PubMed Health⌕ Search

Biomedical subjects

M Kattan

Publications and source records attributed to M Kattan.

At least 37 records · Page 2Linked to original sources
PubMed1997

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study.

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.

Adult↗
PubMed1997

Morbidity and mortality of open lung biopsy in children.

OBJECTIVE: In patients with diffuse pulmonary infiltrates, when empiric therapy or less-invasive diagnostic procedures fail, physicians frequently resort to open lung biopsy (OLB) to provide a definite diagnosis and to help redirect therapeutic treatment. OLB is still widely regarded as a safe diagnostic procedure, even in the critically ill child. The objective of this study is to evaluate the accuracy of this view with regard to children with acute respiratory failure (ARF) and, for this purpose, compares the mortality and morbidity of such patients with those without ARF. DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS: Forty-two patients (mean age, 6.6 years) underwent 47 OLBs for undiagnosed diffuse pulmonary infiltrates between July 1984 and December 1994. Twenty-six patients (55%) were in ARF. Fifteen of these patients were intubated and receiving mechanical ventilatory support before the OLB procedure. RESULTS: The overall incidence of serious complications associated with the OLB procedure was 51%. Of the patients with ARF, 17 (65%) had at least one major complication compared with 3 (14%) of the patients without ARF. Pleural air complications (62% of the total) occurred only in patients with ARF: pneumothoraces and/or prolonged air leaks developed in 10 (38%) after their OLBs; 9 of these patients died, and 7 had pneumothorax complicating their chest tube removal, which required replacement chest tubes. All patients with ARF preoperatively required prolonged ventilatory support after the OLB procedure, whereas 90% of the patients without ARF could be extubated within 24 hours. Overall, 10 patients (24%) died after the OLB procedure. All deaths occurred in patients with ARF. Both ARF preoperatively and the presence of postoperative complications were significantly associated with decreased survival. CONCLUSIONS: The morbidity and mortality rates of children with ARF undergoing OLB for diffuse pulmonary infiltrates differ considerably from those of children without ARF. For children with ARF, OLB is associated with the risk of prolonged ventilatory support, recurrent pneumothoraces, and air leaks. These complications may be attributable to such patients' having diseased lungs with poor healing. Moreover, these complications may, in turn, contribute to the patients' poor outcomes.

Acute Disease↗
PubMed1996

Short-term compliance with peak flow monitoring: results from a study of inner city children with asthma.

The objective of the study was to assess the feasibility of initiating daily peak flow monitoring in a research study of asthma in inner city children. We performed a descriptive study of patterns of peak flow monitoring in children randomized to receive a simple mini-Wright (SM) or an electronic recording meter (ERM). The ERM served as a "covert" meter, providing objective documentation of actual peak flow use. Sixty-five Hispanic or African-American children, ages 5-9 years, with a history of physician-diagnosed asthma participated in the study. All children resided in census tracts with 40% or more of the population living at or below the poverty level. Subjects were instructed to use a peak flow meter (the SM or ERM) at least twice daily over a 3 week period, and to record peak flow values in a paper diary. Subjects who received the ERM were not made aware that measurements were also recorded electronically. Differences in patterns of use of the SM and ERM were assessed with the Wilcoxon signed rank test and Wilcoxon sum rank test. Adherence to peak flow monitoring was evaluated by comparing the percent days with missing values in the manually completed diary with those obtained by computer record. The Friedman statistic was used to compare changes in compliance (percent of days with missing peak flow entries) over time. Accuracy of peak flow readings was assessed by comparing the manual and electronic recordings with paired and unpaired t-tests and with Pearson product moment correlations. The percent of days with missing peak flow entries on diaries increased from 1.4% to 10.6% from the first to third week of monitoring (P < 0.004). The ERMs indicated a significantly greater percent of missing data than did the manual records (P < 0.0002). The difference in the percent of missing data for the electronic and manual records was most notable during the third study week, when the ERM and the manually completed records indicated that 52% and 15% of days, respectively, were without peak flow measures. Large inter-subject variations in the relationship between manually and electronically recorded peak flow measurements were observed, suggesting that errors in reading and transcribing peak flow rates occur in a subset of asthmatics. We conclude that children and caretakers in the inner city may have considerable difficulty initiating and maintaining peak flow recordings. Data obtained by manual records may considerably overestimate actual use. Compliance with monitoring decreases markedly between the first and third week of monitoring.

Black or African American↗
PubMed1996

Increased insulin-like growth factor binding protein-2 (IGFBP-2) gene expression and protein production lead to high IGFBP-2 content in malignant ovarian cyst fluid.

Expression of insulin-like growth factor-I (IGF-I), its receptor and IGF-binding proteins (IGFBPs) by ovarian cancer cells and its mitogenic effect on these cells in vitro, suggest that IGF-I may have a role in regulation of human ovarian cancer. We have recently shown IGFBP-2 to be markedly elevated in malignant ovarian cyst fluid in vivo. To identify the origin of increased IGFBP-2 in these cyst fluids, the gene expression and protein content of IGFBP-2 were investigated in 14 malignant and four benign epithelial ovarian neoplasms. IGFBP-2 mRNA was detected in all ovarian specimens and was 2- to 30-fold higher in malignant than in benign neoplasms. Within the malignant tissues IGFBP-2 mRNA levels correlated with the aggressiveness of the tumour and were higher in invasive tumours than in those with borderline pathology. Southern blot analysis revealed no amplification of IGFBP-2 gene in the DNA samples from ovarian tumours regardless of their nature. IGFBP-2 was the major binding protein in tissue extracts, as measured by both Western ligand blotting and immunoblotting, and was significantly higher in malignant than in benign neoplasms. These findings were further supported by immunohistochemical detection of IGFBP-2 in tumour sections. Our data suggest that increased local production by the tumour in vivo is responsible for the increased IGFBP-2 levels in the cyst fluid bathing the ovarian malignancy. This may represent an autocrine regulatory mechanism for IGF-I proliferative effect of ovarian cancer.

Blotting, Northern↗
PubMed1995

Effect of zidovudine on human fetal lung development.

Zidovudine (AZT) is currently used to treat human immunodeficiency virus (HIV)-positive women during pregnancy to prevent the prenatal transmission of HIV type 1 (HIV-1). However, AZT not only inhibits HIV replication but also affects the DNA polymerases of human cells; hence AZT is not recommended during the first trimester of pregnancy. The lung is a unique organ because it continues to grow and develop throughout fetal life. Using a human fetal lung organ culture system, we sought to determine the effect of AZT on morphogenesis and epithelial cytodifferentiation of developing alveoli. Lung tissues from three fetuses, 14-15 weeks gestational age, were grown in culture for 24 hours (day 0). AZT at a concentration of either 0.4, 4.0, 8.0, or 40.0 mumol/L was added on days 1, 5, and 10 of growth. The cultures were interrupted on days 6 and 15 and examined by light and electron microscopy for alveolar saccular development, interstitial thinning, and epithelial cell differentiation. On day 6 of growth the treated cultures demonstrated fewer alveolar saccules and a thicker, more cellular interstitium compared to the controls. After 15 days of growth the cultures treated with 0.4 mumol/L of AZT appeared structurally similar to the controls. The cultures treated with AZT concentrations of 4.0 to 40.0 mumol/L appeared unchanged from day 6, implying arrested maturation of the culture. However, epithelial cell differentiation was unaffected. We conclude that AZT at concentrations of 4.0 mumol/L and greater affects the structural development of the human fetal lung in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Differentiation↗
PubMed1995

Transforming growth factor-beta 1: comparative immunohistochemical localization in human primary and metastatic prostate cancer.

BACKGROUND: We have shown previously that primary prostate cancer demonstrates significant extracellular accumulation of transforming growth factor-beta 1 (TGF-beta 1). To further investigate the potential role of TGF-beta 1 in prostate cancer progression, we evaluated an expanded series of primary prostatic carcinomas and associated lymph node metastases. EXPERIMENTAL DESIGN: Prostate tissue samples from 37 patients were examined. Three were organ donors, all less than 30 years of age, whose prostates were included as normal controls. Eighteen had undergone radical prostatectomy and pelvic lymph node dissection. Eleven were without evidence of metastasis, whereas seven were found to have prostate cancer within at least one of their pelvic lymph nodes. Sixteen had undergone transurethral resection of the prostate for benign disease, yet all had prostate cancer within the resected specimen (15 were stage T1b; 1 was stage T1a). Twelve of the patients with stage T1b disease underwent pelvic lymph node dissection and implantation of radioactive gold seeds. All 12 had prostate cancer in at least one lymph node. All specimens were examined for the level of expression and localization of TGF-beta 1 by immunohistochemistry using Ab that distinguish intracellular from extracellular TGF-beta 1. RESULTS: Normal prostate tissue and benign prostatic hyperplasia demonstrated negative or weak intracellular and extracellular staining for TGF-beta 1. By comparison, 29 of 34 primary prostate cancers showed extensive extracellular TGF-beta 1 staining with pronounced intracellular accumulation within epithelial cells in 13 of 34 patients. There was no difference in the staining pattern for extracellular TGF-beta 1 between primary cancers with and without pelvic lymph node metastases. However, in primary cancers without pelvic lymph node metastases, only 1 of 15 patients showed strong intracellular staining for TGF-beta 1 compared with 12 of 19 primary tumors with metastatic disease. In addition, only 2 of 19 lymph node metastases demonstrated weak extracellular TGF-beta 1 staining, but all 19 contained intracellular TGF-beta 1. CONCLUSIONS: These findings confirm our previous observation that prostate cancer exhibits enhanced intracellular and extracellular accumulation of TGF-beta 1 relative to normal prostate tissue and benign prostatic hyperplasia. In addition, our study documented a significantly more pronounced accumulation of intracellular TGF-beta 1 in primary prostate cancer with metastasis than in primary tumors without metastasis. Moreover, although the pattern of intracellular TGF-beta 1 staining observed in the primary tumor is maintained in the metastasis, a lack of extracellular accumulation of TGF-beta 1 in the metastatic site was noted. This differential pattern may be biologically important and could conceivably reflect a role for TGF-beta 1 in disease progression.

Adenocarcinoma↗
PubMed1994

A study of pediatric house staff's knowledge of pulse oximetry.

OBJECTIVE: Pulse oximetry is widely used to measure oxygen saturation in inpatient and outpatient settings. As with any medical technology, competence in interpretation and application of the data is essential for patient care. We therefore undertook a study to quantify pediatric house staff's knowledge of pulse oximetry and their ability to interpret the information. METHODS: A 16-item multiple choice questionnaire (6 demographic, 10 knowledge) was developed to assess knowledge of pulse oximetry. The questionnaire was administered to a total of 134 pediatric house staff from five medical school-affiliated residency programs in New York City. RESULTS: The mean test score and standard deviation was 64.3% +/- 1.9, with a range of 10% to 100%. Regarding three questions related to the knowledge of the oxyhemoglobin deviation curve, only 17% of the the respondents answered all three questions correctly. In three questions pertaining to the accuracy of the pulse oximeter, 36% of the respondents answered all questions correctly. Forty-three percent of the house staff believed that training in the use of pulse oximetry was inadequate. CONCLUSIONS: The results showed that there is marked variability in pediatric house staff's knowledge of all aspects of pulse oximetry. This could contribute to patient morbidity. We suggest that medical schools and residency programs place more emphasis on teaching the principles and applications of pulse oximetry and the oxyhemoglobin dissociation curve.

Clinical Competence↗
PubMed1992

Facemasks versus mouthpieces for aerosol treatment of asthmatic children.

Mouthpieces and facemasks are being used with nebulizers for delivery of medication in acute asthma. To compare the effectivity of the two devices, 64 children age 6 to 19 years presenting to the hospital with acute asthma were enrolled in a randomized, single-blind study. Group 1 used a facemask. Group 2 used a mouthpiece connected to the nebulizer via short T-shaped tubing. Clinical evaluation and spirometry were performed at baseline and 20, 40, and 60 minutes after a single treatment with albuterol. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow over the middle 50% of FVC (FEF25-75) were determined at each point. Adverse effects were recorded. There was no significant difference in improvement between the groups. Patients with nasal congestion, age below 10 years, or severe airway obstruction did equally well with each method. Patients in the facemask group had a higher incidence of tremor. We conclude that the mouthpiece is an effective as the facemask and produces less tremor.

Acute Disease↗
PubMed1992

Childhood asthma and passive smoking. Urinary cotinine as a biomarker of exposure.

To assess the relationship between passive smoking and asthma, we investigated (1) whether passive smoking was more prevalent among asthmatic than control children and (2) whether exposure to tobacco smoke was higher in acute asthma than in nonacute asthma. Three groups were recruited into a case-control study: 72 acute asthmatic children from the emergency room (ER), 35 nonacute asthmatic children from the asthma clinic, and 121 control children from the ER. Both questionnaire and urinary cotinine/creatinine ratio (CCR) were used to assess passive smoking. Levels of CCR greater than or equal to 30 ng/mg were used to identify children exposed at home. Mean CCR was also computed. Acute and nonacute asthmatic children had similar prevalences of passive smoking at home. Acute cases showed a higher mean CCR than nonacute cases, but this was not significant. In comparing all asthmatic to control children, smoking by the maternal caregiver was more prevalent among asthmatic children (odds ratio OR = 2.0, 95% CI 1.1, 3.4). This was confirmed by CCR greater than or equal to 30 ng/mg (OR = 1.9, 95% CI 1.04, 3.35) and by the difference in mean CCR (43.6 versus 25.8 ng/mg, p = 0.06). We conclude that smoking by the maternal caregiver is associated with clinically significant asthma in children. We could not show that it is a trigger of acute asthma attacks.

Acute Disease↗
PubMed1991

Pulmonary manifestations of HIV infection in children.

We retrospectively reviewed the spectrum, course, and outcome of pulmonary diseases in 66 children with AIDS, hospitalized between 1982 and 1988, prior to the use of zidovudine. Fifty-two of the 66 (79%) patients developed pulmonary problems. In fifty-two percent of all patients, a pulmonary problem was the first symptom of HIV infection. The most common respiratory illness requiring hospitalization was an episode of respiratory distress with normal PaO2 and unchanged X-ray with a 9.7 +/- 6.8 days mean duration of hospitalization. Bacterial pneumonia, Pneumocystis carinii pneumonia (PCP) and pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonia occurred in 30%, 32% and 22% of the patients, respectively. Bacterial pneumonia and PCP were associated with a high mortality rate. Sixty-eight percent of the patients died within 24 months of the onset of pulmonary disease. In 50% of the children, pulmonary disease was a primary cause of death. The results of this study can be useful in developing prospective studies for the prevention and treatment of pulmonary complications of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Current recommendations for breast-feeding in cystic fibrosis centers.

In recent years, breast-feeding has been strongly recommended, and the decision to breast-feed is made by a large percentage of women before pregnancy. We performed a survey to determine the current recommendations given to mothers in cystic fibrosis (CF) centers. For mothers of infants with CF, 77% of centers recommend breast-feeding alone or with pancreatic enzyme supplements and/or hydrolyzed formula. For mothers with CF, the following responses were given: 11% recommend breast-feeding, 8% do not recommend it, 42% make the recommendation according to the health status of the mother, and 32% make the recommendation according to the personal wishes of the mother. The duration of breast-feeding for mothers of infants with CF was reported to be from 3 to 6 months by 43% of centers, whereas for mothers with CF, 41% of centers reported the duration to be less than 3 months. Several centers reported that their experiences were not always positive, thus indicating a need to establish criteria to predict and ensure a successful outcome.

Breast Feeding↗
PubMed1990

Brush cells in the human fetal trachea.

We performed a morphologic examination of human fetal lung tissue, using scanning and transmission electron microscopy, in order to establish the presence of brush cells in extrapulmonary and intrapulmonary airways, and developing acinar epithelium. Brush cells, characterized by a border of regular straight microvilli containing a filamentous core, were observed within the tracheal epithelium of a 19-20 week gestational age fetus. These cells constituted 0.5% of the total epithelial cell population. Brush cells were not seen within the bronchial, bronchiolar or developing acinar epithelium. Our study shows that brush cells occur infrequently but normally in the developing tracheal epithelium of the second trimester fetus.

Fetus↗
PubMed1989

Efficacy of a nonrestricted fat diet in patients with cystic fibrosis.

We sought to determine if an increased oral intake with a noninvasive nutrition program in patients with cystic fibrosis could influence growth, weight gain, and pulmonary function. Thirty-seven patients, aged 2 to 27 years, were instructed to consume a nonrestricted fat diet during an intervention period of 4 years. The results showed that patients increased the mean energy intake significantly to a level of more than 120% of the recommended daily allowance. The enhanced intake resulted in significant weight gain. Pulmonary function (forced expiratory flow 25%-75%) deteriorated during the 2-year preintervention period but stabilized during the 4-year intervention period. Both male and female patients were able to maintain their established height and weight scores during adolescence. The recommendation for a high-energy diet with no restrictions placed on the fat intake and the control of the steatorrhea by administration of an optimal enzyme dosage is supported by our data. Individualized nutritional counseling should be attempted before implementing invasive nutritional intervention programs.

Adolescent↗
PubMed1989

Outcome of mechanical ventilation in children with acquired immunodeficiency syndrome.

We retrospectively reviewed the records of 18 children with acquired immunodeficiency syndrome (AIDS) who required mechanical ventilation for respiratory failure. These patients represented 35% of the patients seen with pulmonary disease and AIDS. The most common causes of respiratory failure were Pnuemocystis carinii pneumonia (77%) and bacterial pneumonia (33%). Bronchial lavage by fiberoptic bronchoscopy or endotracheal tube suctioning in mechanically ventilated children with AIDS had a high yield for P. carinii. Eight of 18 (44%) children survived the episode of respiratory failure and were weaned from the ventilator. However, four of eight survivors died within 6 months. Arterial oxygen tension on admission and maximum peak inspiratory pressure on the ventilator did not differ between survivors and nonsurvivors. We conclude that children with AIDS who are mechanically ventilated can be weaned from the respirator but that the subsequent course remains poor.

Acquired Immunodeficiency Syndrome↗