Impact of specialty care on cost containment and pulmonary function.
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Adolescent↗
Biomedical subjects
N Eid
Publications and source records attributed to N Eid.
Electro-migration of nitrate in sandy soil.
Migration of nitrate to groundwater has become a serious threat in many agricultural areas. This paper presents the results of experimental laboratory tests studying the nitrate gradient developed in response to an electrical potential. Two systems were tested; the first had no flow (closed system) and the second had flow opposite to the direction of the electrical current. A solution of sodium nitrate in sandy soil was used in both systems. The tests showed that the electro-kinetic process effectively concentrated and retained nitrate close to the anode. The movement of NO(3)(-) through the soil column was significantly influenced by the development of a pH gradient. Statistical analysis was performed to determine best-fit equations relating the nitrate gradient to the electrical input and pH gradient. A simple one-dimensional finite difference model was used to predict the pH gradient developed during the electro-kinetic process. The experimental measurements closely agreed with the predicted spatial and temporal distribution of the nitrate gradient for both closed and open system configurations.
Electrochemistry↗
Can peak expiratory flow predict airflow obstruction in children with asthma?
STUDY OBJECTIVES: A recent trend in the treatment of asthma has been the widespread, independent use of peak expiratory flow (PEF). We examined whether PEF monitoring creates inaccuracies in assessment of children with moderate to severe asthma. METHODS: We compared the negative predictive value of PEF in relation to the forced expiratory volume in 1 second (FEV(1)), and to the forced expiratory flow between 25% and 75% of the vital capacity (FEF(25-75%)) at different levels of air trapping as determined by the residual volume over total lung capacity ratio (RV/TLC). RESULTS: The study included 244 patients, ages 4 to 18 years with all classes of asthma severity, with FEV(1) ranging from 28% to 134% of predicted value. We analyzed 367 sets of pulmonary function tests performed throughout a 3-year period. Thirty percent of patients with a normal PEF value had an abnormal FEV(1) or FEF(25-75%). As air trapping increased, the ability of a normal PEF to predict normal FEV(1) and FEF(25-75%) readings fell from 83% to 53%. The negative predictive value was significantly lower for patients with RV/TLC ratio >30 compared with patients with RV/TLC <30. CONCLUSIONS: The results of this study suggest that it might be possible to identify children for whom the PEF is likely to give false-negative results. As air trapping increases, it causes the PEF to give misleading reassurance of normal pulmonary function. Furthermore, poor predictiveness of PEF is obtained when values 80% of predicted for age are considered normal.
Adolescent↗
Lung function in infants with wheezing and gastroesophageal reflux.
Eighty-four otherwise healthy infants with daily wheezing underwent infant pulmonary function tests (IPFTs) and 24-h esophageal pH probe studies. Fifty-four (64%) infants had positive pH probe studies, and 30 infants had negative pH probe studies. Many infants in both groups had evidence of peripheral airflow obstruction at tidal breathing and on forced expiration as measured by thoracoabdominal compression. In infants with gastroesophageal reflux (GER), only 9 of 54 (16.6%) responded to bronchodilator therapy compared to 20 of 30 (66.6%) in the group with negative pH probe studies (P < 0.0005). In infants with positive pH studies, family history of asthma (n = 16) correlated well with positive response to bronchodilators (P < 0.0005), and all infants exposed to maternal smoking (n = 11) had no response to bronchodilators. Forty-four percent of infants with a positive pH probe had no gastrointestinal symptoms suggestive of GER. In infants with a negative pH probe, family history of asthma (n = 24) correlated well with positive response to bronchodilators (P < 0.0005), and exposure to maternal smoking (n = 8) correlated well with no response to bronchodilator therapy (P < 0.0005). We conclude that silent GER is common in infants with persistent wheezing. Furthermore, infants with GER are less likely to respond to bronchodilator therapy, and exposure to maternal smoking and family history of asthma may be significant independent factors.
Asthma↗
Moderate hemoptysis of unknown etiology.
The underlying cause and treatment of hemoptysis should be addressed promptly to avoid potentially life-threatening complications. We report on a previously healthy 11-year-old white boy who presented with acute hemoptysis. On bronchoscopy, bleeding was noted from the right upper and lower lobes. Right bronchial arteriography revealed multiple regions of abnormal "blushing" throughout the right bronchial arterial distribution which was successfully controlled by right bronchial arterial embolization. In spite of an extensive work-up, we were not able to determine the cause of bleeding. The patient has been followed for 18 months without any recurrence and without evidence of any systemic disease. Our patient does not fit any diagnostic category of pulmonary bleeding and further case reports are needed to delineate this entity.
Acute Disease↗
Gastroesophageal reflux in infants with wheezing.
The relation between silent gastroesophageal reflux (GER) and respiratory problems such as persistent wheezing in infants is not well-established. Between January 1994 and June 1997, we evaluated the incidence of GER in 84 otherwise healthy infants referred to the Pediatric Pulmonary Medicine Division at Kosair Children's Hospital for evaluation of daily wheezing, and we followed their clinical course for 18 months. All underwent 24-hr esophageal pH studies to evaluate GER. The pH probe study was performed at a mean age of 8.74 +/- 4.6 months. Infants with a positive GER study were treated with an H2 receptor antagonist (H2RA) and a prokinetic agent for a mean of 5.6 +/- 2.4 months. At first follow-up visit 3 weeks after esophageal pH studies infants treated with an H2RA and those who did not have GER but continued with daily wheezing were started on flunisolide nasal solution (0.025%) delivered by nebulizer (125 mcg t.i.d.). Infants in both groups were followed every 1-2 months for a mean of 18 months and if clinically improved, attempts to decrease their daily asthma medications were made. Fifty-four of 84 (64%) had positive esophageal pH studies (GER-positive group), and 24 of them (44%) had no gastrointestinal symptoms suggestive of GER. Thirty patients had normal esophageal pH studies (GER-negative group). Twenty-two of these 30 (73%) infants without GER required nebulized flunisolide, compared to 13 of 54 (24%) infants with GER (P < 0.0005). Thirty-five of 54 (64.8%) infants with GER were able to discontinue all daily asthma medications within 3 months of starting antireflux therapy, while none of the infants without GER were able to discontinue daily asthma medications during the follow-up period (P < 0.0005). We conclude that silent GER is common in infants with daily wheezing, and controlling GER improves morbidity and decreases the need for daily asthma medications.
Anti-Asthmatic Agents↗
Comparison of the efficacy of inhaled fluticasone propionate, 880 microg/day, with flunisolide, 1500 microg/day, in moderate-to-severe persistent asthma.
BACKGROUND: Inhaled corticosteroids have become the mainstay of asthma therapy. Few studies however, have compared inhaled steroids in children. We compared the efficacy of inhaled fluticasone propionate (FP), 880 microg/day (2 puffs of 220 microg/puff, BID) with inhaled flunisolide (FLU), 1500 microg/day (3 puffs of 250 microg/puff, BID). METHODS: Thirty children with moderate to severe asthma, mean age 12.7 years (range 10 to 17 years), mean duration of asthma 8.4 years, initially received flunisolide 1500 microg/day for 1 year, and then were switched to fluticasone propionate 880 microg/day and followed for an additional year. Pulmonary function tests (PFTs) were monitored and analyzed before and after the switch for the duration of study. Mean percent predicted for age values for FVC, FEV1, FEF25-75%, and FEFR were compared at 1 month, 2 to 6-month intervals, and 7 to 12-month intervals and during the same season of the year. Pulmonary function tests within 3 weeks of an exacerbation were not included in the study. The number of asthma exacerbations, emergency room visits, hospital admissions, and number of school days lost were also compared. RESULTS: There was significant improvement in mean asthma exacerbations/patient/year (1.7 +/- 1.66 SD) versus (4 +/- 2.6) (P < .0002); mean emergency room visits/patient/year (0.23 +/- 0.62) versus (1.2 +/- 1.74) (P = .004); mean hospital admissions for asthma/patient/year (0.2 +/- 0.61) versus (1.13 +/- 1.45) (P < .0002); and number of school days lost/patient/year (1.4 +/- 2.38) versus (7.93 +/- 6.7) (P < .0002) while patients were receiving fluticasone propionate as compared with flunisolide. Also, the mean percent values predicted for age in all time-periods (at 1 month, 2 to 6 months, and 7 to 12 months) revealed significant improvement in FEV1 and FEF25-75% (P < .05 for both parameters). As PFT can be affected by seasonal changes, PFT parameters were compared during the same season of the year and significant improvement in FVC and FEV1 was observed in all seasons while patients were receiving fluticasone propionate (FP) compared with flunisolide (FLU) (P < .05 for all parameters). Significant improvement in PEFR and FEF25-75% was observed only in spring and summer season. CONCLUSION: Fluticasone propionate 880 microg/day improved lung function and quality of life in adolescents with moderate-to-severe asthma when compared with flunisolide 1500 microg/day.
Absenteeism↗
Comparison of lung function in infants exposed to maternal smoking and in infants with a family history of asthma.
STUDY OBJECTIVE: To compare lung function in infants exposed to maternal smoking with lung function in infants with a family history of asthma. There are no published studies comparing lung function in both groups. DESIGN: Cross-sectional study. SETTING: A tertiary pulmonary care center at a children's hospital. PATIENTS: One hundred five infants with daily wheezing. Thirty-five infants had persistent exposure to maternal smoking, and 70 had a family history of asthma in parents or siblings. MEASUREMENTS: Infant pulmonary function tests were compared between the two groups. The ratio of terminal to peak expiratory flow at tidal breathing at 25% of the previous expiration remaining and the ratio of terminal to peak expiratory flow with forced expiration at 25% of the previous expiration remaining (FEF25/PFEF) were used to evaluate peripheral airflow. A > 25% improvement in FEF25/PFEF after a bronchodilator challenge test was considered a positive response. RESULTS: Most infants in both groups had evidence of peripheral airflow obstruction with forced expiration. In infants exposed to maternal smoking, only 4 of 35 (11.4%) responded to a bronchodilator, compared to 51 of 70 (72.9%) in the group with a family history of asthma (p < 0.0005). There was no statistically significant difference in total respiratory system compliance, total respiratory system resistance, tidal volume, and degree of peripheral airflow obstruction at tidal breathing or after forced expiration in both groups. CONCLUSION: Infants with exposure to maternal smoking and infants with a family history of asthma have altered lung function, and a positive response to a bronchodilator is one variable that seems to differentiate the two groups.
Airway Resistance↗
Role strain in couples with and without a child with a chronic illness: associations with marital satisfaction, intimacy, and daily mood.
This study examined marital role strain in 33 couples caring for a child with cystic fibrosis (CF) and 33 couples with a healthy child. The relationship between role strain, marital satisfaction, and psychological distress was tested. Couples completed a structured interview, questionnaires, a card sort procedure, and 4 daily diaries assessing activities and mood. Couples in the CF versus comparison group reported greater role strain on measures of role conflict, child-care tasks, and exchanges of affection. They also spent less time in recreational activities, but no reliable group differences were found in marital satisfaction or depression. Regression analyses indicated that role strain was related to marital satisfaction and depression and that recreation time accounted for additional variance. Path analysis suggested that recreation mediated the negative relationship between role strain and distress. The importance of using a contextual, process-oriented approach is discussed.
Adult↗
Acute eosinophilic pneumonia with respiratory failure: a new syndrome?
Acute, noninfectious, eosinophilic pneumonia with respiratory failure has been described in adults. This new form of eosinophilic lung disease differs from the previously described types of eosinophilic pneumonia. Patients with this entity develop rapid progressive respiratory failure, which seems to respond to corticosteroid therapy. Eosinophilia in lung biopsy specimen, or in bronchoalveolar lavage fluid seems to be a common denominator. We present the first pediatric case of this new, distinct form of eosinophilic lung disease and review the pertinent literature.
Acute Disease↗
Tracheomalacia and bronchopulmonary dysplasia.
Wheezing in the infant with bronchopulmonary dysplasia results from various pathophysiologic mechanisms, including upper or central airway obstruction. We report an infant with bronchopulmonary dysplasia who presented with episodic wheezing associated with hypoxia and bradycardia without evidence of stridor. Bronchoscopy revealed the presence of tracheomalacia. Upper or central airway obstruction, if undiagnosed, may be life-threatening. We suggest that wheezing with hypoxia and bradycardia in neonates should alert the physician to the possibility of tracheomalacia, even in the absence of audible stridor. Infants presenting with these symptoms should undergo bronchoscopy to confirm the diagnosis.
Adult↗
Antidiuretic hormone response in children with bronchopulmonary dysplasia during episodes of acute respiratory distress.
We investigated the antidiuretic hormone (ADH) response in 12 infants with bronchopulmonary dysplasia during acute respiratory distress. All of the infants had hypoxemia with air-trapping in the chest at the time of admission to the hospital. None had documented infection. There was a dramatic increase in the plasma levels of ADH during acute respiratory distress, with a subsequent reduction of levels toward normal when the respiratory distress decreased to the preadmission well state. Three of 12 infants manifested hyponatremia at 24 hours after admission, with two of them exhibiting persistent hypertension for up to three days. The mechanism for elevated ADH levels is air-trapping in the chest, causing pulmonary hypovolemia and decreased left atrial filling and/or decreased transmural pressure of the left atrium.
Bronchopulmonary Dysplasia↗
[General characteristics and dimensional variations of elastomers].
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Chemical Phenomena↗