Corynebacterium Species Inhibit Streptococcus pneumoniae Colonization and Infection of the Mouse Airway

The stability and composition of the airway microbiome is an important determinant of respiratory health. Some airway bacteria are considered to be beneficial due to their potential to impede the acquisition and persistence of opportunistic bacterial pathogens such as Streptococcus pneumoniae. Among such organisms, the presence of Corynebacterium species correlates with reduced S. pneumoniae in both adults and children, in whom Corynebacterium abundance is predictive of S. pneumoniae infection risk. Previously, Corynebacterium accolens was shown to express a lipase which cleaves host lipids, resulting in the production of fatty acids that inhibit growth of S. pneumoniae in vitro. However, it was unclear whether this mechanism contributes to Corynebacterium-S. pneumoniae interactions in vivo. To address this question, we developed a mouse model for Corynebacterium colonization in which colonization with either C. accolens or another species, Corynebacterium amycolatum, significantly reduced S. pneumoniae acquisition in the upper airway and infection in the lung. Moreover, the lungs of co-infected mice had reduced pro-inflammatory cytokines and inflammatory myeloid cells, indicating resolution of infection-associated inflammation. The inhibitory effect of C. accolens on S. pneumoniae in vivo was mediated by lipase-dependent and independent effects, indicating that both this and other bacterial factors contribute to Corynebacterium-mediated protection in the airway. We also identified a previously uncharacterized bacterial lipase in C. amycolatum that is required for inhibition of S. pneumoniae growth in vitro. Together, these findings demonstrate the protective potential of airway Corynebacterium species and establish a new model for investigating the impact of commensal microbiota, such as Corynebacterium, on maintaining respiratory health.

Diagnosis and treatment of obstructive sleep apnea

Obstructive sleep apnea (OSA) has become a health issue of high prevalence. The prevalence is rising between 1990-2010 by approximately 30%, with absolute increases of 4.2% in women and 7.5% in men. This condition is characterized by a breathing disorder of partial or complete upper airway obstruction leading to increased resistance to airflow and potential cessation of breathing during sleep. Its multifactorial etiology Such etiologies involve obesity, craniofacial anatomy, and the use of stimulants and medications to reduce muscle tension. This review aims to summarize the recent diagnosis and treatment modalities of OSA. The database PubMed and google scholar were searched for relevant published records. A total of 39 articles were collected randomly limited to the English language. We placed no restrictions on the date of publication. Evidence from methodological studies indicate that undiagnosed OSA is associated with hypertension, cardiovascular disease, stroke, and daytime sleepiness. Thorough clinical and instrumental examinations should precede a proper diagnosis selection. The primary goal of treatment is reducing the Patient’s symptoms, depending on the severity of the patient’s condition. OSA can be treated in different ways, including behavioral therapy, medical device, surgery, and pharmacological therapies. There are limitations in dental school about education and training of OSA and oral appliances (OA). OSA teamwork must include both qualified sleep physicians and dentists. The Orthodontist plays a critical role in evaluating and treating OSA patients, choosing the right oral appliance, and assessing and adjusting the appliance.

An anesthetic experience of hereditary angioedema type I patient undertook total laparoscopic hysterectomy - A case report -

Background: Hereditary angioedema (HAE) is an autosomal dominant disorder. The characteristic of HAE is recurrent angioedema episodes due to low C1 esterase inhibitor (C1-INH) level. HAE symptoms, especially those affecting oropharynx or larynx may develop respiratory distress syndrome due to impaired airway, which can be potentially fatal. Case: We report a clinical case of a 57 year-old woman, with type I HAE, scheduled for total laparoscopic hysterectomy under general endotracheal anesthesia, which was done successfully without inducing airway edema. Danazol, which increases liver synthesis of C1-INH, was administered and fresh frozen plasma (FFP), which contained C1-INH, was transfused after induction.Conclusions: For HAE patients, the greatest concern is that general anesthesia can induces upper airway edema by direct mucosal irritation by the endotracheal tube. The perioperative management should include both prophylactic increase of C1-INH production and on-demand administration of C1-INH or FFP.

Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

Indications and complications of paediatric tracheostomies at a tertiary care centre in rural Haryana: a retrospective study

<p><strong>Background:</strong> The indications for paediatric tracheostomies have had a significant change world over during last few decades. Emergency management of paediatric airway by tracheostomy has its own share of complications which need fair amount of expertise to manage.</p><p><strong>Methods:</strong> We carried out a retrospective study at a tertiary care centre in rural area of Haryana and analysed the available data of last 5 years (2017-2021) for determining various indications of paediatric tracheostomies and complications encountered during or after the surgery.</p><p><strong>Results:</strong> The study included 65 paediatric patients (&lt;14 years of age) who underwent tracheostomy at our tertiary care institute between January 2017 and December 2021. Out of them 38 (60.3%) were males, 35 (55.17%) patients were in 0-5 years age group. Most frequent indication for paediatric tracheostomy turned out to be upper airway obstruction due to a vaccine preventable disease diphtheria (n=56, i.e., 86.15%), other less common causes were need of prolonged ventilation, subglottic stenosis, congenital airway anomalies, retropharyngeal abscess, laryngeal papilloma. Complications were observed in 30 cases (46.15%). Mortality in tracheostomized children was nearly 29.2%, which was mainly attributed to the underlying cause which turned out to be diphtheria in most of the cases.</p><p><strong>Conclusions:</strong> High number of paediatric tracheostomies and sheer presence of diphtheria in this rural area of Haryana suggests that there is dire need of proper immunisation coverage and an active participation at community level.</p>