Seasonality of the incidence of bronchiolitis in infants — Brazil, 2016-2022: An interrupted time-series analysis / Sazonalidade da incidência de bronquiolite em lactentes — Brasil, 2016-2022: Uma análise de série temporal interrompida

ABSTRACT Objective: To evaluate the seasonality of acute bronchiolitis in Brazil during the 2020-2022 season and compare it with the previous seasons. Methods: Data from the incidence of hospitalizations due to acute bronchiolitis in infants <1 year of age were obtained from the Department of Informatics of the Brazilian Public Health database for the period between 2016 and 2022. These data were also analyzed by macro-regions of Brazil (North, Northeast, Southeast, South, and Midwest). To describe seasonal and trend characteristics over time, we used the Seasonal Autoregressive Integrated Moving Averages Model. Results: Compared to the pre-COVID-19 period, the incidence of hospitalizations related to acute bronchiolitis decreased by 97% during non-pharmacological interventions (March 2020 - August 2021) but increased by 95% after non-pharmacological interventions relaxation (September 2021 - December 2022), resulting in a 16% overall increase. During the pre-COVID-19 period, hospitalizations for acute bronchiolitis followed a seasonal pattern, which was disrupted in 2020-2021 but recovered in 2022, with a peak occurring in May, approximately 4% higher than the pre-COVID-19 peak. Conclusions: This study underscores the significant influence of COVID-19 interventions on acute bronchiolitis hospitalizations in Brazil. The restoration of a seasonal pattern in 2022 highlights the interplay between public health measures and respiratory illness dynamics in young children.

RESUMO Objetivo: Avaliar a sazonalidade da bronquiolite aguda no Brasil durante a temporada 2020-2022 e compará-la com a das temporadas anteriores. Métodos: Os dados de incidência de internações por bronquiolite aguda em lactentes <1 ano de idade foram obtidos do Departamento de Informática da base de dados da Saúde Pública Brasileira para o período entre 2016 e 2022. Esses dados também foram analisados por macrorregiões do Brasil (Norte, Nordeste, Sudeste, Sul e Centro-Oeste). Para descrever características sazonais e de tendência ao longo do tempo, utilizamos o Modelo de Médias Móveis Integradas Autorregressivas Sazonais. Resultados: Em comparação com o período pré-COVID-19, a incidência de hospitalizações relacionadas com bronquiolite aguda diminuiu 97% durante as intervenções não farmacológicas (março de 2020 - agosto de 2021), mas aumentou 95% após a flexibilização das intervenções não farmacológicas (setembro de 2021 - dezembro de 2022), resultando no aumento geral de 16%. Durante o período pré-COVID-19, as hospitalizações por bronquiolite aguda seguiram um padrão sazonal, que foi interrompido em 2020-2021, mas recuperaram-se em 2022, com um pico ocorrido em maio, aproximadamente 4% superior ao pico pré-COVID-19. Conclusões: Este estudo ressalta a influência significativa das intervenções contra a COVID-19 nas hospitalizações por bronquiolite aguda no Brasil. A restauração de um padrão sazonal em 2022 sublinha a interação entre as medidas de saúde pública e a dinâmica das doenças respiratórias em crianças pequenas.

Clinical analysis of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation / 器官移植

<b>Objective</b> To evaluate clinical efficacy of lung transplantation for lung chronic graft-versus-host disease (cGVHD) after hematopoietic stem cell transplantation (HSCT). <b>Methods</b> Clinical data of 12 patients undergoing lung transplantation for lung cGVHD were retrospectively analyzed. Preoperative clinical manifestations and involved organs of patients were analyzed. The lung function before and after lung transplantation was compared, and the survival of patients after lung transplantation was analyzed. <b>Results</b> Eleven patients underwent HSCT due to primary hematological malignancies, including 9 cases of leukemia, 1 case of myelodysplastic syndrome, 1 case of lymphoma. And 1 case underwent HSCT for systemic lupus erythematosus. Among 12 cGVHD patients, skin involvement was found in 8 cases, oral cavity involvement in 5 cases, gastrointestinal tract involvement in 4 cases and liver involvement in 3 cases. All 12 patients developed severe respiratory failure caused by cGVHD before lung transplantation, including 9 cases of typeⅡ respiratory failure and 3 cases of type Ⅰ respiratory failure. Two patients underwent right lung transplantation, 2 cases of left lung transplantation and 8 cases of bilateral lung transplantation. The interval from HSCT to lung transplantation was 75 (19-187) months. Upon the date of submission, postoperative follow-up time was 18 (7-74) months. Ten patients survived, 1 died from severe hepatitis at postoperative 22 months, and 1 died from gastrointestinal bleeding at postoperative 6 months. No recurrence of primary diseases was reported in surviving patients. <b>Conclusions</b> Lung transplantation is an efficacious treatment for lung cGVHD after HSCT, which may prolong the survival time and improve the quality of life of the recipients.

Predictive value of IL-33,Eotaxin and sCD163 levels for recurrent wheezing in children with bronchiolitis / 国际检验医学杂志

Objective To investigate the predictive value of interleukin-33(IL-33),eosinophil chemotactic factor(Eotaxin),soluble scavenger receptor CD163(sCD163)for recurrent wheezing in children with bronchi-olitis.Methods A total of 120 children with bronchiolitis who were treated in Jiamusi Maternal and Child Health Hospital from August 2019 to October 2021 were enrolled in the study.The clinical data of the chil-dren were collected,including demographic factors,birth factors,atopic factors,length of hospital stay,time from symptom onset to visit,and respiratory distress assessment tool(RDAI)score.Respiratory syncytial vi-rus(RSV)and rhinovirus(RV)were detected.Blood samples were collected for detection.Blood test indica-tors included total immunoglobulin E(IgE),white blood cell count(WBC),IL-33,Eotaxin and sCD163.The discharged children were followed up for 1 year,and they were divided into non-recurrent group and recurrent group according to the number of wheezing episodes.The two groups were compared in terms of clinical data and blood test indicators.Logistic regression was used to analyze the risk factors for recurrent wheezing in children with bronchiolitis.Pearson correlation analysis was used to analyze the correlation between blood test indexes and RDAI score.The receiver operating characteristic(ROC)curve was drawn to analyze the value of IL-33,Eotaxin,and sCD163 levels alone and in combination in predicting recurrent wheezing in children with bronchiolitis.Results Compared with the non-recurrent group,the recurrent group had significantly higher RDAI score,higher proportion of patients with a history of eczema,a personal history of allergy,and a signifi-cantly higher RSV infection rate(P＜0.05).The recurrent group had significantly higher levels of IL-33,Eotaxin,and sCD163 than the non-recurrent group(P＜0.05).Pearson correlation analysis showed that the levels of IL-33,Eotaxin,and sCD163 in children with bronchiolitis were positively correlated with RDAI score(r=0.516,0.611,0.522,P＜0.05).Logistic regression analysis showed that RDAI score,history of eczema,personal history of allergy,RSV infection,increased IL-33 levels,increased Eotaxin levels,and increased sCD163 levels were risk factors for recurrent wheezing in children with bronchiolitis(OR＞1,P＜0.05).The ROC curve found that The area under the curve(AUC)of IL-33,Eotaxin,and sCD163 levels alone and in combination for predicting recurrent wheezing in children with bronchiolitis was 0.829(95％CI:0.757-0.901),0.858(95％CI:0.794-0.922),and 0.857(95％CI:0.789-0.925)and 0.954(95％CI:0.921-0.987).Conclusion Increased levels of IL-33,Eotaxin and sCD163 in children with bronchiolitis can increase the risk of recurrent wheezing,and the combined detection of the three can effectively predict the occurrence of recurrent wheezing.

Correlation analysis between serum total IgE and FeNO and idiosyncratic reaction in bronchiolitis

Abstract Objective This article focused on the correlation between the changes of serum total Immunoglobulin E (IgE) and Fractional exhaled Nitric Oxide (FeNO) and idiosyncratic reactions in children with bronchiolitis. Methods One hundred children with bronchiolitis and fifty healthy children were enrolled. Serum total IgE and FeNO were assessed, and the diagnostic value for bronchiolitis and the correlation with the severity of bronchiolitis were analyzed. Bronchiolitis children were divided into idiosyncratic + bronchiolitis and non-idiosyncratic + bronchiolitis groups, the relationship between serum total IgE and FeNO and idiosyncratic reaction was determined, and the diagnostic value of serum total IgE and FeNO for idiosyncratic bronchiolitis was examined. Results FeNO in bronchiolitis children was lower than that in healthy children but there was no significant difference in serum total IgE levels between the two populations. Serum total IgE increased while FeNO decreased with the aggravation of bronchiolitis in bronchiolitis children. The serum total IgE was positively correlated while FeNO was negatively correlated with the severity of bronchiolitis. Serum total IgE was higher in children with idiosyncratic bronchiolitis, but serum total IgE and FeNO were not the risk factors for idiosyncratic bronchiolitis; Area Under the Curve (AUC) of serum total IgE and FeNO for the diagnosis of idiosyncratic bronchiolitis was less than 0.7. Conclusion Serum total IgE and FeNO in children with bronchiolitis are related to disease severity and idiosyncratic reaction. FeNO has a diagnostic value for bronchiolitis, but not for idiosyncratic bronchiolitis.

Acute viral bronchiolitis phenotype in response to glucocorticoid and bronchodilator treatment

Abstract Objective To analyze whether infants admitted to hospital with Acute Viral Bronchiolitis (AVB), who received glucocorticoids and bronchodilators, and who had an atopic phenotype, spent less time in hospital and/or less time on oxygen therapy when compared to those who did not have the phenotype. Method A cross-sectional, retrospective epidemiological study was developed with data from medical records of infants admitted to hospital due to AVB from 2012 to 2019 in a sentinel public hospital. It was verified that the frequency of prescription of glucocorticoids, bronchodilators and antibiotics. Length of stay and oxygen therapy duration were then compared in the group that used glucocorticoids and bronchodilators between those who had a personal or family history of atopy and those who did not. Subsequently, the length of hospital stay was compared among infants who received antibiotic therapy and those who did not. Results Fifty-eight infants were included. Of these, 62.1 % received an antibiotic, 100 % a bronchodilator and 98.3 % a glucocorticoid. When comparing infants without a family history of atopy, those who received antibiotics had a longer hospital stay (p = 0.01). Conclusion The presence of an atopic phenotype did not interfere with the length of stay and/or oxygen therapy duration of those who received bronchodilators and glucocorticoids. Increased length of stay of infants without a family history of atopy, who used antibiotics without evidence of bacterial co-infection, and the high frequency of prescription of non-recommended drugs call attention to stricter protocol implementation and professional training in AVB diagnosis and care.

Características clínico-etiológicas de pacientes pediátricos hospitalizados con diagnóstico de bronquiolitis. Ciudad de Santa Fe, Argentina

Introducción: La bronquiolitis constituye una de las principales causas de Infecciones Respiratorias Agudas Bajas en Pediatría, y es responsable de una proporción significativa de hospitalizaciones en lactantes, fundamentalmente, en menores de 1 año. Su diagnóstico es clínico, caracterizado por síntomas y signos de amplio grado de gravedad. Objetivo: Describir las características clínico-etiológicas de casos de bronquiolitis en menores de 1 año, internados en un hospital de niños de la ciudad de Santa Fe, durante un periodo de un año. Materiales y Métodos: Estudio observacional, transversal. Se analizaron datos demográficos, clínicos y de laboratorio de fichas médicas de vigilancia epidemiológica. Las técnicas diagnósticas usadas según el agente viral fueron RT-PCR en tiempo real, PCR-punto final e Inmunofluorescencia Indirecta. Resultados: Sobre un total de 108 casos, 90,7% tuvo de 1 a 6 meses de edad. La mediana de internación fue de 5 días, y el nacimiento prematuro fue la condición médica previa más frecuente. Un 78,7% (85) tuvo diagnóstico viral positivo, siendo Rinovirus (hRV) y Virus Sincicial Respiratorio (VSR) los agentes más prevalentes, tanto en infección única como en coinfección. El tiempo de oxigenoterapia fue mayor en los pacientes más graves (p<0,001). El 32,4% (35) recibió alguna medicación que fue, en mayor frecuencia, antibiótico. Se encontró asociación positiva y significativa entre la edad menor de 3 meses y una hospitalización mayor a 5 días (OR=2,5; IC: 1,1-5,8; p=0,02); y entre un diagnóstico VSR positivo y un cuadro grave (OR: 7,7; IC: 1,95-39,6; p<0,001). Conclusión: Las características y condiciones médicas consideradas por la literatura como factores de riesgo para el padecimiento y la gravedad de una IRAB, fueron halladas con mayor frecuencia en la población de estudio. El hRV y el VRS fueron los agentes de mayor rescate viral, encontrándose una asociación positiva entre la infección por VSR y la gravedad del cuadro.

Introduction: Bronchiolitis is one of the main causes of Acute Lower Respiratory Infections in pediatrics, and is responsible for a significant proportion of hospitalizations in infants, mainly in children under 1 year of age. Its diagnosis is clinical. The disease is characterized by a wide variety and degree of signs and symptoms. Objective: To describe the clinical-etiological characteristics of cases of bronchiolitis in children under 1 year of age, admitted to a children's hospital in the city of Santa Fe, over a period of one year. Materials and Methods: This was an observational and cross-sectional study. Demographic, clinical and laboratory data from epidemiological surveillance medical records were analyzed. The diagnostic techniques used, based on the viral agent, were real-time RT-PCR, end-point PCR and Indirect Immunofluorescence. Results: Out of a total of 108 cases, 90.7% were between 1 and 6 months old. The median hospital stay was 5 days, and premature birth was the most common prior medical condition. 78.7% (85) had a positive viral diagnosis, with Rhinovirus (hRV) and Respiratory Syncytial Virus (RSV) being the most prevalent agents, both in single infection and coinfection. Oxygen therapy time was longer in the most seriously ill patients (p<0.001). 32.4% (35) received some medication, which was, most frequently, antibiotics. A positive and significant association was found between age less than 3 months and hospitalization longer than 5 days (OR=2.5; CI: 1.1-5.8; p=0.02); and between a positive RSV diagnosis and a severe condition (OR: 7.7; CI: 1.95-39.6; p<0.001). Conclusions: The characteristics and medical conditions considered by the literature as risk factors for the morbidity and severity of a lower respiratory tract infection were found more frequently in the study population. hRV and RSV were the most commonly-detected viral agents. We found a positive association between RSV infection and the severity of the condition.

Usefulness of lung ultrasound in the evaluation of children with lower respiratory tract infection in the emergency room / Utilidad de ecografía pulmonar en la valoración de niños con infección respiratoria baja en urgencias

Abstract Background: Lung ultrasound is a bedside tool that allows the evaluation of pulmonary parenchymal involvement in pediatric patients through the lung ultrasound score (LUS). We aimed to evaluate a group of patients under 3 years of age with lower respiratory tract infections using LUS at the Hospital Infantil del Estado de Sonora. Methods: We included patients younger than 3 years admitted to the emergency department with lower respiratory tract infections. A lung ultrasound was performed within the first 24 h of admission to the emergency department and evaluated using LUS. We analyzed age, sex, etiology of infection, days of stay, use of mechanical ventilation, Downes scale, failure of mechanical ventilation on admission, and mortality. Descriptive analysis was performed with frequencies and percentages for qualitative variables and medians and interquartile intervals for quantitative variables. Differences in the distribution of LUS variables were evaluated with the Fishers´ exact test and Student´s t-test. Results: We included a total of 19 patients with lower respiratory tract infections, 73.7% with bronchiolitis. Fifty percent of the cases scored 7 on the LUS, 91.7% were admitted to the pediatric intensive care unit, and 53.8% required invasive mechanical ventilation. Conclusions: The use of LUS in lower respiratory tract infections can predict the need for PICU admission, the use of invasive ventilatory support, and prolonged hospital stay.

Resumen Introducción: El ultrasonido pulmonar es una herramienta a pie de cama que permite evaluar la afectación del parénquima pulmonar en pacientes pediátricos por medio de la escala de LUS (lung ultrasound score, por sus siglas en inglés). El objetivo del estudio fue evaluar a niños menores de 3 años con infección respiratoria baja mediante la escala de LUS, en el Hospital Infantil del Estado de Sonora. Métodos: Se incluyeron pacientes menores de 3 años que ingresaron al Servicio de Urgencias con infección respiratoria baja. Se realizó ecografía pulmonar en las primeras 24 horas de ingreso a urgencias y se evaluó mediante la escala de LUS. Se analizó, edad, sexo, etiología de la infección, días de estancia, uso de terapia ventilatoria, escala de Downes, fracaso a la terapia ventilatoria de ingreso y mortalidad. Se realizó un análisis descriptivo por medio de frecuencia y porcentaje para las variables cualitativas y para las cuantitativas con mediana e intervalo intercuartil. Las diferencias en la distribución de las variables por la escala de LUS con la prueba exacta de Fisher y la t de Student. Resultados: Se identificaron 19 pacientes con infección pulmonar aguda, de los cuales el 73.7% presentó bronquiolitis. El 50% de los casos obtuvo 7 puntos de la escala de LUS, el 91.7% ingresó a UCIP y el 53.8% requirió ventilación mecánica asistida. Conclusiones: El uso de la escala LUS en infección respiratoria baja puede predecir la necesidad de ingreso a Unidad de Cuidados Intensivos Pediátricos, así como la utilización de soporte ventilatorio invasivo y una estancia hospitalaria prolongada.

Bronquiolitis obliterante postinfecciosa en niños: serie de casos en un hospital pediátrico de Perú / Postinfectious bronchiolitis obliterans in children: case series at a pediatric hospital in Peru

Resumen Introducción: La bronquiolitis obliterante postinfecciosa es una enfermedad pulmonar poco frecuente; existen limitados reportes en Sudamérica. Caso clínico: En esta serie se reportan 10 pacientes con esta enfermedad diagnosticados en el Instituto Nacional de Salud del Niño-Breña (Lima-Perú). La mediana de edad al diagnóstico fue de 19 meses. Todos los pacientes presentaron el antecedente de infección respiratoria aguda grave. Los síntomas más frecuentes fueron tos, dificultad respiratoria, sibilancias e hipoxemia; el patrón de atenuación en mosaico fue la característica más frecuente en la tomografía. Todos tenían serología positiva para adenovirus. Se administró tratamiento con pulsos de metilprednisolona, azitromicina, hidroxicloroquina y corticoides inhalados. Ningún paciente falleció durante el seguimiento. Conclusiones: En los niños previamente sanos con antecedente de infección respiratoria aguda grave y sintomatología obstructivo bronquial persistente se debe considerar el diagnóstico de bronquiolitis obliterante postinfecciosa. Este es el primer reporte en Perú con un régimen terapéutico adaptado a nuestra institución.

Abstract Background: Postinfectious bronchiolitis obliterans is a rare lung disease; there are limited reports in South America. Case report: We report 10 patients with this disease diagnosed at the Instituto Nacional de Salud del Niño-Breña (Lima-Peru). The median age at diagnosis was 19 months and all patients had a history of severe acute respiratory infection. The most frequent symptoms were cough, respiratory distress, wheezing, and hypoxemia. The mosaic attenuation pattern was the most frequent on the tomography. All the patients had positive serology for adenovirus. The treatment received was methylprednisolone pulses, azithromycin, hydroxychloroquine, and inhaled corticosteroids. No patient died during the follow-up. Conclusions: In previously healthy children with a history of severe acute respiratory infection and persistent bronchial obstructive symptoms, the diagnosis of postinfectious bronchiolitis obliterans should be considered. This is the first report in Peru with a therapeutic regimen adapted to our institution.

Two cases of airway dysfunction related to diacetyl exposure / 中华劳动卫生职业病杂志

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

A multicenter clinical study of the impact of COVID-19 pandemic on hospitalization of children with bronchiolitis / 国际儿科学杂志

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

Application of early respiratory training program based on 4E model in children with bronchiolitis obliterans / 中国实用护理杂志

Objective:To explore application effect of early respiratory training schemes based on 4E mode (Engage, Educate, Execute, Evaluate) in children with bronchiolitis obliterans (BO) and provide evidence for the clinical implementation of early respiratory rehabilitation in children with BO.Methods:This was a quasi-experimental study. The children with BO who were admitted to 2 wards of the Department of Respiratory Medicine of Hunan Children's Hospital from January 1 to December 31, 2021 were selected as the research objects. They were randomly divided into the control group and the experimental group, with 23 cases in each group. The control group received routine treatment, nursing and rehabilitation guidance. The experimental group established a multidisciplinary team based on the control group, and used the early respiratory training program based on the 4E model to implement intervention. The clinical symptom severity scale was used to evaluate the improvement of the clinical symptoms of the children within 24 hours of being diagnosed as BO, the day of discharge, and 1 and 3 months after discharge for re-examination, and the hospitalization time of the children and the incidence of adverse events related to respiratory training were counted by using medical records and questionnaires.Results:The clinical symptom severity scores of the experimental group within 24 hours of admission diagnosis and the day of discharge were (20.00 ± 2.51) and (11.30 ± 2.46)points respectively, while those of the control group were (20.57 ± 2.21) and (11.70 ± 2.42) points respectively, with no statistically significant difference ( t=0.81, 0.54, both P>0.05). The clinical symptom severity scores of the experimental group were(10.52 ± 2.31) and (8.55 ± 1.06) points, lower than (12.32 ± 1.39) and (12.45 ± 2.19) points of the control group when they returned to the hospital for re-examination 1 and 3 months after discharge, with a statistically significant difference ( t=3.14, 7.25, both P<0.05). The experimental group was hospitalized for (11.78 ± 1.17) days, which was showter than (13.74 ± 1.63) days in the control group, with a statistically significant difference ( t=4.68, P<0.05). No respiratory training-related adverse events occurred in both groups of children during hospitalization. During home respiratory training after discharge, 1 and 2 respiratory training-related adverse events occurred in the experimental group 1 and 3 months after discharge, respectively, compared with 6 and 9 in the control group. The difference was statistically significant ( χ2=4.64, 5.94, both P<0.05). Conclusions:Early respiratory training solutions based on the 4E mode can improve the clinical symptoms of BO children, shorten the hospitalization time, reduce the number of adverse events related to respiratory training, and promote the recovery of children.

Establishment and validation of a model for predicting recurrent wheezing in children with bronchiolitis / 中国医师进修杂志

Objective:To analyze the risk factors of recurrent wheezing in children with bronchiolitis and to construct a predictive model.Methods:Prospective research methods was used. One hundred and eighty children with bronchiolitis who were treated in Hefei Eighth People's Hospital from February 2017 to February 2019 were selected as the study subjects, and the included children were separated into a modeling group (126 cases) and a validation group (54 cases) according to 7∶3. The children were followed up for 3 years, and then the modeling group was divided into wheezing group (48 cases) and no wheezing group (78 cases) according to whether the children had recurrent wheezing. The Hosmer-Lemeshow fitting curve and receiver operating characteristic (ROC) curve were drawn to evaluate the validity and accuracy of the constructed prediction model.Results:Multivariate Logistic regression analysis showed that artificial feeding ( OR = 8.838, 95% CI 2.601 to 30.027), family history of allergies ( OR = 6.709, 95% CI 1.825 to 24.665), underlying diseases ( OR = 8.114, 95% CI 1.638 to 40.184), and higher IgE level ( OR = 1.020, 95% CI 1.012 to 1.029) were the independent risk factors for recurrent wheezing in children with bronchiolitis ( P<0.05). The area under the curve of the modeling group was 0.917 (95% CI 0.855 to 0.959), and the sensitivity and specificity were 83.33% and 85.90%, respectively; the area under the curve of the validation group was 0.911 (95% CI 0.847 to 0.954), and the sensitivity and specificity were 89.58% and 79.49%, respectively. Conclusions:Artificial feeding, family history of allergies, underlying diseases, and higher IgE level are the independent risk factors for recurrent wheezing in children with bronchiolitis. The constructed prediction model has good accuracy and validity, and can be used as an effective tool for clinical prediction of recurrent wheezing in children with bronchiolitis.

Effects of aerosol therapy with budesonide suspension combined with compound ipratropium bromide on partial pressure of carbon dioxide and tumor necrosis factor α in children with bronchiolitis / 中国基层医药

Objective:To investigate the effects of aerosol therapy with budesonide suspension combined with compound ipratropium bromide on partial pressure of carbon dioxide (PaCO 2) and tumor necrosis factor α (TNF-α) in children with bronchiolitis. Methods:A total of 124 children with bronchiolitis admitted to Gujiao Central Hospital from January 2019 to December 2021 were included in this study. These children were randomly divided into two groups using the coin-tossing method. The control group ( n = 62) was treated with routine symptomatic treatment, and the study group ( n = 62) was treated with aerosol therapy of budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment. The time at which clinical symptoms disappear, clinical efficacy, inflammatory reaction, and blood gas index were determined in each group. Results:After treatment, the time at which asthma, cough, pulmonary rales, and fever in the study group were (2.28 ± 0.71) days, (3.30 ± 0.82) days, (5.25 ± 1.03) days, and (19.01 ± 2.65) hours, respectively, which were significantly shorter than (2.71 ± 0.89) days, (3.81 ± 0.98) days, (5.72 ± 1.37) days, and (20.76 ± 3.12) hours in the control group ( t = 2.97, 3.14, 2.15, 3.36, all P < 0.05). Total response rate and PaO 2 in the study group were 91.94% and (83.94 ± 4.02) mmHg, respectively, which were significantly higher than 77.42% and (81.25 ± 5.53) mmHg in the control group ( χ2 = 5.03, t = 3.09, both P < 0.05). Interleukin-18, interleukin-33, TNF-α, and PaCO 2 in the study group were (141.03 ± 34.69) ng/L, (143.87 ± 38.43) ng/L, (75.49 ± 18.43) ng/L, and (41.85 ± 3.31) mmHg, respectively, which were significantly lower than (158.64 ± 47.92) ng/L, (162.75 ± 50.32) ng/L, (83.22 ± 21.75) ng/L, and (43.58 ± 4.46) mmHg in the control group ( t = -2.34, -2.34, -3.23, -2.45, all P < 0.05). Conclusion:Aerosol therapy with budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment is more effective on bronchiolitis than routine symptomatic treatment alone. The combined therapy can effectively decrease PaCO 2 and TNF-α levels.

A Case of Paraneoplastic Pemphigus with Malignant Thymoma and Obliterated Bronchiolitis / 罕见病研究

Paraneoplastic pemphigus (PNP) is a rare and life-threatening autoimmune blistering disease characterized by severe mucosal erosions and polymorphous cutaneous eruptions associated with lymphoproliferative neoplasmas. Castleman's disease, non-Hodgkin's lymphoma, thymoma, follicular dendritic cell sarcoma and chronic lymphocytic leukemia are the commonly associated neoplasmas in PNP, whereas malignant thymoma is rare. The prognosis of PNP is poor due to severe infections during immunosuppressive treatment, underlying malignancies and bronchiolitis obliterans mediated by autoimmunity. A 58-year-old woman who experienced recurrent oral erosive ulcer for 3 years, systemic erythema for 10 months, and dyspnea for 3 months was diagnosed with PNP with malignant thymoma and obliterated bronchiolitis by clinical, radiological, histopathological, and immunological examinations. She died of respiratory failure 3 weeks after resection of the malignant thymoma.

Analysis of family management level and its influencing factors of family with bronchiolitis obliterans children / 中国实用护理杂志

Objective:To investigate the family management level of children with bronchiolitis obliterans and analyze its influencing factors, so as to provide reference for clinical medical staff to adopt targeted nursing and health education programs.Methods:This was a cross-sectional study. From January 1, 2019, to April 30, 2022, 201 families of bronchiolitis obliterans children hospitalized in Hunan Children's Hospital were selected as the research objects, and the General Data Questionnaire, Family Management Scale, Coping Style Scale of Parents, and Chronic Disease-Related Health Literacy Scale was used to investigate. Single-factor analysis and multiple regression analysis were used to analyze the influencing factors of bronchiolitis obliterans children's family management level.Results:The total score of bronchiolitis obliterans children's family management was (179.67 ± 9.92) points, the total score for parents' coping style was (177.14 ± 22.19) points, and the total score for health literacy was (102.95 ± 8.60) points. Multiple regression analysis showed that age, disease course, family residence, parents' education level, family monthly income, parents' coping style, and health literacy level were the influencing factors of family management level (all P<0.05). Conclusions:The family management ability of parents of children with bronchiolitis obliterans needs to be further improved. It is suggested that medical staff should formulate corresponding measures according to the age, course of the disease, family residence, parents' education level, etc., carry out targeted health education and home management training, improve the parents' health literacy level, and guide them to deal with diseases positively, to improve their family management level and promote the recovery of children's diseases.

Nursing care for a child underwent lung retransplantation / 中华护理杂志

To summarize the nursing experience of a child with pulmonary rejection after hematopoietic stem cell transplantation who underwent double lung transplantation and was complicated with bronchiolitis obliterans after lung transplantation and underwent second lung transplantation.The key points of nursing included:the implementation of step-wise lateral position and prone position alternate non-invasive mechanical ventilation to improve lung function;sequential airway clearance was used to control pulmonary infection;precise volume management to prevent pulmonary edema;to strengthen the observation and medication management,prevent hospital infection and rejection;to provide goal-oriented personalized nutritional support to improve nutritional status;psychological nursing measures were implemented to improve the treatment confidence and compliance of children;health education and follow-up management should be strengthened to improve the long-term quality of life.After active treatment and careful nursing,the child recovered and was discharged 26 days after surgery.

Protective effect and mechanism of silymarin on bronchiolitis caused by respiratory syncytial virus in mice / 中国医师杂志

Objective:To investigate the protective effect and mechanism of silymarin on bronchiolitis caused by respiratory syncytial virus (RSV) in mice.Methods:A mouse model of bronchiolitis was established by intranasal instillation of RSV. After successful modeling, the mice were randomly divided into a model group, a positive control group (ribavirin, 10 mg/kg), a low-dose silymarin group (25 mg/kg), a medium-dose silymarin group (50 mg/kg), and a high-dose silymarin group (100 mg/kg). In addition, a control group was established, with 12 mice in each group. The pulmonary index and RSV virus load were determined in each group of mice. Hematoxylin-eosin (HE) staining was used to observe the pathological changes in the lungs. The levels of interleukin-4 (IL-4), interferon-γ (IFN-γ), transforming growth factor-β (TGF-β), IL-17, and IL-10 in bronchoalveolar lavage fluid (BALF) were detected by enzyme-linked immunosorbent assay (ELISA). Flow cytometry was used to detect the proportion of helper T cells 17 (Th17) and regulatory T cells (Treg) in peripheral blood. Western blot was used to detect the expression levels of Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), nuclear factor κB subunit p65 (NF-κB p65), and phosphorylated nuclear protein p-NF-κB p65 in lung tissue.Results:Compared with the model group, the pulmonary injury and inflammatory response were significantly improved in the medium-and high-dose silymarin groups. The pulmonary indexes were (1.27±0.17)% and (0.94±0.10)%, respectively, and the RSV virus loads were (2.65±0.19) and (2.13±0.14), respectively, which were significantly lower than those in the model group (all P<0.05). The proportion of Th17 cells in peripheral blood was (4.47±0.19)% and (3.52±0.13)%, respectively, which was significantly lower than that in the model group (all P<0.05), while the proportion of Treg cells in peripheral blood was (0.88±0.08)% and (1.33±0.12)%, respectively, which was significantly higher than that in the model group (all P<0.05). The expression levels of IL-4 and IL-17 in BALF and the protein expression levels of TLR4/NF-κB signaling pathway related proteins in lung tissue were significantly lower than those in the model group (all P<0.05), while the expression levels of IFN-γ, TGF-β, and IL-10 in BALF were significantly higher than those in the model group (all P<0.05). Conclusions:Silymarin can regulate immune function and inhibit inflammatory response, thereby improving airway inflammation in bronchiolitis mice. The mechanism may be related to inhibit activation of TLR4/NF-κB signaling pathway.

Temporal-spatial analysis of hospitalizations for bronchiolitis in Brazil: prediction of epidemic regions and periods for immunization against the Respiratory Syncytial Virus / Análise temporal-espacial de hospitalizações por bronquiolite no Brasil: previsão das regiões e períodos epidêmicos para imunização contra o vírus sincicial respiratório

Abstract Objective: Due to the high cost and short term of passive immunization against the respiratory syncytial virus, the main virus causing acute viral bronchiolitis, predicting epidemic regions and epidemic months is extremely important. The objective of this study is to identify both the month when the seasonal peak begins and Brazilian regions and states with the highest incidence of monthly hospitalizations due acute viral bronchiolitis. Methods: Based on data obtained from DATASUS, monthly hospitalization rates due acute viral bronchiolitis were calculated for every 10,000 live births to children under 12 months of age in all Brazilian states and the Federal District between 2000 and 2019. Seasonal autoregressive integrated moving average models were estimated to forecast monthly hospitalization rates in 2020. Results: A higher incidence of hospitalizations was found for male children, especially under six months of age. As for Brazilian regions, between 2000 and 2019, the South region registered the highest incidence of hospitalizations, followed by the Southeast, Midwest, North and Northeast regions, in this order. Considering the seasonal peak, the period between March and July 2020 comprised the highest expected hospitalization rates. Conclusions: Palivizumab is suggested to be started between February/March and June/July for most Brazilian states, with the exception of Rio Grande do Sul, which, in addition to presenting the highest rates of hospitalizations for acute viral bronchiolitis per 10,000 live births, has the longest seasonal peak between May and September.

RESUMO Objetivo: Em razão do alto custo e do curto prazo da imunização passiva contra o vírus sincicial respiratório, principal vírus causador de bronquiolite viral aguda, a previsão das regiões e meses epidêmicos é extremamente importante. Objetiva-se identificar o mês de início do pico sazonal e as regiões e Estados brasileiros de maior incidência de hospitalizações mensais por bronquiolite viral aguda. Métodos: Com dados obtidos no Departamento de Informática do Sistema Único de Saúde do Brasil, foram calculadas as taxas mensais de hospitalizações por bronquiolite viral aguda a cada 10 mil nascidos vivos de crianças com idade inferior a 12 meses, em todos os Estados brasileiros e no Distrito Federal, no período entre 2000 e 2019. Modelos sazonais autorregressivos integrados e de médias móveis foram estimados para a previsão das taxas mensais de hospitalizações em 2020. Resultados: Verificou-se maior incidência de hospitalizações em crianças do sexo masculino, principalmente naquelas com idade inferior a seis meses. Em relação às regiões brasileiras, entre 2000 e 2019, a Região Sul apresentou a maior incidência de hospitalizações, seguida pelas Regiões Sudeste, Centro-Oeste, Norte e Nordeste, respectivamente. Quanto ao pico sazonal, o período entre março e julho de 2020 compreende as maiores taxas de hospitalizações previstas. Conclusões: Sugere-se o início da administração do Palivizumab entre fevereiro/março e junho/julho para a maioria dos Estados brasileiros, com exceção do Rio Grande do Sul, que, além de apresentar as maiores taxas de hospitalizações por bronquiolite viral aguda a cada 10.000 nascidos vivos, possui o pico sazonal de maior duração entre maio e setembro.

Evaluation of respiratory bronchiolitis nodules with maximum intensity projection images

SUMMARY OBJECTIVE: Respiratory bronchiolitis is a disease associated with heavy smoking. Computed tomography in this disease often shows symmetrical and bilaterally ill-defined circumscribed centriacinar micronodular involvement in the upper-middle lobes. The maximum intensity projection method is a kind of image processing method and provides a better evaluation of nodules and vascular structures. Our study aimed to show whether maximum intensity projection images increase the diagnostic accuracy in the detection of micronodules in respiratory bronchiolitis. METHODS: Two radiologists with different experiences (first reader: 10-year radiologist with cardiothoracic radiology experience and second reader: nonspecific radiologist with 2 years of experience) reviewed images of patients whose respiratory bronchiolitis diagnosis was supported by clinical findings. The evaluation was done independently of each other. Both conventional computed tomography images and maximum intensity projection images of the same patients were examined. The detection rates on conventional computed tomography and maximum intensity projection images were then compared. RESULTS: A total of 53 patients were evaluated, of whom 48 were men and 5 were women. The first reader detected centriacinar nodules in 42 (79.2%) patients on conventional computed tomography and centriacinar nodules in all 53 (100%) patients on maximum intensity projection images. The second reader detected centriacinar nodules in 12 (22.6%) patients on conventional computed tomography images and in 48 (90.6%) patients on maximum intensity projection images. For the less experienced reader, the detection rate of micronodules in respiratory bronchiolitis in maximum intensity projection images increased statistically significantly (p<0.001). CONCLUSION: Maximum intensity projection images in respiratory bronchiolitis increase the detectability of micronodules independently of the experience of the radiologist.

Reporte de caso: hemoptisis masiva como manifestación clínica de un síndrome de Swyer-James-Mac Leod / Case report: massive hemoptysis as a clinical manifestation of Swyer-James-Mac Leod syndrome

El síndrome de Swyer-James-Mac Leod es una entidad poco frecuente adquirida en la infancia, generalmente tras una infección pulmonar moderada a grave de tipo bronquiolitis o neumonía, generalmente virales. Ocasionalmente se tiene el antecedente de infecciones repetidas de este tipo. Consiste en el desarrollo de enfisema hipoplásico pulmonar unilateral, que puede a veces relacionarse con bronquiectasias ipsilaterales o bilaterales, obstrucción fija al flujo aéreo y puede también asociarse a reducción del flujo sanguíneo del pulmón hipoplásico, de manera focal o difusa, con o sin tortuosidad de la vascularización proximal y a veces con una compensación del pulmón contralateral, en forma de sobredistensión e hiperflujo vascular relativo. Presentamos el caso de un varón de 79 años de edad con antecedentes de infecciones tipo bronquiolitis virales repetidas en la infancia, obstrucción fija grave al flujo aéreo y hemoptisis masiva secundaria a una infección por Pseudomonas aeruginosa sensible a la terapia antibiótica habitual.

Swyer-James-Mac Leod syndrome is a rare condition acquired in childhood, usually after a moderate to severe lung infection such as bronchiolitis or pneumonia, usually viral. Occasionally there is a history of repeated infections of this type. It consists of the development of unilateral pulmonary hypoplastic emphysema, which can sometimes be related to ipsilateral or bilateral bronchiectasis, fixed airflow obstruction, and may also be associated with reduced blood flow in the hypoplastic lung, with or without tortuosity of the proximal vascular supply and sometimes with compensation from the contralateral lung, in the form of overdistension and relative vascular hyperflow. We present the case of a 79-year-old man with a history of recurrent viral bronchiolitis-type infections in childhood, severe fixed airflow obstruction, and massive hemoptysis secondary to a Pseudomonas aeruginosa infection sensitive to usual antibiotic therapy.