Preventive Effect of Cow's Milk Fermented with Lactobacillus paracasei CBA L74 on Common Infectious Diseases in Children: A Multicenter Randomized Controlled Trial

Background: Fermented foods have been proposed to prevent common infectious diseases (CIDs) in children attending day care or preschool. Objectives: To investigate the efficacy of dietary supplementation with cow’s skim milk fermented with the probiotic Lactobacillus paracasei CBA L74 in reducing CIDs in children attending day care or preschool. Methods: Multicenter, randomized, double-blind, placebo-controlled trial on healthy children (aged 12–48 months) consuming daily 7 grams of cow’s skim milk fermented with L. paracasei CBA L74 (group A), or placebo (maltodextrins group B) attending day care or preschool during the winter season. The main outcome was the proportion of children who experienced ≥1 episode of CID during a 3-month follow-up. Fecal biomarkers of innate (α- and β-defensins, cathelicidin) and acquired immunity (secretory IgA) were also monitored. Results: A total of 126 children (71 males, 56%) with a mean (SD) age of 33 (9) months completed the study, 66 in group A and 60 in group B. At intention to treat analysis, the proportion of children presenting ≥1 CID was 60% in group A vs. 83% in group B, corresponding to an absolute risk difference (ARD) of −23% (95% CI: −37% to −9%, p < 0.01). At per-protocol-analysis (PPA), the proportion of children presenting ≥1 CID was 18% in group A vs. 40% in group B, corresponding to an absolute risk difference (ARD) of −22% (95% CI: −37% to −6%, p < 0.01). PPA showed that the proportion of children presenting ≥1 acute gastroenteritis (AGE) was significantly lower in group A (18% vs. 40%, p < 0.05). The ARD for the occurrence of ≥1 AGE was −22% (95% CI: −37% to −6%, p < 0.01) in group A. Similar findings were obtained at PPA regarding the proportion of children presenting ≥1 upper respiratory tract infection (URTI), which was significantly lower in group A (51% vs. 74%, p < 0.05), corresponding to an ARD of −23% (95% CI: −40% to −7%, p < 0.01). Significant changes in innate and acquired immunity biomarkers were observed only in subjects in group A. Conclusions: Dietary supplementation with cow’s skim milk fermented with L. paracasei CBA L74 is an efficient strategy in preventing CIDs in children.

[CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF VAC- CINATION OF CHILDREN AGAINST PNEUMOCOCCAL INFECTION IN THE AMUR REGION]

AIM

To study the effectiveness of anti-pneumococcal vaccination of children in the organiza- tion of anti-epidemic measures in the areas of the flood in the Amur region.

MATERIAL AND METHODS

The monitoring program included 4988 children aged 2 to 5 years who have risk factors for pneu- mococcal infection. Pneumococcal conjugate vaccine Prevenar- 13 was used for immunization. Data on the incidence of child with acute respiratory infection, acute otitis media, pneumonia, meningitis during the post-vaccination period were taken into account. To evaluate the effective- ness of vaccination we used indicators and specific criteria (coefficient prophylactic vaccination and infection index).

RESULTS

The level of total morbidity of children in post-immunization pe- riod decreased by 13.6%; the number of cases ofpneumonia in the population of observed children decreased by 2.3 times; the total duration of the illness in children decreased by 14.6%, the number of.courses of antibiotic therapy was reduced by 21.3%, the number of hospital admissions of children - 38.4%, the number of days of temporary disability ofparents - 11.1%. Direct dependence of the degree of effectiveness of vaccination against pneumococcal disease by the age of children is determined.

CONCLUSION

The findings suggest that implementation of the program of clinical and epidemiological monitoring and prevention of community-acquired pneumonia with use of a vaccine against pneumococcal infections in the territory of the Amur Region has a high level of medical and socio-economic efficiency.

Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age

BACKGROUND

Undifferentiated acute respiratory infections (ARIs) are a large and heterogeneous group of infections not clearly restricted to one specific part of the upper respiratory tract, which last for up to seven days. They are more common in pre-school children in low-income countries and are responsible for 75% of the total amount of prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications.

OBJECTIVES

To assess the effectiveness and safety of antibiotics in preventing bacterial complications in children aged two months to 59 months with undifferentiated ARIs.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to August week 1, 2015) and EMBASE (1974 to August 2015).

SELECTION CRITERIA

Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotic prescriptions with placebo or no treatment in children aged two months to 59 months with an undifferentiated ARI for up to seven days.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted and analysed data using the standard Cochrane methodological procedures.

MAIN RESULTS

We identified four trials involving 1314 children. Three trials investigated the use of amoxicillin/clavulanic acid to prevent otitis and one investigated ampicillin to prevent pneumonia.The use of amoxicillin/clavulanic acid compared to placebo to prevent otitis showed a risk ratio (RR) of 0.70 (95% confidence interval (CI) 0.45 to 1.11, three trials, 414 selected children, moderate-quality evidence). Methods of random sequence generation and allocation concealment were not clearly stated in two trials. Performance, detection and reporting bias could not be ruled out in three trials.Ampicillin compared to supportive care (continuation of breastfeeding, clearing of the nose and paracetamol for fever control) to prevent pneumonia showed a RR of 1.05 (95% CI 0.74 to 1.49, one trial, 889 selected children, moderate-quality evidence). The trial was non-blinded. Random sequence generation and allocation concealment methods were not clearly stated, so the possibility of reporting bias could not be ruled out.Harm outcomes could not be analysed as they were expressed only in percentages.We found no studies assessing mastoiditis, quinsy, abscess, meningitis, hospital admission or death.

AUTHORS' CONCLUSIONS

There is insufficient evidence for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.

Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age

BACKGROUND

Undifferentiated acute respiratory infections (ARIs) are a large and heterogeneous group of infections not clearly restricted to one specific part of the upper respiratory tract, which last for up to seven days. They are more common in pre-school children in low-income countries and are responsible for 75% of the total amount of prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications.

OBJECTIVES

To assess the effectiveness and safety of antibiotics in preventing complications in children aged two to 59 months with undifferentiated ARIs.

SEARCH METHODS

We searched CENTRAL 2013, Issue 4, MEDLINE (1950 to May week 2, 2013) and EMBASE (1974 to May 2013).

SELECTION CRITERIA

Randomised controlled trials (RCT) or quasi-RCTs comparing antibiotic prescriptions with placebo or non-treatment in children up to 59 months with an undifferentiated ARI for up to seven days.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted and analysed data using the standard Cochrane methodological procedures.

MAIN RESULTS

We identified four trials involving 1314 children. Three trials investigated the use of amoxicillin/clavulanic acid to prevent otitis and one investigated ampicillin to prevent pneumonia.The use of amoxicillin/clavulanic acid compared to placebo to prevent otitis showed a risk ratio (RR) of 0.70 (95% confidence interval (CI) 0.45 to 1.11, three trials, 414 selected children, moderate-quality evidence). Methods of random sequence generation and allocation concealment were not clearly stated in two trials. Performance, detection and reporting bias could not be ruled out in three trials.Ampicillin compared to supportive care (continuation of breastfeeding, clearing of the nose and paracetamol for fever control) to prevent pneumonia showed a RR of 1.05 (95% CI 0.74 to 1.49, one trial, 889 selected children, moderate-quality evidence). The trial was non-blinded. Random sequence generation and allocation concealment methods were not clearly stated so the possibility of reporting bias could not be ruled out.Harm outcomes could not be analysed as they were expressed only in percentages.No studies were found assessing mastoiditis, quinsy, abscess, meningitis, hospital admission or death.

AUTHORS' CONCLUSIONS

The quality of evidence currently available does not provide strong support for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.

Otitis: anatomy every practitioner should know

Chronic otitis externa is a difficult, frustrating problem. Four etiologic components must be considered: primary and secondary causes and perpetuating and predisposing factors.1 Usually, these cases are complex and involve more than one component. Perpetuating factors are changes in the anatomy and physiology of the ear that occur in response to inflammation in the ear canal and the perpetuating factors already present. They are self-perpetuating, are not disease specific, and include failure of self-cleaning mechanisms and proliferative changes that create folds and stenosis of the lumen of the ear canal. Elimination of perpetuating factors often requires aggressive cleaning of the ear and long-term therapy. It is important to avoid damaging key structures while aggressively cleaning the ear. Therefore, to adequately diagnose and manage perpetuating factors, veterinarians must recognize normal ear anatomy and physiology.

Oral administration of probiotic Escherichia coli after birth reduces frequency of allergies and repeated infections later in life (after 10 and 20 years)

BACKGROUND

The development of allergies is a complex in which both composition and influence of the intestinal flora play an important role. We observed in earlier studies that the presence of an orally administered probiotic Escherichia coli strain in the intestine stimulated both a serum and local antibody response, decreased the presence of pathogens, the number of infections and the need for antibiotics.

METHODS

The preventive effect of oral colonization after birth with a probiotic E. COLI strain was assessed by evaluating the results of a questionnaire both 20 years (150 full-term infants) and 10 years (77 preterm infants) after colonization.

RESULTS

Differences in occurrence of allergies in colonized and control subjects were statistically significant both after 10 and 20 years (p < 0.01). Specific serum IgE antibodies confirmed the presence of allergies in 100% of 10-year-old and 91% of 20-year-old patients with clinical symptoms of allergy. Ten years after colonization, the occurrence of repeated infections was significantly lower in colonized subjects than it was in controls (p < 0.01); 20 years later, no differences were found in these groups.

CONCLUSIONS

Intentional colonization of the intestine with E. coli after birth (offering the advantage of the first colonizer) was found to decrease the incidence of allergies and repeated infections in later life.

Duration of breastfeeding, daycare, and physician visits among infants 6 months and younger

PURPOSE

To describe the association between duration of breastfeeding and an illness requiring a visit to a health care provider within the past 30 days (IRHP) among infants </= 6 months.

METHODS

Participants were breastfeeding women who delivered at a birthing center in suburban Detroit, Michigan and women employed by a company in Omaha, Nebraska. Subjects were interviewed by telephone at 3,6,9, and 12 weeks postpartum and by mailed questionnaire at 6 months postpartum.

RESULTS

Of the 674 breastfeeding women, 233 (34.5%) reported an IRHP. An IRHP was more likely among infants attending daycare (RR = 1.60; 95% CI 1.30, 1.96). There was an interaction between duration of breastfeeding, the number of children in the household, and IRHP (p < 0.0001). For firstborn children, each additional week of breastfeeding decreased the likelihood of an IRHP by 4%. An increased duration of breastfeeding was not significantly protective against an IRHP for infants living with additional children in the household.

CONCLUSIONS

Breastfeeding offers protection against an IRHP among firstborn children. Having additional children in the household or attending daycare outside of the home may diminish these benefits.

The public health problem of acute respiratory illness in childcare

Acute respiratory illness continues to be a significant problem for children attending childcare. The problems for the child are in terms of prevalence, incidence, and quality of life. Additional costs relate to parental absence from work and loss of earnings. This paper reports on the literature, and notes that little research has been undertaken to determine whether there are long-term risks or benefits to experiencing acute respiratory illness in early childhood. Research to date is presented, and the role of public health nurses is discussed in relation to how they might assist in reducing the incidence/prevalence of acute respiratory illness in children attending childcare.

[Pharmacological studies of luohanguo yanhou tablet]

Luohanguo Yanhou Tablet possesses the action of cotton ball granuloma of mice and the auricular edema induced by xylol, and also inhibiting the swelling of rat hind paw induced by carrageenin. The tests of mice writhing induced by acetic acid showed that the preparation had obvious analgesic action. It also possesses the obvious bacteriostatic action in vitro on five kinds of strains.

A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States

BACKGROUND

Studies on the health benefits of breastfeeding in developed countries have shown conflicting results. These studies often fail to account for confounding, reverse causality, and dose-response effects. We addressed these issues in analyzing longitudinal data to determine if breastfeeding protects US infants from developing diarrhea and ear infections.

METHODS

Mothers participating in a mail panel provided information on their infants at ages 2, 3, 4, 5, 6, and 7 months. Infants were classified as exclusively breastfed; high, middle, or low mixed breast- and formula-fed; or exclusively formula-fed. Diarrhea and ear infection diagnoses were based on mothers' reports. Infant age and gender; other liquid and solid intake; maternal education, occupation, and smoking; household size; family income; and day care use were adjusted for in the full models.

RESULTS

The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7).

CONCLUSIONS

Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she

The pre-travel medical evaluation: the traveler with chronic illness and the geriatric traveler

The pre-travel medical evaluation of elderly patients and patients with chronic illness requires special assessment and advice. Screening and special precautions are reviewed for traveling patients with respiratory disease, cardiac disease, sinusitis, diabetes mellitus, HIV infection, and other chronic medical conditions. Current guidelines for empiric therapy and prophylaxis of travelers' diarrhea are reviewed, with emphasis on concerns in geriatric or chronically ill travelers. Special considerations such as potential drug-drug interactions and insurance coverage are also discussed.

Swimming and ear infection

Surface swimming in fresh or ocean water is not contraindicated in children with otitis media or in children with tympanostomy tubes. Diving should be prohibited in children with acute or chronic otitis media or in children with tympanostomy tubes. Hot tub water, bath water, chlorinated water, or water from stagnant ponds may pose a risk for either otitis media or otitis externa.

Arabinogalactan- and dextran-induced ear inflammation in mice: differential inhibition by H1-antihistamines, 5-HT-serotonin antagonists and lipoxygenase blockers

Intravenous injection of arabinogalactan or dextran together with pontamine sky-blue dye into mice increased vascular permeability and led to marked blueing of the ears. Arabinogalactan caused a rapidly progressing ear blueing (maximal coloration 20-30 min after injection). This response was suppressed by pretreating the animals with the histamine H1-antihistamines levocabastine and loratadine. In contrast, dextran induced a slowly evolving ear inflammation (maximal coloration 60-90 min after injection), which was blocked by the 5-HT-serotonin antagonists cinanserin, metergoline and ritanserin. Furthermore, the dextran reaction was inhibited by the lipoxygenase (LO)/cyclooxygenase (CO) inhibitors BW540C, BW755C and phenidone and by the specific 5-LO inhibitor AA-861. Both arabinogalactan and dextran responses were inhibited by aprotinin, a kallikrein inhibitor, and the mixed H1/5-HT antagonists astemizole and azatadine. The inflammogenic activity of the polysaccharides was not affected by administration of the CO inhibitors indomethacin and suprofen, the thromboxane synthetase inhibitor dazoxiben, the H2-antihistamines cimetidine and ranitidine, the anticholinergics isopropamide or the PAF-antagonist L-652, 731. These data indicate the existence of distinctive endogenous molecules that mediate the pinnal extravasation reaction to both polysaccharides: histamine for arabinogalactan, serotonin and lipoxygenase-derived arachidonic acid metabolites for dextran.