Spectrum of pneumotropic pathogens in pediatric patients with acute bronchitis and pneumonia]

One hundred eighty nine children with acute bronchopulmonary infectious pathological processes were examined bacteriologically and serologically for typical pneumotropic pathogens, 47 of them being as well examined for atypical organisms. Microbial associations mainly with Mycoplasma and Pneumocystis and to a lesser extent with Chlamydia were isolated from the majority of the children. Reactivation of the cytomegalovirus infection was observed in 25 per cent of the children. Pneumonia and bronchitis due to Mycoplasma pneumoniae either as a monoagent or in associations were mainly stated in children over 7 years of age. No significant changes between the indices of the infection due to a definite organism and the active progression of the infectious process of the same etiology were revealed, though in the cases of chlamydiosis the changes reached almost 10 per cent. In cases of acute bronchitis and pneumonia the chlamydial or cytomegalovirus infection could be assumed to be of the persisting nature, mainly acute in cases of pneumococcal infection, mixed in cases of hemophilic or pneumocystic infection, primary contamination with a tendency to prolonged in cases of mycoplasmic infection. The findings of the examination and the clinical and anamnestic data showed that the clinical picture of acute pneumonia had specific features associated with the supposed etiological agents, still it could change under the action of associations of pneumotropic pathogens.     

Effects of hypoxic stimulation in experimental animals and in children with bronchial asthma]

Inhalations using hypoxic mixture of 12-15% O2 were tested in 40 rats (daily for 20 min. during 1-4 months) and in 200 children with light and mid-serious forms of bronchial asthma (for 5-10 min. 2-4 times with 5 min. break, course-10 days). Stimulation effect in animals was observed for 1-2 months and then depression came. The immunological and allergological indices were observed to distinctly improve, whereas the indices of the pulmonary function remained practically unchanged. The clinical indices in most patients improved and the similarity of this method and effects of other nonmedicamental methods was noted.     

Prevalence,natural history,and relationship of wheezy bronchitis and asthma in children. An epidemiological study

Three randomly selected groups of 7-year-old schoolchildren in Melbourne with mild wheezy bronchitis, with moderate wheezy bronchitis, and with asthma were compared with a control group, and the patients followed up until 10 years of age. Comparison showed that if there was any significant difference between the study groups and the controls it was usually present in all these study groups. It was considered that children with wheezy bronchitis and asthma were from the same population with the same underlying basic disorder, and that there was a wide spectrum in various aspects of the natural history of the disorder.About 11% of all children aged 10 years had had some asthmatic episodes. Seventy per cent. of these children ceased having asthma before 10 years of age, while about 30% (3·7% of the whole community) continued to have episodes. There was a highly significant correlation between early age of onset, the frequency of episodes in the first year of symptoms, and the persistence of asthmatic episodes up to 10 years of age.Ten per cent. of all children with asthmatic episodes continued to have symptoms as severely at 10 years as at an earlier period. In this group the onset of symptoms was almost always before 3 years of age, there was a high frequency of episodes in the first year of symptoms, and boys and girls were affected in the ratio of 7:3.     

Reassessment of inflammation of airways in chronic bronchitis.

The term chronic bronchitis has been criticised because it is associated with hypersecretion of mucus rather than bronchial inflammation. This study was designed to establish the presence or absence of clinical chronic bronchitis and measure pulmonary function in 45 patients about to undergo resection of the lung. The condition in the cartilaginous and small airways and the severity of the emphysema were then measured in the resected specimen. The results from 20 patients who had clinical chronic bronchitis were compared with those in 25 patients who did not. The data show that patients with chronic bronchitis had greater inflammation (a) on mucosal surfaces (p less than 0.05) of all bronchi larger than 2 mm luminal diameter and (b) around glands (p less than 0.005) and gland ducts (p less than 0.05) in bronchi larger than 4 mm diameter. A variable degree of inflammation was present in the submucosa of smaller bronchi. The groups had equivalent proportions of mucous glands and Reid''s indices in central airways, and no differences were noted in measurements of pulmonary function, condition of small airways, or emphysema. These data show that the term chronic bronchitis is justified by inflammation of cartilaginous airways and suggest that this abnormality may be the cause of the chronic productive cough.     

Role of dopamine in the peripheral mechanisms of respiration control

Under clinical conditions, we studied the interaction between dopamine (DA) metabolism and hypoxia stimulationrelated ventilatory responses (HVR) before and after adaptation to periodical hypoxic episodes. Thirty-seven young and elder persons were tested; among elder tested subjects there were patients with Parkinson’s desease treated or not treated with DOPA-DA precursor-containing drugs (levoDOPA/carbiDOPA). We measured the HVR indices and DA and DOPA contents in the venous blood of tested persons before and after a 14-day-long hypoxic training. The highest indices of the ventilation sensitivity to hypoxia together with the lowest above-mentioned chemical indices were observed in young persons. An increase in the DA and DOPA levels in the venous blood were observed concurrently with suppression of the ventilation responses to hypoxic episodes. After a course of periodical hypoxic sessions, we observed in all groups opposite dynamics of DA and DOPA metabolism. An increase in the DA level in young persons and a trend toward its decrease in older healthy persons and parkinsonian patients was nevertheles accompanied by an HVR increase in all groups. Possible relations between the DA metabolism indices and peripheral mechanisms of respiratory control are discussed.     

EEG in Children: Periodometric Analysis,Typology, and Age Peculiarities

We carried out a computer analysis of the EEG of 169 healthy schoolchildren (6 to 17 years old) with the use of a periodometric approach allowing us to obtain a number of quantitative indices that characterize the temporal structure of the analyzed EEG segment (histogram of distribution of the frequencies of EEG oscillations within the analyzed time period, indices of the different rhythms, and matrix of the probabilities of conversion from waves of one frequency range to waves of other ranges). We demonstrated that data of the periodometric analysis can be used for objective classification of EEG patterns. In children of different age groups, five types of background EEG activity were classified and described; we also demonstrated that the intragroup frequencies of these EEG types vary in healthy children with age. We discuss the advantages and disadvantages of the periodometric analysis of EEG, as well as the prospects and expediency of use of this analysis in physiological studies and in clinics.     

The effect of the background color of computer programs on the functional state of preschool children working on a computer

The effect of work on a computer on the functional state of preschool children (five to six years of age) using developing software (DS) with differently colored backgrounds (lettuce green, blue, black, or graypurple) has been studied. All other characteristics of DS were alike: the same children were examined while working with each of the four experimental DS. Different methods were used for processing and analysis of 240 to 1920 measurements. Only the lettuce green background proved to be adequate for five- to six-tear-old children: eight out of the nine tested indices of the functional state of preschool children showed a favorable tendency from the beginning to the end of the work. On the contrary, most indices after the work of children with DS on the blue, black, and gray-purple backgrounds (six, nine, and nine out of nine indices, respectively) were significantly impaired; impairment of the functional state of the central nervous system was detected in 14–25% of cases; general mental fatigue was observed in many cases (31–40%); and visual fatigue was found in 16–25% of cases.     

Pulmonary function and incident bronchitis and asthma in children: a community-based prospective cohort study

Background

Previous studies revealed that reduction of airway caliber in infancy might increase the risks for wheezing and asthma. However, the evidence for the predictive effects of pulmonary function on respiratory health in children was still inconsistent.

Methods

We conducted a population-based prospective cohort study among children in 14 Taiwanese communities. There were 3,160 children completed pulmonary function tests in 2007 and follow-up questionnaire in 2009. Poisson regression models were performed to estimate the effect of pulmonary function on the development of bronchitis and asthma.

Results

After adjustment for potential confounders, pulmonary function indices consistently showed protective effects on respiratory diseases in children. The incidence rate ratios of bronchitis and asthma were 0.86 (95% CI 0.79–0.95) and 0.91 (95% CI 0.82–0.99) for forced expiratory volume in 1 second (FEV₁). Similar adverse effects of maximal mid-expiratory flow (MMEF) were also observed on bronchitis (RR = 0.73, 95% CI 0.67–0.81) and asthma (RR = 0.85, 95% CI 0.77–0.93). We found significant decreasing trends in categorized FEV₁ (p for trend = 0.02) and categories of MMEF (p for trend = 0.01) for incident bronchitis. Significant modification effects of traffic-related air pollution were noted for FEV₁ and MMEF on bronchitis and also for MMEF on asthma.

Conclusions

Children with high pulmonary function would have lower risks on the development of bronchitis and asthma. The protective effect of high pulmonary function would be modified by traffic-related air pollution exposure.     

Obesity and the occurrence of bronchitis in adolescents

Objective:

Previous studies have shown that an elevated BMI was associated with higher risks of bronchitis among children. The magnitude of how increase in BMI influencing the risk of incident bronchitis remained unexplored. The objective of this study is to assess the association between BMI and the incidence of bronchitis in the Taiwan Children Health Study.

Design:

A school‐based prospective cohort study.

Methods:

We conducted a population‐based prospective cohort study among seventh‐grade school children in 14 Taiwanese communities. A total of 3,634 adolescents completed follow‐up questionnaire in 2009. Associations between BMI and incident bronchitis were analyzed by multiple Poisson regression models, taking overdispersion into account.

Results:

Among eligible cohort participants without bronchitis at study entry, the proportion of overweight and obesity were 32.1% and 17.9%. Overweight was 40.7% and obesity was 27.7% among those with incident bronchitis. The BMI percentile categories showed significant increasing trends for bronchitis in total eligible children and in girls (P for trend <0.001). Overweight and obesity were both associated with increased risks of incident bronchitis. This association was significant in girls only while stratified by gender.

Conclusions:

Our data showed that the BMI percentile and weight status were associated with higher risks of incident bronchitis in adolescents, especially in girls.     

Asthma as a link between chest illness in childhood and chronic cough and phlegm in young adults

The link between chest illnesses in childhood to age 7 and the prevalence of cough and phlegm in the winter reported at age 23 was investigated in a cohort of 10 557 British children born in one week in 1958 (national child development study). Both pneumonia and asthma or wheezy bronchitis to age 7 were associated with a significant excess in the prevalence of chronic cough and phlegm at age 23 after controlling for current smoking. This excess was largely attributable to the association of cough and phlegm at age 23 with a history of asthma or wheezy bronchitis from age 16. When adjustment was made for recent wheezing, current cigarette consumption, previous smoking habit, and passive exposure to smoke the relative odds of cough or phlegm, or both, in subjects with a history of childhood chest illness was 1·11 (95% confidence interval 0·97 to 1·27). When analysed separately asthma, wheezy bronchitis, and pneumonia up to age 7 did not significantly increase the prevalence of either cough or phlegm.The explanation for the observed continuity between chest illness in childhood and respiratory symptoms in later life may lie more in the time course of functional disturbances related to asthma than in the persistence of structural lung damage.     

Clinical efficacy of cycloferon in complex therapy of infectious mononucleosis in pediatrics

The results of the cycloferon use in therapy of 80 children at the age of 1 to 15 years with infectious mononucleosis are presented. The children were divided by chance sampling into two comparable groups of 40 subjects each. In the first group the children in addition to the standard therapy were treated with cycloferon for 10 days, intramuscularly or orally depending on the age. The reference group included the patients under the standard therapy alone. The efficacy of the drug was evaluated by reduction and more rapid disappearance of the main clinical symptoms of the disease. The improvement of certain laboratory indices, including those of the liver protein synthesis function were recorded, that allowed to reduce the hospitalization term. No side effects of the cycloferon use were observed.     

Early respiratory experience and subsequent cough and peak expiratory flow rate in 36 year old men and women.

Earlier work on the respiratory health of members of the Medical Research Council''s national survey of health and development (1946 birth cohort) was extended to age 36. At that age measures of peak expiratory flow rate and respiratory symptoms, elicited by the MRC chronic bronchitis questionnaire, were made in 3261 cohort members. In both men and women lower peak expiratory flow and higher respiratory morbidity were independently associated not only with current indices of poor social circumstances and cigarette smoking but also with poor home environment at age 2 years and lower respiratory tract illness before age 10. The findings provide additional evidence for a causal relation between childhood respiratory experience and adult respiratory disease.     

Larval toxocariasis and its clinical manifestation in childhood in the Slovak Republic

Results are presented of 90 children aged 1-15 years hospitalized with toxocariasis. Blood count analysis and laboratory examination were done by routine clinical laboratory methods. Anti-Toxocara antibodies were detected in the serum of patients using an ELISA method. Demographic analysis of the children's families exposed to the risk of disease allowed estimation of age-specific rates for clinical toxocariasis. The probability of toxocaral infection and the intensity of its clinical manifestations in children are determined by the epidemiology of this zoonosis and by the risk factors in the family. The presence of high titres of specific IgG antibodies in all age categories correlates with the clinical manifestations of toxocariasis. The highest admission rate is in the age categories of 3-5 years (43.3%) and 6-10 years (36.7%). Laboratory findings show that the most conspicuous changes occur in the age category 1-5 years. The high percentage of seropositive dog-keeping and puppy-breeding families and the possibility of infection with repeated doses of larvae stimulate eosinophilia, which prevails in children under the age of five years. We present the percentage of patients whose parameters showed deviations from the reference values for a particular age category. Analyses of laboratory indices and of clinical manifestations will contribute to the accuracy of diagnosis and effectiveness of treatment of this disease.     

Arterial Blood Gas Tensions and pH in Acute Asthma in Childhood

Studies of the arterial blood gas tensions and pH in 21 children during 24 acute attacks of asthma showed that all were hypoxic on admission to hospital, and in 10 there was evidence of carbon dioxide retention. Cyanosis, invariably present when the So₂ was below 85%, and restlessness in patients breathing air were the most reliable indices of the severity of hypoxia. There were no reliable clinical guides to the Pco₂ level. Conventional oxygen therapy in tents (25–40%) did not always relieve hypoxia, and in three cases the administration of oxygen at a concentration of 40% or over failed to produce a normal arterial oxygen tension. Uncontrolled oxygen therapy may aggravate respiratory acidosis, and three of our patients developed carbon dioxide narcosis while breathing oxygen. The necessity for blood gas measurements in the management of severe acute asthma in childhood is emphasized.     

Hereditary blood factors and infectious diseases in children in the 1st 7 years of life

Infectious morbidity in respect to 23 nosological forms was studied in 958 children with known blood groups and Rh factors during the first 7 years of their life. The absence of statistically significant differences in morbidity rates in children with different age groups was revealed in respect to 16 nosological forms. Significant differences in morbidity rates in children with different blood groups were revealed in respect to parotitis, rubella, scarlet fever, E. coli infections, bronchitis and pneumonia; similar differences linked with Rh factor were observed only in cases of measles, rubella and tonsillitis.     

Surfactant function in children with chronic airway inflammation.

Pulmonary surfactant is necessary to keep the terminal conducting airways patent. It is unknown whether mild to moderate airway inflammation may influence surfactant function and thus contribute to the pathogenesis of chronic airway inflammation in children. To answer this question, 21 children with chronic obstructive bronchitis and 19 asymptomatic children with long-term tracheostomy and increased numbers of neutrophils in their airways were compared with 15 healthy controls. Bronchoalveolar lavage fluid was separated into large surfactant aggregates (LA) and a supernatant containing inhibitory constituents. Surfactant function of LA, recombinations of LA and supernatant, and recombinations of a defined bovine surfactant and supernatant was assessed in a capillary surfactometer. Compared with controls, the function of the LA surfactant was reduced and there was no difference between children with tracheostomy and chronic obstructive bronchitis. The function of LA-supernatant recombinations was poor in all subjects. This may be explained by the well-known protein influx during the lavage procedure. The activity of bovine surfactant-supernatant reconstitutions was impaired in children with tracheostomy. In all surfactant mixtures assessed, surfactant function was inversely correlated to the number of neutrophils in the lavage fluid. Chronic lower airway inflammation with mild or no clinical symptoms is associated with impaired surfactant function. The dysfunction may contribute to airflow restrictions frequently observed in these children.     

三拗片联合布地奈德混悬液雾化吸入对急性支气管炎患儿炎症细胞因子和T淋巴细胞亚群的影响

摘要 目的：观察布地奈德混悬液雾化吸入、三拗片联合治疗对急性支气管炎患儿T淋巴细胞亚群、炎症细胞因子的影响。方法：选取2021年1月到2023年1月期间合肥市第二人民医院收治的急性支气管炎患儿78例,按照双色球法将患儿分为对照组和研究组,各为39例。对照组患儿接受布地奈德混悬液雾化吸入,研究组患儿接受三拗片联合布地奈德混悬液雾化吸入。对比两组疗效、炎症因子水平、临床指标、T淋巴细胞亚群和用药安全性。结果：研究组的临床总有效率高于对照组（P<0.05）。研究组的喘息缓解时间、咳嗽缓解时间、体温正常缓解时间、肺部啰音缓解时间短于对照组（P<0.05）。治疗7 d后,两组降钙素原（PCT）、白细胞介素-8（IL-8）、白细胞介素-6（IL-6）下降,且研究组低于对照组（P<0.05）。治疗7 d后,两组CD8⁺下降,且研究组低于对照组（P<0.05）;两组CD4⁺、CD4⁺/CD8⁺升高,且研究组高于对照组（P<0.05）。两组患儿不良反应对比未见统计学差异（P>0.05）。结论：急性支气管炎患儿采用布地奈德混悬液雾化吸入联合三拗片治疗,有助于缩短临床症状缓解时间,减轻炎症细胞因子水平,调节T淋巴细胞亚群。     

Socioeconomic status dependent medical complexities in children with sickle cell disease in Saudi Arabia

A look into the associations of socioeconomic status (SES) with prevalence of various complications in sickle cell disease (SCD) is necessary, for an improvement of societal norms, governmental health policies and strategies. We therefore studied the influence of SES indices on certain hematological and clinical parameters in children with SCD in Saudi Arabia. We included 32 female and 33 male patients aged 5–16 years, who were classified based upon their family income. Family monthly income was divided into 4 categories from lowest to highest, with socioeconomic class1 having low earnings of <5000 SAR; the middle income class divided further into class 2 with earnings >5000–10,000 SAR, and class 3 with earnings >10,000–15,000 SAR; and the higher income class 4 with earnings of >15,000 SAR. The assessment indices used were, the frequency of vaso-occlusive crisis (VOC), adverse events, and hematological parameters. A higher percentage of children affected with the disease were from class1, which is the low socio-economic class. It was found that the percentage of frequency of VOC pain crisis, and adverse events was higher in social class 1 patients than in the classes 2, 3, and 4. Also, the age group 5–10 years appeared more susceptible to adverse events and VOC. Our findings suggest the need to conduct future larger studies, to deduce the modifying influence of disparity in SES on certain clinical and hematological indices in children with SCD.     

TUBERCULOUS BRONCHITIS IN CHILDREN

Of 63 children with primary pulmonary tuberculosis who were examined bronchoscopically without particular regard for the usual criteria for the procedure, 18 (28.5 per cent) had visible tuberculous bronchitis.Certain endobronchial lesions resolved spontaneously, others responded to bronchoscopic treatment, and still others persisted despite all efforts.X-ray observations and clinical signs were of limited value in determining prior to bronchoscopy which child would have visible bronchial disease.Bronchoscopy is essential for both diagnosis and treatment of these lesions.Tuberculous bronchitis should be suspected whenever a child who is being treated for pulmonary tuberculosis by conservative means does not improve.     

Effects of iptakalim hydrochloride, a novel KATP channel opener, on pulmonary vascular remodeling in hypoxic rats

To investigate whether pulmonary artery remodeling could be prevented or not in hypoxic pulmonary hypertensive rats by treatment, the effects of iptakalim hydrochloride, a novel KATPCO, were evaluated. Iptakalim hydrochloride was orally administered at the doses of either 1.5 mg/kg/day or 0.75 mg/kg/day before their 4-week exposure to hypoxia (10% oxygen). It was demonstrated that iptakalim hydrochloride could reverse all pathological indices of pulmonary arterial remodeling and significantly reduce right ventricular hypertrophy in hypoxic rats. The reversal of hypoxic indices was dose-dependent, in which the higher dose of iptakalim hydrochloride reversed pathological indices more effectively than the lower dose did. This was further confirmed electrophysiologically using whole cell patch-clamp technique, which revealed that the outward potassium currents could be enhanced by iptakalim hydrochloride, and the decrease of K+ current density and increase of membrane capacitance could be reversed by chronic iptakalim hydrochloride treatment. These findings implied that iptakalim hydrochloride could play its role through activating plasmalemmal K+ channels of pulmonary arterial SMCs. The results indicated that iptakalim hydrochloride had anti-remodeling properties of pulmonary artery in hypoxic pulmonary hypertensive rats. It is therefore suggested that KATPCOs might be promising in the treatment of patients with hypoxic, and even possibly other forms of, pulmonary hypertension.