In this study, we found that the novel Alere i RSV assay detects RSV infection with high sensitivity and speciﬁcity in NPS samples obtained from children hospitalized with acute respiratory tract infection. Results are delivered within 13 min, and positive samples usually are identiﬁed within 7 min. The assay displays a combined positive or negative test result for both RSV A and B without providing further information on RSV subtype. Both RSV A and B strains were reliably detected by the test assay. This provides clinicians with the conﬁdence to act appropriately when a negative Alere i RSV test result is obtained. The assay requires 3 to 4 min of hands-on time. In our experience, it was user friendly and efﬁcient, although some initial training is still required. We obtained 3 invalid test results due to a handling failure in the transfer of the sample eluate into the lyophilized test base.
With mean follow-up time of 36 weeks, the partici- pants contributed 105,526 person-weeks under surveil- lance. Missing data was ≤7% for all variables. Increasing hand-washing frequency above 2–4 times daily was not associated with a reduction in the incidence of respiratory tract infection in the crude analysis. On the contrary, over- all it was associated with a moderately increased incidence of both ARI and ILI up through the second highest expos- ure category (10–19 times per day), whereupon the rela- tive risk fell somewhat (Table 2). The multivariably adjusted excess risk was only borderline significant for ARI among those washing hands 10–19 times per day, and non-significant for ILI. With ARI as the outcome, there was no interaction between hand-washing frequency and, respectively, household size (p = 0.24), overall contact frequency (p = 0.52) or child contact frequency (p = 0.49). For ILI, hand-washing tended to interact with household size (p = 0.09). Among subjects living in households with 3 members or more, there was a slight, statistically non- significant tendency for point estimates of relative risk of ILI to be below unity in categories with frequent hand- washing, however without any clear dose-risk pattern (Table 3).
Objective: To assess Knowledge, Attitude and Practices of mothers on ARI (Acute Respiratory Tract Infection) in children less than five years of age. Methods: This cross-sectional survey was conducted in the Department of Pediatrics, Mayo hospital, Lahore from 1 st December 2014 to 28 th February 2015. Mothers(n=335) who were local residents, had at least one child below the age of five years and coming to the hospital for any medical problem along with accompanying women were included. Foreign mothers and/or those having difficulty in perceiving questions were excluded Language used in the Questionnaire was English which was translated to Urdu for better understanding. Questionnaire was interviewer administered. Researchers and two house physicians took part in questioning the mothers. Results: Total 335 children were studied. Out of 335 children 228(68%) had ARI. Mean age of the children was 20 months ±17 SD while mean Birth weight was 2.7 kg ± 1.8 SD. The most common symptom perceived was cough (n=303, 40%), mostly worsening during winter season (n=255,87%), commonest aggravating factor was dust (n=174,81%), most common complication was Pneumonia (n=135, 83%), and most mothers opted for medical practitioner (n=268,89%) for treatment. Self-medication was practiced by 192(58%) and paracetamol was frequently used medication (n=117, 42%). Conclusion: The study reveals good knowledge of mothers on ARI symptoms, worsening environmental conditions, aggravating factors and complications. Their attitude towards ARI was appropriate with early consultation with qualified medical practitioner. Better literacy rate, has a positive influence on the Knowledge, Attitude and Practices of mothers.
Objective: To assess Knowledge, Attitude and Practices of mothers on ARI (Acute Respiratory Tract Infection) in children less than five years of age. Methods: This cross-sectional survey was conducted in the Department of Pediatrics, Allied Hospital, Faisalabad from 1 st December 2016 to 28 th February 2017. Mothers(n=335) who were local residents, had at least one child below the age of five years and coming to the hospital for any medical problem along with accompanying women were included. Foreign mothers and/or those having difficulty in perceiving questions were excluded. Language used in the Questionnaire was English which was translated to Urdu for better understanding. Questionnaire was interviewer administered. Researchers and two house physicians took part in questioning the mothers. Results: Total 335 children were studied. Out of 335 children 228(68%) had ARI. Mean age of the children was 20 months ±17 SD while mean Birth weight was 2.7 kg ± 1.8 SD. The most common symptom perceived was cough (n=303, 40%), mostly worsening during winter season (n=255,87%), commonest aggravating factor was dust (n=174,81%), most common complication was Pneumonia (n=135, 83%), and most mothers opted for medical practitioner (n=268,89%) for treatment. Self-medication was practiced by 192(58%) and paracetamol was frequently used medication (n=117,42%). Conclusion: The study reveals good knowledge of mothers on ARI symptoms, worsening environmental conditions, aggravating factors and complications. Their attitude towards ARI was appropriate with early consultation with qualified medical practitioner. Better literacy rate, has a positive influence on the Knowledge, Attitude and Practices of mothers.
Adv: Adenoviruses; ALRTI: Acute lower Respiratory Tract Infection; ARI: Acute Respiratory Tract Infection; BHIB: Brain Heart Infusion Broth; BSA: Bovine Serum Albumin; CHRPE: Committee for Human Research Publications and Ethic; DALYs: Disability Adjusted Life Years; Flu A: Influenza A; Flu B: Influenza B; KATH: Komfo Anokye Teaching Hospital; KNUST: Kwame Nkrumah University Of Science and Technology; PCR: Polymerase Chain Reaction; PIV: Parainfluenza Virus; RSV: Respiratory Syncytial Virus; SARS: Severe Acute Respiratory Syndrome; TSI: Triple Sugar Iron agar; WHO-IMCI: (World Health Organisation Integrated Management of Childhood Illness).
with mild, intermittent asthma or exercise-induced asthma. We observed no increased risk for asthma events 0 to 14 days after vaccination in children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age. In vaccine year 1, children who were 18 months to 4 years of age did have a significantly higher RR (2.85; 95% CI: 1.01– 8.03) for asthma events 15 to 42 days after vaccination. In vaccine year 2, the formulation of LAIV-T was identical to the vaccine formulation used in vaccine year 1; however, in chil- dren who were 18 months to 4 years of age, no statistically significant increased risk was detected for asthma events 15 to 42 days after vaccination (RR: 1.42; 95% CI: 0.59 –3.42). Similarly, in vaccine years 3 and 4, children who were 18 months to 4 years of age did not have a statistically significant increased risk for asthma events 15 to 42 days after vaccination (vaccine year 3, RR: 0.47 [95% CI: 0.12–1.83]; vaccine year 4, RR: 0.20 [95% CI: 0.03–1.54]). Also, LAIV-T did not increase the risk for asthma in children who received 1, 2, 3, or 4 annual doses of LAIV-T (Table 6). Although the possibility for a true increased risk for asthma was observed in 1 of 4 years in children who were 18 months to 4 years at 15 to 42 days after vaccination, it is more likely that the association is a chance effect because of the 190 comparisons made without adjustment for multiple comparisons. In 3 of those 4 vaccine years, the composition of LAIV-T was revised according to the recommendation of the FDA, thus adding to the robustness of safety with multiple LAIV-T compositions. Finally, we con- trolled for misclassification of asthma events by re- viewing the medical records of all events with an ICD-9 asthma diagnostic code and making a priori assignments to acute asthma or other. We believe that this process was crucial in reducing misclassifi- cation and in obtaining reliable safety data for ad- ministrative database analyses.
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Paramyxoviridae include two other genera, Morbillivirus (measles virus) and the Paramyxoviruses (mumps and parainfluenza viruses). The nonsegmented, singlestranded, negative-sense RNA genome is composed of approximately 15,222 nucleotides and 10 genes which encode 11 proteins . The virus is composed of a nucleocapsid core of N, P, and L proteins (which together is the viral replicase) and virion RNA surrounded by a lipid bilayer obtained from the host cell membrane into which are embedded three transmembrane glycoproteins (G, F, and SH). Infection is initiated with the G protein binding to a host cell receptor, possibly a heparin-like glycosaminoglycan, followed by F protein-mediated fusion of the viral and cell membranes and penetration of the nucleocapsid complex into the cytoplasm Antibodies directed against the F or G glycoprotein neutralize virus in vitro and in vivo.
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As in other studies from developed countries [37, 38], HIV infection was associated with a 2-fold increase in risk of CAP. This effect size is likely to be an under- estimate due to the use of hospital controls, despite at- tempts to exclude from the control population those with HIV-related diseases. The prevalence of HIV among controls was 30.3%; population-based estimates of HIV sero-prevalence at the same time were 7.5% . Use of hospital controls also explains the seemingly protective effect of malaria infection. Infection with malaria parasites in the tropics is a common cause of presentation to hospi- tals with non-pneumonia syndromes. Interestingly, markers of chronic malaria infection, anemia and splenomegaly were strongly associated with pneumonia, suggesting that chronic or recurrent malaria may in fact be a risk factor for pneumonia, although splenomegaly may also be a marker of HIV or tuberculosis, both common in this population.
from mild upper to severe lower respiratory tract infec- tions, and may cause exacerbation of underlying diseases such as asthma and chronic obstructive pulmonary disease . Viral respiratory infections can be sporadic or epidemic. RSV epidemics in adults usually alternate with epidemics of influenza and are clinically difficult to distinguish. Picornaviruses (hRV/EV) are predominantly associated with the common cold but are also the cause of lower respiratory tract infections, especially in small children and the elderly .] HMPV and hCoV are distributed worldwide, and in countries with temperate climates they usually cause winter epidemics, which often follow an RSV outbreak [8, 9]. Nevertheless, know- ledge about infections with these viruses in NH residents is incomplete. In comparison to acute care hospitals, infection control practices in NH cannot be as strict; many vulnerable people with underlying chronic diseases share common spaces for daily activities and infections can spread easily. Due to daily visitors and NH staff, viral infections from the community can be introduced into the NH. In addition, scant clinical symptoms com- bined with a shortage of medical personnel and limited diagnostic facilities can lead to delayed recognition of infections and consequently delayed introduction of preventive measures.
In old people tuberculosis can be either due to exogenous reinfection or endogenous reactivation. In this age group there is an increased risk of tuberculosis infection due to natural aging process of the immune system. Several factors apart from aging contribute to decline in immunity. These are underweight, malnutrition, cancer, diabetes mellitus, gastrointestinal surgery, immunosuppressive treatment like corticosteroids, smoking and HIV.
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Streptococcus pneumoniae (S. pneumoniae) is the most common cause of community- acquired pneumonia worldwide 34 . It also causes meningitis and otitis media. S. pneumoniae is commonly carried in the nasopharynx of healthy individuals, with one particular study finding 26% of two month old infants, and 62% of two year olds to be carriers 35 . Problems arise when S. pneumoniae spreads from the nasopharynx to the lower respiratory tract causing pneumonia, or other sites such as the meninges, blood or middle ear, causing meningitis, bacteraemia or otitis media – these together are termed invasive pneumococcal disease 34 . Risk factors for carriage of S. pneumoniae include a young age, young siblings, day care attendance, asthma and, in adults, smoking 34 . Invasive pneumococcal disease is a huge problem, causing an estimated one million deaths in children under the age of five annually 34 . Human immunodeficiency virus (HIV) infection is an important risk factor for invasive pneumococcal disease, particularly in Sub-Saharan Africa. Those with HIV have a 10-100 times increased risk of developing invasive pneumococcal disease when compared to the general population 36 .
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Consent for enrolment was sought from parents by study personnel. All children less than 2 years of age who were hospitalized with symptoms suggesting LRTI were enrolled in the study. LRTI were categorized on the basis of clinical and roentgenographic findings, according to the criteria proposed by Ruuskanen and Ogra . The disease was diagnosed: a) as wheezy bronchitis, when an acute illness characterized by cough, rhonchi, and expira- tory wheezing was detected; b) as bronchiolitis, when wheezing dyspnea, tachypnea and CXR hyperinflation of the lung with or without areas of collapse were present; c)
In the Coronaviridae family there have already been two epidemics the first in 2002-2003 with SARS-CoV (Severe Acute Respiratory Syndrome) and the second with the MERS-CoV (Middle East Respiratory Syndrome), whose outbreak was in the 2012, with a mortality of approximately 11% and 35% respectively, highlighting the high mortality that this group of viruses can have in humans [1,2]. Its name is derived from its microscopic shape similar to that of a solar corona and from the Latin corona, it has a wide distribution in the animal kingdom, mainly in mammals (porcines, felines, canines, humans, horses) and avian, considered a zoonotic infection, its clinical manifestations are mainly respiratory (from common flue to Acute respiratory distress syndrome -ARDS) and enteric symptoms (diarrhea), but in some cases neurological and liver involvement has been reported [1,2].
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The most prominent echocardiographic finding of the heart failure patients in the prevailing study were Pulmonary hypertension along with LV systolic dysfunction (Table-IV). Although right heart involvement is a more common finding in patients with pulmonary hypertension, especially with respiratory tract infections as found by Shann et al 5 where 26% of the subjects developed right ventricular failure secondary to pulmonary hypertension, but this current study interestingly found left ventricular involvement. These findings can be related to the study carried out by Shah et al 26 , who stated that
problem of acute respiratory infection is relatively high in Uttar Pradesh, Punjab and Haryana as compared to Himachal Pradesh which indicates that this may be due to the extensive burning of biomass in these states. The fieldwork of NFHS-4 was conducted in the rabi season in the respective states which shows that the problem of ARI is extreme in this season, this problem will definitely be very intense in the kharif season. A recent study regarding the implication of pollution due to stubble burning on health and pulmonary functions, conducted by Dr. Vitul K. Gupta in Bathinda and its neighboring districts in Malwa region of Punjab revealed a significant increase in the health disorders among normal people and particularly those who suffered from Chronic Obstructive Pulmonary Disorder (COPD) after stubble burning (29 September, 2018, Times of India). Out of total 8,573 respondents, 84.5 percent respondents suffered from health problems due to smoke and in all, 76.8 percent respondents reported irritation in eyes (24 January, 2016, Times of India).
1. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O'Brien KL, Roca A, Wright PF, Bruce N, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545 – 55. 2. Bashir U, Nisar N, Arshad Y, Alam MM, Ashraf A, Sadia H, Kazi BM, Zaidi SS.
It is well know that infants born at < 37 week gestational age (wGA) are at highest risk for severe RSV infection . Prophylaxis with palivizumab (a monoclo- nal antibody anti-F protein) reduces RSV LRTI in late- moderate preterm population; however, infants are eli- gible for prophylaxis only according to specific national guidelines. According to the recommendation by the American Academy of Pediatrics, in 2016 the Italian Drug Agency (AIFA) limited the prescription of palivizu- mab to the group of < 29 wGA and age < 12 months at the beginning of the RSV season [26, 27]. Since then, several evidences in Italy reported an increase in
Background: The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness. Methods: The effect of the project was estimated through propensity score matching between project and non- project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.
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Objective: Ciprofloxacin is an antibiotic for the treatment of several bacterial infections, and is used as the drug of choice in the treatment of Acute Respiratory Infection (ARI). Previous studies have shown that resistance has occurred with ciprofloxacin antibiotics in the ARI case. This study aims to identify genus of bacteria in clinical isolates of ARI patients who have been resistant to ciprofloxacin antibiotics. Methods: The identification of bacteria was carried out through the method of determining the morphology of isolates, gram staining, biochemical testing. Results: The results of identification of bacteria in clinical isolates of patients showed that the bacteria genus
Respiratory tract infection (RTI) is a major cause of morbidity and mortality worldwide especially in low- and middle-income countries. RTIs are common in children and significantly contribute to pediatric mor- bidity and mortality . Lower respiratory tract infec- tions (LRTI) (pneumonia predominantly) is one of the leading causes of death in infants and children, especially in developing countries. Approximately 2 million chil- dren who die from acute respiratory tract infections (ARTIs) each year [2, 3]. ARTI is the most prevalent in children in primary care: 50 % of children aged 0–4 are diagnosed with ARTI and 10 % of those aged 5–9 . The true incidence of the condition in community may be much higher as usually parents do not consult their doctors when their children develop an upper respira- tory tract infection (URTI) .