Glucocorticoids for acute viral bronchiolitis in infants and young children
Ricardo M. FernandesLiza BialyBen VandermeerLisa TjosvoldAmy C. PlintHema PatelDavid W. JohnsonTerry P. KlassenLisa Hartling
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Context Respiratory syncytial virus (RSV) causes more lower respiratory tract infections, often manifested as bronchiolitis, among young children than any other pathogen.Few national estimates exist of the hospitalizations attributable to RSV, and recent advances in prophylaxis warrant an update of these estimates. ObjectivesTo describe rates of bronchiolitis-associated hospitalizations and to estimate current hospitalizations associated with RSV infection.Design and Setting Descriptive analysis of US National Hospital Discharge Survey data from 1980 through 1996.Participants Children younger than 5 years who were hospitalized in short-stay, nonfederal hospitals for bronchiolitis.Main Outcome Measure Bronchiolitis-associated hospitalization rates by age and year. ResultsDuring the 17-year study period, an estimated 1.65 million hospitalizations for bronchiolitis occurred among children younger than 5 years, accounting for 7.0 million inpatient days.Fifty-seven percent of these hospitalizations occurred among children younger than 6 months and 81% among those younger than 1 year.Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996.During 1988-1996, infant hospitalization rates for bronchiolitis increased significantly (P for trend Ͻ.001), while hospitalization rates for lower respiratory tract diseases excluding bronchiolitis did not vary significantly (P for trend = .20).The proportion of hospitalizations for lower respiratory tract illnesses among children younger than 1 year associated with bronchiolitis increased from 22.2% in 1980 to 47.4% in 1996; among total hospitalizations, this proportion increased from 5.4% to 16.4%.Averaging bronchiolitis hospitalizations during 1994-1996 and assuming that RSV was the etiologic agent in 50% to 80% of November through April hospitalizations, an estimated 51 240 to 81 985 annual bronchiolitis hospitalizations among children younger than 1 year were related to RSV infection.During 1980-1996, rates of hospitalization of infants with bronchiolitis increased substantially, as did the proportion of total and lower respiratory tract hospitalizations associated with bronchiolitis.Annual bronchiolitis hospitalizations associated with RSV infection among infants may be greater than previous estimates for RSV bronchiolitis and pneumonia hospitalizations combined. Conclusions
Acute Bronchiolitis
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Background. In recent years, traditional Chinese exercises (TCEs) have been gradually used to reduce the blood pressure levels of patients with essential hypertension. However, there are several types of TCEs, and there is no comparative study on the antihypertensive effects of various TCEs in patients with essential hypertension. Objective. The objective is to compare the therapeutic effects of Taijiquan (TJQ), Baduanjin (BDJ), Wuqinxi (WQX), and Yijinjing (YJJ) on essential hypertension and provide a reference for clinical treatment and scheme optimization. Methods. The China National Knowledge Infrastructure (CNKI), Wanfang, China Scientific Journal Database, China Biology Medicine database (CBM), PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect all randomized controlled trials (RCTs) of TCEs in the treatment of essential hypertension. The search time was from the establishment of each database to November 2021. After data extraction and quality evaluation, the network meta-analysis was performed with Stata 16.0 and ADDIS 1.16.8. Results. Finally, 45 RCTs involving 3864 patients were included. Network meta-analysis showed that YJJ had the best effect in reducing systolic blood pressure, and the difference was statistically significant [MD = −14.27, 95% CI = (−20.53∼−8.08), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). In terms of reducing diastolic blood pressure, the treatment effect of YJJ was the best, and the difference was statistically significant [MD = −7.77, 95% CI (−12.19∼−3.33), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). Conclusion. The results showed that TCEs significantly reduced systolic and diastolic blood pressure compared with the control group, and YJJ might be the best choice. However, a larger sample, multicenter, double-blinded, high-quality RCTs are needed to make clear conclusions.
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Bronchiolitis and more specifically respiratory syncytial virus (RSV) bronchiolitis is a leading cause of global childhood morbidity and mortality. Despite the previous identification of possible risk factors associated with the severity of bronchiolitis, the data from Lebanon remains limited. We described the burden of bronchiolitis hospitalizations in children under 5 years of age in a tertiary care center in Lebanon from October 2004 to October 2014 and identified the risk factors associated with severe bronchiolitis. This was a retrospective cohort study conducted at the American University of Beirut Medical Center. Records of children younger than 5 years of age admitted with a diagnosis of bronchiolitis were reviewed. More than half the patients were RSV positive. RSV bronchiolitis was found to be significantly associated with longer hospital stay compared to children with non-RSV bronchiolitis (P = 0.007). Children exposed to smoking had an increased risk for longer hospital stay (P = 0.002) and were more likely to require ICU admission (P < 0.001) and supplemental oxygen (P = 0.045). Congenital heart disease was found to be a significant risk factor for severe bronchiolitis (P < 0.005). Conclusion: Patients with RSV bronchiolitis had a longer hospital stay compared to patients with non-RSV bronchiolitis. Exposure to smoking was associated with a more severe and complicated RSV infection. Congenital heart disease was the only risk factor significantly associated with all markers of bronchiolitis disease severity.
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Results of published studies on the association between the miR-146a rs2910164 polymorphism and the risk of hepatocellular carcinoma (HCC) were inclusive. We performed a meta-analysis. A literature research was conducted using PubMed, Cochrane Library, Ovid, Embase, Wanfang and China National Knowledge Infrastructure (CNKI) databases, to identify studies. Statistical analyses were conducted in STATA version 11.0 (Stata Corporation, College station, TX, USA). A total of 12 publications were included in this meta-analysis. The results of this meta-analysis suggested that miR-146a rs2910164 was associated with an increased risk of HCC (OR = 1.09, 95% CI = 1.00-1.19). In sensitivity analysis, the result was still positive when excluding the studies without HWE (OR = 1.12, 95% CI = 1.01-1.23). In conclusion, this meta-analysis suggested a significant association between miR-146a rs2910164 polymorphism and HCC risk.
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Background: Bronchiolitis is the most common reason for hospitalization of children. Infants hospitalized for bronchiolitis undergo examinations and treatments not supported by current research evidence. Aim: To assess practice variations about the management of children hospitalized for bronchiolitis under the age of two. Methods: This retrospective study was conducted in a pediatric unit in a university hospital. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analyzed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing. Results: The median age of the 263 children was 8.8 months. Clinical management varied when stratified by strict and loose bronchiolitis subgroup definitions: complete blood counts and chest x-ray was performed in all patients, mean length of hospitalization (4.5 vs 4.4 days), intravenous fluids (97% vs 88%), oxygen supplementation (79% vs. 67%), use of salbutamol (21% vs 65%) and use of iv corticosteroids (21% vs 55%). Conclusion: The clinical management of bronchiolitis varied considerably about the two definitions of bronchiolitis. A stronger commitment to evidence-based bronchiolitis guidelines is needed.
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Background: An increase in the number of children hospitalized for bronchiolitis has been observed on February to April over the past 5 years. This study aimed to describe the bronchiolitis characteristic during the 2019 epidemic as well as its management at the Tsaralalàna Teaching Hospital.Methods: This is a 3 months retrospective descriptive study, from February to April 2019, including all children diagnosed with bronchiolitis.Results: Bronchiolitis was diagnosed in 1704 children (40.1%) and 425(29.4%) were hospitalized. Severe bronchiolitis was found in 212 children (49.9%) which were aged under 3 months in 46.7%. Secondary bacterial infection was noted in 359 children (84.5%) and cardiac failure in 145 children (34.1%). Hypertonic saline 3% was prescribed at 76.4% of children.Conclusions: Younger infant under 3 months were the most frequently admitted in hospitalization. Severe or complicated bronchiolitis are predominant. Using a pediatric plan adapted to bronchiolitis epidemic may improve care of children.
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Acute Bronchiolitis
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