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Sample records for acute severe asthma

  1. Spontaneous pnemomedastinum in acute severe asthma

    Directory of Open Access Journals (Sweden)

    Aleemuddin N

    2010-01-01

    Full Text Available Spontaneous medastinal emphysema, as a complication of acute severe asthma, is an uncommon entity. It usually runs a benign course and resolves spontaneously without any surgical intervention. Recognition of this complication is critical, as it has to be differentiated from other life threatening ones including oesophageal rupture, Boerhave′s syndrome, acute coronary syndrome and pulmonary embolism. This case is being presented to emphasize its recognition in the differential diagnosis of complications arising from acute severe asthma and to present its management strategy in detail.

  2. Chapter 14: Acute severe asthma (status asthmaticus).

    Science.gov (United States)

    Shah, Rachna; Saltoun, Carol A

    2012-01-01

    Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy such as inhaled albuterol, levalbuterol, or subcutaneous epinephrine. It is a medical emergency that requires immediate recognition and treatment. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6-12 hours. Approximately 50% of episodes are attributable to upper respiratory infections, and other causes include medical nonadherence, nonsteroidal anti-inflammatory exposure in aspirin-allergic patients, allergen exposure (especially pets) in severely atopic individuals, irritant inhalation (smoke, paint, etc.), exercise, and insufficient use of inhaled or oral corticosteroids. The patient history should be focused on acute severe asthma including current use of oral or inhaled corticosteroids, number of hospitalizations, emergency room visits, intensive-care unit admissions and intubations, the frequency of albuterol use, the presence of nighttime symptoms, exercise intolerance, current medications or illicit drug use, exposure to allergens, and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, pulsus paradoxus, refusal to recline below 30°, a pulse >120 beats/min, and decreased breath sounds. Physicians' subjective assessments of airway obstruction are often inaccurate. More objective measures of airway obstruction via peak flow (or forced expiratory volume in 1 second) and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values >90% are less commonly associated with problems although CO(2) retention and a low Pao(2) may be missed. PMID:22794687

  3. Emergency presentation and management of acute severe asthma in children

    OpenAIRE

    Øymar Knut; Halvorsen Thomas

    2009-01-01

    Abstract Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronc...

  4. Assisted ventilation in severe acute asthma.

    OpenAIRE

    Higgins, B; Greening, A P; Crompton, G K

    1986-01-01

    During the period 1973-85 assisted ventilation was used for the treatment of severe asthma on 48 occasions in 18 patients (one patient was ventilated 29 times). On each occasion arterial blood gas abnormalities were restored to normal as quickly as possible irrespective of peak inflation pressures. One patient was thought to be brain dead on transfer from another hospital but was ventilated for 48 hours while this diagnosis was confirmed. There was one episode of mediastinal emphysema. There ...

  5. Emergency presentation and management of acute severe asthma in children

    Directory of Open Access Journals (Sweden)

    Øymar Knut

    2009-09-01

    Full Text Available Abstract Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronchodilators may include selective b2-agonists, adrenaline and anticholinergics. Additional treatment in selected cases may involve intravenous administration of theophylline, b2-agonists and magnesium sulphate. Both non-invasive and invasive ventilation may be options when medical treatment fails to prevent respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.

  6. Randomised controlled trial of aminophylline for severe acute asthma

    OpenAIRE

    Yung, M; South, M

    1998-01-01

    OBJECTIVES—To determine whether children with severe acute asthma treated with large doses of inhaled salbutamol, inhaled ipratropium, and intravenous steroids are conferred any further benefits by the addition of aminophylline given intravenously.
STUDY DESIGN—Randomised, double blind, placebo controlled trial of 163 children admitted to hospital with asthma who were unresponsive to nebulised salbutamol.
RESULTS—The placebo and treatment groups of children were similar at b...

  7. Methylprednisolone pulse therapy in severe acute asthma.

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    Pedersen, B K; Laursen, L C; Lervang, H H; Stjernebjerg, T; Weeke, B

    1987-02-01

    In a group comparative double blind pilot study six asthmatic patients with an acute exacerbation of their disease were randomly treated with either methylprednisolone pulse therapy (MPPT) (1000 mg daily for 3 days) (n = 2) followed by placebo tablets, or standard doses of methylprednisolone (MP) (50 mg daily gradually decreased to zero over 3 weeks) (n = 4). The results showed that the effect of MPPT did not differ from that of standard doses of MP. MPPT has, however, the potential of being preferable to standard treatment with MP, because of easy administration and optimal patient compliance. PMID:3296841

  8. Pathophysiological analysis of hypoxaemia during acute severe asthma.

    OpenAIRE

    Hori, T.

    1985-01-01

    Blood gas measurements obtained during 35 episodes of acute, severe asthma in 19 children were analysed. Arterial carbon dioxide tension (PaCO2) was mean (SD) 5.7 (1.2) kPa and the arterial oxygen tension (PaO2) was 7.7 (1.1)kPa. Hypoxaemia was severe (PaO2 less than or equal to 7.9 kPa) on 19 occasions, was present alone (type I) on eight of these, and was associated with hypercapnia (type II) on 11. The PaO2 was similar in both the type I and type II subgroups, but PaCO2 was significantly h...

  9. Acute severe asthma: new approaches to assessment and treatment.

    Science.gov (United States)

    Papiris, Spyros A; Manali, Effrosyni D; Kolilekas, Likurgos; Triantafillidou, Christina; Tsangaris, Iraklis

    2009-01-01

    The precise definition of a severe asthmatic exacerbation is an issue that presents difficulties. The term 'status asthmaticus' relates severity to outcome and has been used to define a severe asthmatic exacerbation that does not respond to and/or perilously delays the repetitive or continuous administration of short-acting inhaled beta(2)-adrenergic receptor agonists (SABA) in the emergency setting. However, a number of limitations exist concerning the quantification of unresponsiveness. Therefore, the term 'acute severe asthma' is widely used, relating severity mostly to a combination of the presenting signs and symptoms and the severity of the cardiorespiratory abnormalities observed, although it is well known that presentation does not foretell outcome. In an acute severe asthma episode, close observation plus aggressive administration of bronchodilators (SABAs plus ipratropium bromide via a nebulizer driven by oxygen) and oral or intravenous corticosteroids are necessary to arrest the progression to severe hypercapnic respiratory failure leading to a decrease in consciousness that requires intensive care unit (ICU) admission and, eventually, ventilatory support. Adjunctive therapies (intravenous magnesium sulfate and/or others) should be considered in order to avoid intubation. Management after admission to the hospital ward because of an incomplete response is similar. The decision to intubate is essentially based on clinical judgement. Although cardiac or respiratory arrest represents an absolute indication for intubation, the usual picture is that of a conscious patient struggling to breathe. Factors associated with the increased likelihood of intubation include exhaustion and fatigue despite maximal therapy, deteriorating mental status, refractory hypoxaemia, increasing hypercapnia, haemodynamic instability and impending coma or apnoea. To intubate, sedation is indicated in order to improve comfort, safety and patient-ventilator synchrony, while at the

  10. [Severe asthma].

    Science.gov (United States)

    González, Claudio D

    2016-01-01

    The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients' characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended.

  11. Methylprednisolone pulse therapy in acute severe asthma. A randomized, double-blind study.

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    Engel, T; Dirksen, A; Frølund, L; Heinig, J H; Svendsen, U G; Pedersen, B K; Weeke, B

    1990-04-01

    Methylprednisolone pulse therapy (MPPT) has been shown to possess a long-lasting effect in other immune-inflammatory diseases without the well-known side effects caused by long-term treatment with glucocorticosteroids. In an attempt to reduce the long-term use of oral steroids in asthmatics, we conducted this double-blind, double-dummy study to compare the use of MPPT (1 g of methylprednisolone intravenously) (8 patients) with a short course of oral prednisolone (10 patients) in asthmatics presenting with acute severe asthma. Both treatments were effective in relieving the acute attack of asthma. The MPPT-treated patients did not show a faster resolution than did the orally treated group. No patients needed assisted ventilation, and no deaths occurred. One week after the treatment FEV1 tended to decrease in the methylprednisolone group compared with the oral prednisolone group (P = 0.06). The patients initially receiving MPPT needed supplementary prednisolone earlier and in higher doses than did the patients receiving oral prednisolone as initial treatment. At the end of the 12 weeks' study period, the groups reached identical FEV1. In conclusion, we did not find intravenous methylprednisolone superior to oral prednisolone in the treatment of acute attacks of severe asthma, but methylprednisolone pulse therapy had a shorter duration as regards protection against future asthma attacks. PMID:2183645

  12. Ventilation-perfusion mismatching in acute severe asthma: effects of salbutamol and 100% oxygen.

    OpenAIRE

    Ballester, E.; Reyes, A.; Roca, J; R Guitart; Wagner, P D; Rodriguez-Roisin, R.

    1989-01-01

    Ventilation-perfusion (VA/Q) relationships and gas exchange were studied by the multiple inert gas technique in 19 patients admitted to hospital with acute severe asthma (FEV1 41% predicted) before and during the administration of intravenous salbutamol, inhaled salbutamol, or 100% oxygen. Eight patients received a continuous intravenous infusion of salbutamol (4 micrograms/min, total dose 360 micrograms) and were studied before treatment, after 60 and 90 minutes of treatment, and one hour af...

  13. Acute bronchial asthma.

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    Grover, Sudhanshu; Jindal, Atul; Bansal, Arun; Singhi, Sunit C

    2011-11-01

    Acute asthma is the third commonest cause of pediatric emergency visits at PGIMER. Typically, it presents with acute onset respiratory distress and wheeze in a patient with past or family history of similar episodes. The severity of the acute episode of asthma is judged clinically and categorized as mild, moderate and severe. The initial therapy consists of oxygen, inhaled beta-2 agonists (salbutamol or terbutaline), inhaled budesonide (three doses over 1 h, at 20 min interval) in all and ipratropium bromide and systemic steroids (hydrocortisone or methylprednisolone) in acute severe asthma. Other causes of acute onset wheeze and breathing difficulty such as pneumonia, foreign body, cardiac failure etc. should be ruled out with help of chest radiography and appropriate laboratory investigations in first time wheezers and those not responding to 1 h of inhaled therapy. In case of inadequate response or worsening, intravenous infusion of magnesium sulphate, terbutaline or aminophylline may be used. Magnesium sulphate is the safest and most effective alternative among these. Severe cases may need ICU care and rarely, ventilatory support. PMID:21769523

  14. Antifungals in severe asthma

    NARCIS (Netherlands)

    Parulekar, Amit D.; Diamant, Zuzana; Hanania, Nicola A.

    2015-01-01

    Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes

  15. Intravenous magnesium for acute asthma?

    Science.gov (United States)

    2003-10-01

    Each year in the UK, around 1,500 people die from asthma. Standard treatment has been based on bronchodilators (e.g. beta 2-stimulants) and anti-inflammatory drugs (corticosteroids). The recently revised British Guideline on the Management of Asthma suggests also using a single dose of i.v. magnesium sulphate in patients with acute severe asthma, an unlicensed indication. Here we discuss the rationale for giving i.v. magnesium and whether it offers any advantage for patients with acute severe asthma.

  16. Biomarkers in Severe Asthma.

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    Wan, Xiao Chloe; Woodruff, Prescott G

    2016-08-01

    Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma. PMID:27401625

  17. Procalcitonin guidance for reduction of antibiotic use in patients hospitalized with severe acute exacerbations of asthma: a randomized controlled study with 12-month follow-up

    OpenAIRE

    Long, Wei; Li, Li-juan; Huang, Gao-zhong; Zhang, Xue-Min; Zhang, Yi-cui; Tang, Jian-Guo; Zhang, Yu; Lu, Gang

    2014-01-01

    Introduction Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. We aimed to determine whether serum procalcitonin (PCT) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma. Methods In this randomized controlled trial, a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month foll...

  18. Pharmacotherapy of severe asthma

    OpenAIRE

    Firszt, Rafael; Kraft, Monica

    2010-01-01

    Severe asthma is a complex and heterogeneous phenotype where management can be challenging. While many patients with severe asthma respond to high-dose inhaled corticosteroids in combination with a long-acting β-agonist, there remains a significant subset of patients that require oral corticosteroids to control symptoms. Alternative therapies are needed to help reduce the need for continuous oral corticosteroids; however, there are currently very few effective options. Several new alternative...

  19. Mechanical ventilation for severe asthma.

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    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. PMID:26033128

  20. A Randomized Controlled Trial of Intravenous Magnesium Sulphate as an Adjunct to Standard Therapy in Acute Severe Asthma

    Directory of Open Access Journals (Sweden)

    Singh Anupam Kumar

    2008-12-01

    Full Text Available Though intravenous (IV Magnesium Sulphate (MgS04 has additive effect to beta-2 agonists, its additive benefit in face of combination therapy with beta-2-agonists and ipratropium (standard therapy of severe acute exacerbation of asthma remains unaddressed. The aim of this investigation was to evaluate the role of IV MgSO4 when used as an adjunct to standard therapy of severe exacerbations of asthma. Randomized, single blinded, placebo-controlled study was carried out in Emergency Department (ED. Patients aged 18-60 years presenting with acute asthma and FEV1 In group1 (controls, patients were nebulised with salbutamol and ipratropium thrice at 20 minutes interval and were given 2g IV MgSO4 at 30 minutes. In group2 patients were nebulised similarly, but were given IV normal saline at 30 minutes for blinding. FEV1 was evaluated at baseline and at 30 minutes intervals. The primary efficacy end point was FEV1%pred. at 120 mins and pooled discharge rate (derived from comparing proportion of groups attaining PEFR >60%pred. and relief in dyspnea at 30, 60, 90, 120 minutes. Both groups of 30 patients each, were matched with respect to demographic and pulmonary parameters (Baseline FEV1% :22.0+5.1% in group2 vs.22.07+5.2% in group1, p=0.87.At 120 minutes, there was a higher mean FEV1 %pred (62.84+4.73% vs. 56.7+4.5% and %improvement from baseline of (40.7+9.2%vs34.77+7.3%, in group 2 as compared to group1 (Mean Difference= 6.07%, C.I.1.87-10.62., pMagnesium sulfate as an adjunct to standard therapy in patients with severe exacerbation of asthma could cause improvement in pulmonary function and decrease in hospital admission.

  1. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

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    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  2. Low Magnesium Concentration in Erythrocytes of Children with Acute Asthma

    Directory of Open Access Journals (Sweden)

    Mostafa Sedighi

    2006-12-01

    These results indicate that intracellular Mg level may be a more accurate method to assess Mg level in patients with asthma. Hence, determination of Mg concentration in erythrocytes may be used in evaluation of asthma pathophysiology. There are recommendations for using intravenous Mg sulfate in acute asthma, and this study supports the rational for using it in emergency departments for acute severe asthma.

  3. Traditional Therapies for Severe Asthma.

    Science.gov (United States)

    Wang, Eileen; Hoyte, Flavia C L

    2016-08-01

    Severe asthma is a complex and heterogeneous disease. The European Respiratory Society and American Thoracic Society guidelines define severe asthma for patients 6 years or older as "asthma which requires treatment with high-dose inhaled corticosteroids…plus a second controller or systemic corticosteroids to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy." This article reviews available traditional therapies, data behind their uses in severe asthma, and varying recommendations. As various asthma endotypes and phenotypes are better understood and characterized, targeted therapies should help improve disease outcomes, efficacy, and cost-effectiveness. PMID:27401628

  4. Circulating catecholamines in acute asthma.

    OpenAIRE

    Ind, P. W.; Causon, R C; Brown, M. J.; Barnes, P. J.

    1985-01-01

    Plasma catecholamine concentrations were measured in 15 patients (six male) aged 14-63 years attending the casualty department with acute severe asthma (peak expiratory flow 27% (SEM 3%) of predicted). Nine patients were admitted and six were not. The plasma noradrenaline concentration, reflecting sympathetic nervous discharge, was two to three times normal in all patients and was significantly higher in those who required admission compared with those discharged home (mean 7.7 (SEM 0.6) v 4....

  5. Acute bronchial asthma

    Directory of Open Access Journals (Sweden)

    Susanna Ramuscello

    2007-04-01

    Full Text Available Asthma is one of the main causes of morbidity worldwide. It affects some 300 million individuals and has risen over the past 20 years, especially in the paediatric population. Asthma is a chronic inflammation of the airways, subject to periodic exacerbations, characterised by coughing and progressive dyspnoea. Clinical conditions may vary greatly, ranging from moderate exacerbation with an increase in nocturnal awakening and a less than 20% reduction in the flow peak, through to severe respiratory insufficiency that requires immediate intubation of the airways. Pharmacological treatment envisages a step approach that aims to obtain and maintain control over the symptoms, taking into consideration the effectiveness of the treatment available, potential side effects and cost. β2-agonists and corticosteroids are the drugs of election for both maintenance therapy and for treating exacerbations. Other therapeutic devices may prove useful in particular cases. One fundamental key point in treatment over time is the cooperation between patient and attending doctor. The latest review of the Global Initiative for Asthma (GINA guidelines was published in 2006.

  6. The management of acute asthma.

    Science.gov (United States)

    Cross, S

    1997-04-01

    Health professionals likely to come into contact with people experiencing an acute episode of asthma, such as school nurses, ambulance personnel and A&E staff, need clear guidelines on management. The British Thoracic Society guidelines, revised this year, advise on the categorisation of asthma, assessment and treatment.

  7. Asthma Is More Severe in Older Adults

    OpenAIRE

    Zein, Joe G.; Dweik, Raed A.; Comhair, Suzy A.; Bleecker, Eugene R.; Moore, Wendy C.; Peters, Stephen P.; Busse, William W.; Jarjour, Nizar N.; Calhoun, William J.; Castro, Mario; Chung, K. Fan; Fitzpatrick, Anne; Israel, Elliot; Teague, W. Gerald; Sally E. Wenzel

    2015-01-01

    Background: Severe asthma occurs more often in older adult patients. We hypothesized that the greater risk for severe asthma in older individuals is due to aging, and is independent of asthma duration. Methods: This is a cross-sectional study of prospectively collected data from adult participants (N=1130; 454 with severe asthma) enrolled from 2002 – 2011 in the Severe Asthma Research Program. Results: The association between age and the probability of severe asthma, which was performed by ap...

  8. Chronic Infection and Severe Asthma.

    Science.gov (United States)

    Carr, Tara F; Kraft, Monica

    2016-08-01

    Chronic bacterial infection is implicated in both the development and severity of asthma. The atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae have been identified in the airways of asthmatics and correlated with clinical features such as adult onset, exacerbation risks, steroid sensitivity, and symptom control. Asthmatic patients with evidence of bacterial infection may benefit from antibiotic treatment directed towards these atypical organisms. Examination of the airway microbiome may identify microbial communities that confer risk for or protection from severe asthma. PMID:27401621

  9. Therapeutic options for severe asthma

    OpenAIRE

    Mathew, Jilcy; Aronow, Wilbert S.; Chandy, Dipak

    2012-01-01

    As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidit...

  10. Eosinophilic bioactivities in severe asthma.

    Science.gov (United States)

    Carr, Tara F; Berdnikovs, Sergejs; Simon, Hans-Uwe; Bochner, Bruce S; Rosenwasser, Lanny J

    2016-01-01

    Asthma is clearly related to airway or blood eosinophilia, and asthmatics with significant eosinophilia are at higher risk for more severe disease. Eosinophils actively contribute to innate and adaptive immune responses and inflammatory cascades through the production and release of diverse chemokines, cytokines, lipid mediators and other growth factors. Eosinophils may persist in the blood and airways despite guidelines-based treatment. This review details eosinophil effector mechanisms, surface markers, and clinical outcomes associated with eosinophilia and asthma severity. There is interest in the potential of eosinophils or their products to predict treatment response with biotherapeutics and their usefulness as biomarkers. This is important as monoclonal antibodies are targeting cytokines and eosinophils in different lung environments for treating severe asthma. Identifying disease state-specific eosinophil biomarkers would help to refine these strategies and choose likely responders to biotherapeutics. PMID:27386041

  11. Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.

    Science.gov (United States)

    Pearson, M G; Ryland, I; Harrison, B D

    1996-10-01

    This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.

  12. Emerging Biologics in Severe Asthma.

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    Pavord, Ian D; Hilvering, Bart; Shrimanker, Rahul

    2016-08-01

    Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by persistently elevated sputum and/or blood eosinophils and by a significant response to treatments that suppress eosinophilia. Eosinophil activity in the airway may be more important than their numbers and this needs to be investigated. Transcriplomic or Metabolomic signatures may also be useful to identify this endotype. PMID:27401629

  13. ACUTE LIFE-THREATENING ASTHMA IN ASIR CENTRAL HOSPITAL

    OpenAIRE

    Al-Ghamdi, Badr R.; Taklu, Bayu G.

    1997-01-01

    Aim: This study was conducted to analyze the severe acute asthma admissions in Asir Central Hospital (ACH) in Abha, Saudi Arabia. In particular, it aimed to identify risk factors and final outcome of acute life-threatening asthma. Method: All patients admitted to the Intensive Care Unit (ICU) with acute bronchial asthma from June 1989 to May 1995 were analyzed. Total admis-sions to the ICU were obtained to determine the prevalence of asthma admission to the ICU. Results: There were 13 admissi...

  14. [Severe asthma--where are we today?].

    Science.gov (United States)

    von Bülow, Anna; Backer, Vibeke; Porsbjerg, Celeste

    2014-01-13

    Severe asthma is defined by persistent symptoms and frequent exacerbations despite intensive asthma therapy. The prevalence is estimated to be 5-10% of all asthmatics. Severe asthma is responsible for a major burden of illness including low quality of life and a disproportionate use of health-care resources. The clinical assessment of severe asthma must include verification of the correct diagnosis, adherence to medication, excluding differential diagnosis and identification and treatment of aggravating co-morbidities and trigger factors.

  15. Epidemiology and Pulmonary Physiology of Severe Asthma.

    Science.gov (United States)

    O'Toole, Jacqueline; Mikulic, Lucas; Kaminsky, David A

    2016-08-01

    The epidemiology and physiology of severe asthma are inherently linked because of varying phenotypes and expressions of asthma throughout the population. To understand how to better treat severe asthma, we must use both population data and physiologic principles to individualize therapies among groups with similar expressions of this disease. PMID:27401616

  16. Linkage and Genetic Association in Severe Asthma.

    Science.gov (United States)

    Jones, Bridgette L; Rosenwasser, Lanny J

    2016-08-01

    A significant body of work in the genetics of asthma currently exists. However, current knowledge has not been clarifying in understanding the pathophysiology of asthma and therapeutic treatment of the disease. Severe asthma in adults and children is a significant burden in relation to disproportionate disease morbidity, mortality, and health utilization. This disease phenotype is not well understood; current effective treatment regimens are limited. Genetic studies may lead to improved understanding of the pathophysiology of severe asthma and identification of relevant subsets, which allow more targeted and effective therapies and the realization of Precision Medicine in asthma. PMID:27401617

  17. Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

    Directory of Open Access Journals (Sweden)

    Arvind Rajamani

    2011-01-01

    Full Text Available Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity. One of the least understood prognosticators is generalised status myoclonus (GSM, with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]. With several prognostic indicators (including status myoclonus having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.

  18. Assessment of problematic severe asthma in children

    DEFF Research Database (Denmark)

    Carlsen, K. C. L.; Hedlin, G.; Bush, A.;

    2011-01-01

    Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi...... in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small...

  19. Asthma in Primary Care : Severity, Treatment and Level of Control

    OpenAIRE

    Ställberg, Björn

    2008-01-01

    Aims. The overall aim was to examine the severity, treatment and level of control in patients with asthma in primary care in Sweden. The specific aims were to assess what matters to asthma patients, evaluate symptoms, medication and identify factors related to asthma severity, compare the extent of asthma control in 2001 and 2005, and investigate the development of asthma and degree of asthma control in adolescents and young adults who had reported asthma six years earlier. Methods. The first...

  20. Psychosocial Factors in Severe Pediatric Asthma.

    Science.gov (United States)

    Booster, Genery D; Oland, Alyssa A; Bender, Bruce G

    2016-08-01

    Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions. PMID:27401618

  1. Psychosocial Factors in Severe Pediatric Asthma.

    Science.gov (United States)

    Booster, Genery D; Oland, Alyssa A; Bender, Bruce G

    2016-08-01

    Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.

  2. Asthma severity is associated with body mass index and early menarche in women. : Body mass index and asthma severity

    OpenAIRE

    Varraso, Raphaëlle; Siroux, Valérie; Maccario, Jean; Pin, Isabelle; Kauffmann, Francine

    2005-01-01

    International audience; Asthma severity in relation to body mass index (BMI) has rarely been studied. The relation between BMI and asthma severity was studied by sex in 366 adults with asthma from the Epidemiological Study on the Genetics and Environment of Asthma, a case-control and family study on asthma. Factors related to asthma severity and BMI such as smoking, FEV(1), bronchial hyperresponsiveness, and dyspnea were taken into account. The influence of early menarche was studied to asses...

  3. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

    OpenAIRE

    Matsunaga, Natasha Yumi; Ribeiro, Maria Angela Gonçalves de Oliveira; Saad, Ivete Alonso Bredda; Morcillo, André Moreno; Ribeiro, José Dirceu; Toro, Adyléia Aparecida Dalbo Contrera

    2015-01-01

    ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global In...

  4. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

    OpenAIRE

    Natasha Yumi Matsunaga; Maria Angela Gonçalves de Oliveira Ribeiro; Ivete Alonso Bredda Saad; André Moreno Morcillo; José Dirceu Ribeiro; Adyléia Aparecida Dalbo Contrera Toro

    2015-01-01

    ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Globa...

  5. Severe asthma and the omalizumab option

    Directory of Open Access Journals (Sweden)

    Johnston Chambless

    2008-05-01

    Full Text Available Abstract Atopic diseases and asthma are increasing at a remarkable rate on a global scale. It is now well recognized that asthma is a chronic inflammatory disease of the airways. The inflammatory process in many patients is driven by an immunoglobulin E (IgE-dependent process. Mast cell activation and release of mediators, in response to allergen and IgE, results in a cascade response, culminating in B lymphocyte, T lymphocyte, eosinophil, fibroblast, smooth muscle cell and endothelial activation. This complex cellular interaction, release of cytokines, chemokines and growth factors and inflammatory remodeling of the airways leads to chronic asthma. A subset of patients develops severe airway disease which can be extremely morbid and even fatal. While many treatments are available for asthma, it is still a chronic and incurable disease, characterized by exacerbation, hospitalizations and associated adverse effects of medications. Omalizumab is a new option for chronic asthma that acts by binding to and inhibiting the effects of IgE, thereby interfering with one aspect of the asthma cascade reviewed earlier. This is a humanized monoclonal antibody against IgE that has been shown to have many beneficial effects in asthma. Use of omalizumab may be influenced by the cost of the medication and some reported adverse effects including the rare possibility of anaphylaxis. When used in selected cases and carefully, omalizumab provides a very important tool in disease management. It has been shown to have additional effects in urticaria, angioedema, latex allergy and food allergy, but the data is limited and the indications far from clear. In addition to decreasing exacerbations, it has a steroid sparing role and hence may decrease adverse effects in some patients on high-dose glucocorticoids. Studies have shown improvement in quality of life measures in asthma following the administration of omalizumab, but the effects on pulmonary function are

  6. Benralizumab: a unique IL-5 inhibitor for severe asthma

    Directory of Open Access Journals (Sweden)

    Tan LD

    2016-04-01

    Full Text Available Laren D Tan,1 Jennifer M Bratt,2 Dorottya Godor,3 Samuel Louie,2 Nicholas J Kenyon2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 2Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA; 3School of Medicine, Semmelweis University, Budapest, Hungary Abstract: The presence of eosinophilic inflammation is a characteristic feature of chronic and acute inflammation in asthma. An estimated 5%–10% of the 300 million people worldwide who suffer from asthma have a severe form. Patients with eosinophilic airway inflammation represent approximately 40%–60% of this severe asthmatic population. This form of asthma is often uncontrolled, marked by refractoriness to standard therapy, and shows persistent airway eosinophilia despite glucocorticoid therapy. This paper reviews personalized novel therapies, more specifically benralizumab, a humanized anti-IL-5Rα antibody, while also being the first to provide an algorithm for potential candidates who may benefit from anti-IL-5Rα therapy. Keywords: asthma, eosinophils, asthma treatments, benralizumab, IL-5, IL-5Rα, MEDI-563

  7. Why Does Asthma Attack Severely at Night?

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The rhythmic changes of human physiological activities by day and at night may cause regular change of the patient's condition within one day. The following is the explanation with the theory of Chinese medicine for the reason why asthma attacks severely at night.

  8. Comparison of Rapid Bronchodilatory Effects of Salmeterol and Formoterol in Patients with Moderate to Severe Asthma

    OpenAIRE

    Ebrahim Salehifar; Javad Ghaffari; Shahram Ala; Fatemeh Moghimi

    2015-01-01

    Backgrounds: All of Long-acting β2-agonists are beneficial in maintenance treatment of asthma but their use in relieving acute asthma attacks is not well known. The aim of this study was to compare rapid bronchodilatory effects of Salmeterol and Formoterol in patient with moderate to severe asthma.Methods: It was a randomized, double blind, cross-over study on 60 patients with moderate to severe asthma. Patients randomly received 50 micrograms of salmeterol or 18 micrograms of formoterol  and...

  9. Survey of the management of acute asthma in children.

    LENUS (Irish Health Repository)

    Widger, J

    2009-12-01

    Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.

  10. The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma Estudo sobre Asma Grave na América Latina e Espanha (1994-2004): características dos pacientes hospitalizados com asma aguda grave

    OpenAIRE

    Gustavo Javier Rodrigo; Vicente Plaza; Jesús Bellido-Casado; Hugo Neffen; María Teresa Bazús; Gur Levy; Joseph Armengol

    2009-01-01

    OBJECTIVE: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. METHODS: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-Am...

  11. Drug Development for Severe Asthma: What Are the Metrics?

    OpenAIRE

    Robinson, Cynthia B.; Leonard, Joanne; Reynold A Panettieri

    2012-01-01

    Although reversible airway obstruction in part defines asthma, lung function as measured by spirometry alone inadequately predicts the value of new therapeutic agents in the treatment of severe asthma.

  12. ASTHMA SEVERITY IN CHILDHOOD AND METABOLOMIC PROFILING OF BREATH CONDENSATE

    OpenAIRE

    Carraro, Silvia; Giordano, Giuseppe; RENIERO Fabiano; CARPI DONATELLA; Stocchero, Matteo; Sterk, Peter; Baraldi, Eugenio

    2012-01-01

    Background. Asthma is a heterogeneous disease and its different phenotypes need to be better characterized from a biochemical-inflammatory standpoint. The present study aimed to apply the metabolomic approach to exhaled breath condensate (breathomics) to discriminate different asthma phenotypes, with a particular focus on severe asthma in children. Methods. In this cross sectional study we recruited 42 asthmatic children (age 8-17 years): 31 with non-severe asthma (treated with inhaled ste...

  13. Job strain and the risk of severe asthma exacerbations

    DEFF Research Database (Denmark)

    Heikkilä, K; Madsen, I E H; Nyberg, S T;

    2014-01-01

    BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations...... asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. RESULTS: During a median follow-up of 10 years......, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95...

  14. The potential role of vitamin D in the link between obesity and asthma severity/control in children.

    Science.gov (United States)

    Vo, Phuong; Bair-Merritt, Megan; Camargo, Carlos A

    2015-06-01

    Childhood obesity and asthma are major public health problems. Obesity is not only associated with increased risk of incident asthma, but it may worsen asthma severity/control. Although the mechanisms linking obesity with asthma expression have not been completely elucidated, evidence suggests that increased frequency of acute respiratory infection (ARI) and decreased corticosteroid responsiveness may help to explain how obesity worsens asthma expression. In addition, obese individuals have low vitamin D status, and emerging evidence suggests vitamin D affects risk of ARI and corticosteroid responsiveness in individuals with asthma. In this review, we summarize the association between obesity and asthma severity/control in children and discuss ARI and corticosteroid responsiveness as potential mediators in the obesity-asthma pathway. We also discuss the potential role of vitamin D, including a brief summary of recent randomized controlled trials of vitamin D supplementation.

  15. A study of asthma severity in adult twins

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; van der Sluis, Sophie; Kyvik, Kirsten Ohm;

    2012-01-01

    twins from the Danish Twin Registry, a total of 575 subjects (256 intact pairs and 63 single twins) who themselves and/or their co-twins reported a history of asthma at a questionnaire survey were clinically examined. The severity of asthma symptoms was graded according to a clinical interview......Introduction: The tendency to develop asthma runs in families, but whether the severity of asthma symptoms is inherited is not known. Objectives: The aim of this study was to examine whether genetic factors influence the variation in the severity of asthma. Methods: Of a sample of 21 133 adult......, and markers of airway impairment and allergy were measured. Results: After adjusting for confounders, genetic factors explained 24% (10%-37%), P = 0.0004, of the variation in overall asthma symptom severity, whereas non-shared environment accounted for the remaining 76% of the variation. A significant genetic...

  16. Risk factors for death in patients with severe asthma

    Directory of Open Access Journals (Sweden)

    Andréia Guedes Oliva Fernandes

    2014-08-01

    Full Text Available OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4. Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

  17. Factors associated with emergency department visits due to acute asthma

    Directory of Open Access Journals (Sweden)

    Dalcin P.T.R.

    2004-01-01

    Full Text Available It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED. The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older attending the ED (N = 86 and the AC (N = 86. Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001 and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001 used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001 and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001. The history of hospital admissions (odds ratio, OR, 4.00 and use of inhaled corticosteroids (OR, 0.27 were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

  18. Acute asthma: emergency department management and prospective evaluation of outcome.

    OpenAIRE

    Fitzgerald, J M; Hargreave, F. E.

    1990-01-01

    To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done ...

  19. Implementation of spacer therapy for acute asthma in children.

    LENUS (Irish Health Repository)

    Vandeleur, M

    2009-09-01

    The aim was to develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination. Children admitted to Cork University Hospital Paediatric Department with acute asthma were identified during two identical 2 month seasonal periods before (2005) and after (2006) implementation of the new guidelines in September 2006. Pre-intervention and post-intervention audits by case note review were performed to determine the impact of and compliance with this evidence-based guideline emphasising patient assessment, spacer delivered bronchodilator and specific discharge criteria. Patients had similar characteristics during the two study periods. There was a raised threshold for admission after guideline implementation with 11\\/52 patients having mild exacerbations in 2006, compared to 21\\/36 in 2005. Duration of admission was less in the post-implementation group for equivalent exacerbation severity e.g. for moderate severity; 28 hours in 2005, 23 hours in 2006. Duration of bronchodilator therapy was shorter in 2006 and more likely to be given by spacer device earlier for equivalent levels of severity e.g. for moderate exacerbations, in 2006 the average length of salbutamol therapy was 18 hours with 12 hours by spacer device, in 2005 the average length of therapy was 25 hours with 3 hours by spacer. There was earlier initiation of oral corticosteroids; the average time to administration was 56 minutes in 2006 and 227 minutes in 2005. There was an improved documentation of asthma education in 2006 e.g. inhaler technique was reviewed in 37\\/52 in 2006, 21\\/35 in 2005 and better use of written action plans.

  20. 降钙素原测定对危重支气管哮喘急性发作抗生素使用的指导作用%Procalcitonin Guidance of Antibiotic Therapy in Acute Exacerbations of Severe Asthma

    Institute of Scientific and Technical Information of China (English)

    龙威; 邓星奇; 张学敏; 谢娟; 杨敬业; 钟远

    2012-01-01

    Objective To investigate the value of procalcitonin-guided treatment on antibiotic use in severe acute exacerbations of asthma.Methods From April 2008 to December 2010, a total of 77 patients with severe acute exacerbations of asthma were randomly assigned into a PCT group(n = 38 ) and a control group(n = 39).The serum concentration of procalcitonin(PCT) were measured in all patients.On the base of similar routine treatment, the control group received antibiotics based on the physician' s decision.Meanwhile the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level = 0.25ng/mL and was discontinoued with PCT level 0.05 ).Conclusion PCT guidance can reduce antibiotic duration and antibiotic cost in treatment of acute severe exacerbations of asthma.%目的 研究血清降钙素原(PCT)检测在危重支气管哮喘急性发作患者对使用抗生素的指导作用.方法 选取2008年4月至2010年12月间收治的危重哮喘急性加重患者77例,随机分配到两组:PCT指导治疗组38例(PCT组)和常规治疗组39例(对照组),检测血清PCT水平.在相同常规治疗基础上,对照组由经治医师按照抗生素使用指南决定抗生素疗程,PCT组按照血清PCT水平决定何时停用抗生素,在血清PCT≥0.25 ng/mL时,进行抗生素治疗,PCT<0.25 ng/mL时,停止抗生素治疗.观察两组患者的抗生素疗程,抗生素费用及住院时间.结果 PCT组抗生素疗程[7(5~11)d]短于对照组[11(7~16)d](Z值=-2.26,P=0.025),抗生素费用[2125( 1560~4347)元]低于对照组[3588(2677 ~5280)元](Z值=-2.01,P=0.033),两组的住院时间及预后无明显差异.结论 危重支气管哮喘急性发作患者根据PCT使用抗生素,能够缩短抗生素疗程,减少抗生素费用.

  1. Severe Asthma in Childhood Linked to COPD Risk Later

    Science.gov (United States)

    ... 158815.html Severe Asthma in Childhood Linked to COPD Risk Later Treatments for kids didn't seem ... go on to develop chronic obstructive pulmonary disease (COPD) in early adulthood, a new study suggests. People ...

  2. Acute pancreatitis complicating severe dengue

    OpenAIRE

    Vishakha Jain; O P Gupta; Tarun Rao; Siddharth Rao

    2014-01-01

    Dengue is an arthropod borne viral infection endemic in tropical and subtropical continent. Severe dengue is life threatening. Various atypical presentations of dengue have been documented. But we present a rare and fatal complication of severe dengue in form of acute pancreatitis. A 27-year-old male had presented with severe dengue in decompensated shock and with pain in abdomen due to pancreatitis. The pathogenesis of acute pancreatitis in dengue is not clearly understood, but various mecha...

  3. From asthma severity to control: a shift in clinical practice

    DEFF Research Database (Denmark)

    Pedersen, Søren

    2009-01-01

    -driven management rather than management based on disease severity. Good asthma control is associated with reductions in patients' perception of the asthma burden, reduced healthcare resource utilisation, lower levels of impairment/restriction, normal quality of life, and low risk of exacerbations. Asthma control...... involves the control of several outcomes. Its assessment should include components relevant to achievement of best possible clinical control and reduction of future risk of adverse outcomes. Focusing on a single or a few outcomes can lead to incorrect control assessment and increased risk of under......-treatment. Several validated asthma control assessment tools have been developed to facilitate correct assessment of the level of control in clinical practice. It is hoped that focusing on control will reduce the frequency of sub-optimal treatment in the primary care setting. Further validation of the best way to...

  4. Indications for the use of bronchial thermoplasty in severe asthma.

    Science.gov (United States)

    Dheda, Keertan; Koegelenberg, Coenraad F N; Esmail, Aliasgar; Irusen, Elvis; Wechsler, Michael E; Niven, Rob M; Chung, Kian Fan; Bateman, Eric D

    2015-09-18

    Approximately 5% of the ~3 million asthmatics in South Africa have severe asthma that is associated with substantial morbidity, cost, absenteeism, preventable mortality, and the requirement for costly chronic medication that may be associated with significant adverse events. There is an unmet need for alternative safer and more effective interventions for severe asthma. A recently introduced option, bronchial thermoplasty (BT), imparts radiofrequency-generated heat energy to the airways to cause regression of airway smooth muscle. The effectiveness of this technique has been confirmed in randomised control trials and is now endorsed by several international guidelines, including the Global Initiative for Asthma (GINA) guideline, the British Asthma Guideline, and the UK National Institute of Clinical Excellence (NICE) guideline. We recommend BT as a potential therapeutic intervention for severe uncontrolled asthma, provided that it is performed by an experienced pulmonologist at an accredited centre and done within the broader context of appropriate management of the disease by doctors experienced in treating difficult-to-control asthma.

  5. Differential serum protein markers and the clinical severity of asthma

    Directory of Open Access Journals (Sweden)

    Meyer N

    2014-04-01

    predictors for the severity of asthmatic inflammation, asthma control, and response to therapy, and therefore might be useful for treatment optimization.Keywords: asthma, cluster, phenotype, serum cytokines

  6. Reducing asthma attacks in patients with severe asthma: The role of bronchial thermoplasty.

    Science.gov (United States)

    Dunn, Ryan; Wechsler, Michael E

    2015-01-01

    Asthma remains one of the most common diseases worldwide and results in significant societal health care costs and in morbidity and mortality to those afflicted. Despite currently available medications, 5-10% of patients with asthma have severe disease with debilitating symptoms and/or life-threatening exacerbations. Bronchial thermoplasty is a device-based therapy with proven efficacy in this subgroup of patients. Thus far, bronchial thermoplasty has been shown to reduce exacerbations and to improve important measures of asthma control. The purpose of this article is to review the pathophysiology of severe asthma, including the role of airway smooth muscle cells and the procedural aspects of bronchial thermoplasty, and to review the evidence behind this important therapy. PMID:26108080

  7. Telematic system for monitoring of asthma severity in patients' homes.

    Science.gov (United States)

    Finkelstein, J; Hripcsak, G; Cabrera, M

    1998-01-01

    Despite advances in the treatment of asthma the morbidity and mortality of this disease has increased significantly in the past several years. Recent studies have shown that monitoring of asthma severity in the patient home especially combined with patient education can reduce incidence of asthma exacerbation and subsequent hospitalization. The existing methods for home asthma monitoring are limited by four factors; they completely rely on a patient's ability to document and to evaluate test results; there is no easy way for a physician to review data in a timely manner; they use imprecise tools for evaluation of asthma severity and they don't provide clinical decision support tools. The goal of this study is to develop and to evaluate a telematic system for asthma severity monitoring which will minimize patients' efforts in performing self-testing at their homes and allow prompt reciprocal exchange of all relevant information between patients and health care providers. In our setting, patients use portable spirometer and pocket-sized palmtop computer for data exchange. Our system allows daily serial monitoring of asthma severity at patients' homes using Forced Vital Capacity test and symptom diary. The results of the tests become available for physicians review immediately after completion of self-testing procedures via Web browser. The results can be transmitted from patients' homes (or any other remote location) to the medical records database via landline or wireless networks in several minutes. Each time the remote server receives patient's results, it invokes the application which tests the validity of data, analyzes parameters trends and dispatches corresponding messages for the patient and, if necessary, for physicians. Such an approach provides constant feedback loop between asthma patient and physician. The system has been tested in 10 healthy volunteers and asthma patients. Patients participated in the study from two to 21 days. The test results showed

  8. Risk factors for pediatric intensive care admission in children with acute asthma

    NARCIS (Netherlands)

    G.E. van den Bosch (Gerbrich); P.J.F.M. Merkus (Peter); C.M.P. Buysse (Corinne); A.L. Boehmer; A.A.P.H. Vaessen-Verberne (Anja); L. van Veen (Leoniek); W.C.J. Hop (Wim); M. de Hoog (Matthijs)

    2012-01-01

    textabstractINTRODUCTION: Severe acute asthma in children is associated with substantial morbidity and may require pediatric ICU (PICU) admission. The aim of the study was to determine risk factors for PICU admission. METHODS: The study used a retrospective multicenter case-control design. The cases

  9. Risk factors for pediatric intensive care admission in children with acute asthma.

    NARCIS (Netherlands)

    Bosch, G.E. van den; Merkus, P.J.F.M.; Buysse, C.M.; Boehmer, A.L.; Vaessen-Verberne, A.A.; Veen, L.N. van; Hop, W.C.J.; Hoog, M. de

    2012-01-01

    INTRODUCTION: Severe acute asthma in children is associated with substantial morbidity and may require pediatric ICU (PICU) admission. The aim of the study was to determine risk factors for PICU admission. METHODS: The study used a retrospective multicenter case-control design. The cases included ch

  10. Severe acute malnutrition and infection

    OpenAIRE

    Jones, Kelsey D. J.; Berkley, James A

    2014-01-01

    Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Over...

  11. Pulmonary Function Tests in Emergency Department Pediatric Patients with Acute Wheezing/Asthma Exacerbation

    Directory of Open Access Journals (Sweden)

    Kathryn Giordano

    2012-01-01

    Full Text Available Background. Pulmonary function tests (PFT have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35% were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.

  12. Health status measurement in patients with severe asthma

    NARCIS (Netherlands)

    Peters, J.B.; Rijssenbeek-Nouwens, L.H.; Bron, A.O.; Fieten, K.B.; Weersink, E.J.; Bel, E.H.; Vercoulen, J.H.M.M.

    2014-01-01

    BACKGROUND: Patients with severe asthma experience problems in different areas of their health status. Identification of these areas will provide insight in the patients needs and perhaps what determines the burden of disease. The Nijmegen Clinical Screening Instrument (NCSI) was recently developed

  13. ACUTE PANCREATITIS - THE SEVERE FORM

    Directory of Open Access Journals (Sweden)

    Ioana Grigoras

    2005-01-01

    Full Text Available Acute pancreatitis is an acute inflammatory disease. Frequently it is a challenging condition for the surgeon and for the intensive care physician, taking into account that etiology is sometimes obscure, the pathophysiology is complex and incompletely understood, the timing of surgical treatment is still under debate and the general treatment is mostly supportive. The incidence is about 30 – 50 / 100.000 / year. In 80% of cases the disease is associated with interstitial edema, mild infiltration with inflammatory cells and intra- or peripancreatic fat necrosis. Evolution is benign and self-limited with proper treatment. The severe form occurs less frequent (15 - 20%, results in long lasting hospitalization and is associated with high mortality (30 - 40%, due to infected necrosis and multiple organ failure. Alcoholism and biliary disease account for 80% of cases. Rare etiologies of disease include metabolic factors (hypercalcemia, hyperlipoproteinemia, drug ingestion, obstructive factors (abdominal tumors, trauma, endoscopic retrograde cholecistopancreatography, and s.o., infections (viral, parasitic and hemodynamic factors. Postoperative pancreatitis is a complication after major abdominal surgery (abdominal aorta aneurism repair, extensive upper abdominal surgery, hepatic or cardiac transplant, so.. The common pathophysiological mechanism is pancreatic hypoperfusion. Acute pancreatitis is not a stable disease, being characterized by time-dependent stages with specific morphologic and clinical patterns. The terminology used to designate these stages is stated in the Ulm classification. Since the consensus Conference in Atlanta (1992 the severe form of acute pancreatitis is defined by the presence of organ dysfunction/failure or by the presence of local complications. The initiating event is the premature zymogene activation and the impairment of the exocytosis process with local consequences (ongoing tissue necrosis and general consequences

  14. Recommendation for optimal management of severe refractory asthma

    Directory of Open Access Journals (Sweden)

    Jaymin B Morjaria

    2010-07-01

    Full Text Available Jaymin B Morjaria1, Riccardo Polosa21Department of IIR, University of Southampton, Southampton, UK; 2Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, ItalyAbstract: Patients whose asthma is not adequately controlled despite treatment with a ­combination of high dose inhaled corticosteroids and long-acting bronchodilators pose a major clinical challenge and an important health care problem. Patients with severe refractory disease often require regular oral corticosteroid use with an increased risk of steroid-related adverse events. Alternatively, immunomodulatory and biologic therapies may be considered, but they show wide variation in efficacy across studies thus limiting their generalizability. Managing asthma that is refractory to standard treatment requires a systematic approach to evaluate ­adherence, ensure a correct diagnosis, and identify coexisting disorders and trigger factors. In future, ­phenotyping of patients with severe refractory asthma will also become an ­important element of this systematic approach, because it could be of help in guiding and tailoring ­treatments. Here, we propose a pragmatic management approach in diagnosing and treating this challenging subset of asthmatic patients.Keywords: severe asthma, corticosteroids, immunological modifiers, steroid-sparing, ­anti-TNF-a drugs, omalizumab, mepolizumab, daclizumab, bronchial thermoplasty

  15. Reduced severity and improved control of self-reported asthma in Finland during 2001-2010

    OpenAIRE

    Kauppi, Paula; Peura, Sirpa; Salimäki, Johanna; Järvenpää, Salme; Linna, Miika; Haahtela, Tari

    2015-01-01

    Background Asthma and allergies are common and cause substantial burden in symptoms and suffering, hospitalizations and medication costs. However, despite the high prevalence, asthma burden has already decreased in Finland in 2000s. Objective We carried out an asthma barometer survey in all Finnish pharmacies to study changes in asthma severity and control, and use of health care services from 2001 to 2010. Methods Asthma severity, comorbid allergic conditions, and use of medication and healt...

  16. Viruses and bacteria in acute asthma exacerbations - A GA(2) LEN-DARE* systematic review

    DEFF Research Database (Denmark)

    Papadopoulos, N G; Christodoulou, I; Rohde, G;

    2011-01-01

    accurate and sensitive methodologies. This systematic review summarizes current knowledge and developments in infection epidemiology of acute asthma in children and adults, describing the known impact for each individual agent and highlighting knowledge gaps. Among infectious agents, human rhinoviruses are...... the most prevalent in regard to asthma exacerbations. The newly identified type-C rhinoviruses may prove to be particularly relevant. Respiratory syncytial virus and metapneumovirus are important in infants, while influenza viruses seem to induce severe exacerbations mostly in adults. Other agents are...

  17. Improving asthma severity and control screening in a primary care pediatric practice

    OpenAIRE

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer...

  18. Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency

    OpenAIRE

    Korn, Stephanie; Hübner, Marisa; Jung, Matthias; Blettner, Maria; Buhl, Roland

    2013-01-01

    Background Vitamin D has effects on the innate and adaptive immune system. In asthmatic children low vitamin D levels are associated with poor asthma control, reduced lung function, increased medication intake, and exacerbations. Little is known about vitamin D in adult asthma patients or its association with asthma severity and control. Methods Clinical parameters of asthma control and 25-hydroxyvitamin D (25(OH)D) serum concentrations were evaluated in 280 adult asthma patients (mean ± SD: ...

  19. Quantitative computed tomography imaging of airway remodeling in severe asthma.

    Science.gov (United States)

    Grenier, Philippe A; Fetita, Catalin I; Brillet, Pierre-Yves

    2016-02-01

    Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively. PMID:26981458

  20. Quantitative computed tomography imaging of airway remodeling in severe asthma

    OpenAIRE

    Grenier, Philippe A.; Fetita, Catalin I.; Brillet, Pierre-Yves

    2016-01-01

    Asthma is a heterogeneous condition and approximately 5–10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. ...

  1. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma

    NARCIS (Netherlands)

    Abraham, B; Anto, JM; Barreiro, E; Bel, EHD; Bonsignore, G; Bousquet, J; Castellsague, J; Chanez, P; Cibella, F; Cuttitta, G; Dahlen, B; Dahlen, SE; Drews, N; Djukanovic, R; Fabbri, LM; Folkerts, G; Gaga, M; Gratziou, C; Guerrera, G; Holgate, ST; Howarth, PH; Johnston, SL; Kanniess, F; Kips, JC; Kerstjens, HAM; Kumlin, M; Magnussen, H; Nijkamp, FP; Papageorgiou, N; Papi, A; Postma, DS; Pauwels, RA; Rabe, KF; Richter, K; Roldaan, AC; Romagnoli, M; Roquet, A; Sanjuas, C; Siafakas, NM; Timens, W; Tzanakis, N; Vachier, [No Value; Vignola, AM; Watson, L; Yourgioti, G

    2003-01-01

    Since severe asthma is a poorly understood, major health problem, 12 clinical specialist centres in nine European countries formed a European Network For Understanding Mechanisms Of Severe Asthma (ENFUMOSA). In a cross-sectional observational study, a total of 163 subjects with severe asthma were co

  2. Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma

    OpenAIRE

    Robert L Cowie; Underwood, Margot F; Little, Cinde B; Ian Mitchell; Sheldon Spier; Ford, Gordon T

    2002-01-01

    BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional gr...

  3. A review of omalizumab for the management of severe asthma

    Directory of Open Access Journals (Sweden)

    Lin CH

    2016-07-01

    Full Text Available Ching-Hsiung Lin,1–3 Shih-Lung Cheng4,5 1Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, Republic of China; 2Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, Republic of China; 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; 4Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China; 5Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan, Republic of China Abstract: Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. Keywords: severe asthma, IgE, omalizumab, exacerbation, chronic idiopathic urticarial, inhaled corticosteroid

  4. A STUDY OF ASSOCIATION OF BODY MASS INDEX WITH SEVERITY OF BRONCHIAL ASTHMA IN 132 PATIENTS

    OpenAIRE

    Vijaykumar; Mahavir; Dattatray; Rakhi

    2014-01-01

    As the prevalence of both obesity and severity of asthma are in increasing trend, we study association between body mass index (BMI) and asthma severity in cross sectional study. OBJECTIVE: To study association between Body mass index and Asthma severity METHODOLOGY- We included adults (age >13yrs), who are diagnosed as patients of asthma by Pulmonologist and who are non -smoker, without any other lung pathology, are not on long term systemic steroids. Total of 132 patient...

  5. Studying the Effects of Fasting during Ramadan on Pulmonary Functioning Test and Asthma Severity

    OpenAIRE

    Seyyed Hassan Adeli; Mohammad Aghaali; jaffar motahari nasab

    2015-01-01

    Background and Objectives: Studies have shown that fasting can have an impact on the course and severity of chronic diseases. There are a few studies on the association of fasting and asthma. Therefore, this study has been conducted with the purpose of examining the effects of fasting on asthma severity and pulmonary functioning tests. Methods: 30 patients with asthma who attended a pulmonology clinic in Qom were enrolled in this study. The severity of patients’ asthma has been stud...

  6. Arterial blood gas analysis or oxygen saturation in the assessment of acute asthma?

    OpenAIRE

    Carruthers, D M; Harrison, B. D.

    1995-01-01

    BACKGROUND--A study was undertaken to determine if arterial blood gas estimation is always necessary in the assessment of patients presenting to hospital with acute severe asthma, or whether oxygen saturation as measured by pulse oximetry is a reliable screening test for predicting those in respiratory failure. METHODS--A prospective study was conducted in a specialist respiratory medical unit. Arterial blood gas tensions and pulse oximetry were measured in 89 consecutive patients admitted wi...

  7. A review of omalizumab for the management of severe asthma

    Science.gov (United States)

    Lin, Ching-Hsiung; Cheng, Shih-Lung

    2016-01-01

    Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. PMID:27528798

  8. Improving asthma severity and control screening in a primary care pediatric practice.

    Science.gov (United States)

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer the Asthma Control Test (TM), a validated questionnaire to assess asthma control. The stakeholders involved were the physicians, nursing staff, and the Health Information Team (HIT). All patients who had a prior diagnosis of asthma or with an asthma medication in their chart, who presented for any clinical visit including asthma were administered ACT. The staff scored the ACT and included the form in the encounter sheet so that the physicians can review the scores, address the asthma control, severity, and document in the chart. The number of patients whose asthma control was assessed improved from 10% per year to 85% after the three PDSA cycles. Administration of the tool did not impact the flow of the patients in a busy primary care practice. Screening asthma severity and control for patients diagnosed with asthma with a validated questionnaire when presenting for any chief complaint including asthma will help the provider address the severity and control of asthma symptoms in a timely manner and would potentially help prevent unwanted emergency department or urgent care usage. PMID:27408718

  9. Improving asthma severity and control screening in a primary care pediatric practice

    Science.gov (United States)

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer the Asthma Control Test (TM), a validated questionnaire to assess asthma control. The stakeholders involved were the physicians, nursing staff, and the Health Information Team (HIT). All patients who had a prior diagnosis of asthma or with an asthma medication in their chart, who presented for any clinical visit including asthma were administered ACT. The staff scored the ACT and included the form in the encounter sheet so that the physicians can review the scores, address the asthma control, severity, and document in the chart. The number of patients whose asthma control was assessed improved from 10% per year to 85% after the three PDSA cycles. Administration of the tool did not impact the flow of the patients in a busy primary care practice. Screening asthma severity and control for patients diagnosed with asthma with a validated questionnaire when presenting for any chief complaint including asthma will help the provider address the severity and control of asthma symptoms in a timely manner and would potentially help prevent unwanted emergency department or urgent care usage. PMID:27408718

  10. Acute pancreatitis - severity classification, complications and outcome

    OpenAIRE

    Andersson, Bodil

    2010-01-01

    Acute pancreatitis, with an annual incidence of approximately 35 per 100 000 inhabitants in Sweden, is in most cases mild and self-limiting. Severe acute pancreatitis, affecting 10-15% of the cases is, however, associated with severe complications and even death. The optimal management of acute pancreatitis includes accurate early prediction of the disease severity. The aims of this thesis were to investigate early severity classification, complications and outcome in acute pancreatitis patie...

  11. Problematic severe asthma: a proposed approach to identifying children who are severely resistant to therapy.

    Science.gov (United States)

    Konradsen, Jon R; Nordlund, Björn; Lidegran, Marika; Pedroletti, Christophe; Grönlund, Hans; van Hage, Marianne; Dahlen, Barbro; Hedlin, Gunilla

    2011-02-01

    Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p=0.003), came from families with a lower socioeconomic status (p=0.01), were less physically active (p=0.04), and had more comorbidity with rhinoconjunctivitis (p=0.01) than did the 39 children with CA. The former also exhibited lower FEV(1) values (p=0.02) and increased bronchial hyper-responsiveness (p=0.01), but there were no differences in atopy (p=0.81) or FE(NO) (p=0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma. PMID:20880352

  12. Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

    NARCIS (Netherlands)

    Verkleij, Marieke; van de Griendt, E-J.; Colland, V.; Van Loey, N.E.E.; Beelen, A.; Geenen, R.

    2015-01-01

    Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in

  13. Severe Acute Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Bahiyah Abdullah

    2015-01-01

    Full Text Available This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

  14. Arginase 1 and arginase 2 variations associate with asthma, asthma severity and beta(2) agonist and steroid response

    NARCIS (Netherlands)

    Vonk, Judith M.; Postma, Dirkje S.; Maarsingh, Harm; Bruinenberg, Marcel; Koppelman, Gerard H.; Meurs, Herman

    2010-01-01

    Rationale Arginase probably plays an important role in asthma development, severity and progression. Polymorphisms in arginase 1 and arginase 2 genes have been associated with childhood asthma and FEV1 reversibility to beta(2) agonists. Objectives We investigated the association between arginase 1 a

  15. Evaluation of Omeprazole in the Treatment of Moderate to Severe Persistent Asthma in Children

    OpenAIRE

    F Behmanesh; SA Jafari; A Khakshour; E Khodashenas; A. Motiee

    2014-01-01

    Background and Objective: Asthma is the most common chronic disease of childhood. The disease is caused by a temporary blockage of airflow due to chronic inflammation of the airways . One of the conditions that often occur with asthma and exacerbate disease, is gastroesophageal reflux. The aim of this study is to evaluate the role of acid suppressing therapy in patients with refractory asthma.   Materials and Methods: In this study children with moderate to severe asthma under m...

  16. Mild, Moderate, Severe Asthma: What Do Grades Mean?

    Science.gov (United States)

    ... and may include measures of lung function including spirometry or peak flow measurements. This information enables your ... once a week. Lung function is 80% of normal or greater. Moderate Persistent Asthma Asthma is classified ...

  17. Asthma Status and Severity Affects Missed School Days

    Science.gov (United States)

    Moonie, Sheniz A.; Sterling, David A.; Figgs, Larry; Castro, Mario

    2006-01-01

    Excessive school absence disrupts learning and is a strong predictor of premature school dropout. School-aged children with asthma are absent more often compared to their healthy peers without asthma; yet, the causes are inadequately documented. We sought to determine the difference in mean absence days between children with and without asthma,…

  18. Obesity and Asthma

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is more prevalent in obese compared with normal weight subjects. Our aim has been to review current knowledge of the impact of obesity on asthma severity, asthma control, and response to therapy.Several studies have shown that overweight and obesity is associated with more severe asthma...... and impaired quality of life compared with normal weight individuals. Furthermore, obesity is associated with poorer asthma control, as assessed by asthma control questionnaires, limitations in daily activities, breathlessness and wheezing, use of rescue medication, unscheduled doctor visits, emergency...... department visits, and hospitalizations for acute asthma. Studies of the impact of a high body mass index (BMI) on response to asthma therapy have, however, revealed conflicting results. Most studies show that overweight and obesity is associated with less favorable response to asthma therapy with regard...

  19. Greater severity of new onset asthma in allergic subjects who smoke: a 10-year longitudinal study

    Directory of Open Access Journals (Sweden)

    Antic Tjana

    2011-01-01

    Full Text Available Abstract Background Little is known about the association between cigarette smoking and asthma severity. We assessed smoking as a determinant of disease severity and control in a cohort of clinic-referred allergic subjects who developed new onset asthma. Methods Allergic rhinitis subjects with no asthma (n = 371 were followed-up for 10 years and routinely examined for asthma diagnosis. In those who developed asthma (n = 152, clinical severity and levels of asthma control were determined. Among these subjects, 74 (48.7% were current smokers, 17 (11.2% former smokers, and 61 (40.1% never smokers. Results When comparing current or past smokers to never smokers they had a higher risk of severe asthma in the univariate analysis, which became non-significant in the multivariate analysis. On the other hand, the categories of pack-years were significantly related to severe asthma in a dose response relationship in both the univariate and multivariate analysis: compared to 0 pack years, those who smoked 1-10 pack-years had an OR(95% CI of 1.47(0.46-4.68, those who smoked 11-20 pack-years had an OR of 2.85(1.09-7.46 and those who smoked more than 20 pack-years had an OR of 5.59(1.44-21.67 to develop more severe asthma. Smokers with asthma were also more likely to have uncontrolled disease. A significant dose-response relationship was observed for pack-years and uncontrolled asthma. Compared to 0 pack years, those who smoked 1-10 pack-years had an OR of 5.51(1.73-17.54 and those who smoked more than 10 pack-years had an OR of 13.38(4.57-39.19 to have uncontrolled asthma. Conclusions The current findings support the hypothesis that cigarette smoking is an important predictor of asthma severity and poor asthma control.

  20. Comparison of Rapid Bronchodilatory Effects of Salmeterol and Formoterol in Patients with Moderate to Severe Asthma

    Directory of Open Access Journals (Sweden)

    Ebrahim Salehifar

    2015-10-01

    Full Text Available Backgrounds: All of Long-acting β2-agonists are beneficial in maintenance treatment of asthma but their use in relieving acute asthma attacks is not well known. The aim of this study was to compare rapid bronchodilatory effects of Salmeterol and Formoterol in patient with moderate to severe asthma.Methods: It was a randomized, double blind, cross-over study on 60 patients with moderate to severe asthma. Patients randomly received 50 micrograms of salmeterol or 18 micrograms of formoterol  and  after  one-week  washed  out  period  exchanged  their  medications. All  patients undergone spirometry for four times (before receiving the drugs, as well as 3, 30 and 60 minutes after drug inhalation and Forced Expiratory Volume in 1 second (FEV1, Forced Vital Capacity (FVC, FVC percentage predicted value, FEV1/FVC, Peak Expiratory Flow Rate (PEFR and PEFR percentage predicted value were measured.Results: Both medications could significantly increase FEV1/FVC and PEFR at 3, 30 and 60 minutes after inhalation (P<0.001 compared to baseline.Three minutes after inhalation of salmeterol and formoterol, FEV1 increased by 8.7% and 12.2% respectively. Formoterol was associated with more increase in the amounts of FEV1 compared to Salmeterol.Conclusion: This study showed that fromoterol has a more rapid onset of bronchodilating action compared with salmeterol at 3 minutes after inhalation. Both agents had significant increases in FEV1/FVC and PEFR compared to baseline with no significant differences between two drugs.

  1. Phenotypes of severe asthma among children and adolescents in Brazil: a prospective study

    OpenAIRE

    Andrade, Wenderson Clay Correia de; Lasmar, Laura Maria de Lima Belizário Facury; Ricci, Cristiane de Abreu Tonelli; Camargos, Paulo Augusto Moreira; Álvaro A Cruz

    2015-01-01

    Background The morbidity associated with severe uncontrolled asthma is disproportionately higher in low- and middle-income countries than in high-income countries. The aim of this study was to describe the phenotypic characteristics of difficult-to-treat severe asthma and treatment-resistant severe asthma in a sample of children and adolescents in Brazil. Methods This was a prospective study, conducted between 2010 and 2014, following 61 patients (6–18 years of age) who had been diagnosed wit...

  2. Exhaled nitric oxide levels in childhood asthma: a more reliable indicator of asthma severity than lung function measurement?

    Science.gov (United States)

    Piacentini, G L; Suzuki, Y; Bodini, A

    2000-04-01

    The level of exhaled nitric oxide (NO) has been demonstrated to reflect the degree of airway inflammation in patients with asthma and to be related to the severity of asthma, as well as to the efficacy of treatment. In contrast, lung function tests provide information about airway volumes and flows reflecting the level of airway obstruction, but do not allow any direct information about the degree of airway inflammation. Several studies have evaluated the relationships between the level of airway inflammation assessed by exhaled NO and the levels of airway obstruction and/or bronchial hyperresponsiveness in asthmatic adults and children. These studies highlight the complex pathophysiology of asthma and suggest that exhaled NO may have a promising role in addition to lung function measurement in the evaluation of asthma severity in children. PMID:18034534

  3. Pazopanib-Induced Severe Acute Pancreatitis

    OpenAIRE

    Kawakubo, Kazumichi; Hata, Hiroo; Kawakami, Hiroshi; Kuwatani, Masaki; Kawahata, Shuhei; Kubo, Kimitoshi; Imafuku, Keisuke; Kitamura, Shinya; Sakamoto, Naoya

    2015-01-01

    Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopan...

  4. Persistent severe hypereosinophilic asthma is not associated with airway remodeling.

    Science.gov (United States)

    Alagha, Khuder; Jarjour, Baihas; Bommart, Sebastien; Aviles, Berta; Varrin, Muriel; Gamez, Anne Sophie; Molinari, Nicolas; Vachier, Isabelle; Paganin, Fabrice; Chanez, Pascal; Bourdin, Arnaud

    2015-02-01

    Hypereosinophilic asthma (HEA) is considered as a specific severe asthma phenotype. Whether eosinophils have a link with airway remodeling characterized by pathological (thickening of the basement membrane), functional (persistent airflow impairment and decline in lung function) and imaging features (increase airway wall thickness at CT scan) is still debated. In a one year prospective cohort of 142 severe asthma patients (according to IMI), 14 persistent HEA patients (defined by a persistent blood eosinophilia >500/mm(3) at two consecutive visits) were identified and compared with ten patients without any blood eosinophilia during the follow-up period (NEA, blood eosinophilia always Bronchial biopsies obtained at enrollment were stained for eosinophils (EG2) and basement membrane thickness (BM) was quantified. Imaging by CT scan acquisition was standardized and bronchial abnormalities quantified. ACQ score and exacerbations were prospectively recorded. HEA was not associated with preeminent features of airway remodeling assessed by airflow impairment (Best ever FEV1 values 97% ± 20 in HEA vs. 80 ± 24% in NEA, p = 0.020), decline of FEV1 (FEV1 Decline 40 ± 235 ml/y in HEA vs. 19 ± 40 ml/y in NEA, P = 0.319), submucosal abnormalities (BM thickness 7.80 ± 2.66 μm in HEA vs. 6.84 ± 2.59 in NEA, p = 0.37) and airway wall thickening at CT-scan (0.250 ± 0.036 mm vs. 0.261 ± 0.043, p = 0.92). Eosinophils blood count was inversely correlated with semiquantitative imaging score (rho -0.373, p = 0.039). Smoking history and positive skin prick tests were independent risk factors for increased BM thickening. Outcomes were similar in both populations (Control and exacerbations). Persistent HEA is not associated with evidences of airway remodeling. PMID:25592243

  5. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    Science.gov (United States)

    Ulahannan, T; Hardern, R D; Hamer, D W

    1996-03-01

    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  6. Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma.

    Science.gov (United States)

    Rogers, Linda

    2016-08-01

    Gastroesophageal reflux and obstructive sleep apnea syndrome are conditions that practitioners have been encouraged to evaluate and treat as part of a comprehensive approach to achieving asthma control. In this review, the author looks at the evidence linking these two conditions as factors that may impact difficult-to-control asthma and looks critically at the evidence suggesting that evaluation and treatment of these conditions when present impacts asthma control. PMID:27401619

  7. Neutrophilic and Pauci-immune Phenotypes in Severe Asthma.

    Science.gov (United States)

    Panettieri, Reynold A

    2016-08-01

    Although 2 T-helper type 2 inflammation evokes airway hyperresponsiveness and narrowing, neutrophilic or pauci-immune asthma accounts for significant asthma morbidity. Viruses, toxicants, environmental tobacco smoke exposure, and bacterial infections induce asthma exacerbations mediated by neutrophilic inflammation or by structural cell (pauci-immune) mechanisms. Therapeutic challenges exist in the management of neutrophilic and pauci-immune phenotypes because both syndromes manifest steroid insensitivity. The recognition that neutrophil subsets exist and their functions are unique poses exciting opportunities to develop precise therapies. The conventional thought to target neutrophil activation or migration globally may explain why current drug development in neutrophilic asthma remains challenging. PMID:27401627

  8. National asthma observational survey of severe asthmatics in Israel: the no-air study

    OpenAIRE

    Izbicki Gabriel; Grosman Anna; Weiler Zeev; Shulimzon Tiberiu; Laxer Uri; Fink Gershon

    2012-01-01

    Abstract Background Asthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control. Objective This is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel. Material and method One hundred and twenty-three pa...

  9. National asthma observational survey of severe asthmatics in Israel: the no-air study

    Directory of Open Access Journals (Sweden)

    Izbicki Gabriel

    2012-06-01

    Full Text Available Abstract Background Asthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control. Objective This is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel. Material and method One hundred and twenty-three patients with a diagnosis of asthma for more then one year, as well as a hospitalization during the last 12 months due to asthma exacerbation or maintenance systemic steroids therapy, were included in this non-interventional observational study. Results Asthma was uncontrolled in 43.9%, partly controlled in 50.4% and well controlled in only 5.7%. The majority of the patients (83% were compliant with drug treatment. Conclusion The fact that 83% of the asthma patients included in this study were compliant with their asthma therapy was not manifested in asthma control. Therefore concrete tools are required for achieving and maintaining asthma control, especially in the treatment of the most severe asthmatic patients.

  10. Pharmacological treatment of severe, therapy-resistant asthma in children: what can we learn from where?

    DEFF Research Database (Denmark)

    Bush, A; Pedersen, S; Hedlin, G;

    2011-01-01

    There is a lack of high-quality evidence on what treatment should be used in children with properly characterised severe, therapy-resistant asthma. Data have to be largely extrapolated from trials in children with mild asthma, and adults with severe asthma. Therapeutic options can be divided...... into medications used in lower doses for children with less severe asthma, and those used in other paediatric diseases but not for asthma (for example, methotrexate). In the first category are high-dose inhaled corticosteroids (ICS) (≤ 2,000 μg · day(-1) fluticasone equivalent), oral prednisolone, the anti......, particularly in the context of good baseline asthma control, are particularly difficult to treat; baseline control and lung function must be optimised with the lowest possible dose of ICS, and allergen triggers and exposures minimised. The use of high-dose ICS, leukotriene receptor antagonists or both...

  11. Comorbidities in Severe Asthma: Frequency of Rhinitis, Nasal Polyposis, Gastroesophageal Reflux Disease, Vocal Cord Dysfunction and Bronchiectasis

    OpenAIRE

    Carla Bisaccioni; Marcelo Vivolo Aun; Edcarlos Cajuela; Jorge Kalil; Rosana Câmara Agondi; Pedro Giavina-Bianchi

    2009-01-01

    OBJECTIVES: Severe asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD), nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 20...

  12. Noninvasive assessment of asthma severity using pulse oximeter plethysmograph estimate of pulsus paradoxus physiology

    Directory of Open Access Journals (Sweden)

    Jenkins Cathy A

    2010-03-01

    Full Text Available Abstract Background Pulsus paradoxus estimated by dynamic change in area under the oximeter plethysmograph waveform (PEP might provide a measure of acute asthma severity. Our primary objective was to determine how well PEP correlates with forced expiratory volume in 1-second (%FEV1 (criterion validity and change of %FEV1 (responsiveness during treatment in pediatric patients with acute asthma exacerbations. Methods We prospectively studied subjects 5 to 17 years of age with asthma exacerbations. PEP, %FEV1, airway resistance and accessory muscle use were recorded at baseline and at 2 and 4 hours after initiation of corticosteroid and bronchodilator treatments. Statistical associations were tested with Pearson or Spearman rank correlations, logistic regression using generalized estimating equations, or Wilcoxon rank sum tests. Results We studied 219 subjects (median age 9 years; male 62%; African-American 56%. Correlation of PEP with %FEV1 demonstrated criterion validity (r = - 0.44, 95% confidence interval [CI], - 0.56 to - 0.30 and responsiveness at 2 hours (r = - 0.31, 95% CI, - 0.50 to - 0.09 and 4 hours (r = - 0.38, 95% CI, - 0.62 to - 0.07. PEP also correlated with airway resistance at baseline (r = 0.28 for ages 5 to 10; r = 0.45 for ages 10 to 17, but not with change over time. PEP was associated with accessory muscle use (OR 1.16, 95% CI, 1.11 to 1.21, P Conclusions PEP demonstrates criterion validity and responsiveness in correlations with %FEV1. PEP correlates with airway resistance at baseline and is associated with accessory muscle use at baseline and at 2 and 4 hours after initiation of treatment. Incorporation of this technology into contemporary pulse oximeters may provide clinicians improved parameters with which to make clinical assessments of asthma severity and response to treatment, particularly in patients who cannot perform spirometry because of young age or severity of illness. It might also allow for earlier recognition

  13. The clinical significance of lung hypoexpansion in acute childhood asthma

    Energy Technology Data Exchange (ETDEWEB)

    Spottswood, Stephanie E. [Department of Radiology, Medical College of Virginia, Virginia Commonwealth University Health System, Box 980615, 23298-0615, Richmond, VA (United States); Department of Radiology, The Children' s Hospital of the King' s Daughters, 601 Children' s Lane, Norfolk, VA 23507 (United States); Allison, Kelley Z.; Narla, Lakshmana D.; Lowry, Patricia A. [Department of Radiology, Medical College of Virginia, Virginia Commonwealth University Health System, Box 980615, 23298-0615, Richmond, VA (United States); Lopatina, Olga A.; Sethi, Narinder N. [School of Medicine, Medical College of Virginia, Virginia Commonwealth University Health System, Richmond, VA (United States); Nettleman, Mary D. [Department of Internal Medicine, B-427 Clinical Center, Michigan State University, East Lansing, MI 48824 (United States)

    2004-04-01

    Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy. (orig.)

  14. The clinical significance of lung hypoexpansion in acute childhood asthma

    International Nuclear Information System (INIS)

    Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy. (orig.)

  15. Harsh parent-child conflict is associated with decreased anti-inflammatory gene expression and increased symptom severity in children with asthma.

    Science.gov (United States)

    Ehrlich, Katherine B; Miller, Gregory E; Chen, Edith

    2015-11-01

    Asthma is a chronic respiratory disorder that affects over 7 million children in the United States. Evidence indicates that family stressors are associated with worsening of asthma symptoms, and some research suggests that these stressful experiences engender changes in children's immune systems in ways that exacerbate airway inflammation and contribute to both acute and chronic asthma symptoms. We examined the association between observed experiences of parent-child conflict and the expression of signaling molecules involved in the transduction of anti-inflammatory signals that regulate airway inflammation and obstruction. Fifty-seven children and their parents participated in a conflict task, and coders rated interactions for evidence of harsh and supportive behaviors. Children reported on their perceptions of parental support and reported on their daily asthma symptoms for 2 weeks. We collected peripheral blood in children to measure leukocyte expression of messenger RNA for the glucocorticoid receptor and the β2-adrenergic receptor. Analyses revealed that harsh conflict behaviors were associated with decreased expression of both messenger RNAs and more severe asthma symptoms. Neither supportive behaviors nor perceived parental support was associated with gene expression or asthma symptoms. These findings suggest that harsh interactions with parents are associated with downregulation of key anti-inflammatory signaling molecules and difficulties breathing in children with asthma. Children with asthma who are also victims of maltreatment may be particularly susceptible to transcriptional changes in immune cells that could worsen asthma over time. PMID:26535943

  16. Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity

    Directory of Open Access Journals (Sweden)

    Mohammed Nadeem Shaikh

    2016-01-01

    Full Text Available Background. Serum magnesium levels affect the concentration of circulating vitamin D in blood and subsequently it affects the immunity; thus it plays significant role in the pathogenesis of asthma. Asthma, in adults, is less studied and hypomagnesemia along with vitamin D deficiency and insufficiency is common in asthmatic individuals, which causes frequent asthma attacks, respiratory infections, severe exacerbations, and poor response to bronchodilators. Objective. To detect the magnitude of vitamin D insufficiency and deficiency and serum magnesium levels among asthmatic patients and to correlate them with the severity of asthma. Materials and Methods. This is a cross-sectional case-control study which includes 60 patients of chronic stable asthma and 60 healthy controls. After taking clinical history and systemic examination, pulmonary function test was done. Serum levels of magnesium, 25-hydroxycholecalciferol [25(OHD], and calcium were measured in all the subjects. Results. Significant correlation was found between vitamin D deficiency, hypomagnesemia, and asthma severity. Serum calcium levels were unaffected by that. Conclusion. Vitamin D and serum magnesium deficiency are highly prevalent in patients with asthma. Increased asthma severity, frequency of attacks, and exacerbation are associated with lower levels of one or both. Serum 25(OHD and magnesium levels may serve as important markers of asthma severity.

  17. Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study.

    NARCIS (Netherlands)

    Moual, N. le; Varraso, R.; Zock, J.P.; Henneberger, P.; Speizer, F.E.; Kauffmann, F.; Camargo, C.A.

    2013-01-01

    Objective: To assess the associations between operating room (OR) nursing, a category of health care workers at high risk of exposure to various inhaled agents, and asthma severity/control among women with asthma. Methods: The level of severity/control in nurses with prevalent doctor-diagnosed asthm

  18. Association of Body Mass Index with Asthma Severity and Pulmonary Function among Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Rasuol Nasiri Kalmarzi

    2016-09-01

    Full Text Available Background Asthma is a chronic inflammatory disease in respiratory system and obesity is another inflammatory disease which incidence rate is increasing. Although, many studies have been conducted on severity of asthma and its relationship with obesity, but different results have been obtained. This study aimed to determine a relationship between asthma severity, Body Mass Index (BMI and pulmonary function in Kurdistan province, Iran. Materials and Methods: In this cross sectional study 90 asthmatic patients referred to referral hospital in Kurdistan, North West of Iran, were selected by simple random method. BMI was calculated by dividing weight by height.Pulmonary Function Test (PFT and bronchial-stimulation-test were used for confirmation and investigation of asthma severity. Data were analyzed using SPSS-15 and Chi-square and spearman correlation coefficient tests. Results: Relationship between BMI and severity of asthma (mild, medium and severe was evaluated, there was a relationship and positive relationship between them (P

  19. The influence of asthma onset and severity on malocclusion prevalence in children and adolescents

    OpenAIRE

    Luiz Sekio Tanaka; Cássia Cilene Dezan; Karen Barros Parron Fernandes; Flaviana Bombarda de Andrade Ferreira; Luiz Reynaldo de Figueiredo Walter; Alcindo Cerci Neto; Silvia Fernandes Chadi

    2012-01-01

    OBJECTIVE: The influence of asthma, its severity levels and onset time on malocclusion occurrence were investigated. METHODS: The sample was composed by 176 children/adolescents, of both genders, aged 3 to 15 years, that were divided in two groups. The asthma group (AG) enrolled 88 children/adolescents that were seen at the Breathe Londrina Program. The asthma-free group (AFG) enrolled 88 preschool and school children recruited in 2 public schools. Malocclusion diagnosis was made according to...

  20. Cotinine level is associated with asthma severity in passive smoker children.

    Directory of Open Access Journals (Sweden)

    Maryam Hassanzad

    2015-02-01

    Full Text Available Asthma environmental triggers play important roles in severity of disease. Passive smoking could exacerbate asthma symptoms and enhance the decrease in lung function. Cotinine levels could be a reflection of passive exposure to the cigarette both in adults and pediatrics. The aim of this study was to determine degree of association of asthma severity and cotinine level as a marker of passive smoking. In a cross-sectional study, 100 pediatric patients (under 10 years old with asthma were enrolled, 50 of whom, had been exposed to passive smoking and 50 others included as controls. A complete clinical history, lab exam, and spirometry were performed. A sample of urine, serum and saliva was collected from all attendant patients and controls in the study after confirmation of diagnosis and determination of severity of asthma. The results revealed that age, sex, age of onset of asthma, family history and allergic history were not significantly different between two groups of patients. According to GINA classification, percentage of patients with severe asthma was significantly higher in passive smoker group (p=0.001. Cotinine was significantly higher in passive smoker group compared to control group in serum (p=001, saliva (p=0.001, and urine (p=0.0014. In passive smoker group, cotinine levels were significantly higher in serum (p=0.001, urine (p=0.007, and saliva (p=0.01 of patients with severe asthma than moderate and mild asthma. Serum cotinine (OR: 1.81, 95% CI: 1.35-2.32, p=0.024, urine cotinine (OR: 3.56,95% CI = 1.29-5.53, p=0.01 and saliva cotinine (OR: 1.66, 95% CI: 1.23-1.98, p=0.031 were also significantly associated with higher risk of severe asthma. Cotinine levels were higher in passive smokers compared to non-passive smokers. Besides, cotinine was a predictive risk factor for severe asthma.

  1. Asthma

    Science.gov (United States)

    ... it as a kid. What Causes an Asthma Flare-Up? Anything that causes an asthma flare-up (attack) is called an asthma trigger. Different kids ... doctor will think about what causes the asthma flare-ups, how fast the flare-ups happen, and how ...

  2. Enteral Nutrition in Severe Acute Pancreatitis

    OpenAIRE

    Rudra Prasad Doley; Thakur Deen Yadav; Jai Dev Wig; Gurpreet Singh; Kishore Gurumoorthy Subramanya Bharathy; Ashwini Kudari; Rajesh Gupta; Vikas Gupta; Rakesh Kochhar; Kuchhangi Sureshchandra Poornachandra; Usha Dutta; Chetna Vaishnavi

    2009-01-01

    Context There is controversy concerning the merits of enteral and pa renteral nutrition in the manage ment of patients with severe acute pancreatitis. Objective This study was undertaken to evalua te the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis. Setting Tertiary care centre in North India. Design A prospective clinical trial. Metho...

  3. Association of asthma with the risk of acute leukemia and non-Hodgkin lymphoma

    OpenAIRE

    ZHOU, MIN-HANG; Yang, Qing-Ming

    2015-01-01

    An increasing incidence of hematological malignancies has been observed in children and adults worldwide over the last few decades. Asthma is a common chronic inflammatory disease. The aim of the present meta-analysis was to evaluate the potential association between a history of asthma and the risk of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL). A literature search was performed through PubMed and the Cochrane Database of Systematic Reviews...

  4. Use of a guideline based questionnaire to audit hospital care of acute asthma.

    OpenAIRE

    Bell, D.; Layton, A J; Gabbay, J.

    1991-01-01

    OBJECTIVES--To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians. DESIGN--Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma. SETTING--One district general hospital. PATIENTS--76 adult patients w...

  5. The dark side of the moon: severe therapy-resistant asthma in children.

    Science.gov (United States)

    de Benedictis, F M; Carloni, I; Bush, A

    2012-06-01

    Problematic severe asthma is the term used to describe children whose asthma is not responsive to standard therapy with high-dose inhaled corticosteroids and additional controllers. These children need to be assessed by a step-wise systematic protocol in order to confirm the diagnosis, evaluate co-morbidities, assess the adherence to treatment, and finally evaluate the basic management. More than half of these children have "difficult-to-treat asthma", which improves if the basic management is correct. Children whose asthma remains uncontrolled despite resolution of any reversible factors are termed "severe therapy-resistant" asthmatics; for them, an individualised treatment plan is developed after a detailed and invasive protocol of investigation. Therapeutic options for these patients can be divided into medications used in lower doses for children with less severe asthma, and those used in other pediatric diseases but not for asthma. Most treatments are unlicensed and there is a lack of high-quality evidence. Children with recurrent severe exacerbations, in particular in the context of good baseline asthma control, are particularly difficult to treat, and there is no evidence on which therapeutic option to recommend. International collaborations, using standard protocols of investigation, are needed to better understand mechanisms of severe therapy-resistant asthma and to deliver evidence-based treatments in the future.

  6. Stable admission rate for acute asthma in Danish children since 1977

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Pipper, Christian Bressen; Bisgaard, Hans

    2016-01-01

    35 years in Denmark. We analyzed time-trends in the national incidence rate of hospitalization for acute severe asthma in children aged 5-15 in Denmark during the 35-year period 1977-2012 in the Danish national registry. Only in-patient admissions with a principal diagnosis of asthma (ICD-8: 493......** or ICD-10: J45** or J46**) were included. Among children with asthma hospitalizations, we investigated the risk of readmission beyond 1 month of first admission. Admissions were summarized as rates per thousand person years at risk. The overall time-trend is stable with a rate of one admission per year...... per thousand children at risk and a per-year incidence rate ratio 0.999 [95 % CI 0.997-1.001]. The rate of any readmission decreased from approximately 20 per thousand children in the eighties to less than 10 in the early nineties before stabilizing at around 10 per thousand children from mid...

  7. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

    Science.gov (United States)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J; Fleming, Louise J; Roberts, Graham; Corfield, Julie; Pandis, Ioannis; Bansal, Aruna T; Bel, Elisabeth H; Auffray, Charles; Compton, Chris H; Bisgaard, Hans; Bucchioni, Enrica; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Dahlen, Sven-Erik; Dyson, Kerry; Frey, Urs; Geiser, Thomas; Gerhardsson de Verdier, Maria; Gibeon, David; Guo, Yi-Ke; Hashimoto, Simone; Hedlin, Gunilla; Jeyasingham, Elizabeth; Hekking, Pieter-Paul W; Higenbottam, Tim; Horváth, Ildikó; Knox, Alan J; Krug, Norbert; Erpenbeck, Veit J; Larsson, Lars X; Lazarinis, Nikos; Matthews, John G; Middelveld, Roelinde; Montuschi, Paolo; Musial, Jacek; Myles, David; Pahus, Laurie; Sandström, Thomas; Seibold, Wolfgang; Singer, Florian; Strandberg, Karin; Vestbo, Jorgen; Vissing, Nadja; von Garnier, Christophe; Adcock, Ian M; Wagers, Scott; Rowe, Anthony; Howarth, Peter; Wagener, Ariane H; Djukanovic, Ratko; Sterk, Peter J; Chung, Kian Fan

    2015-11-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; plife, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach. PMID:26357963

  8. 25-Hydroxyvitamin D3-deficiency enhances oxidative stress and corticosteroid resistance in severe asthma exacerbation.

    Directory of Open Access Journals (Sweden)

    Nan Lan

    Full Text Available Oxidative stress plays a significant role in exacerbation of asthma. The role of vitamin D in oxidative stress and asthma exacerbation remains unclear. We aimed to determine the relationship between vitamin D status and oxidative stress in asthma exacerbation. Severe asthma exacerbation patients with 25-hydroxyvitamin D3-deficiency (V-D deficiency or 25-hydroxyvitamin D-sufficiency (V-D sufficiency were enrolled. Severe asthma exacerbation with V-D-deficiency showed lower forced expiratory volume in one second (FEV1 compared to that with V-D-sufficiency. V-D-deficiency intensified ROS release and DNA damage and increased TNF-α, OGG1 and NFκB expression and NFκB phosphorylation in severe asthma exacerbation. Supplemental vitamin D3 significantly increased the rates of FEV1 change and decreased ROS and DNA damage in V-D-deficiency. Vitamin D3 inhibited LPS-induced ROS and DNA damage and were associated with a decline in TNF-α and NFκB in epithelial cells. H2O2 reduces nuclear translocation of glucocorticoid receptors in airway epithelial cell lines. V-D pretreatment enhanced the dexamethasone-induced nuclear translocation of glucocorticoid receptors in airway epithelial cell lines and monocytes from 25-hydroxyvitamin D3-deficiency asthma patients. These findings indicate that V-D deficiency aggravates oxidative stress and DNA damage, suggesting a possible mechanism for corticosteroid resistance in severe asthma exacerbation.

  9. 25-Hydroxyvitamin D3-deficiency enhances oxidative stress and corticosteroid resistance in severe asthma exacerbation.

    Science.gov (United States)

    Lan, Nan; Luo, Guangyan; Yang, Xiaoqiong; Cheng, Yuanyuan; Zhang, Yun; Wang, Xiaoyun; Wang, Xing; Xie, Tao; Li, Guoping; Liu, Zhigang; Zhong, Nanshan

    2014-01-01

    Oxidative stress plays a significant role in exacerbation of asthma. The role of vitamin D in oxidative stress and asthma exacerbation remains unclear. We aimed to determine the relationship between vitamin D status and oxidative stress in asthma exacerbation. Severe asthma exacerbation patients with 25-hydroxyvitamin D3-deficiency (V-D deficiency) or 25-hydroxyvitamin D-sufficiency (V-D sufficiency) were enrolled. Severe asthma exacerbation with V-D-deficiency showed lower forced expiratory volume in one second (FEV1) compared to that with V-D-sufficiency. V-D-deficiency intensified ROS release and DNA damage and increased TNF-α, OGG1 and NFκB expression and NFκB phosphorylation in severe asthma exacerbation. Supplemental vitamin D3 significantly increased the rates of FEV1 change and decreased ROS and DNA damage in V-D-deficiency. Vitamin D3 inhibited LPS-induced ROS and DNA damage and were associated with a decline in TNF-α and NFκB in epithelial cells. H2O2 reduces nuclear translocation of glucocorticoid receptors in airway epithelial cell lines. V-D pretreatment enhanced the dexamethasone-induced nuclear translocation of glucocorticoid receptors in airway epithelial cell lines and monocytes from 25-hydroxyvitamin D3-deficiency asthma patients. These findings indicate that V-D deficiency aggravates oxidative stress and DNA damage, suggesting a possible mechanism for corticosteroid resistance in severe asthma exacerbation.

  10. Bronchial thermoplasty : Long-term safety and effectiveness in patients with severe persistent asthma

    NARCIS (Netherlands)

    Wechsler, Michael E.; Laviolette, Michel; Rubin, Adalberto S.; Fiterman, Jussara; Silva, Jose R. Lapa e; Shah, Pallav L.; Fiss, Elie; Olivenstein, Ronald; Thomson, Neil C.; Niven, Robert M.; Pavord, Ian D.; Simoff, Michael; Hales, Jeff B.; McEvoy, Charlene; Slebos, Dirk-Jan; Holmes, Mark; Phillips, Martin J.; Erzurum, Serpil C.; Hanania, Nicola A.; Sumino, Kaharu; Kraft, Monica; Cox, Gerard; Sterman, Daniel H.; Hogarth, Kyle; Kline, Joel N.; Mansur, Adel H.; Louie, Brian E.; Leeds, William M.; Barbers, Richard G.; Austin, John H. M.; Shargill, Narinder S.; Quiring, John; Armstrong, Brian; Castro, Mario

    2013-01-01

    Background: Bronchial thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective: We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy. Methods: BT-treated subjects from the A

  11. Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma.

    Science.gov (United States)

    Verkleij, Marieke; van de Griendt, Erik-Jonas; Colland, Vivian; van Loey, Nancy; Beelen, Anita; Geenen, Rinie

    2015-09-01

    Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.

  12. Airway β-Defensin-1 Protein Is Elevated in COPD and Severe Asthma

    Directory of Open Access Journals (Sweden)

    Katherine J. Baines

    2015-01-01

    Full Text Available Background. Innate immune antimicrobial peptides, including β-defensin-1, promote the chemotaxis and activation of several immune cells. The role of β-defensin-1 in asthma and chronic obstructive pulmonary disease (COPD remains unclear. Methods. Induced sputum was collected from healthy controls and individuals with asthma or COPD. β-defensin-1 protein in sputum supernatant was quantified by ELISA. Biomarker potential was examined using receiver operating characteristic curves. β-defensin-1 release from primary bronchial epithelial cells (pBECs was investigated in culture with and without cigarette smoke extract (CSE. Results. Airway β-defensin-1 protein was elevated in COPD participants compared to asthma participants and healthy controls. Inflammatory phenotype had no effect on β-defensin-1 levels in asthma or COPD. β-defensin-1 protein was significantly higher in severe asthma compared to controlled and uncontrolled asthma. β-defensin-1 protein could predict the presence of COPD from both healthy controls and asthma patients. Exposure of pBECs to CSE decreased β-defensin-1 production in healthy controls; however in pBECs from COPD participants the level of β-defensin-1 remanied unchanged. Conclusions. Elevated β-defensin-1 protein is a feature of COPD and severe asthma regardless of inflammatory phenotype. β-defensin-1 production is dysregulated in the epithelium of patients with COPD and may be an effective biomarker and potential therapeutic target.

  13. Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

    Directory of Open Access Journals (Sweden)

    Hodder R

    2012-08-01

    Full Text Available Rick Hodder*Divisions of Pulmonary and Critical Care, University of Ottawa and The Ottawa Hospital, Ottawa, Canada, *Dr Rick Hodder passed away on Tuesday April 17,2012. Please see the Dedication for more information on Dr Hodder.Abstract: Emergency department clinicians are frequently called upon to assess, diagnose, and stabilize patients who present with acute respiratory failure. This review describes a rapid initial approach to acute respiratory failure in adults, illustrated by two common examples: (1 an airway disease – acute potentially fatal asthma, and (2 a pulmonary parenchymal disease – acute lung injury/acute respiratory distress syndrome. As such patients are usually admitted to hospital, discussion will be focused on those initial management aspects most relevant to the emergency department clinician.Keywords: acute asthma, acute lung injury, ARDS, acute respiratory failure

  14. Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics

    DEFF Research Database (Denmark)

    Bildstrup, Line; Backer, Vibeke; Thomsen, Simon Francis

    2015-01-01

    AIM: To examine the relationship between body mass index (BMI) and different indicators of asthma severity in a large community-based sample of Danish adolescents and adults. METHODS: A total of 1186 subjects, 14-44 years of age, who in a screening questionnaire had reported a history of airway...

  15. Asthma

    Science.gov (United States)

    ... by allergens or physical activity. Occasionally, doctors use X-rays to diagnose asthma. Doctors treat each asthma case ... them. If you get flare-ups during a game or workout, stop what you're doing until ...

  16. Assessing biomarkers in a real-world severe asthma study (ARIETTA).

    Science.gov (United States)

    Buhl, Roland; Korn, Stephanie; Menzies-Gow, Andrew; Aubier, Michel; Chapman, Kenneth R; Canonica, Giorgio W; Picado, César; Martin, Nicolas; Escobar, Ramon Aguiar; Korom, Stephan; Hanania, Nicola A

    2016-06-01

    The prognostic value of asthma biomarkers in routine clinical practice is not fully understood. ARIETTA (NCT02537691) is an ongoing, prospective, longitudinal, international, multicentre real-world study designed to assess the relationship between asthma biomarkers and disease-related health outcomes. The trial aims to enrol and follow for 52 weeks approximately 1200 severe asthma patients from approximately 160 sites in more than 20 countries. Severe asthmatics, treated with daily inhaled corticosteroid (≥500 μg of fluticasone propionate or equivalent) and at least 1 second controller medication are to be included. In this real-world study, patients will be treated according to the investigator's routine clinical practices and no treatment regimen will be implemented as part of the trial. At baseline and again at 26 and 52 weeks, FEV1, FeNO, serum periostin, blood eosinophil count and serum IgE will be measured. Asthma-related symptom and quality of life questionnaires will be administered at the visits and during telephone interviews at Weeks 13 and 39. Data about medication use, asthma exacerbation data, asthma-related healthcare utilization and events raising safety concerns will also be collected. This study design, unique in both its scope and scale, will address fundamental unanswered questions regarding asthma biomarkers and their interrelationship, as well as predict deviations in the course of asthma in a real-world setting.

  17. Acute effects of air pollution on asthma hospitalization in Shanghai, China

    International Nuclear Information System (INIS)

    Air pollution has been accepted as an important contributor to asthma development and exacerbation. However, the evidence is limited in China. In this study, we investigated the acute effect of air pollution on asthma hospitalization in Shanghai, China. We applied over-dispersed generalized additive model adjusted for weather conditions, day of the week, long-term and seasonal trends. An interquartile range increase in the moving average concentrations of PM10, SO2, NO2 and BC on the concurrent day and previous day corresponded to 1.82%, 6.41%, 8.26% and 6.62% increase of asthmatic hospitalization, respectively. The effects of SO2 and NO2 were robust after adjustment for PM10. The associations appeared to be more evident in the cool season than in the warm season. Our results contribute to the limited data in the scientific literature on acute effects of air pollution on asthma in high exposure settings, which are typical in developing countries. - Highlights: • Few prior studies in China examine the effect of air pollution on asthma. • We found acute effect of air pollution on asthma hospitalization in Shanghai. • Our results contribute to limited data on air pollution and asthma in China. - Ambient air pollution increases the risk of asthma hospitalization in Shanghai, China

  18. Assessment of the Relationship Between Measures of Disease Severity, Quality of Life, and Willingness to Pay in Asthma

    OpenAIRE

    Zillich, Alan J; Karen Blumenschein; Magnus Johannesson; Patricia Freeman

    2002-01-01

    Objective:The primary objective was to evaluate the relationship between willingness-to-pay (WTP), quality-of-life (QOL), and disease-severity measures in patients with asthma. The hypothesis studied was that patients with asthma with more severe disease are willing to pay more for a hypothetical cure of asthma than those with less severe disease. Design setting/Patients and participants: One hundred patients with asthma were recruited from community pharmacies in Kentucky for 30-minute face-...

  19. Impacts of coexisting bronchial asthma on severe exacerbations in mild-to-moderate COPD: results from a national database

    Science.gov (United States)

    Lee, Hyun; Rhee, Chin Kook; Lee, Byung-Jae; Choi, Dong-Chull; Kim, Jee-Ae; Kim, Sang Hyun; Jeong, Yoolwon; Kim, Tae-Hyung; Chon, Gyu Rak; Jung, Ki-Suck; Lee, Sang Haak; Price, David; Yoo, Kwang Ha; Park, Hye Yun

    2016-01-01

    Background Acute exacerbations are major drivers of COPD deterioration. However, limited data are available for the prevalence of severe exacerbations and impact of asthma on severe exacerbations, especially in patients with mild-to-moderate COPD. Methods Patients with mild-to-moderate COPD (≥40 years) were extracted from Korean National Health and Nutrition Examination Survey data (2007–2012) and were linked to the national health insurance reimbursement database to obtain medical service utilization records. Results Of the 2,397 patients with mild-to-moderate COPD, 111 (4.6%) had severe exacerbations over the 6 years (0.012/person-year). Severe exacerbations were more frequent in the COPD patients with concomitant self-reported physician-diagnosed asthma compared with only COPD patients (P<0.001). A multiple logistic regression presented that asthma was an independent risk factor of severe exacerbations in patients with mild-to-moderate COPD regardless of adjustment for all possible confounding factors (adjusted odds ratio, 1.67; 95% confidence interval, 1.002–2.77, P=0.049). In addition, age, female, poor lung function, use of inhalers, and low EuroQoL five dimensions questionnaire index values were independently associated with severe exacerbation in patients with mild-to-moderate COPD. Conclusion In this population-based study, the prevalence of severe exacerbations in patients with mild-to-moderate COPD was relatively low, compared with previous clinical interventional studies. Coexisting asthma significantly impacted the frequency of severe exacerbations in patients with mild-to-moderate COPD, suggesting application of an exacerbation preventive strategy in these patients. PMID:27143869

  20. [A new spacer, Babyhaler, for BDP inhalation therapy in severe infantile asthma].

    Science.gov (United States)

    Yamada, Y; Yoshihara, S; Abe, T; Fukuda, N; Watanabe, M; Ono, M; Arisaka, O

    2000-11-01

    Recently, it has been recognized that airway inflammation is the most important pathogenesis of bronchial asthma, and inhaled corticosteroids therapy is effective for childhood asthma. However, using metered dose inhalers (MDI) of beclomethasone dipropionate (BDP) is difficult for infants. In this study, we administered BDP inhalation therapy with a new spacer, Babyhaler, for five cases of early childhood with severe infantile asthma that we could not control even by combination of theophylline round the clock (RTC) therapy and disodium cromoglycate (DSCG) + beta 2 stimulant (beta 2) regular use. We compared symptom score of asthma attack between the pre-treatment period (prior 2 weeks) and post-treatment period (following 8 weeks) of BDP inhalation therapy with Babyhaler. As a result, symptom score decreased significantly within 4 weeks after treatment of BDP with Babyhaler as compared with the score before treatment of BDP. These findings suggest that Babyhaler is useful for BDP inhalation therapy in infantile asthma. PMID:11193463

  1. Difficult asthma.

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

    Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.

  2. An increased ratio of Th2/Treg cells in patients with moderate to severe asthma

    Institute of Scientific and Technical Information of China (English)

    SHI Yu-heng; SHI Guo-chao; WAN Huan-ying; AI Xiang-yan; ZHU Hai-xing; TANG Wei; MA Jia-yun

    2013-01-01

    Background Recent studies have shown that T helper type-2 (Th2) cells can induce the apoptosis of CD4+CD25+ Treg cells or resist the immunosuppressive effect of Treg cells.We hypothesize that an imbalance of Th2/Treg is present in patients with allergic asthma.Methods Twenty-two patients with mild asthma,17 patients with moderate to severe asthma,and 20 healthy donors were enrolled.All patients were allergic to house dust mites.The proportion of peripheral blood CD4+CD25+ Treg cells and Th2 cells were determined by flow cytometry.The concentration of interleukin (IL)-10,transforming growth factor (TGF)-β and IL-4 in plasma was determined by enzyme linked immunosorbent assay.In these subjects,peripheral blood mononuclear cells from 17 mild asthmatic patients,13 moderate to severe asthmatic patients and 14 healthy donors were acquired and expression of forkhead box P3 (Foxp3) and GATA-3 mRNA was detected by reverse-transcriptase polymerase chain reaction.Results Compared with healthy donors and patients with mild asthma,the percent of CD4+CD25+ Treg cells and plasma IL-10 levels were decreased in patients with moderate to severe asthma.There were no significant differences in Foxp3 mRNA expression among three groups,but a downward trend seen among patients with asthma.However,the percent of Th2 cells,IL-4 levels and expression of GATA-3 mRNA was markedly higher in patients with mild and moderate to severe asthma than in the control group.The ratio of Th2/Treg and their cytokines was increased in allergic asthma,especially for moderate to severe asthma.The ratio of GATA-3/Foxp3 mRNA was also increased in allergic asthma.In patients with moderate to severe asthma,the percentage of peripheral blood Treg cells was negatively correlated to the percentage of Th2 cells and IL-4 levels.Conclusions The decline of CD4+CD25+ Treg cells in patients with moderate to severe asthma may play an important role in progress of the disease.Furthermore,the deficiency of CD4+CD25+ Treg

  3. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2012-02-01

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 +\\/- 0.41 to 0.8 +\\/- 0.37 and the mean number of bed days occupied was reduced from 16.6 +\\/- 2.94 to 5.3 +\\/- 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 +\\/- 0.27 to 1.2 +\\/- 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  4. Standardized Treatment of Asthma (3 Cases of Severe Asthma Rescue Report)%支气管哮喘的规范化治疗体会(附3例重症支气管哮喘抢救报告)

    Institute of Scientific and Technical Information of China (English)

    徐晓波; 李善群; 李春; 潘珏; 朱蕾; 钮善福; 白春学

    2011-01-01

    Objective: To explore the importance and necessity of standardized treatment of asthma.Methods: We reviewed and analyzed 3 cases of severe asthma treatment process in our respiratory intensive care unit (RICU), and compared the control level before and after standardized treatment, combining the related literature review.Results:Three patients had a clear history of asthma, but they did not accept the standardized treatment, they were not controlled before admission, and the acute severe asthma attack caused serious respiratory failure and hospitalization.During asthma attack, it was also, without exception, there were serious lung infection.After they received standardized management and treatment, they got full control of asthma symptoms, and lung functions were restored and maintained relatively good.Conclusions: Although asthma is not completely curable, but it can be completely controlled through standardized treatment and management, that is the only way to gradually reduce the acute attack of asthma, especially the acute severe asthma attack.%目的:探讨哮喘规范化治疗的重要性和必要性.方法:复旦大学附属中山医院呼吸重症监护室收治的3例重症哮喘救治过程,对比规范化治疗前后控制水平,并结合病例进行相关文献复习.结果:3例患者均有明确的哮喘病史,均未接受规范化治疗,在入院前属于哮喘未控制,入院时急性发作属于危重状态,均存在严重的肺部感染和呼吸衰竭.当病情获得好转后,给予规范化管理和治疗,哮喘症状基本控制,肺功能也恢复和保持相对较好水平.结论:虽然哮喘尚不能完全治愈,但通过规范化的治疗和管理可以达到完全控制,只有这样才能逐步减少哮喘的急性发作,特别是危重状态的急性发作.

  5. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen;

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20...... survey to 4.8% in the second survey (pSmoking decreased...... significantly from 62% in 1976-8 to 45% in 1991-4 (pyoung adults in Copenhagen over a 15 year period. The severity of asthma, as judged by the level of FEV(1), has also increased. These findings cannot be explained...

  6. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen;

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20...... significantly from 62% in 1976-8 to 45% in 1991-4 (pyoung adults in Copenhagen over a 15 year period. The severity of asthma, as judged by the level of FEV(1), has also increased. These findings cannot be explained...

  7. Effects of oral montelukast on airway function in acute asthma.

    Science.gov (United States)

    Cýllý, A; Kara, A; Ozdemir, T; Oğüş, C; Gülkesen, K H

    2003-05-01

    Montelukast, a specific cysteinyl leukotriene receptor antagonist, has been shown to improve pulmonary function within 1 h of ingestion. This study was undertaken to compare the effects on peak expiratory flow rate (PEFR) of oral montelukast added to intravenous steroid, intravenous steroid alone and placebo during the 24 h period following administration. Seventy asthmatic patients (FEV1 40-80% predicted and > or = 15% improvement after inhaled beta agonist) were enrolled in a single blind study to receive oral montelukast (10 mg) plus intravenous prednisolone (1 mg/kg), intravenous prednisolone (1 mg/kg) or placebo in a randomised fashion. The patients received one ofthe above three groups of medication before any other treatments. This was immediately followed by the aerosol treatments of 100 mcg of terbutaline sulphate divided into three doses during 1 h as described in the consensus statement. Thereafter, patients were observed for 24 h to document the effects on PEFR, Borg dyspnoea score and need for rescue medication. The primary end point was percentage change at different time points. Secondary end points were Borg dyspnoea score and use of rescue medication. Compared with placebo, montelukast added to the prednisolone group and the prednisolone alone group had significant percentage change from baseline in PEFR in the entire 24 h period (P<0.05). The difference in PEFR between montelukast plus prednisolone group and prednisolone group favoured the montelukast plus prednisolone group but did not reach statistical significance. Furthermore, montelukast plus prednisolone group required less inhaled short-acting beta agonistthan other two groups. The results of this study indicate that adding montelukast to steroid in acute asthma may have some additive improvement in lung functions. PMID:12735671

  8. Asthma

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  9. Sputum interleukin-17 is increased and associated with airway neutrophilia in patients with severe asthma

    Institute of Scientific and Technical Information of China (English)

    SUN Yong-chang; ZHOU Qing-tao; YAO Wan-zhen

    2005-01-01

    @@ Asthma is a chronic inflammatory airway disease characterized by the involvement of many cells (including eosinophils, mast cells, T cells, neutrophils and airway epithelial cells) and their cellular components.1 While airway eosinophilic inflammation is considered as a characteristic of asthma, our previous reports2,3 and other recent studies4,5 have demonstrated that neutrophils may play important roles in airway inflammation, or even in airway remodeling, particularly in severe asthma. The mechanisms underlying the neutrophil accumulation in asthmatic airway remain to be elucidated. Interleukin-8 (IL-8) is a potent chemotactic factor for neutrophils, and was demonstrated to be increased in asthmatic airways.6,7 More recent studies have shown that T-cell derived IL-17 can accumulate neutrophils via a IL-8 dependent pathway.8,9 Whether IL-17/IL-8 mechanism is involved in airway inflammation in severe asthma is not clear.

  10. Pathogenesis of acute lung injury in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    SHI Lei; YUE Yuan; ZHANG Mei; PAN Cheng-en

    2005-01-01

    Objective:To study the pathogenesis of acute lung injury in severe acute pancreatitis (SAP). Methods:Rats were sacrificed at 1, 3, 5, 6, 9 and 12 h after establishment of inducing model. Pancreas and lung tissues were obtained for pathological study, microvascular permeability and MPO examination. Gene expressions of TNF-α and ICAM-1 in pancreas and lung tissues were detected by RT-PCR. Results:After inducing SAP model, the injury degree of the pancreas and the lung increased gradually, accompanied with gradually increased MPO activity and microvascular permeability. Gene expressions of TNF-α and ICAM-1 in pancreas rose at 1 h and reached peak at 7 h. Relatively, their gene expressions in the lungs only rose slightly at 1 h and reached peak at 9-12 h gradually. Conclusion:There is an obvious time window between SAP and lung injury, when earlier protection is beneficial to prevent development of acute lung injury.

  11. COPD assessment test and severity of airflow limitation in patients with asthma, COPD, and asthma–COPD overlap syndrome

    OpenAIRE

    Kurashima K; Takaku Y; Ohta C; Takayanagi N; Yanagisawa T; Sugita Y

    2016-01-01

    Kazuyoshi Kurashima, Yotaro Takaku, Chie Ohta, Noboru Takayanagi, Tsutomu Yanagisawa, Yutaka Sugita Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan Objective: The COPD assessment test (CAT) consists of eight nonspecific scores of quality of life. The aim of this study was to compare the health-related quality of life and severity of airflow limitation in patients with asthma, COPD, and asthma–COPD overlap syndrome (ACOS) ...

  12. Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.

    OpenAIRE

    Marie-Christine Dombret; Khuder Alagha; Louis Philippe Boulet; Pierre Yves Brillet; Guy Joos; Michel Laviolette; Renaud Louis; Thierry Rochat; Paola Soccal; Michel Aubier; Pascal Chanez

    2014-01-01

    Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk-benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study des...

  13. The influence of asthma onset and severity on malocclusion prevalence in children and adolescents

    Directory of Open Access Journals (Sweden)

    Luiz Sekio Tanaka

    2012-02-01

    Full Text Available OBJECTIVE: The influence of asthma, its severity levels and onset time on malocclusion occurrence were investigated. METHODS: The sample was composed by 176 children/adolescents, of both genders, aged 3 to 15 years, that were divided in two groups. The asthma group (AG enrolled 88 children/adolescents that were seen at the Breathe Londrina Program. The asthma-free group (AFG enrolled 88 preschool and school children recruited in 2 public schools. Malocclusion diagnosis was made according to WHO criteria (OMS, 1999. RESULTS: A higher prevalence in malocclusions in asthmatic patients in mixed dentition was observed when compared to controls (p0.05 and permanent dentition (p>0.05. A significant association was seen between asthma onset time and marked maxillary overjet (p<0.05, and open bite (p<0.05 in the mixed dentition, being both conditions more common among those that have presented the symptoms of asthma prior to 12 months of age. CONCLUSION: The results of this study indicate that the early manifestation of asthma at first year of life can cause dentofacial changes. Therefore, the prompt diagnostic of the illness, as well as the establishment of a proper therapy could improve the symptoms and chronic complications of asthma and also reduce its impact on craniofacial development.

  14. The Efficacy of Tiotropium as a Steroid-Sparing Agent in Severe Asthma

    Directory of Open Access Journals (Sweden)

    Anmol S Kapoor

    2009-01-01

    Full Text Available People with severe asthma account for 5% to 10% of all asthmatic patients; however, this small group uses the majority of health care resources. Novel methods are needed to cope with the burden that this minority of patients places on the health care system. A severe asthma clinic patient, who was monitored through the University of Alberta’s Virtual Asthma Clinic (Edmonton, Alberta is presented. Despite optimization of his disease and individualized asthma education (provided by a certified asthma educator, the patient remained on oral glucocorticosteroids (OGS to control his disease. Following optimization and stabilization, a further reduction in the dose of his OGS by the addition of the long-acting anticholinergic agent tiotropium bromide, was demonstrated. The role of tiotropium as a potential ‘steroid-sparing agent’ in severe refractory asthma is discussed, noting that if patients who are on OGS are not monitored for active inflammation, they may overuse the amount of prescribed systemic steroids, which can result in long-term steroid-related sequelae.

  15. February 2015 pulmonary case of the month: severe asthma

    Directory of Open Access Journals (Sweden)

    Uppalapu S

    2015-02-01

    Full Text Available No abstract available. Article truncated at 150 words. History of present illness: A 50-year-old African-American woman with a history of asthma presented to the emergency department with a chief complaint of shortness of breath for 2 weeks. She reported some chest tightness, wheezing and dry cough. She denied fever, chills, myalgias or arthralgias at the time of admission. PMH, SH and FH: In addition to asthma, she has a past medical history of type 2 diabetes mellitus, hypertension, and multiple sclerosis. She admitted to social smoking but states she quit 6 to 7 months ago. She denies alcohol, recreational drug use, or a family history of early coronary artery disease, strokes or cancers. Medications: montelukast 10 mg daily; salmeterol/fluticasone 250/50 inhaled twice a day; albuterol inhaler as needed for shortness of breath; metformin 500 mg bid; dimethyl fumarate 240 mg bid; omega 3 fish oil; calcium carbonate 600 mg daily; naproxen 500 mg bid; lisinopril 10 mg daily ...

  16. Therapeutic Strategies for Severe Acute Lung Injury

    Science.gov (United States)

    Diaz, Janet. V.; Brower, Roy; Calfee, Carolyn S.; Matthay, Michael A.

    2015-01-01

    Objective In the management of patients with severe Acute Lung Injury and the Acute Respiratory Distress Syndrome (ALI/ARDS), clinicians are sometimes challenged to maintain acceptable gas exchange while avoiding harmful mechanical ventilation practices. In some of these patients, physicians may consider the use of “rescue therapies” to sustain life. Our goal is to provide a practical, evidence-based review to assist critical care physicians’ care for patients with severe ALI/ARDS. Data Sources and Study Selection We searched the Pub Med database for clinical trials examining the use of the following therapies in ALI/ARDS: recruitment maneuvers, high positive end expiratory pressure, prone position, high frequency oscillatory ventilation, glucocorticoids, inhaled nitric oxide, buffer therapy and extracorporeal life support. Study selection All clinical trials that included patients with severe ALI/ARDS were included in the review. Data Synthesis The primary author reviewed the aforementioned trials in depth and then disputed findings and conclusions with other authors until consensus was achieved. Conclusions This article is designed to: a) provide clinicians with a simple, bedside definition for the diagnosis of severe ARDS; b) describe several therapies that can be used in severe ARDS with an emphasis on the potential risks as well as the indications and benefits; and c) to offer practical guidelines for implementation of these therapies. PMID:20562704

  17. MicroRNAs profiling in murine models of acute and chronic asthma: a relationship with mRNAs targets.

    Directory of Open Access Journals (Sweden)

    Nancy Garbacki

    Full Text Available BACKGROUND: miRNAs are now recognized as key regulator elements in gene expression. Although they have been associated with a number of human diseases, their implication in acute and chronic asthma and their association with lung remodelling have never been thoroughly investigated. METHODOLOGY/PRINCIPAL FINDINGS: In order to establish a miRNAs expression profile in lung tissue, mice were sensitized and challenged with ovalbumin mimicking acute, intermediate and chronic human asthma. Levels of lung miRNAs were profiled by microarray and in silico analyses were performed to identify potential mRNA targets and to point out signalling pathways and biological processes regulated by miRNA-dependent mechanisms. Fifty-eight, 66 and 75 miRNAs were found to be significantly modulated at short-, intermediate- and long-term challenge, respectively. Inverse correlation with the expression of potential mRNA targets identified mmu-miR-146b, -223, -29b, -29c, -483, -574-5p, -672 and -690 as the best candidates for an active implication in asthma pathogenesis. A functional validation assay was performed by cotransfecting in human lung fibroblasts (WI26 synthetic miRNAs and engineered expression constructs containing the coding sequence of luciferase upstream of the 3'UTR of various potential mRNA targets. The bioinformatics analysis identified miRNA-linked regulation of several signalling pathways, as matrix metalloproteinases, inflammatory response and TGF-β signalling, and biological processes, including apoptosis and inflammation. CONCLUSIONS/SIGNIFICANCE: This study highlights that specific miRNAs are likely to be involved in asthma disease and could represent a valuable resource both for biological makers identification and for unveiling mechanisms underlying the pathogenesis of asthma.

  18. Profile of acute severe malaria with hepatopathy

    Directory of Open Access Journals (Sweden)

    Aminul Khan

    2014-10-01

    Full Text Available Background: The single most dreaded complication in severe malaria is cerebral malaria, but extracerebral serious complications are becoming frequent in endemic areas, which include hepatic dysfunctions with jaundice. Materials and Methods: This prospective case series study was undertaken to observe the clinical profile in 81cases of complicated malaria presenting with jaundice out of 344 hospitalized patients diagnosed with acute severe malaria. Liver function tests were assessed and the patients were followed up to 4 weeks. Results: 85% cases with jaundice had Plasmodium falciparum (Pf infection. Significant findings included a predominantly hemolytic jaundice (mean bilirubin 7.6 mg%, unconjugated 4.83 mg%, conjugated 2.79 mg%, raised ALT > AST (mean 101.2 vs.74.7 iu and a mean prothrombin time of 3 sec > control. Acute renal failure was common (77%. No residual hepatic dysfunctions were detected in survivors on follow-up. Mortality was 10%, mostly due to delayed diagnosis and associated serious co-morbid conditions. Conclusion: Differentiating fulminant viral hepatitis with multi-organ failure and early treatment of associated complications are crucial to reduce mortality in malaria presenting with jaundice. Hemolytic jaundice with mild and relatively early reversibility of hepatocellular dysfunction usually points towards complicated Pf malaria. Histologically, there is mild hepatic derangement. Acute renal failure is commonly associated. Vivax malaria can also cause hepatic dysfunctions. Mere presence of jaundice does not increase mortality compared to those without jaundice

  19. The need to differentiate between adults and children when treating severe asthma.

    Science.gov (United States)

    Fainardi, Valentina; Saglani, Sejal

    2015-08-01

    Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally. Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.

  20. Breath formate is a marker of airway S-nitrosothiol depletion in severe asthma.

    Directory of Open Access Journals (Sweden)

    Roby Greenwald

    Full Text Available BACKGROUND: Children with severe asthma have poor symptom control and elevated markers of airway oxidative and nitrosative stress. Paradoxically, they have decreased airway levels of S-nitrosothiols (SNOs, a class of endogenous airway smooth muscle relaxants. This deficiency results from increased activity of an enzyme that both reduces SNOs to ammonia and oxidizes formaldehyde to formic acid, a volatile carboxylic acid that is more easily detected in exhaled breath condensate (EBC than SNOs. We therefore hypothesize that depletion of airway SNOs is related to asthma pathology, and breath formate concentration may be a proxy measure of SNO catabolism. METHODS AND FINDINGS: We collected EBC samples from children and adolescents, including 38 with severe asthma, 46 with mild-to-moderate asthma and 16 healthy adolescent controls, and the concentration of ionic constituents was quantified using ion chromatography. The concentrations of EBC components with volatile conjugates were log-normally distributed. Formate was the principal ion that displayed a significant difference between asthma status classifications. The mean EBC formate concentration was 40% higher in samples collected from all asthmatics than from healthy controls (mean = 5.7 microM, mean+/-standard deviation = 3.1-10.3 microM vs. 4.0, 2.8-5.8 microM, p = 0.05. EBC formate was higher in severe asthmatics than in mild-to-moderate asthmatics (6.8, 3.7-12.3 microM vs. 4.9, 2.8-8.7 microM, p = 0.012. In addition, formate concentration was negatively correlated with methacholine PC(20 (r = -0.39, p = 0.002, asthmatics only, and positively correlated with the NO-derived ion nitrite (r = 0.46, p<0.0001 as well as with total serum IgE (r = 0.28, p = 0.016, asthmatics only. Furthermore, formate was not significantly correlated with other volatile organic acids nor with inhaled corticosteroid dose. CONCLUSIONS: We conclude that EBC formate concentration is significantly higher in the breath of

  1. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2011-05-11

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 ± 0.41 to 0.8 ± 0.37 and the mean number of bed days occupied was reduced from 16.6 ± 2.94 to 5.3 ± 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 ± 0.27 to 1.2 ± 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  2. A study of air pollutants and acute asthma exacerbations in urban areas: status report

    International Nuclear Information System (INIS)

    Details of a study to investigate the possible roles of a variety of hazardous air pollutants on asthma exacerbations at ambient air concentrations. - A study to try to better understand the interactions between various air contaminants and acute asthma exacerbations is described. The study evaluates temporal associations between a panel of air contaminants and acute asthmatic exacerbations as measured by emergency room visits for asthma in communities in the Bronx and Manhattan in New York City (NYC). In addition, ambient levels of various air pollutants in two NYC communities are being compared. Almost 2 years of daily data have been collected for most of the air contaminants to be investigated. The air contaminants measured include gaseous compounds (ozone, sulfur dioxide, nitrogen oxides, aldehydes, nitrous acid, nitric acid, hydrochloric acid and ammonia), particulate matter components (metals, elemental and organic carbon, sulfate, hydrogen ion, pollen, mold spores and particle mass and number)

  3. Serum total IgE levels and total eosinophil counts: relationship with treatment response in patients with acute asthma Relação dos níveis séricos de IgE total e das contagens de eosinófilos com a resposta ao tratamento em pacientes com asma aguda

    OpenAIRE

    Ebrahim Razi; Gholam Abbass Moosavi

    2010-01-01

    OBJECTIVE: To determine whether serum total IgE levels and total eosinophil counts have any relationship with the response to routine pharmacological treatment in patients with acute asthma. METHODS: A cross-sectional study involving 162 patients with acute asthma. Serum total IgE levels, peripheral blood cell counts and eosinophil counts were determined. The treatment was adjusted for each patient according to the severity of asthma. Spirometry was performed at baseline and two weeks after t...

  4. Pooled Sequencing of Candidate Genes Implicates Rare Variants in the Development of Asthma Following Severe RSV Bronchiolitis in Infancy.

    Directory of Open Access Journals (Sweden)

    Dara G Torgerson

    Full Text Available Severe infection with respiratory syncytial virus (RSV during infancy is strongly associated with the development of asthma. To identify genetic variation that contributes to asthma following severe RSV bronchiolitis during infancy, we sequenced the coding exons of 131 asthma candidate genes in 182 European and African American children with severe RSV bronchiolitis in infancy using anonymous pools for variant discovery, and then directly genotyped a set of 190 nonsynonymous variants. Association testing was performed for physician-diagnosed asthma before the 7th birthday (asthma using genotypes from 6,500 individuals from the Exome Sequencing Project (ESP as controls to gain statistical power. In addition, among patients with severe RSV bronchiolitis during infancy, we examined genetic associations with asthma, active asthma, persistent wheeze, and bronchial hyperreactivity (methacholine PC20 at age 6 years. We identified four rare nonsynonymous variants that were significantly associated with asthma following severe RSV bronchiolitis, including single variants in ADRB2, FLG and NCAM1 in European Americans (p = 4.6x10-4, 1.9x10-13 and 5.0x10-5, respectively, and NOS1 in African Americans (p = 2.3x10-11. One of the variants was a highly functional nonsynonymous variant in ADRB2 (rs1800888, which was also nominally associated with asthma (p = 0.027 and active asthma (p = 0.013 among European Americans with severe RSV bronchiolitis without including the ESP. Our results suggest that rare nonsynonymous variants contribute to the development of asthma following severe RSV bronchiolitis in infancy, notably in ADRB2. Additional studies are required to explore the role of rare variants in the etiology of asthma and asthma-related traits following severe RSV bronchiolitis.

  5. Severe acute pancreatitis: Clinical course and management

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically.Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the SepsisRelated Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions.Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

  6. Effects of inhaled L-arginine administration in a murine model of acute asthma.

    Directory of Open Access Journals (Sweden)

    Zeynep Arikan-Ayyildiz

    2014-10-01

    Full Text Available Increased arginase activity in the airways decreases L-arginine and causes deficiency of bronchodilating and anti-inflammatory nitric oxide (NO in asthma. As, it is suggested that L-arginine may have therapeutic potential in asthma treatment, we aimed to investigate the effects of inhaled L-arginine on oxygen saturation (SaO₂ and airway histology in a murine model of acute asthma. Twenty eight BALB/c mice were divided into four groups; I, II, III and IV (control. All groups except the control were sensitized and challenged with ovalbumin. After establishement of acute asthma attack by metacholine administration, the mice were treated with inhaled L-arginine (Group I, saline (Group II and budesonide (Group III, respectively. SaO₂was measured by pulse oximeter just before and 5 min after methacholine. A third measurement of SaO₂was also obtained 15 min after drug administration in these study groups. Inflammation in the lung tissues of the sacrificed animals were scored to determine the effects of the study drugs. The number of eosinophils in bronchoalveolar lavage (BAL was determined. The results indicated that inflammatory scores significantly improved in groups receiving study drugs when compared with placebo and L-arginine was similar in decreasing scores when compared with budesonide. SaO₂had a tendency to increase after L-arginine administration after acute asthma attack and this increase was statistically significant (p=0.043. Eosinophilia in BAL significantly reduced in group receiving L-arginine when compared with placebo (p<0.05. Thus in this study we demonstrated that L-arginine improved SaO₂and inflammatory scores in an acute model of asthma.

  7. Inflammation and immunosuppression in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Marja-Leena; Kylnp; Heikki; Repo; Pauli; Antero; Puolakkainen

    2010-01-01

    Acute pancreatitis(AP) is a common disease,which usually exists in its mild form.However,in a fifth of cases,the disease is severe,with local pancreatic complications or systemic organ dysfunction or both.Because the development of organ failure is the major cause of death in AP,early identification of patients likely to develop organ failure is important.AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas.Destruction of the pancreatic parenchyma first indu...

  8. A Comparative Efficacy of Oral Prednisone with Intramuscular Triamcinolone in Acute Exacerbation of Asthma

    Directory of Open Access Journals (Sweden)

    Ebrahim Razi Gholam Abbass Moosavi

    2006-03-01

    We conclude that in adults with acute asthma, oral prednisone is more effective than intramuscular triamcinolone LA in improvement of FEV1, but although efficacy of oral prednisone in improvement of FVC is more than intramuscular triamcinolone LA group, this effect is not significant.

  9. Anti-IgE therapy with omalizumab for severe asthma: current concepts and potential developments.

    Science.gov (United States)

    Pelaia, Girolamo; Vatrella, Alessandro; Busceti, Maria Teresa; Gallelli, Luca; Terracciano, Rosa; Maselli, Rosario

    2015-01-01

    The humanized monoclonal anti-IgE antibody omalizumab is currently the only biologic drug approved for asthma treatment. Omalizumab inhibits allergic responses by binding to serum immunoglobulins E (IgE), thus preventing their interactions with cellular IgE receptors. Omalizumab is also capable of down-regulating the expression of high affinity IgE receptors on inflammatory cells, as well as the numbers of eosinophils in both peripheral blood and induced sputum. The clinical effects of omalizumab include relevant improvements in respiratory symptoms and quality of life, paralleled by a marked reduction of asthma exacerbations, emergency room visits, and use of systemic corticosteroids and rescue bronchodilators. Moreover, some recent studies suggest potential benefits of omalizumab also in non allergic phenotypes of severe asthma. Very interesting are also further recent reports referring to the potential inhibitory effect of omalizumab with regard to bronchial structural changes, especially occurring in severe asthma and globally defined as airway remodeling. Omalizumab is relatively well tolerated, and only very rarely induces anaphylactic reactions. Therefore, this drug represents a valid option as add-on therapy for patients with severe persistent asthma, inadequately controlled by high doses of standard inhaled treatments. PMID:25523898

  10. Detrimental effects of environmental tobacco smoke in relation to asthma severity.

    Directory of Open Access Journals (Sweden)

    Suzy A A Comhair

    Full Text Available BACKGROUND: Environmental tobacco smoke (ETS has adverse effects on the health of asthmatics, however the harmful consequences of ETS in relation to asthma severity are unknown. METHODS: In a multicenter study of severe asthma, we assessed the impact of ETS exposure on morbidity, health care utilization and lung functions; and activity of systemic superoxide dismutase (SOD, a potential oxidative target of ETS that is negatively associated with asthma severity. FINDINGS: From 2002-2006, 654 asthmatics (non-severe 366, severe 288 were enrolled, among whom 109 non-severe and 67 severe asthmatics were routinely exposed to ETS as ascertained by history and validated by urine cotinine levels. ETS-exposure was associated with lower quality of life scores; greater rescue inhaler use; lower lung function; greater bronchodilator responsiveness; and greater risk for emergency room visits, hospitalization and intensive care unit admission. ETS-exposure was associated with lower levels of serum SOD activity, particularly in asthmatic women of African heritage. INTERPRETATION: ETS-exposure of asthmatic individuals is associated with worse lung function, higher acuity of exacerbations, more health care utilization, and greater bronchial hyperreactivity. The association of diminished systemic SOD activity to ETS exposure provides for the first time a specific oxidant mechanism by which ETS may adversely affect patients with asthma.

  11. Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma.

    Directory of Open Access Journals (Sweden)

    Camille Taillé

    Full Text Available Obstructive sleep apnoea (OSA is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA.An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies.In total, 27/55 patients (49% had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2 ± 1.6 event/h [5-35], the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8 ± 0.4 vs. 7.8 ± 0.4 μm, p<0.05. RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05. OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment.Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling.

  12. Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Mónica; García; José; Julián; Calvo

    2010-01-01

    Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Although the majority of patients have a mild episode of AP, 10%-20% develop a severe acute pancreatitis (SAP) and suffer systemic inflammatory response syndrome (SIRS) and/or pancreatic necrosis. The main aim of this article is to review the set of events, f irst localized in the pancreas, that lead to pancreatic inflammation and to the spread to other organs contributing to multiorganic shock. The early pathogenic mechanisms in SAP are not completely understood but both premature activation of enzymes inside the pancreas, related to an impaired cytosolic Ca2+ homeostasis, as well as release of pancreatic enzymes into the bloodstream are considered important events in the onset of pancreatitis disease. Moreover, afferent f ibers within the pancreas release neurotransmitters in response to tissue damage. The vasodilator effects of these neurotransmitters and the activation of pro-inflammatory substances play a crucial role in amplifying the inflammatory response, which leads to systemic manifestation of AP. Damage extension to other organs leads to SIRS, which is usually associated with cardiocirculatoryphysiology impairment and a hypotensive state. Hypotension is a risk factor for death and is associated with a signif icant hyporesponsiveness to vasoconstrictors. This indicates that stabilization of the patient, once this pathological situation has been established, would be a very diff icult task. Therefore, it seems particularly necessary to understand the pathological mechanisms involved in the f irst phases of AP to avoid damage beyond the pancreas. Moreover, efforts must also be directed to identify those patients who are at risk of developing SAP.

  13. Bronchodilator response following methacholine-induced bronchoconstriction predicts acute asthma exacerbations.

    Science.gov (United States)

    Park, Heung-Woo; Song, Woo-Jung; Chang, Yoon-Suk; Cho, Sang-Heon; Datta, Soma; Weiss, Scott T; Tantisira, Kelan G

    2016-07-01

    Methacholine bronchial provocation test provides the concentration of methacholine causing a 20% decrease in forced expiratory volume in 1 s (FEV1) from baseline (PC20). The dose-response slope (DRS), and other continuous indices of responsiveness (CIR; the percentage decline from the post-diluent baseline FEV1 after the last dose of methacholine), and per cent recovery index (PRI; the percentage increase from the maximally reduced FEV1 after bronchodilator inhalation) are alternative measures. The clinical relevance of these indices in predicting acute asthma exacerbations has not been fully evaluated.In two prospective cohorts of childhood and elderly asthmatics, baseline PC20, DRS, CIR and PRI were measured and evaluated as predictors of acute asthma exacerbations.We found that PRI was significantly related to the presence of asthma exacerbations during the first year of follow-up in both cohorts of childhood (p=0.025) and elderly asthmatics (p=0.003). In addition, PRI showed a significant association with the total number of steroid bursts during 4.3 years of follow-up in the cohort of childhood asthmatics (p=0.04).We demonstrated that PRI, an index of reversibility following methacholine-induced bronchoconstriction, was a good clinical predictor of acute exacerbations of asthma in both childhood and elderly asthmatics. PMID:27076579

  14. Acute relief of exercise-induced bronchoconstriction by inhaled formoterol in children with persistent asthma

    DEFF Research Database (Denmark)

    Hermansen, Mette Northman; Nielsen, Kim Gjerum; Buchvald, Frederik;

    2006-01-01

    -controlled, crossover study of the immediate effect of formoterol, 9 microg, vs terbutaline, 0.5 mg, and placebo administered as dry powder at different study days. Exercise challenge test was used as a model of acute bronchoconstriction. PATIENTS: Twenty-four 7- to 15-year-old children with persistent asthma......STUDY OBJECTIVE: To compare the acute bronchodilatory effect of the long-acting beta2-agonist formoterol against the short-acting beta2-agonist (SABA) terbutaline during exercise-induced bronchoconstriction (EIB) in children with asthma. DESIGN: A randomized, double-blind, placebo...... dose. RESULTS: Formoterol and terbutaline offered a significant acute bronchodilatory effect from 3 min after dose compared with placebo (p

  15. Mannose binding lectin (MBL levels predict lung function decline in severe asthma

    Directory of Open Access Journals (Sweden)

    Ilonka. H. van Veen

    2006-12-01

    Full Text Available There is increasing evidence that activation of the complement system in asthma contributes to ongoing inflammation, tissue damage and airway remodeling. Mannose binding lectin (MBL is a pattern recognition molecule that serves as the key mediator of the lectin pathway of complement activation. MBL levels are genetically determined and vary widely amongst individuals. In the present study we hypothesized that high MBL levels in asthma are associated with increased loss of lung function over time, as a consequence of inflammatory tissue damage. We measured serum MBL levels by ELISA in 68 patients with severe asthma and prospectively determined the change in post-bronchodilator (pb FEV1 over a mean period of 5.7 years. The relationship between MBL and change in pbFEV1 (FEV1 was analysed using (multiple regression analysis and corrected for possible confounders (age, sex, age of onset, asthma duration, and pbFEV1. The median (range MBL level was 332 (10.8-3587 ng·ml–1. MBL was significantly associated with FEV1 (p<0.04. Patients with a high MBL level (332 ng·ml–1 had an increased risk of lung function decline compared to those with low MBL levels (OR (CI: 3.16 (1.14-8.79, p = 0.027; the excess decline being 42 ml·yr–1 (p = 0.01. We conclude that a high MBL level is associated with an increased decline in lung function in patients with severe asthma. MBL might provide a clue towards better understanding of the pathophysiology of ongoing inflammation and subsequent decline in lung function of patients with severe asthma.

  16. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda

    DEFF Research Database (Denmark)

    Nantanda, Rebecca; Tumwine, James K; Ndeezi, Grace;

    2013-01-01

    Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based...

  17. The immune profile associated with acute allergic asthma accelerates clearance of influenza virus

    OpenAIRE

    Samarasinghe, Amali E.; Woolard, Stacie N; Boyd, Kelli L.; Hoselton, Scott A; Schuh, Jane M; McCullers, Jonathan A.

    2014-01-01

    Asthma was the most common comorbidity in hospitalized patients during the 2009 influenza pandemic. For unknown reasons, hospitalized asthmatics had less severe outcomes and were less likely to die from pandemic influenza. Our data with primary human bronchial cells indicate that changes intrinsic to epithelial cells in asthma may protect against cytopathology induced by influenza virus. To further study influenza virus pathogenesis in allergic hosts, we aimed to develop and characterize muri...

  18. [Duration of bronchodilator effect of inhaled Salmeterol (dry powder x metered dose inhaler) in children with acute asthma attack].

    Science.gov (United States)

    Solé, D; Rizzo, M C; Porto, I M; Gomez, I D; Sano, F; Figueiredo, M A; Naspitz, C K

    1996-01-01

    Patients during a mild to moderate acute attack of asthma (FEV1: 50 - 80% of predicted) were treated with Salmeterol MDI - 50mcg or Rotadisk - 50mcg or Salbutamol (MDI -200mcg). The children were followed by Spirometry, measuring FEV1 (basal) and after treatment: at 30 minutes, 60 minutes and thereafter every 60 minutes until 780 minutes, if the patients maintained the FEV1 above 80% of the predicted value and/or an increment of 20% in the VEF1 basal value. The Salmeterol group showed a significant bronchodilation at 60 minutes which was maintained in half of the patients up to 9 hours. This was not observed in the Salbutamol group: the peak bronchodilatation was observed at 30 minutes and the bronchodilation effect was observed in half of the patients up to 6 hours. There were no significant differences between both presentations of Salmeterol. This drug allowed a prolonged bronchodilator effect and is, according to the several consensus on management of asthma, an adequate option in the treatment of moderate to severe asthma. PMID:14688969

  19. CHARACTERIZATION OF VEGETATIVE CHANGES IN BRONCHIAL ASTHMA OF VARIOUS SEVERITIES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Hurmatoy Khankeldieva

    2015-06-01

    Full Text Available This article presents a study of the state of vegetative balance and prognostic possibilities of quantitative parameters of functional activity of VNS to estimate a state of bodily adaptive reserves in children with severe BA. Bronchial asthma, being one of the most common chronic diseases in childhood, requires further research into predisposing and causally-significant factors, mechanisms of pathogenesis and peculiarities of a clinical course, improvement of methods of diagnostics, treatment, and prevention. Great importance in the development of bronchial asthma in children is given to genetically-fixed functional insufficiency of barrier tissues of the respiratory system, increased ability to synthesize allergic antibodies and produce certain cytokines, high bronchopulmonary sensitivity to mediators of allergic inflammation, lowered sensitivity of 3g-adrenoreceptors to endogenous catecholamins, changes in immunologic responsiveness, and disorder of neuroendocrinal regulation of immune responses. Implementation of genetic predisposition to bronchial asthma development is promoted by influence of adverse environmental factors.

  20. Pathogenesis of severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ding-mei; LU Jia-hai; ZHONG Nan-shan

    2008-01-01

    Severe acute respiratory syndrome (SARS) first emerged in Guangdong province,China in November2002.During the following 3 months,it spread rapidly across the world,resulting in approximately 800 deaths.In 2004,subsequent sporadic cases emerged in Singapore and China.A novel coronavims,SARS-CoV,was identified as the etiological agent of SARS.1,2 This virus belongs to a family of large,positive,single-stranded RNA viruses.Nevertheless,genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses,SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract.The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins,and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003.The predominant pathological finding in these cases was diffuse alveolar damage (DAD).This severe pulmonary injury of SARS patients is caused both by direct viral effects and immunopathogenetic factors.5 Many important aspects of the pathogenesis of SARS have not yet been fully clarified.In this article,we summarize the most important mechanisms involved in the complex pathogenesis of SARS,including clinical characters,host and receptors,immune system response and genetic factors.

  1. The burden of severe asthma in childhood and adolescence

    DEFF Research Database (Denmark)

    Fleming, Louise; Murray, Clare; Bansal, Aruna T;

    2015-01-01

    preschoolers with mild/moderate wheeze in a cross-sectional study. Despite high-dose treatment, the severe cohorts had more severe exacerbations compared with the mild/moderate ones (annual medians: school-aged 3.0 versus 1.1, preschool 3.9 versus 1.8; ptobacco exposure was common...

  2. Fluid therapy for severe acute pancreatitis in acute response stage

    Institute of Scientific and Technical Information of China (English)

    MAO En-qiang; TANG Yao-qing; FEI Jian; QIN Shuai; WU Jun; LI Lei; MIN Dong; ZHANG Sheng-dao

    2009-01-01

    Background Fluid therapy for severe acute pancreatitis (SAP) should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP. Methods Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group (Group I, n=36) and a controlled fluid expansion group (Group Ⅱ, n=40). Hemodynamic disorders were either quickly (fluid infusion rate was 10-15 ml·kg-1·h-1, Group Ⅰ) or gradually improved (fluid infusion rate was 5-10 ml·kg-1·h-1, Group Ⅱ) through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE Ⅱ scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome (ACS), sepsis, and survival rate were obtained. Results The two groups had statistically different (P 0.05). Total amount of fluid sequestration within 4 days was higher in Group Ⅰ ((5378±2751)ml) than in Group Ⅱ ((4215±1998)ml, P<0.05). APACHE Ⅱ scores were higher in Group Ⅰ on days 1,2, and 3 (P<0.05). Rate of mechanical ventilation was higher in group Ⅰ (94.4%) than in group Ⅱ (65%, P<0.05). The incidences of abdominal compartment syndrome (ACS) and sepsis were significantly lower in Group Ⅱ (P <0.05). Survival rate was remarkably lower in Group Ⅰ (69.4%) than in Group Ⅱ (90%, P <0.05). Conclusions Controlled fluid resuscitation offers better prognosis in patients with severe volume deficit within 72 hours of SAP onset.

  3. Evaluation of the Correlation Between Body Mass Index and the Severity of Asthma in Recently Diagnosed Patients

    OpenAIRE

    Davood Attaran; Mohammad Tohidi; Amir-Hashem Asna-Ashari; Habibillah Ismaili; Ehsan Khadivi; Shiva Gharaei

    2011-01-01

    Introduction: Asthma and obesity are among diseases that cause several problems and impair quality of life.  The concurrence of these diseases, changes in the respiratory physiology, changes associated with obesity and limited activity associated with asthma may cause an interaction between the two conditions. Materials and Methods: We studied the epidemiologic characteristics of all recently diagnosed cases of asthma with no previous treatment who visited the Respiratory Diseases Clinic of t...

  4. A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

    DEFF Research Database (Denmark)

    Bønnelykke, Klaus; Sleiman, Patrick; Nielsen, Kasper;

    2014-01-01

    Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6 ......-related family member 3), which is highly expressed in airway epithelium. These results demonstrate the strength of applying specific phenotyping in the search for asthma susceptibility genes....

  5. Effect of High Dose Inhaled Glucocorticoids on Quality of Life in Patients with Moderate to Severe Asthma

    OpenAIRE

    Choi, Jae-Sung; Jang, An-Soo; Lee, June-Hyuk; Park, Jong-Sook; Park, Sung Woo; Kim, Do-Jin; Park, Choon-Sik

    2005-01-01

    Asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients. Inhaled glucocorticoids (GCs) are the most effective controller therapy. The purpose of this study was to evaluate the effect of inhaled GCs on quality of life in patients with moderate to severe asthma. Patients completed the asthma quality of life questionnaire (AQLQ) and pulmonary function test at baseline and after 4 wks treatment of GCs. We enroll...

  6. Pathological study on severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    郎振为; 张立洁; 张世杰; 孟忻; 李俊强; 宋晨朝; 孙琳; 周育森

    2003-01-01

    Objective To study the pathological characteristics of severe acute respiratory syndrome (SARS) and its relationship to clinical manifestation. Methods Tissue specimens from 3 autopsies of probable SARS cases were studied by microscope, and the clinical data was reviewed.Results The typical pathological changes of lungs were diffuse hemorrhaging on the surface. A combination of serous, fibrinous and hemorrhagic inflammation was seen in most of the pulmonary alveoli with the engorgement of capillaries and detection of micro-thrombosis in some of these capillaries. Pulmonary alveoli thickened with interstitial mononuclear inflammatory infiltrates, suffered diffuse alveolar damage, experienced desquamation of pneumocytes and had hyaline-membrane formation, fibrinoid materials, and erythrocytes in alveolar spaces. There were thromboembolisms in some bronchial arteries. Furthermore, hemorrhagic necrosis was also evident in lymph nodes and spleen with the attenuation of lymphocytes. Other atypical pathological changes, such as hydropic degeneration, fatty degeneration, interstitial cell proliferation and lesions having existed before hospitalization were observed in the liver, heart, kidney and pancreas.Conclusion Severe damage to the pulmonary and immunological systems is responsible for the clinical features of SARS and may lead to the death of patients.

  7. Impacts of coexisting bronchial asthma on severe exacerbations in mild-to-moderate COPD: results from a national database

    Directory of Open Access Journals (Sweden)

    Lee H

    2016-04-01

    prevalence of severe exacerbations and impact of asthma on severe exacerbations, especially in patients with mild-to-moderate COPD.Methods: Patients with mild-to-moderate COPD (≥40 years were extracted from Korean National Health and Nutrition Examination Survey data (2007–2012 and were linked to the national health insurance reimbursement database to obtain medical service utilization records.Results: Of the 2,397 patients with mild-to-moderate COPD, 111 (4.6% had severe exacerbations over the 6 years (0.012/person-year. Severe exacerbations were more frequent in the COPD patients with concomitant self-reported physician-diagnosed asthma compared with only COPD patients (P<0.001. A multiple logistic regression presented that asthma was an independent risk factor of severe exacerbations in patients with mild-to-moderate COPD regardless of adjustment for all possible confounding factors (adjusted odds ratio, 1.67; 95% confidence interval, 1.002–2.77, P=0.049. In addition, age, female, poor lung function, use of inhalers, and low EuroQoL five dimensions questionnaire index values were independently associated with severe exacerbation in patients with mild-to-moderate COPD.Conclusion: In this population-based study, the prevalence of severe exacerbations in patients with mild-to-moderate COPD was relatively low, compared with previous clinical interventional studies. Coexisting asthma significantly impacted the frequency of severe exacerbations in patients with mild-to-moderate COPD, suggesting application of an exacerbation preventive strategy in these patients. Keywords: bronchial asthma, chronic obstructive pulmonary disease, acute exacerbation

  8. Body composition in severe refractory asthma: comparison with COPD patients and healthy smokers.

    Directory of Open Access Journals (Sweden)

    Markos Minas

    Full Text Available BACKGROUND: Body composition is an important parameter for patients with chronic obstructive pulmonary disease (COPD whereas the association between asthma and obesity is not fully understood. The impact of severe refractory asthma (SRA on fat free mass (FFM has not been investigated. METHODOLOGY AND PRINCIPAL FINDINGS: 213 subjects (70 healthy smokers, 71 COPD patients and 72 asthma patients without significant comorbidities were included in the study. In all patients, body composition assessment (using bioelectrical impendance analysis, skinfold and anthropometric measurements and spirometry were performed. Differences in fat free mass index (FFMI between groups were assessed and determinants of FFMI in asthma were evaluated. Patients with SRA had lower values of FFMI compared to patients with mild-to-moderate asthma [18.0(17.3-18.3-19.5(18.4-21.5, p<0.001], despite the fact that they were more obese. The levels of FFMI in SRA were lower than those of GOLD stage I-III COPD and comparable to those of stage IV COPD patients [18.0(17.3-18.3-18.8(17.8-20.1, p = ns]. These differences were present even after proper adjustments for sex, age, smoking status, daily dose of inhaled corticosteroids (ICS and daily use of oral corticosteroids (OCS. In multivariate analysis, independent predictors of FFMI in asthmatic patients were age, use of OCS and the presence of SRA, but not smoking, sex or cumulative dose of ICS used. CONCLUSIONS AND SIGNIFICANCE: SRA is related to the presence of low FFMI that is comparable to that of GOLD stage IV COPD. The impact of this observation on asthma mechanisms and outcomes should be further investigated in large prospective studies.

  9. Factors associated with quality of life in patients with severe asthma: the impact of pharmacotherapy

    Directory of Open Access Journals (Sweden)

    Daiane Silva Souza

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To identify, characterize, and quantify associations of various factors with quality of life (QoL in patients with asthma, according to the pharmacotherapy employed. METHODS: This was a cross-sectional study involving 49 patients (≥ 18 years of age with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ. The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age; Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy; and comorbidities. RESULTS: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001, "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001, and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029. Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015. CONCLUSIONS: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients.

  10. Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.

    Science.gov (United States)

    Dombret, Marie-Christine; Alagha, Khuder; Boulet, Louis Philippe; Brillet, Pierre Yves; Joos, Guy; Laviolette, Michel; Louis, Renaud; Rochat, Thierry; Soccal, Paola; Aubier, Michel; Chanez, Pascal

    2014-12-01

    Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk-benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future. PMID:25445950

  11. Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults

    Directory of Open Access Journals (Sweden)

    Marie-Christine Dombret

    2014-12-01

    Full Text Available Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk–benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future.

  12. Pterostilbene as treatment for severe acute pancreatitis.

    Science.gov (United States)

    Lin, Y J; Ding, Y; Wu, J; Ning, B T

    2016-01-01

    Acute pancreatitis (AP) has a fast onset and progression, which lead to an unfavorable prognosis. Therefore, the development of novel drugs for its treatment is critical. As a homologous derivative of resveratrol, pterostilbene exerts a variety of effects including anti-inflammatory, antioxidant, and antitumor effects. This study investigated the potential of pterostilbene for treatment of severe AP (SAP) and related mechanisms. Effects of pterostilbene were evaluated in a Wistar rat model of AP. Serum levels of amylase (AMY), creatinine (Cr), and alanine aminotransferase (ALT) were quantified. Furthermore, serum levels of tumor necrosis factor (TNF)-a and interleukin (IL)-1b were quantified using enzyme-linked immunosorbent assay. Nuclear factor (NF)-kB expression in pancreatic tissues was quantified by real-time PCR and western blotting. The production of reactive oxygen species (ROS) was determined using a spectrometer, while superoxide dismutase (SOD) activity was assayed. In the AP rat model, the expression of inflammatory markers TNF-a and IL-1b, expression of NF-kB, and serum indices (AMY, Cr, and ALT) increased compared to the corresponding levels in the control group (P pancreatic tissues. PMID:27525946

  13. Organ failure associated with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ai-Jun Zhu; Jing-Sen Shi; Xue-Jun Sun

    2003-01-01

    AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure.METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology,extent of necrosis, infection of necrosis and mortality was analyzed.RESULTS: A total of 47 patients (63.5 %) showed organ failure, 20 patients (27.0 %) multiple organ failure, whereas 27 patients (36.5 %) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0 %) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P>0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P>0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P<0.05). The death of SAP was associated with multiple organ failure (P<0.005), pulmonary failure (P<0.005), cardiovascular dysfunction (P<0.05) and gastrointestinal dysfunction (P<0.05).CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.

  14. Management of acute severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Saurabh; Kedia; Vineet; Ahuja; Rakesh; Tandon

    2014-01-01

    The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine na?ve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patientsnot responding to infliximab or cyclosporin should be considered for colectomy.

  15. Characteristics and severity of asthma in children with and without atopic conditions: A cross-sectional study

    NARCIS (Netherlands)

    Arabkhazaeli, Ali; Vijverberg, Susanne J. H.; van Erp, Francine C.; Raaijmakers, Jan A. M.; van der Ent, Cornelis K.; Maitland van der Zee, Anke H.

    2015-01-01

    Background: Childhood allergic diseases have a major impact on a child's quality of life, as well as that of their parents. We studied the coexistence of reported allergies in children who use asthma medication. Additionally, we tested the hypothesis that asthma severity is greater among children wi

  16. Characteristics and severity of asthma in children with and without atopic conditions : a cross-sectional study

    NARCIS (Netherlands)

    Arabkhazaeli, Ali; Vijverberg, Susanne J H; van Erp, Francine C; Raaijmakers, Jan A M; van der Ent, Cornelis K.; Maitland van der Zee, Anke H

    2015-01-01

    BACKGROUND: Childhood allergic diseases have a major impact on a child's quality of life, as well as that of their parents. We studied the coexistence of reported allergies in children who use asthma medication. Additionally, we tested the hypothesis that asthma severity is greater among children wi

  17. A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

    NARCIS (Netherlands)

    Bonnelykke, Klaus; Sleiman, Patrick; Nielsen, Kasper; Kreiner-Moller, Eskil; Mercader, Josep M.; Belgrave, Danielle; den Dekker, Herman T.; Husby, Anders; Sevelsted, Astrid; Faura Tellez, Grissel; Mortensen, Li Juel; Paternoster, Lavinia; Flaaten, Richard; Molgaard, Anne; Smart, David E.; Thomsen, Philip F.; Rasmussen, Morten A.; Bonas-Guarch, Silvia; Holst, Claus; Nohr, Ellen A.; Yadav, Rachita; March, Michael E.; Blicher, Thomas; Lackie, Peter M.; Jaddoe, Vincent W. V.; Simpson, Angela; Holloway, John W.; Duijts, Liesbeth; Custovic, Adnan; Davies, Donna E.; Torrents, David; Gupta, Ramneek; Hollegaard, Mads V.; Hougaard, David M.; Hakonarson, Hakon; Bisgaard, Hans

    2014-01-01

    Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6 yea

  18. Steroid-induced acute psychosis in a child with asthma: report of one case.

    Science.gov (United States)

    Lee, K M; Lin, Y Z; Huang, F Y

    2001-01-01

    A 5-year-old girl was admitted due to severe asthmatic attack. She was treated with methylprednisolone (40 mg i.v. q6h), aminophylline (loading with 5 mg/kg and maintained with 0.6 mg/kg/hr i.v. drip), nebulized terbutaline sulphate (5 mg q6h), oral procaterol 12.5 micrograms bid, along with oxygen therapy. Acute psychotic reaction with visual hallucination, delusion, panic reaction and myoclonic movement of hands developed on day 3 of admission. The patient had no previous history of psychiatric problems. The theophylline level was 9.89 micrograms/ml at the moment of psychotic reaction. After the dose of methylprednisolone was reduced from 40 mg to 20 mg i.v. q6h and shifted to other anti-asthma treatment by procaterol metered dose inhaler via spacer, the psychotic reaction disappeared a few hours later. The psychotic reaction was thought to be due to steroid therapy since no other causes could explain the psychotic reaction. PMID:11431864

  19. Association of pediatric asthma severity with exposure to common household dust allergens

    Energy Technology Data Exchange (ETDEWEB)

    Gent, Janneane F., E-mail: janneane.gent@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Belanger, Kathleen [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Triche, Elizabeth W. [Brown University, Department of Community Health/Epidemiology, Providence, RI (United States); Bracken, Michael B. [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Beckett, William S. [Mount Auburn Hospital, Department of Internal Medicine, Cambridge, MA (United States); Leaderer, Brian P. [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States)

    2009-08-15

    Background: Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. Objective: To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. Methods: Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. Results: Der p 1 house dust mite allergen concentration of 2.0 {mu}g/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 {mu}g/g and OR 2.55 95% CI 1.13, 5.73 for {>=}10.0 {mu}g/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). Conclusion: Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.

  20. Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents?

    Science.gov (United States)

    Meca, Olga; Cruz, María-Jesús; Sánchez-Ortiz, Mónica; González-Barcala, Francisco-Javier; Ojanguren, Iñigo; Munoz, Xavier

    2016-01-01

    Introduction The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. Methods Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. Results OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136–11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0–16), compared with patients with OA caused by HMW agents (0.87, range 0–72), (p = 0.024). Conclusions OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents. PMID:27280473

  1. Association of pediatric asthma severity with exposure to common household dust allergens

    International Nuclear Information System (INIS)

    Background: Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. Objective: To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. Methods: Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. Results: Der p 1 house dust mite allergen concentration of 2.0 μg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 μg/g and OR 2.55 95% CI 1.13, 5.73 for ≥10.0 μg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). Conclusion: Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.

  2. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    Science.gov (United States)

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

  3. Plasma antibodies against heat shock protein 70 correlate with the incidence and severity of asthma in a Chinese population

    Directory of Open Access Journals (Sweden)

    Wei Qingyi

    2005-02-01

    Full Text Available Abstract Background The heat shock proteins (Hsps are induced by stresses such as allergic factors and inflammatory responses in bronchi epithelial cells and therefore may be detectable in patients with asthma. However, the etiologic link between anti-Hsps and asthma (its severity and related inflammatory responses such as interleukin-4 and immunoglobulin E has not been established. We determined whether antibodies against Hsp60 and Hsp70 were present in patients with asthma and evaluated their associations with risk and severity of asthma. Methods We determined the levels of anti-Hsp60 and anti-Hsp70 by immunoblot and their associations with risk and symptom severity of asthma in 95 patients with asthma and 99 matched non-symptomatic controls using multivariate logistic regression analysis. Results Compared to the controls, asthma patients were more likely to have detectable anti-Hsp60 (17.2% vs 5.1% and anti-Hsp70 (33.7% vs 8.1% (p ≤ 0.001. In particular, the presence of anti-Hsp70 was associated with a greater than 2 fold risk for asthma (adjusted OR = 2.21; 95% CI = 1.35~3.59. Furthermore, both anti-Hsp60 and anti-Hsp70 levels were positively correlated with symptom severity (p Conclusions These data suggest that anti-Hsp60 and especially anti-Hsp70 correlate with the attacks and severity of asthma. The underlying molecular mechanisms linking antibodies to heat shock proteins and asthma remain to be investigated.

  4. Severe and Moderate Asthma Exacerbations in Asthmatic Children and Exposure to Ambient Air Pollutants

    Science.gov (United States)

    Tétreault, Louis-Francois; Doucet, Marieve; Gamache, Philippe; Fournier, Michel; Brand, Allan; Kosatsky, Tom; Smargiassi, Audrey

    2016-01-01

    Background: It is well established that short-term exposure to ambient air pollutants can exacerbate asthma, the role of early life or long-term exposure is less clear. We assessed the association between severe asthma exacerbations with both birth and annual exposure to outdoor air pollutants with a population-based cohort of asthmatic children in the province of Quebec (Canada). Method: Exacerbations of asthma occurring between 1 April 1996 and 31 March 2011 were defined as one hospitalization or emergency room visit with a diagnosis of asthma for children (<13 years old) already diagnosed with asthma. Annual daily average concentrations of ozone (O3) and nitrogen dioxide (NO2) were estimated at the child’s residential postal code. Satellite based levels of fine particulate (PM2.5) estimated for a grid of 10 km by 10 km were also assigned to postal codes of residence for the whole province. Hazard ratios (HRs) were estimated from Cox models with a gap time approach for both birth and time-dependant exposure. Results: Of the 162,752 asthmatic children followed (1,020,280 person-years), 35,229 had at least one asthma exacerbation. The HRs stratified by age groups and adjusted for the year of birth, the ordinal number of exacerbations, sex, as well as material and social deprivation, showed an interquartile range increase in the time-dependant exposure to NO2 (4.95 ppb), O3 (3.85 ppb), and PM2.5 (1.82 μg/m3) of 1.095 (95% CI 1.058–1.131), 1.052 (95% CI 1.037–1.066) and 1.025 (95% CI 1.017–1.031), respectively. While a positive association was found to PM2.5, no associations were found between exposure at birth to NO2 or O3. Conclusions: Our results support the conclusion, within the limitation of this study, that asthma exacerbations in asthmatic children are mainly associated with time dependent residential exposures less with exposure at birth. PMID:27490556

  5. Linoleic acid metabolite drives severe asthma by causing airway epithelial injury

    OpenAIRE

    Mabalirajan, Ulaganathan; Rehman, Rakhshinda; Ahmad, Tanveer; Kumar, Sarvesh; Singh, Suchita; Leishangthem, Geeta D.; Aich, Jyotirmoi; Kumar, Manish; Khanna, Kritika; Singh, Vijay P.; Dinda, Amit K; Biswal, Shyam; Agrawal, Anurag; Ghosh, Balaram

    2013-01-01

    Airway epithelial injury is the hallmark of various respiratory diseases, but its mechanisms remain poorly understood. While 13-S-hydroxyoctadecadienoic acid (13-S-HODE) is produced in high concentration during mitochondrial degradation in reticulocytes little is known about its role in asthma pathogenesis. Here, we show that extracellular 13-S-HODE induces mitochondrial dysfunction and airway epithelial apoptosis. This is associated with features of severe airway obstruction, lung remodeling...

  6. Early Prediction of Severity in Acute Pancreatitis. Is This Possible?

    OpenAIRE

    Sandberg AA; Borgstrom A

    2002-01-01

    One out of ten cases of acute pancreatitis develops into severe acute pancreatitis which is a life threatening disorder with a high mortality rate. The other nine cases are self limiting and need very little therapy. The specificity of good clinical judgement on admission, concerning the prognosis of the attack, is high (high specificity) but misses a lot of severe cases (low sensitivity). The prediction of severity in acute pancreatitis was first suggested by John HC Ranson in 1974. Much eff...

  7. Near-fatal asthma in the elderly.

    Science.gov (United States)

    Arjona, Nydia

    2015-01-01

    Asthma affects the elderly as often as other age groups; however, it more often becomes fatal in the elderly. Unfortunately, asthma is often unmanaged or underdiagnosed in the older population. It is important for health care providers to recognize risk factors in the elderly and properly treat them before asthma becomes fatal. This article describes near-fatal asthma and identifies risk factors specifically for the elderly. Symptoms of asthma are reviewed as well as assessments and diagnostic tests to identify asthma severity and complications. Proper management needs to be urgently initiated to prevent worsening respiratory distress; this includes fast-acting drug treatments appropriate for elderly patients. Decompensated acute respiratory failure, secondary to severe asthma, requires the skills of an experienced anesthesiologist because these patients may rapidly deteriorate during induction and intubation. Ventilator management must include strategies to prevent worsening hyperinflation of the lungs. Elderly asthma patients have a higher mortality risk related to ventilator complications and other comorbidities. PMID:25470264

  8. Airway wall remodeling in asthma : novel mechanisms of human bronchial smooth muscle cells in the induction of angiogenesis

    OpenAIRE

    Keglowich, Laura Franziska

    2014-01-01

    Asthma is a global major health concern and it affects estimated 300 million people. The prevalence of asthma is rising and there is no cure for asthma, only the symptoms can be controlled. Acute asthma attacks are characterized by severe symptoms such as breathlessness, wheezing, tightness of the chest, and coughing, which may lead to hospitalization or death. Besides the acute symptoms, asthma is characterized by persistent airway inflammation and airway wall remodeling....

  9. Japanese Guideline for Adult Asthma 2014

    Directory of Open Access Journals (Sweden)

    Ken Ohta

    2014-01-01

    Full Text Available Adult bronchial asthma (hereinafter, asthma is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause intractable asthma. The number of patients with asthma has increased, and that of patients who die from asthma has decreased (1.5 per 100,000 patients in 2012. The aim of asthma treatment is to enable patients with asthma to lead a normal life without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management with antiasthmatic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high. Long-acting 02-agonists, leukotriene receptor antagonists, and sustained-release theophylline are recommended as concomitant drugs, while anti-immunoglobulin E antibody therapy has been recently developed for the most severe and persistent asthma involving allergic reactions. Inhaled 02-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks. Allergic rhinitis, chronic obstructive pulmonary disease, aspirin-induced asthma, pregnancy, asthma in athletes, and coughvariant asthma are also important issues that need to be considered.

  10. Cortisol response to acute stress in asthma: Moderation by depressive mood.

    Science.gov (United States)

    Trueba, Ana F; Simon, Erica; Auchus, Richard J; Ritz, Thomas

    2016-05-15

    Both individuals with asthma and depression show signs of a dysregulated hypothalamus-pituitary-adrenal axis. However, little is known about the cortisol response to stress in the context of co-occurring asthma and depressive mood. Thirty-nine individuals with asthma and 41 healthy controls underwent a combined speech and mental arithmetic stressor. During the course of the laboratory session, salivary cortisol was collected 5 times, with 1 sample at 0min before the stressor and 4 samples at 0, 15, 30 and 45min after the stressor. Depressive mood in the past week was assessed with the Hospital Anxiety and Depression Scale at the beginning of the session. Depressive symptoms moderated cortisol response to the acute stressor, but only among asthmatic patients. Higher depressive mood was associated with a significant increase in cortisol, whereas low depressive mood was associated with no cortisol response. In healthy participants, depressive mood had no substantial effect on cortisol response to the stressor. These findings suggest that depressive mood and chronic inflammatory diseases such as asthma can interact to augment cortisol response to stress.

  11. Revealing the acute asthma ignorome: characterization and validation of uninvestigated gene networks.

    Science.gov (United States)

    Riba, Michela; Garcia Manteiga, Jose Manuel; Bošnjak, Berislav; Cittaro, Davide; Mikolka, Pavol; Le, Connie; Epstein, Michelle M; Stupka, Elia

    2016-01-01

    Systems biology provides opportunities to fully understand the genes and pathways in disease pathogenesis. We used literature knowledge and unbiased multiple data meta-analysis paradigms to analyze microarray datasets across different mouse strains and acute allergic asthma models. Our combined gene-driven and pathway-driven strategies generated a stringent signature list totaling 933 genes with 41% (440) asthma-annotated genes and 59% (493) ignorome genes, not previously associated with asthma. Within the list, we identified inflammation, circadian rhythm, lung-specific insult response, stem cell proliferation domains, hubs, peripheral genes, and super-connectors that link the biological domains (Il6, Il1ß, Cd4, Cd44, Stat1, Traf6, Rela, Cadm1, Nr3c1, Prkcd, Vwf, Erbb2). In conclusion, this novel bioinformatics approach will be a powerful strategy for clinical and across species data analysis that allows for the validation of experimental models and might lead to the discovery of novel mechanistic insights in asthma. PMID:27097888

  12. Efficacy and safety of reslizumab in patients with moderate to severe eosinophilic asthma.

    Science.gov (United States)

    Lim, Hui Fang; Nair, Parameswaran

    2015-04-01

    Reslizumab, a neutralizing anti-IL-5 monoclonal antibody, is a promising adjunctive treatment for severe eosinophilic asthma. Monthly intravenous 3.0 mg/kg reslizumab had resulted in improvements in lung function and asthma control. It is well tolerated and common adverse events include headache, nasopharyngitis and upper respiratory tract infection. Rebound eosinophilia after cessation of reslizumab and attenuation of the treatment response with repeated dosing had been reported. Stringent selection of patients with a high eosinophil burden, who are poorly controlled despite moderate to high doses of inhaled corticosteroid, confers the most significant treatment response. Future trials should compare the dose, delivery platform, frequency of dosing and study combinations with other biologics, which will affect its maximal clinical efficacy. PMID:25578680

  13. ROLE OF ORAL MONTELUKAST IN ACUTE ASTHMA EXACERBATIONS : A RANDOMIZED PLACEBO CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Gaude

    2015-08-01

    Full Text Available BACKGROUND: Leukotriene receptor antagonists (LTRAs are well established in the management of outpatient asthma. However, there is very little information as to their role in acute asthma exacerbations. The present study was done to evaluate the clinical efficacy of oral Montelukast as an add on therapy to the usual standard therapy of acute attack of bronchial asthma. MATERIALS AND METHODS: A randomized single blinded controlled study was conducted in a tertiary car e teaching hospital. A total of 320 patients with age >18 years of acute exacerbations due to bronchial asthma were included in the study. The patients were randomized into two study and control groups. The study group patients received oral Montelukast (1 0mg once daily for 2 weeks, while the control group received a placebo. All the patients received standard therapy according to GINA guidelines. Improvements in lung function tests, clinical symptoms and relapse rates were monitored at baseline, at discha rge and at 2 weeks. Side effects profile was also monitored. RESULTS: A total of 255 patients were finally assessed. One hundred thirty patients belonged to study group and 125 in the control group. Baseline characteristics were similar and well matched in both the groups. Mean age was 39.9±15.8 years in study group and 42.8±12.8 in the control group and majority were female patients in both the groups. At the end of 2 weeks, it was observed that there were no significant improvements in FEV 1 and FVC as com pared to the control group. However, there was significant improvement in PEFR at 2 weeks (0.4 L/sec, 12% as compared to the control group (p <0.0376. Length of hospital stay was similar in both the groups. No serious adverse effects were noted during th e course of the study. CONCLUSIONS: In acute asthma exacerbations, the present study showed that additional administration of oral Montelukast resulted in significantly higher PEFR at 2 weeks as compared to the standard

  14. Acute effects of air pollution on pediatric asthma exacerbation: evidence of association and effect modification.

    Science.gov (United States)

    Samoli, E; Nastos, P T; Paliatsos, A G; Katsouyanni, K; Priftis, K N

    2011-04-01

    We investigated the short-term effects of particulate matter with aerodynamic diameter ozone (O(3)) on pediatric asthma emergency admissions in Athens, Greece over the period 2001-2004. We explored effect modification patterns by season, sex, age and by the presence of desert dust transported mainly from the Sahara area. We used daily time-series data provided by the children's hospitals and the fixed monitoring stations. The associations were investigated using Poisson regression models controlling for seasonality, weather, influenza episodes, day of the week and holiday effects. A 10 μg/m(3) increase in PM(10) was associated with a 2.54% increase (95% confidence interval (CI): 0.06%, 5.08%) in the number of pediatric asthma hospital admissions, while the same increase in SO(2) was associated with a 5.98% (95% CI: 0.88%, 11.33%) increase. O(3) was associated with a statistically significant increase in asthma admissions among older children in the summer. Our findings provide limited evidence of an association between NO(2) exposure and asthma exacerbation. Statistically significant PM(10) effects were higher during winter and during desert dust days, while SO(2) effects occurred mainly during spring. Our study confirms previously reported PM(10) effects on emergency hospital admissions for pediatric asthma and further provides evidence of stronger effects during desert dust days. We additionally report severe effects of SO(2), even at today's low concentration levels. PMID:21296347

  15. Chinese herbal medicine for severe acute respiratory syndrome

    DEFF Research Database (Denmark)

    Liu, Jianping; Manheimer, Eric; Shi, Yi;

    2004-01-01

    To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

  16. Structured discharge procedure for children admitted to hospital with acute asthma: a randomised controlled trial of nursing practice

    OpenAIRE

    Wesseldine, L; McCarthy, P.; Silverman, M

    1999-01-01

    BACKGROUND—Discharge planning is becoming an important part of the management of childhood asthma in hospital. Readmission to hospital, although often inevitable, might represent a failure of the opportunity for intervention presented by a brief period of supervised care in hospital.
AIM—To examine the impact of a structured, nurse-led discharge package for children admitted to hospital with acute asthma on readmission to hospital, reattendance at the accident and emergen...

  17. [Determinant-based classification of acute pancreatitis severity. International multidisciplinary classification of acute pancreatitis severity: the 2013 German edition

    NARCIS (Netherlands)

    Layer, P.; Dellinger, E.P.; Forsmark, C.E.; Levy, P.; Maravi-Poma, E.; Shimosegawa, T.; Siriwardena, A.K.; Uomo, G.; Whitcomb, D.C.; Windsor, J.A.; Petrov, M.S.; Geenen, E.J.M. van

    2013-01-01

    OBJECTIVE: The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND: The Atlanta definitions of acute pancreatitis severity a

  18. Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction.

    Science.gov (United States)

    Morgan, Sherwin E; Vukin, Kirissa; Mosakowski, Steve; Solano, Patti; Stanton, Lolita; Lester, Lucille; Lavani, Romeen; Hall, Jesse B; Tung, Avery

    2014-11-01

    Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation.

  19. The value of pulmonary function tests in the management of acute asthma

    OpenAIRE

    Worthington, J R; Ahuja, J

    1989-01-01

    We examined the influence of the forced expiratory volume in 1 second (FEV1) on the decision to admit or discharge patients who present with acute bronchospasm due to asthma and the ability of the FEV1 to predict the need for admission or the likelihood of relapse after discharge. The FEV1 was recorded at presentation before treatment and immediately after a decision to admit or discharge had been made. Of the 96 patients 10.4% were admitted, 10.4% were discharged but suffered a relapse, and ...

  20. The efficacy of nebulized magnesium sulfate alone and in combination with salbutamol in acute asthma

    Directory of Open Access Journals (Sweden)

    Sarhan HA

    2016-06-01

    Full Text Available Hatem A Sarhan,1 Omar H EL-Garhy,1 Mohamed A Ali,2 Nouran A Youssef1 1Department of Pharmaceutics, Faculty of Pharmacy, 2Department of Chest Diseases, Faculty of Medicine, Minia University, Minia, Egypt Objective: Evaluation of the efficacy of nebulized magnesium sulfate (MgSO4 alone and in combination with salbutamol in acute asthma.Methods: A double-blind randomized controlled study was conducted in Chest and Emergency Departments. Thirty patients of acute attack of bronchial asthma were randomized into three groups: MgSO4 nebulization (group A, salbutamol nebulization (group B, and their combination (group C. All patients were monitored before and after nebulization (each 20 minutes for peak expiratory flow rate (PEFR, respiratory rate (RR, heart rate (HR, blood pressure, pulsus paradoxus, oxygen saturation, clinical examination, and Fischl index.Results: A highly significant improvement in PEFR, PEFR percentage, and Fischl index and significant decrease in RR and HR was observed in all groups. A similar improvement in PEFR was observed in group A and group B (P=0.389. The difference in peak expiratory flow (PEF improvement was insignificant between group B and group C (P=0.101, while there was a significant differ­ence between group A and group C (P=0.014 in favor of group C.Conclusion: Nebulized MgSO4 alone or combined with salbutamol has a clinically significant bronchodilator effect in acute asthma and leads to clinical improvement, increase in PEFR, reduction in HR, and reduction in RR. The response to nebulized MgSO4 alone (PEFR improvement 54±35.6 L/min, P=0.001 is comparable (P=0.389 to that of nebulized salbutamol (PEFR improvement 67.0±41.9 L/min, P=0.001 and is significantly less than (P=0.014 that of nebulized combination (PEFR improvement 92.0±26.9 L/min, P=0.000. Keywords: nebulized magnesium sulfate, salbutamol, acute asthma, peak expiratory flow rate, Fischl index

  1. Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications

    OpenAIRE

    Su, Mao-Sheng; Jiang, Ying; YAN, XIAO-YUAN HU; Zhao, Qing-hua; Liu, Zhi-Wei; Wen-zhi ZHANG; He, Lei

    2012-01-01

    Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, lab...

  2. Effect of Vitamin C Administration on Leukocyte Vitamin C Level and Severity of Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    Seyed Hamid Hashemi

    2012-04-01

    Full Text Available Oxidative stress mediated by reactive oxygen species is known to contribute to the inflammatory process of bronchial asthma. Reactive oxygen species are released into the bronchial tree by activated inflammatory cells. In this study, we aimed to determine the effect of vitamin C administration on leukocyte vitamin C level as well as severity of asthma. In this double blind clinical trial study we evaluated 60 patients with chronic stable asthma. The patients were divided into two groups (A and B including 30 patients in each group. Patients in these groups were matched according to their age, weight, height, gender, BMI and drug consumption. In addition to standard asthma treatment (according to stepwise therapy in 4th step of bronchial asthma in which the patients were controlled appropriately, group A received 1000 mg vitamin C daily and group B received placebo. At the baseline and after one month treatment, non-fasting blood samples were drawn for laboratory evaluations. Asthmatic patient's clinical condition was evaluated through standard pulmonary function test (PFT. The mean (±SD leukocyte vitamin C level in group A at the baseline and after one month treatment with 1000 mg/day vitamin C, were 0.0903 (±0.0787 µg/108 leukocytes and 0.1400 (±0.0953 µg/108 leukocytes respectively (P<0.05. The mean (±SD leukocyte vitamin C level in group B at the baseline and after one month administration of placebo, were 0.0867 (±0.0629 µg/108 leukocytes and 0.0805(±0.0736 µg/108 leukocytes respectively. The leukocyte vitamin C level in group A was higher than those of group B after one month treatment with vitamin C and placebo and the difference was statistically significant (P<0.05. Comparing PFT (FEV1, FVC and FEV1/FVC in group B during the study period showed a significant increase in FEV1 (P<0.05, while the other two parameters remained unchanged. In group A, who received 1000 mg/day vitamin C, none of the spirometry parameters changed after

  3. Exploring the association between severe respiratory syncytial virus infection and asthma: a registry-based twin study

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; van der Sluis, Sophie; Stensballe, Lone G;

    2009-01-01

    " RSV hospitalization fitted the data significantly better (P = 0.39 for deterioration in model fit) than a model in which RSV hospitalization "causes" asthma (P pregnancy were accounted for. CONCLUSIONS......RATIONALE: Severe respiratory syncytial virus (RSV) infection is associated with asthma but the nature of this association is imperfectly understood. OBJECTIVES: To examine the nature of the association between severe RSV infection and asthma in a population-based sample of twins. METHODS: Data...... on hospitalization due to RSV infection was gathered for all twins born in Denmark between 1994 and 2000 (8,280 pairs) and linked to information on asthma obtained from hospital discharge registries and parent-completed questionnaires. Genetic variance components models and direction of causation models were fitted...

  4. Asthma in childhood.

    Science.gov (United States)

    de Benedictis, Fernando Maria; Attanasi, Marina

    2016-03-01

    Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events. Recent data suggest the possibility that exhaled volatile organic compounds may qualify as biomarkers in detecting early signs of asthma. Adding information of exhaled volatile organic compounds and expression of inflammation genes to a clinical tool significantly improves asthma prediction in preschool wheezy children. Personal communication with children and adolescents is likely more important than the tools actually used for monitoring asthma. Systemic corticosteroids do not affect the long-term prognosis in children with first viral-induced wheezing episode and should be used cautiously during acute episodes. Finally, stress and a polymorphism upstream of a specific gene are both associated with reduced bronchodilator response in children with asthma.

  5. Asthma in childhood

    Directory of Open Access Journals (Sweden)

    Fernando Maria de Benedictis

    2016-03-01

    Full Text Available Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events. Recent data suggest the possibility that exhaled volatile organic compounds may qualify as biomarkers in detecting early signs of asthma. Adding information of exhaled volatile organic compounds and expression of inflammation genes to a clinical tool significantly improves asthma prediction in preschool wheezy children. Personal communication with children and adolescents is likely more important than the tools actually used for monitoring asthma. Systemic corticosteroids do not affect the long-term prognosis in children with first viral-induced wheezing episode and should be used cautiously during acute episodes. Finally, stress and a polymorphism upstream of a specific gene are both associated with reduced bronchodilator response in children with asthma.

  6. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

    DEFF Research Database (Denmark)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J;

    2015-01-01

    compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; plife, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum......U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe...

  7. Influence of degree of specific allergic sensitivity on severity of rhinitis and asthma in Chinese allergic patients

    Directory of Open Access Journals (Sweden)

    Zhao Changqing

    2011-07-01

    Full Text Available Abstract Background The association between sensitizations and severity of allergic diseases is controversial. Objective This study was to investigate the association between severity of asthma and rhinitis and degree of specific allergic sensitization in allergic patients in China. Method A cross-sectional survey was performed in 6304 patients with asthma and/or rhinitis from 4 regions of China. Patients completed a standardized questionnaire documenting their respiratory and allergic symptoms, their impact on sleep, daily activities, school and work. They also underwent skin prick tests with 13 common aeroallergens. Among the recruited subjects, 2268 provided blood samples for serum measurement of specific IgE (sIgE against 16 common aeroallergens. Results Significantly higher percentage of patients with moderate-severe intermittent rhinitis were sensitized to outdoor allergens while percentage of patients sensitized to indoor allergens was increased with increasing severity of asthma. Moderate-severe intermittent rhinitis was associated with the skin wheal size and the level of sIgE to Artemisia vulgaris and Ambrosia artemisifolia (p Dermatophagoides (D. pteronyssinus and D. farinae (p Conclusions Artemisia vulgaris and Ambrosia artemisifolia sensitizations are associated with the severity of intermittent rhinitis and D. pteronyssinus and D. farinae sensitizations are associated with increasing severity of asthma in China. Increase in number of allergens the patients are sensitized to may also increase the severity of rhinitis and asthma.

  8. Role of serum eosinophil cationic protein as a biological marker to assess the severity of bronchial asthma

    International Nuclear Information System (INIS)

    Objective: The study was carried out to evaluate the role of serum eosinophil cationic protein (ECP) as a biological marker for the diagnosis and to assess the severity of bronchial asthma. Methodology: This observational cross-sectional study was conducted among 70 bronchial asthma patients and 45 disease controls (tuberculosis-15, chronic obstructive pulmonary disease-15, interstitial lung disease-15) enrolled from patients attending the outpatient department of the National Institute of Disease of the Chest and Hospital (NIDCH), Dhaka, Bangladesh during July 2010 to June 2011. Global Initiative of Asthma Management and Prevention (GINA) criteria were followed for selection of both atopic and non-atopic patients with intermittent or persistent (mild, moderate and severe) asthma. Serum level of eosinophil cationic protein (ECP), IgE, forced expiratory volume in 1 second (FEV 1% predicted) and circulatory eosinophil (CE) count were estimated. Results: Mean serum ECP level (28.8 +- 42.9 vs. 6.82 +- 3.5 ng/mL; P<0.001), IgE level (383.59 - 225.3 vs. 135 +- 131.8 IU/mL; P<0.001) and percent circulatory eosinophil count (9.95 +- 3.7 vs. 5.95 +- 1.4; P<0.024) were all found significantly raised among asthma patients than disease controls but % FEV1 was equivocal. All grades of persistent asthma patients had significantly (P<0.025 and P<0.002) higher mean ECP level than intermittent cases but serum IgE level and CE count did not differ significantly. FEV1 % predicted correlated well among moderate and severe persistent asthma but was equivocal for intermittent and mild persistent cases. Conclusion: This study has reinforced that serum eosinophil cationic protein is a dependable biological marker with more discriminatory power over other indicators for bronchial asthma and to assess its severity. (author)

  9. Budesonide/formoterol and formoterol provide similar rapid relief in patients with acute asthma showing refractoriness to salbutamol

    OpenAIRE

    Lombardi DM; Fairall L; Bateman ED; English R

    2006-01-01

    Abstract Background To compare the efficacy and safety of budesonide/formoterol (Symbicort®) with formoterol (Oxis®) in the treatment of patients with acute asthma who showed evidence of refractoriness to short-acting β2-agonist therapy. Methods In a 3 hour, randomized, double-blind study, a total of 115 patients with acute asthma (mean FEV1 40% of predicted normal) and a refractory response to salbutamol (mean reversibility 2% of predicted normal after inhalation of 400 μg), were randomized ...

  10. Airway inflammatory response to ozone in subjects with different asthma severity

    Energy Technology Data Exchange (ETDEWEB)

    Vagaggini, B.; Carnevali, S.; Macchioni, P. [Univ. of Pisa, Cardio-Thoracic Dept., Respiratory patho-physiology (IT)] (and others)

    1999-07-01

    The aim of this study was to evaluate whether ozone exposure induces a similar airway inflammatory response in subjects with different degrees of asthma severity. Two groups of asthmatic subjects were studied: seven with intermittent mild asthma not requiring regular treatment (group A); and seven with persistent mild asthma requiring regular treatment with inhaled corticosteroids and long-acting {beta}{sub 2}-agonists (group B). All subjects were exposed, in a randomized cross-over design, to air or O{sub 3} (0.26 parts per million (ppm) for 2 h with intermittent exercise); subjects in group B withdrew from regular treatment 72 h before each exposure. Before the exposure, and 1 and 2 h after the beginning of the exposure they performed a pulmonary function test, and a questionnaire was completed to obtain a total symptom score (TSS). Six hours after the end of the exposure, hypertonic saline (HS) sputum induction was conducted. Sputum cell percentages, eosinophil cationic protein (ECP) and interleukin (IL)-8 concentrations in the sputum supernatant were measured. TSS significantly increased and forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) significantly decreased after O{sub 3} exposure in comparison with air exposure in group A, whereas no changes were observed in group B except for a significant decrement of FEV1 2 h after the beginning of O{sub 3} exposure. Sputum neutrophil percentage was significantly higher after O{sub 3} exposure than after air exposure in both groups (Group A: 70.2% (28-87) versus 26.6% (8.6-73.2); Group B: 62.1% (25-82.4) versus 27.9% (14.4-54)). IL-8 was higher in sputum supernatant collected 6 h after O{sub 3} exposure than after air, only in group A. No change due to O{sub 3} has been found in sputum eosinophil percentage and ECP concentration in both groups. In conclusion, the degree of airway response to a short-term exposure to ozone is different in subjects with asthma of different severity. The

  11. PROSPECTIVE STUDY OF VITAMIN D DEFICIENCY IN CHILDREN WITH BRONCHIAL ASTHMA AND ITS SEVERITY

    OpenAIRE

    Senthil Kumar; Sasikumar; Theenathayalan

    2015-01-01

    BACKGROUND Bronchial asthma is one of the most common chronic respiratory diseases in children worldwide. Though the cause is multifactorial due to various genetic and environmental factors, the hypothesis that link between the rising asthma prevalence and low Vitamin D levels has evolved. There are conflicting reports between studies on Vitamin D deficiency and prevalence of asthma in children. Due to the conflicting results and high prevalence of both asthma and Vitamin D de...

  12. [Effect of inhaled terbutaline sulphate (dry powder, Turbuhaler and nebulizer solution) in children with acute asthma].

    Science.gov (United States)

    Solé, D; Rizzo, M C; Pimentel, A F; Sano, F; Barreto, B A; Wandalsen, N F; Naspitz, C K

    1995-01-01

    Forty seven children (6-14 years), with an acute mild or moderate attack of asthma (clinical score 3 or FEV1 > 50% of the predicted), were treated with terbutaline sulphate, by inhalation route with a dry powder inhaler (Turbuhaler - 0,5 mg - group T; N=27, or by a nebulizer 1% solution-in saline-compressed air (6 l/min.) group S; N=20. The children were evaluated at 5, 15, 25 and 30 minutes after the initial treatment. In both groups a significant fall of the clinical score (starting at 15 minutes) (p 0.05). At the end of the first treatment, the number of patients with a FEV(1) < 80% was similar in both groups (T = 13/27 and S = 10/20). The same treatment was repeated, and all the children showed a marked improvement, except for one boy of the group T was hospitalized. In conclusion, children with mild or moderate acute attacks of asthma can be treated up to a week with an inhalation of dry powder, resulting in adequate bronchodilatation without important side effects. PMID:14689023

  13. INTERCONNECTION BETWEEN NITRIC OXIDE FORMATION AND HYPERSENSITIVITY PARAMETERS UNDER GUINEA PIG MODEL OF ACUTE ASTHMA WITH MULTIPLE CHALLENGES.

    Science.gov (United States)

    Parilova, O O; Shandrenko, S G

    2015-01-01

    An immunoregulatory role of nitric oxide (NO) in the development of adaptive immune responses associated with allergic diseases is very important. The present study extended these observations by the examination of the reciprocal changes in characteristic immunologic parameters of the disease and NO level of bronchoalveolar lavage (BAL) cells under guinea pig model of acute asthma with multiple challenges. Development of guinea pig Th2 mediated asthma was accompanied by increasing the level of allergic markers: ovalbumin (OVA) specific IgG and IL-4. We demonstrated that the infiltrate of airway cells contributes to NO synthesis in the respiratory tract during allergic inflammation. The level of intracellular NO formation significantly correlated with plasma allergen specific IgG value in OVA-induced asthma. The presented data evidence that the elevated intracellular NO level in BAL fluid may reflect a nitrosative stress in respiratory tract in general, when allergic asthma exacerbation is present.

  14. Angiographic Features in Acute Pancreatitis: The Severity of Abdominal Vessel Ischemic Change Reflects the Severity of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Inoue K

    2003-11-01

    Full Text Available CONTEXT: Assessment of tissue microcirculation is one of the important aspects of pathological evaluation in acute pancreatitis. Severe ischemic change sometimes leads to the development of organ dysfunction and/or infectious complications. OBJECTIVE: To evaluate the angiographic features of acute pancreatitis and correlate them with the severity of the disease. DESIGN: Retrospective study. PATIENTS: Twenty-seven consecutive patients with acute pancreatitis who had undergone angiography were retrospectively investigated. MAIN OUTCOME MEASURES: Vascular findings and Ranson score. RESULTS: Ischemic changes were found in 18 patients (66.7%; 11 (40.7% were severe changes. Pseudoaneurysm, bleeding, and staining were seen in 4 (14.8%, 2 (7.4% and 5 (18.5% patients, respectively. The rate of severe ischemic changes was significantly correlated with the Ranson score (P=0.012. Conclusions Angiographic findings are useful for the evaluation of severe acute pancreatitis.

  15. Pancreatic encephalopathy- a rare complication of severe acute biliary pancreatitis

    OpenAIRE

    Vlad Denis Constantin; Alexandru Carȃp; Bogdan Socea; Simona Bobic

    2014-01-01

    Background. Pancreatic encephalopathy is a rare complication of severe acute pancreatitis, with high mortality, being difficult to diagnose and treat, thus requiring continuous research regarding its management. Materials and Methods. Of 20 patients diagnosed with severe acute pancreatitis on admission at Department of Emergency and Admission (DEA), from January 1st 2010 to March 31st 2014, 5 cases complicated by pancreatic encephalopathy were analyzed using a descriptive observational...

  16. Anti-IgE treatment, airway inflammation and remodelling in severe allergic asthma: current knowledge and future perspectives

    Directory of Open Access Journals (Sweden)

    Konstantinos Samitas

    2015-12-01

    Full Text Available Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic inflammation and structural alterations in the airways, also known as remodelling. IgE is an important mediator of allergic reactions and has a central role in allergic asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating IgE in the development of airway remodelling. The use of monoclonal antibodies targeting IgE, such as omalizumab, has proven very effective in improving respiratory symptoms and quality of life, while reducing asthma exacerbations, emergency room visits and the use of systemic corticosteroids in allergic severe asthma. These effects are believed to be mainly mediated by omalizumab's inhibitory effect on the initiation and further propagation of the allergic inflammation cascade. However, there is evidence to suggest that anti-IgE treatment remains effective long after it has been discontinued. In part, these findings could be attributed to the possible ameliorating effects of anti-IgE treatment on airway remodelling. In this review, we discuss recent findings supporting the notion that anti-IgE treatment modulates the complex immune responses that manifest clinically as asthma and ameliorates airway remodelling changes often observed in allergic severe asthma phenotypes.

  17. Anti-IgE treatment, airway inflammation and remodelling in severe allergic asthma: current knowledge and future perspectives.

    Science.gov (United States)

    Samitas, Konstantinos; Delimpoura, Vasiliki; Zervas, Eleftherios; Gaga, Mina

    2015-12-01

    Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic inflammation and structural alterations in the airways, also known as remodelling. IgE is an important mediator of allergic reactions and has a central role in allergic asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating IgE in the development of airway remodelling. The use of monoclonal antibodies targeting IgE, such as omalizumab, has proven very effective in improving respiratory symptoms and quality of life, while reducing asthma exacerbations, emergency room visits and the use of systemic corticosteroids in allergic severe asthma. These effects are believed to be mainly mediated by omalizumab's inhibitory effect on the initiation and further propagation of the allergic inflammation cascade. However, there is evidence to suggest that anti-IgE treatment remains effective long after it has been discontinued. In part, these findings could be attributed to the possible ameliorating effects of anti-IgE treatment on airway remodelling. In this review, we discuss recent findings supporting the notion that anti-IgE treatment modulates the complex immune responses that manifest clinically as asthma and ameliorates airway remodelling changes often observed in allergic severe asthma phenotypes. PMID:26621973

  18. Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district.

    Science.gov (United States)

    Pinnock, H; Johnson, A; Young, P; Martin, N

    1999-06-01

    This audit aimed to observe the management of acute asthma by primary and secondary care within a Health District. Asthma attacks occurring during the first 6 weeks of 1996 to patients between the ages of 3 and 74 years in Canterbury and Thanet District were notified by general practitioners, out-of-hours co-operatives and hospitals. Data were obtained retrospectively from the patient records. A total of 378 episodes was registered: 342 (90%) to primary care. Of these 234 (76% of patients aged 6 years or over) had a peak flow recorded; 114 (30%) were given emergency bronchodilation: oxygen was not used in primary care; 204 (54%) were given systemic steroids; and 43 (11%) were referred for hospital care of whom 36 were admitted. Of the attacks, 212 (69% of the patients aged 6 years or over) could be classified by percentage predicted peak flow and management compared to the Guidelines published by the British Thoracic Society. Twenty-eight patients presented with 'life-threatening' asthma: 20 (71%) were given emergency bronchodilation; oxygen was used in only two; 24 (86%) were given systemic steroids; and six (21%) were referred for admission. In their confidential enquiry into the asthma deaths the British Thoracic Society identified a failure to appreciate the severity of the attack, resulting in inadequate emergency treatment and delay in referring to hospital. These data suggest that, 15 years later, these problems may still exist.

  19. Surfactant protein B polymorphisms are associated with severe respiratory syncytial virus infection, but not with asthma

    Directory of Open Access Journals (Sweden)

    Heinzmann Andrea

    2007-05-01

    Full Text Available Abstract Background Surfactant proteins (SP are important for the innate host defence and essential for a physiological lung function. Several linkage and association studies have investigated the genes coding for different surfactant proteins in the context of pulmonary diseases such as chronic obstructive pulmonary disease or respiratory distress syndrome of preterm infants. In this study we tested whether SP-B was in association with two further pulmonary diseases in children, i. e. severe infections caused by respiratory syncytial virus and bronchial asthma. Methods We chose to study five polymorphisms in SP-B: rs2077079 in the promoter region; rs1130866 leading to the amino acid exchange T131I; rs2040349 in intron 8; rs3024801 leading to L176F and rs3024809 resulting in R272H. Statistical analyses made use of the Armitage's trend test for single polymorphisms and FAMHAP and FASTEHPLUS for haplotype analyses. Results The polymorphisms rs3024801 and rs3024809 were not present in our study populations. The three other polymorphisms were common and in tight linkage disequilibrium with each other. They did not show association with bronchial asthma or severe RSV infection in the analyses of single polymorphisms. However, haplotypes analyses revealed association of SP-B with severe RSV infection (p = 0.034. Conclusion Thus our results indicate a possible involvement of SP-B in the genetic predisposition to severe RSV infections in the German population. In order to determine which of the three polymorphisms constituting the haplotypes is responsible for the association, further case control studies on large populations are necessary. Furthermore, functional analysis need to be conducted.

  20. Comorbidities in severe asthma: frequency of rhinitis, nasal polyposis, gastroesophageal reflux disease, vocal cord dysfunction and bronchiectasis

    Directory of Open Access Journals (Sweden)

    Carla Bisaccioni

    2009-01-01

    Full Text Available OBJECTIVES: Severe asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD, nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4%; 18 (7.3% had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3% had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6% patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6% patients. Vocal cord dysfunction was suspected in 16 (6.5% and confirmed through laryngoscopy in 4 (1.6%. The patient records provided CT scans of the chest for 105 patients, and 26 (24.8% showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

  1. Paediatric acute asthma management in Australia and New Zealand : practice patterns in the context of clinical practice guidelines

    NARCIS (Netherlands)

    Babl, F. E.; Sheriff, N.; Borland, M.; Acworth, J.; Neutze, J.; Krieser, D.; Ngo, P.; Schutz, J.; Thomson, F.; Cotterell, E.; Jamison, S.; Francis, P.

    2008-01-01

    Objectives: To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n= 9) and New Zealand (n= 2). All 11 sites participate in the Paediatric Res

  2. Treatment and evaluation of patients with acute exacerbation of asthma before and during a visit to the ER in Denmark

    DEFF Research Database (Denmark)

    Backer, V.; Harving, H.; Soes-Petersen, U.;

    2008-01-01

    leading to admission. Material and methods: In a retrospective design, we audited the hospital records of all patients aged 18-40 years admitted to five Danish university hospitals with an acute exacerbation of asthma in 2004. Results: We found records covering 323 asthmatic patients (186 women). Before...

  3. Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Roth Dalcin

    2009-01-01

    Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

  4. Liver transplantation for acute liver failure accompanied by severe acute pancreatitis.

    Science.gov (United States)

    Kirino, Izumi; Fujimoto, Yasuhiro; Hata, Koichiro; Uemoto, Shinji

    2016-01-01

    The role of liver transplantation (LT) in acute liver failure (ALF) complicated by severe acute pancreatitis is still unclear. We here report a case of deceased-donor LT for idiopathic ALF accompanied by severe acute pancreatitis. A 58-year-old man with no history of liver disease presented with idiopathic ALF and acute pancreatitis. After careful consideration, he received a liver from a deceased donor. Following surgery, the patient's liver function rapidly reverted to normal level and the acute pancreatitis simultaneously subsided. The patient later developed a pancreatic pseudocyst, which was treated successfully with combination interventional radiology. LT can be considered for ALF associated with severe acute pancreatitis if there is no clinical evidence of an absolute contraindication for organ transplantation, such as systemic or local infection. Moreover, we recommend a close follow-up by ultrasonography to allow early detection and treatment of pancreatic pseudocysts following surgery. PMID:27600056

  5. Effect of high dose inhaled glucocorticoids on quality of life in patients with moderate to severe asthma.

    Science.gov (United States)

    Choi, Jae-Sung; Jang, An-Soo; Lee, June-Hyuk; Park, Jong-Sook; Park, Sung-Woo; Kim, Do-Jin; Park, Choon-Sik

    2005-08-01

    Asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients. Inhaled glucocorticoids (GCs) are the most effective controller therapy. The purpose of this study was to evaluate the effect of inhaled GCs on quality of life in patients with moderate to severe asthma. Patients completed the asthma quality of life questionnaire (AQLQ) and pulmonary function test at baseline and after 4 wks treatment of GCs. We enrolled 60 patients who had reversibility in FEV1 after 200 microgram of albuterol of 15% or more and/or positive methacholine provocation test, and initial FEV1% predicted less than 80%. All patients received inhaled GCs (fluticasone propionate 1,000 microgram/day) for 4 wks. The score of AQLQ was significantly improved following inhaled GCs (overall 51.9+/-14.3 vs. 67.5+/-12.1, presponsiveness. Quality of life was improved after inhaled GCs regardless of asthma severity and GCs responsiveness in patients with moderate to severe asthma. PMID:16100448

  6. Early diagnosis and treatment of severe acute cholangitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Zhong Zhang; Yi-Shao Chen; Jin-Wei Wang; Xue-Rong Chen

    2002-01-01

    AIM: To investigate the diagnostic standard for earlyidentification of severe acute cholangitis in order to lowerthe incidence of morbidity and mortality rate.METHODS: A diagnostic standard was proposed in thisstudy as follows: documented biliary duct obstruction byultrasound or computerized tomography or other imagingtools with the manifestation of systemic inflammatoryresponse syndrome (SIRS). The surgical proceduresincluded emergency common bile duct exploration with Ttube insertion or cholecystostomy with secondary commonbile duct exploration. And incidence of postoperativemultiple organ dysfunction syndrome (MODS), duration ofsystemic inflammatory response and hospital mortality wereanalyzed.RESULTS: Fourty - three patients conforming to thediagnostic standard described above were employed in thisstudy. 1 patient was admitted in acutely ill condition andcomplicated with acute relapse of chronic bronchitis,cholecystostomy procedure was performed but the patientwas complicated with postoperative acute lung injury whiclwas treated by assisted mechanical ventilation for 5 d; 2 wllater, two- stage common bile duct Exploration and T tubeinsertion were performed. The remaining 42 patientsunderwent primary common bile duct exploration and T tubeinsertion, 1 developed acute lung injury and recovered 3 dlater, 2 patients developedl acute renal dysfunction, 1 ofwhich recovered 2 d later and the other died on d 4. For allpatients, the postoperative systemic inflammatory responsepersisted for 2 to 8 d with median of 3 d.CONCLUSION: Early diagnosis of severe acute cholangitiscan be made using this diagnostic standard, furtherdevelopment of systemic inflammatory response could beprevented and incidence of MODS as well as hospitalmortality decreased.

  7. The severe acute respiratory syndrome epidemic in mainland China dissected

    NARCIS (Netherlands)

    W.C. Cao (Wu Chun); S.J. de Vlas (Sake); J.H. Richardus (Jan Hendrik)

    2011-01-01

    textabstractThis paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS) epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large ge

  8. Acute painful paraplegia in a 49-year-old man with allergic asthma.

    Science.gov (United States)

    Sorino, Claudio; Agati, Sergio; Milani, Giuseppe; Maspero, Annarosa

    2014-01-01

    We present a case of a 49-year-old man, with a 10-year history of bronchial asthma and nasal polyposis, who developed acutely painful paraplegia and paresthesias. Laboratory data showed elevated blood creatine kinase levels and myoglobinuria, which were diagnostic for rhabdomyolysis but only partially explained the neurological deficit. Electrophysiological studies revealed a sensorimotor neuropathy of multiple mononeuritis type. The patient also had leucocytosis with marked eosinophilia and antineutrophil cytoplasmic autoantibodies. Bronchial biopsies showed inflammatory infiltrates with a prevalence of eosinophils. All these findings led us to diagnose eosinophilic granulomatosis with polyangiitis, a systemic vasculitis with almost constant respiratory tract involvement and good response to corticosteroid treatment. This can also affect other organs including the nervous system, while muscular involvement is unusual. Some diseases deserve attention in differential diagnosis. Histology can support the diagnosis which remains essentially clinical. Steroid sparing agents/immunosuppressants are suggested for extensive disease. PMID:24980994

  9. Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with acute asthma.

    Science.gov (United States)

    Pendergast, J; Hopkins, J; Timms, B; Van Asperen, P P

    1989-10-01

    We compared the use of terbutaline sulphate that was delivered by a nebulizer with its delivery by a Nebuhaler at two dose levels in 27 children (nine children per group) of between three and six years of age with acute asthma. No significant difference was found in the mean baseline clinical score among the three groups, and a significant decline occurred in the mean clinical scores in all groups by 15 minutes which was maintained to 60 minutes after the dose was administered. The decline that was achieved with delivery of the drug by way of a Nebuhaler (at either dose level) was not significantly different from that with a nebulizer, although cooperation with Nebuhaler usage was not universal in the age-group. PMID:2677624

  10. In-Patient Treatment of Severe Acute Malnutrition

    DEFF Research Database (Denmark)

    Rytter, Maren Johanne Heilskov

    of malnutrition, Kwashiorkor, where the children develop oedema. Finally, we explored symptoms, findings or treatments given that were associated with a higher risk of death in the children. Hopefully, these findings may contribute to improving the treatment offered to children with severe acute......Severe acute malnutrition is a serious health problem among children in low-income countries. Particularly malnourished children requiring in-hospital treatment are at high risk of dying. This dissertation investigates possible reasons for this high mortality, by following a group of 120 children...... during their in-hospital treatment of severe acute malnutrition at Mwanamugimu Nutrition Unit in Kampala, Uganda. We assessed how malnutrition affected the children’s immune system, by measuring the size of their thymus gland with ultrasound. We examined characteristics of children with the serious form...

  11. Criteria for the diagnosis and severity stratification of acute pancreatitis

    OpenAIRE

    Otsuki, Makoto; Takeda, Kazunori; Matsuno, Seiki; Kihara, Yasuyuki; Koizumi, Masaru; Hirota, Masahiko; Ito, Tetsuhide; Kataoka, Keisho; Kitagawa, Motoji; Inui, Kazuo; TAKEYAMA, YOSHIFUMI

    2013-01-01

    Recent diagnostic and therapeutic progress for severe acute pancreatitis (SAP) remarkably decreased the case-mortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examina...

  12. Wernicke Encephalopathy Presenting in a Patient with Severe Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ana Cecilia Arana-Guajardo

    2012-01-01

    Full Text Available Context Acute pancreatitis can lead to prolonged fasting and malnutrition. Many metabolic changes, including thiamine deficiency, may lead to the well know pancreatic encephalopathy. In this condition however the thiamine deficiency is rarely suspected. Case report We report the case of a 17-year-old woman with severe acute pancreatitis who developed mental status changes and ophthalmoplegia. A magnetic resonance image showed hyperintensive signals in periventricular areas, medial thalamus, and mammillary bodies, findings consistent with the diagnosis of Wernicke encephalopathy. Thiamine treatment reversed neurological complications. Conclusion Wernicke encephalopathy secondary to thiamine deficiency should be considered as a possible cause of acute mental status changes in patients with acute pancreatitis and malnutrition. Prophylactic doses of thiamine could be considered in susceptible patients.

  13. Acute renal failure and severe thrombocytopenia associated with metamizole

    Directory of Open Access Journals (Sweden)

    Maria Dolores Redondo-Pachon

    2014-01-01

    Full Text Available Metamizole or dipyrone is a pyrazolone derivative that belongs to the non-steroidal anti-inflammatory drugs. Its main side-effect is hematological toxicity. Thrombocytopenia due to metamizole is rare and is usually associated with the involvement of the two other blood series. Drug-induced thrombocytopenia is more frequently related to immune mechanisms, and the diag-nosis is still largely made by exclusion of other causes and by correlation of timing of thrombocytopenia with the administration of drug. Metamizole may cause acute renal failure due to hemodynamic renal failure/acute tubular necrosis and/or acute tubulointerstitial nephritis. We report a case of acute renal failure and severe thrombocytopenia after metamizole. As far as we know, this combination of adverse effects from this drug has not been reported previously.

  14. Current concept of pathogenesis of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xie Ning Wu

    2000-01-01

    @@ The pathogenesis of severe acute pancreatitis is very complicated. It is a multifactorial as well as multifaceted disease. First of all, the etiologic agents initiate the pancreatic acinar injury by release of pancreatic enzymes and overstimulation of macrophages and neutrophils, then the cytokines and inflammatory mediators are liberated. There is also interaction between neutrophils and endothelial cells producing free radicals, the cytokines cause increasing vascular permeability, activating complement component, resulting in microcirculatory impairment and imbalance of thrombo-fibrinolytic system. Many of these events occur not only in the pancreas itself, but also in the other vital organs and tissues, leading to severe acute pancreatitis and complications. The sequencial events are as follows.

  15. Psychosocial Care and its Association with Severe Acute Malnutrition.

    Science.gov (United States)

    Singh, Anurag; Agarwal, Sheesham

    2016-05-01

    This cross-sectional study compared 120 children having severe acute malnutrition with 120 healthy children for exposure to 40 behaviors, by measuring psychosocial care based on Home Observation for Measurement of the Environment (HOME) inventory. The mean (SD) psychosocial care score of cases and controls significantly differed [18.2 (2.2) vs 23.5 (2.1); P<0.001]. A score of less than 14 was significantly associated with severe acute malnutrition (OR 23.2; 95% CI 8.2, 50). PMID:27254059

  16. Pancreatic encephalopathy- a rare complication of severe acute biliary pancreatitis

    Directory of Open Access Journals (Sweden)

    Vlad Denis Constantin

    2014-10-01

    Full Text Available Background. Pancreatic encephalopathy is a rare complication of severe acute pancreatitis, with high mortality, being difficult to diagnose and treat, thus requiring continuous research regarding its management. Materials and Methods. Of 20 patients diagnosed with severe acute pancreatitis on admission at Department of Emergency and Admission (DEA, from January 1st 2010 to March 31st 2014, 5 cases complicated by pancreatic encephalopathy were analyzed using a descriptive observational, retrospective, single-center study. Results. The study shows different types of diagnostic algorithm and therapeutical approaches, in correlation with morbidity and mortality rates. Conclusions. Our study highlighted the fact that speed is critical, early management being the key to outcome.

  17. Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

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    Andrea Mendonça Rodrigues

    2015-08-01

    Full Text Available AbstractObjective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA treated at a referral center in southern Brazil.Methods: We retrospectively analyzed children and adolescents (3-18 years of age with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting β2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results.Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years. Of those, 18 (86% were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody, 7 (87.5% showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations.Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

  18. Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

    Institute of Scientific and Technical Information of China (English)

    Yan Luo; Chao Xin Yuan; Yu Lan Peng; Pei Lin Wei; Zhao Da Zhang; Jun Ming Jiang; Lin Dai; Yun Kai Hu

    2001-01-01

    @@INTRODUCTION The spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

  19. Management of patients after recovering from acute severe biliary pancreatitis.

    Science.gov (United States)

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-09-14

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  20. Self-hypnosis for anxiety associated with severe asthma: a case report

    Directory of Open Access Journals (Sweden)

    Anbar Ran D

    2003-07-01

    Full Text Available Abstract Background Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations. Case Presentation The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy. Conclusions This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma.

  1. Early Prediction of Severity in Acute Pancreatitis. Is This Possible?

    Directory of Open Access Journals (Sweden)

    Sandberg AA

    2002-09-01

    Full Text Available One out of ten cases of acute pancreatitis develops into severe acute pancreatitis which is a life threatening disorder with a high mortality rate. The other nine cases are self limiting and need very little therapy. The specificity of good clinical judgement on admission, concerning the prognosis of the attack, is high (high specificity but misses a lot of severe cases (low sensitivity. The prediction of severity in acute pancreatitis was first suggested by John HC Ranson in 1974. Much effort has been put into finding a simple scoring system or a good biochemical marker for selecting the severe cases of acute pancreatitis immediately on admission. Today C-reactive protein is the method of choice although this marker is not valid until 48-72 hours after the onset of pain. Inflammatory mediators upstream from CRP like interleukin-6 and other cytokines are likely to react faster and preliminary results for some of these mediators look promising. Another successful approach has been to study markers for the activation of trypsinogen such as TAP and CAPAP. This is based on studies showing that active trypsin is the initial motor of the inflammatory process in acute pancreatitis. In the near future a combined clinical and laboratory approach for early severity prediction will be the most reliable. Clinical judgement predicts 1/3 of the severe cases on admission and early markers for either inflammation or trypsinogen activation should accurately identify 50-60% of the mild cases among the rest, thus missing only 2-4% of the remaining severe cases. One problem is that there is no simple and fast method to analyze any of these parameters.

  2. Evaluation of the Correlation Between Body Mass Index and the Severity of Asthma in Recently Diagnosed Patients

    Directory of Open Access Journals (Sweden)

    Davood Attaran

    2011-06-01

    Full Text Available Introduction: Asthma and obesity are among diseases that cause several problems and impair quality of life.  The concurrence of these diseases, changes in the respiratory physiology, changes associated with obesity and limited activity associated with asthma may cause an interaction between the two conditions. Materials and Methods: We studied the epidemiologic characteristics of all recently diagnosed cases of asthma with no previous treatment who visited the Respiratory Diseases Clinic of the Ghaem Hospital from 2004 to 2007, their Body Mass Indexes (BMI were calculated and then spirometry was performed in all cases. Results: We studied 232 cases with the mean age of 38.96±12.94 years and the mean BMI of 27.05±4.92. Cough and exertional dyspnea were the most common clinical symptoms. In spirometric evaluations, the mean maximum mid-expiratory flow (MMEF increased with weight, which was not, however, insignificant. FVC in obese patients was significantly less than in normal weight cases. A significant correlation was not also seen between BMI and FEV1 (r=-0.023, P=0.729. Conclusion: Except for FVC which had a significant correlation with BMI, other studied indices yielded no significant results, which calls for more extensive studies with larger populations. Considering the fact that mild asthma is less common in obese patients, better weight control in asthmatic patients can promote their quality of life and make asthma management more effective.

  3. Use of medicinal herbs by patients with severe asthma managed at a Referral Center

    Directory of Open Access Journals (Sweden)

    Tacila Pires Mega

    2011-09-01

    Full Text Available Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1% out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5% attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de rem

  4. Asthma and Food Allergies

    Science.gov (United States)

    ... Español Text Size Email Print Share Asthma and Food Allergies Page Content Article Body A family history of ... child may develop asthma . Children with asthma and food allergies are at increased risk for anaphylaxis, a severe ...

  5. Consensus for the manaegment of severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Chinese Medical Association,China Association of C

    2003-01-01

    @@ INTRODUCTION Since recognition of the first case of sever acute respiratory syndrome (SARS) in Guangdong Province in November 2002,health care worker engaged in basic medicine,clinical medicine and preventive progress in the understanding of the etiology,epidemiology,diagnosis,treatment and prevention of SARS.

  6. Neonatal bronchial hyperresponsiveness precedes acute severe viral bronchiolitis in infants

    DEFF Research Database (Denmark)

    Chawes, Bo L K; Poorisrisak, Porntiva; Johnston, Sebastian L;

    2012-01-01

    Respiratory syncytial virus and other respiratory tract viruses lead to common colds in most infants, whereas a minority develop acute severe bronchiolitis often requiring hospitalization. We hypothesized that such an excessive response to respiratory tract viral infection is caused by host factors...

  7. Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis

    OpenAIRE

    Yoshihisa Tsuji; Naoki Takahashi; Chiba Tsutomu

    2012-01-01

    Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early s...

  8. MODIFIED COMPUTED TOMOGRAPHY SEVERITY INDEX IN ACUTE PANCREATITIS

    Directory of Open Access Journals (Sweden)

    Shivanand

    2014-12-01

    Full Text Available : 100 cases of acute pancreatitis patients were studied to evaluate the complications using MCTSI and its comparison with CTSI. Age distribution of patients varied from 11 to 79 years. Maximum patients were male. The CTSI grades are classified into mild (0-3, moderate (4-6 and severe (7-10 and MCTSI grades are classified into mild (0-2, moderate (4-6 and severe (8-10

  9. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis

    OpenAIRE

    Prashant Nasa; George Alexander; Amitabh Kulkarni; Deven Juneja; Sudhish Sehra; Rajesh Agarwal; Kandy Koul

    2015-01-01

    Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancr...

  10. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  11. Acute kidney injury in severe acute pancreatitis: An experience from a tertiary care center

    OpenAIRE

    Ravindra Kumar; Naresh Pahwa; Neeraj Jain

    2015-01-01

    Acute kidney injury (AKI) is an important cause of morbidity and mortality in severe acute pancreatitis (SAP). We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the S...

  12. Does vitamin d deficiency contribute to the severity of asthma in children and adults

    International Nuclear Information System (INIS)

    Role of vitamin D in the health of bones has been well established for over decades. It was known that its deficiency caused rickets in children and osteomalacia in adults. Later it was discovered that these can be corrected by giving vitamin D. Researchers discovered that vitamin D can be synthesized by exposure to sun. Hence it was also named the sunshine vitamin. As time passed it was observed that low levels of vitamin D were associated with multiple diseases. This sparked the interest of the scientific community to further the research on vitamin D which led to the studies that started associating vitamin D with various diseases like cancers (prostate, colon and breast), autoimmune diseases (rheumatoid arthritis), infectious diseases (tuberculosis, hepatitis B, hepatitis C, HIV), cardiovascular diseases, mental illnesses (schizophrenia), diabetes mellitus (type 1, type 2 and gestational) and allergic conditions like asthma. With time, more studies were carried out relating levels of vitamin D to development of asthma, asthma exacerbations and risk factors leading to development of asthma like respiratory tract infections with positive associations. A number of studies were carried out which tried to explain the possible molecular mechanisms relating deficiency of vitamin D in pathogenesis of asthma. This review summarizes the role of vitamin D in development of asthma and probable mechanisms relating vitamin D to the pathogenesis of asthma. (author)

  13. Fenótipos clínicos de asma grave Clinical phenotypes of severe asthma

    Directory of Open Access Journals (Sweden)

    Roseliane de Souza Araújo Alves

    2008-09-01

    Full Text Available OBJETIVO: Estabelecer os fenótipos clínicos em portadores de asma grave. MÉTODOS: Foram estudados, retrospectivamente, 111 pacientes em um ambulatório especializado. Os pacientes foram avaliados e acompanhados de maneira sistemática, estabelecendo-se ao final do acompanhamento a adesão e o controle ou não da doença por dados clínicos e funcionais. A resistência ao tratamento foi definida como o não preenchimento, ao final do acompanhamento, por pelo menos seis meses, dos critérios de controle de asma, apesar do uso correto e adesão à medicação. Os fenótipos foram determinados por análise fatorial e comparados por testes diversos. RESULTADOS: Ao final, 88 pacientes foram considerados aderentes e 23 não aderentes. Por análise fatorial do grupo aderente, quatro fenótipos foram determinados: o fenótipo 1 (28 pacientes, formado pelos pacientes resistentes ao tratamento, com maior freqüência de sintomas noturnos, maior número de exacerbações e uso mais freqüente de broncodilatador de resgate; o fenótipo 2 (48 pacientes, formado pelos pacientes com obstrução persistente, com menores valores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada na avaliação inicial, idade mais avançada e maior tempo de doença; o fenótipo 3 (42 pacientes, representa os pacientes com rinossinusite alérgica, sendo constituído de não fumantes com obstrução predominantemente reversível; e o fenótipo 4 (15 pacientes, formado por casos com história de intolerância à aspirina associado à asma quase fatal. CONCLUSÕES: Um número significativo de portadores de ama grave não adere ao tratamento. Muitos pacientes com asma grave têm obstrução irreversível, mas o fenótipo clínico mais relevante é constituído pelos pacientes resistentes ao tratamento habitual.OBJECTIVE: To characterize clinical phenotypes of severe asthma. METHODS: A total of 111 patients were retrospectively evaluated at a

  14. Severe Hypophosphatemia in a Patient with Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Rizos E

    2000-11-01

    Full Text Available CONTEXT: We describe a patient with alcohol-induced pancreatitis who developed severe life-threatening hypophosphatemia of multifactorial origin during hospitalization. CASE REPORT: Decreased phosphate levels along with urine phosphate wasting were already noticed on the patient's admission due to underlying chronic alcoholism. However, a further deterioration of hypophosphatemia appeared on the second day of hospitalization presumably resulting from an increased transfer of phosphate from extracellular to intracellular fluid. CONCLUSIONS: Phosphate deficiency is often overlooked in patients with acute pancreatitis. Our case emphasizes that serum phosphate levels should be checked along with serum calcium levels in patients with acute pancreatitis, especially in alcoholic patients.

  15. Extracorporeal life support for adults with severe acute respiratory failure.

    Science.gov (United States)

    Del Sorbo, Lorenzo; Cypel, Marcelo; Fan, Eddy

    2014-02-01

    Extracorporeal life support (ECLS) is an artificial means of maintaining adequate oxygenation and carbon dioxide elimination to enable injured lungs to recover from underlying disease. Technological advances have made ECLS devices smaller, less invasive, and easier to use. ECLS might, therefore, represent an important step towards improved management and outcomes of patients with acute respiratory distress syndrome. Nevertheless, rigorous evidence of the ability of ECLS to improve short-term and long-term outcomes is needed before it can be widely implemented. Moreover, how to select patients and the timing and indications for ECLS in severe acute respiratory distress syndrome remain unclear. We describe the physiological principles, the putative risks and benefits, and the clinical evidence supporting the use of ECLS in patients with acute respiratory distress syndrome. Additionally, we discuss controversies and future directions, such as novel technologies and indications, mechanical ventilation of the native lung during ECLS, and ethics considerations. PMID:24503270

  16. Mode of dendritic cell activation: the decisive hand in Th2/Th17 cell differentiation. Implications in asthma severity?

    Science.gov (United States)

    Vroman, Heleen; van den Blink, Bernt; Kool, Mirjam

    2015-02-01

    Asthma is a heterogeneous chronic inflammatory disease of the airways, with reversible airflow limitations and airway remodeling. The classification of asthma phenotypes was initially based on different combinations of clinical symptoms, but they are now unfolding to link biology to phenotype. As such, patients can suffer from a predominant eosinophilic, neutrophilic or even mixed eosinophilic/neutrophilic inflammatory response. In adult asthma patients, eosinophilic inflammation is usually seen in mild-to-moderate disease and neutrophilic inflammation in more severe disease. The underlying T cell response is predominated by T helper (Th) 2, Th17, or a mixed Th2/Th17 cell immune response. Dendritic cells (DCs) are "professional" antigen presenting cells (APCs), since their principal function is to present antigens and induce a primary immune response in resting naive T cells. DCs also drive the differentiation into distinctive Th subsets. The expression of co-stimulatory molecules and cytokines by DCs and surrounding cells determines the outcome of Th cell differentiation. The nature of DC activation will determine the expression of specific co-stimulatory molecules and cytokines, specifically needed for induction of the different Th cell programs. Thus DC activation is crucial for the subsequent effector Th immune responses. In this review, we will discuss underlying mechanisms that initiate DC activation in favor of Th2 differentiation versus Th1/Th17 and Th17 differentiation in the development of mild versus moderate to severe asthma. PMID:25245013

  17. Increased expression of bronchial epithelial transient receptor potential vanilloid 1 channels in severe asthma

    OpenAIRE

    McGarvey, Lorcan P.; Butler, Claire A; Stokesberry, Susan; Polley, Liam; McQuaid, Stephen; Abdullah, Hani'ah; Ashraf, Sadaf; McGahon, Mary K; Curtis, Tim M; Arron, Joe; Choy, David; Warke, Tim J.; Bradding, Peter; Ennis, Madeleine; Zholos, Alexander

    2014-01-01

    BACKGROUND: The airway epithelium is exposed to a range of physical and chemical irritants in the environment that are known to trigger asthma. Transient receptor potential (TRP) cation channels play a central role in sensory responses to noxious physical and chemical stimuli. Recent genetic evidence suggests an involvement of transient receptor potential vanilloid 1 (TRPV1), one member of the vanilloid subfamily of TRP channels, in the pathophysiology of asthma. The functional expression of ...

  18. The role of omalizumab in the treatment of severe allergic asthma

    OpenAIRE

    Chapman, Kenneth R.; Andre Cartier; Jacques Hébert; R Andrew McIvor; R Robert Schellenberg

    2006-01-01

    BACKGROUND: A novel anti-immunoglobulin E (anti-IgE) therapy for asthma, omalizumab, has been approved for use in Canada.OBJECTIVE: To review the basic and clinical data for omalizumab, and to examine its possible role for asthma management in Canada.METHODS: A literature search from 1960 to 2006 was conducted in MEDLINE to identify studies of omalizumab. In addition, abstracts from recent respiratory and allergy scientific meetings were sought, and any unpublished data were requested from th...

  19. Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients

    Science.gov (United States)

    Jeong, Suk Hyeon; Lee, Hyun; Carriere, KC; Shin, Sun Hye; Moon, Seong Mi; Jeong, Byeong-Ho; Koh, Won-Jung; Park, Hye Yun

    2016-01-01

    Background Comorbidities have a serious impact on the frequent severe acute exacerbations (AEs) in patients with COPD. Previous studies have used the Charlson comorbidity index to represent a conglomerate of comorbidities; however, the respective contribution of each coexisting disease to the frequent severe AEs remains unclear. Methods A retrospective, observational study was performed in 77 COPD patients who experienced severe AE between January 2012 and December 2014 and had at least 1-year follow-up period from the date of admission for severe AE. We explored the incidence of frequent severe AEs (≥2 severe AEs during 1-year period) in these patients and investigated COPD-related factors and comorbidities as potential risk factors of these exacerbations. Results Out of 77 patients, 61 patients (79.2%) had at least one comorbidity. During a 1-year follow-up period, 29 patients (37.7%) experienced frequent severe AEs, approximately two-thirds (n=19) of which occurred within the first 90 days after admission. Compared with patients not experiencing frequent severe AEs, these patients were more likely to have poor lung function and receive home oxygen therapy and long-term oral steroids. In multiple logistic regression analysis, coexisting asthma (adjusted odds ratio [OR] =4.02, 95% confidence interval [CI] =1.30–12.46, P=0.016), home oxygen therapy (adjusted OR =9.39, 95% CI =1.60–55.30, P=0.013), and C-reactive protein (adjusted OR =1.09, 95% CI =1.01–1.19, P=0.036) were associated with frequent severe AEs. In addition, poor lung function, as measured by forced expiratory volume in 1 second (adjusted OR =0.16, 95% CI =0.04–0.70, P=0.015), was inversely associated with early (ie, within 90 days of admission) frequent severe AEs. Conclusion Based on our study, among COPD-related comorbidities, coexisting asthma has a significant impact on the frequent severe AEs in COPD patients. PMID:27536097

  20. Atomic structure of a rhinovirus C, a virus species linked to severe childhood asthma.

    Science.gov (United States)

    Liu, Yue; Hill, Marchel G; Klose, Thomas; Chen, Zhenguo; Watters, Kelly; Bochkov, Yury A; Jiang, Wen; Palmenberg, Ann C; Rossmann, Michael G

    2016-08-01

    Isolates of rhinovirus C (RV-C), a recently identified Enterovirus (EV) species, are the causative agents of severe respiratory infections among children and are linked to childhood asthma exacerbations. The RV-C have been refractory to structure determination because they are difficult to propagate in vitro. Here, we report the cryo-EM atomic structures of the full virion and native empty particle (NEP) of RV-C15a. The virus has 60 "fingers" on the virus outer surface that probably function as dominant immunogens. Because the NEPs also display these fingers, they may have utility as vaccine candidates. A sequence-conserved surface depression adjacent to each finger forms a likely binding site for the sialic acid on its receptor. The RV-C, unlike other EVs, are resistant to capsid-binding antiviral compounds because the hydrophobic pocket in VP1 is filled with multiple bulky residues. These results define potential molecular determinants for designing antiviral therapeutics and vaccines. PMID:27511920

  1. Serum 25-hydroxyvitamin D and CD4+CD25(+high) FoxP3+ Regulatory T cell as Predictors of Severity of Bronchial Asthma in Children.

    Science.gov (United States)

    Ismail, Ahlam M; Aly, Sanaa S; Fayed, Hanan M; Ahmed, Samar S

    2015-01-01

    Bronchial asthma (BA) is one of the common chronic diseases of childhood. Vitamin D deficiency has been associated with BA. Suppressor regulatory T cells (Treg) are important for the induction, maintenance of immunological tolerance to allergens. This study assessed serum 25-hydroxyvitamin D (vitamin D) and the percentages of CD4+CD25+(high) Foxp3+ Treg, in peripheral blood, as predictors of asthma severity and level of clinical control. The study enrolled 72 children divided equally between asthmatic children (AC) and age and sex matched controls. Diagnostic criteria and level of asthma severity followed the Global Initiative for Asthma guidelines. Serum vitamin D was determined by an immunoassay and the percentages of CD4+CD25+ig Foxp3+ Treg by flow cytometry. Serum vitamin D level and percentage of CD4+CD25+(high) Treg were lower in AC compared to controls (P asthma compared to mild and moderate forms (P = 0.008) and in uncontrolled attacks compared to partially or completely controlled children. No difference in percentage of Treg in relation to asthma severity and clinical control was observed. Since AC has decreased serum vitamin D with inverse relationship between its levels and asthma severity, we conclude that it can be used to predict severity of asthma. PMID:26415368

  2. Prediction of relapse within eight weeks after an acute asthma exacerbation in adults.

    Science.gov (United States)

    McCarren, M; McDermott, M F; Zalenski, R J; Jovanovic, B; Marder, D; Murphy, D G; Kampe, L M; Misiewicz, V M; Rydman, R J

    1998-02-01

    Associations between historical, presenting, and treatment-related characteristics and relapse within 8 weeks after a moderate to severe asthma exacerbation were studied in a cohort of 284 adult asthmatics. Data were collected prospectively, and a multivariate model was developed and internally validated. Within 10 days, only 8% had relapsed, increasing to 45% by 8 weeks. Three variables that could be identified at the time of discharge were independently associated with relapse. These included: having made three or more visits to an emergency department in the prior 6 months (hazard ratio (HR) = 2.3, 95% CI = 1.6-3.4); difficulty performing work or activities as a result of physical health in the 4 weeks prior (HR = 2.7, 95% CI = 1.6-4.3); discontinuing hospital-based treatment for the exacerbation within 24 hours without having achieved a peak expiratory flow rate of at least 50% of predicted (HR = 2.6, 95% CI = 1.6-4.1). These risk factors may help to identify patients with poorly controlled asthma in need of more intensive and comprehensive management. PMID:9474071

  3. Severe Acute Respiratory Syndrome: Clinical and Laboratory Manifestations

    OpenAIRE

    Lam, Christopher W.K.; Chan, Michael H M; Wong, Chun K.

    2004-01-01

    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase...

  4. Probing the urinary proteome of severe acute pancreatitis

    OpenAIRE

    Flint, Richard S.; Phillips, Anthony R.J.; Farrant, Glenn J.; Mckay, Duncan; Buchanan, Christina M.; Cooper, Garth S.J.; Windsor, John A.

    2007-01-01

    Background. Proteinuria is a characteristic feature of severe acute pancreatitis (SAP) that may allow unique insights into AP pathophysiology. This study used a proteomic approach to differentiate the abundant urinary proteins in AP patients. Materials and methods. Urine samples were prospectively collected from 4 groups (5 SAP, 10 mild gallstone AP, 7 mild alcohol AP, 7 controls). Reverse-phase high-performance liquid chromatography (RP-HPLC) and matrix-assisted laser desorption/ionization t...

  5. Anxiety symptom severity differentiates HPA acute stress reactivity in children

    OpenAIRE

    Slattery, Marcia J.; Grieve, Adam J.; Paletz, Elliott M.; Kalin, Ned H.

    2012-01-01

    Rationale/statement of the problem : Considerable research has focused on the relationship of anxiety with alterations in the hypothalamic-pituitary-adrenal (HPA) acute stress response. Findings, however, differ among studies on adults and children, and among different types of anxiety. This study investigates the relationship of anxiety symptom severity with HPA reactivity to the cold pressor task (CPT) in preadolescent children. We hypothesize that children with increased symptoms of anxiet...

  6. Efficacy and safety of budesonide/formoterol single inhaler therapy versus a higher dose of budesonide in moderate to severe asthma

    NARCIS (Netherlands)

    Scicchitano, R; Aalbers, R; Ukena, D; Manjra, A; Fouquert, L; Centanni, S; Boulet, LP; Naya, IP; Hultquist, C

    2004-01-01

    Objectives:This study evaluated the efficacy and safety of a novel asthma management strategy - budesonide/formoterol for both maintenance and symptom relief (Symbicort Single Inhaler Therapy*) - compared with a higher maintenance dose of budesonide in patients with moderate to severe asthma. Method

  7. Soluble CD40 ligand in prediction of acute severe pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jean Louis Frossard; Philippe Morel; Brenda Kwak; Catherine Pastor; Thierry Berney; Léo Buhler; Alain Von Laufen; Sandrine Demulder; Fran(c)ois Mach

    2006-01-01

    AIM: To assess the early predictability of the soluble CD40L (sCD40L) in pancreatitis severity.METHODS: Between February 2000 and February 2003,279 consecutive patients with acute pancreatitis were prospectively enrolled in our study. In this report, 40 patients with mild and 40 patients with severe pancreatitis were randomly studied. sCD40L concentrations were measured 48 hours after admission.RESULTS: sCD40L levels were significantly higher 48 hours after admission in severe pancreatitis than in mild pancreatitis. Using a cutoff of 1000 pg/L, the sensitivity and specificity of sCD40L to detect a severe course of the disease were 78% and 62% respectively compared to 72% and 81% for CRP. Logistic regression analysis found that CRP was the only statistically significant marker able to detect a severe course of the disease.CONCLUSION: These findings indicate that CRP remains a valuable marker to determine the severity and prognosis of acute pancreatitis whereas sCD40L levels should be assessed in further studies.

  8. Defective Resensitization in Human Airway Smooth Muscle Cells Evokes β-Adrenergic Receptor Dysfunction in Severe Asthma.

    Directory of Open Access Journals (Sweden)

    Manveen K Gupta

    Full Text Available β2-adrenergic receptor (β2AR agonists (β2-agonist are the most commonly used therapy for acute relief in asthma, but chronic use of these bronchodilators paradoxically exacerbates airway hyper-responsiveness. Activation of βARs by β-agonist leads to desensitization (inactivation by phosphorylation through G-protein coupled receptor kinases (GRKs which mediate β-arrestin binding and βAR internalization. Resensitization occurs by dephosphorylation of the endosomal βARs which recycle back to the plasma membrane as agonist-ready receptors. To determine whether the loss in β-agonist response in asthma is due to altered βAR desensitization and/or resensitization, we used primary human airway smooth muscle cells (HASMCs isolated from the lungs of non-asthmatic and fatal-asthmatic subjects. Asthmatic HASMCs have diminished adenylyl cyclase activity and cAMP response to β-agonist as compared to non-asthmatic HASMCs. Confocal microscopy showed significant accumulation of phosphorylated β2ARs in asthmatic HASMCs. Systematic analysis of desensitization components including GRKs and β-arrestin showed no appreciable differences between asthmatic and non-asthmatic HASMCs. However, asthmatic HASMC showed significant increase in PI3Kγ activity and was associated with reduction in PP2A activity. Since reduction in PP2A activity could alter receptor resensitization, endosomal fractions were isolated to assess the agonist ready β2ARs as a measure of resensitization. Despite significant accumulation of β2ARs in the endosomes of asthmatic HASMCs, endosomal β2ARs cannot robustly activate adenylyl cyclase. Furthermore, endosomes from asthmatic HASMCs are associated with significant increase in PI3Kγ and reduced PP2A activity that inhibits β2AR resensitization. Our study shows that resensitization, a process considered to be a homeostasis maintaining passive process is inhibited in asthmatic HASMCs contributing to β2AR dysfunction which may underlie

  9. Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Yoshihisa Tsuji

    2012-01-01

    Full Text Available Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early stage of SAP.

  10. Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003.

    Science.gov (United States)

    2003-03-28

    CDC continues to support the World Health Organization (WHO) in the investigation of a multicountry outbreak of unexplained atypical pneumonia referred to as severe acute respiratory syndrome (SARS). This report includes summaries of the epidemiologic investigations and public health responses in several affected locations where CDC is collaborating with international and national health authorities. This report also describes an unusual cluster of cases associated with a hotel in Hong Kong and identifies the potential etiologic agent of SARS. Epidemiologic and laboratory investigations of SAPS are ongoing. PMID:12680518

  11. Severe Raynaud's phenomenon-A streamlined approach to acute management.

    Science.gov (United States)

    Lee, Regent; Lomas, Oliver; Handa, Ashok

    2011-01-01

    Raynaud's phenomenon is an exaggerated vasospastic response to cold or emotional stress which not only may cause the patient severe pain but also critical ischaemia and necrosis of the digits. We report the case of a 69-year-old woman who presented with rest pain, impending ulceration and necrosis of finger tips due to an episode of left-sided Raynaud's phenomenon. Intravenous prostacyclin was administered successfully as a bridge to endoscopic thoracic sympathectomy. Vascular surgery units are ideally positioned for the acute management of severe Raynaud's phenomenon to provide continuity of care to patients with profound digital ischaemia and impending tissue loss.

  12. The Three A’s in Asthma – Airway Smooth Muscle, Airway Remodeling & Angiogenesis

    OpenAIRE

    Keglowich, L F; Borger, P

    2015-01-01

    Asthma affects more than 300 million people worldwide and its prevalence is still rising. Acute asthma attacks are characterized by severe symptoms such as breathlessness, wheezing, tightness of the chest, and coughing, which may lead to hospitalization or death. Besides the acute symptoms, asthma is characterized by persistent airway inflammation and airway wall remodeling. The term airway wall remodeling summarizes the structural changes in the airway wall: epithelial cell shedding, goblet ...

  13. The three A's in asthma - airway smooth muscle, airway remodeling & angiogenesis

    OpenAIRE

    Keglowich, L F; Borger, P

    2015-01-01

    Asthma affects more than 300 million people worldwide and its prevalence is still rising. Acute asthma attacks are characterized by severe symptoms such as breathlessness, wheezing, tightness of the chest, and coughing, which may lead to hospitalization or death. Besides the acute symptoms, asthma is characterized by persistent airway inflammation and airway wall remodeling. The term airway wall remodeling summarizes the structural changes in the airway wall: epithelial cell shedding, goblet ...

  14. Evaluation of acute bacterial rhino sinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

    International Nuclear Information System (INIS)

    Objective: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. Methods: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. Results: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. Conclusions: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution. (author)

  15. Significance of CT severity index in acute pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ho; Ahn, In Oak; Kim, Young Mi; Na, Jae Boem; Chung, Sung Hoon; You, Jin Jong [Gyeongsang National Univ. College of Medicine, Chinju (Korea, Republic of); Jun, Se June [Inchon Christian Hospital, Inchon (Korea, Republic of); Song, Ik Hoon [Masan Samsung Hospital, Masan (Korea, Republic of)

    1997-02-01

    To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-socre(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p < .05 and p= .08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis.

  16. Incidence and risk factors for exacerbations of asthma during pregnancy

    Directory of Open Access Journals (Sweden)

    Ali Z

    2013-05-01

    Full Text Available Zarqa Ali, Charlotte Suppli UlrikDepartment of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Copenhagen, DenmarkBackground: Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma during pregnancy.Methods: A narrative literature review was carried out using the PubMed database.Results: During pregnancy, up to 6% of women with asthma are hospitalized for an acute exacerbation. The maternal immune system is characterized by a very high T-helper-2:T-helper-1 cytokine ratio during pregnancy and thereby provides an environment essential for fetal survival but one that may aggravate asthma. Cells of the innate immune system such as monocytes and neutrophils are also increased during pregnancy, and this too can exacerbate maternal asthma. Severe or difficult-to-control asthma appears to be the major risk factor for exacerbations during pregnancy, but studies also suggest that nonadherence with controller medication and viral infections are important triggers of exacerbations during pregnancy. So far, inconsistent findings have been reported regarding the effect of fetal sex on exacerbations during pregnancy. Other risk factors for exacerbation during pregnancy include obesity, ethnicity, and reflux, whereas atopy does not appear to be a risk factor.Discussion: The incidence of asthma exacerbations during pregnancy is disturbingly high. Severe asthma – better described as difficult-to-control asthma – nonadherence with controller therapy, viral infections, obesity, and ethnicity are likely to be important risk factors for exacerbations of asthma during pregnancy, whereas inconsistent findings have been reported with regard to the importance of sex of the fetus.Keywords: acute exacerbations

  17. Relevance of serology for Mycoplasma pneumoniae diagnosis compared with PCR and culture in acute exacerbation of bronchial asthma.

    Science.gov (United States)

    El Sayed Zaki, Maysaa; Raafat, Doaa; El Metaal, Amal Abd

    2009-01-01

    We studied Mycoplasma pneumoniae as the etiologic pathogen in acute exacerbations of asthma and the value of polymerase chain reaction (PCR), culture, and serologic tests for its accurate diagnosis. For the study, 59 nonsmoking patients with asthma (37 females, 22 males; age, 15-50 years) underwent clinical, radiologic, and laboratory examinations. Bacteria isolated from sputum were Streptococcus pneumoniae (32 [54%]), Staphylococcus aureus (23 [39%]), and M pneumoniae (5 [15%]). All M pneumoniae were associated with S pneumoniae (8/32 [25%]) and S aureus (1/23 [4%]). No M pneumoniae were isolated as single pathogens. Serologic testing for M pneumoniae revealed that all samples were positive for specific IgG; 40 (68%) had a high titer, and 19 (32%) had a moderate titer. Of 59 samples, 29 (49%) were positive by Serodia Myco II gelatin particle testing (Fujirebio, Tokyo, Japan). PCR was positive in 25 samples, all of which had a high IgG titer; all culture-positive cases were PCR+. M pneumoniae is a common bacterial pathogen associated with acute exacerbations of asthma in people 15 years or older. Prompt laboratory diagnosis of M pneumoniae requires direct detection by PCR and culture. A high serologic titer can be a clue for the presence of M pneumoniae.

  18. Interleukin-33 Drives Activation of Alveolar Macrophages and Airway Inflammation in a Mouse Model of Acute Exacerbation of Chronic Asthma

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    Melissa M. Bunting

    2013-01-01

    Full Text Available We investigated the role of interleukin-33 (IL-33 in airway inflammation in an experimental model of an acute exacerbation of chronic asthma, which reproduces many of the features of the human disease. Systemically sensitized female BALB/c mice were challenged with a low mass concentration of aerosolized ovalbumin for 4 weeks to induce chronic asthmatic inflammation and then received a single moderate-level challenge to trigger acute airway inflammation simulating an asthmatic exacerbation. The inflammatory response and expression of cytokines and activation markers by alveolar macrophages (AM were assessed, as was the effect of pretreatment with a neutralizing antibody to IL-33. Compared to chronically challenged mice, AM from an acute exacerbation exhibited significantly enhanced expression of markers of alternative activation, together with enhanced expression of proinflammatory cytokines and of cell surface proteins associated with antigen presentation. In parallel, there was markedly increased expression of both mRNA and immunoreactivity for IL-33 in the airways. Neutralization of IL-33 significantly decreased both airway inflammation and the expression of proinflammatory cytokines by AM. Collectively, these data indicate that in this model of an acute exacerbation of chronic asthma, IL-33 drives activation of AM and has an important role in the pathogenesis of airway inflammation.

  19. Risk factors of pulmonary infections in children with acute asthma%急性哮喘患儿肺部感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    闫向真; 温慧敏; 刘新健; 牛芳; 叶文艳

    2013-01-01

    OBJECTIVE To discuss the risk factors of pulmonary infections in the children with acute asthma and explore the composition of the pathogenic bacteria so as to effectively reduce the incidence of pulmonary infections in the children with acute asthma.METHODS A total of 389 cute asthma children complicated with pulmonary infections,who were treated in the hospital from Jan 2007 to Dec 2012,were chosen as the infection group,while 411 children with simple cute asthma who were hospitalized during the same period were selected as the control group,and the deep sputum culture was performed for all the children on the admission,then the risk factors of the pulmonary infections in the acute asthma children and the composition of the pathogenic bacteria were retrospectively analyzed,finally,multivariate logistic regression analysis was carried out.RESULTS Multivariate logistic regression analysis revealed that corticosteroid or aminophylline (OR =2.72;95% CI =1.66-4.47),antibiotics abuse(OR=1.35;95 % CI=1.05-1.73),complication with rhinitis or nasal polyps or sinusitis (OR =3.18;95%CI=1.80-5.62),and the gram-negative bacteria infecitons(OR=4.01;95%CI=1.20-13.38) were the risk factors of the pulmonary infections in the children with acute asthma.As compared with the compsition of the gram-negative bacteria,the infection group was higher than the control group,the difference was statistically sig nificant (P<0.05),the gram-negative bacteria were the most common pathogens causing infections in the children with acute asthma.CONCLUSION The condition of the acute asthma children complicated with pulmonary infections is severe and complicated.The corticosteroid or aminophylline,antibiotics abuse,complication with rhinitis or nasal polyps or sinusitis,and gram-negative bacteria infection are the risk factors of the pulmoanry infections in the children with acute asthma.It is neceassary to perform the clear diagnosis in the early stage and carry out the targeted nurisng

  20. Acute kidney injury in severe acute pancreatitis: An experience from a tertiary care center

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    Ravindra Kumar

    2015-01-01

    Full Text Available Acute kidney injury (AKI is an important cause of morbidity and mortality in severe acute pancreatitis (SAP. We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the SAP study patients. There was a significant association of diabetes and alcohol with AKI in patients with SAP. Alcohol was found to be an independent significant risk factor for AKI in SAP. All the eight patients with SAP who expired had AKI. None of the patients of SAP without AKI expired during the study. We conclude that the patients with SAP with AKI have a greater mortality rate as compared with the SAP patients without AKI.

  1. Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Cássio; Vieira; de; Oliveira; Alecsro; Moreira; Julio; P; Baima; Leticia; de; C; Franzoni; Talles; B; Lima; Fabio; da; S; Yamashiro; Kunie; Yabuki; Rabelo; Coelho; Ligia; Y; Sassaki; Carlos; Antonio; Caramori; Ferno; G; Romeiro; Giovanni; F; Silva

    2014-01-01

    Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

  2. A PAF receptor antagonist inhibits acute airway inflammation and late-phase responses but not chronic airway inflammation and hyperresponsiveness in a primate model of asthma

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    R. H. Gundel

    1992-01-01

    Full Text Available We have examined the effects of a PAF receptor antagonist, WEB 2170, on several indices of acute and chronic airway inflammation and associated changes in lung function in a primate model of allergic asthma. A single oral administration WEB 2170 provided dose related inhibition of the release of leukotriene C4 (LTC4 and prostaglandin D2 (PGD2 recovered and quantified in bronchoalveolar lavage (BAL fluid obtained during the acute phase response to inhaled antigen. In addition, oral WEB 2170 treatment in dual responder primates blocked the acute influx of neutrophils into the airways as well as the associated late-phase airway obstruction occurring 6 h after antigen inhalation. In contrast, a multiple dosing regime with WEB 2170 (once a day for 7 consecutive days failed to reduce the chronic airway inflammation (eosinophilic and associated airway hyperresponsiveness to inhaled methacholine that is characteristic of dual responder monkeys. Thus, we conclude that the generation of PAF following antigen inhalation contributes to the development of lipid mediators, acute airway inflammation and associated late-phase airway obstruction in dual responder primates; however, PAF does not play a significant role in the maintenance of chronic airway inflammation and associated airway hyperresponsiveness in this primate model.

  3. Nasogastric or nasointestinal feeding in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Matteo; Piciucchi; Elettra; Merola; Massimo; Marignani; Mari-anna; Signoretti; Roberto; Valente; Lucia; Cocomello; Flavia; Baccini; Francesco; Panzuto; Gabriele; Capurso; Gianfranco; Delle; Fave

    2010-01-01

    AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside intragastric insertion,tube position was assessed,and enteral nutrition(EN) started at day 4,irrespective of tube localization.Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric(NG) or NI tube.RESULTS:Spontaneous tube ...

  4. Control dynamics of severe acute respiratory syndrome transmission

    Institute of Scientific and Technical Information of China (English)

    WANG Haiying; RONG Feng; KE Fujiu; BAI Yilong

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a serious disease with many puzzling features. We present a simple, dynamic model to assess the epidemic potential of SARS and the effectiveness of control measures. With this model, we analysed the SARS epidemic data in Beijing. The data fitting gives the basic case reproduction number of 2.16 leading to the outbreak, and the variation of the effective reproduction number reflecting the control effect. Noticeably, our study shows that the response time and the strength of control measures have significant effects on the scale of the outbreak and the lasting time of the epidemic.

  5. A Critical Evaluation of Anti-IL-13 and Anti-IL-4 Strategies in Severe Asthma.

    Science.gov (United States)

    Bagnasco, Diego; Ferrando, Matteo; Varricchi, Gilda; Passalacqua, Giovanni; Canonica, Giorgio Walter

    2016-01-01

    Asthma is a high-prevalence disease, still accounting for mortality and high direct and indirect costs. It is now recognized that, despite the implementation of guidelines, a large proportion of cases remain not controlled. Certainly, adherence to therapy and the education of patients remain the primary objective, but the increasingly detailed knowledge about the pathogenic mechanisms and new biotechnologies offer the opportunity to better address and treat the disease. Interleukin (IL)-13 and IL-4 appear as the most suitable targets to treat the T helper 2 (TH2)-mediated forms (endotypes) of asthma. IL-13 and IL-4 partly share the same receptor and signaling pathways and both are deeply involved in immunoglobulin E (IgE) synthesis, eosinophil activation, mucus secretion and airways remodeling. Several anti-IL-13 strategies have been proposed (anrukinzumab, lebrikizunab and tralokinumab), with relevant clinical results reported with lebrikizumab. Such studies facilitate better definition of the possible predictive markers of response to a specific treatment (e.g. eosinophils, total IgE, fraction of exhaled nitric oxide and periostin). In parallel, anti-IL-4 strategies have been attempted (pascolizumab, pitakinra and dupilumab). So far, dupilumab was reported capable of reducing the severity of asthma and the rate of exacerbations. IL-13 and IL-4 are crucial in TH2-mediated inflammation in asthma, but it remains clear that only specific endotypes respond to these treatments. Although the use of anti-IL-14 and anti-IL-13 strategies is promising, the search for appropriate predictive biomarkers is urgently needed to better apply biological treatments. PMID:27637004

  6. Cough and asthma diagnosis: physicians’ diagnosis and treatment of patients complaining of acute, subacute and chronic cough in rural areas of Japan

    OpenAIRE

    Yamasaki, Akira; Hanaki, Keichi; Tomita, Katsuyuki; WATANABE, MASANARI; Hasagawa, Yasuyuki; Okazaki, Ryota; Yamamura, Miki; Fukutani, Kouji; Sugimoto, Yuji; Kato, Kazuhiro; KODANI, MASAHIRO; Ikeda, Toshikazu; Konishi, Tatsuya; Kawasaki, Yuji; Tokuyasu, Hirokazu

    2010-01-01

    Background: Cough is one of the most common reasons for visiting a clinic. The causes of cough differ according to the duration of cough. Infectious disease is commonly observed in acute cough while noninfectious disease is commonly observed in chronic cough. On the other hand, cough is frequently observed in patients with asthma/cough variant asthma (CVA). Objective: In this study, we investigated the causes of cough in a rural region in Japan and the clinical examination and treatment for t...

  7. Predictors of treatment with antibiotics and systemic corticosteroids for acute exacerbations of asthma and chronic obstructive pulmonary disease in primary care

    OpenAIRE

    Al-ani, Salwan Tariq; Spigt, Marcus; Laue, Johanna; Melbye, Hasse

    2015-01-01

    Background: Antibiotic and oral corticosteroid prescribing rate in patients suffering from acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma in general practice are only sparsely described. Our aim was to identify predictors for such prescribing when results from CRP testing, spirometry, and pulse oximetry are available. Methods: Patients aged 40 years or more diagnosed with asthma, COPD or both, the previous five years from seven general practice offices in Norway...

  8. JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

    OpenAIRE

    Hirota, Masahiko; Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Sekimoto, Miho; Kimura, Yasutoshi; Takeda, Kazunori; ISAJI, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

    2006-01-01

    This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement...

  9. Hemoconcentration is a poor predictor of severity in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    José M. Remes-Troche; Andrés Duarte-Rojo; Gustavo Morales; Guillermo Robles-Díaz

    2005-01-01

    AIM: To determine whether the hematocrit (Hct) at admission or at 24 h after admission was associated with severe acute pancreatitis (AP), organ failure (OF), and pancreatic necrosis.METHODS: A total of 336 consecutive patients with a first AP episode were studied. Etiology, Hct values at admission and at 24 h, development of severe AP according to Atlanta's criteria, pancreatic necrosis, OF and mortality were recorded. Hemoconcentration was defined as Hct level >44% for males and >40% for females. The t-test and χ2 test were used to assess the association of hemoconcentration to the severity, necrosis and OF.Diagnostic accuracy was also determined.RESULTS: Biliary disease was the most frequent etiology(n = 148). Mean Hct levels at admission were 41±6%for females and 46±7% for males (P<0.01). Seventyeight (23%) patients had severe AP, and OF developed in 45 (13%) patients. According to contrast-enhanced computed tomography scan, 36% (54/150) patients showed pancreatic necrosis. Hct levels were elevated in58% (55/96) and 61% (33/54) patients with interstitial and necrotizing pancreatitis, respectively. Neither Hct levels at admission nor hemoconcentration at 24 h were associated with the severity, necrosis or OF. Sensitivity,specificity and positive predictive values for both determinations were very low; and negative predictive values were between 61% and 86%, being the highest value for OF.CONCLUSION: Hct is not a useful marker to predict a worse outcome in acute pancreatitis. In spite of the high negative predictive value of hemoconcentration, the prognosis gain is limited due to an already high incidence of mild disease.

  10. Comparison of oral montelukast with oral zileuton in acute asthma: A randomized, double-blind, placebo-controlled study

    Science.gov (United States)

    Magazine, Rahul; Shahul, Hameed Aboobackar; Chogtu, Bharti; Kamath, Asha

    2016-01-01

    Background: Leukotriene modifiers have an established role in the management of chronic asthma but their role in acute asthma is still under evaluation. Objective: To study and compare the effects of oral montelukast with oral zileuton in acute asthma. Materials and Methods: This study included 120 asthmatics and was conducted from September 2012 to March 2014. Patients were randomized into three different groups to receive montelukast or zileuton or placebo in addition to standard treatment for asthma exacerbation. Peak expiratory flow rate (PEFR) values, details of rescue medication and vital signs were recorded at 6 h, 12 h, 24 h, and 48 h of drug or placebo administration and at discharge. Additional recording was done in the morning (8–10 am) following admission. The primary endpoint was the mean PEFR of each group at these time points; the secondary end point being the need for rescue medications. Results: The mean PEFR recordings of the three study groups – placebo, montelukast, and zileuton – respectively, at various time points were as follows: at 6 h (223.25 ± 90.40, 199.00 ± 82.52, 233.75 ± 84.05; P = 0.240); at 12 h (271.00 ± 109.38, 251.50 ± 101.44, 309.50 ± 129.63; P = 0.048); at 24 h (288.25 ± 114.26, 269.00 ± 107.51, 324.50 ± 127.88; P = 0.080); and at 48 h (295.00 ± 114.80, 293.50 ± 113.24, 344.75 ± 119.91; P = 0.015); discharge (305.00 ± 118.56, 305.25 ± 119.51, 361.25 ± 119.70; P = 0.010). The mean PEFR for the three study groups at 8–10 am on the morning following admission was 268.75 ± 111.43, 252.50 ± 99.99, 306.75 ± 114.44; P = 0.047. Total rescue doses needed were 10, 1, and 0, respectively (P = 0.049). Conclusion: Zileuton is better than montelukast as an additional drug in acute asthma and results in significant improvement in lung function, and reduction in the need for rescue medications. PMID:27185992

  11. Comparison of oral montelukast with oral zileuton in acute asthma: A randomized, double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Rahul Magazine

    2016-01-01

    Full Text Available Background: Leukotriene modifiers have an established role in the management of chronic asthma but their role in acute asthma is still under evaluation. Objective: To study and compare the effects of oral montelukast with oral zileuton in acute asthma. Materials and Methods: This study included 120 asthmatics and was conducted from September 2012 to March 2014. Patients were randomized into three different groups to receive montelukast or zileuton or placebo in addition to standard treatment for asthma exacerbation. Peak expiratory flow rate (PEFR values, details of rescue medication and vital signs were recorded at 6 h, 12 h, 24 h, and 48 h of drug or placebo administration and at discharge. Additional recording was done in the morning (8-10 am following admission. The primary endpoint was the mean PEFR of each group at these time points; the secondary end point being the need for rescue medications. Results: The mean PEFR recordings of the three study groups - placebo, montelukast, and zileuton - respectively, at various time points were as follows: at 6 h (223.25 ± 90.40, 199.00 ± 82.52, 233.75 ± 84.05; P = 0.240; at 12 h (271.00 ± 109.38, 251.50 ± 101.44, 309.50 ± 129.63; P = 0.048; at 24 h (288.25 ± 114.26, 269.00 ± 107.51, 324.50 ± 127.88; P = 0.080; and at 48 h (295.00 ± 114.80, 293.50 ± 113.24, 344.75 ± 119.91; P = 0.015; discharge (305.00 ± 118.56, 305.25 ± 119.51, 361.25 ± 119.70; P = 0.010. The mean PEFR for the three study groups at 8-10 am on the morning following admission was 268.75 ± 111.43, 252.50 ± 99.99, 306.75 ± 114.44; P = 0.047. Total rescue doses needed were 10, 1, and 0, respectively (P = 0.049. Conclusion: Zileuton is better than montelukast as an additional drug in acute asthma and results in significant improvement in lung function, and reduction in the need for rescue medications.

  12. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    En-Qiang Mao; Yao-Qing Tang; Sheng-Dao Zhang

    2003-01-01

    AIM: To investigate a formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis (HL-SAP).METHODS: Thirty-two consecutive patients with severe acute pancreatitis were included in the clinical trial. All of them met the following five criteria for admission to the study, namely the Atlanta classification and stratification system for the clinical diagnosis of SAP, APACHEII score more than 8, time interval for therapeutic intervention less than 72 hours after onset of the disease, serum triglyceride (TG) level 6.8 mmol/l or over, and exdusion of other etiologies.They were divided into severe acute pancreatitis group (SAP,22 patients) and fulminant severe acute pancreatitis group (FSAP, 10 patients). Besides the conventional therapeutic measures, Penta-association therapywas also applied in the two groups, which consisted of blood purification (adsorption of triglyceride and hemofiltration), antihyperlipidemic agents (fluvastatin or lipanthyl), low molecular weight heparin (fragmin), insulin, topical application of Pixiao (a traditional Chinese medicine) over the whole abdomen, serum triglyceride,pro-inflammatory cytokines and anti-inflammatory cytokines were determined before blood purification (PF), at the end of blood purification (AFE) and on the 7th day after onset of the disease (AF7) respectively. Simultaneously, severity of the diseases was assessed by the APACHE Ⅱ system.Prognosis was evaluated by non-operation cure rate,absorption rate of pseudocyst, time interval pseudocyst absorption, hospital stay and survival rate.RESULTS: Serum triglyceride level (mmol/L), TNFα (U/mi) concentration and APACHE Ⅱ score were significantly decreased (P<0.05) at AFE and AF7, as compared with PF.However, serum IL-10 concentration (pg/ml) was increased significantly (P<0.001) at AFE, and decreased significantly (P<0.05) at AF7 when compared with PF. Operations: The First surgical intervention time was 55.8±42.6 days in SAP group (5 patients) and

  13. The Effect of Combined Therapy ICS/LABA and ICS/LABA plus Montelukast in Patients with Uncontrolled Severe Persistent Asthma Based on the Serum IL-13 and FEV1

    Directory of Open Access Journals (Sweden)

    Elena Jovanovska Janeva

    2015-05-01

    CONCLUSION: Treatment with ICS/LABA plus Montelukast proved superior compared to therapy of ICS/LABA in patients with uncontrolled severe persistent asthma and allows achievement of well controlled of asthma with subjective clinical improvement.

  14. Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xi-Ping Zhang; Hua Tian

    2007-01-01

    BACKGROUND:Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was regarded as a poor prognosis sign of SAP, but the pathogenesis of PE in SAP still has not been clariifed in the past decade. The purpose of this review is to elucidate the possible pathogenesis of PE in SAP. DATA SOURCES:The English-language literature concern-ing PE in this review came from the Database of MEDLINE (period of 1991-2005), and the keywords of severe acute pancreatitis and pancreatic encephalopathy were used in the searching. RESULTS:Many factors were involved in the pathogenesis of PE in SAP. Pancreatin activation, excessive release of cytokines and oxygen free radicals, microcirculation abnormalities of hemodynamic disturbance, ET-1/NO ratio, hypoxemia, bacterial infection, water and electrolyte imbalance, and vitamin B1 deifciency participated in the development of PE in SAP. CONCLUSIONS:The pathogenesis of PE in SAP has not yet been fully understood. The development of PE in SAP may be a multi-factor process. To ifnd out the possible inducing factor is essential to the clinical management of PE in SAP.

  15. The effect of various breathing exercises (pranayama in patients with bronchial asthma of mild to moderate severity

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    Saxena Tarun

    2009-01-01

    Full Text Available Background/Aim: The incidence of bronchial asthma is on increase. Chemotherapy is helpful during early course of the disease, but later on morbidity and mortality increases. The efficacy of yoga therapy though appreciated is yet to be defined and modified. Aim: To study the effect of breathing exercises ( pranayama in patients with bronchial asthma of mild to moderate severity. Materials and Methods: Fifty cases of bronchial asthma (Forced Expiratory Volume in one second (FEV1 > 70% were studied for 12 weeks. Patients were allocated to two groups: group A and group B (control group. Patients in group A were treated with breathing exercises (deep breathing, Brahmari , and Omkara , etc. for 20 minutes twice daily for a period of 12 weeks. Patients were trained to perform Omkara at high pitch (forceful with prolonged exhalation as compared to normal Omkara . Group B was treated with meditation for 20 minutes twice daily for a period of 12 weeks. Subjective assessment, FEV1%, and Peak Expiratory Flow Rate (PEFR were done in each case initially and after 12 weeks. Results: After 12 weeks, group A subjects had significant improvement in symptoms, FEV1, and PEFR as compared to group B subjects. Conclusion: Breathing exercises ( pranayama , mainly expiratory exercises, improved lung function subjectively and objectively and should be regular part of therapy.

  16. Budesonide/formoterol and formoterol provide similar rapid relief in patients with acute asthma showing refractoriness to salbutamol

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    Lombardi DM

    2006-01-01

    Full Text Available Abstract Background To compare the efficacy and safety of budesonide/formoterol (Symbicort® with formoterol (Oxis® in the treatment of patients with acute asthma who showed evidence of refractoriness to short-acting β2-agonist therapy. Methods In a 3 hour, randomized, double-blind study, a total of 115 patients with acute asthma (mean FEV1 40% of predicted normal and a refractory response to salbutamol (mean reversibility 2% of predicted normal after inhalation of 400 μg, were randomized to receive either budesonide/formoterol (320/9 μg, 2 inhalations at t = -5 minutes and 2 inhalations at 0 minutes [total dose 1280/36 μg] or formoterol (9 μg, 2 inhalations at t = -5 minutes and 2 inhalations at 0 minutes [total dose 36 μg]. The primary efficacy variable was the average FEV1 from the first intake of study medication to the measurement at 90 minutes. Secondary endpoints included changes in FEV1 at other timepoints and change in respiratory rate at 180 minutes. Treatment success, treatment failure and patient assessment of the effectiveness of the study medication were also measured. Results FEV1 increased after administration of the study medication in both treatment groups. No statistically significant difference between the treatment groups was apparent for the primary outcome variable, or for any of the other efficacy endpoints. There were no statistically significant between-group differences for treatment success, treatment failure or patient assessment of medication effectiveness. Both treatments were well tolerated. Conclusion Budesonide/formoterol and formoterol provided similarly rapid relief of acute bronchoconstriction in patients with asthma who showed evidence of refractoriness to a short-acting β2-agonist.

  17. Near fatal asthma: treatment and prevention.

    Science.gov (United States)

    D'Amato, G; Vitale, C; Lanza, M; Sanduzzi, A; Molino, A; Mormile, M; Vatrella, A; Bilò, M B; Antonicelli, L; Bresciani, M; Micheletto, C; Vaghi, A; D'Amato, M

    2016-07-01

    Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. Risk factors for near fatal asthma have not been fully elucidated. In 80-85% of all fatal events, a phenotype, characterized by eosinophilic inflammation associated with gradual deterioration occurring in patients with severe and poorly controlled asthma, has been identified. Regarding to the management, acute severe asthma remains a significant clinical problem, which needs to be identified to facilitate early and appropriate therapeutic interventions. The assessment relies on clinical signs, but additional information might be obtained from chest radiography or blood gas analysis. No investigation should delay the initiation of appropriate therapy. The goals of therapy are the maintenance of oxygenation, relief of airflow obstruction, reduction of airways edema and mucus plugging (with Increased use of medications such as beta-agonists via metered dose inhalers and nebulizers, oral and/or intravenous (other than by inhalation) corticosteroids and oral or intravenous theophylline) whereas supporting ventilation as clinically indicated. Of course, the emergency physician needs to consider the wide range of potential complications, as attention to these problems when managing severe acute asthma might significantly improve outcome. An understanding of the available agents and potential pitfalls in the management of NFA is mandatory for the emergency physician. PMID:27425166

  18. Asma agudo severo en niños: ¿Fenotipo diferente? Severe asthma in children: A different phenotype?

    Directory of Open Access Journals (Sweden)

    Jaime Lozano C

    2012-12-01

    Full Text Available La magnitud de la respuesta al tratamiento de una exacerbación de asma es variable entre los pacientes y una proporción significativa de ellos debe hospitalizarse. Objetivos: Definir el perfil de los niños que se hospitalizaron por asma grave y los posibles indicadores y determinantes de la respuesta desfavorable al tratamiento. Método: Estudio prospectivo en niños de 4 años o más, con búsqueda etiológica de la exacerbación y estudio de perfil inflamatorio en esputo. Resultados: 60 niños entre 4 y 15 años. El 50% tenía diagnóstico previo de asma sin uso regular de corticoesteroides inhalados en dos tercios. Hospitalizaciones previas por asma en el 40%. La etiología de la exacerbación fue identificada en el 52% siendo los agentes más frecuentes Rhinovirus, Metapneumovius, VRS y Mycoplasma pneumoniae. El perfil inflamatorio fue determinado en 33 niños: eosinofílico en 36% y eosinoflico/neutroflico en 64%. Comentario: El asma severa con exacerbaciones graves sería un fenotipo cuyos aspectos destacados en esta cohorte serían: niños con hospitalizaciones previas, falta de tratamiento profiláctico, infección viral como desencadenante frecuente, patrón inflamatorio combinado del esputo y rinitis atópica.Background: The magnitude of response to treatment of asthma exacerbations is variable and a significant proportion of them need hospitalization. Objectives: to define the profile of children that were hospitalized for severe asthma and the possible indicators and determinants of their poor responsiveness. Methods: a prospective study in 60 children 4 years or more of age with a search of the ethiology of the exacerbation and a study of the inflammatory profile in sputum. Results: 60 children between 4 and 15 years. 50% had a previous diagnosis of asthma without regular use of inhaled corticosteroids in two thirds. 40% had previous admissions for asthma. Etiology of the exacerbation was identified in 52% with Rhinovirus, human

  19. Detection of human coronavirus strain HKU1 in a 2 years old girl with asthma exacerbation caused by acute pharyngitis

    Directory of Open Access Journals (Sweden)

    Amini Razieh

    2012-08-01

    Full Text Available Abstract Respiratory viral infections can trigger asthma attack which may lead to sever morbidity. In this report, using molecular methods, we show the chronological association between human coronavirus - HKU1 infection and asthma exacerbation in a two years and seven months old asthmatic girl who was not under treatment and was otherwise healthy.

  20. Protective effects of rhubarb on experimental severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yu-Qing Zhao; Xiao-Hong Liu; Tetsuhide Ito; Jia-Ming Qian

    2004-01-01

    AIM: To investigate the effects of rhubarb on severe acute pancreatitis (SAP) in rats.METHODS: Severe acute pancreatitis was induced by two intraperitoneal injections of cerulein (40 μg/kg body weight) plus 5-h restraint water-immersion stress. Rhubarb (75-150 mg/kg) was orally fed before the first cerulein injection.The degree of pancreatic edema, serum amylase level,local pancreatic blood flow (PBF), and histological alterations were investigated. The effects of rhubarb on pancreatic exocrine secretion in this model were evaluated by comparing with those of somatostatin.RESULTS: In the Cerulein+Stress group, severe edema and diffuse hemorrhage in the pancreas were observed,the pancreatic wet weight (11.60±0.61 g/Kg) and serum amylase (458 490±43 100 U/L) were markedly increased (P<0.01 vs control). In the rhubarb (150 mg/kg) treated rats, necrosis and polymorphonuclear neutrophil (PMN) infiltration in the pancreas were significantly reduced (P<0.01), and a marked decrease (50%) in serum amylase levels was also observed (P<0.01). PBF dropped to 38%(93±5 Ml/min per 100 g) of the control in the Cerulein+Stressgroup and partly recovered in the Cerulein+Stress+Rhubarb 150 mg group (135±12 Ml/min per 100 g) (P<0.01). The pancreatic exocrine function was impaired in the SAP rats.The amylase levels of pancreatic juice were reduced in the rats treated with rhubarb or somatostatin, comparing with that of untreated SAP group. The bicarbonate concentration of pancreatic juice was markedly elevated only in the rhubarb treated group (P<0.01).CONCLUSION: Rhubarb can exert protective effects on SAP, probably by inhibiting the inflammation of pancreas,improving pancreatic microcirculation, and altering exocrine secretion.

  1. Role of leukotrienes in asthma pathophysiology

    DEFF Research Database (Denmark)

    Bisgaard, H

    2000-01-01

    Inflammation is an essential component of asthma pathophysiology. While beta(2)-agonists are often used for short-term relief of acute bronchospasm, anti-inflammatory agents are required for the long-term management of chronic inflammation in this disease. Corticosteroids have emerged as the first......-line anti-inflammatory therapy for asthma management. However, in some patients, especially children, the high doses of corticosteroids that may be required to control features of hyperresponsiveness, including exercise-induced asthma, raise safety concerns. Thus, there is a need for complementary anti......-inflammatory, steroid-sparing agents in asthma therapy. Several inflammatory mediators have been targeted in an attempt to thwart this inflammatory process, but so far with little success. The cysteinyl leukotrienes (CysLT), LTC(4), LTD(4), and LTE(4), have been shown to be essential mediators in asthma, making them...

  2. Comparison of efficacy combination of inhaled phormoterol / budesonide turbuhaler vs. combination of nebulized salbutamol / ipratropium bromide on moderate asthma acute exacerbation in Persahabatan Hospital

    Directory of Open Access Journals (Sweden)

    Zulkarnain Barasila

    2006-03-01

    Full Text Available The aim of this study was to compare efficacy combination of phormoterol/budesonide turbuhaler vs. salbutamol/ipratropium bromide nebulization. Main therapy for acute asthma is inhaled short acting β2-agonist. Asthma patients are using two drugs, controller and reliever. Recently there is device-containing combination of long-acting β2-agonist with rapid onset and corticosteroid. This combination can act as reliever and controller. An opened randomized clinical trial of 76 patients between the ages of 12 and 60 years presenting to Persahabatan Hospital with asthma score between 8-12 participated in this study. After initial evaluation, patients were divided into two groups. Thirty-eight patients were administered combination of formoterol/budesonide 4.5/160 µg via turbuhaler (T-group every 20 minutes, total of three doses, and another 38 of salbutamol/ipratropium bromide 2.5/0.25 mg via nebulizer (N-group also with the same manner. There were no statistical difference in sex, mean age, high, weight, initial PEFR, and asthma score between two groups. The significant increased of PEFR and decreased of asthma score were observed in both groups. However, there were no significant difference of PEFR and asthma score between the two groups within every time-interval. Adverse events were mild including hoarseness, tremor and palpitation. Of T-group, 1 subject was suffered from 3 adverse events simultaneously (hoarseness, tremor and palpitation, 5 subjects were only tremor. Of N-group, all 6 subjects were only suffered from tremor. A combination of formoterol/budesonide turbuhaler and a combination of nebulized salbutamol/ipratropium bromide are clinically equivalent for treatment moderate acute asthma. However, nebulized salbutamol/ipratropium bromide had less adverse effects. (Med J Indones 2006; 15:34-42Keywords: phormoterol, budesonide, salbutamol, ipratropium bromide, acute asthma

  3. Accounts of severe acute obstetric complications in Rural Bangladesh

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    Sikder Shegufta S

    2011-10-01

    Full Text Available Abstract Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely

  4. Asthma Research: The NIH–NJRC Connection

    Science.gov (United States)

    ... early life exposures to allergens may help protect children from asthma. Some of NJRC's most important research addresses the ... story. ) In pediatric asthma, doctors are studying and treating the progression of asthma, infant wheezing that leads to asthma, and severe ...

  5. Acute Promyelocytic Leukemia Presenting with Severe Marrow Fibrosis

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    Harsh Shah

    2015-01-01

    Full Text Available We report a case of acute promyelocytic leukemia (APL presenting with severely fibrotic marrow. There are four other reports of similar cases in the literature. Our patient was treated with All-Transretinoic Acid- (ATRA- containing induction chemotherapy, followed by consolidation and maintenance therapy. He achieved a complete morphologic remission with adequate count recovery in a timely fashion, and later a molecular remission was documented. The patient remains in molecular remission and demonstrates normal blood counts now more than 4 years after induction. Since the morphological appearance may not be typical and the bone marrow may not yield an aspirate for cytogenetic analysis, awareness of such entity is important to make a correct diagnosis of this potentially curable disease.

  6. Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

    Institute of Scientific and Technical Information of China (English)

    Chun Tang; Baolin Wang; Bing Xie; Hongming Liu; Ping Chen

    2011-01-01

    A treatment method based on drainage via retroperitoneal laparoscopy was adopted for 15 severe acute pancreatitis (SAP) patients to investigate the feasibility of the method.Ten patients received only drainage via retroperitoneai laparoscopy,four patients received drainage via both retroperitoneal and preperitoneal laparoscopy,and one patient received drainage via conversion to laparotomy.Thirteen patients exhibited a good drainage effect and were successfully cured without any other surgical treatment.Two patients had encapsulated effusions or pancreatic pseudocysts after surgery,but were successfully cured after lavage and B ultrasound-guided percutaneous catheter drainage.SAP treatment via retroperitoneal laparoscopic drainage is an effective surgical method,resulting in minor injury.

  7. Contemporary management of infected necrosis complicating severe acute pancreatitis

    Science.gov (United States)

    Jamdar, Saurabh; Siriwardena, Ajith K

    2006-01-01

    Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions. PMID:16356213

  8. [A comparative study of clinical score and lung function tests in the classification of asthma by severity of disease].

    Science.gov (United States)

    Nakaie, C M; Rozov, T; Manissadjian, A

    1998-01-01

    Fifty nine asthmatic children and adolescents, clinically stable, aged 6 to 15 years, 37 boys and 22 girls, from Instituto da Criança do Hospital das Clínicas da FMUSP, were studied from September to November, 1994. The patients were classified by the clinical score of the International Consensus for Asthma Diagnosis and Management. They performed baseline spirometry and peak expiratory flow rates (PEFR), before and after bronchodilator, and measured PEFR three times a day (6 pm, at bedtime and on waking), for one day, at home. Five PEF measurements were made serially and the best readings were considered. Variability of PFE was calculated for 24 hours, as assessed by maximal amplitude. The results were summited to statistical analysis of the Laboratorio de Informática Médica da Faculdade de Medicina da USP. The results of PEFR and it's variability were compared to spirometry, (functional score, FEV1-forced expiratory volume in the first second) and to the clinical score of the International Consensus for Asthma Diagnosis and Management. In case of disagreement between the clinical parameters, the more severe one was chosen. The clinical score classified 20.3% of our patients as mild obstruction, 49.2% as moderate and 30.5% as severely compromised. According to FEV1, 58% of patients were classified as normal while the PEFR and its variability classified as normal 76% and 71%. The PEFR and it's variability in 24 hours, correlated with the VEF1, as gold standard, showed good specificity, 91% and 76% respectively and low sensibility, 44% and 32%. It was detected a low level of agreement between FEV1, PEFR and it's variability in 24 hours, in the clinical severity classification of asthma. The results of this study showed that FEV1 and PEFR had a low level of agreement in the clinical severity classification of asthma and when they were correlated to the clinical score of the International Consensus, they both presented low sensitivity. PMID:9699357

  9. Chronic Hepatitis B with Spontaneous Severe Acute Exacerbation

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    Wei-Lun Tsai

    2015-11-01

    Full Text Available Chronic hepatitis B virus (HBV infection is a major global health problem with an estimated 400 million HBV carriers worldwide. In the natural history of chronic hepatitis B (CHB, spontaneous acute exacerbation (AE is not uncommon, with a cumulative incidence of 10%–30% every year. While exacerbations can be mild, some patients may develop hepatic decompensation and even die. The underlying pathogenesis is possibly related to the activation of cytotoxic T lymphocyte-mediated immune response against HBV. An upsurge of serum HBV DNA usually precedes the rise of alanine aminotransferase (ALT and bilirubin. Whether antiviral treatment can benefit CHB with severe AE remains controversial, but early nucleos(tide analogues treatment seemed to be associated with an improved outcome. There has been no randomized study that compared the effects of different nucleos(tide analogues (NA in the setting of CHB with severe AE. However, potent NAs with good resistance profiles are recommended. In this review, we summarized current knowledge regarding the natural history, pathogenetic mechanisms, and therapeutic options of CHB with severe AE.

  10. Acute arterial infarcts in patients with severe head injuries

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2012-01-01

    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  11. Prevalence and severity of self-reported asthma in young adults, 1976-2004

    DEFF Research Database (Denmark)

    Browatzki, A; Ulrik, Charlotte Suppli; Lange, P

    2009-01-01

    ) subjects answered a questionnaire, and had their height, weight, forced expiratory volume in 1 s (FEV1) and forced vital capacity measured. The prevalence of self-reported asthma was 1.5, 4.7 and 6.9%, respectively, in the three surveys (p... males and females, although it was highest among females. The difference in FEV1 between asthmatic and nonasthmatic subjects gradually increased, being 2.3 (p = 0.56) and 14.2% of the predicted value (p... index, especially >30 kg.m(-2), was associated with a lower percentage predicted FEV1 (p

  12. Clinical characteristics and prognostic factors of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Lei Kong; Nn Santiago; Tian-Quan Han; Sheng-Dao Zhang

    2004-01-01

    AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP).METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology,length of hospitalization, APACHE Ⅱ score at admission,local and organ/systemic complications of the patients.RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE Ⅱ was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ clysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%),renal failure (50.0%). In the SAP patients, 90.9% (20/22)developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization,APACHE Ⅱ score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients.By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure,cardiovascular failure and renal failure.CONCLUSION: SAP patients are characterized by advanced age, high APACHE Ⅱ score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.

  13. Relaxin prevents the development of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Laura Iris Cosen-Binker; Marcelo Gustavo Binker; Rodica Cosen; Gustavo Negri; Osvaldo Tiscornia

    2006-01-01

    AIM: To investigate the severity of acute pancreatitis (AP) is associated to the intensity of leukocyte activation,inflammatory up-regulation and microcirculatory disruption associated to ischemia-reperfusion injury.Microvascular integrity and inhibition of pro-inflammatory mediators are key-factors in the evolution of AP. Relaxin is an insulin-like hormone that has been attributed vasorelaxant properties via the nitric oxide pathway while behaving as a glucocorticoid receptor agonist.METHODS: AP was induced by the bilio-pancreatic duct-outlet-exclusion closed-duodenal-loops model.Treatment with relaxin was done at different timepoints. Nitric oxide synthase inhibition by L-NAME and glucocorticoid receptor (GR) blockage by mifepristone was considered. AP severity was assessed by biochemical and histopathological analyses.RESULTS: Treatment with relaxin reduced serum amylase, lipase, C-reactive protein, IL-6, IL-10, hsp72,LDH and 8-isoprostane as well as pancreatic and lung myeloperoxidase. Acinar and fat necrosis, hemorrhage and neutrophil infiltrate were also decreased. ATP depletion and ADP/ATP ratio were reduced while caspases 2-3-8 and 9 activities were increased. L-NAME and mifepristone decreased the efficiency of relaxin.CONCLUSION: Relaxin resulted beneficial in the treatment of AP combining the properties of a GR agonist while preserving the microcirculation and favoring apoptosis over necrosis.

  14. Fibromyalgia after severe acute respiratory syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    TIAN Xin-ping; ZENG Xiao-feng; XU Wen-bin

    2006-01-01

    @@ Since November 2002, an infectious disease with unknown cause occurred in China and many countries had been involved. Cases were reported in 28 countries and more than 5050 individuals had been infected.1 Lung is the most frequently involved organ and can be fatal in severe cases. At the end of February 2003, it was defined as Severe Acute Respiratory Syndrome (SARS) by World Health Organization. China had a SARS epidemic in the spring of 2003. More than 1000 patients were infected and some patients died of respiratory failure.Finally, a new variant of coronavirus was suspected to be the pathogen although the pathogenesis was still unclear. Since it is a new disease and we have very limited knowledge about its clinical sequela, we followed the survived patients closely in order to understand it in depth. During the follow up, we discovered an interesting patient who was finally diagnosed as fibromyalgia. We report this case herein to share our experience with clinicians who may see patients with SARS or fibromyalgia.

  15. A STUDY OF NASAL EOSINOPHILIA IN ASTHMA PATIENTS

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    Ramachandra Prabhu

    2014-05-01

    Full Text Available INTRODUCTION: Asthma is an inflammatory, reversible and progressive disease with episodes of exacerbations. Asthma is now considered as single airway disease and hence comprehensive diagnosis, treatment and follow-up of upper and lower respiratory tract is essential. Both the Nasal and Bronchial mucosa are the elements of united airway disease and Eosinophils measured from this mucosa can be an indirect marker of Airway inflammation in asthma. Eosinophil infiltration is hallmark feature of pathogenesis of asthma which is the trigger for the chronic airway inflammation and these are raised in acute exacerbations. Hence assessing Eosinophil is evidence of serological marker for Airway inflammation (AI. Nasal Smear Eosinophils (NSE is used in asthma with Allergic Rhinitis (AR. This study Using Definition of GINA explores the utility of NSE as marker for management of Asthma. METHODS: In this study 100 patients diagnosed with bronchial asthma attending the outpatient department in KIMS were studied. The severity of asthma was assessed as per FEV1 classification- Adapted from 2007 NHLBI Guidelines for the diagnosis and treatment of Asthma Expert panel Report 3. The Statistical analysis was done with SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0 and R environment ver.2.11.1.software. RESULTS: Asthma was more common in Females in this study with M: F ratio of 1.04 and Allergic Rhinitis was found in 55% of Asthmatics. Nasal Eosinophilia was seen in 44% in asthmatic group and 49% in Asthma with Allergic Rhinitis. Absolute Eosinophil count (AEC and Differential count (DC for Eosinophils was almost same in both groups. The Sensitivity of NSE with respect to DC is 70% and in AR group with Asthma and in Asthma group with/without AR it was 38%. Similarly the NSE with respect to AEC was 47% in AR group with Asthma whereas in Asthma group with/without AR it was 38%. CONCLUSIONS: The finding confirms that symptoms, Variable airflow Obstruction and

  16. Montelukast improves air trapping, not airway remodeling, in patients with moderate-to-severe asthma: a pilot study

    Institute of Scientific and Technical Information of China (English)

    GAO Jin-ming; CAI Feng; PENG Min; MA Yi; WANG Bin

    2013-01-01

    Background Evidence has demonstrated that the distal lung,which includes airways of <2 mm in diameter and lung parenchyma,constitutes an important component of asthma pathology.Cysteinyl leukotrienes (CysLTs) are potent proinflammatory mediators and bronchoconstrictors involved in the asthmatic process.Guidelines recommend the leukotriene-modifying agents for asthma treatment.We hypothesized that a leukotriene receptor antagonist with an inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combination would improve small airways function in moderate-tosevere asthmatics evaluated by physiological tests and high-resolution computed tomography (HRCT) analysis.This study was performed at a tertiary university hospital in Beijing.Methods This was a randomized,double-blind,parallel study performed in 38 patients with moderate-to-severe asthma treated with salmeterol/fluticasone (SFC) plus montelukast (SFC+M) or SFC plus placebo over 24 weeks.Small airway function was assessed by physiological studies and HRCT image analysis.Results Montelukast significantly improved air trapping as expressed by the residual volume (RV)/total lung capacity (TLC).Over 24 weeks of treatment,RV/TLC was improved by (15.41±6.67)% in patients receiving SFC+M while RV/TLC was decreased by (8.57±10.26)% in patients receiving SFC alone,the difference between the two groups was significant (P=0.02).There was a trend towards a significant difference in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) in the SFC+M group compared to that in the SFC group ((17.87±8.17)% vs.(12.28±9.20)%,P=0.056).There was no significant change in percentage wall area (WA%) after 24 weeks of add-on treatment with montelukast.Patients receiving SFC+M showed significant improvement in the ratio of CT-determined values at full expiration to those at full inspiration (E/I ratio) (0.894±0.005 vs.0.871±0.003,P=0.002).Conclusion We have shown,using lung function tests

  17. Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

    Science.gov (United States)

    Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

    2009-01-01

    The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

  18. Shiitake mushroom (Lentinus edodes: A poorly known allergen in Western countries responsible for severe work-related asthma

    Directory of Open Access Journals (Sweden)

    Valerio Pravettoni

    2014-10-01

    Full Text Available Objectives: The aim of this study was to investigate the IgE-mediated pathogenesis of severe asthma presented by a patient only after handling shiitake (Lentinus edodes mushrooms (SM. Material and Methods: Skin tests were performed using in-house extracts from mushrooms that the patient usually handled, i.e., shiitake, porcini, oyster and black fungus mushroom varieties. Specific IgE to champignons and various molds were determined. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE immunoblotting was performed to detect IgE-binding components. Four negative controls were included in the study. Results: Skin prick tests performed with in-house mushroom extracts from varieties other than shiitake were completely negative, in contrast to the positive test obtained for shiitake mushrooms. Serum specific IgE levels for common molds and champignons were all negative. SDS-PAGE revealed many protein bands in the four mushroom extracts. Immunoblotting using the patient’s serum showed allergenic bands at about 15 and 24 kDa exclusively for SM that were not shared with negative controls. Another faint band was detectable at approximately 37 kDa for SM and porcini varieties. Conclusions: Here, we present the first European case of SM-induced occupational asthma, a disease more frequently occurring in Asia. Asthma attacks stopped when the patient avoided contact with shiitake mushrooms. No skin reactions and no IgE-binding proteins by immunoblotting were detectable with the other mushrooms tested. The positive skin test with shiitake mushrooms and IgE-binding components in the shiitake extract confirmed the IgE-mediated etiology of the reaction.

  19. Phase-contrast computed tomography for quantification of structural changes in lungs of asthma mouse models of different severity

    Energy Technology Data Exchange (ETDEWEB)

    Dullin, Christian, E-mail: christian.dullin@med.uni-goettingen.de [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Larsson, Emanuel [Elettra-Sincrotrone Trieste, Strada Statale 14, km 163,5 in AREA Science Park, Basovizza (Trieste) 34149 (Italy); University of Trieste, Trieste (Italy); Linkoeping University, SE-581 83 Linkoeping (Sweden); Tromba, Giuliana [Elettra-Sincrotrone Trieste, Strada Statale 14, km 163,5 in AREA Science Park, Basovizza (Trieste) 34149 (Italy); Markus, Andrea M. [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Alves, Frauke [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Max Planck Institut for Experimental Medicine, Hermann-Rein-Strasse 3, Goettingen, Lower Saxony 37075 (Germany)

    2015-06-17

    Synchrotron inline phase-contrast computed tomography in combination with single-distance phase retrieval enables quantification of morphological alterations in lungs of mice with mild and severe experimental allergic airways disease in comparison with healthy controls. Lung imaging in mouse disease models is crucial for the assessment of the severity of airway disease but remains challenging due to the small size and the high porosity of the organ. Synchrotron inline free-propagation phase-contrast computed tomography (CT) with its intrinsic high soft-tissue contrast provides the necessary sensitivity and spatial resolution to analyse the mouse lung structure in great detail. Here, this technique has been applied in combination with single-distance phase retrieval to quantify alterations of the lung structure in experimental asthma mouse models of different severity. In order to mimic an in vivo situation as close as possible, the lungs were inflated with air at a constant physiological pressure. Entire mice were embedded in agarose gel and imaged using inline free-propagation phase-contrast CT at the SYRMEP beamline (Synchrotron Light Source, ‘Elettra’, Trieste, Italy). The quantification of the obtained phase-contrast CT data sets revealed an increasing lung soft-tissue content in mice correlating with the degree of the severity of experimental allergic airways disease. In this way, it was possible to successfully discriminate between healthy controls and mice with either mild or severe allergic airway disease. It is believed that this approach may have the potential to evaluate the efficacy of novel therapeutic strategies that target airway remodelling processes in asthma.

  20. Phase-contrast computed tomography for quantification of structural changes in lungs of asthma mouse models of different severity

    International Nuclear Information System (INIS)

    Synchrotron inline phase-contrast computed tomography in combination with single-distance phase retrieval enables quantification of morphological alterations in lungs of mice with mild and severe experimental allergic airways disease in comparison with healthy controls. Lung imaging in mouse disease models is crucial for the assessment of the severity of airway disease but remains challenging due to the small size and the high porosity of the organ. Synchrotron inline free-propagation phase-contrast computed tomography (CT) with its intrinsic high soft-tissue contrast provides the necessary sensitivity and spatial resolution to analyse the mouse lung structure in great detail. Here, this technique has been applied in combination with single-distance phase retrieval to quantify alterations of the lung structure in experimental asthma mouse models of different severity. In order to mimic an in vivo situation as close as possible, the lungs were inflated with air at a constant physiological pressure. Entire mice were embedded in agarose gel and imaged using inline free-propagation phase-contrast CT at the SYRMEP beamline (Synchrotron Light Source, ‘Elettra’, Trieste, Italy). The quantification of the obtained phase-contrast CT data sets revealed an increasing lung soft-tissue content in mice correlating with the degree of the severity of experimental allergic airways disease. In this way, it was possible to successfully discriminate between healthy controls and mice with either mild or severe allergic airway disease. It is believed that this approach may have the potential to evaluate the efficacy of novel therapeutic strategies that target airway remodelling processes in asthma

  1. Efficacy analysis of Dahuang Fuzi Decotion on treating severe acute pancreatitis in patients with ARDS

    Institute of Scientific and Technical Information of China (English)

    吕春雨

    2013-01-01

    Objective To observe the the therapeutic efficacy of Dahuang Fuzi Decoction in patients with acute respiratory distress syndrome(ARDS)and severe acute pancreatitis(SAP).Methods A prospective,multi-center,randomized

  2. Severe acute axonal neuropathy following treatment with arsenic trioxide for acute promyelocytic leukemia: a case report

    Directory of Open Access Journals (Sweden)

    Marcus Kuhn

    2016-05-01

    Full Text Available Peripheral neuropathy is a common complication of arsenic toxicity. Symptoms are usually mild and reversible following discontinuation of treatment. A more severe chronic sensorimotor polyneuropathy characterized by distal axonal-loss neuropathy can be seen in chronic arsenic exposure. The clinical course of arsenic neurotoxicity in patients with coexistence of thiamine deficiency is only anecdotally known but this association may potentially lead to severe consequences. We describe a case of acute irreversible axonal neuropathy in a patient with hidden thiamine deficiency who was treated with a short course of arsenic trioxide for acute promyelocytic leukemia. Thiamine replacement therapy and arsenic trioxide discontinuation were not followed by neurological recovery and severe polyneuropathy persisted at 12-month follow-up. Thiamine plasma levels should be measured in patients who are candidate to arsenic trioxide therapy. Prophylactic administration of vitamin B1 may be advisable. The appearance of polyneuropathy signs early during the administration of arsenic trioxide should prompt electrodiagnostic testing to rule out a pattern of axonal neuropathy which would need immediate discontinuation of arsenic trioxide.

  3. Severe acute respiratory syndrome: vaccine on the way

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ding-mei; WANG Guo-ling; LU Jia-hai

    2005-01-01

    @@ In November 2002, a new disease-severe acute respiratory syndrome, or SARS-first emerged in Guangdong Province, China. Subsequently, it spread to more than 30 countries worldwide.1 The causative agent was identified to be a previously unknown member of the coronaviridae family, and was named SARS coronavirus (SARS-CoV). SARS coronavirus is a large, enveloped, positive-sense RNA virus. The genome is about 30 kb, which is predicted to contain 14 functional open reading frames (ORFs). Two large 5'-terminal ORFs (1a and 1b) encode the polymerases that are required for viral RNA synthesis. The remaining twelve ORFs encode four structural proteins [spike protein (S), envelope protein (E), membrane protein (M) and nucleocapsid protein (N)] and eight accessory proteins.2 Though the SARS-CoV genome is clear, a great deal more work will be required to develop an efficient vaccine and effective drugs. Neutralizing antibodies were detectable in the convalescent sera of SARS patients, and sera from recovered patients could be used to treat newly infected individuals.3 The data suggest that protective humoral immunity is achievable and that vaccines can be developed for prevention of SARS. In this article, we review and discuss progress towards development of a SARS vaccine.

  4. Current status of severe acute respiratory syndrome in China

    Institute of Scientific and Technical Information of China (English)

    Qing-He Nie; Xin-Dong Luo; Jian-Zhong Zhang; Qin Su

    2003-01-01

    Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality.SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an acumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARSCoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy,antiviralagents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals,SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research.Otherstudies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.

  5. Present and future of prophylactic antibiotics for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Kun Jiang; Wei Huang; Xiao-Nan Yang; Qing Xia

    2012-01-01

    AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses.METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis.CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

  6. Severe acute respiratory syndrome (SARS): a year in review.

    Science.gov (United States)

    Skowronski, Danuta M; Astell, Caroline; Brunham, Robert C; Low, Donald E; Petric, Martin; Roper, Rachel L; Talbot, Pierre J; Tam, Theresa; Babiuk, Lorne

    2005-01-01

    Severe acute respiratory syndrome (SARS) emerged from China as an untreatable and rapidly spreading respiratory illness of unknown etiology. Following point source exposure in February 2003, more than a dozen guests infected at a Hong Kong hotel seeded multi-country outbreaks that persisted through the spring of 2003. The World Health Organization responded by invoking traditional public health measures and advanced technologies to control the illness and contain the cause. A novel coronavirus was implicated and its entire genome was sequenced by mid-April 2003. The urgency of responding to this threat focused scientific endeavor and stimulated global collaboration. Through real-time application of accumulating knowledge, the world proved capable of arresting the first pandemic threat of the twenty-first century, despite early respiratory-borne spread and global susceptibility. This review synthesizes lessons learned from this remarkable achievement. These lessons can be applied to re-emergence of SARS or to the next pandemic threat to arise. PMID:15660517

  7. Epidemiology of severe acute respiratory syndrome (SARS): adults and children.

    Science.gov (United States)

    Zhong, Nan-Shan; Wong, Gary W K

    2004-12-01

    Severe acute respiratory syndrome (SARS) is a newly described respiratory infection with pandemic potential. The causative agent is a new strain of coronavirus most likely originating from wild animals. This disease first emerged in November 2002 in Guangdong Province, China. Early in the outbreak the infection had been transmitted primarily via household contacts and healthcare settings. In late February 2003 the infection was transmitted to Hong Kong when an infected doctor from the mainland visited there. During his stay in Hong Kong at least 17 guests and visitors were infected at the hotel at which he stayed. By modern day air travel, the infection was rapidly spread to other countries including Vietnam, Singapore and Canada by these infected guests. With the implementation of effective control strategies including early isolation of suspected cases, strict infection control measures in the hospital setting, meticulous contact tracing and quarantine, the outbreak was finally brought under control by July 2003. In addition, there were another two events of SARS in China between the end of December 2003 and January 2004 and from March to May 2004; both were readily controlled without significant patient spread. PMID:15531250

  8. The severe acute respiratory syndrome epidemic in mainland China dissected

    Directory of Open Access Journals (Sweden)

    Wuchun Cao

    2011-02-01

    Full Text Available This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteo­necrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.

  9. Severe acute respiratory syndrome coronavirus persistence in Vero cells

    Institute of Scientific and Technical Information of China (English)

    Gustavo Palacios; Omar Jabado; Neil Renwick; Thomas Briese; W. Ian Lipkin

    2005-01-01

    Background Several coronaviruses establish persistent infections in vitro and in vivo, however it is unknown whether persistence is a feature of the severe acute respiratory syndorme coronavirus (SARS-CoV) life cycle. This study was conducted to investigate viral persistence.Methods We inoculated confluent monolayers of Vero cells with SARS-CoV at a multiplicity of infection of 0.1 TCID50 and passaged the remaining cells every 4 to 8 days for a total of 11 passages. Virus was titrated at each passage by limited dilution assay and nucleocapsid antigen was detected by Western blot and immunofluoresence assays. The presence of viral particles in passage 11 cells was assessed by electron microscopy. Changes in viral genomic sequences during persistent infection were examined by DNA sequencing. Results Cytopathic effect was extensive after initial inoculation but diminished with serial passages. Infectious virus was detected after each passage and viral growth curves were identical for parental virus stock and virus obtained from passage 11 cells. Nucleocapsid antigen was detected in the majority of cells after initial inoculation but in only 10%-40% of cells at passages 2-11. Electron microscopy confirmed the presence of viral particles in passage 11 cells. Sequence analysis at passage 11 revealed fixed mutations in the spike (S) gene and ORFs 7a-8b but not in the nucleocapsid (N) gene. Conclusions SARS-CoV can establish a persistent infection in vitro. The mechanism for viral persistence is consistent with the formation of a carrier culture whereby a limited number of cells are infected with each round of virus replication and release. Persistence is associated with selected mutations in the SARS-CoV genome. This model may provide insight into SARS-related lung pathology and mechanisms by which humans and animals can serve as reservoirs for infection.

  10. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun

    2008-01-01

    AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

  11. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Recent Asthma Data AsthmaStats Asthma-related Missed School Days among Children aged 5–17 Years Asthma Severity ... the Nation Fact Sheet State Data Profiles (2011) Work-related Asthma NCHS Asthma FastStats Survey Questions Resources ...

  12. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    Directory of Open Access Journals (Sweden)

    Perković-Vukčević Nataša

    2012-01-01

    Full Text Available Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. Case report. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L, and a toxicological analysis (liquid chromatography with ultraviolet detection proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L. On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. Conclusion. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the

  13. Effects of the tulobuterol patch on the treatment of acute asthma exacerbations in young children.

    Science.gov (United States)

    Katsunuma, Toshio; Ohya, Yukihiro; Fujisawa, Takao; Akashi, Kenichi; Imamura, Naoto; Ebisawa, Motohiro; Daikoku, Kazunari; Kondo, Naomi; Terada, Akihiko; Doi, Satoru; Nishimuta, Toshiyuki; Noma, Takeshi; Hamasaki, Yuhei; Kurihara, Kazuyuki; Masuda, Kei; Yamada, Takashi; Yamada, Masanori; Yoshihara, Shigemi; Watanabe, Kazuhiko; Watanabe, Tohru; Kitabayashi, Taeru; Morikawa, Akihiro; Nishima, Sankei

    2012-01-01

    The tulobuterol patch (TP) is a beta(2)-adrenergic agonist with a favorable pharmacokinetic profile used for asthma management in Japan. Because it contains tulobuterol in a molecular, crystallized form that is gradually absorbed percutaneously, TP exerts a prolonged bronchodilator effect exceeding 24 hours. Although it is a well-established treatment for asthma and wheezing, few studies have investigated whether it can reduce or prevent the symptoms associated with upper respiratory tract infections (URTIs) in young children. This study evaluated the effect of TP on the long-term management of asthma in young children. In this 1-year, randomized, multicenter, double-blind, placebo-controlled study, children aged 0.5-3 years old with mild-to-moderate persistent asthma were treated with either TP or placebo patch. The parents/guardians applied the TP or placebo patch to their children after URTI symptoms appeared. Respiratory symptoms were recorded daily during the 1-year observation period. Overall, 86 patients were enrolled and 80 were treated and analyzed in this study. All patients had been treated with anti-inflammatory drugs before enrollment. The time to symptom resolution was significantly shorter (p = 0.001) and the total respiratory symptom score (p = 0.0457) was significantly lower in the TP group than in the placebo group. In young children with mild-to-moderate asthma who had been treated with anti-inflammatory drugs, using the TP soon after the appearance of URTI symptoms led to quicker resolution of respiratory symptoms and lower respiratory symptom scores.

  14. A collagen IV matrikine inhibits neutrophil recruitment in a mouse model of asthma exacerbation

    NARCIS (Netherlands)

    Weckmann, M.; Nissen, G.; Lundig, L.; Burgess, J.K.; Holst, O.; Wegmann, M.; Kopp, M.V.

    2015-01-01

    Background: Increased neutrophilic infiltration of the airways is a key feature of acute asthma exacerbation, which may lead to prolonged hospital admissions and an enhanced rate of decline of lung function. The increase in asthma severity in this subpobulation of patients is thought to be partially

  15. Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children

    International Nuclear Information System (INIS)

    We enrolled a cohort of primary school children with a history of wheeze (n=148) in an 11-month longitudinal study to examine the relationship between ambient air pollution and respiratory morbidity. We obtained daily air pollution (ozone, particulate matter less than 10 μm, and nitrogen dioxide), meteorological, and pollen data. One hundred twenty-five children remained in the final analysis. We used logistic regression models to determine associations between air pollution and respiratory symptoms, asthma medication use, and doctor visits for asthma. There were no associations between ambient ozone concentrations and respiratory symptoms, asthma medication use, and doctor visits for asthma. There was, however, an association between PM10 concentrations and doctor visits for asthma (RR=1.11, 95% CI=1.04-1.19) and between NO2 concentration and wet cough (RR=1.05, 95% CI=1.003-1.10) in single-pollutant models. The associations remained significant in multipollutant models. There was no consistent evidence that children with wheeze, positive histamine challenge, and doctor diagnosis of asthma reacted differently to air pollution from children with wheeze and doctor diagnosis of asthma and children with wheeze only. There were significant associations between PM10 levels and doctor visits for asthma and an association between NO2 levels and the prevalence of wet cough. We were, however, unable to demonstrate that current levels of ambient air pollution in western Sydney have a coherent range of adverse health effects on children with a history of wheezing

  16. Clinical features of probable severe acute respiratory syndrome in Beijing

    Institute of Scientific and Technical Information of China (English)

    Hai-Ying Lu; Xiao-Yuan Xu; Yu Lei; Yang-Feng Wu; Bo-Wen Chen; Feng Xiao; Gao-Qiang Xie; De-Min Han

    2005-01-01

    AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing.METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type.The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%)and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positiveT cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality.CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

  17. Clinical significance of hepatic derangement in severe acute espiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Henry Lik-Yuen Chan; Ambrose Chi-Pong Kwan; Ka-Fai To; Sik-To Lai; Paul Kay-Sheung Chan; Wai-Keung Leung; Nelson Lee; Alan Wu; Joseph Jao-Yiu Sung

    2005-01-01

    AIM: Elevation of alanine aminotransferase (ALT) level iscommonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient.METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death.RESULTS: Two hundred and ninety-four patients wereincluded in this study. Seventy (24%) patients had elevatedserum ALT on admission and 204 (69%) patients hadelevated ALT during the subsequent course of illness. Using peek ALT >5xULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peek ALT >5x ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P = 0.018), ICU care was 3.70 (95%CT 1.38-9.89, P = 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P = 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes. CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severehepatitis had worse clinical outcome.

  18. Clinical experience of surgical intervention for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xu Yuan; Shao Qinshu; Yang Jin; Yu Xiaojun; Xu Ji

    2014-01-01

    Background The controversy on the treatment strategy for severe acute pancreatitis (SAP) has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two:early intervention group (within 2 weeks) 103 cases,and late intervention group (after 2 weeks) 109 cases.Results In the conservative treatment group,the cure rate was 82.29% (79/96),the death rate was 13.54% (13/96),and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% (179/212) and the death rate was 10.85% (23/212) with 10 cases self-discharged.The difference was of no statistical significance between these two groups (P >0.05).In surgical intervention group,the death rate 15.53% (16/103) in the early surgical intervention group was higher than that of late surgical intervention group 6.42% (7/109),and the difference was statistically significant (P <0.05).Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.

  19. Prevention of bacterial infection and sepsis in acute severe pancreatitis.

    OpenAIRE

    McClelland, P.; Murray, A; Yaqoob, M.; Van Saene, H. K.; Bone, J M; Mostafa, S. M.

    1992-01-01

    Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six pati...

  20. Nocturnal Asthma

    Science.gov (United States)

    ... Medical Director, Health Initiatives View full profile Nocturnal Asthma Worsening of asthma at night, or nocturnal asthma, ... give extra protection during the night. More Nocturnal Asthma Information Back to Asthma: Types Print Page Email ...

  1. Asthma Basics

    Science.gov (United States)

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth Asthma Basics KidsHealth > For Parents > Asthma Basics Print A ... Asthma Categories en español Asma: aspectos fundamentales About Asthma Asthma is a common lung condition in kids ...

  2. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis

    OpenAIRE

    Windsor, A; Kanwar, S; Li, A.; Barnes, E.; Guthrie, J; Spark, J; Welsh, F.; Guillou, P; Reynolds, J

    1998-01-01

    Background—In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis. 
Aims—To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with ac...

  3. Organ dysfunction as a risk factor for early severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jan De Waele; S.Blot; Francis Colardyn

    2004-01-01

    @@ To the Editor: We read with interest the review paper by Tao et al.[1] on the topic of early severe acute pancreatitis (EASP, defined as severe acute pancreatitis according to the Altanta criteria[2], with organ dysfunction within 72 h after the start of symptoms) in a recent issue of the World Journal of Gastroenterology. It addresses an important problem in patients with severe acute pancreatitis,namely early organ dysfunction and its effect on outcomes.

  4. The absence of exanthema is related with death and illness severity in acute enterovirus infection

    Directory of Open Access Journals (Sweden)

    Hong-Tao Zhou

    2014-11-01

    Conclusions: A considerable proportion of children with an acute enterovirus infection in Guangdong Province, China during 2009–2012 presented no exanthema, and the absence of exanthema was found to be related to death and illness severity for these acute enterovirus infections. Clinicians in China should consider enterovirus as the possible pathogen when treating children with an acute pathogen infection without exanthema.

  5. Pioglitazone attenuates the severity of sodium taurocholate-induced severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ping Xu; Xiao-Jiang Zhou; Ling-Quan Chen; Jiang Chen; Yong Xie; Long-Hua Lv; Xiao-Hua Hou

    2007-01-01

    AIM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ (PPARγ)ligand, on development of severe acute pancreatitis (SAP) and expression of nuclear factor-kappa B (NF-κB)and intercellular adhesion molecule-1 (ICAM-1) in the pancreas.METHODS: Male Sprague-Dawley (SD) rats (160-200 g)were randomly allocated into three groups (n = 18in each group): severe acute pancreatitis group,pioglitazone group, sham group. SAP was induced by retrograde infusion of 1 mL/kg body weight 5% sodium taurocholate (STC) into the biliopancreatic duct of male SD rats. Pioglitazone was injected intraperitoneally two hours piror to STC infusion. Blood and ascites were obtained for detecting amylase and ascitic capacity. Pancreatic wet/dry weight ratio, expression of NF-κB and ICAM-1 in pancreatic tissues were detected by immunohistochemical staining. Pancreatic tissue samples were stained with hematoxylin and eosin (HE)for routine optic microscopy.RESULTS: Sham group displayed normal pancreatic structure. SAP group showed diffuse hemorrhage,necrosis and severe edema in focal areas of pancreas.There was obvious adipo-saponification in abdominal cavity. Characteristics such as pancreatic hemorrhage,necrosis, severe edema and adipo-saponification were found in pioglitazone group, but the levels of those injuries were lower in pioglitazone group than those in SAP group. The wet/dry pancreatic weight ratio,ascetic capacity, serum and ascitic activities of anylase in the SAP group were significantly higher than those in the sham group and pioglitazone group respectively (6969.50 ± 1368.99 vs 2104.67 ± 377.16, 3.99 ± 1.22 vs 2.48 ± 0.74, P < 0.01 or P < 0.05). According to Kusske criteria, the pancreatic histologic score showed that interstitial edema, inflammatory infiltration,parenchyma necrosis and parenchyma hommorrhage in SAP group significantly differed from those in the sham group and pioglitazone group (7.17 ± 1.83 vs 0.50 ±0.55, 7

  6. An analysis of the utilisation and expenditure of medicines dispensed for the management of severe asthma.

    LENUS (Irish Health Repository)

    McGowan, B

    2009-03-01

    There are approximately 6,300 people in Ireland with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and with a fast growing elderly population the incidence of COPD is likely to increase. This study examines the prescribing patterns of medicines dispensed for the management Asthma\\/COPD in patients over the age of 35 years using the HSE-Primary Care Reimbursement Services (PCRS) prescribing databases. The HSE-PCRS pharmacy claims data, which covers all those over 70 years of age and means tested for those less than 70 years, was analysed for the years 2005\\/2006. Approximately 26,548 (17.9%) of patients who were prescribed a respiratory drug received inhaled short-acting beta2 agonists in combination with a regular standard-dose inhaled corticosteroid. A further 5,044 (3.4%) were also prescribed a regular inhaled long-acting beta2 agonist (salmeterol or formoterol). A total of 2506 patients (6.2%) on combination therapy were co-prescribed four different anti-asthmatic treatments inclusive of oral prednisolone. A small proportion of the patients prescribed a respiratory drug were co-prescribed nicotine replacement therapy (n = 5177, 3.5%). In total there were 9,728 (6.2%) patients prescribed a mucolytic drug in combination with a respiratory drug and the rate of co-prescribing with antibiotics was 22%. COPD is a debilitating disease that is primarily caused by smoking and is therefore largely preventable. The HSE-PCRS pharmacy claims data is a valuable tool for helping to assess the burden of this disease in the Irish context.

  7. Severe acute respiratory syndrome: clinical and laboratory manifestations.

    Science.gov (United States)

    Lam, Christopher W K; Chan, Michael H M; Wong, Chun K

    2004-05-01

    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase (LD), alanine aminotransferase (ALT) and creatine kinase (CK) activities. Treatment has been empirical; initial potent antibiotic cover, followed by simultaneous ribavirin and corticosteroids, with or without pulse high-dose methylprednisolone, have been used. The postulated disease progression comprises (1) active viral infection, (2) hyperactive immune response, and (3) recovery or pulmonary destruction and death. We investigated serum LD isoenzymes and blood lymphocyte subsets of SARS patients, and found LD1 activity as the best biochemical prognostic indicator for death, while CD3+, CD4+, CD8+ and natural killer cell counts were promising predictors for intensive care unit (ICU) admission. Plasma cytokine and chemokine profiles showed markedly elevated Th1 cytokine interferon (IFN)-gamma, inflammatory cytokines interleukin (IL)-1beta, IL-6 and IL-12, neutrophil chemokine IL-8, monocyte chemoattractant protein-1 (MCP-1), and Th1 chemokine IFN-gamma-inducible protein-10 (IP-10) for at least two weeks after disease onset, but there was no significant elevation of inflammatory cytokine tumor necrosis factor (TNF)-alpha and anti-inflammatory cytokine IL-10. Corticosteroid reduced IL-8, MCP-1 and IP-10 concentrations from 5-8 days after treatment. Measurement of biochemical markers of bone metabolism demonstrated significant but transient increase in bone resorption from Day 28-44 after onset of fever, when pulse steroid was most frequently given. With tapering down of steroid

  8. Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition.

    Directory of Open Access Journals (Sweden)

    Ling Zhang

    Full Text Available Severe acute malnutrition (SAM is a major cause of mortality in children under 5 years and is associated with hepatic steatosis. Bile acids are synthesized in the liver and participate in dietary fat digestion, regulation of energy expenditure, and immune responses. The aim of this work was to investigate whether SAM is associated with clinically relevant changes in bile acid homeostasis.An initial discovery cohort with 5 healthy controls and 22 SAM-patients was used to identify altered bile acid homeostasis. A follow up cohort of 40 SAM-patients were then studied on admission and 3 days after clinical stabilization to assess recovery in bile acid metabolism. Recruited children were 6-60 months old and admitted for SAM in Malawi. Clinical characteristics, feces and blood were collected on admission and prior to discharge. Bile acids, 7α-hydroxy-4-cholesten-3-one (C4 and FGF-19 were quantified.On admission, total serum bile acids were higher in children with SAM than in healthy controls and glycine-conjugates accounted for most of this accumulation with median and interquartile range (IQR of 24.6 μmol/L [8.6-47.7] compared to 1.9 μmol/L [1.7-3.3] (p = 0.01 in controls. Total serum bile acid concentrations did not decrease prior to discharge. On admission, fecal conjugated bile acids were lower and secondary bile acids higher at admission compared to pre- discharge, suggesting increased bacterial conversion. FGF19 (Fibroblast growth factor 19, a marker of intestinal bile acid signaling, was higher on admission and was associated with decreased C4 concentrations as a marker of bile acid synthesis. Upon recovery, fecal calprotectin, a marker of intestinal inflammation, was lower.SAM is associated with increased serum bile acid levels despite reduced synthesis rates. In SAM, there tends to be increased deconjugation of bile acids and conversion from primary to secondary bile acids, which may contribute to the development of liver disease.

  9. Methomyl-Induced Severe Acute Pancreatitis: Possible Etiological Association

    Directory of Open Access Journals (Sweden)

    Ioannides M

    2005-03-01

    Full Text Available CONTEXT: N-methyl carbamate insecticides are widely used in homes, gardens and agriculture. They share the capacity to inhibit cholinesterase enzymes with organophosphates and therefore share similar symptomatology during acute and chronic exposures. One of the serious effects of organophosphate and carbamate intoxication is the development of acute pancreatitis and subsequent intrapancreatic fluid formation. CASE REPORT: An 18-year old Caucasian man was admitted to our Intensive Care Unit with cholinergic crisis symptomatology, after the ingestion of an unknown amount of a carbamate insecticide (methomyl. Pseudocholinesterase levels were 2 kU/L on the day of admission (reference range: 5.4-13.2 kU/L. Two days after admission, an abdominal CT scan revealed blurring of the peripancreatic fat planes, inflammation and swelling of the pancreas, and a substantial amount of ascitic fluid in the left anterior pararenal space and pelvis. Paracentesis and analysis of the ascitic fluid demonstrated findings diagnostic of pancreatic ascites. There had been no other evident predisposing factors for acute pancreatitis, other than methomyl intoxication. Eleven days after admission, pseudocholinesterase levels returned to normal, while a new abdominal CT scan revealed the formation of intrapancreatic fluid collection. The patient was discharged in good physical condition two weeks after admission. A follow up abdominal CT scan performed one month later showed a significant reduction in the size of the intrapancreatic fluid. DISCUSSION: Acute pancreatitis is not uncommon after organophosphate intoxication and carbamates share the same risk as organophosphorus pesticides. The development of acute pancreatitis and subsequent intrapancreatic fluid collection after methomyl intoxication has not previously been reported. This is the first case reported of acute pancreatitis and pancreatic ascite formation after anticholinesterase insecticide ingestion.

  10. Silent ischemia and severity of pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F;

    1991-01-01

    An overall low tendency to complain of pain, due to a low perception of pain, has been suggested in the pathogenesis of silent ischemia, independent of the extent of the diseased coronaries and a history of previous acute myocardial infarction. This hypothesis has been tested indirectly...... in this retrospective study by comparison of the use of analgesics during admission for a first acute myocardial infarction with the occurrence of silent ischemia at exertion tests four weeks after discharge from hospital. The study did not show a lower use of analgesics in patients with silent ischemia, but this may...

  11. Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asthma: a pilot study

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Ferreira Pereira

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate respiratory muscle strength and six-minute walk test (6MWT variables in patients with uncontrolled severe asthma (UCSA. METHODS: This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT. The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. RESULTS: We included 25 patients. Mean FEV1 was 58.8 ± 21.8% of predicted, and mean ACT score was 14.0 ± 3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14. During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9 ± 15.2% and 67.6 ± 22.2%, respectively. Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15 or MEP (p = 0.45. CONCLUSIONS: Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength.

  12. Acute hypothyroidism in a severely ill surgical patient

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C

    1988-01-01

    A case of acute postoperative hypothyroidism in a 62-year old woman is presented. One month before emergency admission because of a perforated gastric ulcer the patient had normal thyroid function, despite removal of a thyroid adenoma 20 years earlier. Following surgery the patient developed...

  13. Evaluation of the Correlation Between Body Mass Index and the Severity of Asthma in Recently Diagnosed Patients

    Directory of Open Access Journals (Sweden)

    Davood Attaran

    2011-06-01

    Except for FVC which had a significant correlation with BMI, other studied indices yielded no significant results, which calls for more extensive studies with larger populations. Considering the fact that mild asthma is less common in obese patients, better weight control in asthmatic patients can promote their quality of life and make asthma management more effective.

  14. Effectiveness and Safety of Bronchial Thermoplasty in the Treatment of Severe Asthma A Multicenter, Randomized, Double-Blind, Sham-Controlled Clinical Trial

    NARCIS (Netherlands)

    Castro, Mario; Rubin, Adalberto S.; Laviolette, Michel; Fiterman, Jussara; Lima, Marina De Andrade; Shah, Pallav L.; Fiss, Elie; Olivenstein, Ronald; Thomson, Neil C.; Niven, Robert M.; Pavord, Ian D.; Simoff, Michael; Duhamel, David R.; McEvoy, Charlene; Barbers, Richard; ten Hacken, Nicolaas H. T.; Wechsler, Michael E.; Holmes, Mark; Phillips, Martin J.; Erzurum, Serpil; Lunn, William; Israel, Elliot; Jariour, Nizar; Kraft, Monica; Shargill, Narinder S.; Quiring, John; Berry, Scott M.; Cox, Gerard

    2010-01-01

    Rationale Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. Objectives: To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic desp

  15. Obstructive sleep apnea and asthma*

    OpenAIRE

    Cristina Salles; Regina Terse-Ramos; Adelmir Souza-Machado; Cruz, Alvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worseni...

  16. Clinical Progress in the Treatment of Severe Acute Pancreatitis with Integrative Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Severe acute pancreatitis (SAP), one of the crucial acute abdominal diseases, has high mortality for its quick initiation, severe condition, long duration, and frequent complication with multiple organ failure. In this paper, the clinical progress in the treatment of SAP with integrative Chinese and Western medicine is inspected and summarized.

  17. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B; Nieuwenhuijs, V B; Hofker, H.S.; Zijlstra, J.G.

    2016-01-01

    INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS

  18. Early preventive treatment for severe acute pancreatitis combined with lung injury

    Institute of Scientific and Technical Information of China (English)

    刘学民; 刘青光; 潘承恩

    2002-01-01

    @@ Severe acute pancreatitis (SAP) can cause systematic inflammatory response syndrome (SIRS),which leads to injury or failure of the internal organs and systems.1 Among them,acute respiratory distress syndrome(ARDS)is a severe or fatal complication.In this article,the early preventive treatment for SAP combined with lung injure is studied.

  19. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US.

    Science.gov (United States)

    Mudarri, David H

    2016-01-01

    Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3-4.7) billion for allergic rhinitis, $1.9 (1.1-2.3) billion for acute bronchitis, $15.1 (9.4-20.6) billion for asthma morbidity, and $1.7 (0.4-4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality. PMID:27313630

  20. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US

    Directory of Open Access Journals (Sweden)

    David H. Mudarri

    2016-01-01

    Full Text Available Two foundational methods for estimating the total economic burden of disease are cost of illness (COI and willingness to pay (WTP. WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$ of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3–4.7 billion for allergic rhinitis, $1.9 (1.1–2.3 billion for acute bronchitis, $15.1 (9.4–20.6 billion for asthma morbidity, and $1.7 (0.4–4.5 billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality.

  1. Asthma and pregnancy.

    Science.gov (United States)

    Vatti, Rani Reddy; Teuber, Suzanne S

    2012-08-01

    Asthma is probably the most common serious medical disorder that may complicate pregnancy. A third of pregnant women with asthma will experience worsening of their symptoms, a third will see improvement of their symptoms and a third will see no change. The primary goal is to maintain optimal control of asthma for maternal health and well-being as well as fetal maturation. Vital patient education should cover the use of controller medication, avoidance of asthma triggers and early treatment of asthma exacerbations. Proper asthma management should ideally be started in the preconception period. Since smoking is probably the most modifiable risk factor of asthma, pregnant woman should avoid active and passive smoking. Acute asthma exacerbation during the first trimester is associated with an increased risk of congenital malformations. Poorly controlled asthma is associated with low birth weight, preeclampsia, and preterm birth. Medications used for asthma control in the non-pregnant population are generally the same in pregnancy with a few exceptions. Inhaled corticosteroids (ICS) are the preferred controller therapy. Budesonide is the preferred ICS. Long-acting B-agonists (LABA) are the preferred add-on therapy to medium to high dose ICS. Major triggers for asthma exacerbations during pregnancy are viral infections and ICS nonadherence. PMID:21858482

  2. Use of a total traffic count metric to investigate the impact of roadways on asthma severity: a case-control study

    Directory of Open Access Journals (Sweden)

    deVos Annemarie JBM

    2011-06-01

    Full Text Available Abstract Background This study had two principal objectives: (i to investigate the relationship between asthma severity and proximity to major roadways in Perth, Western Australia; (ii to demonstrate a more accurate method of exposure assessment for traffic pollutants using an innovative GIS-based measure that fully integrates all traffic densities around subject residences. Methods We conducted a spatial case-control study, in which 'cases' were defined as individuals aged under 19 years of age with more severe asthma (defined here as two or more emergency department contacts with asthma in a defined 5-year period versus age- and gender-matched 'controls' with less severe asthma (defined here as one emergency department contact for asthma. Traffic exposures were measured using a GIS-based approach to determine the lengths of the roads falling within a buffer area, and then multiplying them by their respective traffic counts. Results We examined the spatial relationship between emergency department contacts for asthma at three different buffer sizes: 50 metres, 100 metres and 150 metres. No effect was noted for the 50 metre buffer (OR = 1.07; 95% CI: 0.91-1.26, but elevated odds ratios were observed with for crude (unadjusted estimates OR = 1.21 (95% CI: 1.00-1.46 for 100 metre buffers and OR = 1.25 (95% CI: 1.02-1.54 for 150 metre buffers. For adjusted risk estimates, only the 150 metre buffer yielded a statistically significant finding (OR = 1.24; 95% CI:1.00-1.52. Conclusions Our study revealed a significant 24% increase in the risk of experiencing multiple emergency department contacts for asthma for every log-unit of traffic exposure. This study provides support for the hypothesis that traffic related air pollution increases the frequency of health service contacts for asthma. This study used advanced GIS techniques to establish traffic-weighted buffer zones around the geocoded residential location of subjects to provide an accurate

  3. Traditional Chinese medicine, Qing Ying Tang, ameliorates the severity of acute lung injury induced by severe acute pancreatitis in rats via the upregulation of aquaporin-1

    OpenAIRE

    GAO, ZHENMING; Xu, Junfeng; Sun, Deguang; ZHANG, Rixin; LIANG, RUI; Wang, Liming; Fan, Rong

    2014-01-01

    Aquaporin-1 (AQP-1) is expressed in lung endothelial cells and regulates water transport; thus, AQP-1 plays an important role in a number of edema-associated lung diseases. Qing Yin Tang (QYT), a traditional Chinese medicine, has been shown to effectively reduce the mortality rate of acute lung injury (ALI) induced by severe acute pancreatitis (SAP). The current study aimed to investigate the detailed mechanisms underlying the effects of QYT on ALI induced by SAP, particularly the effects on ...

  4. Comparing the efficacy and safety of two regimens of sequential systemic corticosteroids in the treatment of acute exacerbation of bronchial asthma

    Directory of Open Access Journals (Sweden)

    Aggarwal Praveen

    2010-01-01

    Full Text Available Background : Corticosteroids are commonly used in the management of acute asthma. However, studies comparing various steroids in the management of acute asthma are lacking. Objective : To compare the efficacy and safety of two treatment regimens - intravenous (IV methylprednisolone (MP followed by oral MP and IV hydrocortisone (HC followed by oral prednisolone in acute bronchial asthma patients. Materials and Methods : This was a randomized, prospective study performed in the emergency department (ED of a tertiary care hospital in North India. A total of 94 patients with acute asthma were randomly allocated to either of the two treatment groups: Group A (n = 49 or Group B (n = 45. Patients in Group A were administered HC 200 mg IV 6-hourly until discharge from the ED, followed by oral prednisolone 0.75 mg/kg daily for 2 weeks. Patients in Group B were administered MP 125 mg IV bolus, followed by 40 mg MP IV 6-hourly until discharge, and then oral MP 0.6 mg/kg daily for 2 weeks. All clinical variables, peak expiratory flow (PEF and forced expiratory volume in one second (FEV 1 were assessed at baseline, at 1, 3 and 6 h and at every 6 h thereafter until discharge from the ED. The patients were followed-up after 2 weeks of discharge. The response to treatment was assessed by clinical and spirometric evaluation. Independent t-tests and chi-square tests were used to compare the two treatment regimens. Results : The baseline characteristics were comparable in the two groups. There was a significant improvement in PEF and FEV 1 within the groups at 2 weeks of treatment when compared to the baseline. At 2 weeks of follow-up, Group B showed significant improvement over Group A in PEF (P < 0.0001, FEV 1 (P < 0.0001 and asthma score (P = 0.034. There was a significant increase in the blood sugar value at 2 weeks in both the groups. However, the increase was greater in Group A as compared to Group B (P < 0.0001. Conclusion : This study suggests that in

  5. Pulmonary vasculature and critical asthma syndromes: a comprehensive review.

    Science.gov (United States)

    Avdalovic, Mark

    2015-02-01

    One of the important factors and consequences in persistent asthma is the change in the vasculature of the airways and lung parenchyma. These changes could contribute to worsening asthma control and predispose asthmatics to critical asthma syndromes. For many years, the contribution of vasculature to severe asthma was limited to discussion of small and medium vessel vasculitis commonly referred to as Churg-Strauss syndrome. This comprehensive review will explore the known mechanisms that are associated with remodeling of the vasculature in a variety of critical asthma presentations. Inflammation of pulmonary and bronchial small blood vessels may contribute significantly but silently to asthma pathobiology. Inflammation in the vasculature of the lung parenchyma can decrease lung capacity while inflammation in airway vasculature can decrease airflow. This review will provide a modern perspective on Churg-Strauss syndromes with a focus on phenotyping, mechanism, and ultimately modern therapeutic approaches. Vascular remodeling and airway remodeling are not mutually exclusive concepts in understanding the progression of asthma and frequency of acute exacerbations. Furthermore, the contribution of vascular leak, particularly in the parenchymal vasculature, has become an increasingly recognized component of certain presentations of poorly controlled, severe persistent asthmatic and during exacerbations. We highlight how these mechanisms can contribute to some the severe presentations of influenza infection in patients with a history of asthma. The ultimate aim of this review is to summarize the current literature concerning vasculitis and the contribution of airway and parenchymal vascular remodeling to presentation of persistent asthma and its consequences during acute exacerbations and critical asthma syndromes. PMID:24752370

  6. Clinical characteristics and treatment analysis of pregnancy combined with bronchial asthma acute attack%妊娠合并支气管哮喘急性发作的发病特点及治疗分析

    Institute of Scientific and Technical Information of China (English)

    幸似瑛; 谢文峰

    2015-01-01

    目的:探讨妊娠合并支气管哮喘急性发作的发病特点及治疗效果。方法:2011年10月-2014年10月收治妊娠合并支气管哮喘急性发作患者52例,根据自身病况,采用β2受体激动剂和糖皮质激素,补液、纠正水电解质平衡紊乱等治疗措施。回顾性分析其临床资料。结果:52例患者无并发症出现,胎儿在母体中各项体征正常。经过上述治疗之后,治疗总有效率96.1%。结论:妊娠促使部分患者支气管哮喘急性发作,半卧位、吸氧、静脉注射氨茶碱及肾上腺糖皮质激素等措施能有效控制严重支气管哮喘急性发作。%Objective:To explore the clinical characteristics and treatment effect of pregnancy combined with bronchial asthma acute attack.Methods:52 patients with pregnancy combined with bronchial asthma acute attack were selected from October 2011 to October 2014. According to the own conditions,52 patients were given β2 receptor agonist and corticosteroids,fluid infusion, correct water and electrolyte balance disorder and other treatment measures.The clinical data were retrospectively analyzed. Results:There was no complications,all signs of fetus in the womb are normal.After the above treatment,the total effective rate of patients was 96.1% .Conclusion:Pregnancy prompts part of patients with bronchial asthma acute attack,semi supine,oxygen inhalation,intravenous injection of aminophylline and adrenal cortex and other measures can effectively control the severe bronchial asthma acute attack.

  7. Stroke severity and incidence of acute large vessel occlusions in patients with hyper-acute cerebral ischemia

    DEFF Research Database (Denmark)

    Hansen, Christine Kraup; Christensen, Anders Fogh; Ovesen, C;

    2015-01-01

    BACKGROUND: The frequency of acute large vessel occlusions in relation to clinical severity has not yet been established in a comprehensive, consecutive and unselected cohort of patients with hyper-acute cerebral ischemia. AIM: The aim of this study was to establish the frequency of acute large...... vessel occlusions and describe the relations to the National Institutes of Health Stroke Scale (NIHSS), lesion site and time from symptom onset in unselected consecutive patients with hyper-acute cerebral ischemia. METHODS: A prospective single hospital registry was based on consecutive unselected...... patients admitted from July 2009 to December 2011 with symptoms of acute cerebral ischemia within 4.5 h from symptom onset. ICA, M1, M2, ACA, PCA, BA and VA were assed for occlusions. Best NIHSS-cut-off values were calculated based on sensitivity and specificity for detecting any, anterior and posterior...

  8. Severe acute post-streptococcal glomerulonephritis in an infant

    Directory of Open Access Journals (Sweden)

    Jameela A Kari

    2013-01-01

    Full Text Available Acute post-streptococcal glomerulonephritis (APSGN is very rare below the age of two years. We report a 14-month-old girl who presented with frank hematuria and nephrotic syndrome following group A streptococcal pharyngitis (GAS, which was confirmed by laboratory investigations. The patient underwent a renal biopsy to confirm the diagnosis and was treated with prednisolone. The proteinuria and hematuria resolved completely in eight weeks. Our case demonstrates that APSGN should be considered in evaluating hematuria and nephrotic syndrome in infants and children below two years of age.

  9. Peak heart rate decreases with increasing severity of acute hypoxia

    DEFF Research Database (Denmark)

    Lundby, C; Araoz, M; Van Hall, Gerrit

    2001-01-01

    , 459, and 404 mmHg) in a hypobaric chamber and while breathing 9% O(2) in N(2). These conditions were equivalent to altitudes of 3300, 4300, 5300, and 6300 m above sea level, respectively. At 4300 m, maximal exercise was also repeated after 4 and 8 h. Peak heart rate (HR) decreased from 191 (182......The purpose of the present study was to investigate the degree to which peak heart rate is reduced during exhaustive exercise in acute hypoxia. Five sea-level lowlanders performed maximal exercise at normobaric normoxia and at three different levels of hypobaric hypoxia (barometric pressures of 518...

  10. Bronchodilatory effect of inhaled budesonide/formoterol and budesonide/salbutamol in acute asthma: a double-blind, randomized controlled trial

    OpenAIRE

    Arun Jenish J; Lodha Rakesh; Kabra Sushil K

    2012-01-01

    Abstract Background There are no published studies that have compared bronchodilatory effect of inhaled budesonide/formoterol combination with budesonide/salbutamol delivered by metered dose inhaler with a spacer in acute exacerbation of asthma in children. We, therefore, compared the bronchodilatory effects of inhaled budesonide/formoterol (dose: 200 μg and 12 μg respectively) combination with budesonide (200 μg)/salbutamol (200 μg) administered by metered dose inhaler and spacer in children...

  11. Bronchodilatory effect of inhaled budesonide/formoterol and budesonide/salbutamol in acute asthma: a double-blind, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Arun Jenish J

    2012-03-01

    Full Text Available Abstract Background There are no published studies that have compared bronchodilatory effect of inhaled budesonide/formoterol combination with budesonide/salbutamol delivered by metered dose inhaler with a spacer in acute exacerbation of asthma in children. We, therefore, compared the bronchodilatory effects of inhaled budesonide/formoterol (dose: 200 μg and 12 μg respectively combination with budesonide (200 μg/salbutamol (200 μg administered by metered dose inhaler and spacer in children of 5-15 years with mild acute exacerbation of asthma [Modified Pulmonary Index Score (MPIS between 6-8] in this double-blind, randomized controlled trial. The primary outcome was FEV1 (% predicted in the two groups at 1, 5, 15, 30, 60 min after administration of the study drug. Results We did not observe any significant differences in the % predicted FEV1 and MPIS between formoterol and salbutamol at various time points from 1 min to 60 min post drug administration. There was significant improvement in FEV1 (% predicted from baseline in both the groups as early as 1 min after drug administration. Conclusions Salbutamol or formoterol delivered along with inhaled corticosteroid by metered dose inhaler with spacer in children between 5-15 years of age with mild acute exacerbation of asthma had similar bronchodilatory effects. Trial Registration ClinicalTrials.gov: NCT00900874

  12. Advances in Pediatric Asthma in 2013: Coordinating Asthma Care

    OpenAIRE

    Szefler, Stanley J.

    2014-01-01

    Last year’s Advances in Pediatric Asthma: Moving Toward Asthma Prevention concluded that: “We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.” This year’s summary will focus on recent advances in pediatric asthma on pre- and postnatal factors alt...

  13. Severe renal failure in acute bacterial pyelonephritis: Do not forget corticosteroids

    Directory of Open Access Journals (Sweden)

    Sqalli Tarik

    2010-01-01

    Full Text Available Acute renal failure (ARF is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.

  14. Time for the new approach in management of early phase of severe acute pancreatitis?

    Institute of Scientific and Technical Information of China (English)

    Darko Zdravkovic; Dragoljub Bilanovi(c); Tomislav Randjelovic; Borislav Toskovic

    2010-01-01

    @@ To the Editor: We read with a great interest the recent article by Dr. Yang et al, in which they summarized the surgical treatment of patients with fulminant acute pancreatitis in their hospital. This is a very interesting paper on treating severe acute panceratitis (SAP) since the management of acute pancreatitis has been controversial over the past decades, varying between a conservative medical approach on the one hand and aggressive surgical approach on the other.

  15. Anti-IgE treatment, airway inflammation and remodelling in severe allergic asthma: current knowledge and future perspectives

    OpenAIRE

    Konstantinos Samitas; Vasiliki Delimpoura; Eleftherios Zervas; Mina Gaga

    2015-01-01

    Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic inflammation and structural alterations in the airways, also known as remodelling. IgE is an important mediator of allergic reactions and has a central role in allergic asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating IgE in th...

  16. Association of ADAM33 gene polymorphisms with adult-onset asthma and its severity in an Indian adult population

    Indian Academy of Sciences (India)

    Priya Tripathi; Shally Awasthi; Rajendra Prasad; Nuzhat Husain; Subramaniam Ganesh

    2011-08-01

    ADAM33, a member of the ADAM (a disintegrin and metalloprotease) gene family, is an asthma susceptibility gene originally identified by positional cloning. In the present study, we investigated the possible association of five single-nucleotide polymorphisms (SNPs) in the ADAM33 (rs511898, rs528557, rs44707, rs597980 and rs2787094) with adult-onset asthma in an Indian population. The study included 175 patients with mild intermittent ($n = 44$), mild persistent ($n = 108$) or moderate persistent ($n = 23$) subgroups of asthma, and 253 nonasthmatic control individuals. SNPs were genotyped with the help of restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) method, and data were analysed using chi-square test and logistic regression model. Bonferroni’s correction for multiple comparisons was applied for each hypothesis. Genotypes and allele frequencies of SNPs rs511898 and rs528557 were significantly associated with adult-onset asthma ($P = 0.010-\\lt 0.001$). A significant association of the homozygous mutant genotype and mutant alleles of SNPs rs2787094, rs44707 and rs597980 with the asthma was also observed ($P = 0.020-\\lt 0.001$). A positive association between asthma and haplotypes AGCCT, GGCCT, AGACT, GCAGT, GGACT, ACCCC and AGACC were also found ($P = 0.036-\\lt 0.001$, OR $= 2.07-8.49$). Haplotypes AGCGT, GCAGC, ACAGC, ACAGT, GGAGC and GGCGT appear to protect against asthma ($P = 0.013-\\lt 0.0001$, OR $= 0.34-0.10$). Our data suggest that ADAM33 gene polymorphisms serve as genetic risk factors for asthma in Indian adult population.

  17. Thunderstorm asthma.

    Science.gov (United States)

    2014-10-01

    AN ASSOCIATION between asthma and thunderstorms based on retrospective data has been noted in several papers. This study, however, draws on almost-real-time, anonymised attendance data from 35 emergency departments (EDs) in the UK, and lightning-strike plots from the Met Office. PMID:25270814

  18. Effects of abdominal fat distribution parameters on severity of acute pancreatitis.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2012-07-01

    Obesity is a well-established risk factor for acute pancreatitis. Increased visceral fat has been shown to exacerbate the pro-inflammatory milieu experienced by patients. This study aimed to investigate the relationship between the severity of acute pancreatitis and abdominal fat distribution parameters measured on computed tomography (CT) scan.

  19. Acute myocardial infarction in sickle cell anaemia associated with severe hypoxia.

    OpenAIRE

    Saad, S. T.; ARRUDA, V R; Junqueira, O. O.; Schelini, F. A.; Coelho, O. B.

    1990-01-01

    A 17 year old boy with sickle cell anaemia presented with acute myocardial infarction associated with severe hypoxia and reticulocytopenia. Ischaemic heart disease is rare in sickle cell anemia and in this case it is possible that the acute episode of hypoxia led to myocardial infarction.

  20. Molecular signature of clinical severity in recovering patients with severe acute respiratory syndrome coronavirus (SARS-CoV)

    OpenAIRE

    Wu Ting-Shu; Chiang Ping-Cherng; Eng Hock-Liew; Liu Jien-Wei; Wang Yi-Hsi; Lin Meng-Chih; Yang Kuender D; Chen Lung-Kun; Wei Min-Li; Chen En-Shih; Chao Angel; Chen Chun-Houh; Lee Yun-Shien; Tsao Kuo-Chein; Huang Chung-Guei

    2005-01-01

    Abstract Background Severe acute respiratory syndrome (SARS), a recent epidemic human disease, is caused by a novel coronavirus (SARS-CoV). First reported in Asia, SARS quickly spread worldwide through international travelling. As of July 2003, the World Health Organization reported a total of 8,437 people afflicted with SARS with a 9.6% mortality rate. Although immunopathological damages may account for the severity of respiratory distress, little is known about how the genome-wide gene expr...

  1. The effects of aminophylline infusion in the treatment of children with acute asthma exacerbation. Evaluation with {sup 81m}Kr ventilation scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Matsubara, Yasuko; Shimada, Takao [Jikei Univ., Tokyo (Japan). School of Medicine

    1998-09-01

    The use of intravenous aminophylline in the treatment of children with acute asthma remains controversial. Most authors suggest that aminophylline be used with caution because of its poor efficacy with adverse reactions and instead recommend other drugs, such as {beta}{sub 2}-adrenergic agonists and glucocorticoids. However other studies have reported the benefits of aminophylline, and current Japanese guidelines for the management of asthma recommend its use. Here, we have evaluated the efficacy of aminophylline infusion in children with acute asthma exacerbations. Twenty children with acute asthma exacerbations were given an infusion of 5 mg/kg of aminophylline over 5 minutes, 30 minutes after the same volume of normal saline had been infused as a control. {sup 81m}Kr ventilation scintigraphy was done sequentially, and lung function was measured with spirometry before and after each infusion. Side effects were also evaluated with a questionnaire. Ventilation images obtained with {sup 81m}Kr scintigraphy, which initially showed widespread ventilatory defects caused by bronchoconstriction, decreased 54.9% after aminophylline infusion (p<0.0001). Ventilatory defects, caused by both central and peripheral airway disturbances and confirmed with the {sup 81m}Kr bolus inhalation procedure, also showed significant improvement (p<0.0001). These improvement were accompanied by improvements in lung function as assessed with forced expiratory volume in 1 second (p<0.01) and maximum expiratory flow rates at 25% (p<0.001) and 50% (p<0.001). No serious adverse reactions were recognized in any subjects. Our results show that aminophylline is a useful bronchodilator which decreased ventilatory imbalance and improves lung function in both central and peripheral airways. (author)

  2. The effects of aminophylline infusion in the treatment of children with acute asthma exacerbation. Evaluation with 81mKr ventilation scintigraphy

    International Nuclear Information System (INIS)

    The use of intravenous aminophylline in the treatment of children with acute asthma remains controversial. Most authors suggest that aminophylline be used with caution because of its poor efficacy with adverse reactions and instead recommend other drugs, such as β2-adrenergic agonists and glucocorticoids. However other studies have reported the benefits of aminophylline, and current Japanese guidelines for the management of asthma recommend its use. Here, we have evaluated the efficacy of aminophylline infusion in children with acute asthma exacerbations. Twenty children with acute asthma exacerbations were given an infusion of 5 mg/kg of aminophylline over 5 minutes, 30 minutes after the same volume of normal saline had been infused as a control. 81mKr ventilation scintigraphy was done sequentially, and lung function was measured with spirometry before and after each infusion. Side effects were also evaluated with a questionnaire. Ventilation images obtained with 81mKr scintigraphy, which initially showed widespread ventilatory defects caused by bronchoconstriction, decreased 54.9% after aminophylline infusion (p81mKr bolus inhalation procedure, also showed significant improvement (p<0.0001). These improvement were accompanied by improvements in lung function as assessed with forced expiratory volume in 1 second (p<0.01) and maximum expiratory flow rates at 25% (p<0.001) and 50% (p<0.001). No serious adverse reactions were recognized in any subjects. Our results show that aminophylline is a useful bronchodilator which decreased ventilatory imbalance and improves lung function in both central and peripheral airways. (author)

  3. The experience of extracorporeal membrane oxygenation for severe acute respiratory failure in adults

    Institute of Scientific and Technical Information of China (English)

    孙兵

    2013-01-01

    Objective To summarize the experience of extracor-poreal membrane oxygenation(ECMO) for patients with severe acute respiratory failure in adults and to investigate the factors associated with death. Methods The

  4. Interleukin-22 ameliorates acute severe pancreatitis-associated lung injury in mice

    OpenAIRE

    Qiao, Ying-Ying; Liu, Xiao-Qin; Xu, Chang-Qin; Zhang, Zheng; Xu, Hong-wei

    2016-01-01

    AIM: To investigate the potential protective effect of exogenous recombinant interleukin-22 (rIL-22) on L-arginine-induced acute severe pancreatitis (SAP)-associated lung injury and the possible signaling pathway involved.

  5. Dexamethasone and dextran 40 treatment of 32 patients with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Zi-Fa Wang; Chang Liu; Yi Lu; Rui Dong; Jun Xu; Liang Yu; Ying-Min Yao; Qing-Guang Liu; Cheng-En Pan

    2004-01-01

    AIM: Based on the pathogenesis of severe acute pancreatitis and our experimental studies, to investigate the effect of dexamethasone and dextran in treatment of patients with severe acute pancreatitis.METHODS: Thirty-two patients with severe acute pancreatitis were treated with 0.5-1 rg/kg per day dexamethasone for 3-5 d, and 500-1 000 mL/d of dextran 40 for 7 d, besides the routine therapy.RESULTS: After 4-8 h of treatment, abdominal pain began to be relieved; range of tenderness began to be localized in 27 patients. They were cured with nonsurgical treatment.Five of them were deteriorated, and treated with surgery.Four patients in this group died.CONCLUSION: Dexamethasone and dextran 40 block the pathologic process of severe acute pancreatitis through inhibition of inflammatory mediators and improvement of microcirculation disorders respectively.

  6. CRP: AN AID TO ASSESS THE SEVERITY, COMPLICATIONS AND PROGNOSIS OF ACUTE PANCREATITIS

    OpenAIRE

    Manoranjan Ujjaini; Nikhil; Durganna

    2016-01-01

    BACKGROUND - AIMS Acute pancreatitis, a routine surgical emergency encountered, intensity of treatment depends on proper prognostic indicators to assess the severity of the disease. The present study investigated the use of C-reactive protein (CRP) as prognosticator of the severity of the disease. METHODS Fifty-eight patients with acute pancreatitis were studied. Serum samples for measurement of CRP were collected on the day of admission and additionally on the 5 th ...

  7. Experimental evidence of obesity as a risk factor for severe acute pancreatitis

    OpenAIRE

    Frossard, Jean-Louis; Lescuyer, Pierre; Pastor, Catherine M

    2009-01-01

    The incidence of acute pancreatitis, an inflammation of the pancreas, is increasing worldwide. Pancreatic injury is mild in 80%-90% of patients who recover without complications. The remaining patients may develop a severe disease with local complications such as acinar cell necrosis, abscess and remote organ injury including lung injury. The early prediction of the severity of the disease is an important goal for physicians in management of patients with acute pancreatitis in order to optimi...

  8. Severe Hypertriglyceridemia in Diabetic Ketoacidosis Accompanied by Acute Pancreatitis: Case Report

    OpenAIRE

    Hahn, Suk Jae; Park, Jung-Hyun; Lee, Jong Ho; Lee, Jun Kyu; Kim, Kyoung-Ah

    2010-01-01

    We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other co...

  9. How to Evaluate the Severity of Acute Pancreatitis: Back to the Past?

    OpenAIRE

    Raffaele Pezzilli

    2012-01-01

    Selecting patients with severe acute pancreatitis as early as possible after the onset of symptoms is crucial for appropriate treatment [1]. The guidelines indicate that the assessment of severity should be carried out as soon as possible by a scoring system, such as Acute Physiology and Chronic Health Evaluation (APACHE) II which is a grade A recommendation [2, 3]. The comment added by the authors of the Italian guidelines is that an APACHE II score greater than 8 is important for determinin...

  10. Acute starvation in pregnancy: a cause of severe metabolic acidosis.

    Science.gov (United States)

    Patel, A; Felstead, D; Doraiswami, M; Stocks, G M; Waheed, U

    2011-07-01

    We report a case of starvation-induced metabolic ketoacidosis in a previously healthy 29-year-old, nulliparous woman at 32 weeks of gestation. She was admitted to hospital with mild preeclampsia associated with persistent nausea and vomiting that progressed to severe preeclampsia requiring urgent control of hypertension before caesarean delivery. Prolonged and severe vomiting limited oral caloric intake and led to starvation ketoacidosis, characterised by ketonuria and a raised anion gap metabolic acidosis that required intensive care support. Despite significant metabolic derangement the patient appeared clinically well. Intravascular volume was replenished. Fluid restriction used as part of our preeclampsia treatment regimen delayed the therapeutic administration of sufficient dextrose, which rapidly corrected her metabolic derangement when commenced after delivery. Electrolyte supplementation was given to prevent re-feeding syndrome. Both mother and baby were discharged without sequelae.

  11. Celiac disease unmasked by acute severe iron deficiency anemia

    OpenAIRE

    Marcelle G. Meseeha; Maximos N. Attia; Kolade, Victor O.

    2016-01-01

    The prevalence of celiac disease (CD) appears to be increasing in the United States. However, the proportion of new CD cases with atypical presentations is also rising. We present the case of a 49-year-old woman who was diagnosed with CD in the setting of new, severe iron-deficiency anemia, 13 years into treatment of diarrhea-predominant irritable bowel syndrome associated with chronic mildly elevated liver function tests. While CD and iron deficiency anemia are common, this is a rare present...

  12. Celiac disease unmasked by acute severe iron deficiency anemia

    Science.gov (United States)

    Meseeha, Marcelle G.; Attia, Maximos N.; Kolade, Victor O.

    2016-01-01

    The prevalence of celiac disease (CD) appears to be increasing in the United States. However, the proportion of new CD cases with atypical presentations is also rising. We present the case of a 49-year-old woman who was diagnosed with CD in the setting of new, severe iron-deficiency anemia, 13 years into treatment of diarrhea-predominant irritable bowel syndrome associated with chronic mildly elevated liver function tests. While CD and iron deficiency anemia are common, this is a rare presentation of CD. PMID:27406450

  13. Thunderstorm asthma: an overview of the evidence base and implications for public health advice.

    Science.gov (United States)

    Dabrera, G; Murray, V; Emberlin, J; Ayres, J G; Collier, C; Clewlow, Y; Sachon, P

    2013-03-01

    Thunderstorm asthma is a term used to describe an observed increase in acute bronchospasm cases following the occurrence of thunderstorms in the local vicinity. The roles of accompanying meteorological features and aeroallergens, such as pollen grains and fungal spores, have been studied in an effort to explain why thunderstorm asthma does not accompany all thunderstorms. Despite published evidence being limited and highly variable in quality due to thunderstorm asthma being a rare event, this article reviews this evidence in relation to the role of aeroallergens, meteorological features and the impact of thunderstorm asthma on health services. This review has found that several thunderstorm asthma events have had significant impacts on individuals' health and health services with a range of different aeroallergens identified. This review also makes recommendations for future public health advice relating to thunderstorm asthma on the basis of this identified evidence. PMID:23275386

  14. A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

    OpenAIRE

    Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R. Joan H.; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q. Sue; Gross, Diane

    2015-01-01

    Background The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity s...

  15. Physiopathology of severe asthma

    OpenAIRE

    Todo-Bom, Ana; Mota-Pinto, Anabela

    2006-01-01

    A história natural da asma e as condições determinantes de evolução para formas moderadas ou graves não estão completamente estabelecidas. Contudo, quer os fatores genéticos quer os fatores ambientais serão determinantes na fisiopatologia e no prognóstico da doença. Nesta revisão são apresentados os mecanismos envolvidos na fisiopatologia da asma grave

  16. CRP: AN AID TO ASSESS THE SEVERITY, COMPLICATIONS AND PROGNOSIS OF ACUTE PANCREATITIS

    Directory of Open Access Journals (Sweden)

    Manoranjan Ujjaini

    2016-05-01

    Full Text Available BACKGROUND - AIMS Acute pancreatitis, a routine surgical emergency encountered, intensity of treatment depends on proper prognostic indicators to assess the severity of the disease. The present study investigated the use of C-reactive protein (CRP as prognosticator of the severity of the disease. METHODS Fifty-eight patients with acute pancreatitis were studied. Serum samples for measurement of CRP were collected on the day of admission and additionally on the 5 th day, CT Balthazar scoring was done in each of the cases and severity assessed. RESULTS The mean serum CRP in people with mild pancreatitis was 39 U/L and that in those suffering with severe pancreatitis was 127.93, this difference was statistically significant (p<0.001. CONCLUSIONS Measurement of CRP levels seem to be an accurate method in order to assess the extent and persistence of the inflammatory process and progression of acute pancreatitis to severity and complications.

  17. Molecular signature of clinical severity in recovering patients with severe acute respiratory syndrome coronavirus (SARS-CoV

    Directory of Open Access Journals (Sweden)

    Wu Ting-Shu

    2005-09-01

    Full Text Available Abstract Background Severe acute respiratory syndrome (SARS, a recent epidemic human disease, is caused by a novel coronavirus (SARS-CoV. First reported in Asia, SARS quickly spread worldwide through international travelling. As of July 2003, the World Health Organization reported a total of 8,437 people afflicted with SARS with a 9.6% mortality rate. Although immunopathological damages may account for the severity of respiratory distress, little is known about how the genome-wide gene expression of the host changes under the attack of SARS-CoV. Results Based on changes in gene expression of peripheral blood, we identified 52 signature genes that accurately discriminated acute SARS patients from non-SARS controls. While a general suppression of gene expression predominated in SARS-infected blood, several genes including those involved in innate immunity, such as defensins and eosinophil-derived neurotoxin, were upregulated. Instead of employing clustering methods, we ranked the severity of recovering SARS patients by generalized associate plots (GAP according to the expression profiles of 52 signature genes. Through this method, we discovered a smooth transition pattern of severity from normal controls to acute SARS patients. The rank of SARS severity was significantly correlated with the recovery period (in days and with the clinical pulmonary infection score. Conclusion The use of the GAP approach has proved useful in analyzing the complexity and continuity of biological systems. The severity rank derived from the global expression profile of significantly regulated genes in patients may be useful for further elucidating the pathophysiology of their disease.

  18. Early and Late Acute Kidney Injury in Severely Burned Patients

    Science.gov (United States)

    Witkowski, Wojciech; Kawecki, Marek; Surowiecka-Pastewka, Agnieszka; Klimm, Wojciech; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2016-01-01

    Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR burns, respiratory failure, low protein concentration (for all ppatients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

  19. Rhinitis: a complication to asthma

    DEFF Research Database (Denmark)

    Hansen, J W; Thomsen, S F; Nolte, H;

    2010-01-01

    Asthma and rhinitis often co-occur, and this potentially increases the disease severity and impacts negatively on the quality of life. We studied disease severity, airway responsiveness, atopy, quality of life and treatment in subjects with both asthma and rhinitis compared to patients with asthma...

  20. Vitamin A deficiency decreases and high dietary vitamin A increases disease severity in the mouse model of asthma

    Science.gov (United States)

    The Th1/ Th2 paradigm has become an important issue in the pathogenesis of asthma, characterized by normal Th-1 and elevated Th-2 cytokine expression, resulting in a Th2 predominance. Vitamin A deficiency (VAD) produces a significant Th1 bias, while high-level dietary vitamin A supplementation promo...

  1. Canadian Economic Evaluation of Budesonide-Formoterol as Maintenance and Reliever Treatment in Patients with Moderate to Severe Asthma

    Directory of Open Access Journals (Sweden)

    Elizabeth Miller

    2007-01-01

    Full Text Available OBJECTIVES: To compare the cost-effectiveness of budesonide-formoterol in a single inhaler used as both maintenance and reliever medication versus clinician-directed titration of salmeterol-fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.

  2. SERPINE1-675 4G/5G polymorphism is associated with asthma severity and inhaled corticosteroid response

    NARCIS (Netherlands)

    Dijkstra, A.; Postma, D. S.; Bruinenberg, M.; van Diemen, C. C.; Boezen, H. M.; Koppelman, G. H.; Timens, W.; Vonk, J. M.

    2011-01-01

    Asthma is characterised by chronic airway inflammation and remodelling, which can be (partially) suppressed by inhaled corticosteroids (ICSs). Plasminogen activator inhibitor-1, encoded by the SERPINE1 gene, is the key inhibitor of the plasminogen activator system, which affects tissue repair and re

  3. MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

    2012-11-15

    Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

  4. Soluble E-Cadherin: An Early Marker of Severity in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    A. Sewpaul

    2009-01-01

    Full Text Available Background/Aims. At present, there is no simple test for predicting severity in acute pancreatitis. We investigated the use of an assay of soluble E-cadherin (sE-cadherin. Methods. Concentrations of sE-cadherin, from 19 patients with mild acute pancreatitis, 7 patients with severe acute pancreatitis, 11 patients with other acute gastrointestinal pathologies, and 12 healthy subjects were measured using a commercially available sandwich ELISA kit based on two monoclonal antibodies specific to the extracellular fragment of human E-cadherin. Measurements were made at 12 hours or less from onset of pain and also at 24 and 48 hours after onset of pain. Results. Mean (standard deviation concentration of sE-cadherin in patients with severe acute pancreatitis at <12 hours was 17780 ng/mL (7853, significantly higher than that of healthy volunteers 5180 ng/mL (1350, =.0039, patients with other gastrointestinal pathologies 7358 ng/mL (6655, =.0073, and also significantly higher than that of patients with mild pancreatitis, 7332 ng/mL (2843, =.0019. Discussion. Serum sE-cadherin could be an early (within 12 hours objective marker of severity in acute pancreatitis. This molecule warrants further investigation in the form of a large multicentre trial.

  5. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  6. Comparison of two simplified severity scores (SAPS and APACHE II) for patients with acute myocardial infarction.

    Science.gov (United States)

    Moreau, R; Soupison, T; Vauquelin, P; Derrida, S; Beaucour, H; Sicot, C

    1989-05-01

    The Simplified Acute Physiology Score (SAPS), the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Acute Physiology Score (APS), and the Coronary Prognostic Index (CPI), calculated within the first 24 h of ICU admission, were compared in 76 patients with acute myocardial infarction (AMI). Sixteen (21%) patients subsequently died in the ICU. The nonsurvivors had significantly higher SAPS, APACHE II, and CPI scores than the survivors. ROC curves drawn for each severity index were in a discriminating position. There were no significant differences either between the areas under the ROC curves drawn for SAPS, APACHE II, and CPI, or between the overall accuracies of these indices. APS provided less homogeneous information. We conclude that SAPS and APACHE II, two severity indices which are easy to use, assess accurately the short-term prognosis, i.e., the ICU outcome, of patients with AMI. PMID:2707010

  7. [Acute severe coxsackie virus B myocarditis of pseudonecrotic form. Apropos of 2 cases].

    Science.gov (United States)

    Beard, T; Boudjemaa, B; Carrié, D; Chakra, G; Ferrières, J; Delay, M; Bernadet, P

    1993-05-01

    This study reports two cases of acute severe Coxsackie virus B4 myocarditis in which the immediate clinical signs suggested the acute phase of myocardial infarction, apparently antero-lateral in the first case in a context of cardiogenic shock and infero-lateral in the second case, in the context of acute pulmonary edema. Both cases were characterized by the severity of the initial signs. Numerous other cases of acute Coxsackie virus B myocarditis, simulating myocardial infarction, have been reported in the literature and these contexts deserve to be recognized earlier as they call for specific treatment. The immediate outcome was favorable in both cases but required massive cardiological intensive care in the first patient. Long term follow-up was excellent. PMID:8396381

  8. Luminal lactate in acute pancreatitis - validation and relation to disease severity

    DEFF Research Database (Denmark)

    Pynnönen, Lauri; Minkkinen, Minna; Räty, Sari;

    2012-01-01

    the physiological validity of the method. Rectal luminal lactate at the hospital admission was not associated with the first day or the highest SOFA score, CRP level, hospital length of stay, length of stay in intensive care or mortality. In this cohort of unselected consecutive patients with acute pancreatitis we...... patients admitted to hospital due to acute pancreatitis to test the hypothesis that a single measurement of rectal luminal lactate predicts the severity of acute pancreatitis, the length of hospital stay, the need of intensive care and ultimately, mortality. We also tested the physiological validity...... and systemic inflammation. In acute pancreatitis (AP) bacterial translocation is considered as the key event leading to infection of necrotic pancreatic tissue and high severity of illness. METHODS: We used rectal luminal equilibration dialysis for the measurement of gut luminal lactate in 30 consecutive...

  9. The Perfect Way to Predict the Severity of Acute Pancreatitis: The Search Continues

    Directory of Open Access Journals (Sweden)

    Daniel C Sadowski

    2004-01-01

    Full Text Available This study was designed to determine the clinical utility of three rating scales (Ranson's, Acute Physiology And Chronic Health Evaluation [APACHE] II and Glasgow in predicting the severity of acute pancreatitis experienced by patients known to have human immunodeficiency virus (HIV or acquired immunodeficiency syndrome (AIDS. A retrospective analysis identified 73 patients with both acute pancreatitis and HIV who had been admitted to two Canadian hospitals between 1989 and 1999. Of those 73, 11 (15% went on to have a clinical course consistent with a diagnosis of severe pancreatitis. For the purposes of the study, severe pancreatitis was defined by the occurrence of death, intensive care unit admission, surgical intervention or significant symptomatic local complications (necrosis, abscess or pseudocyst. The authors found that the APACHE II and Ranson's scores had a sensitivity of 100% and specificities of 70% and 33% for severe pancreatitis, respectively. The Glasgow score had a statistically poorer diagnostic performance.

  10. Efficacy of high dose steroid therapy in children with severe acute transverse myelitis

    OpenAIRE

    Defresne, P; Meyer, L.; Tardieu, M.; Scalais, E.; Nuttin, C; Bont, B De; Loftus, G; Landrieu, P; Kadhim, Hazim; Sébire, G.

    2001-01-01

    No effective treatment has been demonstrated for patients with acute transverse myelopathy. In a multicentre controlled study, 12 children with severe acute transverse myelopathy were treated with intravenous methylprednisolone (IVMP) and compared with a historical group of 17 patients. The treatment had a significant effect on the proportion of patients walking independently at 1 month and on the proportion with full recovery at 1 year, with no differences in the frequency ...

  11. Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the Netherlands

    NARCIS (Netherlands)

    Dekker, Ruth R.; Schutte, Joke M.; Stekelenburg, Jelle; Zwart, Joost J.; van Roosmalen, Jos

    2011-01-01

    Objective: To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands. Study design: A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the Netherlan

  12. Mathematical Modeling of the Expert System Predicting the Severity of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Maria A. Ivanchuk

    2014-01-01

    Full Text Available The method of building the hyperplane which separates the convex hulls in the Euclidean space Rn is proposed. The algorithm of prediction of the presence of severity in patients based on this method is developed and applied in practice to predict the presence of severity in patients with acute pancreatitis.

  13. Long-term smoking increases the need for acute care among asthma patients: a case control study

    OpenAIRE

    Kauppi, Paula; Kupiainen, Henna; Lindqvist, Ari; Haahtela, Tari; Laitinen, Tarja

    2014-01-01

    Background To examine risk factors for asthma patients’ emergency room (ER) visits in a well organized asthma care setting. Methods A random sample of 344 asthma patients from a Pulmonary Clinic of a University Hospital were followed through medical records from 1995 to 2006. All the ER visits due to dyspnea, respiratory infections, chest pain, and discomfort were evaluated. Results The mean age of the study population was 56 years (SD 13 years), 72% being women. 117 (34%) of the patients had...

  14. Risk factors for pulmonary infections in children with acute asthma%急性哮喘患儿肺部感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    冯佩君; 沈秋娣; 陆菲

    2014-01-01

    OBJECTIVE To analyze the clinical risk factors for lung infection in children with acute asthma and to explore reasonable care measures to improve the clinical cure rate .METHODS Clinical data of 200 children with acute asthma admitted during Jun .2009 to Jun .2012 were respectively analyzed .The general information of the children was recorded and the univariate analysis was conducted on the potential risk factors for lung infection in children with acute asthma ,then multivariate logistic regression analysis was conducted for all factors .Data were statistically analyzed by the software 15 .0 .RESULTS A total of 55 children with acute asthma had concurrent lung infection ,the infection rate was 27 .5% .The univariate analysis showed acute episodes of asthma ,rhinitis or nasal polyps ,Mycoplasma pneumoniae infection ,total serum immunoglobulins ,eosinophil count ,time of antimicrobial drug use ,use of antiasthmatics were risk factors for infection .The logistic regression analysis showed that M . pneumoniae infection (OR value=4 .02) ,time of antimicrobial drug use (OR=1 .35) ,the application of antiasth-matics (OR value=2 .73) ,concurrent rhinitis or nasal polyps (OR value=3 .17) were independent risk factors for lung infection in children with acute asthma .CONCLUSION Pediatric acute asthma disease complicated with lung infection is complicated .M . pneumoniae infection ,abuse of antibiotics ,application of antiasthmatic glucocorti-coids or aminophylline as well as concurrent rhinitis or nasal polyps are independent risk factors for lung infection in children with acute asthma .Early diagnosis ,the implementation of targeted therapy ,and the use of scientific integrated care measures are of great importance for control of lung infection in children with acute asthma .%目的:分析急性哮喘患儿肺部感染的临床高危因素,探讨合理的护理对策,以提高临床治愈率。方法回顾性分析2009年6月-2012年6

  15. Asthma at acute attack stage treated with “Shao’s five needling therapy”: a multi-central randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    邵素菊

    2013-01-01

    Objective To evaluate the clinical efficacy of asthma at acute attack stage treated with"Shao’s five needling therapy".Methods The randomized controlled method was applied to divide 210 cases into an observation group and a control group,105 cases in each one.In the observation group,"Shao’s five needling therapy"[Feishu (BL 13) ,Dazhui (GV 14) ,Fengmen (BL 12) ]and the combined therapy were adopted,including oxygen uptake,aerosol inhalation and oral administration of prednisone.In the control group,the oral administration of theophylline sustained release tablet and the combined ther-

  16. Pediatric Asthma

    Science.gov (United States)

    ... MD Dept. of Pediatrics View full profile Pediatric Asthma: Overview For some children with asthma, their first ... Calendar Read the News View Daily Pollen Count Asthma Treatment Program At National Jewish Health, we offer ...

  17. The cost of asthma: can it be reduced?

    Science.gov (United States)

    Mellis, C M; Peat, J K; Woolcock, A J

    1993-03-01

    Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient's quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost-effectiveness analyses should be concentrated on these areas. Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected, using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications {sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids}, more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient's home, the doctor's office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into

  18. Social, dietary and clinical correlates of oedema in children with severe acute malnutrition

    DEFF Research Database (Denmark)

    Rytter, Maren Johanne Heilskov; Namusoke, Hanifa; Babirekere-Iriso, Esther;

    2015-01-01

    BACKGROUND: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates...... of oedema, in children hospitalised with severe acute malnutrition. METHODS: We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was collected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive protein and α1-acid...... glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis. RESULTS: Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were slightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children...

  19. Modified Da Chengqi granules improvement in immune function in early severe acute pancreatitis patients.

    Science.gov (United States)

    Jiang, D-L; Yang, J; Jiang, S-Y; Yuan, F-L; Gu, Y-L; Li, J-P; Pei, Z-J

    2016-01-01

    We investigated the role of modified Da Chengqi granules in improving immune function in early severe acute pancreatitis patients. Early severe acute pancreatitis patients who agreed to receive combined treatment of traditional Chinese and Western medicine were randomly assigned to the experimental or control group. All subjects received conventional therapy to support organ function. The experimental group also received modified Da Chengqi granules. Cytokine (interleukin-6, interleukin-10, and tumor necrosis factor-α) levels, immunological markers (HLA-DR, Treg, and Th1/Th2), urinary lactulose/mannitol ratio, and endotoxin levels were measured at 1, 3, 7, and 14 days after hospital admission. The total mortality rate was 11.69% (9/77), which was significantly lower in the experimental group [4.88% (2/41)] than in the control group [19.44% (7/36); χ(2) = 3.940, P Da Chengqi granules can improve immune function in early severe acute pancreatitis patients.

  20. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  1. Canadian economic evaluation of budesonide-formoterol as maintenance and reliever treatment in patients with moderate to severe asthma

    OpenAIRE

    Elizabeth Miller; Sears, Malcolm R; Andrew McIvor; Anna Liovas

    2007-01-01

    OBJECTIVES: To compare the cost-effectiveness of budesonide-formoterol in a single inhaler used as both maintenance and reliever medication versus clinician-directed titration of salmeterol-fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.METHODS: A Canadian economic evaluation was conducted based on the results of a large (n=2143), open-label, randomized, controlled effectiveness trial in which health resource use was pro...

  2. Psychological aspects of asthma.

    Science.gov (United States)

    Lehrer, Paul; Feldman, Jonathan; Giardino, Nicholas; Song, Hye-Sue; Schmaling, Karen

    2002-06-01

    Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures. PMID:12090377

  3. Monitoring asthma in childhood

    Directory of Open Access Journals (Sweden)

    Karin C. Lødrup Carlsen

    2015-06-01

    Full Text Available The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems.

  4. Asthma in Olympians.

    Science.gov (United States)

    Carlsen, Kai-Håkon

    2016-01-01

    High prevalence of asthma has been reported repeatedly among elite athletes, especially among endurance athletes. So many athletes used asthma drugs that the objective demonstration of bronchial hyperresponsiveness was required to obtain approval for their use in international sports until 2012 when the most used inhaled asthma drugs was allowed for free use, but with a maximum dose for inhaled β2-agonists. Several factors contribute to the development of asthma among the Olympians causing airways inflammation and bronchial hyper-responsiveness. PMID:26631837

  5. Asthma and Therapeutics: Recombinant Therapies in Asthma

    OpenAIRE

    Cockcroft Donald W

    2005-01-01

    Abstract Numerous recombinant therapies are being investigated for the treatment of asthma. This report reviews the current status of several of these novel agents. Anti-immunoglobulin (Ig)E (omalizumab, Xolair) markedly inhibits all aspects of the allergen challenge in subjects who have reduction of free serum IgE to undetectable levels. Several clinical studies in atopic asthma have demonstrated benefit by improved symptoms and lung function and a reduction in corticosteroid requirements. E...

  6. Respiratory support for severe acute respiratory syndrome: integration of efficacy and safety

    Institute of Scientific and Technical Information of China (English)

    WANG Chen; CAO Zhi-xin

    2005-01-01

    @@ Severe acute respiratory syndrome (SARS) is an acute respiratory illness caused by infection with the SARS virus. The most obvious clinical characteristic of SARS is rapidly progressive pneumonia, and about 20% patients need intensive care due to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).1-3 In the absence of effective drugs for SARS, supportive care, especially respiratory support techniques (RSTs), is of primary importance. On the other hand, offering RSTs to SARS patients may carry a high-risk of infection to healthcare workers because of the high infectivity of SARS. Therefore, the strategy of RSTs for SARS should be the integration of efficacy and safety. In this issue of the Chinese Medical Journal, an article from Hong Kong has retrospectively compared both the safety and efficacy of noninvasive positive pressure ventilation (NIPPV) with that of invasive mechanical ventilation (IMV) in the treatment of respiratory failure in SARS.

  7. Acute sensorineural hearing loss and severe otalgia due to scrub typhus

    Directory of Open Access Journals (Sweden)

    Kim Dong-Min

    2009-10-01

    Full Text Available Abstract Background Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. Case presentations We encountered a patient with sensorineural hearing loss complicating scrub typhus, and three patients with scrub typhus who complained of otalgia, which was sudden onset, severe, paroxysmal, intermittent yet persistent pain lasting for several seconds, appeared within 1 week after the onset of fever and rash. The acute sensorineural hearing loss and otalgia were resolved after antibiotic administration. Conclusion When patients in endemic areas present with fever and rash and have sensorineural hearing loss or otalgia without otoscopic abnormalities, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.

  8. Acute severe head injury resulted from road traffic accidents:a report on 231 cases

    Institute of Scientific and Technical Information of China (English)

    刘敬业; 张赛; 等

    1999-01-01

    Objective:To analyze the epidemiology and clinical outcome of acute severe head injurey induced by road traffic accidents.Methods:The data of 231 patients with acute severe head injury induced by road traffic accidents were retrospectively studied.Results:The major victim-maker was automobiles (98.8%).The first three common types of traffic accidents were automobiles crashing into automobiles,automobiles crashing into bicycles(42.9%),and automobiles crashing pedestrians(40.3%).Eighty-seven patients out of 231 died,with the mortality of 37.7%.Conclusions:It suggests tat improving traffic administration and traffic safety consciousness may significantly reduce traffic trauma.

  9. Percutaneous mechanical assist for severe cardiogenic shock due to acute right ventricular failure.

    Science.gov (United States)

    Kipp, Ryan; Raval, Amish N

    2015-05-01

    Acute right ventricular failure can lead to severe cardiogenic shock and death. Recovery may be achieved with early supportive measures. In many patients, intravenous fluid and inotropic resuscitation is inadequate to improve cardiac output. In these cases, percutaneous mechanical assist may provide a non-surgical bridge to recovery. Herein, we describe a case series of patients with severe, refractory cardiogenic shock due to acute right ventricular failure who received a continuous flow percutaneous ventricular device primarily utilizing the right internal jugular vein for out flow cannula placement.

  10. [Macro-and microelements imbalance in etiology and progression of bronchial asthma in children].

    Science.gov (United States)

    Lytvynets', L Ia

    2013-06-01

    The aim of our work was the study of macro-and microelemensts characteristics of the state of the blood serum of children with asthma, depending on the severity. A total of 107 children aged 10 to 18 years with asthma in the acute stage. The results of the proposed asthma control test (GINA, 2011) to the level of asthma control the children were distributed as follows: 34 (31.8%)--with controlled, 47 (43.9%)--partly controlled and 26--with uncontrolled bronchial asthma. Investigation of serum trace elements were determined by atomic absobtsionnoy spectrophotometry. Found that with varying degrees of control of asthma changes were reduction of magnesium, zinc, when excessive amounts of copper and calcium. We show some dizelements in patients with nontrol bronhial asthma. The most pronounced manifestation dyzelements documented in patients with uncontrolled asthma. It is with same with uncontrolled asthma, there are marked hypoxic change, energy shortage, bronchial hyperreactivity, as a result of increasing stress level of response to an antigen, reduce antioxidant enzyme systems, immune system dysfunction. This changes in the macro-and microelement composition of the blood significantly reduce the reserves of the immune system, chronic inflammatory processes in the bronches, which exacerbates the severity of the disease, which in practice requires a differential diagnosis, comprehensive treatment based on identified dyzelements states.

  11. Abdominal compartment syndrome in severe acute pancreatitis treated with percutaneous catheter drainage.

    Science.gov (United States)

    Park, Soonyoung; Lee, Seungho; Lee, Hyo Deok; Kim, Min; Kim, Kyeongmin; Jeong, Yusook; Park, Seon Mee

    2014-09-01

    Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression. PMID:25325011

  12. Impact of omalizumab on treatment of severe allergic asthma in UK clinical practice: a UK multicentre observational study (the APEX II study)

    Science.gov (United States)

    Niven, Robert M; Saralaya, Dinesh; Chaudhuri, Rekha; Masoli, Matthew; Clifton, Ian; Mansur, Adel H; Hacking, Victoria; McLain-Smith, Susan; Menzies-Gow, Andrew

    2016-01-01

    Objective To describe the impact of omalizumab on asthma management in patients treated as part of normal clinical practice in the UK National Health Service (NHS). Design A non-interventional, mixed methodology study, combining retrospective and prospective data collection for 12 months pre-omalizumab and post-omalizumab initiation, respectively. Setting Data were collected in 22 UK NHS centres, including specialist centres and district general hospitals in the UK. Participants 258 adult patients (aged ≥16 years; 65% women) with severe persistent allergic asthma treated with omalizumab were recruited, of whom 218 (84.5%) completed the study. Primary and secondary outcome measures The primary outcome measure was change in mean daily dose of oral corticosteroids (OCS) between the 12-month pre-omalizumab and post-omalizumab initiation periods. A priori secondary outcome measures included response to treatment, changes in OCS dosing, asthma exacerbations, lung function, employment/education, patient-reported outcomes and hospital resource utilisation. Results The response rate to omalizumab at 16 weeks was 82.4%. Comparing pre-omalizumab and post-omalizumab periods, the mean (95% CIs) daily dose of OCS decreased by 1.61 (−2.41 to −0.80) mg/patient/day (p<0.001) and hospital exacerbations decreased by 0.97 (−1.19 to −0.75) exacerbations/patient (p<0.001). Compared with baseline, lung function, assessed by percentage of forced expiratory volume in 1 s, improved by 4.5 (2.7 to 6.3)% at 16 weeks (p<0.001; maintained at 12 months) and patient quality of life (Asthma Quality of Life Questionnaire) improved by 1.38 (1.18 to 1.58) points at 16 weeks (p<0.001, maintained at 12 months). 21/162 patients with complete employment data gained employment and 6 patients lost employment in the 12-month post-omalizumab period. The mean number of A&E visits, inpatient hospitalisations, outpatient visits (excluding for omalizumab) and number of bed days

  13. Impairment of Venous Drainage on Extracorporeal Membrane Oxygenation Secondary to Air Trapping in Acute Asphyxial Asthma.

    Science.gov (United States)

    Niimi, Kevin S; Lewis, Leslie S; Fanning, Jeffrey J

    2015-06-01

    The inability to adequately support a patient on extracorporeal membrane oxygenation (ECMO) due to impaired drainage is not an uncommon occurrence during support. Typically, the causes include hypovolemia, kinks in the circuit, cannula malposition, or inadequate cannula size. In this report we present an uncommon etiology of this problem. A 3-year-old female presented to our hospital in status asthmaticus and pulseless electrical activity (PEA). This was a result of dynamic hyperinflation of the lungs causing physical obstruction of venous return to the heart. Upon initiating venoarterial (VA) ECMO, we experienced inadequate drainage that did not improve despite multiple interventions. This resolved with the addition of an inhaled anesthetic gas to treat this patient's severe bronchospasm. This case illustrates the importance of considering a patient's physiology or disease state and how that may affect the mechanics of ECMO support. PMID:26405359

  14. Role of Asthma Education in the Management of Adult Asthma

    Directory of Open Access Journals (Sweden)

    Johanne Côté

    1995-01-01

    Full Text Available When a patient is newly diagnosed as having asthma, he or she is often prescribed new medication without getting much information on the disease and its treatment. This article emphasizes the need to educate asthmatics. Asthma treatment should begin with a proper adjustment of the medication, allowing asthmatics to lead a normal life. All asthmatics should be shown how to use their inhalation device properly. They should he knowledgeable about the basic aspects of asthma, airway inflammation and bronchoconstriction, use or medication and early symptoms heralding an asthma attack. Environmental factors that may trigger an asthma attack should be explained. Patients should be able to self-monitor asthma using either symptom severity or a peak flow meter. Because asthma is an unpredictable disease, patients should have a self-action plan to implement when their asthma deteriorates.

  15. Role of Obesity in Asthma Control, the Obesity-Asthma Phenotype

    OpenAIRE

    Shannon Novosad; Supriya Khan; Bruce Wolfe; Akram Khan

    2013-01-01

    Asthma is a disease with distinct phenotypes that have implications for both prognosis and therapy. Epidemiologic studies have demonstrated an association between asthma and obesity. Further studies have shown that obese asthmatics have poor asthma control and more severe asthma. This obese-asthma group may represent a unique phenotype. The mechanisms behind poor asthma control in obese subjects remain unclear, but recent research has focused on adipokines and their effects on the airways as ...

  16. Comparing high altitude treatment with current best care in Dutch children with moderate to severe atopic dermatitis (and asthma): study protocol for a pragmatic randomized controlled trial (DAVOS trial)

    OpenAIRE

    Fieten, Karin; Zijlstra, Wieneke; van Os-Medendorp, Harmieke; Meijer, Yolanda; Venema, Monica; Rijssenbeek-Nouwens, Lous; Hoir, Monique; Bruijnzeel-Koomen, C.A.; Pasmans, Suzanne

    2014-01-01

    Background: About 10 to 20% of children in West European countries have atopic dermatitis (AD), often as part of the atopic syndrome. The full atopic syndrome also consists of allergic asthma, allergic rhinitis and food allergy. Treatment approaches for atopic dermatitis and asthma include intermittent anti-inflammatory therapy with corticosteroids, health education and self-management training. However, symptoms persist in a subgroup of patients. Several observational studies have shown sign...

  17. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma

    OpenAIRE

    Adams, R; B. Smith; Ruffin, R

    2000-01-01

    BACKGROUND—A small proportion of patients with asthma account for a disproportionate number of acute health service events. To identify whether factors other than severity and low socioeconomic status were associated with this disproportionate use, a prospective study was undertaken to examine management and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12month period.
METHODS...

  18. Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine

    OpenAIRE

    Zhang, Min-Jie; Zhang, Guo-Lei; Yuan, Wen-Bin; Ni, Jun; Huang, Li-Feng

    2008-01-01

    AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber’s salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients.

  19. Exploring the Roles and Nature of Science: A Case Study of Severe Acute Respiratory Syndrome

    Science.gov (United States)

    Lee, Yeung Chung

    2008-01-01

    The roles of science in society and the nature of science are the focus of many science curricula. Current views about these two aspects of science have largely been informed by the history of scientific development. This article uses the outbreak of severe acute respiratory syndrome--a recent health scare--as a case study to explore the roles of…

  20. Management of severe acute malnutrition in low-income and middle-income countries

    Science.gov (United States)

    Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environm...

  1. Progress in Global Surveillance and Response Capacity 10 Years After Severe Acute Respiratory Syndrome

    Centers for Disease Control (CDC) Podcasts

    2013-04-10

    Dr. Mike Miller reads an abridged version of the Emerging Infectious Diseases' synopsis, Progress in Global Surveillance and Response Capacity 10 Years after Severe Acute Respiratory Syndrome.  Created: 4/10/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/11/2013.

  2. Characterization of a novel coronavirus associated with severe acute respiratory syndrome

    NARCIS (Netherlands)

    P.A. Rota (Paul); M.S. Oberste (Steven); S.S. Monroe (Stephan); W.A. Nix (Allan); R. Campagnoli (Ray); J.P. Icenogle (Joseph); S. Penaranda; B. Bankamp (Bettina); K. Maher (Kaija); M.H. Chen (Min-hsin); S. Tong (Suxiong); A. Tamin (Azaibi); L. Lowe (Luis); M. Frace (Michael); J.L. DeRisi (Joseph); Q. Chen (Qi); D. Wang (David); D.D. Erdman (Dean); T.C. Peret (Teresa); C. Burns (Cara); T.G. Ksiazek (Thomas); P.E. Rollin (Pierre); A. Sanchez (Berenguer); S. Liffick (Stephanie); B. Holloway (Brian); J. Limor (Josef); K. McCaustland (Karen); M. Olsen-Rasmussen (Mellissa); S. Gunther; A.D.M.E. Osterhaus (Albert); C. Drosten (Christian); M.A. Pallansch (Mark); L.J. Anderson (Larry); W.J. Belline; R.A.M. Fouchier (Ron)

    2003-01-01

    textabstractIn March 2003, a novel coronavirus (SARS-CoV) was discovered in association with cases of severe acute respiratory syndrome (SARS). The sequence of the complete genome of SARS-CoV was determined, and the initial characterization of the viral genome is presented in this report. The geno

  3. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis.

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

    The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.

  4. Toward an Improved Scale for Assessing Symptom Severity in Children With Acute Otitis Media.

    Science.gov (United States)

    Shaikh, Nader; Hoberman, Alejandro; Rockette, Howard E; Kurs-Lasky, Marcia; Paradise, Jack L

    2015-12-01

    The objective of the present study was to determine whether changes in the previously developed 7-item Acute Otitis Media Severity of Symptoms scale could improve its responsiveness and its longitudinal construct validity. The items "diminished activity" and "diminished appetite" had low or borderline levels of responsiveness and longitudinal construct validity. Dropping these items seems to be potentially advantageous.

  5. Severe acute respiratory syndrome--a new coronavirus from the Chinese dragon's lair

    DEFF Research Database (Denmark)

    Knudsen, T B; Kledal, T N; Andersen, O;

    2003-01-01

    The recent identification of a novel clinical entity, the severe acute respiratory syndrome (SARS), the rapid subsequent spread and case fatality rates of 14-15% have prompted a massive international collaborative investigation facilitated by a network of laboratories established by the World Hea...

  6. Gut DNA viromes of Malawian twins discordant for severe acute malnutrition

    Science.gov (United States)

    The bacterial component of the human gut microbiota undergoes a definable program of postnatal development. Evidence is accumulating that this program is disrupted in children with severe acute malnutrition (SAM) and that their persistent gut microbiota immaturity, which is not durably repaired with...

  7. Sources of Stress in Children with Asthma.

    Science.gov (United States)

    Walsh, Michelle; Ryan-Wenger, Nancy M.

    1992-01-01

    Children with asthma were studied to determine their perceptions of the frequency and severity of stressors they experienced other than asthma. Results indicated children with asthma were similar to peers regarding perceptions of stressors. Perceptions of most stressors related more strongly to gender role development than to asthma. (SM)

  8. Report of moderate or severe sodium and chloride disturbance on 82 cases with acute cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    Ma shun-tian

    2000-01-01

    Abtract Objective: To decrease the fatality rate and prevalence rotc of acute cerebral stroke complicated with morderate or servere serum sodium and chioride disturbance by explonng the relation between the pathogency and prognosis Methods: Medical records were surveyed and clinical presentation, laboratory test, complicated。 Actiology pathogency and prognosis were analyzed m 82 cases with moderate or severe serum sodium and chloride disturbance among 736 cases with acute cerebral stroke collected, Results: The prevalence rate and fatality rate of acutc cerebral stroke complicated with moderate or severe serum sodium and chlorede disturbance were 11.3% (82/ 736) and 60.8% (49/52) which were different significantly form that complicated with normal or minimal sedium sodium and chloride disturbame (p (0.001) 。 The 82 cases occured at 3-13 days after hospitalization (mean 6 days) 。 The actiology and pathogency were mainly ralated with some endogenic and iatrogenic factors such as hypothalamic-pituitary system were destroyed resultly from acute cerbral stroke which led to SIADH。 Conclusion: The fatality rate of acute cerebral stroke complicatee with moderate or seyere serum sodium and chloride disturbance is mcreased significantly, Put prophylaxis first to decrease the prevalence rate and fatalty rate。 Pay attlention to comprehensive therapy of acute cerebral stoke to prevent endogenic sodium and chloride disturbance and especially place importance on iatrogenic disturbance。

  9. Understanding mild persistent asthma in children

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Szefler, Stanley J

    2005-01-01

    Limitations in asthma prevalence studies and difficulties in diagnosing pediatric asthma lead to uncertainty over the full extent of mild persistent asthma in children and adolescents. Although recent surveys have reported that the majority of pediatric patients with asthma in the United States...... and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild asthma remains unknown. It is unclear whether children with mild persistent asthma progress to more severe asthma, but the risk of severe asthma exacerbations seems...... to be unrelated to the symptom severity. Clinical studies restricted to pediatric patients with mild asthma are limited, but available data do suggest substantial morbidity of mild persistent asthma in this population and support inhaled corticosteroid intervention. There is a need for further investigation...

  10. Impact of Oxandrolone Treatment on Acute Outcomes After Severe Burn Injury

    OpenAIRE

    Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Silver, Geoffrey M.; Jeschke, Marc G.; Finnerty, Celeste C.; Tompkins, Ronald G.; Herndon, David N

    2008-01-01

    Pharmacologic modulation of hypermetabolism clearly benefits children with major burns, however, its role in adult burns remains to be defined. Oxandrolone appears to be a promising anabolic agent although few outcome data are as yet available. We examined whether early oxandrolone treatment in severely burned adults was associated with improved outcomes during acute hospitalization. We evaluated for potential associations between oxandrolone treatment and outcomes in a large cohort of severe...

  11. X-CT evaluation of the severity of acute pancreatitis; A new 10-point criteria

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung-Hyo (Osaka City Univ. (Japan). Faculty of Medicine)

    1990-09-01

    In some patients with acute pancreatitis, some experience life-threatening complications. Although there are reports of the assessment of the severity of the disease, mainly based on clinical signs and laboratory findings, pertinent criteria remain elusive. As little information is available concerning the degree or extent of pancreatic lesions; it is difficult to predict the severity and outcome. I examined 74 patients with acute pancreatitis, using computed tomography (CT). The severity was evaluated by means of a CT-score consisting of ten points on the CT findings, in the early stage of the acute pancreatitis. The following results were obtained. (1) Infiltration into the retroperitoneal space such as anterior pararenal space was observed by CT earlier and more frequently than were changes within the pancreas parenchyma. (2) Heterogeneous density of the pancreas and involvement of the posterior pararenal space were more significant and frequently in the severe group than in the moderate or mild group. (3) CT observations made 48 hours after the onset were the most adequate for evaluating the severity in case of acute pancreatitis. (4) After evaluating the severity by the CT-score, the 74 patients were grouped into 3: mild in 46, moderate in 22 and severe in 6 patients. The CT-score revealed a significantly greater specifity and accuracy than did the clinical score, Forell's, Ranson's, or the criteria submitted by a committee for the study of this disease appointed by the Japanese Ministry of Health and Welfare. I propose that an evaluation of the severity by CT-score obtained about 48 hours after the onset of symptoms is useful for predicting the prognosis and for designing proper treatment. (author).

  12. Mechanisms of dexamethasone-mediated chemokine down-regulation in mild and severe acute pancreatitis

    OpenAIRE

    Yubero, S.; Ramudo, L.; Manso, M.A.; De Dios, I.

    2009-01-01

    Abstract This study aimed to investigate the role of therapeutic dexamethaxone (Dex) treatment on the mechanisms underlying chemokine expression during mild and severe acute pancreatitis (AP) experimentally induced in rats. Regardless of the AP severity, Dex (1 mg/kg), administered 1 hour after AP, reduced the acinar cell activation of extracellular signal-regulated kinase (ERK) and c-Jun-NH2-terminal kinase (JNK) but failed to reduce p38-mitogen activated protein kinas (MAPK) in s...

  13. Progress in the management of childhood asthma

    OpenAIRE

    Vichyanond, Pakit; Pensrichon, Rattana; Kurasirikul, Suruthai

    2012-01-01

    Asthma has become the most common chronic disease in childhood. Significant advances in epidemiological research as well as in therapy of pediatric asthma have been made over the past 2 decades. In this review, we look at certain aspects therapy of childhood asthma, both in the past and present. Literature review on allergen avoidance (including mites, cockroach and cat), intensive therapy with β2-agonists in acute asthma (administering via continuous nebulization and intravenous routes), a r...

  14. Qing-Yi decoction in participants with severe acute pancreatitis: a randomized controlled trial

    OpenAIRE

    Chen, Weiwei; Yang, Xiaonan; Huang, Lei; Xue, Ping; Wan, Meihua; Guo, Jia; Zhu, Lin; Jin, Tao; Huang, Zongwen; Chen, Guangyuan; Tang, Wenfu; Xia, Qing

    2015-01-01

    Background Qing-Yi Decoction (QYD) has been used for severe acute pancreatitis (SAP) patients in China for many years. There were two kinds of QYD: Num 1. QYD (QYD1) which is used in the acute response stage of SAP and Num 2. QYD (QYD2) which is used in the second stage of SAP. This study aims to evaluate the therapeutic efficacy of QYD in participants with SAP. Methods In this prospective, randomized, double-blind, placebo-controlled trial, participants aged 18–70 years within the first 7 da...

  15. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Minoru Tomizawa

    2016-08-01

    Full Text Available Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis.

  16. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI) enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI) showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis. PMID:27721732

  17. Antibiotic Prophylaxis in Severe Acute Pancreatitis: Do We Need More Meta-Analytic Studies?

    Directory of Open Access Journals (Sweden)

    Raffaele Pezzilli

    2009-03-01

    Full Text Available Several guidelines on acute pancreatitis suggest that carbapenems should be used prophylactically and should be continued for 14 days, and that the development of infected necrosis should be assessed using fine-needle aspiration and the sample should be cultured for germ isolation and characterization [1]. In routine clinical practice, antibiotics are used to cure both extrapancreatic infections which appear during the course of acute pancreatitis and infected pancreatic necrosis and also as a prophylaxis in those patients who have pancreatic necrosis in order to prevent possible infection from the necrosis. In the treatment of extrapancreatic infections, the most used antibiotics were cephalosporins whereas carbapenems, glycopeptides and antifungal antibiotics were the most used antibiotics in the treatment of proven infected pancreatic necrosis [2]. Moreover, there are very few topics in pancreatology which cause as much debate as that regarding the utility of antibiotic prophylaxis in severe acute pancreatitis. There are very few human randomized studies and there are more meta-analyses published than studies published. Of course, the cost of a meta-analysis is much less than carrying out a study on the efficacy of antibiotics in severe acute pancreatitis.

  18. Acute encephalomyelitis complicated with severe neurological sequelae after intrathecal administration of methotrexate in a patient with acute lymphoblastic leukemia.

    Science.gov (United States)

    Nishikawa, Takuro; Okamoto, Yasuhiro; Maruyama, Shinsuke; Tanabe, Takayuki; Kurauchi, Koichiro; Kodama, Yuichi; Nakagawa, Shunsuke; Shinkoda, Yuichi; Kawano, Yoshifumi

    2014-11-01

    A four-year-old girl on maintenance therapy for acute lymphoblastic leukemia (ALL) complained of a headache and low back pain on the day she received her 21st intrathecal methotrexate (it-MTX) administration, and the next day experienced numbness and pain in her foot. This numbness gradually spread to her hand. She thereafter developed a fever and was hospitalized on day 8. After antibiotic therapy, the fever disappeared. However, her lower limbs became paralyzed, and she also developed urinary retention. On day 12, her paralysis progressed upwards, and she also developed paralysis of the upper limbs. Finally, she experienced convulsions with an impairment of consciousness. A magnetic resonance imaging study of the brain and spinal cord showed abnormal signals in the brain cortex and anterior horn. Accordingly, we diagnosed acute encephalomyelitis associated with it-MTX. High-dose intravenous immunoglobulin, steroid pulse therapy, plasma exchange, and dextromethorphan administration were initiated, while she received mechanical ventilation. Despite this intensive treatment, she suffered severe neurological damage and had to be maintained on mechanical ventilation due to persistent flaccid quadriplegia one year after the onset. When patients have symptoms of ascending paralysis during it-MTX treatment, clinicians should carefully consider the possibility of acute encephalomyelitis due to it-MTX. PMID:25501412

  19. Precipitating factors of asthma.

    Science.gov (United States)

    Lee, T H

    1992-01-01

    Asthma is characterised by bronchial hyperresponsiveness. This feature of the asthmatic diathesis predisposes patients to wheezing in response to a number of different factors. These precipitating factors include specific allergen acting via sensitised mediator cells through an IgE-dependent mechanism. There are irritants which may work through a non-specific manner, or stimuli such as exercise and hyperventilation, which probably also act through mediator release via a non-IgE-dependent manner. The mechanism whereby physical stimuli such as exercise induce bronchoconstriction is of interest, because it increases the context in which the mast cell may participate in acute asthmatic bronchoconstriction. Respiratory infections also commonly provoke asthma, especially in infants and may, indeed, precipitate the asthmatic state itself. Finally, drugs can often trigger asthma attacks and the mechanisms of asthma precipitated by non-steroidal anti-inflammatory drugs such as aspirin have been the subject of recent research.

  20. An airway epithelial iNOS-DUOX2-thyroid peroxidase metabolome drives Th1/Th2 nitrative stress in human severe asthma.

    Science.gov (United States)

    Voraphani, N; Gladwin, M T; Contreras, A U; Kaminski, N; Tedrow, J R; Milosevic, J; Bleecker, E R; Meyers, D A; Ray, A; Ray, P; Erzurum, S C; Busse, W W; Zhao, J; Trudeau, J B; Wenzel, S E

    2014-09-01

    Severe refractory asthma is associated with enhanced nitrative stress. To determine the mechanisms for high nitrative stress in human severe asthma (SA), 3-nitrotyrosine (3NT) was compared with Th1 and Th2 cytokine expression. In SA, high 3NT levels were associated with high interferon (IFN)-γ and low interleukin (IL)-13 expression, both of which have been reported to increase inducible nitric oxide synthase (iNOS) in human airway epithelial cells (HAECs). We found that IL-13 and IFN-γ synergistically enhanced iNOS, nitrite, and 3NT, corresponding with increased H(2)O(2). Catalase inhibited whereas superoxide dismutase enhanced 3NT formation, supporting a critical role for H(2)O(2), but not peroxynitrite, in 3NT generation. Dual oxidase-2 (DUOX2), central to H(2)O(2) formation, was also synergistically induced by IL-13 and IFN-γ. The catalysis of nitrite and H(2)O(2) to nitrogen dioxide radical (NO(2)(•)) requires an endogenous peroxidase in this epithelial cell system. Thyroid peroxidase (TPO) was identified by microarray analysis ex vivo as a gene distinguishing HAEC of SA from controls. IFN-γ induced TPO in HAEC and small interfering RNA knockdown decreased nitrated tyrosine residues. Ex vivo, DUOX2, TPO, and iNOS were higher in SA and correlated with 3NT. Thus, a novel iNOS-DUOX2-TPO-NO(2)(•) metabolome drives nitrative stress in HAEC and likely in SA.

  1. A new pathological scoring method for adrenal injury in rats with severe acute pancreatitis.

    Science.gov (United States)

    Deng, Wenhong; Hui, Yuanjian; Yu, Jia; Wang, Weixing; Xu, Sheng; Chen, Chen; Xiong, Xincheng

    2014-12-01

    These studies investigated the appearance and function of adrenal glands in rats with severe acute pancreatitis (SAP) and established a new histopathological score to evaluate adrenal histopathological changes. Severe acute pancreatitis relied on retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. The damage of SAP was estimated by serum amylase, secretory phospholipase A2 and pancreatic histopathology. Light and electron microscopy of adrenal gland, and the levels of serum corticosterone were investigated. These results showed that the generally ascending trend of adrenal pathological score was inversely proportional to the generally descending trend of serum corticosterone levels, but parallel with the changes of pancreatic histopathology. Herein, the new adrenal histopathological score was effective in the evaluation of adrenal injury following SAP. It may indirectly reflect the variation of serum cortisol levels and the severity of pancreatitis to a certain extent.

  2. Assessment of severity of acute pancreatitis by contrast enhanced CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Tanjoh, Katsuhisa; Tomita, Ryoichi; Iwase, Masaaki; Amano, Sadao; Korosu, Yasuhiko; Morita, Ken (Nihon Univ., Tokyo (Japan). School of Medicine)

    1991-10-01

    Thirteen patients with acute pancreatitis underwent dynamic CT scanning. According to the Ranson's criteria, 6 and 7 patients were classified as mild and severe, respectively. The maximum Hounsfield unit (HU) of the pancreas was 40 or more in the group of mild patients and 30 or less in the group of severe patients. According to the HU of the pancreas, the HU of less than 30 was defined as severe pancreatitis, the HU between 30 and 40 as medium, and the HU of more than 40 as mild. A predictive value and sensitivity of this HU criteria were 50% and 100%, respectively, for evaluating death from acute pancreatitis; and both were 100% for evaluating pancreatitis complicated by retroperitoneal infection. Thus, dynamic CT scanning is of value in the evaluation of prognosis of pancreatitis. (N.K.).

  3. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2016-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  4. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2015-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  5. Clinical characteristics and treatment of acute asthma exacerbations during pregnancy%妊娠合并支气管哮喘急性发作的发病特点及治疗原则

    Institute of Scientific and Technical Information of China (English)

    胡文胜; 张治芬

    2008-01-01

    目的 探讨妊娠合并支气管哮喘急性发作的发病特点及治疗原则.方法 对30例妊娠合并支气管哮喘急性发作患者的临床资料进行回顾性分析.结果 25例妊娠合并支气管轻、中度哮喘急性发作患者经吸氧、应用β受体激动剂和糖皮质激素、补液、纠正水电解质平衡等治疗后,母婴预后良好,无一例出现严重并发症;5例重度及危重哮喘急性发作患者,经半卧位、吸氧、补液、纠正酸碱电解质平衡、应用β受体激动剂和糖皮质激素、广谱抗生素、氨茶碱等药物综合治疗后,仍有4例合并肺部感染,1例发生呼吸性酸中毒,1例发生呼吸性酸中毒并代谢性碱中毒,4例发生胎儿生长受限.结论 妊娠可使部分哮喘患者出现急性发作并加重,对重度及危重哮喘急性发作患者,以半卧位、吸氧、补液、纠正酸碱电解质平衡、应用β受体激动剂和糖皮质激素、广谱抗生素、氨茶碱等综合治疗是主要处理原则.%Objective To study the clinical characteristics of acute asthma during pregnancy,focusing on management of pregnant women presenting with an acute exacerbation.Methods A prospective observational study was conducted in 30 cases of acute exacerbations during pregnancy.Results The prognosis of 25 patients with mild or moderate asthma was good for both mother and fetus;none had severe complications.Among 5 women who had severe exacerbations,there were 4 pulmonary co-infections,1 with respiratory acidosis,1 with respiratory acidosis plus metabolic allkalosis,and 4 with fetal growth-restriction.Conclusions,This study highlights that pregnancy can worsen asthma control in some women.Effective management and prevention of asthma exacerbations during pregnancy is key to ensuring the safety of the mother and the fetus.

  6. Isotope Coded Protein Labeling analysis of plasma specimens from acute severe dengue fever patients

    Directory of Open Access Journals (Sweden)

    Fragnoud Romain

    2012-10-01

    Full Text Available Abstract Background Dengue fever is the most important arthropod born viral disease of public health significance. Although most patients suffer only from flu-like symptoms, a small group of patient experiences more severe forms of the disease. To contribute to a better understanding of its pathogenesis this study aims to identify proteins differentially expressed in a pool of five viremic plasma from severe dengue patients relative to a pool of five non-severe dengue patients. Results The use of Isotope Coded Protein Labeling (ICPLTM to analyze plasma depleted of twenty high-abundance proteins allowed for the identification of 51 differentially expressed proteins, which were characterized by mass spectrometry. Using quantitative ELISA, three of these proteins (Leucine-rich glycoprotein 1, Vitamin D binding-protein and Ferritin were confirmed as having an increased expression in a panel of severe dengue plasma. The proteins identified as overexpressed by ICPLTM in severe dengue plasma involve in clear up action after cell injury, tissue coherence and immune defense. Conclusion This ICPLTM study evaluating differences between acute severe dengue plasmas and acute non-severe dengue plasmas suggests that the three proteins identified are overexpressed early in the course of the disease. Their possible use as biomarkers for the prognostic of disease severity is discussed.

  7. Asthma: NIH-Sponsored Research and Clinical Trials | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Asthma Asthma: NIH-Sponsored Research and Clinical Trials Past Issues / Fall 2011 Table of Contents NIH-Sponsored Research Asthma in the Inner City: Recognizing that asthma severity ...

  8. Incidence and risk factors for exacerbations of asthma during pregnancy

    DEFF Research Database (Denmark)

    Ali, Zarqa; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma...... during pregnancy....

  9. Does the Duration of Abdominal Pain Prior to Admission Influence the Severity of Acute Pancreatitis?

    Directory of Open Access Journals (Sweden)

    Karan Kapoor

    2013-03-01

    Full Text Available Context In a prior report involving patients with hemoconcentration at admission, those with necrotizing pancreatitis presented significantly earlier than those with interstitial disease suggesting that duration of abdominal pain prior to presentation may have prognostic significance in acute pancreatitis. Objectives The aim of the present study was to determine whether the duration of abdominal pain prior to admission influences the severity of acute pancreatitis. Methods During a five-year period, all patients presenting directly to our hospital with their first episode of acute pancreatitis were enrolled in a cohort study. We analyzed data obtained from records of all such patients and performed a separate analysis on those with hemoconcentration (hematocrit equal to, or greater than, 44% at presentation to determine whether duration of abdominal pain prior to presentation was associated with severity of acute pancreatitis. Duration of abdominal pain wascategorized as persisting for either less than 12 h or 12 h or more prior to arrival. Prognostic markers of severity included admission hematocrit and blood urea nitrogen (BUN, as well as the development of systemic inflammatory response syndrome (SIRS during the initial 24 h of hospitalization. Outcome measures included pancreatic necrosis based on contrast-enhanced CT scanning, need for intensive care, length of hospitalization, and death. Radiologic severity of peripancreatic inflammatory changes was assessed within 48 h of admission in accordance with the Balthazar-Ranson scoring system (A-E. Results Among a total of 318 patients, there were 62 (19.5% with hemoconcentration at admission. Among the 318 patients, there was no significant difference in the prevalence of pancreatic necrosis when comparing the less than 12 h group to the 12 h or more group. Among the 62 patients with hemoconcentration, those admitted within 12 h compared to those admitted 12 h or more following the onset of

  10. 妊娠期呼吸生理改变与哮喘急性发作的治疗%Respiratory physiological changes during pregnancy and treatment of acute asthma

    Institute of Scientific and Technical Information of China (English)

    曾笑梅; 陈惠华; 邓新宇

    2015-01-01

    哮喘是育龄妇女常见的疾病,大约4%~8%的孕妇患有哮喘。由于激素水平的变化和腹腔内体积增加,正常的妊娠对呼吸生理将产生很大影响。妊娠期间功能残气量(FRC)和补呼气容积(ERV)将减少,同时孕妇氧耗量将增加。氧耗量增加和功能残气量降低导致了氧储备降低并且大大增加了缺氧的敏感性。妊娠合并哮喘患者大约1/3哮喘保持稳定,1/3哮喘控制率有提高,另外1/3哮喘将恶化。孕妇严重哮喘恶化可能导致严重的临床后果,应该结合其呼吸生理改变立即处理。处理措施主要包括立即吸氧,药物治疗,非常严重的情况下需要气管插管机械通气治疗。关注妊娠合并哮喘患者的呼吸生理改变和肺功能变化,并以此为依据适时改变治疗策略可以最大程度确保母亲和胎儿的健康。本文将概述妊娠期呼吸生理改变和哮喘急性发作时的治疗。%Asthma is a common disease in reproductive age women, with a prevalence of 4%-8%. Respiratory physiology will be changed significantly during pregnancy because of the changed level of hormone and intraperitoneal volume. Besides functional residual capacity (FRC) and expiratory reserve volume (ERV) will decrease during pregnancy, and the oxygen consumption will increase during pregnancy. The increase of the oxygen consumption and the decrease of FRC both lead to the lower oxygen reserves and the higher sensitivity to hypoxia. Approximately, one third of the pregnancy combined with asthma will remain stable, one third of them have increased control rate, and in the other one third of them the asthma aggravate. Severe asthma exacerbation in pregnant women can lead to serious clinical consequences, it should be dealt with immediately based on its respiratory physiological changes. The treatments include oxygen uptake, medication, and in the serious situation it need trachea cannula and mechanical ventilation

  11. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new?

    Science.gov (United States)

    Andrew, Rachel E; Messaris, Evangelos

    2016-01-01

    Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC.

  12. Value of adipokines in predicting the severity of acute pancreatitis: Comprehensive review

    Institute of Scientific and Technical Information of China (English)

    Andrius Karpavicius; Zilvinas Dambrauskas; Audrius Sileikis; Dalius Vitkus; Kestutis Strupas

    2012-01-01

    AIM:To analyze the prognostic value of adipokines in predicting the course,complications and fatal outcome of acute pancreatitis (AP).METHODS:We performed the search of PubMed database and the systemic analysis of the literature for both experimental and human studies on prognostic value of adipokines in AP for period 2002-2012.Only the papers that described the use of adipokines for prediction of severity and/or complications of AP were selected for further analysis.Each article had to contain information about the levels of measured adipokines,diagnosis and verification of AP,to specify presence of pancreatic necrosis,organ dysfunction and/or mortality rates.From the very beginning,study was carried out adhering to the PRISMA checklist and flowchart for systemic reviews.To assess quality of all included human studies,the Quality Assessment of Diagnostic Accuracy Studies tool was used.Because of the high heterogeneity between the studies,it was decided to refrain from the statistical processing or meta-analysis of the available data.RESULTS:Nine human and three experimental studies were included into review.In experimental studies significant differences between leptin concentrations at 24 and 48 h in control,acute edematous and acute necrotizing pancreatitis groups were found (P =0.027 and P < 0.001).In human studies significant differences between leptin and resitin concentrations in control and acute pancreatitis groups were found.1-3 d serum adiponectin threshold of 4.5 μg/mL correctly classified the severity of 81% of patients with AR This threshold yielded a sensitivity of 70%,specificity 85%,positive predictive value 64%,negative predictive value88% (area under curve 0.75).Resistin and visfatin concentrations differ significantly between mild and severe acute pancreatitis groups,they correlate with severity of disease,need for interventions and outcome.Both adipokines are good markers for parapancreatic necrosis and the cut-off values of 11

  13. Asthma and Adolescents: Review of Strategies to Improve Control

    Science.gov (United States)

    Hennessy-Harstad, Ellen

    2013-01-01

    One of every 10 adolescents in the United States has asthma. Adolescents who lack asthma control are at increased risk for severe asthma episodes and death. The National Heart, Lung, and Blood Institute 2007 asthma guidelines and research studies indicated that school nurses are instrumental in assisting adolescents to monitor their asthma, learn…

  14. Imaging diagnosis of bronchial asthma and related diseases

    International Nuclear Information System (INIS)

    We describe imaging features of bronchial asthma and related diseases. The practical roles of imaging diagnosis are the evaluation of severity and complications of bronchial asthma and differential diagnosis of diseases showing asthmatic symptoms other than bronchial asthma. (author)

  15. Chediak-Higashi syndrome in accelerated phase masquerading as severe acute malnutrition

    OpenAIRE

    Karande, Sunil; Agarwal, Shruti; Gandhi, Bhaumik; Muranjan, Mamta

    2014-01-01

    A toddler presented with poor appetite, weight loss and frequent respiratory tract infections for the past 6 months, fever and increasing paleness for the past 2 months and bilateral pedal oedema for the past 1 month. Anthropometry confirmed severe acute malnutrition. Clinical and laboratory evaluation revealed that the child also had hypopigmented hair and skin, splenohepatomegaly, pancytopenia and hypoalbuminaemia. The coexistence of hypopigmentation and suspected low immunity prompted us t...

  16. Managing severe acute respiratory syndrome (SARS) intellectual property rights: the possible role of patent pooling.

    OpenAIRE

    2005-01-01

    Patent applications that incorporate the genomic sequence of the severe acute respiratory syndrome (SARS) coronavirus, have been filed by a number of organizations. This is likely to result in a fragmentation of intellectual property (IP) rights which in turn may adversely affect the development of products, such as vaccines, to combat SARS. Placing these patent rights into a patent pool to be licensed on a non-exclusive basis may circumvent these difficulties and set a key precedent for the ...

  17. Acute promyelocytic leukemia with JAK2 V617F and severe differentiation syndrome

    OpenAIRE

    Braun, Theodore P.; Maxson, Julia E; Anupriya Agarwal; Jennifer Dunlap; Spurgeon, Stephen E.; Elie Traer

    2014-01-01

    Myeloproliferative neoplasms transformed into AML usually have a poor prognosis. We report a case of essential thrombocythemia with myelofibrosis that transformed into acute promyelocytic leukemia (APL) with both the t(15;17) translocation as well as the JAK2 V617F mutation. Clinically, this case was notable for severe differentiation syndrome despite treatment with high-dose dexamethasone. Cytokine production by differentiating APL cells was not directly abrogated by JAK2 inhibitors in vitro...

  18. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    OpenAIRE

    Jaballah Sakhri; Houssem Harbi; Rached Ltaief; Chaker Ben Salem; Neila Fathallah

    2010-01-01

    Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing sev...

  19. Chest X ray changes in severe acute respiratory syndrome cases after discontinuation of glucocorticosteroids treatment

    Institute of Scientific and Technical Information of China (English)

    姚婉贞; 陈亚红; 张立强; 王筱宏; 孙永昌; 孙威; 韩江莉; 张福春; 郑亚安; 孙伯章; 贺蓓; 赵鸣武

    2004-01-01

    @@ Severe acute respiratory syndrome (SARS) is a disease identified in Asia, North America and Europe. The drugs for treatment and prevention of and vaccine for the disease are in research.1,2 There is still no agreement on glucocorticosteroid treatment of SARS. In treatment of SARS patients with glucocorticosteroids, we found 5 cases whose chest X ray changes were different from what the literature reported.

  20. Acute Radiation Syndrome Severity Score System in Mouse Total-Body Irradiation Model.

    Science.gov (United States)

    Ossetrova, Natalia I; Ney, Patrick H; Condliffe, Donald P; Krasnopolsky, Katya; Hieber, Kevin P

    2016-08-01

    Radiation accidents or terrorist attacks can result in serious consequences for the civilian population and for military personnel responding to such emergencies. The early medical management situation requires quantitative indications for early initiation of cytokine therapy in individuals exposed to life-threatening radiation doses and effective triage tools for first responders in mass-casualty radiological incidents. Previously established animal (Mus musculus, Macaca mulatta) total-body irradiation (γ-exposure) models have evaluated a panel of radiation-responsive proteins that, together with peripheral blood cell counts, create a multiparametic dose-predictive algorithm with a threshold for detection of ~1 Gy from 1 to 7 d after exposure as well as demonstrate the acute radiation syndrome severity score systems created similar to the Medical Treatment Protocols for Radiation Accident Victims developed by Fliedner and colleagues. The authors present a further demonstration of the acute radiation sickness severity score system in a mouse (CD2F1, males) TBI model (1-14 Gy, Co γ-rays at 0.6 Gy min) based on multiple biodosimetric endpoints. This includes the acute radiation sickness severity Observational Grading System, survival rate, weight changes, temperature, peripheral blood cell counts and radiation-responsive protein expression profile: Flt-3 ligand, interleukin 6, granulocyte-colony stimulating factor, thrombopoietin, erythropoietin, and serum amyloid A. Results show that use of the multiple-parameter severity score system facilitates identification of animals requiring enhanced monitoring after irradiation and that proteomics are a complementary approach to conventional biodosimetry for early assessment of radiation exposure, enhancing accuracy and discrimination index for acute radiation sickness response categories and early prediction of outcome. PMID:27356057