Journal of Pediatric Pulmonology最新文献

{"title":"Words of wisdom from an experienced allergist","authors":"PudupakkamK Vedanthan","doi":"10.4103/jopp.jopp_50_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_50_23","url":null,"abstract":"I have been fortunate enough to get trained under the stalwarts in the field of Allergy at one of the most respected and well-known institutions in the USA: Children’s Asthma Research Institute and Hospital (CARIH) which merged with National Jewish Hospital (NJH), Denver, Colorado, USA, to be known at present as National Jewish Health (NJH). The greatest discovery in the field of Allergy (IgE) occurred at CARIH in 1968 by the Ishizaka couple.[1] Great personalities like Dr. Elliott Middleton, Dr. Henry Claman, Dr. Harold Nelson, Dr. Hyman Chai and Dr. Charles Kirkpatrick were my mentors at the training program through CARIH. NJH, Fitzsimons Army Medical Center and UCD, Denver, Colorado. I have been functioned as a consultant, teacher, and patient advocate for the past 47 years: almost 30 of those years in delivering charity care through International Asthma Services (IAS) in the developing world.[2] This rich global exposure to allergic diseases prompted me to be the lead author for two leading textbooks in the field of Allergy Asthma and Immunology (AAI). The common thread of issues like ‘anxiety, fear of the unknown, under/over/mal treatment of the ailment, impaired quality of life, physical and mental suffering’ were prevalent in a majority of patients across the globe. This occurs irrespective of genetic, environmental, socioeconomic differences. I suggest the following “simple and effective” steps in both patient management and physician empowerment. Start educating your patients: Over the past five decades of professional life, I have learned that one of the most important items of allergy management is “educating the patient and his/her family” about the ailment and promoting “self-management.” This area unfortunately has been neglected due to the fact it is “time-consuming” and many times not “remunerative” to the care provider. An educated Compliant patient is a pleasure to take care of. Education and compliance have positive results overall and hence beneficial to both the patient and provider.My advice is: (i) spend 5 min more at each patient visit with more education, (ii) inquire regarding any concerns or doubts patients may have, and (iii) train your assistant to share this responsibility. Hence, we have initiated the first allergy asthma assistant course (a 3-month online course) a very important initiative of IAS with Med-Train, Bengaluru, India. Patient support groups under physician supervision is a very effective way of education and self managementEducate yourself continuously: Acquiring knowledge is both beneficial and enjoyable. There is no age limit for this quest. This is the only way to keep abreast of the ever-changing dynamic field of AAI. Start applying thus additional knowledge clinically. My advice is to study at least 1 h a day preferably early in the morning when things are relatively quiet, and mind is fresh Start teaching: By teaching, your learning increases. The field of AAI is relatively “unknown” among your p","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135448183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of fractional exhaled nitric oxide in pediatric asthma: An update","authors":"Prawin Kumar, JagdishPrasad Goyal","doi":"10.4103/jopp.jopp_21_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_21_23","url":null,"abstract":"Asthma is the most common chronic respiratory disease in children. It is a heterogeneous disease and includes many phenotypes. Based on pathogenesis, asthma has been classified into Th2-high and non-Th2, known as asthma endotypes. Nitric oxide (NO) is an endogenous regulatory molecule involved in the pathophysiology of lung disease, including asthma. It acts as a bronchodilator, vasodilator, neurotransmitter, and mediator of inflammation. It is present in exhaled breaths. Fractional exhaled nitric oxide (FeNO) is a simple and noninvasive tool used to measure exhaled NO.[1] It is considered a biomarker of Th2 airway inflammation and correlates well with blood and sputum eosinophilia. In addition, it also correlates with serum immunoglobulin E level and skin prick test in atopic individuals.[2] It is given due consideration in diagnosing, monitoring, and selecting biological in asthma. Here, we summarized the recent update on the role of FeNO in pediatric asthma. FeNO can be measured by either chemiluminescence (CLD 88, Eco Medics, Switzerland) or electrochemical (NIOX VERO, Circassia, Sweden) analyzer. The former is highly accurate, but the equipment is expensive and requires regular calibration, whereas latter is simple, portable, and more cost-effective. Its unit of measurement is part per billion (ppb). Its value can be affected by several factors: age, sex, ethnicity, smoking, caffeine intake, etc. Standardization of equipment and method should be addressed before interpreting the result.[1] FeNO may predict future asthma development in school children.[2] In a study of 2568 asthma-free school children (7–10 years), there were two times increased risk of asthma development over 3 years of follow-up in children with higher FeNO than lower value (HR (Hazard ratio) 2.1; 95% CI 1.3–3.5).[3] The higher FeNO values were also associated with lower forced expiratory volume in 1 s and forced vital capacity.[2] The diagnosis of asthma requires the presence of characteristics, symptom patterns, and documentation of expiratory airflow limitation on spirometry. However, in children, asthma symptoms may be misleading, and spirometry may be normal or unable to perform adequately. The role of FeNO in asthma diagnosis is debatable. An adult study has shown that, at a cutoff value of 26 ppb, FeNO has higher diagnostic accuracy than the methacholine challenge test in diagnosing eosinophilic asthma. However, its value may be normal in some asthma phenotypes and during the exacerbation. Moreover, the cutoff value of FeNO for asthma diagnosis is not uniform; the American Thoracic Society (ATS) suggested >25 ppb, while the Global Initiative for Asthma (GINA) has taken >50 ppb as cutoff point.[1,4] Furthermore, FeNO is not specific for asthma, as its value may be increased in other allergic diseases, namely allergic rhinitis, atopic dermatitis, etc., and viral infection. As per GINA, FeNO does not help in ruling in or ruling out the diagnosis of asthma. Therefore, cu","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"280 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in allergy practice","authors":"Arif Ahmed","doi":"10.4103/jopp.jopp_25_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_25_23","url":null,"abstract":"Allergies are very common in India.[1] There are, however, many misconceptions among both clinicians and patients about allergy management, and the field has changed rapidly over the past 5–10 years from a focus on avoidance to tolerance. The lack of knowledge of allergies amongst physicians is fuelled by inadequate attention to the subject of allergy in the undergraduate and postgraduate syllabuses. Fellowship programs in the USA have a minimum of 60 programs of 3-year duration in allergy and immunology, while in India, there are no National Medical Council-recognized programs in allergy. There is a trend to start short-term diploma and certificate courses in allergy nationwide, but these are much handicapped by a lack of hands-on training programs.[2] There are two reputed organizations in allergy in the USA and 12 indexed allergy journals published each year. In India, there are no indexed journals. In a postgraduate examination of pediatrics, it was found that on a question of allergic rhinitis, 70% of the candidates did not go beyond the standard oral drugs and in another examination, 70% did not exactly know what standard immunotherapies are in the management of allergies. Among the Indian public, many are turning to alternative therapies with no proven scientific basis for the treatment of their allergic diseases. An example is the use of fish medicine by people from all over India for respiratory problems. In a study published in Indian Paediatrics, 30% felt that there is a cure for asthma, with a significant section feeling that it can be cured by alternative medicines. The shocking report was that 10% felt that it can be cured by saints.[3] The latter is a popular concept in India, reinforced by our culture and films. Based on this backdrop, it is not difficult to envisage the problems in practice; a few examples are narrated below: Asthma For some parents, this diagnosis in their child is worse than cancer.[4] No amount of convincing will work for a minority of such patients. They avoid the term asthma and prefer descriptive words such as wheezy chest, hyperactive airways, and chesty cough. The moment it is announced, it is like a death sentence. In a busy practice, doctors fail to take the time or follow a standardized approach to the education of their patients. This leaves the patient even more confused. One of the reasons behind this practice is that inhalers are synonymous with asthma treatment. Educating groups of patients and families is a powerful and time-saving tool. There is a need to educate teachers too about how to use inhalers effectively. We have found that many school teachers are unaware and some even consider inhalers as a taboo. The wrong perceptions in the community and the schools need to be corrected. Atopic Dermatitis Parents of eczema patients are more receptive to the diagnosis of atopic dermatitis or eczema. Eczema can be more distressing and troublesome than asthma with the constant itch. Doctor shopping bec","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135447904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upcoming diagnostic modalities: Basophil activation test, CRD, and nasal challenge test","authors":"GayatriSubray Pandit, Sowmya Nagarajan, Shruthi Manjunath","doi":"10.4103/jopp.jopp_33_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_33_23","url":null,"abstract":"We know that the skin prick allergy test is the gold standard test in allergy diagnosis, especially with respect to aeroallergens. However, it still remains as an immunological test and not as a diagnostic test. Challenge tests such as nasal provocation tests are useful in diagnosing local allergic rhinitis which may be missed in skin prick test. It is always beneficial to look at newer diagnostic modalities to help better the scope of allergy management. Alternate tests such as basophil activation test, component resolved diagnostics (CRD), nasal challenge test, basophil histamine test, micro-RNA assay, mast cell activation test, and gene level testing are a few of the newer methods which gives very useful information on risk stratification. These tests are either still under research or not yet standardized in clinical practice but will definitely play a role in improving the process of allergy evaluation. Of all these tests, CRD is already available for clinical utility in India.","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135447916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New guidelines on asthma and allergic bronchopulmonary aspergillosis: Solving the riddle!","authors":"Meenu Singh","doi":"10.4103/jopp.jopp_43_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_43_23","url":null,"abstract":"Allergic bronchopulmonary aspergillosis (ABPA) can occur in children with asthma, though it is relatively uncommon.[1] ABPA is a specific type of allergic lung disease caused by an immune response to the fungus Aspergillus, which is commonly found in the environment.[1] It typically affects individuals with a history of asthma or cystic fibrosis, and children with asthma can also be at risk. ABPA is more commonly seen in adults with asthma, but it can occur in children as well, especially in those with severe and poorly controlled asthma.[1] The condition arises when the immune system overreacts to Aspergillus spores in the airways. Children with asthma may inhale these spores, leading to an immune response that causes inflammation and damage in the lungs. Symptoms of ABPA in children with asthma may include wheezing, coughing, increased production of mucus, difficulty breathing, fatigue, and recurrent respiratory infections. Diagnosing ABPA in children can be challenging because its symptoms can overlap with poorly controlled asthma.[2] A combination of clinical evaluation, laboratory tests, lung function tests, chest X-rays or computed tomography scans, and specific immunological tests (e.g., serological and Aspergillus skin tests, etc.,) are required to make a definitive diagnosis.[2,3] The management of ABPA in children with asthma involves a combination of antifungal therapy, corticosteroids, and asthma management.[4] In refractory cases, biological agents (e.g., omalizumab, mepolizumab, and dupilumab) are used with success.[5] It aims to control Aspergillus infection, reduce inflammation in the airways, and optimize asthma control. Corticosteroids are essential in the treatment of ABPA to reduce airway inflammation. Children with ABPA may require oral corticosteroids during acute exacerbations or when there is significant inflammation and symptoms are not adequately controlled. However, long-term use of systemic corticosteroids should be avoided due to potential side effects, especially in children. Inhaled corticosteroids can be used for asthma management, but they may not be sufficient to control ABPA-related inflammation on their own. The primary antifungal agent used in the management of ABPA is itraconazole. It may improve lung function, reduce asthma exacerbations, and decrease the need for systemic corticosteroids in children with ABPA. Optimizing asthma control is crucial in managing ABPA in children with asthma. This involves using inhaled corticosteroids, bronchodilators, leukotriene modifiers, and other asthma medications as per Global Initiative for Asthma guidelines.[6] Proper asthma management can help reduce the risk of asthma exacerbations and improve overall respiratory health. Regular monitoring and follow-up with a pediatric pulmonologist or respiratory specialist are essential to assess treatment effectiveness, adjust medications as needed, and identify any potential complications. Encouraging allergen avoidance practice","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"280 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimum duration of oral steroid therapy for ABPA in asthmatic children: A systematic review of literature and evidence-based guideline recommendation","authors":"JosephL Mathew, Ketan Kumar, Sheetal Agrawal, Anshula Tayal, Sarika Gupta","doi":"10.4103/jopp.jopp_29_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_29_23","url":null,"abstract":"Background: Allergic bronchopulmonary aspergillosis (ABPA) is a complication of asthma. Oral glucocorticoids are the mainstay of ABPA treatment and prednisolone is most commonly used for this purpose. However, there is lack of clarity on the most appropriate steroid treatment regimen. Objective: We undertook this systematic review to identify the optimum duration of steroid therapy for ABPA in children with asthma, to formulate an evidence-based recommendation. Our research question was framed as: In children with asthma having ABPA, what is the efficacy and safety of longer (>16 weeks), compared to shorter (<16 weeks) oral steroid therapy, on multiple clinical outcomes? Materials and Methods: We systematically searched existing guidelines for recommendations on steroid duration in ABPA, followed by systematic reviews answering the research question. As no relevant guideline or systematic review was identified, we conducted a de novo systematic review, searching for randomized controlled trials (RCT) comparing oral steroid regimens longer than 16 weeks versus those upto 16 weeks. We selected multiple patient-centric outcomes at 12 and >12 months to compare the two regimens. Results: We identified only one RCT addressing the review question. However, it was conducted in adult patients. There was no statistically significant long term difference in efficacy between longer (>16 weeks) and shorter (≤16 weeks) regimens. However, adverse effects were more frequent with higher doses and duration. The available evidence was graded as ‘very low certainty’ due to methodological limitations. Conclusion: We recommend against oral steroid regimens longer than 16 weeks, in children with asthma and ABPA. (conditional recommendation, very low certainty of evidence). There is a need for larger RCTs, evaluating the optimum steroid regimen (both dose and duration) in children.","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of coronavirus disease 2019 in children up to 18 years with tuberculosis","authors":"HemaGupta Mittal, Shamitha Rangarajan, PAnmol Rathore, Parasdeep Kaur, Dheeraj Bahl, Bijoy Patra","doi":"10.4103/jopp.jopp_4_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_4_23","url":null,"abstract":"Background: Bidirectional screening of coronavirus disease 2019 (COVID-19) and tuberculosis (TB) was suggested during the COVID-19 pandemic in view of similar clinical presentation and possible interaction between the two. Only few studies are available in the literature suggesting flare up of TB in children with COVID-19 or poorer/equivocal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with TB. Hence, we planned to evaluate the outcome in children with TB who were diagnosed with of SARS-CoV-2 infections versus those who did not have any of SARS-CoV-2 infection during the COVID-19 pandemic. Objective: The objective of this study was to evaluate the clinical characteristics and outcomes of patients with TB and COVID-19 coinfection. Methods: We reviewed 102 children up to 18 years of age with TB who were admitted or followed up in a pediatric TB clinic from March 2020 to March 2022. Clinicodemographic characteristics of children with TB who suffered from SARS-CoV-2 infection in comparison to those who did not have SARS-CoV-2 infection were compared. Results: A total of 102 children with TB were enrolled during the study period. Among them, 32 children were diagnosed with SARS-CoV-2 co-infection (28 COVID-19 pneumonia, and 4 multisystem inflammatory syndrome in children), while 70 children had no COVID-19 infection at the time of study. Both groups had comparable mean age, sex, socioeconomic status, site of TB, and presenting symptoms. The mean duration of symptoms at diagnosis was less in children with coexistent SARS-CoV-2 infection (17.9 days) as compared to those without coexistent SARS-CoV-2 (32.6 days), however, no statistical significance was seen (P = 0.13). No significant difference in outcome was noted in patients suffering from TB and COVID coinfection (P = 0.09) though they had higher rates of hospitalization. Conclusion: Early presentation, subsequent hospitalization, and screening in patients with COVID infection might have led to early diagnosis of TB. Whether SARS-CoV-2 infection increases the risk of individuals with latent TB to develop active TB requires further analysis.","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution: The invisible health threat","authors":"BhagwanS Sharma","doi":"10.4103/jopp.jopp_51_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_51_23","url":null,"abstract":"What is air pollution, and why does it matter to me? Air pollution is caused by gases and particles emitted by a variety of human activities and natural sources.[1] Over 99% of people breathe unsafe air. Air pollution is the most important health issue of our time, and it can cause heart and lung diseases, lung cancer, stroke and more.[1,2] It also harms our natural environment, decreasing the oxygen supply in our oceans, making it harder for plants to grow and contributing to the climate crisis. But air pollution is preventable. Solutions are available and must be implemented. Air pollution is a public health emergency Each day, as we take a breath, an invisible storm of particles and molecules infiltrates our bodies, posing a threat not only to our lungs but more than that. Air pollution is a major environmental threat and one of the main cases of death among all risk factors, ranking just below hypertension, tobacco smoking and high glucose.[1–3] WHO estimates that, globally, air pollution is responsible for about 7 million premature deaths per year from ischemic heart disease, stroke, chronic obstructive pulmonary disease and lung cancer, and also from acute respiratory infections such as pneumonia which mainly affects children in low- and middle-income countries. Being recognized as one of the main risk factors for non-communicable diseases, air pollution health effects also include preterm and low-birth weight, asthma as well as cognitive and neurological impairment basically having the potential to impact our whole body, way beyond our lungs. Five most dangerous pollutants in our air are: (i) PM2.5: PM2.5 refers to fine particles that are 2.5 microns or less in diameter. They are invisible to the naked eye, though noticeable as particle smog in highly polluted areas, and present indoors and outdoors. PM2.5 particles come from combusting unclean fuels for cooking or heating, burning waste and agriculture residue, industrial activities, transportation and windblown dust, among other sources. (ii) Ground-level ozone: Ground-level ozone, or tropospheric ozone, is a short-lived climate pollutant and although it exists only for a few days to a few weeks, it is a strong greenhouse gas. It forms when pollutants from industry, traffic, waste and energy production interact in the presence of sunlight. It contributes to smog, worsens bronchitis and emphysema, triggers asthma, damages lung tissue and reduces crop productivity. = (iii) Nitrogen: NO2 is the most harmful of these compounds and is generated from the combustion of fuel engines and industry. It can damage the human heart and lungs and it reduces atmospheric visibility at high concentrations. Finally, it is a critical precursor to the formation of ground-level ozone. (iv) Black Carbon: Black carbon, or soot, is a component of PM2.5 and is a short-lived climate pollutant. Agricultural burning to clear land, and the wildfires that sometimes result, are the world’s largest sources of black carb","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135448184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of TrueNat as compared to GeneXpert as a diagnostic tool for diagnosis of pediatric tuberculosis/MDR Tuberculosis under the National Tuberculosis Elimination Program of India","authors":"Meenu Singh, Ragini Bhatia, Madhuri Devaraju, MalkeetSingh Ghuman, Malaisamy Muniyandi, Anil Chauhan, Kulbir Kaur, Monika Rana, Pranita Pradhan, Shivani Saini","doi":"10.4103/jopp.jopp_13_22","DOIUrl":"https://doi.org/10.4103/jopp.jopp_13_22","url":null,"abstract":"Background: According to a study on global burden of tuberculosis (TB), India witnessed 60,000 pediatric deaths in the year 2015. In India, most of the children do not get diagnosed with tuberculosis for various reasons. Aims and Objectives: This study will evaluate the cost-effectiveness of TrueNat and GeneXpert diagnostic strategies used for tuberculosis detection in children, thus aiding policymakers for taking evidence-based decisions. Materials and Methods: For this cost-effectiveness study, a systematic review was done to extract the evidence for estimates of effectiveness of current TB diagnostic tools. Evidence pertinent to cost per test including all direct, indirect costs and health benefits in terms of quality-adjusted life years were researched and documented. Full economic evaluations available in the literature were also explored. Results: The results of the study showed that TrueNat is more cost-effective when compared to GeneXpert in the diagnosis of pediatric tuberculosis cases leading to more life years gained and deaths averted. 13,260 additional cases can be detected with TrueNat with an incremental cost of $14.36 per additional case detected. The incremental cost-effectiveness ratio per life year gained was found to be $20.01. Conclusion: TrueNat proved to be beneficial and cost-effective as compared to GeneXpert MTB being used in case of children. We recommend the use of TrueNat diagnostic test in India as it is in congruence with Indian health-care settings.","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the role of immunomodulators in children with allergic bronchopulmonary aspergillosis and asthma? A systematic review of the literature and evidence-based guideline recommendation","authors":"JosephL Mathew, Satnam Kaur, Amber Kumar, Vivek Saxena","doi":"10.4103/jopp.jopp_37_23","DOIUrl":"https://doi.org/10.4103/jopp.jopp_37_23","url":null,"abstract":"Background: Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex allergic disorder complicating asthma and cystic fibrosis. Steroids and antifungal agents are the mainstay of ABPA treatment. But almost half the patients relapse on tapering the steroids and some become steroid dependent, requiring continuous oral steroids. Therefore, immunomodulators targeting Th2 inflammation are being tried for treating ABPA. Objective: This systematic review was undertaken to evaluate the efficacy of immunomodulators for ABPA in children asthma, to develop an evidence-based recommendation. The research question was: In children with asthma having ABPA, what is the efficacy and safety of therapy with biologicals (compared with not using biologicals), on multiple clinical outcomes? Methods: A search for pre-existing guidelines and systematic reviews yielded no relevant results. We, therefore, undertook a new systematic review of randomised controlled trials (RCTs), addressing the question. Results: We identified only two small RCTs, in ABPA complicating asthma. The first evaluated omalizumab, and the other was a conference abstract on dupilumab. Both trials had methodological limitations, and evidence was graded as ‘very low certainty’. Neither trial suggested any benefit of using immunomodulators in those with asthma, having ABPA. Conclusion: We recommend against immunotherapy with biologicals including omalizumab or dupilumab in children with asthma and ABPA (conditional recommendation, very low certainty of evidence).","PeriodicalId":473926,"journal":{"name":"Journal of Pediatric Pulmonology","volume":"280 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}