粤东地区毛细支气管炎病毒病原谱的变迁探究

目的探讨近年来粤东地区毛细支气管炎病毒病原学的构成现状。方法收集粤东地区2007年7月至2010年6月3年间毛细支气管炎患儿的咽拭子共508份,采用多重PCR方法检测呼吸道合胞病毒、腺病毒、流感病毒A型、流感病毒B型、副流感病毒1型、副流感病毒3型、鼻病毒、人类博卡病毒、人类偏肺病毒、WU多瘤病毒,共8种lO型病毒。结果①508例患儿中男374例（73．6％）,女134例（26．4％）。②508例患儿中1岁以下年龄组393例（77．4％）,病毒检出率为77．2％;1岁以上年龄组115例（22．6％）,病毒检出率为22．8％。③2007年7至2008年6月病毒阳性率为47．5％（77／162）,病毒检出第1位为呼吸道合胞病毒（33．7％）,新发现呼吸道病毒（人类博卡病毒、人类偏肺病毒、wu多瘤病毒）占14．3％;2008年7月至2009年6月病毒阳性率为51．7％（124／240）,病毒检出第1位为流感病毒A型（38．4％）,新发现呼吸道病毒占6．4％;2009年7月至2010年6月病毒阳性率为45．3％（48／106）,病毒检出第1位为鼻病毒（22．4％）,新发现呼吸道病毒占20．9％。④3年间病毒混合感染率分别为20．8％、42．7％、27．1％。结论①毛细支气管炎患儿中男孩多见,1岁以下年龄组发病率及病毒检出率均高于1岁以上年龄组。②鼻病毒、流感病毒A型在不同年度是小儿毛细支气管炎首位病原体,既往研究中占首位的呼吸道合胞病毒有逐年下降趋势。③新发现呼吸道病毒在小儿毛细支气管炎病例中检出,并有逐年上升趋势。④毛细支气管炎病例中存在不同病毒混合感染的现象。     

Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding: A retrospective cohort study

Esophagogastroduodenoscopy (EGD) is a useful procedure performed for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD implementation in intensive care unit (ICU) patients with suspected GI bleeding. The objective of this study was to compare the clinical effectiveness of EGD in critically ill patients who are using high-dose proton pump inhibitor (PPI) for suspected GI bleeding.We retrospectively analyzed ICU patients using high-dose PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 1:1 propensity score matching was performed. The change in hemoglobin level, requirement of red blood cell transfusion, re-suspected bleeding event, length of ICU stay, and ICU mortality were compared between the EGD and non-EGD groups.Of the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI administration. In the EGD group, 22 (42.3%) patients showed normal findings, while esophagitis and gastritis were most common abnormal finding (n = 11, 21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing the 2 groups, the EGD group required a higher amount of red blood cell transfusion (packs) than the non-EGD group for a week (3.04 ± 0.44 vs 2.07 ± 0.25, P = .01). There was no significant difference in the change in hemoglobin level after 1 week (P = .15). After propensity score matching, the EGD group showed similar the requirement of red blood cell transfusion and change in hemoglobin level for a week (P = .52, P = .97, respectively). In analyses for all patients and propensity score matched patients, there was no statistically significant difference in term of re-suspected bleeding event rate, duration of ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU mortality were lower trend in the EGD group than the non-EGD group.This study showed that EGD had no definite clinical benefit in ICU patients using high-dose PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. However, it is necessary to consider EGD in patients who are tolerant.     

Inhaled colistin for the treatment of tracheobronchitis and pneumonia in critically ill children without cystic fibrosis

Data regarding the role of inhaled colistin in critically ill pediatric patients without cystic fibrosis are scarce. Three children (one female), admitted to the intensive care unit (ICU) of a tertiary‐care pediatric hospital in Athens, Greece, during 2004–2009 received inhaled colistin as monotherapy for tracheobronchitis (two children), and as adjunctive therapy for necrotizing pneumonia (one child). Colistin susceptible Acinetobacter baumannii and Pseudomonas aeruginosa were isolated from the cases' bronchial secretions specimens. All three children received inhaled colistin at a dosage of 75 mg diluted in 3 ml of normal saline twice daily (1,875,000 IU of colistin daily), for a duration of 25, 32, and 15 days, respectively. All three children recovered from the infections. Also, a gradual reduction, and finally total elimination of the microbial load in bronchial secretions was observed during inhaled colistin treatment in the reported cases. All three cases were discharged from the ICU. No bronchoconstriction or any other type of toxicity of colistin was observed. In conclusion, inhaled colistin was effective and safe for the treatment of two children with tracheobronchitis, and one child with necrotizing pneumonia. Further studies are needed to clarify further the role of inhaled colistin in pediatric critically ill patients without cystic fibrosis. Pediatr Pulmonol. 2010;45:1135–1140. © 2010 Wiley‐Liss, Inc.     

The controversy of the treatment of critically ill patients with thyroid hormone

There is currently a vast literature available on the changes in thyroid function tests that occur during non-thyroidal illness. The aetiology of these changes is, however, controversial, especially with respect to whether they play an adaptive role for the organism in order to cope with stress or whether they represent primary pathology of the pituitary-thyroid axis. This is particularly true for critically ill patients, in whom the most significant changes in thyroid function are observed. The changes include low levels of thyroxine and very low levels of tri-iodothyronine, which would, on the surface, appear to indicate hypothyroidism. Therapy with thyroid hormone, as either L-T4 or L-T3, has therefore been suggested because of these low values for thyroid hormones in the blood. It is, however, unclear whether treating these patients with thyroid hormone is beneficial or harmful. Multiple studies have addressed this issue with patients with cardiac disease, sepsis, pulmonary disease (e.g. acute respiratory distress syndrome) or severe infection, or with burn and trauma patients. In spite of a very large number of published studies, it is very difficult to form clear recommendations for treatment with thyroid hormone in the intensive care unit. Instead, we find the evidence far from compelling, and would advise withholding thyroid hormone therapy in the critical care setting in the absence of clear clinical or laboratory evidence for hypothyroidism.     

Blood glucose measurements in critically ill patients

Studies on tight glycemic control by intensive insulin therapy abruptly changed the climate of limited interest in the problem of hyperglycemia in critically ill patients and reopened the discussion on accuracy and reliability of glucose sensor devices. This article describes important components of blood glucose measurements and their interferences with the focus on the intensive care unit setting. Typical methodologies, organized from analytical accuracy to clinical accuracy, to assess imprecision and bias of a glucose sensor are also discussed. Finally, a list of recommendations and requirements to be considered when evaluating (time-discrete) glucose sensor devices is given.     

Infection with multiple viruses is not associated with increased disease severity in children with bronchiolitis

Background

The clinical relevance of parallel detection of multiple viruses by real‐time polymerase chain reaction (RT‐PCR) remains unclear. This study evaluated the association between the detection of multiple viruses by RT‐PCR and disease severity in children with bronchiolitis.

Methods

Children less than 2 years of age with clinical symptoms of bronchiolitis were prospectively included during three winter seasons. Patients were categorized in three groups based on disease severity; mild (no supportive treatment), moderate (supplemental oxygen and/or nasogastric feeding), and severe (mechanical ventilation). Multiplex RT‐PCR of 15 respiratory viruses was performed on nasopharyngeal aspirates.

Results

In total, 142 samples were obtained. Respiratory Syncytial virus (RSV) was the most commonly detected virus (73%) followed by rhinovirus (RV) (30%). In 58 samples (41%) more than one virus was detected, of which 41% was a dual infection with RSV and RV. In RSV infected children younger than 3 months, disease severity was not associated with the number of detected viruses. Remarkably, in children older than 3 months we found an association between more severe disease and RSV mono‐infections.

Conclusion

Disease severity in children with bronchiolitis is not associated with infection by multiple viruses. We conclude that other factors, such as age, contribute to disease severity to a larger extent. Pediatr Pulmonol. 2012; 47:393–400. © 2011 Wiley Periodicals, Inc.

     

Lower number of plasmacytoid dendritic cells in peripheral blood of children with bronchiolitis following respiratory syncytial virus infection

Objectives

Dendritic cells (DCs) are key mediators of allergic airway inflammation. Thus, it is important to understand the relationship between respiratory syncytial virus (RSV) infection and DCs, especially in children with RSV bronchiolitis.

Methods

We collected peripheral blood from 71 children with RSV bronchiolitis at the time of admission and 28 children who were followed up 3 months following admission. Flow cytometry was performed to detect dendritic cell immunophenotypes.

Results

Patients with RSV bronchiolitis exhibited significantly higher number of myeloid DCs and lower number of plasmacytoid DCs at the time of admission and 3 months following discharge, compared with healthy controls. These children had a significantly higher myeloid/plasmacytoid ratio 3 months after discharge compared with healthy controls.

Conclusions

Among children with RSV bronchiolitis, there is an imbalance in peripheral blood myeloid/plasmacytoid ratio. The low number of plasmacytoid DCs in peripheral blood indicates the development of bronchiolitis due to RSV infection.