Factors Associated with Acute Respiratory Infections in Children Aged 0 - 5 Years in the Yénawa District of Cotonou (Benin) in 2023

Introduction: Acute respiratory infections remain one of the main causes of mortality in children aged 0 to 5. This work aimed to study the associated factors with the occurrence of acute respiratory infections in children 0 to 5 years old in Yénawa, Cotonou in 2023. Subjects and Method: It was an analytical cross-sectional study of children aged 0 - 5 years and their mothers in Yénawa, selected by four-degree random sampling. The sampling size, calculated using the Schwartz formula, was 126 children and 126 mothers. The dependent variable was the occurrence of acute respiratory infections. The independent variables were classified into four groups: socio-demographic and economic characteristics, behavioral factors, child-related factors, and environmental factors. Data collected by observation and questionnaire survey were analyzed using STATA version 15 software. Associated factors were investigated by bivariate analysis and multiple logistic regression, at the 5% significance level. Results: A total of 126 children aged 0 - 5 years and 126 mothers were surveyed, aged 23.5 (11 - 36) months and 30 (18 - 48) years respectively. The prevalence of acute respiratory infections was 74.60% (CI95% = 66.89 to 82.30). The associated factors were the mother’s age between 18 and 28 (OR = 10.77;CI95% = 1.89 to 61.27;p = 0.007), the use of charcoal/wood for cooking (OR = 7.36;IC = 1.99 to 27.10;p = 0.003)), children's poor personal hygiene (OR = 8.87;IC = 2.92 to 26.97;p 0.001)), and cohabitation with domestic animals (OR = 7.27;IC = 1.67 to 31.71;p = 0.015). Conclusion: Communicating with mothers about the factors identified will help reduce the prevalence of acute respiratory infections in children aged 0 to 5.

Predictive correlation test of acute respiratory failure in children with hand foot mouth disease

Objective:To investigate the predictive correlation test of acute respiratory failure in children with hand foot mouth disease (HFMD).Methods: Selected from our hospital June 2014 to June 2017 HFMD incidence of acute respiratory failure in 31 cases as a observation group;Selected from our hospital same period HFMD patients without acute respiratory failure in 35 cases as the control group;the other is selected from healthy children 40 cases as normal group. There were collected three groups peripheral venous blood 2 mL, and serum was isolated. Enzyme linked immunosorbent assay was used for the determination of IL-6. The content of CRP was measured by Backman OLYMPUS AU640 automatic biochemical analyzer. The contents of creatine kinase (CK), creatine kinase isozyme (CK-MB) and lactate dehydrogenase (LDH) were determined by Backman OLYMPUS AU640 automatic biochemical analyzer. The content of troponin I (cTnI) was measured by Backman ACCESS2 chemiluminescence immunoanalyzer.Results:The serum levels of IL-6, CRP, CK, CK-MB, LDH and cTnI in the observation group were higher than those in the control group and the normal group. After treatment serum levels of IL-6, CRP, CK, CK-MB, LDH and cTnI were lower than those before treatment, and there were statistically significant differences.Conclusion: serum IL-6, CRP index and serum CK, CK-MB, LDH and cTnI indexes can be used as indicators for the prediction of acute respiratory failure in children with hand foot mouth disease, and have important clinical significance.

Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India

BACKGROUND Respiratory syncytial virus(RSV) is a leading cause of lower respiratory infections among children.AIM To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.METHODS Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections(ALRI), admitted between August 2011-August 2013, were included.Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.RESULTS Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9%(130/383) had evidence of viral infection, and RSV was detected in 24.5%(94/383). Co-infections with RSV and other respiratory viruses(influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5%(21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season.Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.CONCLUSION Our study provides evidence of a high proportion of RSV and other virusassociated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.

Comparison of acute pneumonia caused by SARS-CoV-2 and other respiratory viruses in children:a retrospective multi-center cohort study during COVID-19 outbreak

Background:Until January 18,2021,coronavirus disease-2019(COVID-19)has infected more than 93 million individuals and has caused a certain degree of panic.Viral pneumonia caused by common viruses such as respiratory syncytial virus,rhinovirus,human metapneumovirus,human bocavirus,and parainfluenza viruses have been more common in children.However,the incidence of COVID-19 in children was significantly lower than that in adults.The purpose of this study was to describe the clinical manifestations,treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak.Methods:Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study.A total of 64 children with COVID-19 were defined as the COVID-19 cohort,of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort.Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort.The epidemiologic,clinical,and laboratory findings were compared by Kolmogorov-Smirnov test,t-test,Mann-Whitney U test and Contingency table method.Drug usage,immunotherapy,blood transfusion,and need for oxygen support were collected as the treatment indexes.Mortality,intensive care needs and symptomatic duration were collected as the outcome indicators.Results:Compared with the viral pneumonia cohort,children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19(53/64 vs.23/284),were of older median age(6.3 years vs.3.2 years),and had a higher proportion of ground-glass opacity(GGO)on computed tomography(18/40 vs.0/38,P<0.001).Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases(1/40 vs.38/284,P=0.048),and lower cases with high fever(3/40 vs.167/284,P<0.001),requiring intensive care(1/40 vs.32/284,P<0.047)and with shorter symptomatic duration(median 5d vs.8d,P<0.001).The proportion of cases with evaluated inflammatory indicators,biochemical indicators related to organ or tissue damage,D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort(P<0.05).No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs(lopinavir-ritonavir,ribavirin,and arbidol)as compared with duration in 39 children without antiviral therapy(median 10d vs.9d,P=0.885).Conclusions:The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia.Lopinavir-ritonavir,ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19.During the COVID-19 outbreak,attention also must be given to children with infection by other pathogens infection.

Clinical Diagnosis and Treatment Characteristics of Acute Respiratory Infections in Children and New Developments in Laboratory Testing

Acute respiratory tract infection (ARTI) in children is the most common infectious disease in childhood, and its pathogens include viruses, bacteria and fungi, mycoplasma, chlamydia and rickettsia. In recent years, with the continuous development of pathogen detection methods, the diagnosis and treatment of acute respiratory infections has received more and more clinical attention. The clinical diagnosis and treatment characteristics of acute respiratory infections in children and the research of clinical laboratory detection methods have also been continuously developed. The author collected references to review the clinical features and new developments in laboratory testing of acute respiratory tract infection in children.

Acute Thoracic Syndrome in Children: Epidemiological, Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar Senegal

Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.

Acute liver failure with hemolytic anemia in children with Wilson’s disease:Genotype-phenotype correlations?

BACKGROUND Wilson’s disease(WD)is a rare autosomal recessive inherited disorder of copper metabolism.Acute liver failure(ALF)and hemolytic anemia represent the most severe presentation of WD in children.No clear genotype-phenotype correlations exist in WD.Protein-truncating nonsense,frame-shift,or splice-site variants may be associated with more severe disease.In contrast,missense variants may be associated with late-onset,less severe disease,and more neurological manifestations.Recently,a gene variant(HSD17B13:TA,rs72613567)with a possible hepatic protective role against toxins was associated with a less severe hepatic phenotype in WD.AIM To analyze the possible genotype-phenotype correlations in children with WD presented with ALF and non-immune hemolytic anemia.METHODS The medical records of children with WD diagnosed and treated in our hospital from January 2006 to December 2020 were retrospectively analyzed.The clinical manifestations(ALF with non-immune hemolytic anemia or other less severe forms),laboratory parameters,copper metabolism,ATP7B variants,and the HSD17B13:TA(rs72613567)variant were reviewed to analyze the possible genotype-phenotype correlations.RESULTS We analyzed the data of 51 patients with WD,26 females(50.98%),with the mean age at the diagnosis of 12.36±3.74 years.ALF and Coombs-negative hemolytic anemia was present in 8 children(15.67%),all adolescent girls.The Kayser-Fleisher ring was present in 9 children(17.65%).The most frequent variants of the ATP7B gene were p.His1069Gln(c.3207A>G)in 38.24% of all alleles,p.Gly1341Asp(c.4021G>A)in 26.47%,p.Trp939Cys(c.2817G>T)in 9.80%,and p.Lys844Ter(c.2530A>T)in 4.90%.In ALF with hemolytic anemia,p.Trp939Cys(c.2817G>T)and p.Lys844Ter(c.2530A>T)variants were more frequent than in other less severe forms,in which p.His1069Gln(c.3207A>G)was more frequent.p.Gly1341Asp(c.4021G>A)has a similar frequency in all hepatic forms.For 33 of the patients,the HSD17B13 genotype was evaluated.The overall HSD17B13:TA allele frequency was 24.24%.Its frequency was higher in patients with less severe liver disease(26.92%)than those with ALF and hemolytic anemia(14.28%).CONCLUSION It remains challenging to prove a genotype-phenotype correlation in WD patients.In children with ALF and hemolytic anemia,the missense variants other than p.His1069Gln(c.3207A>G)and frame-shift variants were the most frequently present in homozygous status or compound heterozygous status with site splice variants.As genetic analysis is usually time-consuming and the results are late,the importance at the onset of the ALF is questionable.If variants proved to be associated with severe forms are found in the pre-symptomatic phase of the disease,this could be essential to predict a possible severe evolution.

Qingkailing injection for the treatment of acute upper respiratory infection in children: a systematic review and meta-analysis

Objective:To systematically evaluate the clinical efficacy and safety of Qingkailing (QKL) injection for pediatric acute upper respiratory infection (AURI).Methods:We searched for randomized controlled trials (RCTs) of pediatric AURI treated by QKL and western medicine (WM) in the China National Knowledge Infrastructure Database,China Science and Technology Journal Database,Wanfang,Chinese Biomedical Literature Database,PubMed and Cochrane Library from inception to August,2016.Two reviewers independently retrieved the RCTs and extracted information.The Cochrane Collaboration Risk of Bias Assessment Tool was used to evaluate the methodological quality of RCTs.The data were meta-analyzed by RevMan 5.3 software.Results:Ultimately,21 RCTs that involved 2364 participants were included,and the quality of RCTs was generally poor.According to the meta-analysis,the combined use of QKL and WM for treating AURI can be effective,with a higher total effective rate,less defervescence time and less recovery time of tonsil and throat inflammation.Twenty-five adverse drug reactions (ADRs) were reported in three RCTs,but there were no serious ADRs.Conclusion:The combination of QKL and WM for treating pediatric AURI can result in better effects,but no definitive conclusions can be made regarding its safety.More rigorous RCTs are needed to support the clinical application of QKL.

New Progress in Clinical Diagnosis, Treatment and Laboratory Testing of Acute Respiratory Infections in Children

Acute respiratory infection in children (ARTI) is the most common childhood infectious disease, and its pathogens include bacteria, fungi, viruses, chlamydia, mycoplasma and rickettsia. In recent years, with the continuous development of pathogen detection methods, the diagnosis and treatment of acute respiratory infections has received more and more attention from clinicians. The clinical diagnosis and treatment of acute respiratory infections in children and the research of laboratory detection methods have also been continuously developed. The manuscript presents a review of progress in the clinical diagnosis, treatment and laboratory testing of acute respiratory infections in children by collecting references.

Viral Acute Respiratory Infections in Central African Republic Children: Epidemiological and Clinical Aspects

Background: Acute respiratory infections (ARI) are recognized as an important cause of morbidity, mortality, and hospitalization among children in developing countries. Objectives: To identify the respiratory viruses circulating in Central African children before the SARS-COV2 pandemic and to assess the clinical manifestations. Methodology: This is a cross-sectional, descriptive, multicenter study, run from March 1, 2019, to March 31, 2020. Children aged 28 days to 15 year-old, with respiratory symptoms ≤10 days had been included. Nasopharyngeal swabs were taken and sent to the Institute Pasteur in Bangui (WHO National Referral Center for influenza). Virus research was done by cell and molecular culture techniques. Data were recorded and processed with Access 2019 software, then analyzed with STATA version 14 software. Chi-square test and ANOVA test were used to compare proportions at the p 0.05 threshold. Results: Out of 659 children included during the study period, viruses were identified in 231 children, for an overall positivity rate of 35.05% (231/659). Rhinoviruses (RV) and influenza viruses were found in 66.23% and 16.88% respectively. Virus-virus co-infections were found in 10 (10/231) children (4.32%). Children under 5 years of age were more represented (78.60%). The main reasons for consultation were: fever (96.20%), cough (95.45%), runny nose (78.5%), and breathing difficulty (30.50%). ILI (Influenza-Like Illness) was found in 71.02% versus 28.98% of SARI (Severe Acute Respiratory Infection). There was a statistically significant association between age 5 years and severity of acute respiratory infection (p = 0.001). The outcome was known for the 122 children at the CHUPB site with a mortality rate of 17.21% (n = 21). Conclusion: Viral ARI is common in children in Central African Republic. Care givers should think about it in order to reduce the inappropriate prescription of antibiotics.

Sociodemographic Factors for Vitamin D Levels in Children with Acute Respiratory Infection

Background and Objectives: Childhood acute respiratory infection is a public health problem with significant morbidity and mortality in developing countries. The present study was to assess the sociodemographic determinants of vitamin D levels in patient with acute respiratory infections (ARIs) receiving care in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Southeast Nigeria. Methodology: This was a cross-sectional study, conducted in Nnewi, Nigeria, on 250 children with ARI. Sociodemographic data were collected and serum vitamin D levels of the subjects were assayed. The association between sociodemographic variables and vitamin D was evaluated using multivariate logistic regression analysis. Results: A total of 250 children with ARI aged 1 - 59 months were enrolled in this study, with slight male preponderance (57.2%). About 60% of the population was less than 2 years. The majority (85.6%) of the subjects had adequate vitamin D levels (≥20 ng/dL). The mean serum vitamin D level in the subjects was (52.2 ± 25.6 ng/mL). Multivariate logistic regression showed that only gender was significantly related to vitamin D levels with males found to have a lower risk of vitamin D deficiency. {OR = 0.05 (0.004 - 0.77)}, p = 0.03. Conclusion: The association between male gender and high levels of vitamin D in acute respiratory infection was significant in this study. Further studies, however, should explore a probable role for vitamin D supplementation in children with ARI.

Acute Respiratory Disease at a Chinese Military Recruitment Training Center: Three-Year Consecutive Investigation

Background Military recruits are at a higher risk of acute respiratory disease(ARD) and the causative agents might change over time, which needs to be investigated. Methods The nasopharyngeal swabs and blood samples were consecutively collected from conscripts for three years in a military training center. The real-time fluorescent quantitative PCR assays were conducted for 15 species of common respiratory pathogens; the serum anti-Legionella pneumophila antibodies were detected by indirect immunofluorescence(IIF) assay, and serum anti-Microplasma pneumoniae antibodies, serum anti-influenza B virus and anti-influenza A virus-Ig M and Ig G were detected by ELISA. Results The prevalences of ARD were 59.3%(108/182) in 2008, 23.3%(50/215) in 2009,and 19.6%(40/204) in 2010. Among the patients with ARD from 2008 to 2010, the influenza B virus infection accounted for 45.4%, 30.0% and 55.0%, and seasonal influenza A virus infection for 8.3%, 8.0% and 5.0%, respectively; the positive rates of serum anti-Legionella pneumophila and anti-Microplasma pneumoniae antibodies in recruits was lower than 10% each year respectively in the three years without diagnostic significance. Conclusion The early appropriate diagnosis and treatment of ARD in military personnel will ensure the power strength of armed forces.

Temperature Inversions,Meteorological Variables and Air Pollutants and Their Influence on Acute Respiratory Disease in the Guadalajara Metropolitan Zone,Jalisco,Mexico

The presence of temperature inversions (TI), concentration of air pollutants (AP) and meteorological variables (MV) affect the welfare of the population, creating public health problems (acute respiratory diseases ARDs, among others). The Guadalajara Metropolitan Zone (GMZ) experiences high levels of air pollution, which associated with the presence of temperature inversions and meteorological variations is conducive to the incidence of ARDs in children. The aim of this work is to evaluate the TI, MV, AP and their influence on the ARDs in children under five years in the GMZ from 2003 to 2007. In this period, the moderate and strong TI are the most frequent presenting from November to May. The AP shows a variable behavior during the year and between years, with the highest concentration of particles less than 10 microns (PM10), followed by ozone (O3), nitrogen dioxide (NO2), nitrogen oxides (NOX), carbon monoxide (CO) and sulfur dioxide (SO2), the most affected areas are the southeast of the GMZ. Annual arithmetic mean is 213,510 ± 41,209 ARDs consultations. The most important diseases are acute respiratory infections (98.0%), followed by pneumonia and bronchopneumonia (1.1%), asthma and status asthmaticus (0.5%) and streptococcal pharyngitis and tonsillitis (0.4%). Months with most inquiries were from October to March, mainly in the southeast, south and center of the city, coinciding with high levels of AP. Statistical analysis shows that the TI have significant correlation with ARDs in three years, temperature (Temp) in two, relative humidity (RH) in two, wind speed (WS) in three, wind direction (WD) in two, while that air pollutants NOX and NO2 showed significant correlation with ARDs throughout the period. CO and SO2 showed significance in two years, while the PM10 and O3 in one.

Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clinical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Complete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.

Changes in children’s cardiorespiratory fitness and body mass index over the course of the COVID‑19 pandemic:a 34‑month longitudinal study of 331 primary school children

In late 2019,heavy restrictions were enforced on public activities worldwide to diminish the spread of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus[1].These restrictions,which included school closures and strictly limited sports and leisure opportunities,particularly impacted children and adolescents[2].Lifestyle changes in children and adolescents led to reduced physical activity levels[2,3],increased sedentary behavior[3,4],changes in eating habits,and changes in sleep habits[3].

Simultaneous detection of enterovirus-D68 and vaccine-related poliovirus 3 in the stool samples of a 5-month hospitalized child with acute respiratory disease:A case report

Human enterovirus(EV)infections can lead to various manifestations,with variable correlations between genotypes and symptoms.Human enterovirus D68(EV-D68)was considered to be associated with acute respiratory disease and acute flaccid myelitis.In this short report,both EV-D68 and poliovirus 3 were detected in the stool of a hospitalized 5-month child who presented with acute respiratory symptoms and who was recently vaccinated with oral polio vaccine(OPV),using a metatranscriptomic high-throughput sequencing method.The nearly full-length genome sequences with complete open reading frames of EV-D68 and poliovirus 3 were assembled.One previously-reported neurovirulence-related amino acid substitution(T860N)in the EV-D68 VP1 region was observed,but the patient showed no neurological symptoms.More attention should be paid to EV-D68,and continuous multiple syndrome-based surveillance on non-polio enterovirus is called for.

Abnormal liver function in children hospitalized with acute respiratory infection of adenoviruses:a retrospective study

Human adenoviruses(HAdVs)can cause acute hepatitis in immunocompromised patients.However,it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children.In this study,the liver function test(LFT)results were retrospectively analyzed among children hospitalized(age<14 years)between January 2016 and October 2019 for acute respiratory infection caused by adenoviruses.Alanine transaminase(ALT)and aspartate aminotransferase(AST)levels were elevated in 7.74%and 46.89%of patients,respectively.All patients with>2 folds of the upper limit of ALT or AST levels were infected with HAdV-7 or HAdV-55.Significantly higher levels of ALT,AST,γ-glutamyl transpeptidase(γ-GT),and lower albumin levels were observed in the HAdV-7 infection group than in the HAdV-3 infection group.HAdV-55 infection led to significantly higherγ-GT,total bilirubin,and direct bilirubin levels than the other infection types.The records of four patients with serial monitoring of the LFT results were further analyzed.Multiple indicators remained abnormal during the entire hospitalization in these patients.These results indicate that HAdV infection is often accompanied by abnormal liver function,and HAdV-7 and HAdV-55 might be under-recognized contributors to hepatitis among children.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Hepatitis of unknown etiology in children:Current evidence and association

Two years after the coronavirus disease 2019(COVID-19)pandemic,acute hepatitis of unknown etiology in children(AHUCD)began to be reported worldwide.The novel coronavirus and adenovirus were found in pathogen and antibody tests in AHUCD cases reported by the World Health Organization.Children are not exposed to the viruses that children are generally exposed to owing to COVID-19 infection preventive measures such as isolation and wearing masks;therefore,some researchers have speculated that this disease is related to reduced exposure to pathogens.Some scientists have also speculated that the disease is related to liver injury and adenoviral hepatitis,which are the sequelae of COVID-19.Some evidence also suggests a weak association between the disease and COVID-19 vaccination.Therefore,further research and investigation of the pathogenesis,preventive measures,and early treatment of hepatitis of unknown etiology are required.This study aimed to synthesize available evidence to further elucidate this disease in order to treat and prevent it effectively.

Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China:a national cross-sectional study

Background Bronchiolitis is a common acute lower respiratory tract infection(ALRTI)and the most frequent cause of hospitalization of infants and young children with ALRTI.Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis.The disease burden is relatively high.To date,few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available.This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China.Methods This study included the face sheet of discharge medical records collected from 27 tertiary children’s hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords(FUTURE)database.The sociodemographic variables,length of stay(LOS)and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests.Results In total,42,928 children aged 0–3 years were hospitalized due to bronchiolitis from January 2016 to December 2020,accounting for 1.5%of the total number of hospitalized children of the same age in the database during the period and 5.31%of the hospitalizations for ALRTI.The male to female ratio was 2.01:1.Meanwhile,more boys than girls were observed in different regions,age groups,years,and residences.The 1–2 year age group had the greatest number of hospitalizations for bronchiolitis,while the 29 days–6 months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group.In terms of region,the hospitalization rate of bronchiolitis was the highest in East China.Overall,the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016.Seasonally,the peak hospitalizations for bronchiolitis occurred in winter.Hospitalization rates in North China in autumn and winter were higher than those in South China,while hospitalization rates in South China were higher in spring and summer.Approximately,half of the patients with bronchiolitis had no complications.Among the complications,myocardial injury,abnormal liver function and diarrhea were more common.The median LOS was 6 days[interquartile range(IQR)=5–8],and the median hospitalization cost was 758 United States dollars(IQR=601.96–1029.53).Conclusions Bronchiolitis is a common respiratory disease in infants and young children in China,and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children.Among them,children aged 29 days–2 years are the main hospitalized population,and the hospitalization rate of boys is significantly higher than that of girls.The peak season for bronchiolitis is winter.Bronchiolitis causes few complications and has a low mortality rate,but the burden of this disease is heavy.