Atopic dermatitis (AD) is a chronic remitting-relapsing inflammatory skin disorder. Due to the multifactorial pathogenesis, there are numerous therapeutic management approaches, mainly based on symptomatic treatments. In recent years Allergen Immunotherapy (AIT) has been progressively advanced as targeted disease-modifying treatment of allergic disease. The most recent guideline from the American Academy of Dermatology concludes that data available do not support its use in AD. The Joint Task Force and The European Academy of Dermatology suggest that clinicians can consider AIT treatment in selected patients characterized by aeroallergen sensitization, prevalently HDM, severe AD, clinical exacerbation after exposure to the causative allergen. Nevertheless, its role in AD is still under debate, especially in children.

Objective: To investigate the change in C-section rate in 1998-2017 in Indonesia and explore the socioeconomic, geographic, and health system factors associated with the use of C-sections. Design: Analysis from demographic health survey (DHS) data in 2002-3, 2007, 2012, and 2017. Setting: Nationwide. Population: 40743 women who reported giving birth within five years of each round of the survey. Methods: Cross-tabulation was used to examine change of C-section rate by year. We conducted bivariate and multivariate logistic regressions to study the determinants of C-section use. Main outcome measures: C-section rate at the population level. Results: In Indonesia, C-section rate increased from 4.0% in 1998 to 18.5% in 2017. In 2017, C-section rate in urban areas (22.9%) was almost two times that in rural areas (11.8%). It was almost three times among the richest wealth quintile (36.5%), compared to the poorest wealth quintile (12.9%). Between 2008 and 2017, the difference in C-section rate by public services enlarged between the poorest and the richest groups. The absolute increase of C-section by private services was more than public services over time. In 2013-2017, the C-section rates by public and private services were 22.5% and 23.1%, respectively. After adjusting for all variables, higher education, higher household wealth, primiparity, and use of public childbirth services were positively associated with C-section. Conclusions: The C-section rate increased steadily in the past two decades in Indonesia. Women’s socioeconomic status and health system factors were associated with the increased use of C-section.

Objective:Hearing loss is a prevalent disease with free field voice test (FFVT) being a common hearing test performed.FFVT has its own disadvantage as a screening tool as there is no standardization of speech among examiners.We aim to invent mobile-app based hearing screening using Flutter-Dart programming language that mimics findings of FFVT.The app is termed as Free field click test (FFCT).Our aim is to compare sensitivity&specificity of FFCT and FFVT with Pure Tone audiogram (PTA). Methods:This is an open-labelled randomized controlled trial. This study was conducted at the (removed for blind peer review) from December-March 2020. 50 patients from 18-80 years old with complaint of hearing loss were recruited.These patients were randomly assigned into two groups; FFVT&FFCT which were compared with PTA.Categorical data were analyzed with Chi-square test,non-categorical data were calculated with Student t-test for statistical significance. Results:Results were calculated based on degree of hearing loss against PTA.FFCT‘s rate of detection of hearing loss was significant for all degrees of hearing loss with p-values of <0.05. FFVT’s detection rate was only significant to normal hearing, moderate & severe hearing loss. FFCT had higher sensitivity of 94.1% for normal hearing compared to 52% for FFVT.FFVT had higher specificity but with a marginal difference only.A higher rate of accuracy (94%) and strength of the correlation (0.97) were obtained for FFCT than FFVT. Conclusion:FFCT is a more sensitive&accurate tool than FFVT in detecting hearing thresholds. It proves to be an ideal tool to screen hearing loss and is convenient in times of social distancing during COVID-19 pandemic now.

Background: Environmental tobacco smoke (ETS) exposure and sleep associated problems can lead to serious health problems in children. We aimed to evaluate association between ETS and sleep disturbance in children. Methods: We enrolled 209 children without chronic health problems or acute infections aged 4 to 12 years between June 2019 and March 2020 to this cross-sectional study. Parents’ smoking habits and ETS exposure of children were questioned and Children’s Sleep Habits Questionnaire (CSHQ) was administered to screen for the most common sleep problems in children. “Sleep disturbance” was defined as a score ≥41 in CSHQ. Plasma cotinine levels were measured in all subjects enrolled and levels ≥ 3 ng/mL were defined as ETS exposure. Results: Total 115 children (55 %) were in the “sleep disturbance” group according to CSHQ, and 66 (57.3%) of them were exposed to ETS according to parental report. The children with parent reported ETS exposure had increased risk of sleep disturbance (adjusted OR: 1.3). All 209 children had plasma cotinine levels ≥3 ng/ml, with a mean (SD) 50.55 (13.78) ng/ml, revealing that all of them were exposed to ETS although only 105 of them were parent reported. Multivariable analysis of risk factors for sleep disturbance revealed that parent reported ETS exposure was associated with increased risks of sleep disturbance (p=0.023, adjusted OR: 1.9 and 95%CI: 1.09-3.3) Conclusions: Parent reported ETS exposure is associated with sleep disturbance in their children however parental reports about smoking habits may not be compatible with plasma cotinine levels of the children.

Viruses are the main pathogens responsible for acute upper respiratory tract infections; they spread easily among infants, young children, and the elderly population. The strong spreading capability of such viruses poses great difficulties for clinical diagnosis, treatment, and disease prevention and control. During the current coronavirus disease (COVID-19) pandemic, a clear understanding of the epidemiological characteristics of respiratory tract pathogens is essential for the timely identification of non-COVID-19 respiratory tract infections and enhancement of the efficiency of disease prevention and control. In this study, a total of 2,017 patients with upper respiratory tract infections in Kunming, Yunnan province of China, were included as subjects and divided into the Before COVID-19 and During COVID-19 groups. Differences in the infection rate of 13 common respiratory tract pathogens before and during the COVID-19 pandemic were determined using PCR in conjunction with capillary electrophoresis. Results indicated that the infection rate of respiratory tract pathogens (prevailing pathogens and infection status of different age groups) underwent significant changes after the start of the COVID-19 pandemic. Further in-depth research is required to improve the diagnosis, treatment, prevention, and control of respiratory tract infections.

Background: Chronic obstructive pulmonary disease (COPD) exacerbation (CE) is characterized by the rapid deterioration of respiratory symptoms caused by air pollution, but there have been no comprehensive studies with regard to the age-stratified effect of air pollution. We investigate the short-term effects of air pollution and environmental factors on CE. Methods: By merging the individualized environmental data and Korea’s National Health Insurance cohort, we conducted Quasi-Poisson analysis to evaluate the effects of air pollutants and environmental factors on CE. Results: From January 2007 to December 2012, a total of 15110 CE events occurred, which showed seasonal dynamics in CE events, air pollutants (particulate matter less than 10 µm (PM10), NO2, SO2) and environmental factors (wind speed (WS), solar sunshine (SS)). The only factor affecting CE was PM10, and this occurred on lag days 4, 5, and 6 and had a peak hazard ratio (HR) of 1.0404 on lag day 5. PM10 also had a lag-cumulative effect on CE risk from lag day 6 to lag day 10. In subgroup analysis on age and level of parameters, each factor had a different significant effect on CE on different lag days. Conclusions: PM10 uniquely affects CE at lag-specific day 5 (from lag day 4 to lag day 6). PM10 also had a lag-cumulative effect on CE risk which showed a pattern proportional to the concentration of PM10. Considering the subgroup analysis, we need to devise different strategies for air pollutants and age for patients with COPD exacerbation.

Background: Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue.Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aims to assess oxidative stress in VKC patients and controls and to study the effect ofCsA on oxidative stress in these subjects. Methods:Thirty-six consecutive children, including 12 VKC(9 males, 75%; mean age 10,17; SD ± 2.48) patients without treatment,12 VKC treated with CsA(9 males, 75%; mean age 9,08; SD± 2.75) and 12 controls (CT) (7males,58%; mean age8,58; SD ±1,78) were recruited. A cross-sectional study was performed to compare H2O2 in the serum and the tears ofthese children. Results: Compared with CT and VKC children treated with CsA, VKCuntreated children had significantly higher values ofHydrogen peroxide (H2O2) in theserum and the tears.No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2O2 levels. Conclusion: This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome.

Pediatric pulmonologists, and, indeed, general pediatricians, are exposed to the causative virus of Covid-19 , SARS-CoV2, in their daily outpatient practices from both symptomatic and asymptomatic patients. This risk naturally increases with multiple exposures over time. We have developed a simple equation to calculate the probability of a practitioner remaining Covid free over a specified time interval, given the local population prevalence of virus, the transmissibility of the organism or “attack rate,” the mitigating effects of personal protective equipment (PPE), and the number of patients seen over the time interval. The equation can be used to construct a Kaplan Meier -like plot for remaining Covid free. Since studies of transmission of SARS-CoV2 suggest a spectrum between droplet and aerosol spread, even in asymptomatic patients and absence of aerosol generating procedures, the type of masks protection worn by medical practitioners may mitigate risk to different degrees. Eye protection may mitigate the risk further. While the risk of acquiring Covid-19 in a year of practice is low, it is not negligible. However it can be minimized. These considerations may be helpful in deciding local risk to the practitioner according to practice volume and in choosing the level of PPE that would result in minimizing that risk.

Objectives: Risk factors for severe acute bronchiolitis in previously healthy infants are scarcely known. This study investigated the effect of tobacco smoke exposure among severely Pediatric Intensive Care Unit (PICU) patients. Design: A prospective epidemiological observational study Setting: Tertiary pediatric medical center. Pediatric Intensive Care Unit (PICU) of Children’s University Hospital La Paz Patient selection: Infants with bronchiolitis younger than 2 years of age during the October 2017 to March 2018 outbreak Methodology: On admission, parents were asked whether they smoked. In children who required invasive mechanical ventilation, endotracheal aspirate was collected at the time of intubation. Results: A total of 102 patients with bronchiolitis were studied. Among these, 14 (47%) of 30 infants whose parents smoked required invasive mechanical ventilation vs. 14 (19%) of 72 whose parents were nonsmokers (p=0.007) (RR 2.4; 95% CI 1.3–4.4). Among patients on invasive mechanical ventilation, 10 (71%) of 14 infants with secondhand smoke exposure presented PBI vs. 3 (21%) of 14 in the unexposed (p=0.012) (RR 3.3; 95% CI 1.2–9.6). PICU stay was 3 (IQR 3-6) days in infants whose parents didn´t smoke, and 5 (IQR 3-11) days in infants whose parents smoked (p=0.01). Conclusions: Secondhand smoke exposure is an additional high risk for pulmonary bacterial superinfection, invasive mechanical ventilation and PICU length of stay in infants with severe acute bronchiolitis

Background: A systematic assessment of severe clinical outcomes associated with respiratory syncytial virus (RSV) infections in adults is lacking. Methods: Within a prospective surveillance study, we performed a nested retrospective study during two respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes. We explored the impact of RSV-associated hospitalizations on changes in the living situations of surviving patients from admission to discharge. Results: Overall, 403 patients were studied (median age 69 years); 29.5% were > 80 years. Common comorbidities included cardiac (47.6%) and pulmonary (45.9%) conditions and diabetes (41.4%). Severe outcomes occurred in 19.1% of patients including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had 4.43 times higher likelihood of severe RSV infection compared to those living in the community with or without assistance from family or home health aides. After discharge, 56 (15.1%) patients required an increased level of support including 36 (9.7%) with new admissions to residential living facilities. Conclusions: RSV infection was associated with severe illness in adults. Living in a facility was a risk factor for severe outcomes and likely a surrogate for frailty at admission rather than an independent risk factor. The need for an increased level of support after discharge will add RSV-related healthcare costs to those already incurred from hospitalization.

Background Early menarche is reported with the risk of endometriosis (EMS) with varying conclusions. Objective To assess the association between menarche age and EMS risk. Search strategy PubMed, Medline and Embase were searched using “endometriosis”, “early menarche” , “EMS”, “menarche age”, and “early menstrual characteristics”. Selection criteria Articles that reported the EMS risk in early menarche from Jan 2000 to May 2020 were included. Studies without control group, and lack of data of menarche age were excluded. Data collection and analysis EMS risks in these articles were collected and analysed through in random effects meta-analysis. In addition, subgroup analyses and meta-regressionwere were also performed. Main results A total of 16 studies (8913 EMS cases and 876477 controls) were included in the meta-analysis. The pooled risk of EMS in early menarche (<12 years) was 1.34 (95% CI: 1.16–1.54), with statistically significant heterogeneity across the studies (I2 = 72.0%). Stratified analysis showed that the risks of EMS by earlier menarche was increased in studies started after 2000, and in developing area, which was further confirmed by meta-regression analysis. In addition, higher quality in assessment of the exposure (menarche age) and control of potential confounders can elimenate heterogeneity. Conclusions The earlier age of menarche is a major risk factor of EMS, and its risk has an increasing trend in recent years and in developing countries. Large-scale studies in different ethnic groups are warranted.

INTRODUCTION: Information regarding open garbage dumps may cause public health dilemma within the community and cause stray dog proliferation. Most wastes have a family origin and stray dogs are largely attracted by possible wastes from cookery or former foods. The information, besides as attitudes and perception on rabies, is thus vital for the prevention of human deaths. Information regarding major factors associated with increased dog population can spot awareness gaps which can influence bar practices plus lead to needless deaths. METHODS: Two sources i.e. primary and secondary sources were utilized for identifying the probable factors responsible for increased dog population. These factors primarily included garbage management, specific control measures for dog population by stakeholders and perception of people. The secondary source includes Srinagar Municipal Corporation, for collecting the relevant information RESULTS: Regarding the major factors associated with increases dog population, the respondents (both the people 99.68% and commercial 100%) believed that open garbage dumps are a public health barrier in the area and commence to stray dog proliferation. Also combined rabies control measures coupling dog population control, removal of dog free-roaming and proliferation must be fulfilled. Till date around 2,000 sterilizations were conducted and also around 2,000 stray dogs were administered the anti-rabies vaccine. CONCLUSION: Open garbage dumps are a public health obstacle in the Srinagar area and they commence to stray dogs proliferation. Till date only around 2,000 sterilizations were conducted and also around 2,000 stray dogs were administered the anti-rabies vaccine, however, this is too less in comparison with the total population of dogs and still, the ballot of dogs from the particular zones of Srinagar is deficient.

Background: Sickle cell disease (SCD) is a genetic blood disorder that results in vaso-occlusive events and shortened lifespan. Medical advancements have led to a decrease in childhood mortality in SCD, but the transition period is associated with poor outcomes. We analyzed recent US hospitalizations and mortality trends in the transition-aged population and evaluated for differences between patients with and without SCD. Methods: Nationwide Impatient Sample (NIS) database was utilized to analyze hospitalizations among individuals aged 16-24 years from 2003-2017. Diagnoses were coded using ICD-9-CM and ICD-10-CM. Statistical analyses included: bivariate analyses to assess the association between socio-demographic characteristics, joinpoint regression analysis to describe trends in mortality rates, average annual percent change (AAPC) measures were calculated, and adjusted survey logistic regression to assess the association between patient characteristics and in-hospital mortality. Results: Our data captured 37,344,532 total patients between the age of 16 and 24 who were hospitalized during 2003-2017. Patients with SCD comprised of 1.20% of population with a significant +3.2% AAPC in hospitalizations. When comparing SCD to non-SCD hospitalization trends, we observed differences in gender, against-medical-advice discharge status, zip code income, and payer. SCD in-hospital mortality rates showed a non-significant -0.7% AAPC. However, in contrast to non-SCD patients, the odds ratios for in-hospital mortality significantly increased with age for SCD patients. Conclusion: During the transition period, SCD patients have an extremely increased likelihood of mortality. Proposed interventions to address this disparity must include targeting social determinants of health.

Objective First, to estimate the preventive and the curative effects of postmenopausal hormone therapy (PHT) on menopausal symptoms, and secondly to estimate the sensitivity of a woman to identify the exposure to postmenopausal hormone therapy. Design Randomised and blinded trial Setting Postmenopausal Hormone Therapy Trial in Estonia (EPHT), 1999-2002 Participants 593 women who responded to the relevant questions both at the entry and one-year follow-up questionnaires in the blind sub-trial Intervention HT or placebo at entry in women with or without menopausal symptoms Results The participants were asked in the questionnaires the presence of the menopausal symptoms of sweating, hot flushes and sleeping disorders, and at one-year follow-up to identify the exposure (HT or placebo). The net curative effect of HT (the proportion of disappeared symptoms in symptomatic women in the HT arm (46.4%) minus the same proportion in the placebo arm (25.8%) was 20.6%. The net preventive effect of HT (the proportion of incident symptoms in asymptomatic women in the placebo arm, 44.4%, minus the same proportion in the HT arm, 14.3%) was 30.1%. At one-year follow-up 34.6% of the women in the HT arm made a right guess on their arm. The net sensitivity of guessing the HT (right guess on HT minus wrong guess on placebo) was 15.8%. Conclusions The true HT effect on menopausal symptoms was relatively small. The clinical practice may need to further consider the benefit harm ratio of PHT [ISRCTN35338757].

Objective To investigate the risk of congenital heart defects (CHD) and other congenital anomalies (CA) associated with first trimester use of macrolides. Design Population-based case-malformed control study. Setting Thirteen European countries. Population Data on 145,936 livebirths, stillbirths and terminations of pregnancy for CA from 15 EUROCAT registries, covering 9 million births 1995–2012. Methods Cases were babies with CHD, anencephaly, orofacial clefts, genital and limb reduction anomalies associated with antibiotic exposure in the literature. Controls were babies with other CA or genetic conditions. A meta-analysis of the literature, including this study, was conducted for CHD. Main outcome Odds ratios adjusted (AOR) for maternal age and registry, with 95% Confidence Intervals (95%CI). Results Macrolide exposure was recorded for 307 cases, 72 non-genetic controls, 57 genetic controls. AOR for CHD was not significantly raised (AOR 0.94, 95%CI: 0.70 – 1.26 vs non-genetic controls; AOR 1.01, 95%CI: 0.73 – 1.41 vs genetic controls), nor significantly raised for any specific macrolide. The risk of atrioventricular septal defect was significantly raised with exposure to any macrolide (AOR 2.98; 95%CI: 1.48 – 6.01), erythromycin (AOR 3.68, 95%CI: 1.28 – 10.61), and azithromycin (AOR 4.50, 95%CI: 1.30 – 15.58). Erythromycin, clarithromycin, azithromycin and clindamycin, were also associated with an increased risk of at least one other CA. Meta-analysis gave an overall CHD OR 1.14, 95%CI 0.90 –1.49 for macrolides. Conclusions Guidelines for macrolide use in pregnancy should consider the increased risk of specific CA. This is relevant for the potential use of azithromycin in the treatment of COVID-19.

Objectives: Given some of the shared organic and psychogenic pathophysiologic mechanisms in tinnitus and erectile dysfunction (ED), we hypothesized that newly-onset tinnitus may be associated with ED. This study aims to explore the relationship between these two medical conditions using a nationwide population-based database. Design: A case-control study Setting: Taiwan Participants: We retrieved data from Taiwan’s National Health Insurance Dataset, 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls). Main outcome measures: The diagnosis date was the date of the first ED claim for ED, which was the index date for cases. We defined the date of the control patient’s first utilization of ambulatory care during the index year of their matched case as their index date. Tinnitus during a one-year period before the index date was the exposure of interest. Results: Of the 38,658 sampled patients, 1247 (3.23%) had been diagnosed with tinnitus within the year prior to the index date, 792 (4.10%) among cases and 455 (2.35%) among controls. Multiple logistic regression analysis showed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR=1.772; 95% CI=1.577-1.992; p<0.001). After adjusting for co-morbid medical disorders and social economic factors, cases were more likely than controls to have a prior diagnosis of tinnitus (OR=1.779, 95% CI=1.582-2.001, p<0.001). Conclusions: This investigation detected a novel association between ED and newly-onset tinnitus. Physicians should be alert to the possibility of developing ED in patients treated for tinnitus.

Introduction The risk stratification of infants presenting to the emergency department with bronchiolitis who are at risk for receiving airway support during their hospital stay has been insufficiently studied. The aim of this study was to determine the clinical predictors of hospitalization with airway support (“escalated care”) among infants with recurrent wheezing evaluated in the emergency department Methods: We conducted a retrospective cohort study in infants with one or more wheezing episode, younger than two years of age in tertiary centers in Rionegro, Colombia. The primary outcome measure was escalated care defined as hospitalization plus any airway support. A multivariate logistic regression model was performed to estimate predictors of escalated care. To assess discrimination and calibration, area-under-the-curve (AUC) and calibration plots were calculated. Results A total of 665 cases were included and 85 infants received escalated care. The variables included risk score for escalated care within 5 days of admission to the emergency room including prematurity, poor feeding, nasal flaring and/or grunting, and previous wheezing episodes requiring hospitalization, The model has a high specificity (99.6%) with acceptable AUC of 0.70 (CI 95% 0.60- 0.74). Conclusion: A clinical risk score was created based on the odds ratio of each of the identified variables, which appears to be useful for estimating the absolute risk of escalated care within 5 days of admission to the ED. However, external validation is required before this clinical score is applied in general practice in any ED setting

Objective This study aimed to comprehensively evaluate the clinical characteristics of COVID-19 in perinatal period, and systematically assess the mother-to-child transmission potential of SARS-CoV-2. Design A case retrospective study. Setting and Population We retrospectively analyzed the data of 23 pregnant patients in late pregnancy. Methods Maternal and neonatal throat swabs, vaginal secretions, placenta tissues, and breast milk, were collected for the nucleic acid test of the virus. Pregnancy outcomes and neonatal results were also analyzed. Main Outcome Measures The result of viral nucleic acid test and pregnancy outcomes. Results Overall, 10 patients (43.5%) had no symptoms and were found by routine chest CT. Complications appeared after COVID-19 onset included PROM (17.4%) and fetal distress (4.3%). Typical signs of viral pneumonia were recorded in chest CT of all patients. No patients developed severe pneumonia or died of COVID-19. All of 25 neonates were born alive. No severe asphyxia or neonatal death was observed. Although three neonates were tested transiently suspected positive for SARS-CoV-2 after being transferred to neonatology department, no newborns developed COVID-19. Only a rectal swab sample from one pregnant patient was tested positive for SARS-CoV-2, while all the other clinical specimens including first sample of newborn throat swabs were negative. Pathological examination found no obvious chorioamnionitis or clear virus inclusion body in placenta, and ACE2 (angiotension-converting enzyme 2) was expressed at a moderate level. Conclusions Asymptomatic patients were present in pregnant women. There is no confirmatory evidence for mother-to-child transmission in COVID-19 patients with late pregnancy.

Background: The practice of allergology varies widely between countries, and the costs and sales for the treatment of rhinitis differ depending on practices and health systems. To understand these differences and their implications, the rhinitis market was studied in some of the EU countries. Methods: We conducted a pharmaco-epidemiological database analysis to assess the medications that were prescribed for allergic rhinitis in the years 2016, 2017 and 2018. We used the IQVIA platforms for prescribed medicines (MIDAS® - Meaningful Integration of Data, Analytics and Services) and for OTC medicines (OTC International Market Tracking - OTCims). We selected the five most important markets in the EU (France, Germany, Italy, Poland and Spain). The UK was excluded due to a lack of data. Results: Intra-nasal decongestants were excluded from the analyses because they are not prescribed for allergic rhinitis. For both Standard Units (SU) and costs, France is leading the other countries. In terms of SU, the four other countries are similar. For costs, Poland is lower than the three others. However, medication use differs largely. For 2018, in SU, intra-nasal corticosteroid is the first treatment in Poland (70.0%), France (51.3%), Spain (51.1%) and Germany (50.3%) whereas the Italian market is dominated by systemic anti-histamines (41.4%) followed by intra-nasal corticosteroids (30.1%). Results of other years were similar. Discussion: There are major differences between countries in terms of rhino-conjunctivitis medication usage.

ABSTRACT Background: Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia. The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been formally assessed. Patients and methods: Medical records of children <18 years admitted with NP to two pediatric hospitals in Italy between 2005 through 2019 were retrospectively reviewed. The following 4 periods were defined: 2005-2010 (pre-PCV13), 2011-2013 (early post-PCV13), 2014-2016 (intermediate post-PCV13), and 2017-2019 (late post-PCV13). Results: Forty-three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre-PCV13 and post-PCV13 periods. A significant decrease in the rate of NP-associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post-PCV13 period (p=0.001). Streptococcus pneumoniae was the most common agent detected in both periods (pre-PCV13: 11/18, 61%; post-PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre-PCV13: 3/11, 27%; post-PCV13; 4/13, 31%). There were no changes in the bacterial etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post-PCV13 period. Conclusions: The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre- and post-PCV13 periods. Pneumococcal serotypes were mainly represented by strain 3.

Gastrointestinal symptoms are common findings in children with SARS-CoV-2 infection.Diarrhea and vomiting have been reported in about 8-9% of cases, reaching more than 20% in some studies. Children with gastrointestinal involvement appear to be younger than those without, but the severity of the disease seems to be similar between the two groups of subjects.Fecal shedding in children has been reported in 20-30% of children and has been observed both in those with and those without overt gastrointestinal involvement. Moreover, prolonged fecal elimination, lasting several days after negativization of real-time polymerase chain reaction assay on respiratory swabs, have been reported with variable frequency in children with SARS-CoV-2 infection. These observations raise the question regarding the possibility of oral-fecal transmission and the possible role of children in spreading the infection, particularly when they appear asymptomatic or with gastrointestinal symptoms but with no respiratory involvement, as well as during their convalescent phase.

In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma. Emerging concepts and challenges in implementing the exposome paradigm and its application in allergic diseases and asthma are reviewed, including genetic and epigenetic factors, microbial dysbiosis and environmental exposure, particularly to indoor and outdoor substances. The most relevant experimental studies further advancing the understanding of molecular and immune mechanisms with potential new targets for the development of therapeutics are discussed. A reliable diagnosis of asthma, disease endotyping and monitoring its severity are of great importance in the management of asthma. Correct evaluation and management of asthma comorbidity/multimorbidity, including interaction with asthma phenotypes and its value for the precision medicine approach and validation of predictive biomarkers are further detailed. Novel approaches and strategies in asthma treatment linked to mechanisms and endotypes of asthma, particularly biologicals, are critically appraised. Finally, due to the recent pandemics and its impact on patient management, we discuss the challenges, relationships, and molecular mechanisms between asthma, allergies, SARS-CoV-2 and Covid-19.

Objective: To compare the clinical course and outcomes of hospitalized pregnant and non-pregnant patients with coronavirus disease 2019 (COVID-19). Design: Retrospective, single centre and case-control study. Setting: Renmin Hospital of Wuhan University, Wuhan, Hubei province, China Population: SARS-CoV-2-infected hospitalized 31 pregnant and 124 non-pregnant patients diagnosed between 1 January 1 and 7 May, 2020; final date of follow-up was Jul 8, 2020. Main outcomes and measures: Demographic, clinical, laboratory, radiological, treatments and outcomes were collected, analyzed and compared between the two groups. All neonates received detection for SARS-CoV-2. Results: Pregnant patients had higher leucocytes, neutrophil counts, C-reactive protein and lactate dehydrogenase level, but lower lymphocyte counts. More pregnant patients received antibiotic, corticosteroids and oxygen support. All seventeen neonates had negative results of severe acute respiratory syndrome coronavirus (SARS-CoV-2) without complications. All 31 pregnant and 124 non-pregnant patients, with similar clinical symptoms, intensive care unit admission and complications, had been discharged. Conclusion: Pregnant patients might have more obvious inflammatory response, cellular immune deficiency and potential tissue necrosis, but similar clinical manifestations and outcomes as compared with the non-pregnant patients. No evidence of neonatal infections and complications had been shown in this study. Timely and active management may be beneficial for improving the outcomes of pregnant women with COVID-19 and the neonates. Keywords: Coronavirus Disease 2019; COVID-19; Severe Acute Respiratory Syndrome Coronavirus 2; SARS-CoV-2; Pregnant; Non-Pregnant. Tweetable abstract: Pregnant women had more obvious inflammatory response, cellular immune deficiency and potential tissue necrosis, but similar clinical manifestations and outcomes.

Objective To explore the prevalence of contraceptive use, unintended pregnancy, and induced abortions within 24 months postpartum in eastern, central, and western regions of China and in China overall. Design A retrospective cohort study. Setting Hospital-based Maternity units. Population Women who delivered a live baby between 12 and 24 months. Methods: We randomly selected postpartum women at 60 hospitals in eastern, central, and western regions of China. We applied descriptive statistics and life-table analyses. Main outcome measures Prevalence of contraception, unintended pregnancy, and abortions. Results: A total of 18,045 participants were enrolled and interviewed, and 12-, and 24-month contraceptive rates were 85.7% (95% CI 85.2-86.2 ), and 86.8% (95% CI 86.3-87.2 ), respectively. Condoms accounted for 79% of contraceptive initiators. The 12-, and 24-month rates were 5.3% (95% CI 5.0-5.6) , and 13.6% (95% CI 12.2-15.0) for unintended pregnancy; and 4.0% (95% CI 3.7-4.3), and 10.8% (95% CI 9.5-12.1) for induced abortion, respectively. Three-quarters of unintended pregnancies ended in abortion. Postpartum contraceptive use was higher in the western region relative to the eastern or central regions, but the risks of unintended pregnancy and induced abortion were also higher in the west. Conclusions: Postpartum contraception use was relatively high in China but dominated by less-effective methods, and these may contribute to higher risks of unintended pregnancy and induced abortion during the postpartum period. Use of long-acting reversible contraceptives and effective and reliable short-acting methods should thus be fostered in postpartum family planning services in China.