Respiratory Viruses Associated Hospitalization among Children Aged <5 Years in Bangladesh: 2010-2014

Background

We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh.

Methods

Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals.

Results

We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10–12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2–3), 0.5(0.4–0.8), 0.4 (0.3–0.6), 0.4 (0.3–0.6), and 0.4 (0.3–0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3–7), 2 (1–3), 1 (0.6–2), and 3 (2–4) in 2010, 2011, 2012 and 2013, respectively.

Conclusion

Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh.     

Relationships between water chemistry and respiration rate in several populations of lymnaea peregra Müller (Gastropoda: Mollusca)

Respiration rates of specimens of L. peregra obtained from waters with a wide range of ionic concentrations were measured using a constant volume respirometer. Multiple regression analysis showed that hardness of the water from which the snails were taken could significantly affect dry-wet weight relationships, oxygen consumption in relation to shell-free dry weight and oxygen consumption in relation to live wet weight. However there were also significant differences in respiration rate between populations from within water hardness categories (hard > 40 mg l^–1 Ca²⁺, medium 40 – 10 mg l^–1 Ca²⁺, soft < 10 mg l^–1 Ca²⁺). In experiments with constant anion but different cation concentrations, calcium and potassium concentrations were the most significant variables tested. There were no differences in respiration rates of animals taken from the same sites in different years.     

Ventilatory physiology of the numbat (<Emphasis Type="Italic">Myrmecobius fasciatus</Emphasis>)

This study examines the ventilatory physiology of the numbat (Myrmecobius fasciatus), a small to medium-sized (550 g) termitivorous marsupial. Ventilatory parameters at thermoneutrality reflect the slightly low (83% of predicted) basal metabolic rate of the numbat, with ventilation frequency (ƒ_R; 30.6±3.65 breaths min^–1), tidal volume [V_T; 6.0±0.66 ml at body temperature and pressure, saturated (BTPS)] and consequently minute volume (V_I; 117.7±15.22 ml min^–1; BTPS) all being 80–87% of that expected for a marsupial of similar body mass. Oxygen extraction was 27.7±1.37% in the thermoneutral zone. As is typical of marsupials, numbats accommodated increased oxygen consumption rates at ambient temperatures (T _a) below the thermoneutral zone by increasing minute volume (up to 411.2±43.98 ml min^–1; BTPS at T _a=10 °C) rather than oxygen extraction. Minute volume at 10 °C increased more by changes in ventilation frequency (up to 45.5±4.85 breaths min^–1) than tidal volume (9.4±1.03 ml, BTPS), as is also typical for a small-medium sized marsupial.Abbreviations BMR basal metabolic rate - BTPS body temperature and pressure, saturated - EO ₂ oxygen extraction - ƒ _R ventilation frequency - STPD standard temperature and pressure, dry - T _a ambient temperature - T _b body temperature - TNZ thermoneutral zone - V _I minute volume - V _T tidal volume - O ₂ oxygen consumption rate Communicated by I.D. Hume     

Energy metabolism of Chironomus anthracinus (Diptera: Chironomidae) from the profundal zone of Lake Esrom,Denmark, as a function of body size,temperature and oxygen concentration

The profundal zone of Lake Esrom, Denmark has a dense population of Chironomus anthracinus, which survives 2–4 months of oxygen depletion each summer during stratification. The metabolism of 3rd and 4th instar larvae was examined in regard to variation in biomass and temperature. Respiration at air saturation was described by a curvilinear multiple regression relating oxygen consumption to individual AFDW and temperature. At 10 °C and varying oxygen regimes the O₂ consumption and CO₂ production of 4th instar larvae were almost unaltered from saturation to about 3 mg O₂ l^–1, but decreased steeply below this level. The respiratory quotient increased from 0.82 at saturation to about 3.4 at oxygen concentrations near 0.5 mg O₂ l^–1. This implied a shift from aerobic to partially anaerobic metabolism. At 0.5 mg O₂ l^–1 the total energy production equalled 20% of the rate at saturation of which more than one third was accounted for by anaerobic degradation of glycogen. This corresponded to a daily loss of 12 µg mg AFDW^–1 or approximately 5% of the body reserves. At unchanged metabolic rate the glycogen store would last three weeks, but long term oxygen deficiency causes a further suppression of the energy metabolism in C. anthracinus.     

Nomograms for Calculation of Oxygen Consumption and Respiratory Exchange Ratio

Nomograms have been prepared whereby the respiratory exchange ratio may be derived from the concentrations of carbon dioxide and oxygen in expired gas and oxygen consumption from the volume and oxygen concentration of expired gas; they apply only to patients breathing room air. The nomogram for the respiratory exchange ratio has an error of less than 0·01, which is the limit of visual discrimination on the nomogram. The nomogram for oxygen consumption has an error of standard deviation 7·73 ml/min. This error may be substantially reduced by excluding cases with a respiratory exchange ratio outside the range 0·70-0·93. Under these conditions the maximum error was 10 ml/min, which is acceptable for a wide range of clinical purposes.     

Effects of Slow Deep Breathing at High Altitude on Oxygen Saturation,Pulmonary and Systemic Hemodynamics

Slow deep breathing improves blood oxygenation (Sp_O2) and affects hemodynamics in hypoxic patients. We investigated the ventilatory and hemodynamic effects of slow deep breathing in normal subjects at high altitude. We collected data in healthy lowlanders staying either at 4559 m for 2–3 days (Study A; N = 39) or at 5400 m for 12–16 days (Study B; N = 28). Study variables, including Sp_O2 and systemic and pulmonary arterial pressure, were assessed before, during and after 15 minutes of breathing at 6 breaths/min. At the end of slow breathing, an increase in Sp_O2 (Study A: from 80.2±7.7% to 89.5±8.2%; Study B: from 81.0±4.2% to 88.6±4.5; both p<0.001) and significant reductions in systemic and pulmonary arterial pressure occurred. This was associated with increased tidal volume and no changes in minute ventilation or pulmonary CO diffusion. Slow deep breathing improves ventilation efficiency for oxygen as shown by blood oxygenation increase, and it reduces systemic and pulmonary blood pressure at high altitude but does not change pulmonary gas diffusion.     

Standardized estimation of external respiration function

External respiration in healthy males has, in addition to eupnea, six functionally active variants with one or several indices deviating from the normal values. Hyperpnea and hypopnea are determined by deviations in general oxygen consumption accompanied by adequate changes in pulmonary ventilation and gas exchange. Inhibition of gas exchange in the respiratory parts of the lungs is a typical primary event of hyperventilation, a fact indicated by a decrease in the coefficient of oxygen consumption and a compensatory increase in the minute respiratory volume during hyperventilation. Tension of the respiratory system is especially pronounced during enhanced oxygen consumption (O₂C). Highly effective bradypnea is characterized by infrequent and deep breathing. No tension of the respiratory system is observed even for increased O₂C. This state may be considered a genotypic and phenotypic variant of normal respiration. The data obtained may be used to automate the assessment of gas exchange in the respiratory parts of the lungs.     

Cardiac output variations in supine resting subjects during head-out cold water immersion

Five men, aged 31.2 years (SD 2.3), under semi-nude conditions and resting in a dorsal reclining position, were exposed to thermoneutral air for 30 min, followed immediately by a cold water (15°C) immersion for 60 min. Cardiac output was measured using a dualbeam Doppler flow meter. During immersion in cold water, cardiac frequency (f _c) showed an initial bradycardia. The lowest values were reached at about 10 min after immersion, 58.3 (SD 2.5) to 48.3 (SD 7.8) beats min^–1 (P < 0.05). By the 20th min of exposure,f _c had gradually risen to 70.0 beats min^–1 (SD 6.6,P < 0.05). This change could be due to the inhibition of the initial vagal reflex by increased catecholamine concentration. Stroke volume (V _s) was significantly increased (P < 0.05) during the whole cold immersion period. Cardiac output, increased from 3.57 (SD 0.50) to 6.26 (SD 1.33)1 min^–1 (P < 0.05) and its change with time was a function of bothV _s andf _c. On the other hand, systolic flow acceleration was unchanged during the period of immersion. The changes in the respiratory variables (ventilation, oxygen uptake, carbon dioxide output and respiratory exchange ratio) during immersion showed an initial hyperventilation followed, as immersion proceeded, by a slower metabolic increase due to shivering.     

The Administration of 100% Oxygen and Respiratory Drive in Very Preterm Infants at Birth

Aim

To retrospectively investigate the changes of SpO₂ and respiratory drive in preterm infants at birth after administration of 100% oxygen.

Methods

Respiratory parameters, FiO₂ and oximetry of infants <32 weeks gestation before and after receiving FiO₂ 1.0 were reviewed during continuous positive airway pressure (CPAP) or positive pressure ventilation (PPV).

Results

Results are given as median (IQR) or percentages where appropriate. Suitable recordings were made in 50 infants (GA 27 (26–29) weeks), 17 received CPAP and 33 PPV. SpO₂ increased rapidly in the first minute after FiO₂ 1.0 and remained stable. The duration of FiO₂ 1.0 tended to be shorter in the CPAP group than in the PPV group (CPAP vs. PPV: 65 (33–105) vs. 100 (40–280) s; p = 0.05), SpO₂ >95% occurred more often in PPV group (53% vs. 69%) and lasted longer (70(40–95) vs. 120(50–202) s). In CPAP group, minute volume increased from 134 (76–265) mL/kg/min 1 minute before to 240 (157–370) mL/kg/min (p<0.01) 1 minute after start FiO₂ 1.0 and remained stable at 2 minutes (252 (135–376) mL/kg/min; ns). The rate of rise to maximum tidal volume increased (from 13.8 (8.0–22.4) mL/kg/s to 18.2 (11.0–27.5) mL/kg/s; p<0.0001) to 18.8 (11.8–27.8) mL/kg/s; ns). In the PPV group respiratory rate increased from 0(0–4) to 9(0–20) at 1 minute (p<0.001) to 23 (0–34) breaths per minute at 2 minutes (p<0.01).

Conclusion

In preterm infants at birth, a rapid increase in oxygenation, resulting from a transient increase to 100% oxygen might improve respiratory drive, but increases the risk for hyperoxia.     

Correlated Variability in the Breathing Pattern and End-Expiratory Lung Volumes in Conscious Humans

In order to characterize the variability and correlation properties of spontaneous breathing in humans, the breathing pattern of 16 seated healthy subjects was studied during 40 min of quiet breathing using opto-electronic plethysmography, a contactless technology that measures total and compartmental chest wall volumes without interfering with the subjects breathing. From these signals, tidal volume (V_T), respiratory time (T_TOT) and the other breathing pattern parameters were computed breath-by-breath together with the end-expiratory total and compartmental (pulmonary rib cage and abdomen) chest wall volume changes. The correlation properties of these variables were quantified by detrended fluctuation analysis, computing the scaling exponentα. V_T, T_TOT and the other breathing pattern variables showed α values between 0.60 (for minute ventilation) to 0.71 (for respiratory rate), all significantly lower than the ones obtained for end-expiratory volumes, that ranged between 1.05 (for rib cage) and 1.13 (for abdomen) with no significant differences between compartments. The much stronger long-range correlations of the end expiratory volumes were interpreted by a neuromechanical network model consisting of five neuron groups in the brain respiratory center coupled with the mechanical properties of the respiratory system modeled as a simple Kelvin body. The model-based α for V_T is 0.57, similar to the experimental data. While the α for T_TOT was slightly lower than the experimental values, the model correctly predicted α for end-expiratory lung volumes (1.045). In conclusion, we propose that the correlations in the timing and amplitude of the physiological variables originate from the brain with the exception of end-expiratory lung volume, which shows the strongest correlations largely due to the contribution of the viscoelastic properties of the tissues. This cycle-by-cycle variability may have a significant impact on the functioning of adherent cells in the respiratory system.     

Bronchial response to breathing dry gas at 3.7 MPa ambient pressure

In diving, pulmonary mechanical function is limited by the increased density of the gas breathed. Breathing cold and dry gas may cause an additional increase in airways resistance. We have measured forced vital capacity, forced expired volume in 1 s (FEV₁) and forced midexpiratory flow rate (FEF_25%–75%) before and after breathing dry or humid gas at 29–32°C during a standardized exercise intensity on a cycle ergometer at an ambient pressure of 3.7 MPa. The atmosphere was a helium and oxygen mixture with a density of 6.8 kg · m^–3. Six professional saturation divers aged 26–37 years participated in the study. There were no significant differences in convective respiratory heat loss between the exposures. The mean evaporative heat loss was 67 W (range 59–89) breathing dry gas and 37 W (range 32–43) breathing humid gas, corresponding to water losses of 1.7 g · min^–1 (range 1.5–2.2) and 0.9 g · min^–1 (range 0.8–1.1), respectively. There was a significant reduction in FEV₁ of 4.6 (SD 3.6)% (P<0.05), and in FEF_25%–75% of 5.8 (SD 4.7)% (P<0.05) after breathing dry gas. There were no changes after breathing humid gas. By warming and humidifying the gas breathed in deep saturation diving bronchoconstriction may be prevented.     

Growth and final product formation by <Emphasis Type="Italic">Bifidobacterium infantis</Emphasis> in aerated fermentations

Fermentation conditions were developed to allow Bifidobacterium infantis to grow in the presence of air. Batch fermentations in TPYG medium, starting from anoxic conditions followed by the application of low airflow rates [0.02–0.1 air volume, per liquid media volume, per minute (vvm)], were analyzed for growth, oxygen uptake, and product formation by the bacterium. Under all aerated fermentations, B. infantis showed high aerotolerance, with a maximum oxygen-specific consumption rate of 0.34 mmol oxygen per gram dry cell weight per hour in the presence of 0.06 vvm. Similar growth yields were obtained under oxic and anoxic conditions (0.11–0.13 and 0.11 g dry cell weight per mmol glucose, respectively). Oxygen also influenced metabolite formation since lactate production and its molar relation to acetate increased and formate decreased with aeration rate. Under anoxic conditions, a maximum concentration of 8.1 mM lactate and an acetate/lactate ratio of 3.5:1 were obtained, while under oxic conditions the lactate concentration increased more than two-fold and the acetate/lactate molar ratio decreased to 1.5:1. The possibility of balancing acetate/lactate molar ratios for organoleptic purposes as well as for obtaining good growth under microaerated conditions was demonstrated.     

Microbiological investigations after the “Bravo” blowout (Ekofisk oil field,North Sea)

Following the accident in 1977 at an offshore oil producing platform in the Ekofisk oil field (North Sea) an estimated amount of 13000–15000 tons of oil polluted the sea. Microbiological investigations were conducted one to five weeks after the blowout and compared with data collected in the same area during the years before. Bacterial numbers in the water were fairly low. In the floating oil particles, however, extremely high values were obtained (2 × 10¹¹ heterotrophic bacteria 1^–1 and 5 × 10¹⁰ oil degrading bacteria 1^–1). The data on oxygen consumption gave markedly different results indicating that the oil degradation potential of the water seemed to vary widely from one station to another. The greatest increase in oxygen consumption (following the addition of oil to the bottles) occurred in samples taken at the station where oil particles from the blowout were observed floating on the surface. This indicates a higher oil degradation potential.     

Cultivation of cell cultures of Berberis wilsonae in 20-l airlift bioreactors

Suspension cultures of Berberis wilsonae produce 4 berberine-type alkaloids: berberine, palmatine, columbamine and jatrorrhizine. In particular the formation of the phenolic alkaloids columbamine and jatrorrhizine and of berberine proves to be dependent on the concentration of dissolved oxygen. With higher aeration rates, berberine and jatrorrhizine yields can be increased considerably. Thus we reached an alkaloid yield of more than 3 g × 1^–1 with 50% dissolved oxygen tension in the medium. As far as we know this is one of the best results in fermenting of alkaloid-producing cell cultures.Abbreviations pO₂ dissolved oxygen concentration in % saturation (using air) - HPLC high-performance liquid chromatography - vvm volume air × volume medium^–1 × minute^–1 - rpm revolutions per minute - IAA indole-3-acetic acid - 2,4-D 2,4-dichlorophenoxy acetic acid     

Oxygen consumption of engorged nymphs and unfed adults of Hyalomma asiaticum ticks (Acari: Ixodidae) exposed to various photoperiods

The oxygen consumption of engorged nymphs of Hyalomma asiaticum was measured at various intervals after drop-off from mice hosts. Duration of nymphal development to the emergence of adults was 25–32 days at 25°C. The oxygen consumption was high immediately after completing the blood meal (193–248 mm³ g^-1 h^-1 but decreased significantly 18 days later (at 25°C) to 45–65 mm³ g^-1 h^-1. It increased again before ecdysis (81–102 mm³ g^-1 h^-1, and also after ecdysis in freshly moulted adults (177–220 mm³ g^-1 h^-1. The oxygen consumption in 8-month-old adult ticks was very variable ranging from 40–42 to 172 mm³ g^-1 h^-1. Neither engorged nymphs nor unfed adult ticks showed any dependence of their respiratory metabolism on the photoperiodic regimes tested (LD 20:4 and LD 12:12, with or without transfer to an alternative photoperiod after engorgement of nymphs).     

Six-Minute Walk Test: Reference Values and Prediction Equation in Healthy Boys Aged 5 to12 Years

OBJECTIVE

This study aimed to (1) generate normative data in healthy boys aged 5–12 years for the six-minute walk test (6MWT), an outcome measure currently used in clinical trials in Duchenne muscular dystrophy (DMD), (2) to describe the relation with anthropometric variables and myometry, and (3) to compare our data with published equations.

METHODS

The 6MWT was conducted in 442 boys according to a standardized protocol, as currently used in clinical trials in DMD. Maximal voluntary isometric contractions for knee flexion and extension were recorded with a hand-held myometer.

RESULTS

The 6MWD increased significantly with age, from 478.0±44.1 m at age 5, to 650.0±76.8 m at age 12, with the steepest increase between 5 and 8 years. Age- and height related percentile curves of the 6MWD were developed. Correlations with anthropometric variables were fair to good (age r = 0.60, height r = 0.57, weight r = 0.44). Myometric variables (knee flexors and extensors) showed correlations of 0.46 and 0.50 respectively. When dividing into two age categories (5–8 years, 9–12 years), these magnitudes of correlations only applied to the younger age group. Additionally, predicted values were calculated according to available reference equations (Geiger and Ben Saad), indicating an overestimation by those equations. Finally, the Geiger equation was refitted to our population.

CONCLUSION

The percentile curves according to age and height provide a useful tool in the assessment of ambulatory capacity in boys aged 5 to 12 years. Significant correlations with anthropometric variables and myometry were only found in the 5–8 years age group. The Geiger prediction equation, currently used to assess ambulatory capacity in DMD was refitted to obtain a more accurate prediction model based on a large sample with a homogenous distribution across the age categories 5 to 12 years and applying the methodology as currently used in clinical trials in DMD.     

The oxygen transfer rate as key parameter for the characterization of<Emphasis Type="Italic"> Hansenula polymorpha</Emphasis> screening cultures

Screening cultures are usually non-monitored and non-controlled due to a lack of appropriate measuring techniques. A new device for online measurement of oxygen transfer rate (OTR) in shaking-flask cultures was used for monitoring the screening of Hansenula polymorpha. A shaking frequency of 300 rpm and a filling volume of 20 ml in 250-ml flasks ensured a sufficient oxygen transfer capacity of 0.032 mol (l h)^–1 and thus a respiration not limited by oxygen. Medium buffered with 0.01 mol phosphate l^–1 (pH 6.0) resulted in pH-inhibited respiration, whereas buffering with 0.12 mol phosphate l^–1 (pH 4.1) resulted in respiration that was not inhibited by pH. The ammonium demand was balanced by establishing fixed relations between oxygen, ammonium, and glycerol consumption with 0.245±0.015 mol ammonium per mol glycerol. Plate precultures with complex glucose medium reduced the specific growth rate coefficient to 0.18 h^–1 in subsequent cultures with minimal glycerol medium. The specific growth rate coefficient increased to 0.26 h^–1 when exponentially growing precultures with minimal glycerol medium were used for inoculation. Changes in biomass, glycerol, ammonium, and pH over time were simulated on the basis of oxygen consumption.     

Relationship between the activity of the succinoxidase system and the rate of oxygen consumption during the embryonic development of the mealworm,Tenebrio molitor Linnaeus

1. Readings were made on the rates of oxygen consumption and on the activities of the succinoxidase system of eggs of the mealworm for each day of embryonic development at 30°C. 2. The rate of oxygen consumption, expressed as microliters/50 eggs/hour, was low (4.89) in newly laid eggs. It rose to 7.41 during the next 24 hours, remained at this level for the next 2 days, and then increased during the remainder of the embryonic period reaching a high value of 14.79 at the time of hatching. 3. The activity of cytochrome oxidase in eggs from newly emerged beetles, expressed as Δ log [Cy Fe⁺⁺]/minute, remained at a value of 0.042 during the first half of the embryonic period, increasing to 0.233 during the latter half of this period. 4. The activity of succinic dehydrogenase showed the same series of changes except at much lower values. Expressed as Δ log [Cy Fe⁺⁺⁺]/minute, they ranged from 0.010 in the newly laid egg to 0.034 at the end of the embryonic period. 5. The activity of cytochrome oxidase of the egg was found to decrease with parental age. Eggs from newly emerged beetles had activity values considerably higher than those of beetles 6 or 8 weeks after emergence. However, no comparable changes were noted in the activity of succinic dehydrogenase or in the rate of oxygen consumption. These observations suggest that cytochrome oxidase is not a rate-limiting enzyme in the respiratory metabolism of the mealworm egg.     

Continuous measurement of breathlessness during exercise: validity, reliability, and responsiveness.

A continuous method for recording changes in breathlessness (dyspnea) during exercise is introduced and compared with the traditional discrete method. In study 1, a category-rating scale was presented on a computer screen, and 14 healthy, young female subjects exercised on a cycle ergometer until exhaustion. Two approaches were used to obtain ratings of breathlessness: a discrete method, in which subjects gave single judgments every minute, and a continuous method, in which subjects throughout exercise moved the mouse so that a bar on the screen extended to the desired location along the scale. Psychophysical results relating measures of breathlessness and the variables of work, oxygen consumption, and minute ventilation were statistically indistinguishable with the two methods, and both methods were highly reliable across test sessions. In study 2, both measurement methods were employed, and the subjects were 14 healthy, young males. In each of two sessions (discrete or continuous method), subjects first rated their breathlessness during an incremental test in which the workload was increased over time and levels of work, and minute ventilation were recorded. Subjects then exercised for 10 min at 60% of the maximal oxygen consumption achieved during the incremental test. At two points during steady-state exercise, a respiratory load was introduced that lasted for 1 min. It was possible to determine the responsiveness of subjects to onset and offset of the respiratory load for the continuous method but not for the discrete method. In study 3, patients with chronic obstructive pulmonary disease employed both methods, and it was found that the continuous method was better at determining whether subjects showed a significant positive slope of the regression line between breathlessness ratings and physiological variables.