Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children

BACKGROUND: Upper respiratory tract infections (URTIs), including rhinitis, nasopharyngitis, tonsillitis and otitis media (OM), comprise of 88% of total respiratory infections, especially in children. Therefore effective prevention and treatment of RTIs remain a high priority worldwide. Preclinical and clinical data highlight the rationale for the use and effectiveness of immunity-targeted approaches, including targeted immunisations and non-specific immunomodulation in the prevention and management of recurrent upper RTIs. OBJECTIVE OF REVIEW: The idea of this review was to summarise the current evidence and address key questions concerning the use of conservative and immunity-targeted approaches to recurrent and chronic URTIs, with a focus on the paediatric population. SEARCH STRATEGY/EVALUATION METHOD: Literature searches were conducted in March 2017 and updated in September 2017 using: Academic Search Complete; CENTRAL; Health Source: Nursing/Academic Edition; MEDLINE; clinicaltrials.gov; and Cochrane databases. In total, 84 articles were retrieved and reviewed. Two independent researchers focused on primary and secondary endpoints in systematic reviews, meta-analyses and randomised, controlled trials, using immunity-directed strategies as the control group or within a subpopulation of larger studies. Existing guidelines and interventional/observational studies on novel applications were also included. RESULTS: Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, as well as other potential predisposing factors such as day care attendance and/or toxic environmental factors (eg increased pathogenic microbial exposure and air pollutants). Recurrent URTIs can affect otherwise healthy children, leading to clinical sequelae and complications, including the development of chronic conditions or the need for surgery. Available pre-clinical and clinical data highlight the rationale for the use and effectiveness of immunity-targeted approaches, including targeted immunisations (flu and pneumococcal vaccines) and non-specific immunomodulation (bacterial lysates), in the prevention and management of recurrent croup, tonsillitis, otitis media, recurrent acute rhinosinusitis and chronic rhinosinusitis. CONCLUSIONS: In this review, we summarise the current evidence and provide data demonstrating that some immunity-targeted strategies, including vaccination and immunomodulation, have proved effective in the treatment and prevention of recurrent and chronic URTIs in children.info:eu-repo/semantics/publishedVersio

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment. Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches

Predictors of a positive attitude of medical students towards general practice - a survey of three Bavarian medical faculties

Objective: Germany is witnessing an increasing shortage of general practitioners (GPs). The aim was to determine predictors of the job-related motivation of medical students of three medical faculties with different institutionalisation of general practice as an academic discipline.Methods: Medical students were surveyed with a standardised questionnaire about their attitudes towards general practice and their motivation to work as a GP in different working conditions. Predictors for positive attitudes and motivation were calculated using logistic regression models.Results: 940 (15.2%) out of 6182 medical students from three Bavarian medical faculties participated in an online survey. 585 (62.7%) were female, and the average age was 25.0 (standard deviation 3.7). The average grade of a university-entrance diploma was 1.6 (standard deviation 0.5). 718 (76.4%) could imagine working as a GP. However, they favoured being employed within another organisation and not having their own private practice (65.5% vs. 35.1%). "Presence of a professorship of general practice" was associated with a positive attitude towards general practice (OR 1.57; 95%CI 1.13-2.417). Motivation for working as a GP was associated with "being female" (OR 2.56; 95%CI 1.80-3.56) and "presence of a professorship of general practice" (OR 1.68; 95%CI 1.14-2.46). Having a lower grade for one's university-entrance diploma was associated with a higher preference to work in one's own practice (OR 1.39; 95%CI 1.02-1.90).Conclusion: A high amount of medical students were open-minded towards general practice. However, they favoured employment within an organization over working in their own practice. Institutionalisation of general practice as an academic discipline might be of importance to gain positive attitudes towards general practice and motivate medical students to work as a GP.Zielsetzung: Der zunehmende Hausärztemangel wird immer mehr zu einem realen Versorgungsproblem. Ziel war es, an drei Universitäten mit unterschiedlichem Grad der Institutionalisierung des Fachs Allgemeinmedizin Einflussfaktoren zu ermitteln, die die Motivation für eine spätere hausärztliche Tätigkeit begünstigen. Methodik: In einem standardisierten Fragebogen wurde die Haltung gegenüber dem Fach Allgemeinmedizin und die Bereitschaft zur Niederlassung in eigener hausärztlicher Praxis bzw. Motivation zur Arbeit in Anstellungsverhältnissen erfasst. Einflussfaktoren auf Haltung und Motivation für eine spätere hausärztliche Tätigkeit wurden mittels binär logistischer Regression berechnet.Ergebnisse: 940 (15,2%) Studierende von insgesamt 6182 Studierenden aus drei bayerischen Universitäten (Erlangen, LMU und TUM) haben sich an einer internetbasierten Umfrage beteiligt. 585 (62,7%) waren weiblich. Das Durchschnittsalter betrug 25,0 Jahre (Standardabweichung 3,7). Die durchschnittliche Abiturnote war 1,6 (Standardabweichung 0,5). 718 (76%) der Studierenden könnten sich eine hausärztliche Arbeit vorstellen, wobei die Anstellung der Selbstständigkeit vorgezogen wird (65,5 vs. 35,1%). Für die wertschätzende Haltung gegenüber der Allgemeinmedizin zeigt sich die "Existenz eines Lehrstuhls" als stärkster Prädiktor (OR 1,57; 95%CI 1,13-2,417). Die stärksten Prädiktoren für die Motivation zu einer späteren hausärztlichen Tätigkeit sind "weibliches Geschlecht" (OR 2,56; 95%CI 1,80-3,56) und die "Existenz eines Lehrstuhls" (OR 1,68; 95%CI 1,14-2,46). Eine weniger gute Abiturnote war mit einer höheren Bereitschaft zur Selbständigkeit assoziiert (OR 1.39; 95%CI 1.02-1.90).Schlussfolgerung: Diese Studie zeigt, dass durchaus viele Studierenden gegenüber einer hausärztlichen Tätigkeit aufgeschlossen sind, allerdings präferenziell im Angestelltenverhältnis und nicht in selbstständiger Niederlassung. Eine Institutionalisierung der Allgemeinmedizin scheint bedeutsam zu sein für eine positive Einstellung zum Fach und zur Motivation für eine spätere hausärztliche Tätigkeit

Accuracy of FE_NO for diagnosing asthma: A systematic review.

BACKGROUND: Measurement of FENO might substitute bronchial provocation for diagnosing asthma. We aimed to investigate the diagnostic accuracy of FENO measurement compared with established reference standard. METHODS: Systematic review and diagnostic meta-analysis. Data sources were Medline, Embase and Scopus up to 29 November 2015. Sensitivity and specificity were estimated using a bivariate model. Additionally, summary receiver-operating characteristic curves were estimated. RESULTS: 26 studies with 4518 participants (median 113) were included. Risk of bias was considered low for six of seven items in five studies and for five items in seven studies. The overall sensitivity in the meta-analysis was 0.65 (95% CI 0.58 to 0.72), the overall specificity 0.82 (0.76 to 0.86), the diagnostic OR 9.23 (6.55 to 13.01) and the area under the curve 0.80 (0.77 to 0.85). In meta-regression analyses, higher cut-off values were associated with increasing specificity (OR 1.46 per 10 ppb increase in cut-off) while there was no association with sensitivity. Sensitivities varied significantly within the different FENO devices, but not specificities. Neither prevalence, age, use of bronchoprovocation in >90% of participants or as exclusive reference standard test, nor risk of bias were significantly associated with diagnostic accuracy. CONCLUSIONS: There appears to be a fair accuracy of FENO for making the diagnosis of asthma. The overall specificity was higher than sensitivity, which indicates a higher diagnostic potential for ruling in than for ruling out the diagnosis of asthma