Comparative analyses of clinical features reveal the severity of human adenovirus type 55 and type 7 in acute respiratory tract infections

Introduction. Human adenovirus (HAdV) is an important pathogen in acute respiratory tract infections (ARTIs) and HAdV genotypes are associated with disease severity. Hypothesis. Comparative analyses of clinical features could reveal the severity of different HAdV genotypes in ARTIs. Aim. This study aimed to investigate the molecular epidemiology of HAdV infections and explore the correlations between clinical features and HAdV genotypes. Methodology. A retrospective study was conducted on ARTIs at Beijing Chao-Yang Hospital during the period 2011–2016. A standardized data form was used to record the clinical information. HAdV was detected by FQ-PCR from respiratory specimens, and genotypes were determined by entire hexon gene sequencing. Results. A total of 8044 samples were collected, of which 296 (3.7 %) were HAdV-positive. Patients ≤44 years old were more likely to be positive for HAdV. There were three peak periods of adenoviral infections, with detection rates of 13.03, 9.39 and 10.38 %, respectively. Six HAdV genotypes (HAdV-55, -7, -3, -14, -50, -2) were identified, with HAdV-55 and HAdV-7 being the most prevalent (50.6 and 21.5 %). Compared with HAdV-7 and other types, patients infected with HAdV-55 had a longer duration of fever (P=0.0428). Infections with HAdV-55 and HAdV-7 were more severe compared to those caused by other types, with higher rates of oxygen therapy and mechanical ventilation (P=0.0172 and P=0.0144). All five deaths were caused by HAdV‐55. Conclusion. This study describes the epidemiological characteristics of HAdV infections in North China, revealing the higher severity of HAdV-55 and HAdV-7 in ARTIs. Thus, strengthened surveillance of HAdV genotypes is warranted.

Inappropriate antibiotic use for respiratory infections in outpatient settings

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir. Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data. Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names. Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.

Excessive Vitamin A Supplementation Increased the Incidence of Acute Respiratory Tract Infections: A Systematic Review and Meta-Analysis

(1) Background: vitamin A deficiency (VAD) is highly prevalent in children living in poor conditions. It has been suggested that vitamin A supplementation (VAS) may reduce the risk of acute respiratory tract infections (ARTI). Our study provides updates on the effects of oral VAS (alone) in children on ARTI and further explores the effect on interesting subgroups. (2) Methods: eight databases were systematically searched from their inception until 5 July 2021. The assessments of inclusion criteria, extraction of data, and data synthesis were carried out independently by two reviewers. (3) Results: a total of 26 randomized trials involving 50,944 participants fulfilled the inclusion criteria. There was no significant association of VAS with the incidence of ARTI compared with the placebo (RR 1.03, 95% CI 0.92 to 1.15). Subgroup analyses showed that VAS higher than WHO recommendations increased the incidence of ARTI by 13% (RR 1.13, 95% CI 1.07 to 1.20), and in the high-dose intervention group, the incidence rate among well-nourished children rose by 66% (RR 1.66, 95% CI 1.30 to 2.11). (4) Conclusions: no more beneficial effects were seen with VAS in children in the prevention or recovery of acute respiratory infections. Excessive VAS may increase the incidence of ARTI in children with normal nutritional status.

Factors Associated With Corticosteroid Treatment for Pediatric Acute Respiratory Tract Infections

Systemic corticosteroids are not recommended to treat children with acute respiratory tract infections (ARTIs). Using data from a national commercial health care company, we found that corticosteroid treatment occurred in 3.2% of ARTI encounters. The adjusted odds of corticosteroid treatment were highest for bronchitis/bronchiolitis, in emergency departments, and in the South.