Polymorphisms in the promoter region of IL10 gene are associated with virus etiology of infant bronchiolitis

Background Bronchiolitis is the most common infection leading to hospitalization in infancy. Interleukin-10 (IL-10) is an anti-inflammatory cytokine, and in our previous study, IL10 gene rs1800896 (-1082A/G) polymorphism was associated with viral etiology of infant bronchiolitis. The objective of this study was to evaluate the associations between IL10 single nucleotide polymorphisms (SNPs) at rs1800890 (-3575A/T), rs1800871 (-819C/T) or rs1800872 (-592C/A) either alone or combined with the SNP at rs1800896 (-1082G/A), and the etiology and severity of infant bronchiolitis. Methods Data on four IL10 SNPs were available from 135 full-term infants, hospitalized for bronchiolitis at age less than 6 months, and from 378 to 400 controls. Viral etiology was studied, and oxygen support, feeding support and the length of stay in hospital were recorded during bronchiolitis hospitalization. Results Infants with rhinovirus bronchiolitis had the IL10 rs1800890 variant AT or TT genotype less often (18.2%) than controls (63.3%, P=0.03), and likewise, had the IL10 rs1800896 variant AG or GG genotype less often (27.3%) than con-trols (65.5%, P=0.009). Twenty-eight infants with bronchiolitis had the variant–variant Grs1800896Trs1800890 haplotype, and none of them had rhinovirus infection. The IL10 rs1800871 or rs1800872 genotypes showed no associations with viruses. No association was found between any genotypes and bronchiolitis severity measures. Conclusion IL10 rs1800890 and rs1800896 polymorphisms differed between infants with rhinovirus bronchiolitis and con-trols, but not between infants with respiratory syncytial virus bronchiolitis and controls.

The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis

Background This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, com-pared to normal saline inhalations or standard treatment without inhalations as controls. Methods The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitaliza-tion rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies. For the effectiveness estimations, we made a meta-analysis summarizing the results of the meta-analysis of the Cochrane review in 2013 and the results of 10 studies published after it. Results The mean hospitalization rate was 24.7% in the HS inhalation group and 32.6% in the control group [risk ratio: 0.80, 95% confidence interval (CI) 0.67–0.96] and the mean LOS was 3.736 (HS group) and 4.292 (controls) days (mean difference: ? 0.55 days, 95% CI ? 0.96 to ? 0.15), respectively. The expected costs per patient, when both inpatients and outpatients were included, were €816 ($1111) in the HS inhalation group and €962 ($1310) in the control group. The expected costs per hospitalization, when only inpatients were included, were €2600 ($3540) in the HS inhalation group and €2890 ($3935) in the control group. Conclusions HS inhalations slightly reduced the expected hospitalization costs of infant bronchiolitis. However, the low effectiveness, rather than the cost, is the factor that will limit the use of HS inhalations in infant bronchiolitis.

Tonsillitis in children: unnecessary laboratory studies and antibiotic use

Background:The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus(GAS)positive cases with penicillin.The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit.Methods:We analyzed retrospectively the data on microbiological studies and blood tests done,and data on prescribing of antibiotics,of 200 children admitted for febrile exudative tonsillitis.Results:After the clinical diagnosis of exudative tonsillitis,antigen test and/or culture for GAS identifi cation was done in>95%of cases.All the 32(16%)children with GAS infection,but also 52(38%)of the 137 children without any evidence of bacterial infection received antibiotics.Additional laboratory studies were done in 96%of children.Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis.No serious bacterial infection was diagnosed.Conclusions:The Finnish Current Care Guidelines lead to over-treatment with antibiotics.None of the 200 children returned after discharge,suggesting that undertreatment did not happen.