***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND No reagents have been shown to be effective in preventing wheezing attacks provoked by acute respiratory tract illnesses ( ARTIs ) in preschool children . New therapeutic agents and preventive strategies are needed . OBJECTIVES We assessed the effect of OM-85 BV ( Broncho-Vaxom ; OM Pharma , Geneva , Switzerl and ) in preventing ARTI-provoked wheezing attacks in preschool children with recurrent wheezing . METHODS A r and omized , double-blind , placebo-controlled , parallel-group study was carried out between August 2007 and September 2008 . The study included 75 children with recurrent wheezing who were 1 to 6 years old . Participants were r and omly assigned to groups given either OM-85 BV or a placebo ( 1 capsule per day for 10 days each month for 3 consecutive months ) at the start of the trial . Participants were followed for 12 months , which included the administration period of the test article . RESULTS Subjects given OM-85 BV had a lower rate of wheezing attacks . The cumulative difference in wheezing attacks between the 2 groups was 2.18 wheezing attacks per patient in 12 months ; there was a 37.9 % reduction in the group given OM-85 BV compared with the group given placebo ( P < .001 ) . Stepwise multiple ( linear ) regression analysis showed that the main difference between the OM-85 BV and placebo groups was a reduction the number of ARTIs ( R = -0.805 , P < .001 ) . The duration of each wheezing attack was 2 days shorter in the group given OM-85 BV than in the group given placebo ( P = .001 ) . CONCLUSION Administration of OM-85 BV significantly reduced the rate and duration of wheezing attacks in preschool children with ARTIs The aim of this study was to compare the efficacy and the safety of a short oral ribosomal immunotherapy ( Immucytal ) in the prevention of chronic otitis media in children . Seventy-two patients were enrolled in this study , 41 males and 31 females , aged between 6 and 14 years , with an history of recurrent otitis media . Patients were r and omised to receive Immucytal ( group A ) or placebo ( group B ) according to the following protocol : one tablet daily in the morning 8 days per month for three consecutive months . Immucytal and placebo were identical in shape and size , in order to maintain double-blind conditions . The efficacy parameters were ( evaluated before , at the end and 6 months after the beginning of the therapy ) : clinical score ; changes in immunological parameters ; patient 's parents assessment of symptoms on a scale from 0 ( much worse ) to 4 ( much improved ) and hearing tests . Patients of group A , had an improvement of clinical items measured , serum concentrations of immunoglobulins , subjective patient 's parents assessment of symptoms and hearing tests . For all evaluations , a significant difference between treatment groups was found . Using this dosage and posology ( shorter than others ) the beneficial effects of Immucytal were maintained until the end of the 6-month study period BACKGROUND Acute respiratory tract infections ( ARTIs ) are among the main causes of morbidity and mortality in children . The bacterial extract OM-85 BV has shown some protective effect for ARTIs in preschool children and a reduction in exacerbations of chronic bronchitis in adults . OBJECTIVES This trial reports results of a double-masked , placebo-controlled , parallel-group clinical study that assessed the efficacy and tolerability of OM-85 BV in the prevention of ARTIs in school girls living in an orphanage . METHODS Two hundred girls ( age range , 6 to 13 years ) living in an orphanage entered the trial . Participants were r and omly allocated to receive either OM-85 BV or placebo for 10 consecutive days a month for 3 consecutive months . Patients were followed up for 6 months , including the administration period . The trial began in September 1996 and finished in March 1997 . Primary end points were the type and number of infections . Secondary end points included when an infection occurred , time to clinical cure , severity of infection , absenteeism from school due to an ARTI , number of antibiotics or other drugs prescribed , and duration of concomitant drug treatment . RESULTS During the trial , patients in the OM-85 BV group experienced 143 ARTIs ( 135 upper ARTIs and 8 otitis episodes ) and patients in the placebo group experienced 299 ARTIs ( 273 upper ARTIs , 1 lower ARTI , and 25 otitis episodes ) . The median number of ARTIs was 1.0 ( 0.0 , 3.0 ; 5th percentile , 95th percentile ) in the OM-85 BV group compared with 3.0 ( 2.0 , 4.0 ; 5th percentile , 95th percentile ) in the placebo group . This difference was statistically significant ( P < 0.001 ) . Participants who received OM-85 BV also showed significantly better results ( P < 0.001 ) than participants who received placebo in terms of median duration of illness , median number of missed school days due to an ARTI , median number of antibiotic and drug courses , and median duration of concomitant treatment . There were significant differences ( P < 0.05 ) in severity of ARTIs during month 4 of the trial , with patients receiving OM-85 BV showing less severe ARTIs than patients receiving placebo and shorter mean time to clinical cure from the second month to the fourth month . No adverse events related to the trial medications were reported . CONCLUSIONS OM-85 BV had a preventive effect on ARTIs in the school girls , with a reduction in the antibiotic requirements and the duration of ARTIs . Future studies are needed to further explore the role of OM-85 BV in the prevention of ARTIs OBJECTIVES /HYPOTHESIS To examine sinonasal anatomic variants that may predispose toward recurrent acute rhinosinusitis ( RARS ) . STUDY DESIGN Retrospective case-control . METHODS Sinus computed tomography ( CT ) scans from a consecutive series of adult patients meeting strict diagnostic criteria for RARS were retrospectively review ed . A control group was assembled from patients who underwent pituitary or temporal bone CT for a nonrhinosinusitis indication . CT scans were scored for the presence of Haller cells , concha bullosa , and impinging septal spurs . Maximal septal deviation ( degrees ) , infundibular widths , and Lund staging were also assessed . The prevalence of these anatomic variants was statistically compared between the RARS and control groups . RESULTS Thirty-six patients met diagnostic criteria for RARS ( mean age , 47.2 years ; 2:1 female preponderance ) ; 42 control patients were identified . The mean Lund score for patients with RARS was 2.25 versus 1.27 for the control group ( P < .001 ) . Although RARS patients were more likely to manifest concha bullosa ( 41.7 % vs. 28.6 % ) or impinging septal spurs ( 27.8 % vs. 19.0 % ) , these differences were not statistically significant ( P = .165 and P = .260 , respectively ) . However , patients with RARS were significantly more likely to radiographically demonstrate Haller cells ( 39.9 % vs. 11.9 % , respectively , P = .006 ) . Finally , patients with RARS had significantly smaller mean infundibular widths when compared with control patients ( 0.591 mm vs. 0.823 mm , respectively , P < .001 ) . CONCLUSIONS The presence of Haller cells and smaller infundibular widths were statistically associated with RARS when compared to control patients . Our data suggest that anatomy could play a role in the pathogenesis of RARS . Further prospect i ve study is warranted OBJECTIVES Children under 2 years of age with acute otitis media are known to have a relatively poor prognosis . The objective of this study was to assess whether known determinants for recurrent acute otitis media and persistent middle ear effusion after an episode of acute otitis media during childhood also apply to children under 2 years . METHODS STUDY DESIGN prospect i ve study of 210 children under 2 , with identification of potential prognostic determinants . Univariate and multivariate logistic regression analyses were applied to evaluate which parameters independently contributed to the prediction of both outcome measures ( recurrent acute otitis media and persistent middle ear effusion ) . A prognostic function was developed , and the area under the receiving operating characteristic ( ROC ) was used to estimate the predictive ability of the prognostic models . POPULATION children under 2 years of age with an episode of acute otitis media in family practice . OUTCOMES MEASURED recurrent acute otitis media and persistent middle ear effusion . RESULTS For the outcome recurrent acute otitis media data from 210 children were used and winter season , male sex , passive smoking and persistent symptoms for more than 10 days at presentation were independent prognostic determinants . For the outcome persistent middle ear effusion data from 190 children were used and winter season , bilateral disease at entry , a sibling history of recurrent acute otitis media , and a previous episode of acute otitis media independently predicted the outcome . No sufficiently discriminatory prognostic model could be constructed for either outcome measure . CONCLUSION Prediction of recurrent acute otitis media or persistent middle ear effusion in individual young children remains poor OBJECTIVE To investigate the relationship between Vitamin D deficiency and acute otitis media infection . METHODS The r and omised , single-blind , case-control study was conducted at the Paediatric Department of Ataturk University , Erzurum , Turkey , from January to April 2010 . It comprised ambulatory children diagnosed with acute otitis media and healthy controls . The subjects were divided into groups according to their serum 25-hydroxy vitamin D levels . SPSS 18 was used for statistical analysis . RESULTS Of the 169 subjects in the study , 88(52 % ) were the cases and 81(48 % ) were controls . The mean age of the cases was 6.21±3.4 years , and 6.18±3.12 years for the controls  ( p<0.951 ) . Serum 25-hydroxy vitamin D levels in the cases and controls were 20.6±10.2 ng/mL and 23.8±10.3 ng/mL ( p<0.05 ) . There was no statistically significant difference between the groups in terms of parathormone and calcium levels ( p>0.05 ) . CONCLUSION Serum 25-hydroxy vitamin D levels being significantly lower in children diagnosed with acute otitis media compared to the controls in two otherwise similar groups suggests that Vitamin D deficiency plays a role in otitis media infection A comparative study of the occurrence of chronic rhinosinusitis in clinics in the North of Scotl and and Southern Caribbean was performed , to test the hypothesis that patients with chronic rhinosinusitis present more commonly in temperate climates than tropical climates . The data was collected prospect ively over two month periods from outpatient clinics at both sites . A higher surgical trainee or consultant otolaryngologist made the diagnosis of chronic rhinosinusitis . Eight-hundred- and -seventy-two otolaryngology out patients were studied 311 were from Trinidad and 561 from Aberdeen . The proportion of patients presenting with chronic rhinosinusitis  in both sample s is similar , 54(9.6 % ) patients in Aberdeen and 29(9.3 % ) in Trinidad . The proportion of chronic rhinosinusitis patients with a history of allergy is greater in Trinidad 79.3%(23 ) than in the Aberdeen sample 50%(27 ) . Patients with chronic rhinosinusitis were seen as commonly in otolaryngology clinics in a tropical setting as in a temperate setting The usefulness of clinical and laboratory findings for prediction of the presence of Group A streptococci on throat culture and of an increase in antistreptococcal antibodies  was investigated in 693 adult patients . Several findings were shown to increase the likelihood of streptococcal isolation , alone and in combination : tonsillar exu date , tonsillar enlargement , tender anterior cervical adenopathy , myalgias , and a positive throat culture in the preceding year . Compared with a frequency of 9.7 % in all patients , the probabilities of a positive culture were quite different ( ranging from 2 to 53 % ) in subgroups of patients with different combinations of these clinical findings . The results of a  leukocyte count and measurement of C-reactive protein added little additional predictive information . While clinical findings can never predict perfectly the results of a throat culture , they nevertheless can provide useful information — particularly in tending to “ rule out ” streptococcal infection — in adult patients with pharyngitis A 6-month double-blind , prospect i ve , r and omized , placebo-controlled trial was conducted to establish the safety and efficacy of OM-85-BV in the treatment of  subacute sinusitis  and in the following prevention of the respiratory tract infections in 56 children from 18 months to 9 years of age . In the subacute phase of the sinusitis the patients were given one OM-85-BV capsule ( 3.5 mg of bacterial extracts ) ( n = 26 ) or placebo ( n = 30 ) , daily for ten days ; additionally both groups took amoxicillin/clavulanate 40/10 mg/kg daily in three divided doses for 21 days . For the following two months the patients took one O 
    Output:
    
Available pre clinical and clinical data highlight the rationale for the use and effectiveness of immunity-targeted approaches , including targeted immunisations ( flu and pneumococcal vaccines ) , and non-specific immunomodulation ( bacterial lysates ) , in the prevention and management of recurrent croup , tonsillitis , otitis media , recurrent acute rhinosinusitis and chronic rhinosinusitis .
CONCLUSIONS In this review , we summarise the current evidence , and provide data demonstrating that some immunity-targeted strategies , including vaccination and immunomodulation , have proved effective in the treatment and prevention of recurrent and chronic URTIs in children .
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