Detection of Porcine Respirovirus 1 (PRV1) in Poland: Incidence of Co-Infections with Influenza A Virus (IAV) and Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in Herds with a Respiratory Disease

Porcine respirovirus 1 (PRV1) is also known as porcine parainfluenza virus 1 (PPIV1). The prevalence and the role of PRV1 infections for pig health is largely unknown. In order to assess the PRV1 prevalence in Poland, nasal swabs and oral fluids collected from pigs from 30 farms were examined with RT real-time PCR. Additionally, IAV and PRRSV infection statuses of PRV1-positive samples were examined. The results showed that the virus is highly prevalent (76.7% farms positive) and different patterns of PRV1 circulation in herds with mild–moderate respiratory disease were observed. Co-infections with IAV and PRRSV were infrequent and detected in 8 (23.5%) and 4 (11.8%) out of 34 PRV1-positive nasal swab pools from diseased pens, respectively. In one pen PRV1, IAV, and PRRSV were detected at the same time. Interestingly, PRV1 mean Ct value in samples with co-infections was significantly lower (29.8 ± 3.1) than in samples with a single PRV1 infection (32.5 ± 3.6) (p < 0.05), which suggested higher virus replication in these populations. On the other hand, the virus detection in pig populations exhibiting respiratory clinical signs, negative for PRRSV and IAV, suggests that PRV1 should be involved in differential diagnosis of respiratory problems.

The Effect of Maternal Vitamin D Intake on the Incidence of Nonspecific Respiratory Distress in Infants: A Randomized Clinical Trial

Background vitamin D deficiency is associated with respiratory problems in neonates. The late preterm or near-term neonates who have been admitted for tachypnea and fully recovered before 12 h, we called Non-specific respiratory distress syndrome (NRDS). The present study aimed to evaluate the effect of 25(OH) D administration in pregnant women at risk of preterm delivery on the incidence of NRDS in their infants. Methods This single-blind clinical trial was performed on mothers and neonates with a gestational age of 32-37 weeks who were referred with labor pains from February 20th 2021 to June29th 2021 in the obstetrics and gynecology department and intensive treatment unit of Ghaem Hospital, Mashhad University of Medical Sciences, Iran. Within 72 h of preterm delivery, a single dose of 50,000 units of intramuscular 25-hydroxy vitamin D was injected into pregnant women in the intervention group. Also a sample containing 1.5 ml of whole blood was taken from the umbilical cord of the infant and mother to assess the level of vitamin D. Results In the present study, there was a significant relationship between the two groups of control and intervention in terms of weight (P=001), first (P=0.027) and fifth minute Apgar score (P=0.001) in infant, incidence of NRDS (P=0.001) and maternal age (P=0.004). The results showed no statistically significant difference between the two groups in terms of gender (p = 0.673), type of delivery (p = 0.299), level of vitamin D of the mothers (P=0.053) and infants (P=0.805). Conclusions The single injection of vitamin D into the mother prone to preterm birth over 31 weeks of gestation reduces transient respiratory problems in these infants. Trial registration: IRCT20110807007244N7 (19/02/2021)

Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study

Most children have a mild course of acute COVID-19. Only few mainly non-controlled studies with small sample size have evaluated long-term recovery from SARS-CoV-2 infection in children. The aim of this study was to evaluate symptoms and duration of ‘long COVID’ in children. A nationwide cohort study of 37,522 children aged 0–17 years with RT-PCR verified SARS-CoV-2 infection (response rate 44.9%) and a control group of 78,037 children (response rate 21.3%). An electronic questionnaire was sent to all children from March 24th until May 9th, 2021. Symptoms lasting > 4 weeks were common among both SARS-CoV-2 children and controls. However, SARS-CoV-2 children aged 6–17 years reported symptoms more frequently than the control group (percent difference 0.8%). The most reported symptoms among pre-school children were fatigue Risk Difference (RD) 0.05 (CI 0.04–0.06), loss of smell RD 0.01 (CI 0.01–0.01), loss of taste RD 0.01 (CI 0.01–0.02) and muscle weakness RD 0.01 (CI 0.00–0.01). Among school children the most significant symptoms were loss of smell RD 0.12 (CI 0.12–0.13), loss of taste RD 0.10 (CI 0.09–0.10), fatigue RD 0.05 (CI 0.05–0.06), respiratory problems RD 0.03 (CI 0.03–0.04), dizziness RD 0.02 (CI 0.02–0.03), muscle weakness RD 0.02 (CI 0.01–0.02) and chest pain RD 0.01 (CI 0.01–0.01). Children in the control group experienced significantly more concentration difficulties, headache, muscle and joint pain, cough, nausea, diarrhea and fever than SARS-CoV-2 infected. In most children ‘long COVID’ symptoms resolved within 1–5 months.Conclusions: Long COVID in children is rare and mainly of short duration. What is Known:• There are increasing reports on ‘long COVID’ in adults.• Only few studies have evaluated the long-term recovery from COVID-19 in children, and common for all studies is a small sample size (median number of children included 330), and most lack a control group. What is New:• 0.8% of SARS-CoV-2 positive children reported symptoms lasting >4 weeks (‘long COVID’), when compared to a control group.• The most common ‘long COVID’ symptoms were fatigue, loss of smell and loss of taste, dizziness, muscle weakness, chest pain and respiratory problems.• These ‘long COVID’ symptoms cannot be assigned to psychological sequelae of social restrictions.• Symptoms such as concentration difficulties, headache, muscle- and joint pain as well as nausea are not ‘long COVID’ symptoms.• In most cases ‘long COVID’ symptoms resolve within 1-5 months.

SARS-CoV-2 entry sites are present in all structural elements of the human glossopharyngeal and vagal nerves: clinical implications

Severe acute respiratory syndrome coronavirus (SARS-CoV-2) infections result in the temporary loss of smell and taste (anosmia and dysgeusia) in about one third of confirmed cases. Several investigators have reported that the viral spike protein receptor is present in olfactory neurons. However, no study has been published to date showing the presence of viral entry sites angiotensin-converting enzyme 2 (ACE2), neuropilin1 (NRP1), and TMPRSS2, the serine protease necessary for priming the viral proteins, in human nerves that are responsible for taste sensation (cranial nerves: VII, IX and X). We used immunocytochemistry to examine three postmortem donor samples of the IXth (glossopharyngeal) and Xth (vagal) cranial nerves where they leave/join the medulla from three donors to confirm the presence of ACE2, NRP1 and TMPRSS2. Two samples were paraffin embedded; one was a frozen sample. In addition to staining sections from the latter, we isolated RNA from it, made cDNA, and performed PCR to confirm the presence of the mRNAs that encode the proteins visualized. All three of the proteins required for SARS-CoV-2 infections appear to be present in the human IXth and Xth nerves near the medulla. Direct infection of these nerves by the COVID-19 virus is likely to cause the loss of taste experienced by many patients. In addition, potential viral spread through these nerves into the adjacent brainstem respiratory centers might also aggravate the respiratory problems patients are experiencing.

Exercise Related Respiratory Problems in the Young—Is It Exercise-Induced Bronchoconstriction or Laryngeal Obstruction?

Complaints of breathlessness during heavy exercise is common in children and adolescents, and represent expressions of a subjective feeling that may be difficult to verify and to link with specific diagnoses through objective tests. Exercise-induced asthma and exercise-induced laryngeal obstruction are two common medical causes of breathing difficulities in children and adolescents that can be challenging to distinguish between, based only on the complaints presented by patients. However, by applying a systematic clinical approach that includes rational use of tests, both conditions can usually be diagnosed reliably. In this invited mini-review, we suggest an approach we find feasible in our everyday clinical work.

Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Care Military Hospital of Bangladesh

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. It is a major hindrance to the attainment of the Sustainable Development Goal (SDG)-3 targets given its high contribution to neonatal mortality. Early detection of its risk factors and advances in the management have ensured better survival of preterm births. This study was conducted to determine the prevalence, underlying causes, morbidity patterns and outcome of preterm admissions to a neonatal intensive care unit (NICU) of a tertiary care center in Combined Military Hospital (CMH) Sylhet. Material and Methods: A descriptive study was conducted in CMH Sylhet from July 2018 to June 2020. All live preterm babies delivered at CMH Sylhet during the study period were included. Information obtained included gestational age at birth, gender, cause for preterm birth, problems during admission and outcome. Results: During this period, a total of 662 neonates were admitted out of which 107 (16.2%) were preterm with gestational ages ranging from 27 completed weeks to less than 37 completed weeks with a mean gestational age 33.2 weeks (± 2.7 weeks) and birth weights from 800 - 2600 gm with a mean of 2100 gm (± 700 gm). There were 52 males and 55 females (M: F 0.95). One hundred and thirty three (20.1%) were delivered by normal vaginal delivery while 529 (79.9%) were delivered by Caesarean section. The duration of hospital stay ranged from 1 - 45 days, with a mean duration of 15 days (± 9.2 days). The commonest reason for prematurity was premature rupture of membrane (PROM) (39.3%) followed by gestational diabetes mellitus (GDM) (35.5%), hypertensive disorders in pregnancy (30.8%), multiple pregnancy (29.9%) and inadequate ante natal care (ANC) (20.6%). The commonest morbidity in the patients in the present study was neonatal jaundice (90.7%) followed by respiratory problems (78.5%), sepsis (17.8%) and congenital heart disease (CHD) (15.9%). Case fatality rate for patients with respiratory distress syndrome (7.7%) and sepsis (5.3%) were common. Overall survival rate was 91.6% and was significantly (p <0.001) higher in the moderate to late preterm category compared to the very preterm and extremely preterm births. Conclusion: PROM, GDM, hypertensive disorders in pregnancy, multiple pregnancy and inadequate ante natal care were significantly associated with preterm birth. Neonatal jaundice, respiratory problems, sepsis and CHD were common morbidities observed. Case fatality rate was significant in neonates with respiratory distress syndrome and sepsis and overall survival rate was 91.6%. So, at-risk mothers should receive intensified antenatal care to mitigate preterm birth. J Bangladesh Coll Phys Surg 2022; 40: 39-44

Insights Into the COVID-19 Infection Related to Inherited Metabolic Diseases

People with respiratory problems and people prone to decompensations are particularly vulnerable to COVID-19. These characteristics are often present in patients with inherited metabolic diseases (IMDs). It is therefore conceivable that patients with IMDs are at a greater risk of infection and may present a more serious form of COVID-19 disease. Currently available data about the impact of COVID-19 on patients suffering from IMDs are very scarce and no study has been able to confirm this hypothesis. In this chapter, the authors have tried to show that the severity of COVID-19 infection in patients with IMDs is specific to the group that the disease belongs. Indeed, lysosomal storage diseases caused by impaired degradation and accumulation of metabolites in lysosomes leads to dysfunction of lysosomal and possible impairment of the COVID-19 egress process. The fact that COVID-19 disease may be considered itself as an IMD was also discussed to highlight the interference which can exist between COVID-19 disease and IMDs in a patient.

Bronchopneumonia by Streptococcus equi subsp. zooepidemicus in a horse with inhalation of pine branch of Araucaria angustifolia

ABSTRACT: Respiratory problems due to tracheobronchial foreign bodies (FBs) are unusual in horses; although equines kept in pastures eventually inhale FBs, as conifer twigs of Araucaria angustifolia. A 1,5-year-old Criolle foal was presented with hemoptysis, dyspnea, restlessness and fever (40.9 ºC rectal temperature). Complete blood count showed intense neutropenia, monocytosis, thrombocytopenia and hypoproteinemia. Treatment was carried out but no clinical improvement was observed. At the post-mortem examination, marked amount of dark red liquid was observed in the thoracic cavity (hemothorax). The lung parenchyma was diffusely consolidated, predominantly in the cranioventral area, associated with mild pleural fibrin deposition. The right primary bronchus was obliterated by a Araucaria angustifolia pine branch measuring 18 cm in length, with adjacent darkened areas (lung consolidation). Microscopically, there was diffuse necrosis with severe hemorrhage in the lungs, associated with marked neutrophilic inflammatory infiltrate, numerous coccoid bacterial aggregates, and fibrinous pleuritis. Additionally, there was diffuse alveolar edema and multifocal thrombosis. Lung fragments were submitted for bacterial culture and mixed bacterial growth was observed with a predominance of Streptococcus equi subsp. zooepidemicus. Inhalation of branches is not commonly reported in horses, but it must be included in the differential diagnoses of pneumonia, and attention should be taken when allowing horses to graze in areas where the plant occurs.

Anthropometric Measurements to Predict NICU Admission for Infants of Diabetic Mothers

Aim: Can NICU admission of IDM be predicted by anthropometric measurements like birth weight, lenght, head circumference (HC), mid upper arm circumference (MUAC) or triceps skin fold thickness (TSFT). Method: Eighty-six-term IDMs were analyzed prospectively. MUAC, HC and TSFT were measured within 48 hours of life. Prenatal-natal-postnatal problems; NICU admission; maternal characteristics, HbA1c were recorded. Results: Mean birth weight, gestational age were 3453.3±582.4g and 38.0±0.97weeks. 63.9% of IDMs was admitted to NICU. 56.3% hospitalized due respiratory problems; 32,7 % required endotracheal intubation. Mean MUAC, TSFT, HC and MUAC/HC ratio were 11.2±1.1 cm, 7.1±2.2 mm, 35.0±1.8 cm and 0.32±0.03 cm respectively for all. Although there was no significant relation between NICU admission and MUAC (p=0.071), TSFT and MUAC/HC were significantly higher in babies admitted to NICU (p=0.006 for TSFT, p<0.001 for MUAC/HC). HC was significantly low in babies followed in NICU (P<0.001). With increment of TSFT, MUAC/HC and HbA1c, NICU admission increases positively, but HC affects NICU admission negatively (OR for TSFT:1.6, OR for MUAC/HC: 2.1, OR for HbA1c: OR for HC:0,3). Mechanic ventilation requirement is affected positively by TSFT (p=0.008, OR:1.5) and affected negatively by HC (p=0.004, OR:0.6). Conclusion: This preliminary study showed; TSFT, HC and MUAC/HC ratio are helpful criterias to predict NICU admission risk for IDMs and might be helpful for risk assesment in limited settings. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 72-78