Respiratory virus type to guide predictive enrichment approaches in the management of the first episode of bronchiolitis: A systematic review

It has become clear that severe bronchiolitis is a heterogeneous disease; even so, current bronchiolitis management guidelines rely on the one-size-fits-all approach regarding achieving both short-term and chronic outcomes. It has been speculated that the use of molecular markers could guide more effective pharmacological management and achieve the prevention of chronic respiratory sequelae. Existing data suggest that asthma-like treatment (systemic corticosteroids and beta2-agonists) in infants with rhinovirus-induced bronchiolitis is associated with improved short-term and chronic outcomes, but robust data is still lacking. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane’s Library to identify eligible randomized controlled trials to determine the efficacy of a personalized, virus-dependent application of systemic corticosteroids in children with severe bronchiolitis. Twelve studies with heterogeneous methodology were included. The analysis of the available results comparing the respiratory syncytial virus (RSV)-positive and RSV-negative children did not reveal significant differences in the associatons between systemic corticosteroid use in acute episode and duration of hospitalization (short-term outcome). However, this systematic review identified a trend of the positive association between the use of systematic corticosteroids and duration of hospitalization in RSV-negative infants hospitalized with the first episode of bronchiolitis (two studies). This evidence is not conclusive. Taken together, we suggest the design for future studies to assess the respiratory virus type in guiding predictive enrichment approaches in infants presenting with the first episode of bronchiolitis. </p

Distribution of trace metals in the Odra River system: Water–suspended matter–sediments

AbstractExtensive investigations of trace metals concentrations in water, suspended particulate matter (SPM) and bottom sediments of the whole Odra River system were carried out over the years 1997–2000. The vertical distribution of selected metals and their mobility were also studied in the sediment cores from upper and middle river sections. Significant levels of metal contamination were found. Median concentrations (Cd, Pb, Cu, Zn and As) in the SPM and sediments were (mgkg−1) 7.1 and 8.9 Cd, 128 and 146 Pb, 81 and 119 Cu, 1198 and 1204 Zn, 48 and 54 As, respectively. The highest metal pollution of the Odra River solids was found with cadmium, zinc, lead and arsenic, showing high similarity in their frequency distributions in both SPM and sediments. Cd, Zn and As appear to be of particular concern because of the high levels, that appear to be bioavailable, and their high mobility. The exchangeable and carbonate chemical forms of Cd and Zn reached up to 50% of their total amount. Besides the determination of total metal concentration, the metal chemical forms in river solids were investigated. The results of very wide studies of the Odra River system through 4 years suggest that metal pollution decreased, especially for Zn, Pb and Cu. Among all metals studied in the Odra River sediments, substantial reductions of Cd contamination were observed neither in the period after ’97 flood, nor if compared with the earlier results obtained before ’97. No essential differences of the metal contents were observed among the samples for the same river compartment, from the same locality, taken within the five sampling campaigns. The pattern of spatial and vertical metal distributions in the river solids indicates that a variety of sources might be responsible for the contamination; very intensive, historical and current mining and smelting activities probably are the most important ones

Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review

Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor &alpha; ([TNF]-&alpha;). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages and neutrophils and disturbed lymphocyte balance towards Th2. The plethora of presented phenomena fully justifies a restrictive policy aiming at limiting the domestic and public exposure to ETS

A Comparison of the Level of Acceptance and Hesitancy towards the Influenza Vaccine and the Forthcoming COVID-19 Vaccine in the Medical Community

Despite research conducted worldwide, there is no treatment specifically targeting SARS-CoV-2 infection with efficacy proven by randomized controlled trials. A chance for a breakthrough is vaccinating most of the global population. Public opinion surveys on vaccine hesitancy prompted our team to investigate Polish healthcare workers’ (HCWs) attitudes towards the SARS-CoV-2 and influenza vaccinations. In-person and online surveys of HCWs: doctors, nurses, medical students, and other allied health professionals (n = 419) were conducted between 14 September 2020 and 5 November 2020. In our study, 68.7% of respondents would like to be vaccinated against COVID-19. The safety and efficacy of COVID-19 vaccinations would persuade 86.3% of hesitant and those who would refuse to be vaccinated. 3.1% of all respondents claimed that no argument would convince them to get vaccinated. 61.6% of respondents declared a willingness to receive an influenza vaccination, of which 83.3% were also inclined to receive COVID-19 vaccinations. Although most respondents—62.5% (262/419) indicated they trusted in the influenza vaccine more, more respondents intended to get vaccinated against COVID-19 in the 2020/2021 season. The study is limited by its nonrandom sample of HCWs but provides a preliminary description of attitudes towards SARS-CoV-2 vaccination

Respiratory virus type to guide predictive enrichment approaches in the management of the first episode of bronchiolitis:a systematic review

Abstract It has become clear that severe bronchiolitis is a heterogeneous disease; even so, current bronchiolitis management guidelines rely on the one-size-fits-all approach regarding achieving both short-term and chronic outcomes. It has been speculated that the use of molecular markers could guide more effective pharmacological management and achieve the prevention of chronic respiratory sequelae. Existing data suggest that asthma-like treatment (systemic corticosteroids and beta2-agonists) in infants with rhinovirus-induced bronchiolitis is associated with improved short-term and chronic outcomes, but robust data is still lacking. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane’s Library to identify eligible randomized controlled trials to determine the efficacy of a personalized, virus-dependent application of systemic corticosteroids in children with severe bronchiolitis. Twelve studies with heterogeneous methodology were included. The analysis of the available results comparing the respiratory syncytial virus (RSV)-positive and RSV-negative children did not reveal significant differences in the associatons between systemic corticosteroid use in acute episode and duration of hospitalization (short-term outcome). However, this systematic review identified a trend of the positive association between the use of systematic corticosteroids and duration of hospitalization in RSV-negative infants hospitalized with the first episode of bronchiolitis (two studies). This evidence is not conclusive. Taken together, we suggest the design for future studies to assess the respiratory virus type in guiding predictive enrichment approaches in infants presenting with the first episode of bronchiolitis

Lung function testing and inflammation markers for wheezing preschool children:a systematic review for the EAACI clinical practice recommendations on diagnostics of preschool wheeze

Abstract Background: Preschool wheeze is highly prevalent; 30%–50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole‐body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers. Methods: We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction. Results: f applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole‐body plethysmography and IOS may be useful. Bronchial reversibility to beta2‐agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests. Conclusions: The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children