Can steroids cause asthma to remit?
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Asthma↗
Biomedical subjects
S Pedersen
Publications and source records attributed to S Pedersen.
Videoconferencing in psychiatry: a survey of use in northern Norway.
A survey of the use of videoconferencing in mental health care was carried out in northern Norway. A questionnaire was distributed to all user institutions in northern Norway at the same time that ISDN became available, in mid-1995. The questionnaire completion rate for locations recorded as participants in videoconferencing sessions was 62%. Within six months, a total of 1028 persons had participated in 140 videoconferencing sessions from 35 institutions. The purposes of videoconferencing included meetings (50%), supervision, training and teaching (31%), clinical consultations (14%) and tests or demonstrations (5%). The alternative forms of contact which videoconferencing replaced included travel (59%), no contact (25%), telephone (14%), and mail or fax (2%). No problems were reported in 55% of the sessions; in 19% there were audio problems, in 14% there were picture problems, in 5% attempts to connect failed and in 5% disconnection occurred. The majority of users (87%) reported that they were satisfied or very satisfied with the facility; 8% were uncertain and 5% were less satisfied or totally dissatisfied. Continued surveying will provide longitudinal data on the diffusion of telepsychiatry in northern Norway.
Attitude of Health Personnel↗
Rapid characterization of disease-causing mutations in the low density lipoprotein receptor (LDL-R) gene by overexpression in COS cells.
To characterize disease-causing mutations in the low density lipoprotein receptor (LDL-R) gene, COS cells are transfected with the mutant gene in an EBV-based expression vector and characterized by flow cytometry. Using antibodies against the LDL-receptor the amount of receptor protein on the cell surface is quantitated. The receptor activity is measured by incubating the cells with fluorescence labeled LDL (Dil-labelled LDL) at 37 degrees C and 4 degrees C. The transfected cells stained with anti-LDL-R antibodies can also be analysed by immunofluorescence microscopy allowing the study of the intracellular location of variants of the receptor. To evaluate these methods, we are analyzing four previously well-characterized LDL-R mutations, belonging to each of the classes 2 to 5. Preliminary data show that mutant genes belonging to class 3 and 4A give rise to receptor protein on the cell surface, but impaired LDL uptake, while mutant receptors belonging to class 2A and 5 can only be detected intracellularly. Expression of the class 2A mutation results in an ER staining pattern, whereas the class 5 mutation gives rise to an intracellular staining compatible with localization in the endosomal/lysosomal compartments. We conclude that this system is useful for a rapid functional analysis of newly discovered mutations in the LDL-R gene.
Cell Line↗
A flow cytometric competition technique for measuring interaction of LDL with cellular LDL-receptors applied to patients with mutant (Arg3500-->Gln) apolipoprotein B.
We report our experience with a method to evaluate binding and uptake in cells of low density lipoprotein (LDL) from heterozygous patients with familial defective apolipoprotein B-100 (FDB-LDL) and LDL from normolipidemic subjects (nonFDB-LDL). The method is based on competition for binding/uptake in Epstein-Barr Virus (EBV)-transformed lymphocytes or COS cells overexpressing an LDL-receptor transgene between fluorescently labeled LDL and the unlabeled LDL of interest, and measurements are by flow cytometry. With EBV-lymphoblasts, the ability of FDB-LDL to displace fluorescent LDL ("Dil"-LDL) from cells at 4 degrees C (binding) was reduced to approximately 1/3 of normal. Displacement of "Dil"-LDL by FDB-LDL from cells at 20 degrees C (binding/uptake) was reduced to less than 1/2 of normal. Similar results were obtained with COS cells. Freezing of serum to -80 degrees C for 24 hours did not affect results, and we could discriminate between binding/uptake of FDB-LDL and nonFDB-LDL prepared from serum that had been stored at -80 degrees C for three months.
Adult↗
Safety of treatment.
Data concerning safety of treatment in schoolchildren cannot be extrapolated to preschool children due to differences in growth velocity and metabolism. The safety issue in preschool children is further complicated by insufficient knowledge of the optimal dose, and the lung delivery from the devices available. Systemic activity has often been studied as a marker of adverse clinical effect. However, with improving technology, systemic activity can be detected within the range of the normal biological feedback system, where it is of no clinical importance. Therefore, systemic activity is not synonymous with clinically relevant side-effects. Side-effects should be assessed in specific clinical studies. Effect on growth velocity is a potential side-effect of major interest. Knemometry is a sensitive measure of short-term growth of the lower leg length in schoolchildren as well as in preschool children, which enables precise measurements of systemic activity, but it is not a measure of statural growth. The only clinically relevant outcome measure of human growth is the final height in relation to expected final height, allowing for gender and midparental height differences. In addition to effects on statural height, osteoperosis is an important potential side-effect. The importance of bone density during preschool age for final adult bone mineral density needs to be studied. Cataract formation is a side-effect associated with systemic steroid treatment and may be of special consideration during treatment with nebulized steroids, which may expose the eyes to high doses. Thrush, dysphonia and local skin atrophy in steroid-exposed areas are potential local side-effects, and yet the incidence in young children is unknown and dependent on the device used for delivery. When considering adverse effects of treatment, the risk of side-effects from undertreatment should always be observed.
Age Factors↗
Efficacy and safety of salmeterol in childhood asthma.
UNLABELLED: In children with asthma, twice daily administration of salmeterol 25 micrograms, salmeterol 50 micrograms and salbutamol 200 micrograms were compared in two, 3-month, double-blind, parallel group studies, one using metered dose inhalers (MDIs), the other using dry powder inhalers (Diskhaler, DPIs). Both studies were continued for a further 9 months during which time exacerbation rates, lung function at the clinic and adverse events were monitored. Similarities in design and methodology of the two studies justified a combined analysis. Eight hundred and forty-seven asthmatic children aged between 4 and 16 (mean 10.1) years, requiring inhaled beta 2-agonist treatment were randomised to treatment. After a 2 week run-in when all bronchodilator therapy was withdrawn, 279 patients received salmeterol 25 micrograms bd, 290 patients salmeterol 50 micrograms bd and 278 patients salbutamol 200 micrograms bd. After 3 months' treatment the change from baseline in daily morning and evening peak expiratory flow (PEF) was significantly greater with salmeterol 50 micrograms bd than with salbutamol 200 micrograms bd (P < 0.001). Salmeterol 50 micrograms bd was also significantly better than salmeterol 25 micrograms bd at improving mean morning PEF (P = 0.017) but both treatments had a similar effect on evening PEF. Analysis of variance showed an interaction between baseline PEF less than 100% predicted normal value and treatment outcome. Analysis of this sub-set of patients with lower lung function revealed similar results to the total population although the improvements in PEF from baseline were greater. Data from both studies, showed that the improvement in lung function was maintained throughout 12 months' treatment. Patients receiving salmeterol 50 micrograms bd had significantly more symptom-free nights (P < 0.01) and a higher percentage of rescue bronchodilator-free days (P = 0.01). The incidence of asthma exacerbations was evenly distributed between the three treatment groups and there was no evidence of any change in the rate of occurrence of exacerbations over the 12 month period. Adverse events were no different across treatment groups or across age groups and were primarily related to the patients' disease state. CONCLUSION: Salmeterol 50 micrograms bd is the appropriate dose for the treatment of children with mild to moderate asthma.
Administration, Inhalation↗
Telemedicine protocols and standards: development and implementation.
Telemedicine is likely to adopt rather than create most of its protocols and standards as it becomes an integral part of medical practice. To optimize this process, it will be necessary to understand how to use existing protocols and standards, and influence the development, evaluation, and modification of new ones. We have identified key participants in standards setting activities under the titles of international government, United States government, professional certifying organizations, and independent institutes. We have reviewed their roles in establishing standards for identification of patients and providers, content and structure of patient records, terminology and codes of medical information and records, and transfer of messages and data. We have addressed requirements for storing and viewing images, the impact of image resolution on accuracy of clinical interpretation, the choice of communications protocols to satisfy transmission requirements, the need to link images and text data, and the evaluation of telemedicine systems.
Computer Communication Networks↗
Common clonal chromosome aberrations in cytokine-dependent continuous human T-lymphocyte cell lines.
Antigen-mediated T-cell proliferation is a transient phenomenon. Like other somatic cells, T lymphocytes generally show replicative senescence in vitro. However, we here show that cytokine-dependent continuous (immortal) T-cell lines can be established from skin biopsy specimens of inflammatory skin diseases. Continuous growth can be obtained by culturing T cells in medium supplemented with interleukin-2 and interleukin-4, but without antigen or antigen-presenting cells added. Loss of the T-cell antigen receptor complex is observed in some of the continuous T-cell lines. Most T-cell lines develop clonal chromosome aberrations during continuous growth. Aberrations for chromosomes 1, 2, 8, 16, and 18 are most commonly observed.
Cell Division↗
Measures of systemic activity of inhaled glucocorticosteroids in children: a comparison of urine cortisol excretion and knemometry.
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Administration, Inhalation↗
Budesonide treatment of moderate and severe asthma in children: a dose-response study.
OBJECTIVE: The purpose of the study was to evaluate the dose-response relationships of the inhaled corticosteroid budesonide in a double blind crossover study in 19 children with moderate and severe asthma. METHODS: A 2-week placebo treatment period (run-in) was followed by three 4-week treatment periods during which 100, 200, and 400 micrograms of budesonide were given per day in randomized order. Urinary cortisol excretion, lung functions, and protection against exercise-induced asthma were assessed at the end of run-in and each treatment period. Furthermore, morning and evening peak expiratory flow rates, day and night symptoms, and use of rescue beta 2-agonists were recorded throughout the study. RESULTS: One hundred micrograms of budesonide per day markedly improved symptoms, morning and evening peak expiratory flow rates, and use of rescue beta 2-agonists (p < 0.01). No further improvement was seen in these parameters with increasing doses of budesonide. In contrast, a significant dose-response effect was found on lung functions measured at the hospital and fall in lung functions after exercise (p < 0.001); 200 micrograms was significantly better than 100 micrograms, and 400 micrograms was significantly better than 200 micrograms. About 53% of the maximum effect against exercise-induced asthma was achieved by the lowest budesonide dose (p < 0.001), and about 83% by the highest dose. No significant differences were seen in urinary cortisol excretion between run-in and the various budesonide doses. CONCLUSIONS: Low doses of budesonide, which are not associated with any systemic side effects, have a marked antiasthma effect in children. Protection against exercise-induced asthma requires higher doses than achievement of symptom control.
Adolescent↗
Tele-endoscopic otorhinolaryngological examination: preliminary study of patient satisfaction.
OBJECTIVE: Modern telecommunications and computer technologies enable the delivery of expert consultations and remote diagnoses that previously required transportation of patients or medical specialists. The purpose of this study was to determine whether patients are satisfied with one form of telemedicine consultation. METHODS: A general practitioner was trained to perform endoscopic otorhinolaryngological examinations. After the training period, he examined patients at a local health center in Alta, 250 km from Tromsø. Images from the endoscopic examination were transmitted to the otorhinolaryngologist at the University Hospital of Tromsø for real-time consultation. Twenty-six patients, on a randomly selected day, were asked to complete a questionnaire after the tele-endoscopic examination. The questionnaire was returned anonymously by 24 of the patients. RESULTS: Although patients interacted with the specialist only via videoconferencing, the results show that most (23/24) were satisfied with this type of consultation, and they reported more advantages than disadvantages. Twenty-one patients indicated that they would accept another tele-endoscopic consultation if they required examination by an otorhinolaryngologist in the future. CONCLUSION: Although the sample is limited, the results justify continued investigation of this and other types of telemedicine consultations.
Adult↗
Influence of budesonide on the response to inhaled terbutaline in children with mild asthma.
The aim of this study was to evaluate if continuous treatment with budesonide or salmeterol influences the bronchodilator response to terbutaline in children with asthma; 23 children, aged 7 to 16 years (mean = 11 years), with mild asthma were treated with inhaled budesonide 100 micrograms b.i.d. and placebo for three weeks in a randomized, double blind crossover study. These treatments were followed by treatment with inhaled salmeterol 50 micrograms b.i.d. for 3 weeks. On the last day of each period a cumulative dose-response experiment with terbutaline in the doses 50, 100, 250 and 500 micrograms (cumulative dose 900 micrograms) was performed. Lung function was measured before and 20 min after each terbutaline inhalation. Baseline pulmonary functions after budesonide treatment were significantly higher than the baseline measured after the two other treatments (p < 0.05). After budesonide treatment, the dose-response curve was shifted vertically upwards but otherwise parallel to the dose-response curve after placebo. The increase from baseline after the first cumulative dose of terbutaline was significantly lower after salmeterol treatment than after the two other treatments (p < 0.01). Maximal lung functions after 900 micrograms terbutaline also differed significantly between the three dose-response days; budesonide being significantly higher and salmeterol significantly lower than placebo (p = 0.02 and p < 0.001, respectively). It is concluded that budesonide treatment does not enhance the brochodilator response to terbutaline. Further studies are needed to assess if long-term continuous salmeterol treatment reduces the response to terbutaline.
Administration, Inhalation↗
The insulin-like growth factor axis and collagen turnover in asthmatic children treated with inhaled budesonide.
Serum concentrations of growth hormone-dependent insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3), the carboxy terminal propeptide of type I procollagen (PICP), the carboxy terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and the amino terminal propeptide of type III procollagen (PIIINP) were studied in 14 prepubertal children with asthma (mean age 9.7 years) during treatment with inhaled budesonide. The study design was a randomized, crossover trial with two double-blind treatment periods (200 and 800 micrograms) and one open, non-randomized treatment period (400 micrograms). All periods were 18 days' duration. Budesonide treatment was associated with a dose-related suppressive trend in serum concentrations of PIIINP when the 400 micrograms period was included (p < 0.01; z = -2.7) and when it was excluded from the calculations (p < 0.01; z = -2.6), indicating reduced synthesis of type III collagen. A similar trend was observed in ICTP levels when the 400 micrograms period was excluded from the calculations (p = 0.05; z = -1.9). No other statistically significant variations were seen.
Administration, Inhalation↗
The cmk gene encoding cytidine monophosphate kinase is located in the rpsA operon and is required for normal replication rate in Escherichia coli.
A gene encoding a polypeptide of 25 kDa is located immediately upstream of the gene for ribosomal protein S1, rpsA. In high gene copy number, this gene, mssA, was previously found to suppress defects in smbA, which is now known to be identical to pyrH, encoding UMP kinase. We show here that the 25-kDa polypeptide comprises CMP kinase and propose that the gene be designated cmk. In a strain deleted for cmk, the pools of CMP and dCMP were elevated approximately 30-fold. We constructed a plasmid from which synthesis of CMP kinase was regulated by the lac promoter-operator and measured the synthesis rates for RNA and DNA after induction in the delta cmk/lacPO-cmk+ strain. A specific increase in the rate of DNA synthesis was observed. Further analyses showed that the replication elongation rate was halved in the delta cmk strain, most likely caused by the reductions of the dCTP and dTTP pools to 30 and 70%, respectively, of the levels in the parental strain, but that this was compensated for by a doubling in the frequency of initiation. The delta cmk strain is viable at 37 degrees C but cold sensitive. The cold sensitivity may be related to defects in the synthesis of phospholipids or lipopolysaccharides. In addition to the physiological studies, the region upstream of cmk was sequenced, and 120 codons with strong homology to an uncharacterized protein of the speB operon were identified.
Base Sequence↗
Symptoms of the musculoskeletal system and exposure to magnetic fields in an aluminium plant.
OBJECTIVE: The study was performed to examine the influence of the exposure to magnetic fields in the potrooms of an electrolysis plant on the occurrence of musculoskeletal symptoms among the employees. The study was performed after much discussion and worry in the aluminium industry about this issue. METHODS: A retrospective cohort study was performed at an aluminium plant. The occurrence of musculoskeletal symptoms registered at health controls performed by the occupational health care unit in 1986 and 1991 was assessed from employees exposed to magnetic fields in the potrooms (n = 342) and from a control group (n = 277). The data were collected before the discussion about the effects of magnetic fields started. The exposure to static magnetic fields was found to be 3-20 mT inside the potrooms. Ripple components (alternating currents (AC fields)) were registered as well. RESULTS: No difference between the exposed and unexposed groups was found for the reported musculoskeletal symptoms in 1986 or in 1991. CONCLUSIONS: There seems to be no relation between work in potrooms with exposure to static magnetic fields and the occurrence of musculoskeletal symptoms.
Adult↗
[Pseudocroup treated with inhaled steroid (budesonide). A double-blind placebo-controlled trial].
The aim of this prospective, randomised, double blind study was to evaluate whether inhaled nebulized corticosteroid is effective in the treatment of croup. Thirty-seven children (aged 0.4-4.9 years) admitted to hospital with moderate to severe croup were allocated to treatment with either 2 mg nebulized budesonide (20) or saline (17). Disease severity was assessed by a clinical croup score based on stridor, cough, retractions, dyspnoea and cyanosis, and the overall clinical assessment was scored on a visual log scale (0-100). Two hours after treatment there was a significant improvement in croup score in the group treated with budesonide (8 to 4.5), but not in the group treated with saline (8 to 8). Furthermore, the overall clinical assessment score decreased significantly (50 to 25) in the group treated with budesonide, whereas it remained constant in the placebo group (60 to 62). The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe croup.
Administration, Inhalation↗
[Telemedicine--a review].
Modern telecommunication technology enables medical information and images to be transmitted from the general practitioner to a hospital or between hospitals. This allows the specialist to interactively conduct and control the examination carried out by the GP via the two way sound and picture connection within radiology, pathology, dermatology, psychiatry, cardiology and otorhinolaryngology. The diagnostic quality of the technique is equal to that of an ordinary examination. The method gives the patients access to adequate medical expertise in their home environment, is highly effective and saves cost of transport. The patients are satisfied with being able to meet the experts this way.
Norway↗
[Clinical research, teaching and quality assurance in an electronic network].
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Computer Communication Networks↗