scholarly journals Preschool Wheezing and Gastro-Esophageal Reflux: --Causal or Casual Coincidence? Update from Literature

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 180
Author(s):  
Melissa Borrelli ◽  
Giuliana Ponte ◽  
Erasmo Miele ◽  
Marco Maglione ◽  
Carlo Caffarelli ◽  
...  

Gastroesophageal reflux (GER) and wheeze are two common conditions in children. GER has been advocated as a causative factor for explaining recurrent to persistent respiratory symptoms at any age. This association very often means that many children with cough, wheezing, or recurrent respiratory infections receive empirical anti-reflux medications. The causal relationship is still largely discussed. Compared to the large number of studies in infants and adolescents, literature on the relationship between GER and wheeze in preschool children is scarce and inconclusive. The aim of the present narrative review was to summarize what is known so far, and what the literature has proposed in the last 20 years, on the relationship between preschool wheezing and GER. In preschool children with respiratory symptoms there is a high rate of positivity of reflux testing, for this reason pH-MII testing and endoscopy are recommended. Flexible bronchoscopy may be useful to exclude anatomical abnormalities as the cause of wheezing in infancy and preschool years. Several biomarkers, as well as empirical anti-reflux therapy, have been proposed for the diagnosis of GER-related airway diseases, but the conclusions of these studies are controversial or even conflicting. There is a great need for future clinical trials to confirm or rule out the association.

Vestnik ◽  
2021 ◽  
pp. 280-284
Author(s):  
Х. Б. Сарсенбай ◽  
А. Н. Турсынханова ◽  
Б. А. Конысов

Согласно данным ВОЗ, современные эпидемиологические исследования показали, что рецидивирующие респираторные инфекции у детей раннего и дошкольного возраста сохраняются на высоком уровне 10-50% в течение более 40 лет. Конец вакцинации может спровоцировать массовые инфекционные заболевания. Врачи бьют тревогу, что число отказников от обязательной вакцинации растет. Только в каждой поликлинике Алматы 30-40 родителей в год говорят о готовности к профилактике заболеваний. Среди тех, кто категорически отказывается трогать своих детей иголками, - те, кто идет по пути религии. Они считают, что прививка противоречит убеждениям. В последнее время список недовольных групп пополняют и простые жители, которые скептически относятся к квалификации белых. According to WHO, current epidemiological studies have shown that recurrent respiratory infections in young children and preschool children persist at a high level of 10-50% for more than 40 years. The end of vaccination can provoke mass infectious diseases. Doctors are sounding the alarm that the number of refusers from mandatory vaccination is growing. Only in every polyclinic in Almaty, 30-40 parents a year talk about their readiness for disease prevention. Among those who categorically refuse to touch their children with needles are those who follow the path of religion. They believe that vaccination is contrary to their beliefs. Recently, the list of discontented groups has been supplemented by ordinary residents who are skeptical about the qualifications of whites.


Author(s):  
Thanh Xuan Nguyen

TÓM TẮT Đặt vấn đề: Bệnh COVID-19 đa dạng từ không có triệu chứng đến có các triệu chứng nhẹ cho đến viêm phổi nặng, hội chứng suy hô hấp cấp tiến triển (ARDS), nhiễm khuẩn huyết suy đa tạng và tử vong. Người cao tuổi, người có bệnh mạn tính sẽ có nguy cơ diễn biến nặng nhiều hơn. Nghiên cứu này nhằm xác định nồng độ lactate và PCT ở những bệnh nhân Covid-19 và xét mối liên quan giữa lactate và PCT trên bệnh nhân Covid-19. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 126 bệnh nhân được chẩn đoán nhiễm Sars-Cov-2 bằng xét nghiệm RT PCR. Kết quả: Tuổi trung bình 55,98 ± 17,1 tuổi (4 - 98 tuổi). Bệnh nhân > 60 tuổi chiếm tỉ lệ cao nhất (42,8%). Trung vị PCT: 3,6 (95%CI:3,21 - 3,75) ng/ml; trung vị lactate 1,5 (95%CI:1,21 - 1,91) mmol/L; lactate có tương quan thuận và yếu với procalcitonin với r = 0,241; p < 0,001. Nồng độ procalcitonin > 0,1 ng/ml; lactate > 2 mmol/l ở bệnh nhân Covid-19 chiếm tỷ lệ cao với 89,7% và 39,7%. Kết luận: Chỉ điểm procalcitonin, lactate tăng cao ở bệnh nhân Covid-19. ABSTRACT ASSESSMENT OF SERUM LEVEL OF LACTATE AND PROCALCITONIN IN COVID-19 PATIENTS Background: Sars-CoV-2 has been identified as the cause of acute respiratory infections in Wuhan city, Hubei province, China, and has since spread worldwide. Sars-CoV-2 is capable of aerosol transmission in enclosed, crowded, and poorly ventilated spaces. COVID-19 illness ranges from asymptomatic to mild symptoms to severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, multiple organ failure, and death. This study aims to determine lactate and PCT levels in Covid-19 patients and examine the relationship between lactate and PCT in Covid-19 patients. Methods: A cross-sectional study was performed on 126 patients diagnosed with Sars-Cov-2 infection by RT-PCR. Results: Mean age was 55.98 ± 17.1 years (range: 4-98 years). Patients more than 60 years old were accounted for the highest rate (42.8%). Median PCT: 3.6 (95%CI:3.21 - 3.75) ng/ml; median lactate 1.5 (95%CI:1.21 - 1,91) mmol/L; lactate has a positive and weak correlation with procalcitonin with r = 0.241; p < 0.001. Procalcitonin concentration > 0.1 ng/ml; lactate > 2 mmol/l in patients with Covid-19 accounted for a high rate with 89.7% and 39.7%. Conclusion: Serum level of procalcitonin and lactate raise highly in Covid-19 patients. Keywords: Covid-19, procalcitonin, lactate.


2018 ◽  
Vol 52 (3) ◽  
pp. 1800328 ◽  
Author(s):  
Eva Polverino ◽  
Katerina Dimakou ◽  
John Hurst ◽  
Miguel-Angel Martinez-Garcia ◽  
Marc Miravitlles ◽  
...  

Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4–72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20–30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex “mixed airway” phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.


Author(s):  
O. M. Voloshin

Introduction. The results of scientific research that have been received so far in terms of the relationship between health status of children of various age and thymus size are controversial. On the one hand, researchers mainly from the former Soviet Union note the presence of the clear association between thymomegaly and an increased tendency to recurrent respiratory infections among preschool children. On the other hand, according to current data of world medical science, a relatively larger thymus, on the contrary, is considered to be the sign of the optimal state of child's immune system. The study aimed at clarifying of the interdependence between the thymus physical parameters and the frequency of acute respiratory infections in children aged 1-6 years. Materials and Methods. Thirty-seven children (16 boys and 21 girls) aged from one to six years, undergoing inpatient treatment on acute respiratory infection, were involved in the clinical study. Two markers of acute respiratory infections recurrence (infections index, resistance index) were taken into account and several anthropometric parameters were calculated for each child. The participants also underwent ultrasound scan. The statistical processing of the obtained primary digital material was performed by IBM SPSS Statistics 26 licensed program. Results. The thymus size was within the reference values only in 14 (37.84%) examined children. In the majority of the patients (23 (62.16%)), it was below the mentioned values. The significant exceeding the thymic index values in the children of the younger age group as compared with the older children was found. There was no difference between the boys and girls in terms of thymus volume, mass and thymic index. Conclusions. There is а moderately pronounced inverse relationship between the age of the examined children and the thymic index, according to which this index values are decreased with increasing age. The integral indicators of acute respiratory infections recurrence among the preschool children are not correlated with the studied absolute and relative sonometric thymus parameters. The thymic index values are in the closest and inverse correlation with the body surface area among all the anthropometric parameters considered in the children.


Author(s):  
O. M. Voloshyn ◽  
Yu. V. Marushko

Among the current trends in the systemic prevention of recurrent respiratory infections in preschool children is the differentiated detection and clustering of the most significant ante- and prenatal factors associated with frequent acute respiratory infections. Thus, a comprehensive retrospective investigation of such factors in terms of their association with the integral indicators of acute respiratory infections recurrence in preschool children is exceptionally relevant. The study of particular manifestations of undifferentiated connective tissue dysplasia during recurrent respiratory infections is of great clinical and social relevance. This study research aims at determining the levels of inter-dependency between recurrence indicators of acute respiratory infections in preschool children and ante- and prenatal predictors analyzed retrospectively. Fifty-one children (24 boys and 27 girls) aged 1 to 6 years old, undergoing inpatient treatment for acute respiratory infection, were involved in the clinical study. Two markers of acute respiratory infection recurrence (infection index, resistance index) and dolichostenomelia integral indicator, which is used as the marker of external signs of connective tissue undifferentiated dysplasia, were calculated for each child. In addition, the retrospective analysis of 67 ante- and prenatal factors directly related to the children were examined. The statistical processing of the obtained digital material was performed by IBM SPSS Statistics 26 licensed software. Only non-parametric statistics methods were applied in the purpose. The first stage of investigating the inter-dependency between the acute respiratory infections frequency, the particular manifestations of undifferentiated connective tissue dysplasia, on the one hand, and the ante- and prenatal predictors, on the other hand, was carried out. The results obtained provided the grounds for the further research in the outlined direction involving the higher number of patients and using the more sensitive statistical methods. The higher infectious index values in the preschool children correlate with the following factors as lower initial overall age of their parents, smaller number of their mothers’ previous pregnancies, larger mothers’ body weight at the beginning of pregnancies, longer deliveries, lower Apgar scores in the newborns and no vaccination for tuberculosis. The resistance index values in the examined children increase with the simultaneous decreasing in the haemoglobin concentration in the mothers’ blood just before the deliveries and in cases of no vaccination in newborns for tuberculosis. The dolichostenomelia integral indicator in the patients aged from 1 to 6 years directly correlates with their age as well as with such retrospectively studied predictors as the newborns body mass index, the presence of foetoplacental insufficiency and the total number of complications caused by connective tissue dysplasia in their mothers during the pregnancies and deliveries.


Author(s):  
Lawrence Frenkel ◽  
Fernando Gomez ◽  
Joseph A Bellanti

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19–associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2–associated MIS-C similar to KD.


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