and the difficulty of developing new potent antibiotics to target the problematic pathogens, combination regimens are under ardent evaluation as new strategies to overcome increasing drug resistance. Carbapenems such as meropenem have assumed an important antibiotic niche for therapy of various multidrugresistant Gram-negative infections with good safety profile. However, the percentage of carbapenem-resistant enterobacteriaceae (CRE) increased by 4-fold over the last decade and that one particular form of CRE, a resistant form of Klebsiella pneumoniae, has increased 7-fold. Extended-release beta-lactamases (ESBL) production is one of the main bacterial resistance mechanisms to carbapenem antibiotics. The use of ESBL inhibitors like sulbactam combined with carbapenem antibiotics allows the inactivation of ESBLs produced by Gram-negative pathogens. Additionally, sulbactam has an intrinsic antimicrobial activity against penicillin binding proteins. By restoring or expanding the activity of meropenem, the combination with sulbactam offers a new approach to the management of lower respiratory tract infections caused by Gram-negative pathogens. A post marketing observational study was undertaken to evaluate the efficacy and tolerability of (Meropenem 1 g and Sulbactam 0.5 g) injection in the management of lower respiratory tract infections caused by Gram-negative pathogens in adults.

Human Coronavirus NL63 in Hospitalized Children With Respiratory Infection: A 2-Year Study From Chongqing, China.

Human coronavirus (HCoV) NL63, a newly discovered coronavirus, has been associated with acute lower respiratory tract infections (ALRTI). We detected HCoV-NL63 via reverse transcriptional PCR (RT-PCR) in eight out of 878 respiratory specimens freshly collected from hospitalized children with ALRTI between April 2006 and March 2008 in Children’s Hospital of Chongqing Medical University. Peak of HCoV-NL63 activity often appeared during the summer and autumn in Chongqing area. All children with HCoV-NL63 infection were <1 year of age. The diagnosis included bronchial pneumonia, bronchitis, interstitial pneumonia and bronchiolitis. All children recovered.

Influence of exclusive breast feeding on occurrence, severity and recurrence of acute lower respiratory infections in preschool children.

Objective: To determine the association between acute lower respiratory infections (ALRI) and exclusive breast feeding practices in children younger than five years of age Design: Case control study Setting: Lady Ridgeway Hospital for Children, Colombo. Method: Breast feeding practices in children younger than five years of age admitted with ALRI were compared with that of age and gender matched controls. An interviewer administered structured pretested questionnaire was used to collect the data. Results: One hundred and four cases and controls were studied; 53% of cases were exclusively breast fed for four or more months compared to 68% of controls (odds-ratio 2). Of the 14 cases with severe ALRI, 14% were exclusively breast fed for four or more months compared to 56% in non severe ALRI cases (odds-ratio 7.5). Proportion of children exclusively breast fed for four or more months was significantly lower (p < 0.001) in cases who had previous hospital admissions for ALRI (31% against 62%). Conclusions: This study provides further evidence that exclusive breast feeding has protective effect on occurrence, severity and recurrence of ALRI in young children.

Corredores endémicos: Una herramienta útil para la vigilancia epidemiológica de la influenza / Endemic corridors: a useful tool for the epidemiological surveillance of influenza

La vigilancia epidemiológica provee información actualizada y oportuna sobre los problemas de salud y sus condicionantes, lo que permite definir acciones de prevención y control. Para la detección de epidemias es útil disponer de corredores endémicos, que indican el número de casos esperados para un cuadro infeccioso en un momento determinado. Con datos de la sección Microbiología del Hospital de Niños "Dr. Pedro de Elizalde" acerca de pacientes internados con diagnóstico de infección respiratoria aguda baja (IRAB) entre el 1/1/96 y el 31/12/2002 se confeccionaron los corredores para influenza A (IA) por semanas epidemiológicas, correspondientes a un período de siete años. En ese período se internaron 10.473 niños con diagnóstico de IRAB y se identificó IA en 411 aspirados nasofaríngeos. Se calcularon la media y el intervalo de confianza de 95% para los límites superior e inferior de incidencia en períodos semanales, y se encontró que el pico estacional ocurre entre las semanas 25 y 32. Al analizar los datos del año 2003, se observó que el pico se produjo antes, entre las semanas 19 y 25, y con valores muy por encima de los esperados para esas semanas. En 2004 aparecen 2 picos, el primero en la semana 20 y sin superar los valores de fluctuación de la parte central de la curva, y el segundo en la semana 26.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004 , the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.