Multidisciplinary Respiratory Medicine最新文献

{"title":"Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy.","authors":"Shosei Ro,&nbsp;Naoki Nishimura,&nbsp;Ryosuke Imai,&nbsp;Yutaka Tomishima,&nbsp;Clara So,&nbsp;Manabu Murakami,&nbsp;Kohei Okafuji,&nbsp;Atsushi Kitamura,&nbsp;Torahiko Jinta,&nbsp;Tomohide Tamura","doi":"10.4081/mrm.2021.781","DOIUrl":"https://doi.org/10.4081/mrm.2021.781","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.</p><p><strong>Methods: </strong>This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (≥250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.</p><p><strong>Results: </strong>Out of 156 patients who received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, out of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.</p><p><strong>Conclusion: </strong>Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"781"},"PeriodicalIF":2.3,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/cb/mrm-16-1-781.PMC8273631.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39255919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Londrina activities of daily living protocol and Glittre ADL test on cardio-pulmonary response in patients with COPD: a cross-sectional study.","authors":"Chaitali Deshpande,&nbsp;Gopala Krishna Alaparthi,&nbsp;Shyam Krishnan,&nbsp;Kalyan Chakravarthy Bairapareddy,&nbsp;Anand Ramakrishna,&nbsp;Vishak Acharya","doi":"10.4081/mrm.2020.694","DOIUrl":"https://doi.org/10.4081/mrm.2020.694","url":null,"abstract":"<p><strong>Background: </strong>In COPD patients it is very important to assess the activities of daily living (ADL) due to an impairment of independence and quality of life. There is a lack of retrievable data regarding the cardio-pulmonary response to Londrina ADL protocol in patients with COPD. The aim of the present study was to assess the cardio-pulmonary response to Londrina ADL protocol in patients with COPD and to compare this with responses to the Glittre ADL test.</p><p><strong>Methods: </strong>This cross-sectional study was done on 30 COPD subjects. Each subject was taken to perform the Londrina ADL protocol, Glittre ADL test, twice each, on subsequent days. The Londrina ADL protocol comprises 5 activities representing ADL, involving upper limbs, lower limbs, and trunk movements. The Glittre ADL test consists of completing a circuit while carrying a weighted backpack (2.5 kg for women, 5.0 kg for men). The better value of the two was taken into consideration. For the Londrina ADL protocol and Glittre ADL test the outcome of primary interest was time and for the six-minute walk test was the distance walked. The secondary outcomes for all tests were heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, saturation of oxygen in blood and dyspnea.</p><p><strong>Results: </strong>The COPD subjects of age group 63.27±11.07 years took 5.94±0.36 min to complete trial 2 of the Londrina ADL protocol. Significant physiological increases in heart rate (p≤0.01), respiratory rate (p≤0.01), blood pressure (p≤0.01) and severity of dyspnea (p≤0.01) were observed, whereas saturation of oxygen in blood (p≤0.01) was reduced at the end of the Londrina ADL protocol and Glittre ADL test. There was a positive, non-significant correlation between the six-minute walk test distance and the Londrina ADL protocol time (r=0.236) (p=0.209). A positive, not significant correlation was observed between the Glittre ADL test (time) and the Londrina ADL protocol (time) (r=0.194) (p=0.304) and a negative but not significant correlation between the six-minute walk test (distance) and the Glittre ADL test (time) (r= -0.184) (p=0.330).</p><p><strong>Conclusion: </strong>The Londrina ADL protocol can be used as an assessment tool for the evaluation of functional performance and activities of daily living in COPD along with other test protocols in pulmonary rehabilitation.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"694"},"PeriodicalIF":2.3,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/41/mrm-15-1-694.PMC7731885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38718737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel therapeutic approaches for the management of cystic fibrosis.","authors":"Ryan Jaques, Arslan Shakeel, Cameron Hoyle","doi":"10.4081/mrm.2020.690","DOIUrl":"10.4081/mrm.2020.690","url":null,"abstract":"<p><p>Cystic fibrosis (CF) is a genetic condition characterised by the build-up of thick, sticky mucus that can damage many of the body's organs. It is a life-long disease that results in a shortened life expectancy, often due to the progression of advanced lung disease. Treatment has previously targeted the downstream symptoms such as diminished mucus clearance and recurrent infection. More recently, significant advances have been made in treating the cause of the disease by targeting the faulty gene responsible. Hope for the development of potential therapies lies with ongoing research into new pharmacological agents and gene therapy. This review gives an overview of CF, and summarises the current evidence regarding the disease management and upcoming strategies aimed at treating or potentially curing this condition.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"690"},"PeriodicalIF":2.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/5f/mrm-15-1-690.PMC7706361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle.","authors":"Wagner Diniz de Paula,&nbsp;Marcelo Palmeira Rodrigues,&nbsp;Nathali Mireise Costa Ferreira,&nbsp;Viviane Vieira Passini,&nbsp;César Augusto Melo-Silva","doi":"10.4081/mrm.2020.707","DOIUrl":"https://doi.org/10.4081/mrm.2020.707","url":null,"abstract":"<p><strong>Background: </strong>To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers.</p><p><strong>Methods: </strong>Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers.</p><p><strong>Results: </strong>IPF patients had significantly lower %predicted FVC, FEV¹ and DL_CO (p<0.001 for the three variables) and walked significantly less in the 6MWT (p=0.008). Mean quadriceps femoris muscle strength also was significantly lower in IPF patients (p=0.041). Rectus femoris muscle T2* measurements were significantly shorter in IPF patients (p=0.027). No significant intergroup difference was found regarding average muscle cross-sectional areas (p=0.790 for quadriceps and p=0.816 for rectus femoris) or rectus femoris fat fraction (p=0.901). Rectus femoris T2 values showed a non-significant trend to be shorter in IPF patients (p=0.055).</p><p><strong>Conclusions: </strong>Our preliminary findings suggest that, besides disuse atrophy, other factors such as hypoxia (but not inflammation) may play a role in the peripheral skeletal muscle dysfunction observed in IPF patients. This might impact the rehabilitation strategies for IPF patients and warrants further investigation.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"707"},"PeriodicalIF":2.3,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/9d/mrm-15-1-707.PMC7686790.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: general overview, pharmacological options and ventilatory support strategies.","authors":"Francesco Menzella, Andrea Matucci, Alessandra Vultaggio, Chiara Barbieri, Mirella Biava, Chiara Scelfo, Matteo Fontana, Nicola Cosimo Facciolongo","doi":"10.4081/mrm.2020.708","DOIUrl":"10.4081/mrm.2020.708","url":null,"abstract":"<p><p>The novel coronavirus called \"Severe Acute Respiratory Syndrome Coronavirus 2\" (SARS-CoV-2) caused an outbreak in December 2019, starting from the Chinese city of Wuhan, in the Hubei province, and rapidly spreading to the rest of the world. Consequently, the World Health Organization (WHO) declared that the coronavirus disease of 2019 (COVID-19) can be characterized as a pandemic. During COVID-19 several immunological alterations have been observed: in plasma of severe patients, inflammatory cytokines are at a much higher concentration (\"cytokine storm\"). These aspects are associated with pulmonary inflammation and parenchymal infiltrates with an extensive lung tissue damage in COVID-19 patients. To date, clinical evidence and guidelines based on reliable data and randomized clinical trials (RCTs) for the treatment of COVID-19 are lacking. In the absence of definitive management protocols, many treatments are currently being evaluated worldwide. Some of these options were soon abandoned due to ineffectiveness, while others showed promising results. As for ventilatory strategies, at the moment there are still no consistent data published about the different approaches and how they may influence disease progression. What will probably represent the real solution to this pandemic is the identification of a safe and effective vaccine, for which enormous efforts and investments are being put in place. This review will summarize the state-of-the-art of COVID-19 current treatment options and those potentially available in the future, as well as high flow oxygen therapy and non-invasive mechanical ventilation approaches.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"708"},"PeriodicalIF":2.0,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/33/mrm-15-1-708.PMC7662457.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy.","authors":"Valentina Di Lecce,&nbsp;Giovanna Elisiana Carpagnano,&nbsp;Paola Pierucci,&nbsp;Vitaliano Nicola Quaranta,&nbsp;Federica Barratta,&nbsp;Annapaola Zito,&nbsp;Enrico Buonamico,&nbsp;Onofrio Resta","doi":"10.4081/mrm.2020.704","DOIUrl":"https://doi.org/10.4081/mrm.2020.704","url":null,"abstract":"<p><p>The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11^th to May 31^st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO²/FiO₂ ratio between 100 and 200 and 17% showed Pa0₂/FiO₂ ratio <100. Mean Pa0₂/FiO₂ ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% were transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"704"},"PeriodicalIF":2.3,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/9f/mrm-15-1-704.PMC7662452.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of expiratory loaded breathing during moderate exercise on intercostal muscle oxygenation.","authors":"Quentin Bretonneau, Aurélien Pichon, Claire de Bisschop","doi":"10.4081/mrm.2020.702","DOIUrl":"10.4081/mrm.2020.702","url":null,"abstract":"<p><strong>Background: </strong>In patients with obstructive lung disease, maintaining adequate ventilation during exercise may require greater contraction of the respiratory muscles, which may lead to a compression of muscle capillaries. Furthermore, dynamic hyperinflation (DH) is frequent during exercise in these patients, as it allows to reach higher expiratory flows and to satisfy respiratory demand. However, in such situation, intercostal muscles are likely to be stretched, which could affect the diameter of their capillaries. Thus, in a context of high level of expiratory resistance, intercostal muscle oxygenation may be disturbed during exercise, especially if DH occurs.</p><p><strong>Methods: </strong>Twelve participants (22±2 years) performed two sessions of moderate exercise (20 min) by breathing freely with and without a 20-cmH₂O expiratory threshold load (ETL). Tissue saturation index (TSI) and concentration changes from rest (Δ) in oxygenated ([O₂Hb]) and total haemoglobin ([tHb]) were measured in the seventh intercostal space using near-infrared spectroscopy. Respiratory, metabolic and cardiac variables were likewise recorded.</p><p><strong>Results: </strong>Throughout exercise, dyspnea was higher and TSI was lower in ETL condition than in control (p<0.01). After a few minutes of exercise, Δ [O₂Hb] was also lower in ETL condition, as well as Δ [tHb], when inspiratory capacity started to be reduced (p<0.05). Changes in [O₂Hb] and dyspnea were correlated with changes in expiratory flow rate (Vt/Te) (r = -0.66 and 0.66, respectively; p<0.05).</p><p><strong>Conclusion: </strong>During exercise with ETL, impaired muscle oxygenation could be due to a limited increase in blood volume resulting from strong muscle contraction and/or occurrence of DH.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"702"},"PeriodicalIF":2.3,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/95/mrm-15-1-702.PMC7610065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38579687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home.","authors":"Pierachille Santus,&nbsp;Francesco Tursi,&nbsp;Giuseppe Croce,&nbsp;Chiara Di Simone,&nbsp;Francesca Frassanito,&nbsp;Paolo Gaboardi,&nbsp;Andrea Airoldi,&nbsp;Marica Pecis,&nbsp;Giangiuseppe Negretto,&nbsp;Dejan Radovanovic","doi":"10.4081/mrm.2020.713","DOIUrl":"https://doi.org/10.4081/mrm.2020.713","url":null,"abstract":"<p><strong>Background: </strong>To date, the effects of COVID-19 pneumonia on health-related quality of life (HRQoL) and dyspnoea are unknown.</p><p><strong>Methods: </strong>In a real-life observational study, 20 patients with COVID-19-related pneumonia received usual care plus erdosteine (300 mg twice daily) for 15 days after hospital discharge following local standard operating procedures. At discharge (T0) and on Day 15 (T1), participants completed the St George's Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale of dyspnoea during daily activity, the BORG scale for dyspnoea during exertion, and Visual Analogue Scale (VAS) for dyspnoea at rest. Paired t-tests compared scores at T0 and T1.</p><p><strong>Results: </strong>The mean (SD) SGRQ total score decreased from 25.5 (15.5) at T0 to 16.9 (13.2) at T1 (p<0.01); 65% of patients achieved a clinically important change of ≥4 points. SGRQ domain scores (symptoms, activity, and impact) were also significantly reduced (all p<0.01). The mean (SD) VAS score decreased from 1.6 (1.7) to 1.4 (2.5); p<0.01. The mean mMRC score decreased significantly (p=0.031) and 30% of patients achieved a clinically important change of ≥1 point. The mean (SD) Borg score increased from 12.8 (4.2) to 14.3 (2.4); p<0.01.</p><p><strong>Conclusion: </strong>The present proof of concept study is the first to report HRQoL in patients with COVID-19. During 15 days after hospital discharge, patients reported significant improvements in HRQoL and dyspnoea at rest and during daily activities.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"713"},"PeriodicalIF":2.3,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/0c/mrm-15-1-713.PMC7582021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38543271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan.","authors":"Samah Awad, Rawan Hatim, Yousef Khader, Mohammad Alyahya, Nada Harik, Ahmad Rawashdeh, Walaa Qudah, Ruba Khasawneh, Wail Hayajneh, Dawood Yusef","doi":"10.4081/mrm.2020.673","DOIUrl":"10.4081/mrm.2020.673","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan.</p><p><strong>Methods: </strong>The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.</p><p><strong>Results: </strong>Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) <i>vs</i> n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) <i>vs</i> n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) <i>vs</i> n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5(2) <i>vs</i> 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).</p><p><strong>Conclusion: </strong>We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians' behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"673"},"PeriodicalIF":2.3,"publicationDate":"2020-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/4c/mrm-15-1-673.PMC7569331.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38543267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory symptoms and associated risk factors among under-five children in Northwest, Ethiopia: community based cross-sectional study.","authors":"Zewudu Andualem,&nbsp;Asefa Adimasu Taddese,&nbsp;Zelalem Nigussie Azene,&nbsp;Jember Azanaw,&nbsp;Henok Dagne","doi":"10.4081/mrm.2020.685","DOIUrl":"https://doi.org/10.4081/mrm.2020.685","url":null,"abstract":"<p><strong>Introduction: </strong>Acute respiratory infections are still a major public health problem resulting in morbidity and mortality among under-five children. This study aims to assess the extent of respiratory symptoms and associated risk factors among under-five children in Gondar city, Northwest Ethiopia.</p><p><strong>Methods: </strong>A community-based cross-sectional study was carried out from February to June 2019. From 792 study participants, data were collected <i>via</i> face to face interviews by using a semi-structured pre-tested questionnaire. Data were entered in Epi Info version 7, then exported to Stata 14.00 for analysis. Binary (Bivariable and Multivariable) logistic regression analysis was used to test the association of explanatory and outcome variables. Variables with p<0.05 were considered as significantly associated with the outcome variable.</p><p><strong>Results: </strong>The prevalence of respiratory symptoms among under-five children was 37.5% at [95% (CI: 34.3-41)]. Uterine irritability during pregnancy [AOR = 1.89 at 95% CI: (1.11-3.23)], physical exercise during pregnancy [AOR = 0.60 at 95% CI: (0.41-0.89)], using wood and coal for heating [AOR = 2.42 at 95% CI: (1.65-3.53)], cockroaches infestation [AOR = 1.95 at 95% CI: (1.36 - 2.90)], presence of new carpets [AOR = 2.38 at 95% CI: (1.33-4.29)], damp stain [AOR = 2.45 at 95% CI: (1.02-2.69)], opening windows during cooking [AOR = 0.58 at 95% CI: (0.36-0 .93)], living less than 100 m heavy traffic [AOR = 1.94 at 95% CI: (1.16-3.27)], and living less than 100 m (unpaved roads/streets) [AOR= 2.89 at 95% CI: (1.89-4.55)] were significantly associated with respiratory symptoms.</p><p><strong>Conclusion: </strong>The prevalence of respiratory symptoms among under-five children was relatively high in the study area. Personal and environmental characteristics influencing symptom occurrence were identified. Respiratory symptoms will be minimized by reducing exposure to indoor and outdoor air pollution and enhancing housing quality.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"685"},"PeriodicalIF":2.3,"publicationDate":"2020-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/66/mrm-15-1-685.PMC7542992.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38543268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}