Rinovirus y metapneumovirus en pacientes con infección respiratoria aguda grave / Rhinovirus and metapneumovirus in patients with severe acute respiratory infection

Introducción. Los virus son los principales agentes etiológicos en las infecciones respiratorias agudas graves; un alto porcentaje queda sin diagnóstico viral. Objetivo. Describir la frecuencia de rinovirus y metapneumovirus en pacientes pediátricos de una unidad centinela de Mar del Plata con infección respiratoria aguda grave y resultado negativo para virus clásicos por inmunofluorescencia y biología molecular. Población y métodos. Se realizó un estudio descriptivo de corte transversal. Se evaluó la presencia de rinovirus y metapneumovirus por biología molecular en 163 casos negativos para panel respiratorio por técnicas de vigilancia referencial, durante todo el año 2015. Resultados. Se detectó rinovirus en el 51,5 % de los casos, metapneumovirus en el 9,8 % y coinfección rinovirus-metapneumovirus en el 6,1 %. Fueron negativos para ambos virus el 32,5 %. Conclusiones. La selección de muestras sin diagnóstico virológico permitió identificar rinovirus y metapneumovirus como agentes causales de infecciones respiratorias agudas graves pediátricas y su impacto en la morbimortalidad infantil y en nuestro sistema sanitario.

Introduction. Viruses are the main etiologic agents involved in severe acute respiratory tract infections; a viral diagnosis is not established in a high percentage of cases. Objective. To describe the frequency of rhinovirus and metapneumovirus in pediatric patients with severe acute respiratory infection and negative results for typical viruses by immunofluorescence and molecular biology at a sentinel unit of Mar del Plata. Population and methods. This was a descriptive, cross-sectional study. The presence of rhinovirus and metapneumovirus was assessed by molecular biology in 163 cases negative for respiratory panel by referral surveillance techniques throughout 2015. Results. Rhinovirus was detected in 51.5% of cases, metapneumovirus in 9.8%, and coinfection with rhinovirus and metapneumovirus in 6.1%. Results were negative for both viruses in 32.5%. Conclusions. The selection of samples without a viral diagnosis allowed us to identify rhinovirus and metapneumovirus as causative agents of severe acute respiratory infections in children and assess their impact on child morbidity and mortality and on our health care system

Bacterial Isolates Of The Respiratory Tract Infection And Their Current Sensitivity Pattern Among Patients Admitted In Tertiary Care Hospital.

Background & Objectives: This study was aimed to observe the susceptibility pattern of bacterial isolates from respiratory tract infection (RTI). Respiratory tract infection is considered as one of the major public health problems and a leading cause of morbidity and mortality in many developing countries. Respiratory tract is the part of the human system that plays a vital role in breathing processes. In human, the respiratory system can be subdivided into an Upper respiratory tract and a Lower respiratory tract based on anatomical features. The respiratory tract is constantly exposed to microbes due to the extensive surface area. The present study was conducted retrospectively for a periodMethods: of one year November 2021 to October 2022. All respiratory specimens included Sputum, BAL, throat swab; endotracheal aspirate specimens were collected aseptically from patients and cultured on the appropriate bacteriological media (Blood agar, MacConkey agar & Chocolate Agar). Bacterial isolates were identified by biochemical tests and antimicrobial susceptibility performed by standard methods as per CLSI 2022. 152Results: (72.3%) of total 210 samples were positive for bacterial culture. 126 (82.8%) were gram negative bacilli (GNB) and 26 (17.1%) were gram positive cocci (GPC). The predominant pathogen isolated was K. pneumoniae 46 (30.2%) followed by Escherichia coli 28 (18.4%).The overall susceptibility of GNB was highest towards Imipenem, Meropenem followed by Piperacillin tazobactam and Amikacin. Gram positive organisms exhibited highest susceptibility towards Vancomycin and Linezolid. Imipenem is the most sensitive antibiotic followed by Piperacillin tazobactamConclusion: and Amikacin which can be used for empirical therapy for respiratory tract infections (RTI). The antibiotic therapy should be modified as per the culture and sensitivity report. Regular determinations of the type of bacterial pathogens and updation of antibiogram must be followed in every institution to aid in better patient management by helping the clinician in the judicious use of antibiotics.

Influencia de la obesidad en la severidad de la infección por SARS-CoV-2

La obesidad es una enfermedad metabólica crónica asociada a un incremento de la morbimortalidad cuya prevalencia se ha incrementado a niveles pandémicos lo que la constituye como un factor de riesgo clínico típico de peor pronóstico en pacientes con COVID-19. El propósito de esta revisión fue categorizar los principales factores fisiopatológicos que influyen en la gravedad de COVID-19 en pacientes con obesidad, mediante la búsqueda sistemática de artículos publicados hasta el 11 de marzo de 2022 usando diferentes bases de datos (Scopus, Cochrane, PubMed, Web of Science y Medline). Los resultados indican que la presencia de angiotensina II permite el ingreso del virus SARS-CoV-2 en las células del tejido adiposo convirtiéndolo en un depósito importante del virus lo que causa una diseminación más rápida a órganos vecinos. Estos valores incrementados de angiotensina II en el pulmón pueden inducir a vasoconstricción que a su vez conduce a un desajuste de ventilación/perfusión e hipoxemia, así como a inflamación y daño oxidativo. El incremento de la angiotensina II en pacientes con obesidad puede exacerbar el aumento del nivel de angiotensina II inducido por COVID-19, lo que lleva a una lesión pulmonar más grave, además de la formación de microcoágulos que colapsan la irrigación a nivel capilar, sobre todo la del alveolo, causando fallo a este nivel con extravasación de líquidos y neumonía fulminante. Además, la obesidad produce una alteración del sistema inmune comprometiendo así su capacidad de respuesta ante la infección respiratoria y propiciando un empeoramiento de la enfermedad.

Obesity is a chronic metabolic disease associated with increased morbidity and mortality whose prevalence has increased to pandemic levels, making it a typical clinical risk factor for worse prognosis in patients with COVID-19. The purpose of this review was to categorize the main pathophysiological factors that influence the severity of COVID-19 in patients with obesity, through a systematic search for articles published up to March 11, 2022 using different databases (Scopus, Cochrane, PubMed, Web of Science and Medline). The results indicate that the presence of angiotensin II allows the SARS-CoV-2 virus to enter the adipose tissue cells, making it an important reservoir for the virus, which causes faster dissemination to neighboring organs. These increased values of angiotensin II in the lung can induce vasoconstriction which in turn leads to ventilation/perfusion mismatch and hypoxemia, as well as inflammation and oxidative damage. The increase in angiotensin II in the obese can exacerbate the increase in the level of angiotensin II induced by COVID-19, leading to more severe lung injury, in addition to the formation of microclots that collapse the irrigation at the capillary level, especially in the alveolus, causing failure at this level with fluid extravasation and fulminant pneumonia. In addition, obesity produces an alteration of the immune system, thus compromising its ability to respond to respiratory infection and leading to a worsening of the disease.

Cost of lost productivity from acute respiratory infections in South America / Costo de la pérdida de productividad por infecciones respiratorias agudas en América del Sur / Custo da perda de produtividade devido a infecções respiratórias agudas na América do Sul

ABSTRACT Objectives. To estimate the burden of permanent productivity losses caused by acute respiratory infections in South American countries in 2019. Methods. Mortality data from the Global Burden of Disease Study 2019 were analyzed to estimate the burden of disease attributable to acute respiratory infections. An approach based on the human capital method was used to estimate the cost of permanent productivity losses associated with respiratory diseases. To calculate this cost, the sum of the years of productive life lost for each death was multiplied by the proportion in the workforce and the employment rate, and then by the annual minimum wage or purchasing power parity in United States dollars (US$) for each country in the economically active age groups. Separate calculations were done for men and women. Results. The total number of deaths from acute respiratory infections in 2019 was 30 684 and the years of productive life lost were 465 211 years. The total cost of permanent productivity loss was about US$ 835 million based on annual minimum wage and US$ 2 billion in purchasing power parity, representing 0.024% of the region's gross domestic product. The cost per death was US$ 33 226. The cost of productivity losses differed substantially between countries and by sex. Conclusion. Acute respiratory infections impose a significant economic burden on South America in terms of health and productivity. Characterization of the economic costs of these infections can support governments in the allocation of resources to develop policies and interventions to reduce the burden of acute respiratory infections.

RESUMEN Objetivos. Estimar la carga de la pérdida permanente de productividad causada por infecciones respiratorias agudas en países sudamericanos en el 2019. Métodos. Se analizaron los datos de mortalidad del estudio sobre carga mundial de enfermedad del 2019 para estimar la carga de enfermedad atribuible a las infecciones respiratorias agudas. Se empleó un enfoque basado en el método del capital humano para estimar el costo de las pérdidas permanentes de productividad relacionadas con las enfermedades respiratorias. Para ello, la suma de los años perdidos de vida productiva por cada muerte se multiplicó por la proporción de la fuerza de trabajo y la tasa de empleo y, a continuación, por el salario mínimo anual o la paridad del poder adquisitivo en dólares estadounidenses en los grupos etarios económicamente activos de cada país. Se realizaron cálculos separados para hombres y mujeres. Resultados. El número total de muertes por infecciones respiratorias agudas en el 2019 fue de 30 684 y se perdieron 465 211 años de vida productiva. El costo total de la pérdida permanente de productividad fue de aproximadamente US$ 835 millones según el salario mínimo anual y de US$ 2000 millones en cuanto a la paridad de poder adquisitivo, lo que representa el 0,024% del producto interno bruto de la región. El costo por muerte fue de US$ 33 226. El costo de la pérdida de productividad difirió sustancialmente entre los países y según el sexo. Conclusión. Las infecciones respiratorias agudas suponen una carga económica significativa para América del Sur en términos de salud y productividad. La caracterización de los costos económicos de estas infecciones puede ayudar a los gobiernos en la asignación de recursos para elaborar políticas e intervenciones que permitan reducir la carga de las infecciones respiratorias agudas.

RESUMO Objetivos. Estimar a carga de perdas permanentes de produtividade causadas por infecções respiratórias agudas em países da América do Sul em 2019. Métodos. Dados de mortalidade do estudo Carga Global de Doença 2019 foram analisados para estimar a carga de doença atribuível a infecções respiratórias agudas. Utilizou-se uma abordagem baseada no método do capital humano para estimar o custo das perdas permanentes de produtividade associadas às doenças respiratórias. Para calcular esse custo, a soma dos anos de vida produtiva perdidos devido a cada morte foi multiplicada pela proporção da força de trabalho e da taxa de emprego. Em seguida, esse valor foi multiplicado pelo salário mínimo anual ou pela paridade do poder de compra, em dólares dos Estados Unidos (US$), de cada país nas faixas etárias economicamente ativas. Foram feitos cálculos separados para homens e mulheres. Resultados. O número total de mortes por infecções respiratórias agudas em 2019 foi de 30 684, com 465 211 anos de vida produtiva perdidos. O custo total da perda permanente de produtividade foi de cerca de US$ 835 milhões com base no salário mínimo anual e US$ 2 bilhões em paridade de poder de compra, o que representa 0,024% do produto interno bruto da região. O custo por morte foi US$ 33 226. O custo da perda de produtividade diferiu substancialmente entre os países e por sexo. Conclusão. As infecções respiratórias agudas impõem uma carga econômica significativa à América do Sul em termos de saúde e produtividade. A caracterização dos custos econômicos dessas infecções pode fundamentar as decisões de alocação de recursos tomadas pelos governos para desenvolver políticas e intervenções com o intuito de reduzir a carga das infecções respiratórias agudas.

Influenza A(H3N2) infection followed by separate COVID-19 infection / Infección por el virus de la gripe A (H3N2) seguida de infección separada por el virus causante de la COVID-19 / Infecção por influenza A (H3N2) seguida de infecção independente por COVID-19

ABSTRACT This study describes the case of a health professional infected first by influenza virus A(H3N2) and then by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 11 days later. Respiratory samples and clinical data were collected from the patient and from close contacts. RNA was extracted from samples and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to investigate the viruses. The patient presented with two different illness events: the first was characterized by fever, chest and body pain, prostration and tiredness, which ceased on the ninth day; RT-qPCR was positive only for influenza virus A(H3N2). Eleven days after onset of the first symptoms, the patient presented with sore throat, nasal congestion, coryza, nasal itching, sneezing and coughing, and a second RT-qPCR test was positive only for SARS-CoV-2; in the second event, symptoms lasted for 11 days. SARS-CoV-2 sequencing identified the Omicron BA.1 lineage. Of the patient's contacts, one was coinfected with influenza A(H3N2) and SARS-CoV-2 lineage BA.1.15 and the other two were infected only with SARS-CoV-2, one also with Omicron BA.1.15 and the other with BA.1.1. Our findings reinforce the importance of testing for different viruses in cases of suspected respiratory viral infection during routine epidemiological surveillance because common clinical manifestations of COVID-19 mimic those of other viruses, such as influenza.

RESUMEN Este estudio describe el caso de un profesional de la salud que contrajo la infección primero por el virus de la gripe A (H3N2) y a continuación por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) 11 días después. Se recogieron muestras respiratorias y datos clínicos del paciente y sus contactos cercanos. Se extrajo ARN de muestras y se utilizó la reacción en cadena de la polimerasa cuantitativa con transcripción inversa (RT-qPCR, por su sigla en inglés) para investigar los virus. El paciente presentó dos procesos infecciosos distintos: el primero se caracterizó por fiebre, dolor corporal y torácico, postración y cansancio, que cesó en el noveno día. La prueba mediante RT-qPCR solo fue positiva en el virus de la gripe A (H3N2). Once días después del inicio de los primeros síntomas, el paciente manifestó dolor de garganta, congestión nasal, catarro, picazón nasal, estornudos y tos. Una segunda prueba mediante RT-qPCR solo fue positiva para el SARS-CoV-2 y durante este segundo proceso los síntomas duraron 11 días. La secuenciación del SARS-CoV-2 identificó el linaje ómicron BA.1. De los contactos del paciente, uno presentaba una coinfección por el virus de la gripe A (H3N2) y el linaje BA.1.15 del SARS-COV-2, y los otros dos presentaban infecciones únicamente por SARS-CoV-2, uno también del linaje ómicron BA.1.15 y el otro de BA.1.1. Estos hallazgos refuerzan la importancia de realizar pruebas para detectar diferentes virus en casos de sospecha de infección viral respiratoria durante la vigilancia epidemiológica de rutina porque las manifestaciones clínicas comunes de COVID-19 son similares a las de otros virus, como en el caso de la gripe.

RESUMO Este estudo descreve o caso de uma profissional de saúde infectada primeiro pelo vírus influenza A (H3N2) e, 11 dias depois, pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Amostras respiratórias e dados clínicos foram coletados da paciente e de contatos próximos. RNA foi extraído das amostras, e o método de reação em cadeia da polimerase via transcriptase reversa quantitativa (RT-qPCR) foi utilizado para investigar os vírus. A paciente apresentou dois quadros clínicos distintos. O primeiro foi caracterizado por febre, dor no peito e no corpo, prostração e fadiga, que cessou no nono dia. A RT-qPCR foi positiva apenas para o vírus da influenza A (H3N2). Onze dias após o início dos primeiros sintomas, a paciente apresentou dor de garganta, congestão nasal, coriza, prurido nasal, espirros e tosse. Um segundo teste de RT-qPCR foi positivo apenas para SARS-CoV-2. No segundo evento, os sintomas duraram 11 dias. O sequenciamento do SARS-CoV-2 identificou a cepa Ômicron BA.1. Dentre os contatos da paciente, um teve coinfeção por influenza A (H3N2) e SARS-COV-2 (cepa BA.1.15), e os outros dois foram infectados apenas por SARS-CoV-2 (um também pela cepa Ômicron BA.1.15 e o outro pela BA.1.1). Nossos achados reforçam a importância de testes para a detecção de diferentes vírus em casos de suspeita de infecção viral respiratória durante a vigilância epidemiológica de rotina, visto que as manifestações clínicas comuns da COVID-19 imitam as de outros vírus, como o vírus influenza.

Incidence of acute respiratory symptoms and COVID-19 infection in children in public schools in Bogotá, Colombia, from July to November, 2020 / Incidencia de síntomas respiratorios agudos y COVID-19 en niños de escuelas públicas de Bogotá, Colombia, entre julio y noviembre de 2020

Introduction: More than 90% of children infected with COVID-19 worldwide developed mild to moderate disease. In Colombia, during 2020, COVID-19 infections in children stayed below 9.2% of the total cases, with no trends for age group or sex. Objective: To estimate the incidence of acute respiratory symptoms and COVID-19 in children from public schools in Bogotá, Colombia during the second semester of 2020. Material and methods: A telephone survey was conducted in over 5,000 scholar children. Antecedents and use of health services were informed. Descriptive statistics were used. Results: A total of 151.470 persons per day accounting for an IR of 157,8 per 100,000 people; almost three times the rate reported by the official surveillance system in the city. Conclusion: A lack of diagnosis and consultation in children was found compared to the general population. Further research is needed to elucidate the true burden of the disease in children.

Introducción. Más del 90% de los niños infectados con COVID-19 en el mundo, desarrollaron enfermedad leve a moderada. En Colombia, durante el 2020, la infección del COVID-19 en niños se mantuvo por debajo de 9,2 % del total de los casos sin tendencias por grupo de edad o sexo. Objetivo. Estimar la incidencia de síntomas respiratorios agudos y COVID19 en niños de escuelas públicas en Bogotá (Colombia) durante el segundo semestre de 2020. Materiales y métodos. Se hizo una encuesta telefónica en más de 5.000 escolares. Se recolectó información de antecedentes médicos y uso de servicios de salud. La información obtenida se describió mediante estadística descriptiva. Resultados. Se contabilizó un total de 151.470 personas al día para una tasa de incidencia de 157,8 en 100.000 personas, casi tres veces la tasa reportada por el sistema de vigilancia oficial de la ciudad. Conclusión. Se encontraron deficiencias en el diagnóstico y consulta de los niños, al compararlos con la población general. Se necesita más investigación para dilucidar la verdadera carga de la enfermedad en la población infantil.

Fatores que influenciam no cuidado às crianças com agravos respiratórios na atenção primária à saúde / Factors that influence the care of children with respiratory diseases in primary health care / Factores que influyen en la atención de niños con enfermedades respiratorias en atención primaria de salud

Objetivo: Identificar fatores que influenciam no cuidado às crianças com agravos respiratórios na Atenção Primária à Saúde. Métodos: Revisão integrativa realizada mediante pesquisa à Biblioteca Virtual em Saúde, nas bases de dados LILACS, MEDLINE e IBECS, utilizando-se os descritores Infecções Respiratórias, Pneumonia, Asma, Atenção Primária à Saúde e Enfermagem, no período de 2014 a 2018. Foram identificadas 165 publicações, sendo selecionados 34 artigos na língua portuguesa. Os dados foram analisados por meio da análise de conteúdo temática. Resultados: Os resultados foram agrupados nas categorias: determinantes de saúde, resolutividade da atenção primária à saúde e prática de enfermagem. Constatou-se que as condições de nascimento, socioeconômicas e ambientais são os principais aspectos que determinam a manifestação ou complicação dos agravos respiratórios em crianças. Desse modo, também influenciam nas taxas de Internações por Condições Sensíveis à Atenção Primária. Para a redução dessas taxas evidencia-se a necessidade de ampliar a resolutividade da atenção primária à saúde por meio de ações de enfermagem. Conclusão: As ações de enfermagem para o manejo do cuidado dessas crianças na Atenção Primária à Saúde permitem reduzir o número de crianças com necessidade de atendimento de urgência/emergência ou hospitalização, promovendo o controle dos quadros respiratórios agudos e crônicos na atenção básica. (AU)

Objective: Identify factors that influence the care of children with respiratory diseases in Primary Health Care. Methods: Integrative review carried out through research to the Virtual Health Library, in the LILACS, MEDLINE and IBECS databases, using the descriptors Respiratory Infections, Pneumonia, Asthma, Primary Health Care and Nursing, from 2014 to 2018. 165 publications were identified, with 34 articles selected in Portuguese. The data were analyzed using thematic content analysis. Results: The results were grouped into the categories: health determinants, resolvability of Primary Health Care and nursing practice. It was found that birth, socioeconomic and environmental conditions are the main aspects that determine the manifestation or complication of respiratory disorders in children. Thus, they also influence the rates of Hospitalizations for Conditions Sensitive to Primary Care. To reduce these rates, the need to expand the resolution of Primary Health Care through nursing actions is evident. Conclusion: It is concluded that the nursing actions for managing the care of these children in Primary Health Care allow reducing the number of children in need of urgent / emergency care or hospitalization, promoting the control of acute and chronic respiratory conditions in care basic. (AU)

Objetivo: Identificar los factores que influyen en la atención de los niños con enfermedades respiratorias en la Atención Primaria de Salud. Metodos: Revisión integradora realizada por la investigación en la Biblioteca Virtual en Salud, en las bases de datos LILACS, MEDLINE e IBECS, utilizando descriptores Infecciones Respiratorias, Neumonía, Asma, Atención Primaria de Salud y Enfermería, de 2014 a 2018. Se identificaron 165 publicaciones, con 34 artículos seleccionados en portugués. Los datos se analizaron mediante análisis de contenido temático. Resultados: Los resultados se agruparon en las categorías: determinantes de salud, resolubilidad de la Atención Primaria de Salud y práctica de enfermería. Las condiciones de nacimiento, socioeconómicas y ambientales que determinan la manifestación o complicación de los trastornos respiratorios en los niños. Por lo tanto, también influyen en las tasas de Hospitalizaciones por Afecciones Sensibles a la Atención Primaria. Para reducir estas tasas, es evidente la necesidad de ampliar la resolución de la Atención Primaria de Salud por acciones de enfermería. Conclusión: Se concluye que las acciones de enfermería para el manejo de la atención de estos niños en Atención Primaria de Salud permiten reducir el número de niños que necesitan atención de urgência/emergencia o hospitalización, promoviendo el control de las afecciones respiratorias agudas y crónicas en la atención básica. (AU)

Sanitary measures to contain COVID-19 spread decreased pediatric hospitalizations due to other respiratory infections in São Paulo, Brazil

Abstract Objective After the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19. Methods Ecological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model. Results In 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years. Conclusions These findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.

Prescripción de antibióticos en las infecciones respiratorias agudas no neumonías en atención ambulatoria en la práctica privada

Background: The over prescription of antibiotics for acute respiratory infections is a major public health problem worldwide. Aim: To evaluate the frequency of prescription of antibiotics for non-pneumonia acute respiratory infections in private outpatient clinics in individuals without chronic diseases or immunosuppression. Material and Methods: All medical records of adult consultants in a national network of private ambulatory medical centers during May 2018 whose primary diagnosis corresponded to acute respiratory infections not pneumonia (ICD10) were identified and retrospectively analyzed, excluding those with chronic respiratory conditions or states of immunosuppression. Results: Of the 38,072 consultants (aged 36 years, 63% women) who met this criterion, 54% (n = 20,499) received a prescription for at least one antibiotic. The diagnoses that most frequently received this prescription were acute bronchitis (28.7%), acute sinusitis (16.5%) and acute tonsillitis (16.2%). The most frequently prescribed antibiotic globally was azithromycin (37.4%), followed by amoxicillin (20.1%) and amoxicillin plus clavulanic acid (17.7%). Levofloxacin prescription reached 12.5% of total prescriptions. Conclusions: An antibiotic was prescribed in more than half of the non-pneumonia outpatient acute respiratory infections. Azithromycin was the most prescribed antibiotic, while levofloxacin exceeded 10% of prescriptions. These results reinforce the need to implement an antibiotic prescription surveillance system at the outpatient level.

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.

Analysis of pattern of antimicrobial usage in children of age 1 to 12 years with respiratory tract infections admitted in pediatric intensive care unit in a tertiary care hospital

Background: Children are more prone to suffer from recurrent infections of respiratory tract due to their immature developed airway, lungs, and immunity, which makes lower respiratory tract infections as one of the most commonly encountered diseases in PICU and one of the leading causes of death among children below 5 years of age. Antimicrobials are one of the commonly prescribed drugs for respiratory tract infections which act as double edged sword as it has saved many lives from dreadful infections and also its injudicious use can give rise to antimicrobial resistance that can endanger many patients’ lives. Aim and Objectives: The aim of the study was to analyze the pattern of antimicrobial drugs used in in-patients admitted to pediatric intensive care unit with respiratory tract infections and to identify the factors to decide the selection of antibiotics. Materials and Methods: The present study was conducted in Pediatrics along with Pharmacology Department of VIMS, Bellary. After obtaining approval from the institutional ethics committee, the study was conducted. Patients were enrolled in the study after obtaining written informed consent from the patient’s informants. Children of age group 1?12 years, suffering from infections of respiratory tract admitted in PICU who were treated with antibiotics were analyzed in our study. Based on the clinical presentation, the diagnosis of RTI was done by treating pediatrician. Results: In our institute, children of under 5 age group, that is, 2?5 years, about 40% of patients were hospitalized in PICU. Male patient’s preponderance was present about 57.5%. Common most respiratory infection seen was bronchopneumonia (46.5%), followed by lower respiratory tract infection (20.5%) and lobar pneumonia (14.5%). All of these patients were involved with other associated conditions, namely, febrile convulsions, severe anemia, and respiratory distress. Conclusion: Prescribing pattern in pediatric intensive care unit showed the preference of using two antibiotics to treat respiratory tract infections. Ceftriaxone and combination of amoxicillin + clavulanic acid were preferred as first-line antibiotics. Amikacin and vancomycin were used as secondline drugs. Piperacillin, tazobactam, and vancomycin were the next line antimicrobial agents. These drugs were given to patients by parenteral routes such as IV and IM.

Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad / Clinical Practice Guideline for the management of community-acquired pneumonia

Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.

Uso de macrólidos en niños hospitalizados en unidades de cuidados moderados e intensivos durante 2018 / Use of macrolides in children hospitalized in Intensive and moderate care units in 2018 / Uso de macrólidos em crianças hospitalizadas em unidades de cuidados intermediários e intensivos no 2018

Introducción: se describe a nivel mundial un aumento en la prescripción de macrólidos en niños y adolescentes, generando el riesgo de emergencia de cepas resistentes. Objetivo: caracterizar el uso de macrólidos en niños de 1 mes a 14 años hospitalizados en cuidados moderados e intensivos del Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Metodología: estudio descriptivo transversal de niños hospitalizados tratados con macrólidos en el HP-CHPR en 2018. Variables: tipo de macrólido, duración del tratamiento, estudios y hallazgos microbiológicos y diagnóstico al egreso. Resultados: recibieron macrólidos 334 niños, mediana de edad 13 meses, 58,4% varones. 71,0% en Unidad de Terapia Intensiva (UTI). Predominó la prescripción de claritromicina (72,8%), durante los dos últimos cuatrimestres del año (77,5%) y por patología respiratoria (94%): bronquiolitis (23,3%), infección aguda no especificada de las vías respiratorias inferiores (21,9%) y crisis asmática (19,1%). Mediana de tratamiento con azitromicina y claritromicina 5 y 8 días respectivamente. Se realizaron estudios microbiológicos en 96,1% sin determinarse microorganismo en 58,3%. Conclusiones: se destaca el uso de macrólidos principalmente en la UTI y por patología respiratoria. La prescripción por fuera de las recomendaciones nacionales vigentes y la baja confirmación microbiológica que apoye el uso fueron los mayores problemas detectados, por lo que parece fundamental establecer estrategias tendientes a promover un uso racional de estos antibióticos.

Introduction: literature has described a global increase in the prescription of macrolides to children and adolescents , which has increased the risk of emergence of resistant strains. Objective: to characterize the use of macrolides in children from 1 month to 14 years of age hospitalized at the moderate and intensive care units of the Pereira Rossell Pediatric Hospital Center (HP-CHPR). Methodology: descriptive cross-sectional study of hospitalized children treated with macrolides at the HP-CHPR in 2018. Variables: macrolide type, treatment duration, microbiological studies and findings, and diagnosis at discharge. Results: 334 children received macrolides, median age 13 months, 58.4% males. 71.0% hospitalized atnan Intensive Care Unit (ICU). Clarithromycin was mainly prescribed in 72.8% of the cases, during the last two quarters of the year (77.5%), due to respiratory disease (94%): bronchiolitis (23.3%), lower respiratory tract unspecified acute infection (21.9%) and asthma crisis (19.1%). Median treatment included Azithromycin and Clarithromycin for 5 and 8 days respectively. Microbiological studies were carried out in 96.1% of the cases and 58.3% did not show the presence of microorganisms. Conclusions: the use of macrolides stands out, mainly at ICUs and due to respiratory pathologies. The main problems identified were prescriptions made outside the framework of the present national recommendations and the low microbiological confirmation for their use, which suggests it is essential to set strategies to promote a more rational use of these antibiotics.

Introdução: a literatura descreve um aumento a nível global na prescrição de macrolídeos para crianças e adolescentes, o que tem aumentado o risco de surgimento de cepas resistentes. Objetivo: caracterizar o uso de macrolídeos em crianças de 1 mês a 14 anos de idade internadas nas unidades de terapia moderada e intensiva do Centro Hospitalar Pediátrico Pereira Rossell (HP-CHPR). Metodologia: estudo transversal descritivo de crianças hospitalizadas tratadas com macrolídeos no HP-CHPR em 2018. Variáveis: tipo de macrolídeo, duração do tratamento, estudos e achados microbiológicos e diagnóstico no momento da alta. Resultados: 334 crianças receberam macrolídeos, idade mediana de 13 meses, 58,4% do sexo masculino. 71,0% internados em Unidade de Terapia Intensiva (UTI). A Claritromicina foi prescrita principalmente em 72,8% dos casos, nos últimos dois trimestres do ano (77,5%), devido a doença respiratória (94%): bronquiolite (23,3%), infecção aguda não especificada do trato respiratório inferior (21,9%) e crise de asma (19,1%). O tratamento médio incluiu Azitromicina e Claritromicina por 5 e 8 dias, respectivamente. Estudos microbiológicos foram realizados em 96,1% dos casos e 58,3% não evidenciaram a presença de microrganismos. Conclusões: destaca-se o uso de macrolídeos, principalmente em UTIs, e devido a patologias respiratórias. Os principais problemas identificados foram as prescrições feitas fora das atuais recomendações nacionais e a baixa confirmação microbiológica para sua utilização, o que sugere que é essencial definir estratégias para promover uma utilização mais racional destes antibióticos.

Impacto del COVID-19 en la circulación de virus respiratorios en un hospital pediátrico: una ausencia esperada / Impact of COVID-19 on the circulation of respiratory viruses in a children's hospital: an expected absence

Introducción. Los virus respiratorios son la principal causa de infección respiratoria aguda baja (IRAB) en la población pediátrica. En marzo de 2020, la Organización Mundial de la Salud declaró el estado de pandemia de la enfermedad por el nuevo coronavirus 2019 (COVID-19) con un impacto global elevado. El objetivo de este estudio fue describir el impacto de la pandemia de COVID-19 en las internaciones por IRAB en el Hospital de Niños Ricardo Gutiérrez (HNRG) y la circulación viral. Métodos. Estudio observacional, retrospectivo y descriptivo de pacientes internados por IRAB, comparando los años 2019 y 2020. Resultados. En 2020, la tasa de hospitalización por IRAB se redujo un 73 % en el HNRG (575,1/10 000 en 2019 y 155,3/10 000 en 2020). En 2019 se internaron 517 pacientes con IRAB; en 174 se identificaron los virus: sincicial respiratorio (71,2 %), adenovirus (AV) (10,3%), parainfluenza (PIF) (9,7 %) e influenza (FLU) (8,6 %). En 2020, se hospitalizaron 94 pacientes con IRAB. Hasta la semana epidemiológica (SE) 13 se registraron casos de IRAB por PIF y AV; en la SE 29 un caso de bronquiolitis por AV y rinovirus (RV), seguido de casos aislados de RV; no hubo IRAB por VSR ni por FLU. Se registraron 9 casos de IRAB por COVID-19: 2 bronquiolitis moderadas y 7 neumonías focales; con un adolescente fallecido por neumonía por COVID-19 con comorbilidades. En 2020, los casos presentaron mayor edad, más comorbilidades e internaciones previas en comparación con el 2019. La neumonía focal fue la presentación clínica predominante. Conclusión. En 2020, la tasa de hospitalización por IRAB se redujo significativamente en comparación con el año anterior, con ausencia de circulación de virus respiratorios estacionales en la población asistida en nuestro centro.

Introduction. Respiratory viruses are the main cause of acute lower respiratory tract infection (ALRTI) in the pediatric population. In March 2020, the World Health Organization declared that the new coronavirus disease 2019 (COVID-19) had reached the pandemic status. Our objective was to describe the impact of COVID-19 pandemic on hospitalizations due to ALRTI at Hospital de Niños Ricardo Gutiérrez (HNRG) and virus circulation. Methods. Observational, retrospective, and descriptive study of patients hospitalized due to ALRTI comparing 2019 and 2020. Results. In 2020, the rate of hospitalization due to ALRTI decreased by 73%. In 2019, 517 patients with ALRTI were hospitalized; the following viruses were identified in 174: respiratory syncytial virus (RSV) (71.2%), adenovirus (AV) (10.3%), parainfluenza virus (PIV) (9.7%), and influenza virus (FLU) (8.6%). In 2020, 94 patients with ALRTI were hospitalized. Until epidemiological week (EW) 13, cases of ALRTI due to PIV and AV were recorded; in EW 29, there was 1 case of bronchiolitis due to AV and rhinovirus (RV), followed by isolated cases of RV; no ALRTI due to RSV or FLU was recorded. In total, 9 cases of ALRTI due to COVID-19 were recorded: 2 moderate bronchiolitis and 7 focal pneumonia; 1 adolescent with comorbidities died due to COVID-19 pneumonia. In 2020, patients were older and had more comorbidities and prior hospitalizations compared to 2019. Focal pneumonia prevailed. Conclusion. In 2020, the rate of hospitalization due to ALRTI decreased significantly compared to 2019,with the absence of seasonal respiratory virus circulation in the pediatric population.

Clinical study on Guizhi Mahuang Geban Decoction combined with conventional western medicine in the treatment of post infections cough / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Guizhi Mahuang Geban Decoction combined with conventional western medicine in the treatment of post infections cough (PIC), and to explore the mechanism.Methods:A total of 100 PIC patients in our hospital from January 2020 to July 2021 who met the inclusion criteria were divided into 2 groups according to the random number table method, with 50 in each group. The control group was treated with conventional western medicine, and the study group was treated with Guizhi Mahuang Geban Decoction and the treatment of the control group. Both groups were treated for 10 days. TCM symptom scores were performed before and after treatment. The levels of neurokinin A (NKA), substance P (SP), neurokinin B (NKB) and calcitonin gene related peptide (CGRP) were detected by ELISA. Adverse events were recorded and clinical effects were evaluated.Results:The total clinical effective rate was 90.0% (45/50) in the study group and 68.0% (34/50) in the control group, and there was significant difference between the two groups ( χ2=7.29, P=0.007). The scores of cough, expectoration, pharyngeal itch and total score in the study group were significantly lower than those in the control group ( t values were 8.04, 6.30, 9.03, 9.71, all Ps<0.01). After treatment, NKA [(86.08±18.21) ng/L vs. (137.68±28.29) ng/L, t=10.85], SP [(54.23±11.28) ng/L vs. (71.75±15.34) ng/L, t=6.51], NKB [(96.15±20.19) ng/L vs. (149.84±30.22) ng/L, t=10.45], CGRP [(62.93±18.35) ng/L vs. (89.59±23.25) ng/L, t=6.37] levels in the study group were significantly lower than those in the control group ( P<0.01). The incidence of adverse events was 8.0% (4/50) in the control group and 10.0% (5/50) in the study group, and there was no significant difference between the two groups ( χ2=0.13, P=0.727). Conclusions:Compared with western medicine alone, Guizhi Mahuang Geban Decoction combined with western medicine can rapidly improve patients' symptoms, improve curative effect and have better safety for PIC. Its mechanism may be related to the regulation of NKA, SP, NKB and CGRP levels.

Effects of laryngeal mask anesthesia versus tracheal intubation anesthesia on the incidence of pulmonary infection in young children subjected to surgery / 中国基层医药

Objective:To investigate the effects of endotracheal intubation anesthesia versus laryngeal mask anesthesia on the incidence of pulmonary infection in young children undergoing surgery. Methods:A total of 100 young children who underwent surgery under general anesthesia in Hangzhou Children's Hospital from January 2020 to December 2020 were included in this study. They were randomly allocated into the endotracheal intubation anesthesia and laryngeal mask anesthesia groups ( n = 50/group). The symptoms of respiratory tract infection (nasal congestion, cough, sputum ringing, rale, and sputum excretion) and the incidence of pulmonary infection evaluated 24 hours after surgery were compared between the two groups. At the same time, the pathogens of infection and perioperative conditions as well as prognosis were also compared between the two groups. Results:The incidences of nasal obstruction, cough, sputum ringing, rale, sputum excretion, and pulmonary infection were 56.0% (28/50), 42.0% (21/50), 14.0% (7/50), rale 38.0% (19/50), 16.0% (8/50), and 38.00 (19/50) respectively in the endotracheal intubation anesthesia group, which were significantly higher than those in the laryngeal mask anesthesia group [28.0% (14/50), 14.0% (28/50), 4.0% (8/50), 24.0% (12/50) 4.0% (2/50), 6.0%(3/50), χ2 = 12.18, 21.47, all P < 0.001]. A total of 34 strains of pathogens were detected in the two groups, including 4 strains in the laryngeal mask anesthesia group and 30 strains in the endotracheal intubation anesthesia group. The 34 strains of pathogens included 7 strains of gram-positive bacteria (20.6%), 23 strains of gram-negative bacteria (67.6%), and 4 strains of fungi (11.8%). There was no significant difference in pathogen composition between the two groups ( χ2 = 1.04, P = 0.310). The time to recovery and the time to extubation in the laryngeal mask anesthesia group were (10.3 ± 3.1) minutes and (13.5 ± 2.4) minutes, which were significantly shorter than those in the endotracheal intubation anesthesia group [(16.1 ± 5.1) minutes, (19.5 ± 4.1) minutes, t = 3.17, 7.19, both P < 0.05]. There were no significant differences in the proportion of children who needed prolonged hospitalization and the proportion of children scheduled to undergo readmission between the two groups (both P > 0.05). Conclusion:Laryngeal mask anesthesia is simpler to operate, remarkably decreases the incidence of pulmonary infection, and is safer compared with endotracheal intubation anesthesia. Therefore, laryngeal mask anesthesia is preferred for general anesthesia for surgery in young children. The study is of great innovation and science.

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.

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.

Investigation on outbreaks of acute respiratory tract infection caused by respiratory syncytial virus in kindergartens in Hangzhou / 中国学校卫生

Objective@#In order to analyze the characteristics of the outbreak of acute respiratory tract infection in children caused by respiratory syncytial virus(RSV).@*Methods@#The field epidemiological investigations were conducted for the two outbreaks in kindergartens in Hangzhou. Data were analyzed by descriptive method. Samples with positive respiratory syncytial virus nucleic acid were sequenced using PCR.@*Results@#The two outbreaks occurred in kindergartens. There were 21 cases in kindergarten A, lasting 11 days, and 43 cases in kindergarten B, lasting 33 days. The epidemic curve showed a proliferation pattern. The cases were concentrated in nurseries and K1 classes, primarily among children aged 2-4 years. The most common symptoms were fever and cough, mainly upper respiratory tract infection, and no severe cases were found. Upper respiratory tract samples were collected and detected as positive for RSV. Four samples were sequenced and identified as subgroup B.@*Conclusion@#During the outbreak of acute respiratory infection in kindergartens, respiratory syncytial virus should be given primary consideration in the process of identification of the outbreak caused by other respiratory infections, and strictly control measures should be taken to reduce the long term impact of the epidemic.

Investigation on an outbreak of human metapneumovirus respiratory tract infection in a primary school of Huzhou City / 中国学校卫生

Objective@#To understand the epidemiological characteristics of an outbreak of respiratory tract infection caused by human metapneumovirus (hMPV) in a primary school in Huzhou City, and to provide scientific reference for the prevention and control of the outbreak of upper respiratory tract infection caused by hMPV in the future.@*Methods@#The investigation was carried out according to the Guidelines for Handling Influenza Like Case Outbreaks (2018 version). The throat swabs were collected to carry out COVID-19 nucleic acid test. If negative, influenza virus and other common 14 upper respiratory tract virus detection would be conducted.@*Results@#A total of 53 cases of human metapneumovirus infection were found, the first case was found on December 15, 2020; the cases concentrated from December 21 to December 26; the last case was on December 29. It lasted 15 days and the epidemic ended. All the cases were first year students, and the incidence rate of the affected classes was 44.92% (53/118), among which the incidence rate of 101 classes was 23.08% (9/39), 102 classes was 53.85% (21/39), 103 classes was 57.50%( 23/40 ), the difference was statistically significant( χ 2=10.07, P <0.05). The age of the patients ranged from 6 to 7 years. The morbidity rate of boys was 48.00%(24/50) and that of girls was 42.65% (29/68), with no significant difference( χ 2=0.33, P >0.05). The clinical symptoms of all cases were mild, mainly cough, sore throat, runny nose, only a small number of fever. Throat swabs of 20 patients were collected, and 13 cases were positive for human metapneumovirus nucleic acid.@*Conclusion@#The symptoms caused by human metapneumovirus are relatively mild, which is not easy to attract the attention of schools and parents. Schools should carry out relevant prevention and control knowledge publicity, do a good job in the morning and afternoon inspection, and put an end to classes with diseases.