Sample records for normal cough reflex

  1. Attentional modulation of reflex cough. (United States)

    Janssens, Thomas; Silva, Mitchell; Davenport, Paul W; Van Diest, Ilse; Dupont, Lieven J; Van den Bergh, Omer


    Reflex cough is a defensive response generated in the brainstem in response to chemical and mechanical stimulation of the airways. However, converging evidence shows that reflex cough is also influenced by central neural control processes. In this study, we investigate whether reflex cough can be modulated by attentional focus on either external stimuli or internal cough-related stimuli. Healthy volunteers (N = 24; seven men; age range, 18-25 years) completed four blocks of citric acid-induced cough challenges while, simultaneously, auditory stimuli were presented. Within each block, four concentrations were administered (30, 100, 300 and 1,000 mM, randomized). During two subsequent blocks, participants focused their attention externally (counting tones). During the other two blocks, participants focused their attention internally (counting coughs). The order of attentional focus was counterbalanced across participants. Ratings of the urge to cough were collected after each challenge. Cough frequency was determined by audio recording. Cough frequency was higher when participants focused their attention internally vs externally (P Reflex cough can be modulated by attentional focus. Internally focused attention may be a mechanism involved in excessive (idiopathic) cough, while an external focus may be introduced as part of treatments targeting excessive cough.

  2. Sex differences in cough reflex. (United States)

    Plevkova, J; Buday, T; Kavalcikova-Bogdanova, N; Ioan, I; Demoulin-Alexikova, S


    Majority of patients visiting cough clinics are postmenopausal women, who are affected by intractable cough for years. Why the cough reflex becomes exaggerated in women is not known. Basic research excludes females from the studies contributing to the sex bias which may be responsible for lack of understanding of "hypersensitive" cough in women. Biological and behavioural differences between women and men are the factors affecting cough physiology. Gender also shapes the patterns of behaviour and determines the character of environmental exposures which differs between sexes. The article offers an insight into the physiology of the cough, differences in the maturation of it and biological, social and behavioural factors contributing to the sex differences in cough. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. A novel reflex cough testing device. (United States)

    Fujiwara, Kazunori; Kawamoto, Katsuyuki; Shimizu, Yoko; Fukuhara, Takahiro; Koyama, Satoshi; Kataoka, Hideyuki; Kitano, Hiroya; Takeuchi, Hiromi


    The reflex cough test is useful for detecting silent aspiration, a risk factor for aspiration pneumonia. However, assessing the risk of aspiration pneumonia requires measuring not only the cough reflex but also cough strength. Currently, no reflex cough testing device is available that can directly measure reflex cough strength. We therefore developed a new testing device that can easily and simultaneously measure cough strength and the time until the cough reflex, and verified whether screening with this new instrument is feasible for evaluating the risk of aspiration pneumonia. This device consists of a special pipe with a double lumen, a nebulizer, and an electronic spirometer. We used a solution of prescription-grade L-tartaric acid to initiate the cough reflex. The solution was inhaled through a mouthpiece as a microaerosol produced by an ultrasonic nebulizer. The peak cough flow (PCF) of the induced cough was measured with the spirometer. The 70 patients who participated in this study comprised 49 patients without a history of pneumonia (group A), 21 patients with a history of pneumonia (group B), and 10 healthy volunteers (control group). With the novel device, PCF and time until cough reflex could be measured without adverse effects. The PCF values were 118.3 ± 64.0 L/min, 47.7 ± 38.5 L/min, and 254.9 ± 83.8 L/min in group A, group B, and the control group, respectively. The PCF of group B was significantly lower than that of group A and the control group (p reflex was 4.2 ± 5.9 s, 7.0 ± 7.0 s, and 1 s in group A, group B, and the control group, respectively. This duration was significantly longer for groups A and B than for the control group (A: p reflex and the strength of involuntary coughs for assessment of patients at risk of aspiration pneumonia.

  4. Cough reflex sensitization from esophagus and nose. (United States)

    Hennel, Michal; Brozmanova, Mariana; Kollarik, Marian


    The diseases of the esophagus and nose are among the major factors contributing to chronic cough although their role in different patient populations is debated. Studies in animal models and in humans show that afferent C-fiber activators applied on esophageal or nasal mucosa do not initiate cough, but enhance cough induced by inhaled irritants. These results are consistent with the hypothesis that activation of esophageal and nasal C-fibers contribute to cough reflex hypersensitivity observed in chronic cough patients with gastroesophageal reflux disease (GERD) and chronic rhinitis, respectively. The afferent nerves mediating cough sensitization from the esophagus are probably the neural crest-derived vagal jugular C-fibers. In addition to their responsiveness to high concentration of acid typical for gastroesophageal reflux (pH acidic reflux such as receptors highly sensitive to acid and receptors for bile acids. The nature of sensory pathways from the nose and their activators relevant for cough sensitization are less understood. Increased cough reflex sensitivity was also reported in many patients with GERD or rhinitis who do not complain of cough indicating that additional endogenous or exogenous factors may be required to develop chronic coughing in these diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Afferent nerves regulating the cough reflex: Mechanisms and Mediators of Cough in Disease (United States)

    Canning, Brendan J.


    Bronchopulmonary C-fibers and acid-sensitive, capsaicin-insensitive mechanoreceptors innervating the larynx, trachea and large bronchi regulate the cough reflex. These vagal afferent nerves may interact centrally with sensory input arising from afferent nerves innervating the intrapulmonary airways or even extrapulmonary afferents such as those innervating the nasal mucosa and esophagus to produce chronic cough or enhanced cough responsiveness. The mechanisms of cough initiation in health and in disease are briefly described. PMID:20172253

  6. The effect of mindfulness meditation on cough reflex sensitivity. (United States)

    Young, E C; Brammer, C; Owen, E; Brown, N; Lowe, J; Johnson, C; Calam, R; Jones, S; Woodcock, A; Smith, J A


    Chronic cough is common, and medical treatment can be ineffective. Mindfulness is a psychological intervention that aims to teach moment-to-moment non-judgemental awareness of thoughts, feelings and sensations. 30 healthy subjects and 30 patients with chronic cough were studied in two sequential trials. For both studies, cough reflex sensitivity to citric acid (C5) was measured on two occasions, with urge to cough rated following each inhalation; between challenges subjects were randomised to (1) no intervention, (2) mindfulness or (3) no intervention but modified cough challenge (subjects suppress coughing). For the healthy volunteers, measures were 1 h apart and mindfulness was practised for 15 min. For the patients with chronic cough measures were 1 week apart and mindfulness was practised daily for 30 min. In healthy volunteers, median change (interquartile range (IQR)) in cough reflex sensitivity (logC5) for no intervention, mindfulness and suppression was +1.0 (0.0 to +1.3), +2.0 (+1.0 to +3.0) and +3.0 (+2.8 to +3.0) doubling concentrations (p = 0.003); there were significant reductions for both mindfulness (p = 0.043) and suppression (p = 0.002) over no intervention. In patients with cough, median change (IQR) in logC5 for no intervention, mindfulness training and voluntary suppression was 0.0 (-1.0 to +1.0), +1.0 (-0.3 to +1.0) and +1.0 (+1.0 to +2.0) doubling concentrations (p = 0.046); there was a significant reduction for suppression (p = 0.02) but not mindfulness (p = 0.35). Urge to cough did not change after mindfulness compared with control in either healthy subjects (p = 0.33) or those with chronic cough (p = 0.47). Compared with control, mindfulness decreased cough reflex sensitivity in healthy volunteers, but did not alter cough threshold in patients with chronic cough. Both groups were able to suppress cough responses to citric acid inhalation.

  7. Effect of e-Cigarette Use on Cough Reflex Sensitivity. (United States)

    Dicpinigaitis, Peter V; Lee Chang, Alfredo; Dicpinigaitis, Alis J; Negassa, Abdissa


    E-cigarettes (e-cigs) have attained widespread popularity, yet knowledge of their physiologic effects remains minimal. The aim of this study was to evaluate the effect of a single exposure to e-cig vapor on cough reflex sensitivity. Thirty healthy nonsmokers underwent cough reflex sensitivity measurement using capsaicin cough challenge at baseline, 15 min, and 24 h after e-cig exposure (30 puffs 30 s apart). The end point of cough challenge is the concentration of capsaicin inducing five or more coughs (C5). The number of coughs induced by each e-cig inhalation was counted. A subgroup of subjects (n = 8) subsequently underwent an identical protocol with a non-nicotine-containing e-cig. Cough reflex sensitivity was significantly inhibited (C5 increased) 15 min after e-cig use (?0.29; 95% CI, ?0.43 to ?0.15; P < .0001); 24 h later, C5 returned to baseline (0.24; 95% CI, 0.10-0.38; P = .0002 vs post-15-min value). A subgroup of eight subjects demonstrating the largest degree of cough reflex inhibition had no suppression after exposure to a non-nicotine-containing e-cig (P = .0078 for comparison of ?C5 after nicotine vs non-nicotine device). Furthermore, more coughing was induced by the nicotine-containing vs non-nicotine-containing device (P = .0156). A single session of e-cig use, approximating nicotine exposure of one tobacco cigarette, induces significant inhibition of cough reflex sensitivity. Exploratory analysis of a subgroup of subjects suggests that nicotine is responsible for this observation. Our data, consistent with previous studies of nicotine effect, suggest a dual action of nicotine: an immediate, peripheral protussive effect and a delayed central antitussive effect.; No.: NCT02203162; URL: Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. Perception of urge-to-cough and dyspnea in healthy smokers with decreased cough reflex sensitivity


    Kanezaki, Masashi; Ebihara, Satoru; Nikkuni, Etsuhiro; Gui, Peijun; Suda, Chihiro; Ebihara, Takae; Yamasaki, Miyako; Kohzuki, Masahiro


    Background Although cigarette smoking has been implicated as an important risk factor for the development of respiratory symptoms, the perceptional aspects of two symptoms in smokers have not been fully elucidated. Therefore, we simultaneously evaluated the cough reflex sensitivity, the cognition of urge-to-cough and perception of dyspnea in both healthy smokers and non-smokers. Methods Fourteen male healthy never-smokers and 14 age-matched male healthy current-smokers were recruited via publ...

  9. Comparison of cough reflex test against instrumental assessment of aspiration. (United States)

    Miles, Anna; Moore, Sara; McFarlane, Mary; Lee, Fiona; Allen, Jacqueline; Huckabee, Maggie-Lee


    Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). The aim of this study was to validate cough reflex testing (CRT) for identification of silent aspiration against aspiration confirmed by instrumental assessment. Cough reflex threshold testing was completed on all patients using inhaled, nebulised citric acid. Within an hour, 80 patients underwent videofluoroscopic study of swallowing (VFSS) and 101 patients underwent fibreoptic endoscopic evaluation of swallowing (FEES). All tests were recorded and analysed by two researchers blinded to the result of the alternate test. Significant associations between CRT result and cough response to aspiration on VFSS (X(2) (2)=11.046, p=.003) and FEES (X(2) (2)=34.079, pacid provide a better predictive measure of silent aspiration. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Reflex Cough and Disease Duration as Predictors of Swallowing Dysfunction in Parkinson's Disease. (United States)

    Troche, Michelle S; Schumann, Beate; Brandimore, Alexandra E; Okun, Michael S; Hegland, Karen W


    Patients with Parkinson's disease (PD) have progressive and pervasive disorders of airway protection. Recent work has highlighted the relationship between reflex and voluntary cough and swallowing safety. The goal of this study was to test the sensitivity and specificity of several airway protective and disease-specific factors for predicting swallowing safety outcomes in PD. Sixty-four participants (44 males) completed measures of voluntary and reflex cough, and swallowing safety. Clinical predictors included disease severity and duration, and cough airflow and sensitivity measures. ROC and Chi-square analyses identified predictors of swallowing safety (penetration-aspiration score) in PD. Disease duration significantly discriminated between patients with normal and abnormal swallowing safety (p = 0.027, sensitivity: 71 %, specificity: 55.4 %). Cough reflex sensitivity significantly discriminated between patients who penetrated above the level of the vocal folds and those with more severe penetration/aspiration (p = 0.021, sensitivity: 71.0 %, specificity 57.6 %). Urge-to-cough sensitivity (log-log linear slope) was the only variable which significantly discriminated between patients with penetration versus aspiration (p = 0.017, sensitivity: 85.7 %, specificity 73.2 %). It is important to identify the factors which influence airway protective outcomes in PD especially given that aspiration pneumonia is a leading cause of death. Results from this study highlight the ecological validity of reflex cough in the study of airway protection and this study further identifies important factors to consider in the screening of airway protective deficits in PD.

  11. Cough reflex sensitivity and airway inflammation in patients with chronic cough due to non-acid gastro-oesophageal reflux. (United States)

    Qiu, Zhihong; Yu, Li; Xu, Shuchang; Liu, Bo; Zhao, Ting; Lü, Hanjing; Qiu, Zhongmin


    The aim of this study was to explore the pathogenesis of chronic cough caused by non-acid reflux. Seven patients with chronic cough due to non-acid reflux, 12 patients with chronic cough due to acid reflux, 10 patients with gastro-oesophageal reflux disease without cough and 12 healthy volunteers were recruited for the study. All subjects underwent oesophageal multi-channel intraluminal impedance measurements combined with pH monitoring, and assessment of cough reflex sensitivity to capsaicin and induced sputum cytology. The concentrations of substance P, mast cell tryptase, prostaglandin D2 and histamine in induced sputum were measured by ELISA. Cough threshold C2 and C5 did not differ between patients with chronic cough due to non-acid or acid reflux, but the values were significantly lower than those for patients with gastro-oesophageal reflux disease without cough and healthy volunteers. Weakly acidic reflux episodes were obviously more frequent in patients with chronic cough due to non-acid reflux than in the other three groups. Sputum substance P and mast cell tryptase concentrations were remarkably increased in patients with chronic cough, but were similar for those with cough due to non-acid or acid reflux. There were significant inverse correlations between substance P levels and cough threshold C2 or C5 in patients with cough due to non-acid or acid reflux, and between mast cell tryptase levels and cough threshold C2 in patients with cough due to acid reflux. Chronic cough due to non-acid reflux may be related to cough reflex hypersensitivity caused by neurogenic airway inflammation and mast cell activation, in which weakly acidic reflux is possibly a major factor. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

  12. Correlation between voluntary cough and laryngeal cough reflex flows in patients with traumatic brain injury. (United States)

    Lee, Sang Chul; Kang, Seong-Woong; Kim, Min Tae; Kim, Yong Kyun; Chang, Won Hyuk; Im, Sang Hee


    To correlate voluntary cough and laryngeal cough reflex (LCR) flows in patients with traumatic brain injury (TBI). Cross-sectional study. University rehabilitation hospital. Patients with TBI (n=25) and healthy controls (n=48). Not applicable. Peak cough flows (PCFs) and LCR flows were measured using a peak flow meter at the oral-nasal interface. The largest value of 3 attempts was recorded for PCF and LCR, respectively. LCR was elicited by 20% solution of pharmaceutic-grade citric acid dissolved in sterile .15M NaCl solution that was inhaled from a nebulizer. PCF was 447.4 ± 99.0 L/min in the control group and 211.7 ± 58.2 L/min in the patient group. LCR was 209.2 ± 63.8L/min in the control group and 170.0 ± 59.7 L/min in the patient group. Both PCF (P=.000) and LCR (P=.013) were significantly reduced in patients with TBI compared to that of the control group. LCR was strongly related to the PCF in both control (R=.645; P=.000) and patient (R=.711; P=.000) groups. As LCR can be measured as a numerical value and significantly correlates with PCF, LCR can be used to estimate cough ability of patients with TBI who cannot cooperate with PCF measurement. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Reversal of functional disorders by aspiration, expiration and cough reflexes and their voluntary counterparts

    Directory of Open Access Journals (Sweden)

    Zoltan eTomori


    Full Text Available Agonal gasping provoked by asphyxia can save ~15% of mammals even from untreated ventricular fibrillation, but it fails to revive infants with sudden infant death syndrome. Our systematic study of airway reflexes in cats and other animals indicated that in addition to cough, there are 2 distinct airway reflexes that may contribute to auto-resuscitation. Gasp- and sniff-like spasmodic inspirations can be elicited by nasopharyngeal stimulation, strongly activating the brainstem generator for inspiration, which is also involved in the control of gasping. This aspiration reflex (AspR is characterized by spasmodic inspiration without subsequent active expiration and can be elicited during agonal gasping, caused by brainstem trans-sections in cats. Stimulation of the larynx can activate the generator for expiration to evoke the expiration reflex, manifesting with prompt expiration without preceding inspiration. Stimulation of the oro-pharynx and lower airways provokes the cough reflex which results from activating of both generators. The powerful potential of the AspR resembling auto-resuscitation by gasping can influence the control mechanisms of vital functions, mediating reversal of various functional disorders.The AspR in cats interrupted hypoxic apnea, laryngo- and bronchospasm, apneusis and even transient asphyxic coma, and can normalize various hypo- and hyper-functional disorders. Introduction of a nasogastric catheter evoked similar spasmodic inspirations in premature infants and interrupted hiccough attacks in adults. Coughing on demand can prevent anaphylactic shock and resuscitate the pertinent subject. Sniff representing nasal inspiratory pressure and maximal inspiratory and expiratory pressures are voluntary counterparts of airway reflexes, and are useful for diagnosis and therapy of various cardio-respiratory and neuromuscular disorders.

  14. Inhibitory effect of cervical trachea and chest wall vibrations on cough reflex sensitivity and perception of urge-to-cough in healthy male never-smokers


    Kashiwazaki, Naohiro; Ebihara, Satoru; Gui, Peijun; Katayama, Norihiro; Ito, Kumiko; Sato, Ryuhei; Oyama, Chika; Ebihara, Takae; Kohzuki, Masahiro


    Background Non-pharmacological options for symptomatic management of cough are desired. Although chest wall mechanical vibration is known to ameliorate cough reflex sensitivity, the effect of mechanical vibrations on perceptions of urge-to-cough has not been studied. Therefore, we investigated the effect of mechanical vibration of cervical trachea, chest wall and femoral muscle on cough reflex sensitivity, perceptions of urge-to-cough as well as dyspnea. Methods Twenty-four healthy male never...

  15. Cough reflex sensitivity is increased in the guinea pig model of allergic rhinitis. (United States)

    Brozmanova, M; Plevkova, J; Tatar, M; Kollarik, M


    Increased cough reflex sensitivity is found in patients with allergic rhinitis and may contribute to cough caused by rhinitis. We have reported that cough to citric acid is enhanced in the guinea pig model of allergic rhinitis. Here we address the hypothesis that the cough reflex sensitivity is increased in this model. The data from our previous studies were analyzed for the cough reflex sensitivity. The allergic inflammation in the nose was induced by repeated intranasal instillations of ovalbumin in the ovalbumin-sensitized guinea pigs. Cough was induced by inhalation of doubling concentrations of citric acid (0.05-1.6 M). Cough threshold was defined as the lowest concentration of citric acid causing two coughs (C2, expressed as geometric mean [95% confidence interval]). We found that the cough threshold was reduced in animals with allergic rhinitis. C2 was 0.5 M [0.36-0.71 M] and 0.15 M [0.1-0.23 M] prior and after repeated intranasal instillations of ovalbumin, respectively, Preflex sensitivity. C2 was reduced in animals with allergic rhinitis treated orally with vehicle (0.57 M [0.28-1.1] vs. 0.09 M [0.04-0.2 M], Preflex sensitivity is increased in the guinea pig model of allergic rhinitis. Our results suggest that guinea pig is a suitable model for mechanistic studies of increased cough reflex sensitivity in rhinitis.

  16. The effect of titrated fentanyl on suppressed cough reflex in healthy adult volunteers. (United States)

    Kelly, H E; Shaw, G M; Brett, C N; Greenwood, F M; Huckabee, M L


    Cough suppression is part of the pharmacodynamic profile of opioids. We investigated the impact of clinical doses of fentanyl on suppressing the cough reflex. Thirteen volunteers received 2 μ of fentanyl in a divided administration protocol. Three minutes after each administration and at 10 min intervals during washout, suppressed cough reflex testing with nebulised citric acid was performed and compared with fentanyl effect-site concentration. Mean (SD) citric acid concentration provoking cough increased from 0.5 (0.28) mol.l(-1) at baseline to 1.2 (0.50) mol.l(-1) after 2 μ of fentanyl (p = 0.01). Mean (SD) fentanyl effect-site concentration after the final dose of fentanyl was 1.89 (0.05) . A strong positive correlation was found between suppressed cough reflex thresholds and fentanyl effect-site concentrations during both fentanyl administration and washout phases of the study (r(2) = 0.79, p = 0.01). The mean (SD) length of time for return of suppressed cough response was 44.6 (18.8) min. Clinically relevant doses of fentanyl produced cough reflex suppression in healthy volunteers. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  17. Does diurnal variation in cough reflex testing exist in healthy young adults? (United States)

    Perry, Sarah; Huckabee, Maggie-Lee


    The aim of this study was to investigate whether diurnal variation in cough reflex sensitivity exists in healthy young adults when a tidal-breathing method is used. Fifty-three participants (19-37 years) underwent cough reflex testing on two occasions: once in the morning (between 9 am - midday) and once in the afternoon (between 2-5 pm). The order of testing was counter-balanced. Within each assessment, participants inhaled successively higher citric acid concentrations via a facemask, with saline solution randomly interspersed to control for a placebo response. The lowest concentration that elicited a reflexive cough response was recorded. Morning cough thresholds (mean=0.6mol/L) were not different from afternoon cough thresholds (mean=0.6mol/L), p=0.16, T=101, r=-0.14. We found no evidence of diurnal variability in cough reflex testing. There was, however, an order effect irrespective of time of day, confirming that healthy participants are able to volitionally modulate their cough response. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. The capsaicin cough reflex in patients with symptoms elicited by odorous chemicals

    DEFF Research Database (Denmark)

    Holst, H; Arendt-Nielsen, L; Mosbech, H


    Patients with multiple chemical sensitivity and eczema patients with airway symptoms elicited by odorous chemicals have enhanced cough reflex to capsaicin when applying the tidal breathing method. The aims of the present study were to test whether the capsaicin induced cough reflex was enhanced...... when applying the single breath inhalation method in similar groups of patients with symptoms related to odorous chemicals e.g. other persons wearing of perfume; and to investigate to what extent the reporting of lower airway symptoms influenced the cough reflex. Sixteen patients fulfilling Cullen......'s criteria for multiple chemical sensitivity and 15 eczema patients with airway symptoms elicited by odorous chemicals were compared with 29 age-matched, healthy controls. We measured C5--the capsaicin concentration causing five coughs or more--using the single breath inhalation test. No difference was found...

  19. Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients. (United States)

    Kallesen, Molly; Psirides, Alex; Huckabee, Maggie-Lee


    Orotracheal intubation is known to impair cough reflex, but the validity of cough reflex testing (CRT) as a screening tool for silent aspiration in this population is unknown. One hundred and six participants in a tertiary-level intensive care unit (ICU) underwent CRT and videoendoscopic evaluation of swallowing (VES) within 24 hours of extubation. Cough reflex threshold was established for each participant using nebulized citric acid. Thirty-nine (37%) participants had an absent cough to CRT. Thirteen (12%) participants aspirated on VES, 9 (69%) without a cough response. Sensitivity of CRT to identify silent aspiration was excellent, but specificity was poor. There was a significant correlation between intubation duration and presence of aspiration on VES (P= .0107). There was no significant correlation between silent aspiration on VES and length of intubation, age, sex, diagnosis at intensive care unit admission, indication for intubation, Acute Physiology and Chronic Health Evaluation III score, morphine equivalent dose, or time of testing postextubation. Intensive care unit patients are at increased risk of aspiration in the 24 hours following extubation, and an impaired cough reflex is common. However, CRT overidentifies risk of silent aspiration in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Suppression of the cough reflex by α2-adrenergic receptor agonists in the rabbit (United States)

    Cinelli, Elenia; Bongianni, Fulvia; Pantaleo, Tito; Mutolo, Donatella


    The α2-adrenergic receptor agonist clonidine has been shown to inhibit citric acid-induced cough responses in guinea pigs when administered by aerosol, but not orally. In contrast, oral or inhaled clonidine had no effect on capsaicin-induced cough and reflex bronchoconstriction in humans. In addition, intravenous administration of clonidine has been shown to depress fentanyl-induced cough in humans. We investigated the effects of the α2-adrenergic receptor agonists, clonidine and tizanidine, on cough responses induced by mechanical and chemical (citric acid) stimulation of the tracheobronchial tree. Drugs were microinjected (30–50 nL) into the caudal nucleus tractus solitarii (cNTS) and the caudal ventral respiratory group (cVRG) as well as administered intravenously in pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bilateral microinjections of clonidine into the cNTS or the cVRG reduced cough responses at 0.5 mmol/L and abolished the cough reflex at 5 mmol/L. Bilateral microinjections of 0.5 mmol/L tizanidine into the cNTS completely suppressed cough responses, whereas bilateral microinjections of 5 mmol/L into the cVRG only caused mild reductions in them. Depressant effects on the cough reflex of clonidine and tizanidine were completely reverted by microinjections of 10 mmol/L yohimbine. Intravenous administration of clonidine (80–120 μg/kg) or tizanidine (150–300 μg/kg) strongly reduced or completely suppressed cough responses. These effects were reverted by intravenous administration of yohimbine (300 μg/kg). The results demonstrate that activation of α2-adrenergic receptors in the rabbit exerts potent inhibitory effects on the central mechanism generating the cough motor pattern with a clear action at the level of the cNTS and the cVRG. PMID:24400133

  1. Aging deteriorated perception of urge-to-cough without changing cough reflex threshold to citric acid in female never-smokers. (United States)

    Ebihara, Satoru; Ebihara, Takae; Kanezaki, Masashi; Gui, Peijun; Yamasaki, Miyako; Arai, Hiroyuki; Kohzuki, Masahiro


    The effect of aging on the cognitive aspect of cough has not been studied yet. The purpose of this study is to investigate the aging effect on the perception of urge-to-cough in healthy individuals. Fourteen young, female, healthy never-smokers were recruited via public postings. Twelve elderly female healthy never-smokers were recruited from a nursing home residence. The cough reflex threshold and the urge-to-cough were evaluated by inhalation of citric acid. The cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more coughs (C2) and five or more coughs (C5). The urge-to-cough was evaluated using a modified the Borg scale. There was no significant difference in the cough reflex threshold to citric acid between young and elderly subjects. The urge-to-cough scores at the concentration of C2 and C5 were significantly smaller in the elderly than young subjects. The urge-to-cough log-log slope in elderly subjects (0.73 ± 0.71 point · L/g) was significantly gentler than those of young subjects (1.35 ± 0.53 point · L/g, p < 0.01). There were no significant differences in the urge-to-cough threshold estimated between young and elderly subjects. The cough reflex threshold did not differ between young and elderly subjects whereas cognition of urge-to-cough was significantly decreased in elderly subjects in female never-smokers. Objective monitoring of cough might be important in the elderly people.

  2. The capsaicin cough reflex in patients with symptoms elicited by odorous chemicals

    DEFF Research Database (Denmark)

    Holst, H.; Arendt-Nielsen, Lars; Mosbech, H.


    between groups in age, body mass index or pulmonary function. The median C5 were 129 micromol/L (control group), 48 micromol/L (multiple chemical sensitivity patients), 32 micromol/L (eczema patients). The reporting of lower airway symptoms from odorous chemicals was significantly (p......Patients with multiple chemical sensitivity and eczema patients with airway symptoms elicited by odorous chemicals have enhanced cough reflex to capsaicin when applying the tidal breathing method. The aims of the present study were to test whether the capsaicin induced cough reflex was enhanced...... when applying the single breath inhalation method in similar groups of patients with symptoms related to odorous chemicals e.g. other persons wearing of perfume; and to investigate to what extent the reporting of lower airway symptoms influenced the cough reflex. Sixteen patients fulfilling Cullen...

  3. Desensitization of the cough reflex by exercise and voluntary isocapnic hyperpnea. (United States)

    Lavorini, Federico; Fontana, Giovanni A; Chellini, Elisa; Magni, Chiara; Duranti, Roberto; Widdicombe, John


    Little is known about the effects of exercise on the sensory and cognitive aspects of coughing evoked by inhalation of tussigenic agents. The threshold for the cough reflex induced by inhalation of increasing nebulizer outputs of ultrasonically nebulized distilled water (fog), an index of cough reflex sensitivity, was assessed in twelve healthy humans in control conditions, during exercise and during voluntary isocapnic hyperpnea (VIH) at the same ventilatory level as the exercise. The intensity of the urge to cough (UTC), a cognitive component of coughing, was recorded throughout the trials on a linear scale. The relationships between inhaled fog nebulizer outputs and the correspondingly evoked UTC values, an index of the perceptual magnitude of the UTC sensitivity, were also calculated. Cough appearance was always assessed audiovisually. At an exercise level of 80% of anaerobic threshold, the median cough threshold was increased from a control value of 0.73 to 2.22 ml/min (PVIH, the threshold increased from 0.73 to 2.22 ml/min (PVIH compared with control, mean UTC values at cough threshold were unchanged, i.e., control, 3.83 cm; exercise, 3.12 cm; VIH, 4.08 cm. The relationship of the fog nebulizer output/UTC value was linear in control conditions and logarithmic during both exercise and VIH. The perception of the magnitude of the UTC seems to be influenced by signals or sensations arising from exercising limb and thoracic muscles and/or by higher nervous (cortical) mechanisms. The results indicate that the adjustments brought into action by exercise-induced or voluntary hyperpnea exert inhibitory influences on the sensory and cognitive components of fog-induced cough.

  4. Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) with chronic cough and preserved muscle stretch reflexes: evidence for selective sparing of afferent Ia fibres. (United States)

    Infante, Jon; García, Antonio; Serrano-Cárdenas, Karla M; González-Aguado, Rocío; Gazulla, José; de Lucas, Enrique M; Berciano, José


    The aim of this study was to describe five patients with cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) with chronic cough and preserved limb muscle stretch reflexes. All five patients were in the seventh decade of age, their gait imbalance having been initiated in the fifth decade. In four patients cough antedated gait imbalance between 15 and 29 years; cough was spasmodic and triggered by variable factors. Established clinical picture included severe hypopallesthesia predominating in the lower limbs with postural imbalance, and variable degree of cerebellar axial and appendicular ataxia, dysarthria and horizontal gaze-evoked nystagmus. Upper- and lower-limb tendon jerks were preserved, whereas jaw jerk was absent. Vestibular function testing showed bilateral impairment of the vestibulo-ocular reflex. Nerve conduction studies demonstrated normal motor conduction parameters and absence or severe attenuation of sensory nerve action potentials. Somatosensory evoked potentials were absent or severely attenuated. Biceps and femoral T-reflex recordings were normal, while masseter reflex was absent or attenuated. Sympathetic skin responses were normal. Cranial MRI showed vermian and hemispheric cerebellar atrophy predominating in lobules VI, VII and VIIa. We conclude that spasmodic cough may be an integral part of the clinical picture in CANVAS, antedating the appearance of imbalance in several decades and that sparing of muscle spindle afferents (Ia fibres) is probably the pathophysiological basis of normoreflexia.

  5. The capsaicin cough reflex in eczema patients with respiratory symptoms elicited by perfume. (United States)

    Elberling, Jesper; Dirksen, Asger; Johansen, Jeanne Duus; Mosbech, Holger


    Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin. Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n=11) did not relate to the site of the symptoms in the airways and was not associated with increased capsaicin cough responsiveness. In conclusion, respiratory symptoms elicited by perfume may reflect local hyperreactivity related to defensive reflexes in the airways, and measurements of the capsaicin cough reflex are relevant when patients with lower respiratory symptoms related to environmental perfume exposures are investigated.

  6. Comparison of Two Methods for Inducing Reflex Cough in Patients With Parkinson's Disease, With and Without Dysphagia. (United States)

    Hegland, Karen W; Troche, Michelle S; Brandimore, Alexandra; Okun, Michael S; Davenport, Paul W


    Aspiration pneumonia is a common cause of death in people with Parkinson's disease (PD). Dysfunctional swallowing occurs in the majority of people with PD, and research has shown that cough function is also impaired. Previous studies suggest that testing reflex cough by having participants inhale a cough-inducing stimulus through a nebulizer may be a reliable indicator of swallowing dysfunction, or dysphagia. The primary goal of this study was to determine the cough response to two different cough-inducing stimuli in people with and without PD. The second goal of this study was to compare the cough response to the two different stimuli in people with PD, with and without swallowing dysfunction. Seventy adults (49 healthy and 21 with PD) participated in the study. Aerosolized water (fog) and 200 μM capsaicin were used to induce cough. Each substance was placed in a small, hand-held nebulizer, and presented to the participant. Each cough stimulus was presented three times. The total number of coughs produced to each stimulus trial was recorded. All participants coughed more to capsaicin versus fog (p dysphagia. The data show a differential response of the PD participants to the capsaicin versus fog stimuli. Clinically, this finding may allow for earlier identification of people with PD who are in need of a swallowing evaluation. As well, there are implications for the neural control of cough in this patient population.

  7. An investigation into the stability and sterility of citric acid solutions used for cough reflex testing. (United States)

    Falconer, James R; Wu, Zimei; Lau, Hugo; Suen, Joanna; Wang, Lucy; Pottinger, Sarah; Lee, Elaine; Alazawi, Nawar; Kallesen, Molly; Gargiulo, Derryn A; Swift, Simon; Svirskis, Darren


    Citric acid is used in cough reflex testing in clinical and research settings to assess reflexive cough in patients at risk of swallowing disorders. To address a lack of knowledge in this area, this study investigated the stability and sterility of citric acid solutions. Triplicate solutions of citric acid (0.8 M) in isotonic saline were stored at 4 ± 2 °C for up to 28 days and analysed by high-performance liquid chromatography. Microbiological sterility of freshly prepared samples and bulk samples previously used for 2 weeks within the hospital was determined using a pour plate technique. Microbial survival in citric acid was determined by inoculating Staphylococcus aureus, Escherichia coli, or Candida albicans into citric acid solution and monitoring the number of colony-forming units/mL over 40 min. Citric acid solutions remained stable at 4 °C for 28 days (98.4 ± 1.8 % remained). The freshly prepared and clinical samples tested were sterile. However, viability studies revealed that citric acid solution allows for the survival of C. albicans but not for S. aureus or E. coli. The microbial survival study showed that citric acid kills S. aureus and E. coli but has no marked effect on C. albicans after 40 min. Citric acid samples at 0.8 M remained stable over the 4-week testing period, with viable microbial cells absent from samples tested. However, C. albicans has the ability to survive in citric acid solution if inadvertently introduced in practice. For this reason, in clinical and research practice it is suggested to use single-use aliquots prepared aseptically which can be stored for up to 28 days at 4 °C.

  8. The cough reflex is upregulated by lisinopril microinjected into the caudal nucleus tractus solitarii of the rabbit. (United States)

    Cinelli, Elenia; Bongianni, Fulvia; Pantaleo, Tito; Mutolo, Donatella


    We have previously shown that cough potentiation induced by intravenous administration of the AT1 receptor antagonist losartan is lower than that induced by the ACE inhibitor lisinopril in anesthetized and awake rabbits. Since losartan and lisinopril cross the blood-brain barrier, their central action on the cough reflex can be hypothesized. Mechanical stimulation of the tracheobronchial tree and citric acid inhalation were used to induce cough reflex responses in pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bilateral microinjections (30-50 nl) of losartan (5mM), lisinopril (1mM), bradykinin (0.05 mM), HOE-140 (0.2mM, a bradykinin B2 receptor antagonist) and CP-99,994 (1mM, an NK1 receptor antagonist) were performed into the caudal nucleus tractus solitarii, the predominant site of termination of cough-related afferents. Lisinopril, but not losartan increased the cough number. This effect was reverted by HOE-140 or CP-99,994. Cough potentiation was also induced by bradykinin. The results support for the first time a central protussive action of lisinopril mediated by an accumulation of bradykinin and substance P. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Modulation of the cough reflex by GABAA receptors in the caudal ventral respiratory group of the rabbit

    Directory of Open Access Journals (Sweden)

    Elenia eCinelli


    Full Text Available We have previously shown that the caudal ventral respiratory group (cVRG is a possible site of action of some antitussive drugs and plays a crucial role in determining both the expiratory and inspiratory components of the cough motor pattern. In addition, it has been reported that medullary expiratory neurons of the cVRG are subject to potent GABAergic gain modulation. This study was devoted to investigate the role of cVRG GABAA receptors in the control of baseline respiratory activity and cough responses to mechanical and chemical (citric acid stimulation of the tracheobronchial tree. To this purpose, bilateral microinjections (30-50 nl of bicuculline or muscimol were performed into the cVRG of pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bicuculline (1 mM increased peak abdominal activity and respiratory frequency due to decreases in TE. Cough responses were potentiated mainly owing to increases in the cough number. The recovery was observed within ~ 2 h. On the contrary, muscimol (0.3 mM abolished abdominal activity and decreased respiratory frequency due to increases in TE. In addition, cough responses were progressively reduced and completely suppressed within ~ 20 min. Partial recovery of cough responses was achieved after ~ 3 h or within ~ 5 min following bicuculline microinjections at the same locations. The sneeze reflex induced by mechanical stimulation of the nasal mucosa persisted following bicuculline and muscimol microinjections. However, the number and intensity of expiratory thrusts were enhanced by bicuculline and suppressed by muscimol. The results provide evidence that a potent GABAA-mediated inhibitory modulation is exerted at the level of the cVRG not only on respiratory activity, but also on cough and sneeze reflex responses.

  10. The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes (United States)


    Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of chronic cough, however randomised controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngo-pharyngeal reflux, micro-aspiration and neuronal cross-organ sensitisation. How recent evidence might shed light on the failure of acid suppressing therapies and suggest new approaches to treating reflux related cough are also discussed. PMID:23590893

  11. Cough reflex sensitivity does not correlate with the esophageal sensitivity to acid in patients with gastroesophageal reflux disease. (United States)

    Duricek, Martin; Nosakova, Lenka; Zatko, Tomas; Pecova, Renata; Hyrdel, Rudolf; Banovcin, Peter


    The sensitization of cough reflex observed in patients with gastroesophageal reflux disease (GERD) is attributed to activation of vagal C-fibers innervating the esophagus by acid, while the heartburn in GERD is mediated by esophageal acid sensitive C-fibers derived from (dorsal root ganglia) DRG. Here we explored the relationship between cough reflex sensitivity (CRS) and esophageal sensitivity to acid. We evaluated CRS to capsaicin inhalation and esophageal sensitivity to acid (intensity of heartburn evoked by esophageal infusions of acid pH = 3, 2 and 1) in patients with GERD and chronic heartburn before and 3 months after proton pump inhibitor (PPI) treatment. There was no correlation between CRS and esophageal sensitivity to acid at any pH tested. PPI treatment substantially reduced esophageal sensitivity to acid but did not affect CRS. We conclude that a simple direct relationship between CRS and esophageal sensitivity to acid is unlikely. The results indicate that spinal and vagal afferent pathways from the esophagus are probably influenced separately in subjects with GERD. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. The role of excitatory amino acids and substance P in the mediation of the cough reflex within the nucleus tractus solitarii of the rabbit. (United States)

    Mutolo, Donatella; Bongianni, Fulvia; Fontana, Giovanni A; Pantaleo, Tito


    We hypothesized that cough evoked by mechanical stimulation of the tracheobronchial tree in the rabbit is primarily mediated by glutamatergic neurotransmission at the level of the caudal portions of the medial subnucleus of the nucleus tractus solitarii (NTS) and the lateral commissural NTS where cough-related afferents terminate, and that this reflex is potentiated by local release of substance P. To test our hypothesis, we performed bilateral microinjections (30-50 nl) of ionotropic glutamate receptor antagonists or substance P into these locations in pentobarbitone anaesthetized, spontaneously breathing rabbits. Blockade of NMDA and non-NMDA receptors by 50mM kynurenic acid abolished the cough reflex without affecting the Breuer-Hering inflation reflex or the pulmonary chemoreflex. Blockade of non-NMDA receptors using 10mM CNQX or 5mM NBQX caused identical effects. Blockade of NMDA receptors by 10mM D-AP5 strongly reduced, but did not abolish cough responses. Microinjections of 1mM substance P increased peak and rate of rise of abdominal muscle activity as well as cough number. These results are the first to provide evidence that ionotropic glutamate receptors, especially non-NMDA receptors, located within specific regions of NTS are primarily involved in the mediation of cough evoked by mechanical stimulation of the tracheobronchial tree in the rabbit. Present findings on substance P cough-enhancing effects extend previous observations and are relevant to the tachykinin-mediated central sensitization of the cough reflex. They also may provide hints for further studies on centrally acting antitussive drugs.

  13. Influence of viscous Rhodella grisea (Rhodophyceae) proteoglycan on chemically induced cough reflex

    Czech Academy of Sciences Publication Activity Database

    Nosál´ová, G.; Capek, P.; Flešková, D.; Jureček, L´.; Hindák, F.; Lukavský, Jaromír; Cepák, Vladislav; Ray, B.; Breierová, E.; Turjan, J.


    Roč. 49, č. 4 (2011), 1046-1050 ISSN 0141-8130 R&D Projects: GA MŠk 1M0571 Institutional research plan: CEZ:AV0Z60050516 Keywords : Rhodella griesea * proteoglykan * cough Subject RIV: EF - Botanics Impact factor: 2.453, year: 2011

  14. The capsaicin cough reflex in eczema patients with respiratory symptoms elicited by perfume

    DEFF Research Database (Denmark)

    Elberling, Jesper; Dirksen, Asger; Johansen, Jeanne Duus


    Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this st......Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim...... of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case...... control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin. Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n=11) did not relate...

  15. Treatment of recalcitrant cough with baclofen

    Directory of Open Access Journals (Sweden)

    Paolo Agostinis


    Full Text Available Background: Chronic dry cough is a debilitating symptom often refractory to standard antitussive therapy. It may result from increased sensitivity of the cough reflex. Baclofen, an agonist of gamma-aminobutyric acid (GABA, has been shown, in animals, to have antitussive activity via a central mechanism. In normal subjects baclofen has been revealed ability to inhibit capsaicininduced cough and cough due to angiotensin-converting enzyme (ACE inhibitors. In addition, chronic therapy with baclofen has been shown to reduce cough reflex sensitivity in subjects with cervical spinal cord injury. Clinical cases: We describe two patients with chronic refractory cough who obtained symptomatic improvement after oral baclofen administration. The antitussive effect of baclofen, usually used for treatment of spasticity associated with multiple sclerosis and spinal cord lesions, can be explained by central inhibition, but may also involve peripheral inhibitory mechanisms.

  16. Suppression of the cough reflex by inhibition of ERK1/2 activation in the caudal nucleus tractus solitarii of the rabbit. (United States)

    Mutolo, Donatella; Bongianni, Fulvia; Cinelli, Elenia; Giovannini, Maria Grazia; Pantaleo, Tito


    The caudal nucleus tractus solitarii (cNTS), the predominant site of termination of cough-related afferents, has been shown to be a site of action of some centrally acting antitussive agents. A role of ERK1/2 has been suggested in acute central processing of nociceptive inputs. Because pain and cough share similar features, we investigated whether ERK1/2 activation could also be involved in the central transduction of tussive inputs. For this purpose, we undertook the present research on pentobarbital sodium-anesthetized, spontaneously breathing rabbits by using microinjections (30-50 nl) of an inhibitor of ERK1/2 activation (U0126) into the cNTS. Bilateral microinjections of 25 mM U0126 caused rapid and reversible reductions in the cough responses induced by both mechanical and chemical (citric acid) stimulation of the tracheobronchial tree. In particular, the cough number and peak abdominal activity decreased. Bilateral microinjections of 50 mM U0126 completely suppressed the cough reflex without affecting the Breuer-Hering inflation reflex, the pulmonary chemoreflex, and the sneeze reflex. These U0126-induced effects were, to a large extent, reversible. Bilateral microinjections of 50 mM U0124, the inactive analog of U0126, at the same cNTS sites had no effect. This is the first study that provides evidence that ERK1/2 activation within the cNTS is required for the mediation of cough reflex responses in the anesthetized rabbit. These results suggest a role for ERK1/2 in the observed effects via nontranscriptional mechanisms, given the short time involved. They also may provide hints for the development of novel antitussive strategies.

  17. Utility of tests used to diagnose asthma, gastroesophageal reflux and upper airway cough syndrome in patients with chronic cough and normal chest radiography

    Directory of Open Access Journals (Sweden)

    Ahmed E. Mansour


    Conclusion: Asthma, UACS, GERD, or some combination of these represent 78% of the causes of chronic cough in our sample. Therefore, these conditions should be considered first during diagnostic evaluation of patients with chronic cough and normal CXR. Inspite of some discrepancy between initial and final diagnoses, the study identifies the group of diagnostic methods best able to identify the cause in the vast majority of cases of chronic cough including sinuses CT scan, rhinoscopy, pulmonary function tests, and esophageal pH monitoring.

  18. Influence of microinjections of D,L-homocysteic acid into the Botzinger complex area on the cough reflex in the cat. (United States)

    Poliacek, I; Corrie, L W; Rose, M J; Wang, C; Bolser, D C


    Microinjections of D,L-homocysteic acid (DLH) were used to test the hypothesis that neuronal activation within the Botzinger complex area can modify the spatiotemporal characteristics of the cough reflex in 17 spontaneously breathing pentobarbitone anesthetized cats. DLH (50 mM, 1.25-1.75 nmol, 9 cats) reduced the number (P<0.01) of coughs and expiratory amplitude of abdominal electromyographic activity (P<0.01), and also esophageal pressure (P<0.001) during mechanically induced tracheobronchial cough. The duration of cough abdominal activity was shortened by 48% (P<0.05). DLH microinjections also temporarily reduced the respiratory rate (P<0.01) and increased the mean arterial blood pressure (P<0.001), baseline of esophageal pressure (P<0.01), and end tidal CO(2) concentrations (P<0.01). Lower doses of DLH (0.27-0.35 nmol, 7 cats) or vehicle (25-35 nl, 8 cats) induced few alterations in cardiorespiratory or cough characteristics. The results support predominantly inhibitory effects of neurons in the region of the Bötzinger complex on cough abdominal activity and cough number.

  19. A service evaluation of cough reflex testing to guide dysphagia management in the postsurgical adult head and neck patient population. (United States)

    Holmes, Samantha


    The article reviews recent literature supporting the use of cough reflex testing (CRT), and outlines a service evaluation of CRT conducted with postsurgical head and neck cancer patients. There is a growing evidence base to support the use of CRT in dysphagia management to establish laryngeal sensation and screen for silent aspiration; however, there is a lack of evidence relating to using CRT within the head and neck population. Over a 3-month period, inpatients on an ear, nose and throat/maxillofacial ward underwent CRT as part of their clinical swallow evaluation. Data from these patients were collected, including their diagnoses, CRT findings, and subsequent management. The evaluation was limited by difficulties in maintaining a supply of citric acid, accessing medics to prescribe the citric acid, and staffing levels, as administration of the CRT initially required two members of staff to be present. The service evaluation findings, alongside current evidence examining noncancer mortality rates, suggests identification of silent aspiration is important in this population. CRT was useful to rationalize instrumental assessments and was easily incorporated into the swallowing evaluation. More evidence is needed to support the use of CRT within the head and neck population.

  20. Study of Achilles Tendon Reflex in Normal Korean and Various Thyroid Diseases

    International Nuclear Information System (INIS)

    Kang, Jin Yung; Kim, Kwang Won; Yae, Sung Bo; Lee, Hong Kyu; Koh, Chang Soon


    In an attempt to establish the diagnostic value of Achilles tendon reflex and to determine the normal value of Achilles tendon reflex time in normal Korean, the author measured the Achilles tendon reflex time by photomotograph. This study was carried out in 272 cases with various thyroid diseases and 340 normal Korean. 1) The Achilles tendon reflex time in normal Korean was like this, between 11 years old and 20 years old; male (62 cases); 250±27 msec, female (36 cases); 266±27 msec, between 21 years old and 30 years old; male (38 cases); 271±27 msec, female (21 cases); 284±27 msec, between 31 years old and 40 years old; male (26 cases); 275±25 msec, female (29 cases); 291±27 msec, between 41 years old and 50 years old; male (20 cases); 286±35 msec, female (24 cases); 307±42 msec, between 51 years old and 60 years old, male (20 cases); 296±33 msec, female (20 cases); 318±46 msec, over 61 years; male (24 cases) 301±33 msec, female (20 cases); 325±35 msec. The Achilles tendon reflex time was delayed with increasing age and delayed in the female. 2) The Achilles tendon reflex time was markedly shortened to 221±20 msec in untreated hyperthyroidism. 3) The Achilles tendon reflex time was markedly delayed to 435±59 msec in hypothyroidism. 4) The Achilles tendon reflex time was not changed significantly in other thyroid diseases with norms thyroid function. 5) The Achilles tendon reflex time showed good correlationship with ETR, T 3 RU, 131 I thyroid uptake and serum TSH. 6) Reproducibility of Achilles tendon reflex time was good, and no significant difference between left and right was noted. 7) Diagnostic accuracy of Achilles tendon reflex time was 71% in hyperthyroidism and 90% in hypothyroidism. 8) The Achilles tendon reflex time showed useful test to evaluate the clinical course of the hyperthyroidism.

  1. Interindividual differences in H reflex modulation during normal walking

    DEFF Research Database (Denmark)

    Simonsen, Erik B; Dyhre-Poulsen, Poul; Alkjaer, T


    was greater for the S group. The hip joint moment was similar for the groups. The EMG activity in the vastus lateralis and anterior tibial muscles was greater prior to heel strike for the S group. These data indicate that human walking exhibits at least two different motor patterns as evaluated by gating...... of afferent input to the spinal cord, by EMG activity and by walking mechanics. Increasing H reflex excitability during the swing phase appears to protect the subject against unexpected perturbations around heel strike by a facilitated stretch reflex in the triceps surae muscle. Alternatively, in subjects...... with a suppressed H reflex in the swing phase the knee joint extensors seem to form the primary protection around heel strike....

  2. Suppressive effect of pectic polysaccharides from Cucurbita pepo L. var. Styriaca on citric acid-induced cough reflex in guinea pigs. (United States)

    Nosáľová, Gabriela; Prisenžňáková, Lubica; Košťálová, Zuzana; Ebringerová, Anna; Hromádková, Zdenka


    Several water-soluble pectic polysaccharides were isolated from the pumpkin fruit biomass and characterized by composition, structural features and molecular properties. The pectic polysaccharides were tested for antitussive activity by studying the effects of citric acid-induced cough reflex in guinea pigs and reactivity of the airway smooth muscle in vivo conditions in comparison to the narcotic drug codeine. Oral administration of all pectic polysaccharides from pumpkin inhibited the number of coughs induced by citric acid in guinea pigs, but to various extents. The results indicated that the antitussive activity of the pectic polysaccharides is affected by their molecular and structural properties, whereby a synergistic action between the polysaccharide and non-carbohydrate components on the biological response has been suggested as well. The cough depressive efficacy of most of the tested polysaccharides was comparable and even higher than that of codeine. Moreover, the application of these polysaccharides provoked any side effects what is their advantage towards the conventional opioid-derived antitussive agents. Copyright © 2010 Elsevier B.V. All rights reserved.

  3. Human H-reflexes are smaller in difficult beam walking than in normal treadmill walking. (United States)

    Llewellyn, M; Yang, J F; Prochazka, A


    Hoffman (H) reflexes were elicited from the soleus (SOL) muscle while subjects walked on a treadmill and on a narrow beam (3.5 cm wide, raised 34 cm from the floor). The speed of walking on the treadmill was selected for each subject to match the background activation level of their SOL muscle during beam walking. The normal reciprocal activation pattern of the tibialis anterior and SOL muscles in treadmill walking was replaced by a pattern dominated by co-contraction on the beam. In addition, the step cycle duration was more variable and the time spent in the swing phase was reduced on the beam. The H-reflexes were highly modulated in both tasks, the amplitude being high in the stance phase and low in the swing phase. The H-reflex amplitude was on average 40% lower during beam walking than treadmill walking. The relationship between the H-reflex amplitude and the SOL EMG level was quantified by a regression line relating the two variables. The slope of this line was on average 41% lower in beam walking than treadmill walking. The lower H-reflex gain observed in this study and the high level of fusimotor drive observed in cats performing similar tasks suggest that the two mechanisms which control the excitability of this reflex pathway (i.e. fusimotor action and control of transmission at the muscle spindle to moto-neuron synapse) may be controlled independently.

  4. A Study on Achilles Tendon Reflex in Normal Korean Persons and Various Thyroid Diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Jin Yung; Kim, Myung Duk; Lee, Hong Kyu; Lee, Jung Sang; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Since Chaney reported the measurement of ankle jerk in Patients with myxedema for the first time, slowing of the reflex in myxedema has been well documented by many authors. Although its mechanisms have not been elucidated clearly, it has long been held in esteem by clinicians a near pathognomonic sign in myxedema. Possible mechanisms suggested include (a) abnormal activity of the central nervous system, (b) a disorder of muscle like that of myotonia (c) lowered temperature of the muscle, (d) increased viscosity of the muscle due to myxdematous infiltration and (e) part of a general slowing of all vital processes. The brisk reflex in thyrotoxicosis has also been noted to be characteristic. The recent development of several simple methods of quantitating the deep tendon reflex time has made its application an easy, rapid, inexpensive and accurate test in the results of our examinations on the Achilles tendon reflex (ATR) times in normal Koreans along their sexes, ages and in various thyroid diseases. Also we observed the changes of ATR times in the thyrotoxicosis and myxedema after the initiation of treatment and compared them with other thyroid function tests.

  5. What is chronic cough in children?

    Directory of Open Access Journals (Sweden)

    Iulia eIOAN


    Full Text Available The cough reflex is modulated throughout growth and development. Cough – but not expiration reflex – appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient towards specific aetiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, paediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific.

  6. Cough in children. (United States)

    Lamas, Adelaida; Ruiz de Valbuena, Marta; Máiz, Luis


    Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing "normal cough", but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or "chronic cough", must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of "nonspecific chronic cough", in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  7. Operant conditioning of the soleus H-reflex does not induce long-term changes in the gastrocnemius H-reflexes and does not disturb normal locomotion in humans. (United States)

    Makihara, Yukiko; Segal, Richard L; Wolpaw, Jonathan R; Thompson, Aiko K


    In normal animals, operant conditioning of the spinal stretch reflex or the H-reflex has lesser effects on synergist muscle reflexes. In rats and people with incomplete spinal cord injury (SCI), soleus H-reflex operant conditioning can improve locomotion. We studied in normal humans the impact of soleus H-reflex down-conditioning on medial (MG) and lateral gastrocnemius (LG) H-reflexes and on locomotion. Subjects completed 6 baseline and 30 conditioning sessions. During conditioning trials, the subject was encouraged to decrease soleus H-reflex size with the aid of visual feedback. Every sixth session, MG and LG H-reflexes were measured. Locomotion was assessed before and after conditioning. In successfully conditioned subjects, the soleus H-reflex decreased 27.2%. This was the sum of within-session (task dependent) adaptation (13.2%) and across-session (long term) change (14%). The MG H-reflex decreased 14.5%, due mainly to task-dependent adaptation (13.4%). The LG H-reflex showed no task-dependent adaptation or long-term change. No consistent changes were detected across subjects in locomotor H-reflexes, EMG activity, joint angles, or step symmetry. Thus, in normal humans, soleus H-reflex down-conditioning does not induce long-term changes in MG/LG H-reflexes and does not change locomotion. In these subjects, task-dependent adaptation of the soleus H-reflex is greater than it is in people with SCI, whereas long-term change is less. This difference from results in people with SCI is consistent with the fact that long-term change is beneficial in people with SCI, since it improves locomotion. In contrast, in normal subjects, long-term change is not beneficial and may necessitate compensatory plasticity to preserve satisfactory locomotion. Copyright © 2014 the American Physiological Society.

  8. Intramuscular Neurotrophin-3 normalizes low threshold spinal reflexes, reduces spasms and improves mobility after bilateral corticospinal tract injury in rats. (United States)

    Kathe, Claudia; Hutson, Thomas Haynes; McMahon, Stephen Brendan; Moon, Lawrence David Falcon


    Brain and spinal injury reduce mobility and often impair sensorimotor processing in the spinal cord leading to spasticity. Here, we establish that complete transection of corticospinal pathways in the pyramids impairs locomotion and leads to increased spasms and excessive mono- and polysynaptic low threshold spinal reflexes in rats. Treatment of affected forelimb muscles with an adeno-associated viral vector (AAV) encoding human Neurotrophin-3 at a clinically-feasible time-point after injury reduced spasticity. Neurotrophin-3 normalized the short latency Hoffmann reflex to a treated hand muscle as well as low threshold polysynaptic spinal reflexes involving afferents from other treated muscles. Neurotrophin-3 also enhanced locomotor recovery. Furthermore, the balance of inhibitory and excitatory boutons in the spinal cord and the level of an ion co-transporter in motor neuron membranes required for normal reflexes were normalized. Our findings pave the way for Neurotrophin-3 as a therapy that treats the underlying causes of spasticity and not only its symptoms.

  9. The impact of harmfulness information on citric acid induced cough and urge-to-cough. (United States)

    Janssens, Thomas; Brepoels, Sarah; Dupont, Lieven; Van den Bergh, Omer


    The cough reflex is an automatic protective reflex, which can be modulated by conscious effort or other forms of top-down control. In this experiment, we investigated whether information about harmfulness of a cough-inducing substance would augment cough reflex sensitivity and associated urge-to-cough. Healthy participants (N = 39) were randomized to receive information that they were to inhale a harmless substance (natural citric acid), or a potentially harmful substance (a potent agro-chemical acid). Using dosimeter-controlled inhalations, the dose of citric acid eliciting at least three coughs (C3) was determined. Next, participants received 4 blocks of randomized presentations of citric acid at the C3 dose, a sub-threshold dose of citric acid and saline control. C3 was reached for 27/39 participants, and C3 thresholds were not influenced by harmfulness information. During repeated citric acid presentations, framing the cough-inducing substance as a potentially harmful chemical resulted in a greater urge-to-cough compared to information framing it as natural citric acid (p < .01). The experimental manipulation did not influence cough frequencies. Our findings show that harmfulness information influences urge-to-cough, corroborating the role of cortical mechanisms in modulating the urge-to-cough and suggesting that cognitive manipulations may contribute to cough treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Management of Cough: a practical approach | Vally | South African ...

    African Journals Online (AJOL)

    On a regular day, healthcare providers will be contacted by one or more health seekers presenting with cough as a symptom. Cough has been considered an important physiological reflex that protects the airways from aspiration of foreign materials. Cough is one of the most common symptoms for which people seek ...

  11. Persistent cough in an adolescent. (United States)

    Stein, M T; Harper, G; Chen, J


    Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a

  12. An overview of post infectious coughs

    Directory of Open Access Journals (Sweden)

    Samrad Mehrabi


    Full Text Available Coughs lasting more than 3 weeks after airway infections are likely regarded as post-infectious coughs. A normal chest radiography unfavors possibility of pulmonary infection. These coughs are selflimited. This study reviews conducted studies in order to identify and define prevalence, pathogenesis, and cure of post-infectious constant coughs. The necessary data and guidelines are gained from English articles in PubMed website. Post-infectious and cough are searched. Post-infectious cough pathogenesis are not known; nevertheless, inflammation, epithelial damages of upper and lower airways, increased mucus secretion, and an increased reactivity of airways can cause these coughs. Despite self-limitedness of these coughs; dextromethorphan, antihistamines, ipratropium bromide, and decongestant are usually prescribed for cure of these coughs. Conversely, antibiotics play no significant role in this regard. These coughs constitutes smaller percentage of chronic coughs and are primarily classified in subacute coughs. Further studies should cover sub-acute and chronic properties of these coughs as well as their prevalence in different age groups and their determinants.

  13. Cough & Cold Medicine Abuse (United States)

    ... Videos for Educators Search English Español Cough & Cold Medicine Abuse KidsHealth / For Teens / Cough & Cold Medicine Abuse ... resfriado Why Do People Use Cough and Cold Medicines to Get High? There's an ingredient in many ...

  14. Pertussis (Whooping Cough) (United States)

    ... guidelines, articles... Pregnant? Help Protect Your Baby from Whooping Cough frame support disabled and/or not supported in ... the disease. Also available on YouTube. Pregnancy and Whooping Cough Learn more about whooping cough vaccination during pregnancy… ...

  15. Theobromine inhibits sensory nerve activation and cough. (United States)

    Usmani, Omar S; Belvisi, Maria G; Patel, Hema J; Crispino, Natascia; Birrell, Mark A; Korbonits, Márta; Korbonits, Dezso; Barnes, Peter J


    Cough is a common and protective reflex, but persistent coughing is debilitating and impairs quality of life. Antitussive treatment using opioids is limited by unacceptable side effects, and there is a great need for more effective remedies. The present study demonstrates that theobromine, a methylxanthine derivative present in cocoa, effectively inhibits citric acid-induced cough in guinea-pigs in vivo. Furthermore, in a randomized, double-blind, placebo-controlled study in man, theobromine suppresses capsaicin-induced cough with no adverse effects. We also demonstrate that theobromine directly inhibits capsaicin-induced sensory nerve depolarization of guinea-pig and human vagus nerve suggestive of an inhibitory effect on afferent nerve activation. These data indicate the actions of theobromine appear to be peripherally mediated. We conclude theobromine is a novel and promising treatment, which may form the basis for a new class of antitussive drugs.

  16. Coughing (For Parents) (United States)

    ... usually don't prescribe antibiotics because these only work against bacteria. Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but they don't treat the cause of the cough. If you do use an ...

  17. Gastro-oesophageal reflux and cough. (United States)

    Abdulqawi, Rayid; Houghton, Lesley A; Smith, Jaclyn A


    Gastro-oesophageal reflux, either singly or in association with postnasal drip and/or asthma is considered to be a cause of chronic cough. The amount and nature of gastro-oesophageal reflux however is often normal with acid suppression having very little, if any therapeutic effect in these patients. This review examines the challenges posed when exploring the reflux-cough link, and discusses the merits and limitations of the proposed mechanisms of reflux leading to cough.

  18. An annoying persistent cough

    Directory of Open Access Journals (Sweden)

    Francesco Cipollini


    Full Text Available Chronic cough is a stressful condition and can lead to extensive investigations. We report a case of a 48-year-old woman who had suffered from persistent chronic cough for more than 3 months. She had been treated with cough suppressant. However, her cough was not alleviated by these treatments, and the patient was referred to our hospital. She did not exhibit typical gastroesophageal reflux disease (GERD symptoms heartburn and regurgitation. Esophagoscopy did not disclose reflux esophagitis. The patient was treated with a proton-pump inhibitor, which markedly alleviated her cough. Chronic cough due to GERD was diagnosed. Although the diagnosis of chronic cough due to GERD is not easy when traditionally symptoms are not present, our case report underscores the importance of this association to the differential diagnosis of chronic cough. In these cases a relatively simple test as high dose proton pump-inhibitors trial may be useful to confirm GERD related cough.

  19. Cough-induced rib fractures. (United States)

    Hanak, Viktor; Hartman, Thomas E; Ryu, Jay H


    To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors. For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories. The mean +/- SD age of the 54 study patients at presentation was 55+/-17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (> or =3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%). Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.

  20. Whooping Cough (Pertussis) (United States)

    ... Staying Safe Videos for Educators Search English Español Whooping Cough (Pertussis) KidsHealth / For Parents / Whooping Cough (Pertussis) What's in this article? Signs & Symptoms Contagiousness ...

  1. Autosomal dominant hereditary sensory neuropathy with chronic cough and gastro-oesophageal reflux: clinical features in two families linked to chromosome 3p22-p24. (United States)

    Spring, Penelope J; Kok, Cindy; Nicholson, Garth A; Ing, Alvin J; Spies, Judith M; Bassett, Mark L; Cameron, John; Kerlin, Paul; Bowler, Simon; Tuck, Roger; Pollard, John D


    Autosomal dominant hereditary sensory neuropathy (HSN I) is a clinically and genetically heterogeneous group of disorders, and in some families it is due to mutations in the serine palmitoyltransferase (SPTLC1) gene. We have characterized two families with HSN I associated with cough and gastro-oesophageal reflux (GOR). From a large Australian family, 27 individuals and from a smaller family, 11 individuals provided clinical information and blood for genetic analysis. Affected individuals had an adult onset of paroxysmal cough, GOR and distal sensory loss. Cough could be triggered by noxious odours or by pressure in the external auditory canal (Arnold's ear-cough reflex). Other features included throat clearing, hoarse voice, cough syncope and sensorineural hearing loss. Neurophysiological and pathological studies demonstrated a sensory axonal neuropathy. Gastric emptying studies were normal, and autonomic function and sweat tests were either normal or showed distal hypohidrosis. Cough was likely to be due to a combination of denervation hypersensitivity of the upper airways and oesophagus, and prominent GOR. Most affected individuals were shown on 24 h ambulatory oesophageal pH monitoring to have multiple episodes of GOR, closely temporally associated with coughing. Hoarse voice was probably attributable to acid-induced laryngeal damage, and there was no evidence of vocal cord palsy. No other cause for cough was found on most respiratory or otorhinological studies. Linkage to chromosome 3p22-p24 has been found in both families, with no evidence of linkage to loci for known HSN I, autosomal dominant hereditary motor and sensory neuropathy, hereditary GOR or triple A syndrome. These families represent a genetically novel variant of HSN I, with a distinctive cough owing to involvement of the upper aerodigestive tract.

  2. Cough response to citric acid aerosol in occasional smokers.


    Pounsford, J C; Saunders, K B


    Twenty two normal women volunteers underwent a standard cough provocation test by inhaling solutions of citric acid of progressively increasing concentration. Eight were non-smokers, eight moderate smokers, and six occasional smokers. All the non-smokers and moderate smokers coughed. Moderate smokers tended to cough more than non-smokers, but not significantly so. None of the occasional smokers coughed at all (p less than 0.001). Possibly the ability to smoke occasionally with enjoyment is a ...

  3. Influence of Polysaccharides from Aloe vera (Aloe barbadensis Miller, Liliaceae on Mechanically Induced Cough in Cats

    Directory of Open Access Journals (Sweden)

    Martina Šutovská


    Full Text Available Different plants have been reported to be a source of polysaccharides that possess a great variety of biological activities, including cough suppression. The experiments were aimed on the influence of two polysaccharides isolated from the gel (A, HF1-Z and one from the epidermis (SL-1 of Aloe vera leaves, characterized by chemical composition and structural properties, on the cough reflex. The method of mechanically induced cough was used in conscious cats. A nylon fibre directed individually into the mucous area of the laryngopharyngeal and tracheobronchial airways via endotracheal cannula elicited the cough reflex. Statistical evaluation registered cough reflex indicators (number of cough efforts - NE, cough frequency - NE min–1 intensity of cough attacks during expiration and inspiration - IA+ and IA-, intensity of maximal inspiratory and expiratory cough efforts - IME- and IME+ showed that gel polysaccharide HF1-Z possessed higher cough-suppressing activity than dropropizine, a nonnarcotic peripheral cough suppressant. Their antitussive activity was accompanied mainly with a decrease of NE, IA+ and IA- from both laryngopharyngeal and tracheobronchial mucous areas of the airways. Results of the presented study also showed minimal influence of polysaccharide HF1-Z on expectoration predictor, IME- and IME+. New pharmacodynamic property of polysaccharides isolated from Aloe vera was shown during experiments, which could be a base of their possible therapeutic use in this indication in future.

  4. A Study of Relationship between the Acoustic Sensitivity of Vestibular System and the Ability to Trigger Sound-Evoked Muscle Reflex of the Middle Ear in Adults with Normal Hearing

    Directory of Open Access Journals (Sweden)

    S.F. Emami


    Full Text Available Introduction & Objective: The vestibular system is sound sensitive and the sensitivity is related to the saccule. The vestibular afferents are projected to the middle ear muscles (such as the stapedius. The goal of this research was studying the relationship between the vestibular hearing and the sound-evoked muscle reflex of the middle ear to 500 HZ. Materials & Methods: This study was a cross sectional-comparison done in audiology department of Sheikholreis C‍‍linic (Hamadan, Iran. The study groups consisted of thirty healthy people and thirty patients with benign paroxysmal positional vertigo. Inclusion criteria of the present study were to have normal hearing on pure tone audiometry, acoustic reflex, and speech discrimination scores. Based on ipsilateral acoustic reflex test at 500HZ, they were divided to normal and abnormal groups. Then they were evaluated by cervical vestibular evoked myogenic potentials (cVEMPs and finally classified in three groups (N Normal ear , (CVUA Contra lateral vertiginous ear with unaffected saccular sensitivity to sound,(IVA Ipsilateral vertiginous ear with affected saccular sensitivity to sound. Results: Thirty affected ears (IVA with decreased vestibular excitability as detected by ab-normal cVEMPs, revealed abnormal findings of acoustic reflex at 500HZ. Whereas, both un-affected (CVUA and normal ears (N had normal results. Multiple comparisons of mean values of cVEMPs (p13,n23 and acoustic reflex at500HZ among the three groups were sig-nificant. The correlation between acoustic reflex at 500HZ and p13 latencies was significant. The n23 latencies showed significant correlation with acoustic reflex at 500HZ. Conclusion: The vestibular sensitivity to sound retains the ability to trigger sound-evoked re-flex of the middle ear at 500 HZ. (Sci J Hamadan Univ Med Sci 2014; 21 (2:99-104

  5. Pregnancy and Whooping Cough (United States)

    ... cough vaccine recommendation for pregnant women, infants and children, preteens and teens, and adults. You may print ... Vaccinating Pregnant Patients Answering Patient Questions Making a Strong ...

  6. First Aid: Coughing (United States)

    ... this topic for: Parents Kids Teens Flu Center Asthma Center Your Child's Immunizations: Diphtheria, Tetanus & Pertussis Vaccine (DTaP) Whooping Cough (Pertussis) Is It a Cold or the Flu? Why Is Hand Washing So ... Asthma Center Flu Center Whooping Cough Your Lungs & Respiratory ...

  7. Design and characterization of a cough simulator. (United States)

    Zhang, Bo; Zhu, Chao; Ji, Zhiming; Lin, Chao-Hsin


    Expiratory droplets from human coughing have always been considered as potential carriers of pathogens, responsible for respiratory infectious disease transmission. To study the transmission of disease by human coughing, a transient repeatable cough simulator has been designed and built. Cough droplets are generated by different mechanisms, such as the breaking of mucus, condensation and high-speed atomization from different depths of the respiratory tract. These mechanisms in coughing produce droplets of different sizes, represented by a bimodal distribution of 'fine' and 'coarse' droplets. A cough simulator is hence designed to generate transient sprays with such bimodal characteristics. It consists of a pressurized gas tank, a nebulizer and an ejector, connected in series, which are controlled by computerized solenoid valves. The bimodal droplet size distribution is characterized for the coarse droplets and fine droplets, by fibrous collection and laser diffraction, respectively. The measured size distributions of coarse and fine droplets are reasonably represented by the Rosin-Rammler and log-normal distributions in probability density function, which leads to a bimodal distribution. To assess the hydrodynamic consequences of coughing including droplet vaporization and polydispersion, a Lagrangian model of droplet trajectories is established, with its ambient flow field predetermined from a computational fluid dynamics simulation.

  8. Downregulation of cough by exercise and voluntary hyperpnea. (United States)

    Fontana, Giovanni A


    No information exists on the effects of hyperpnea on the sensory and cognitive aspects of coughing evoked by inhalation of tussigenic agents. The threshold for the cough reflex induced by inhalation of increasing concentrations of ultrasonically nebulized distilled water (fog), and the index of cough reflex sensitivity, was assessed in 12 healthy humans in control conditions, during exercise, and during voluntary isocapnic hyperventilation (VIH) to the same level as the exercise. The intensity of the urge-to-cough (UTC), a cognitive component of coughing, was also recorded throughout the trials. The log-log relationship between inhaled fog concentrations and the correspondingly evoked UTC values, an index of the perceptual magnitude of the UTC sensitivity, was also calculated. Cough appearance was always assessed audiovisually. At an exercise level of 80% of anaerobic threshold, the mean cough threshold was increased from a control value of 1.03 +/- 0.65 to 2.25 +/- 1.14 ml/min (p VIH, the mean (+/-SD) threshold increased from 1.03 +/- 0.65 to 2.42 +/- 1.16 ml/min (p VIH compared with control, mean UTC values at cough threshold were not significantly changed: control, 3.83 +/- 1.11 cm; exercise, 3.12 +/- 0.82 cm; VIH, 4.08 +/- 1.67 cm. Since the slopes of the log fog concentration/log UTC value were approximately halved during exercise and VIH compared with control, the UTC sensitivity to fog was depressed (p < 0.01). The results indicate that the adjustments brought into action by exercise-induced or voluntary hyperventilation exert inhibitory influences on the sensory and cognitive components of fog-induced cough.

  9. Preventing Pertussis (Whooping Cough) (United States)

    ... causes a whooping sound. They may gag on mucus and throw up after they cough. Not every ... your baby through the placenta and your breast milk. Your baby can get protection from pertussis for ...

  10. Whooping Cough PSA (:30)

    Centers for Disease Control (CDC) Podcasts

    This 30 second PSA encourages pregnant women to get the whooping cough vaccine, called Tdap, during the third trimester of each pregnancy in order to pass antibodies to their babies so they are born with protection against this serious disease.

  11. Pertussis (Whooping Cough) Outbreaks (United States)

    ... of Search Controls Search Form Controls Cancel Submit Pertussis (Whooping Cough) Note: Javascript is disabled or is not supported ... message, please visit this page: About . Pertussis Home About Pertussis Causes & Transmission Signs & Symptoms Complications ...

  12. Pertussis (Whooping Cough) Complications (United States)

    ... of Search Controls Search Form Controls Cancel Submit Pertussis (Whooping Cough) Note: Javascript is disabled or is not supported ... message, please visit this page: About . Pertussis Home About Pertussis Causes & Transmission Signs & Symptoms Complications ...

  13. Cough in idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Mirjam J.G. van Manen


    Full Text Available Many patients with idiopathic pulmonary fibrosis (IPF complain of chronic refractory cough. Chronic cough is a distressing and disabling symptom with a major impact on quality of life. During recent years, progress has been made in gaining insight into the pathogenesis of cough in IPF, which is most probably “multifactorial” and influenced by mechanical, biochemical and neurosensory changes, with an important role for comorbidities as well. Clinical trials of cough treatment in IPF are emerging, and cough is increasingly included as a secondary end-point in trials assessing new compounds for IPF. It is important that such studies include adequate end-points to assess cough both objectively and subjectively. This article summarises the latest insights into chronic cough in IPF. It describes the different theories regarding the pathophysiology of cough, reviews the different methods to assess cough and deals with recent and future developments in the treatment of cough in IPF.

  14. [H reflex in patients with spastic quadriplegia]. (United States)

    Miyama, Sahoko; Arimoto, Kiyoshi; Kimiya, Satoshi


    Hoffmann reflex (H reflex) is an electrically elicited spinal monosynaptic reflex. H reflex was examined in 18 patients with spastic quadriplegia who had perinatal or postnatal problems. H reflex was elicitable in 11 patients for the abductor pollicis brevis (61.1%), 10 for the abductor digiti minimi (55.6%) and 16 for the abductor hallucis (88.9%). Because the abductor pollicis brevis and the abductor digiti minimi do not exhibit H reflex in normal subjects, it was suggested that the excitability of alpha motor neurons innervating these muscles was increased. H reflex was not detected for the extensor digitorum brevis in any patients, indicating the difference in the excitability among alpha motor neurons. In some patients, H reflex did not disappear under supramaximal stimuli. We conclude that the mechanism of evolution of H reflex in patients with spastic quadriplegia is different from that in normal subjects.

  15. Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study. (United States)

    Streit, Sven; Limacher, Andreas; Zeller, Andreas; Bürge, Markus


    General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction. This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia. In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11%) were demented. If SST or PMR were abnormal, sensitivity was 71% (95% CI 44-90%), and specificity 64% (95% CI 55-72%) for detecting dementia. If both tests were abnormal, sensitivity was 24% (95% CI 7-50%), but specificity increased to 93% (95% CI 88-97%). Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results.

  16. Reflexives and reflexive constructions in Afrikaans

    African Journals Online (AJOL)

    Kate H

    2. Reflexives. Afrikaans items belonging to the traditional lexical category of reflexives (or reflexive ... reflexive and non-reflexive pronouns are syntactically derived from the same lexical root pronoun √PRON. The ...... 32 The matrix verbs in (33) and (34) both concern a future activity of an entity: belowe (“promise”) in the (a).

  17. Whooping Cough PSA (:30)

    Centers for Disease Control (CDC) Podcasts


    This 30 second PSA encourages pregnant women to get the whooping cough vaccine, called Tdap, during the third trimester of each pregnancy in order to pass antibodies to their babies so they are born with protection against this serious disease.  Created: 1/22/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPDB).   Date Released: 1/22/2015.

  18. Chronic Cough in Otorhinolaryngologic Routine

    Directory of Open Access Journals (Sweden)

    Palheta Neto, Francisco Xavier


    Full Text Available Introduction: The chronic cough is sometimes manifested as an imprecise symptom, but of great importance for both the diagnosis and the prognosis. In an otorhinolaryngologic approach, several illnesses that can occur with it can be numbered, including 2 of the 3 main causes of chronic cough. Objective: To identify the main otorhinolaryngologic diseases showing the chronic cough as one of their manifestations. Method: A literature's revision was performed in several scientific articles, specialized books and consultation in Birene and Scielo databases. Literature's revision: cough production in the upper airways is usually associated with an inflammatory reaction by stimulating sensitive receptors of these areas or by mechanic stimulus. The main cause of the chronic cough in the otorhinolaryngology day-to-day is the post-nasal drip, gathering together by itself 02 of the most common diseases: rhinitis and sinusitis. Laryngitis as a result of gastroesophageal reflux (GER stands out in the index of chronic cough etiology, but it is not as severe as GER . Neoplasias are also somewhat frequent causes of cough, and the difficulty in diagnosing the cough cause is common in this disease group. Motility disorder, laryngeal irritation persistence, parasitic disease and injuries by inhalation of toxic products were also found as a cause of cough for longer than 03 months. Conclusion:Chronic cough is a frequent and important finding in otorhinolaryngology and cannot be underestimated, and a careful anamnesis is the best way to determine the etiology and perform a correct treatment for the patient's disease.

  19. Modified Valsalva test differentiates primary from secondary cough headache. (United States)

    Lane, Russell J M; Davies, Paul T G


    The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache. We examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI. None of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with 'posterior fossa crowdedness'. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache). These findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation.

  20. Recognizing and Preventing Whooping Cough

    Centers for Disease Control (CDC) Podcasts

    This podcast provides information about the symptoms of whooping cough and how vaccines can help prevent this serious disease for people of all ages. It is especially important for those who will have close contact with a baby to be up to date with their whooping cough vaccine.

  1. Shoulder reflexes

    DEFF Research Database (Denmark)

    Diederichsen, L.; Krogsgaard, M.; Voigt, Michael


    long latency (300 ms) excitatory reflex has been found when nerves in the capsule were stimulated electrically during shoulder surgery. In addition, when the anterior-inferior capsule was excited in conscious humans with modest amplitude electrical stimuli during muscle activity, a strong inhibition...... activity around the shoulder. This has implications for rehabilitation and shoulder surgery.......Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule...

  2. A simple measurement hammer for quantitative reflex studies

    NARCIS (Netherlands)

    Stam, J.; van Leeuwen, J. R.


    A reflex hammer for measurement of the mechanical stimulus strength was designed. Combined with standard EMG equipment this instrument permits the study of both stimulus-response relations and latencies of myotatic reflexes. Some results in normal subjects are discussed


    Directory of Open Access Journals (Sweden)

    O.A. Danilyuk


    Full Text Available Characteristics of treatment of cough in children with herbal medications are presented in this article. Poly therapeutic effect of medicinal plants, its high biological activity, relatively low toxicity and wide therapeutic index explain a need of phyto therapy use in treatment of cough. Advantages of phyto therapy are described, children's doses, ways of application of herbal extracts are given. The use of plants depending on the stage of disease and principles of combination of herbal medications during treatment are described.Key words: phyto therapy, cough, medicinal plants.

  4. Phenytoin-induced isolated chronic, nocturnal dry cough

    Directory of Open Access Journals (Sweden)

    Fábio A. Nascimento


    Full Text Available We report a 72-year-old man with a four-year history of dyscognitive seizures (with occasional secondary generalization who developed isolated, nocturnal dry cough immediately after being started on PO phenytoin. The cough was not accompanied by any other symptom or sign as his physical exam was completely normal. Further investigation with chest CT and spirometry was unremarkable. This symptom persisted for six months and did not resolve until we weaned him off of phenytoin. According to the Naranjo Adverse Drug Reaction Probability Scale, his cough was classified as being probably (score +6 related to the use of this antiepileptic drug. To our knowledge, there has been only one study that reported phenytoin-triggered cough. It described a postoperative patient who developed cough and bronchospasm after receiving IV phenytoin. By reporting our case and discussing the literature on this specific topic, we have essentially two goals. First, we intend to remind clinicians that isolated persistent cough can be an adverse reaction to phenytoin. Second, we hope to encourage further studies that will be able to elucidate the association presented herein.

  5. Cough-induced rib fractures. (United States)

    Sano, Atsushi; Tashiro, Ken; Fukuda, Tsutomu


    Occasionally, patients who complain of chest pain after the onset of coughing are diagnosed with rib fractures. We investigated the characteristics of cough-induced rib fractures. Between April 2008 and December 2013, 17 patients were referred to our hospital with chest pain after the onset of coughing. Rib radiography was performed, focusing on the location of the chest pain. When the patient had other signs and symptoms such as fever or persistent cough, computed tomography of the chest was carried out. We analyzed the data retrospectively. Rib fractures were found in 14 of the 17 patients. The age of the patients ranged from 14 to 86 years (median 39.5 years). Ten patients were female and 4 were male. Three patients had chronic lung disease. There was a single rib fracture in 9 patients, and 5 had two or more fractures. The middle and lower ribs were the most commonly involved; the 10th rib was fractured most frequently. Cough-induced rib fractures occur in every age group regardless of the presence or absence of underlying disease. Since rib fractures often occur in the lower and middle ribs, rib radiography is useful for diagnosis. © The Author(s) 2015.

  6. Olodaterol Attenuates Citric Acid-Induced Cough in Naïve and Ovalbumin-Sensitized and Challenged Guinea Pigs (United States)

    Wex, Eva; Bouyssou, Thierry


    Excessive coughing is a common feature of airway diseases. Different G-protein coupled receptors, including β2-adrenergic receptors (β2-AR), have been implicated in the molecular mechanisms underlying the cough reflex. However, the potential antitussive property of β2-AR agonists in patients with respiratory disease is a matter of ongoing debate. The aim of our study was to test the efficacy of the long-acting β2-AR agonist olodaterol with regard to its antitussive property in a pre-clinical model of citric acid-induced cough in guinea pigs and to compare the results to different clinically relevant β2-AR agonists. In our study β2-AR agonists were intratracheally administered, as dry powder, into the lungs of naïve or ovalbumin-sensitized guinea pigs 15 minutes prior to induction of cough by exposure to citric acid. Cough events were counted over 15 minutes during the citric acid exposure. Olodaterol dose-dependently inhibited the number of cough events in naïve and even more potently and with a greater maximal efficacy in ovalbumin-sensitized guinea pigs (p citric acid-induced cough in naïve and ovalbumin-sensitized guinea pigs. This is in agreement with pre-clinical and clinical studies showing antitussive efficacy of β2-AR agonists. Indacaterol increased the number of coughs in this model, which concurs with clinical data where a transient cough has been observed after indacaterol inhalation. While the antitussive properties of β2-AR agonists can be explained by their ability to lead to the cAMP-induced hyperpolarization of the neuron membrane thereby inhibiting sensory nerve activation and the cough reflex, the mechanism underlying the pro-tussive property of indacaterol is not known. PMID:25781609

  7. Recognizing and Preventing Whooping Cough

    Centers for Disease Control (CDC) Podcasts


    This podcast provides information about the symptoms of whooping cough and how vaccines can help prevent this serious disease for people of all ages. It is especially important for those who will have close contact with a baby to be up to date with their whooping cough vaccine.  Created: 1/22/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPDB).   Date Released: 1/22/2015.

  8. Chronic dry cough: Diagnostic and management approaches

    Directory of Open Access Journals (Sweden)

    Ashok Mahashur


    Full Text Available Cough is the most common symptom for which medical treatment is sought in the outpatient setting. Chronic dry cough poses a great diagnostic and management challenge due to myriad etiologies. Chronic cough has been commonly considered to be caused by gastroesophageal reflux, post-nasal drip or asthma. However, recent evidences suggest that many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best. This raises questions about the concept of a triad of treatable causes for chronic cough. This article discusses the mechanism and etiology of cough, along with recent advances in the field of cough, highlighting some of the diagnostic and management challenges.

  9. Neurophysiology and Clinical Implications of the Laryngeal Adductor Reflex. (United States)

    Domer, Amanda S; Kuhn, Maggie A; Belafsky, Peter C


    The laryngeal adductor reflex (LAR) is an involuntary protective response to stimuli in the larynx. The superior laryngeal nerve (SLN) acts as the afferent limb and the recurrent laryngeal nerve (RLN) as the efferent limb of this reflex, which is modulated by the central nervous system. Perhaps the most clinically significant application of the LAR is its use in laryngopharyngeal (LP) sensory discrimination testing. Importantly, aberrations in the LAR may predict dysphagia or portend clinical phenotypes of chronic cough, vocal cord dysfunction or pediatric apneas. LP sensation is a potential target for interventions addressing the aforementioned conditions though currently remains an area of active investigation.

  10. Comparison between the effects of lisinopril and losartan on the cougn reflex in anesthetized and awake rabbits. (United States)

    Mutolo, D; Cinelli, E; Bongianni, F; Evangelista, S; Pantaleo, T


    The aim of the present study was to analyze differences in cough induction between losartan and lisinopril in both anaesthetized and awake rabbits, i.e., under conditions in which the influences of higher brain areas on the cough reflex are strongly reduced or abolished. Losartan (500 μg/kg), lisinopril (100 μg/kg) and NaCl 0.9% saline solution (vehicle) were administered by intravenous injections. Animals were randomly assigned to the different experimental treatments. The cough reflex was induced by chemical (citric acid) and/or mechanical stimulation of the tracheobronchial tree. In anaesthetized rabbits, losartan and lisinopril caused similar hypotensive effects. Lisinopril, but not losartan, increased the cough response induced by both mechanical and chemical stimulation due to increases in the cough number, i.e. the number of coughs induced by each stimulation challenge. In awake animals, only lisinopril significantly increased the cough number. The results support the notion that cough potentiation induced by losartan, and possibly other sartans, is lower than that induced by most angiotensin-converting enzyme inhibitors despite the reduction or complete absence of higher brain functions. In this connection, the comparison between present results and our previous findings on ramipril and zofenopril shows that losartan and zofenopril display similar cough-inducing potency, much lower than that of lisinopril and ramipril.

  11. Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh

    Directory of Open Access Journals (Sweden)

    Rukhsana Parvin


    Full Text Available Background: Cough variant asthma (CVA is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional study was conducted in Enam Medical College Hospital, Savar, Dhaka over a period of two years from July 2009 to July 2011. Cough variant asthma was diagnosed mainly on clinical ground as chronic cough without wheezing, fever, weight loss, shortness of breath or sputum or any other apparent cause that persisted for more than eight weeks with absolutely normal physical examination of chest, normal chest radiography and blood count except raised eosinophil count and IgE level. Patients who met these criteria were given 2 weeks course of inhaler beclomethasone propionate and were assessed for improvement. Those who improved after steroid inhalation were categorised as having cough variant asthma. Results: Out of purposively selected 148 patients complaining only of chronic dry cough for more than eight weeks, 92 patients met the primary selection criteria for cough variant asthma. These 92 patients were given 2 weeks trial of 250 ìgm beclomethasone inhalation twice daily. Seventy nine patients reported almost complete recovery from chronic cough after 2 weeks and were categorized as having CVA. Thirteen patients did not improve and were not categorized as CVA. Conclusion: These findings suggest that cough variant asthma is the most common among the patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of this disease.

  12. Cough during infancy and subsequent childhood asthma. (United States)

    Oren, E; Rothers, J; Stern, D A; Morgan, W J; Halonen, M; Wright, A L


    Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding the presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2 and 9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. A total of 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma. © 2015 John Wiley & Sons Ltd.

  13. A near catastrophe from trigeminocardiac reflex

    Directory of Open Access Journals (Sweden)

    Parmod K Bithal


    Full Text Available Trigeminocardiac reflex is a brainstem reflex that results from stimulation of any branch of the trigeminal nerve along its course. It produces a constellation of signs and symptoms decrease in blood pressure (BP and heart rate, dysrhythmias, apnoea and increased gastric motility. We present a case of 80-year-old female patient who developed alarming hypotension and bradycardia during craniotomy for meningioma excision resulting from this reflex. In the face of refractory hypotension despite administering ephedrine and phenylephrine, we had to resort to adrenaline to restore her normal BP.

  14. Ineffective cough and mechanical mucociliary clearance techniques. (United States)

    Fernández-Carmona, A; Olivencia-Peña, L; Yuste-Ossorio, M E; Peñas-Maldonado, L

    Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. Velocity Field Measurements of Human Coughing Using Time Resolved Particle Image Velocimetry (United States)

    Khan, T.; Marr, D. R.; Higuchi, H.; Glauser, M. N.


    Quantitative fluid mechanics analysis of human coughing has been carried out using new Time Resolved Particle Image Velocimetry (TRPIV). The study involves measurement of velocity vector time-histories and velocity profiles. It is focused on the average normal human coughing. Some work in the past on cough mechanics has involved measurement of flow rates, tidal volumes and sub-glottis pressure. However, data of unsteady velocity vector field of the exiting highly time-dependent jets is not available. In this study, human cough waveform data are first acquired in vivo using conventional respiratory instrumentation for various volunteers of different gender/age groups. The representative waveform is then reproduced with a coughing/breathing simulator (with or without a manikin) for TRPIV measurements and analysis. The results of this study would be useful not only for designing of indoor air quality and heating, ventilation and air conditioning systems, but also for devising means of protection against infectious diseases.

  16. Olodaterol attenuates citric acid-induced cough in naïve and ovalbumin-sensitized and challenged guinea pigs.

    Directory of Open Access Journals (Sweden)

    Eva Wex

    Full Text Available Excessive coughing is a common feature of airway diseases. Different G-protein coupled receptors, including β2-adrenergic receptors (β2-AR, have been implicated in the molecular mechanisms underlying the cough reflex. However, the potential antitussive property of β2-AR agonists in patients with respiratory disease is a matter of ongoing debate. The aim of our study was to test the efficacy of the long-acting β2-AR agonist olodaterol with regard to its antitussive property in a pre-clinical model of citric acid-induced cough in guinea pigs and to compare the results to different clinically relevant β2-AR agonists. In our study β2-AR agonists were intratracheally administered, as dry powder, into the lungs of naïve or ovalbumin-sensitized guinea pigs 15 minutes prior to induction of cough by exposure to citric acid. Cough events were counted over 15 minutes during the citric acid exposure. Olodaterol dose-dependently inhibited the number of cough events in naïve and even more potently and with a greater maximal efficacy in ovalbumin-sensitized guinea pigs (p < 0.01. Formoterol and salmeterol showed a trend towards reducing cough. On the contrary, indacaterol demonstrated pro-tussive properties as it significantly increased the number of coughs, both in naïve and ovalbumin-sensitized animals (p < 0.001. In conclusion, olodaterol, at doses eliciting bronchodilation, showed antitussive properties in a model of citric acid-induced cough in naïve and ovalbumin-sensitized guinea pigs. This is in agreement with pre-clinical and clinical studies showing antitussive efficacy of β2-AR agonists. Indacaterol increased the number of coughs in this model, which concurs with clinical data where a transient cough has been observed after indacaterol inhalation. While the antitussive properties of β2-AR agonists can be explained by their ability to lead to the cAMP-induced hyperpolarization of the neuron membrane thereby inhibiting sensory nerve

  17. [Automatic Classification of Dry Cough and Wet Cough Based on Improved Reverse Mel Frequency Cepstrum Coefficients]. (United States)

    Zhu, Chunmei; Liu, Baojun; Li, Ping; Mo, Hongqiang; Zheng, Zeguang


    Automatic classification of different types of cough plays an important role in clinical.In the previous research of cough classification or cough recognition,traditional Mel frequency cepstrum coefficients(MFCC)which extracts feature mainly from low frequency band is usually used as feature expression.In this paper,by analyzing the distributions of spectral energy of dry/wet cough,it is found that spectral difference of two types of cough exits mainly in middle frequency band and high frequency band.To better reflect the spectral difference of dry cough and wet cough,an improved method of extracting reverse MFCC is proposed.In this method,reverse Mel filter-bank in which filters are allocated in reverse Mel scale is adopted and is improved by placing filters only in the frequency band with high spectral energy.As a result,features are mainly extracted from the frequency band where two types of cough show both high spectral energy and distinguished difference.Detailed process of accessing improved reverse MFCC was introduced and hidden Markov models trained by 60 dry cough and 60 wet cough were used as cough classification model.Classification experiment results for 120 dry cough and 85 wet cough showed that,compared to traditional MFCC,better classification performance was achieved by the proposed method and the total classification accuracy was raised from 89.76%to 93.66%.

  18. Antibiotics for whooping cough (pertussis). (United States)

    Altunaiji, S; Kukuruzovic, R; Curtis, N; Massie, J


    Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007). All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough. Three to four review authors independently extracted data and assessed the quality of each trial. Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis. Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

  19. Reflexivity in qualitative research

    DEFF Research Database (Denmark)

    Evans, Adam Brian; Nistrup, Anne; Henderson, Hannah


    There has been something of a “reflexive shift” in sociological research. Sociological researchers are increasingly encouraged to be “present” within their work, and to recognize their own role in structuring the entire research process. One way to achieve this is through engagement in reflexive...... practice, that is, to reflect on our own values, beliefs, and biographies. It can be difficult to know exactly how a researcher should engage in these practices, however. Here, we discuss our reflexive practice in two case studies, both which utilized the same figurational theoretical framework...... Kingdom. Reflexive practice in both studies was affected by researcher biographies and by study design. In Study 1, both researchers were reasonably detached from the study context, the theoretical framework was in place from the very beginning, and reflexive practice was embedded in the study design...

  20. Etnography and Reflexivity

    Directory of Open Access Journals (Sweden)

    Mario Cardano


    Full Text Available This essay deals with a relevant and controversial topic – objectivity in ethnographic research. More specifically, I would like to examine how reflexive procedures, more precisely “reflexive account”, can increase the robustness of results gained through an ethnographic research. The essay is organized in five parts. I will start by giving a preliminary definition of the two key concepts which are at the center of the analysis – objectivity and reflexivity. I will then give a brief description of the epistemological framework in which the proposed conceptions of objectivity and reflexivity are located. Thirdly, I move on to consider the epistemic status of ethnographic research, and will emphasize that ethnographies are not just “theory-laden”, as many writers have stated, but also “praxis” or “procedure laden”. In other words, I will stress that it is not only theories which are inevitably embedded in research, influencing how observations can be made; much the same can also be said of the concrete research practices which contribute to determine the experience of the ethnographer and its representation in a text. Fourthly, I will discuss why it is useful to employ reflexive practices, and then immediately afterwards will illustrate the ways in which reflexive descriptions can contribute to greater objectivity of ethnographic accounts. In conclusion, I will discuss a number of objections which have been raised against this use of reflexivity.

  1. Could patients' coughing have communicative significance? (United States)

    Bailey, Julia V


    Medical discourse positions patients with coughs and colds negatively, so consulting health services with 'minor' respiratory illness is therefore more accountable than for other medical problems. Patients face dilemmas since they must persuade doctors of the doctorability of their illness without being seen as hypochondriacal, and they risk losing face if doctors decide that there is nothing much wrong. It is known that the placement of non-lexical features of talk such as laughing or crying can have interactional meaning. Using a data set of video-recorded doctor-patient cough and cold consultations, this study explores whether patients' coughing could have communicative significance. The study is a qualitative analysis of 33 consultations drawing on a constructionist, sociolinguistic analytic approach. Coughing is co-ordinated with talk rather than occurring randomly. Coughing helps patients to demonstrate the doctorability of their symptoms and to legitimize their claims for medical attention. Coughing is also associated with resistance to 'no problem' diagnoses, resulting in changes in the trajectory of talk (for example, soliciting more explanation from doctors and/or re-negotiation of doctors' investigation or treatment plans). Coughing is undoubtedly a manifestation of respiratory illness, but also has communicative significance in consultations for coughs and colds.

  2. Headache associated with cough : a review

    NARCIS (Netherlands)

    Cordenier, Ann; De Hertogh, Willem; De Keyser, Jacques; Versijpt, Jan


    Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected

  3. On Reflexive Data Models

    Energy Technology Data Exchange (ETDEWEB)

    Petrov, S.


    An information system is reflexive if it stores a description of its current structure in the body of stored information and is acting on the base of this information. A data model is reflexive, if its language is meta-closed and can be used to build such a system. The need for reflexive data models in new areas of information technology applications is argued. An attempt to express basic notions related to information systems is made in the case when the system supports and uses meta-closed representation of the data.

  4. A randomized placebo controlled trial to evaluate the effects of butamirate and dextromethorphan on capsaicin induced cough in healthy volunteers. (United States)

    Faruqi, Shoaib; Wright, Caroline; Thompson, Rachel; Morice, Alyn H


    The examination of cough reflex sensitivity through inhalational challenge can be utilized to demonstrate pharmacological end points. Here we compare the effect of butamirate, dextromethorphan and placebo on capsaicin-induced cough in healthy volunteers. In this randomized, placebo-controlled, six way crossover study the effect of dextromethrophan 30 mg, four doses of butamirate and placebo was evaluated on incremental capsaicin challenges performed at baseline and 2, 4, 6, 8, 12 and 24 h following dosing. The primary end point was the area under the curve (AUC(0,12h)) of log10 C5 from pre-dose to 12 h after dosing. Plasma butamirate metabolites were analyzed to evaluate pharmacokinetic and pharmacodynamic relationships. Thirty-four subjects (13 males, median age 25 years) completed the study. Cough sensitivity decreased from baseline in all arms of the study. Dextromethorphan was superior to placebo (P = 0.01) but butamirate failed to show significant activity with maximum attenuation at the 45 mg dose. There was no apparent relationship between pharmacokinetic and pharmacodynamic parameters for butamirate. We have demonstrated for the first time that dextromethorphan attenuates capsaicin challenge confirming its broad activity on the cough reflex. The lack of efficacy of butamirate could be due to formulation issues at higher doses. © 2014 The British Pharmacological Society.

  5. Exhaled breath condensate pH and cysteinyl leukotriens in patients with chronic cough secondary to acid gastroesophageal reflux. (United States)

    Heffler, Enrico; Crimi, Claudia; Brussino, Luisa; Nicola, Stefania; Sichili, Stefania; Dughera, Luca; Rolla, Giovanni; Crimi, Nunzio


    Chronic cough is one of the most common clinical problems and it may be secondary to different stimuli and diseases, including low-level physical and chemical stimulation of the esophageal-bronchial reflex, suggestive of cough-reflex hyperresponsiveness, in patients with gastroesophageal reflux; however, it is still debated whether gastroesophageal reflux could induce airway inflammation and acidification. The aim of this study was to investigate airway pH and cysteynil-leukotrienes (Cys-LTs) concentration (a marker of airway inflammation) in exhaled breath condensate (EBC). Patients with chronic cough and for which all known causes, excluding gastroesophageal reflux, had been investigated and ruled out, were enrolled in the study. All patients underwent 24 h pH monitoring, and EBC was collected to assess pH and Cys-LTs concentration. Forty-five patients were included in the study and those with gastroesophageal reflux had significantly lower EBC-pH and higher concentration of EBC-Cys-LTs. There was a linear inverse correlation between EBC-pH values and EBC-Cys-LTs logarithmically transformed, and a multivariate analysis confirmed that the only significant determinat variable of EBC-Cys-LTs was the presence of gastroesophageal reflux. This study adds knowledge on possible mechanisms related to chronic cough associated with gastroesophageal reflux, which seems to be strictly dependent on airway acidification and the production of Cys-LTs, therefore suggesting an underlying neurogenic inflammation with tachykinins involvement.

  6. Help Protect Babies from Whooping Cough (United States)

    ... this? Submit What's this? Submit Button Past Emails Help Protect Babies from Whooping Cough Language: English (US) ... Emails Language: English (US) Español (Spanish) File Formats Help: How do I view different file formats (PDF, ...

  7. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... hiv/aids overview current news labs links & resources hpv overview why vaccinate posters buttons and banners videos ... q & a videos chickenpox (varicella) hepatitis b hib hpv pertussis (whooping cough) pneumococcal rotavirus shingles media room ...

  8. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... getvaxed about GETVAXED print ads go to GETVAXED.ORG cme Immunizations Pertussis (Whooping Cough) One family's struggles ... free-of-charge. Branded videos contain the "PKIDs.ORG" end slate; unbranded videos are provided for organizations ...

  9. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... immunizations current news Flu's Gonna Lose hepatitis a & b vaccines im/sq how to do kids infect ... vaccine safety q & a videos chickenpox (varicella) hepatitis b hib hpv pertussis (whooping cough) pneumococcal rotavirus shingles ...

  10. Cough Medicine: Understanding Your OTC Options (United States)

    ... CorrectlyPain Relievers: Understanding Your OTC OptionsAntacids and Acid Reducers: OTC Relief for Heartburn and Acid RefluxOTC Cough ... Loss and Diet Plans Nutrients and Nutritional Info Sugar and Sugar Substitutes Exercise and Fitness Exercise Basics ...

  11. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... freed meet keri russell posters grand article rich media video/audio pneumonia tb overview links & resources families ... hib hpv pertussis (whooping cough) pneumococcal rotavirus shingles media room Flu's Gonna Lose M.O.V.E. ...

  12. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... GETVAXED print ads go to GETVAXED.ORG cme Immunizations Pertussis (Whooping Cough) One family's struggles with pertussis ... not possible without a visit to your doctor. Immunizations stop disease from spreading. Check with your family ...

  13. Predictors of objective cough frequency in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Sumner, Helen; Woodcock, Ashley; Kolsum, Umme


    Cough is one of the principal symptoms of chronic obstructive pulmonary disease (COPD) but the potential drivers of cough are likely to be multifactorial and poorly understood.......Cough is one of the principal symptoms of chronic obstructive pulmonary disease (COPD) but the potential drivers of cough are likely to be multifactorial and poorly understood....

  14. Evaluation of cranial tibial and extensor carpi radialis reflexes before and after anesthetic block in cats. (United States)

    Tudury, Eduardo Alberto; de Figueiredo, Marcella Luiz; Fernandes, Thaiza Helena Tavares; Araújo, Bruno Martins; Bonelli, Marília de Albuquerque; Diogo, Camila Cardoso; Silva, Amanda Camilo; Santos, Cássia Regina Oliveira; Rocha, Nadyne Lorrayne Farias Cardoso


    Objectives This study aimed to test the extensor carpi radialis and cranial tibial reflexes in cats before and after anesthetic block of the brachial and lumbosacral plexus, respectively, to determine whether they depend on a myotatic reflex arc. Methods Fifty-five cats with a normal neurologic examination that were referred for elective gonadectomy were divided into group 1 (29 cats) for testing the extensor carpi radialis reflex, and group 2 (26 cats) for testing the cranial tibial reflex. In group 1, the extensor carpi radialis reflex was tested after anesthetic induction and 15 mins after brachial plexus block with lidocaine. In group 2, the cranial tibial, withdrawal and patellar reflexes were elicited in 52 hindlimbs and retested 15 mins after epidural anesthesia. Results In group 1, before the anesthetic block, 55.17% of the cats had a decreased and 44.83% had a normal extensor carpi radialis reflex. After the block, 68.96% showed a decreased and 27.59% a normal reflex. No cat had an increased or absent reflex before anesthetic block. In group 2, prior to the anesthetic block, 15.38% of the cats had a decreased cranial tibial reflex and 84.62% had a normal response, whereas after the block it was decreased in 26.92% and normal in 73.08% of the cats. None of the cats had an increased or absent reflex. Regarding the presence of both reflexes before and after anesthetic block, there was no significant difference at 1% ( P = 0.013). Conclusions and relevance The extensor carpi radialis and cranial tibial reflexes in cats are not strictly myotatic reflexes, as they are independent of the reflex arc, and may be idiomuscular responses. Therefore, they are not reliable for neurologic examination in this species.

  15. Too Busy for Reflexivity?

    DEFF Research Database (Denmark)

    Ratner, Helene

    What Danish school managers can teach STS researchers about epistemological ideals and pragmatic morals. Reflexivity has an ambivalent status in both anthropology and Science and Technology Studies. On the one hand, the critique of representation at the heart of the reflexivity debates of the 1980s...... highlighted non-symmetric relationships between observer and observed and accused the academic text of enacting a realist genre, concealing the relativism entailed in textual production (Clifford and Marcus 1986, Woolgar 1988, Ashmore 1989). On the other hand, the reflexivity program produced fears...... of a “corrosive relativism in which everything is but a more or less clever expression of opinion” (Geertz 1988:2, 3) and it has suffered the little flattering accusations of piling "layer upon layer of self-consciousness to no avail" (Latour 1988:170) with little “interest [for] … theoretically ambitious...

  16. Reflexivity and social justice

    DEFF Research Database (Denmark)

    Maksimovic, Tijana; Jakobsen, Helle Nordentoft


    Career practitioners’ reflexive understanding of their professional role as change agents in career guidance and counselling practices has a major impact on how social justice can be achieved. This entitles an awareness of the way in which guidance and counselling practices are embedded in the co......Career practitioners’ reflexive understanding of their professional role as change agents in career guidance and counselling practices has a major impact on how social justice can be achieved. This entitles an awareness of the way in which guidance and counselling practices are embedded...

  17. Pheniramine Maleate is more effective than Lidocaine on Fentanyl Induced Cough. (United States)

    Ozmen, Ozgur; Kara, Duygu; Karaman, Emine Uzlas; Karakoc, Fatma; Karakaya, Muhammet Ahmet; Arslan, Zakir


    Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough. This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection. Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p0.05). Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.

  18. [Laryngeal adduction reflex]. (United States)

    Ptok, M; Bonenberger, S; Miller, S; Kühn, D; Jungheim, M


    Laryngeal Adductor Reflex Background: A rapid closure of the vocal folds is necessary, whenever foreign materials or food particles penetrate into the larynx. Otherwise a passage of these particles into the trachea or the lower respiratory tract would be imminent. An aspiration could mechanically block the respiratory tract and cause severe dyspnoea or cause aspiration pneumonia. For this systematic review a selective literature research in PubMed and Scopus using the keywords "laryngeal adductor reflex" and "vocal fold closure" has been carried out. Apart from the oesophago-glottal and pharyngo-glottal closure reflexes, the laryngeal adductor reflex (LAR) has been investigated in particular. The LAR qualifies as a reflectory laryngeal adductor mechanism and involves early, presumably di- or oligosynaptic ipsilateral LAR1 as well as late polysynaptic ipsi- and contralateral LAR2 components. In clinical routine diagnostic settings of dysphagia, LAR is only assessed qualitatively and usually triggered by air pulses or tactile stimulation. Dysphagiologists often find that not only the laryngeal sensibility in general is impaired, but especially the protective laryngeal adduction mechanism, which results in a higher risk of aspiration. Thus, it appears mandatory to test the LAR not only qualitatively but also quantitatively. Unfortunately a valid and reliable method that can be employed in clinical practice has not yet been put forward. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Theory and Application of Audio-Based Assessment of Cough

    Directory of Open Access Journals (Sweden)

    Yan Shi


    Full Text Available Cough is a common symptom of many respiratory diseases. Many medical literatures underline that a system for the automatic, objective, and reliable detection of cough events is important and very promising to detect pathology severity in chronic cough disease. In order to track the development status of an audio-based cough monitoring system, we briefly described the history of objective cough detection and then illustrated the cough sound generating principle. The probable endpoints of cough clinical studies, including cough frequency, intensity of coughing, and acoustic properties of cough sound, were analyzed in this paper. Finally, we introduce some successful cough monitoring equipment and their recognition algorithm in detail. It can be obtained that, firstly, acoustic variability of cough sounds within and between individuals makes it difficult to assess the intensity of coughing. Furthermore, now great progress in audio-based cough detection is being made. Moreover, accurate portable objective monitoring systems will be available and widely used in home care and clinical trials in the near future.

  20. Characterization of urge to cough and cough symptoms associated with the common cold: results of a US internet survey. (United States)

    Eccles, Ron; Dicpinigaitis, Peter; Turner, Ronald B; Druce, Howard M; Adeleke, Maryann; Mann, Ashley L


    Our knowledge of cough physiology is limited despite years of study. Even less is known about the sensation of urge to cough. Given that limited clinical data are available about urge to cough and cough attributes during a common cold, we sought to gain insights into experiences and perceptions related to these symptoms. An internet survey consisting of 51 questions was fielded in the United States. Eligible survey participants included men and women aged 18 years and older who had suffered from a cold with cough within the three months preceding the survey. Participants who confirmed suffering from recurrent cough, asthma, chronic bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, or gastrointestinal reflux were excluded. Of 19,530 initial respondents, 8011 had a cold in the past three months. Of these, 6484 (81%) had experienced cough symptoms; 2708 respondents with cough due to cold and no exclusionary condition made up the analysis sample. Most respondents (62%) reported that cough developed one to two days after the onset of cold symptoms, and 45% felt that cough worsened their other cold symptoms. In 69% of respondents, cough outlasted other cold symptoms. Urge to cough was reported by 98% of respondents, and among these respondents, 64% described it as uncontrollable and 65% rated severity as moderate. More than half of respondents (57%) considered the sensation of urge to cough and the act of coughing as equally bothersome. Although urge to cough and inability to control cough were the most bothersome aspects of cough due to cold, few (<20%) respondents asked healthcare providers for treatment recommendations. Symptoms of urge to cough and cough are common and have a significant impact on cold sufferers. Understanding attributes of these symptoms may provide insights for effective management and the development of novel treatment strategies.

  1. Cough and environmental air pollution in China. (United States)

    Zhang, Qingling; Qiu, Minzhi; Lai, Kefang; Zhong, Nanshan


    With fast-paced urbanization and increased energy consumption in rapidly industrialized modern China, the level of outdoor and indoor air pollution resulting from industrial and motor vehicle emissions has been increasing at an accelerated rate. Thus, there is a significant increase in the prevalence of respiratory symptoms such as coughing, wheezing, and decreased pulmonary function. Experimental exposure research and epidemiological studies have indicated that exposure to particulate matter, ozone, nitrogen dioxide, and environmental tobacco smoke have a harmful influence on development of respiratory diseases and are significantly associated with cough and wheeze. This review mainly discusses the effect of air pollutants on respiratory health, particularly with respect to cough, the links between air pollutants and microorganisms, and air pollutant sources. Particular attention is paid to studies in urban areas of China where the levels of ambient and indoor air pollution are significantly higher than World Health Organization recommendations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. [Pertussis (Whooping cough)--an update]. (United States)

    Stock, Ingo


    Whooping cough is a highly contagious respiratory disease which is caused predominantly by the gram-negative bacterium Bordetella pertussis. Further Bordetella species such as B. parapertussis and the recently discovered species B. holmesii are also involved in whooping cough-like diseases. Depending on age, vaccination status and distance to pre-infection with B. pertussis, whooping cough shows a wide range of symptoms. The disease occurs at any age, leaving only short time immunity. During the last 15 years, in industrialized countries the number of reported pertussis cases has been increased markedly. The reason for this observation is still unclear Macrolides such as azithromycin and clarithromycin are regarded as antibiotics of first choice. In Germany, combination vaccines containing acellular pertussis vaccines is the most important strategy of prevention. To ensure the best possible protection against pertussis, booster doses at determined times should be given after primary vaccination in infancy.

  3. Baclofen vs. Dextromethorphan in the treatment of coughing: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Shahriar M


    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Cough is one of the most common symptoms for which outpatient care is sought. Since, a few research evaluated efficacy and therapeutic effect of baclofen in remedy of cough (especially chronic cough, In this study we compared the efficacy of oral Baclofen 20 mg with Dextromethorphan to improvement of cough in two groups."n"nMethods: In this double blind randomized clinical trial, 120 patients with chronic cough (up to three weeks that were referred to respiratory diseases clinic of Ali Ebn-e Abitaleb (AS hospital in Zahedan, Iran at 2007 were randomly devided to two groups. 60 peoples in each, (baclofen recipient group with mean age 32.32±6.51 and dextromethorphan recipient group with mean age 31.54±5.06 year were evaluated for qualitative decline of severity, period and duration of cough for 14 days. "n"nResults: In baclofen recipient group 73.3% and in dextromethorphan recipient group 65% all patients had decline of severity, period and duration of the cough. Statistically, there were no significant differences between two groups in regard to qualitative decline of severity, period and duration of cough (p>0.05. Also, there were no drug related side effects in the patients."n"nConclusions: Baclofen

  4. Reflex epilepsy: a review

    Directory of Open Access Journals (Sweden)

    Karim Nikkhah


    Full Text Available Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type (most commonly visual, most rarely tactile or proprioceptive stimuli. Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures (such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle. The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain.In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management.

  5. Prevalence of cough throughout childhood: A cohort study.

    Directory of Open Access Journals (Sweden)

    Maja Jurca

    Full Text Available Cough in children is a common reason for medical consultations and affects quality of life. There are little population-based data on the epidemiology of recurrent cough in children and how this varies by age and sex, or between children with and without wheeze. We determined the prevalence of cough throughout childhood, comparing several standardised cough questions. We did this for the entire population and separately for girls and boys, and for children with and without wheeze.In a population-based prospective cohort from Leicestershire, UK, we assessed prevalence of cough with repeated questionnaires from early childhood to adolescence. We asked whether the child usually coughed more than other children, with or without colds, had night-time cough or cough triggered by various factors (triggers, related to increased breathing effort, allergic or food triggers. We calculated prevalence from age 1 to 18 years using generalised estimating equations for all children, and for children with and without wheeze.Of 7670 children, 10% (95% CI 10-11% coughed more than other children, 69% (69-70% coughed usually with a cold, 34% to 55% age-dependently coughed without colds, and 25% (25-26% had night-time cough. Prevalence of coughing more than peers, with colds, at night, and triggered by laughter varied little throughout childhood, while cough without colds and cough triggered by exercise, house dust or pollen became more frequent with age. Cough was more common in boys than in girls in the first decade of life, differences got smaller in early teens and reversed after the age of 14 years. All symptoms were more frequent in children with wheeze.Prevalence of cough in children varies with age, sex and with the questions used to assess it, suggesting that comparisons between studies are only valid for similar questions and age groups.

  6. Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology

    Directory of Open Access Journals (Sweden)

    Balbani, Aracy Pereira Silveira


    Full Text Available Introduction: The cough is the more common respiratory symptom in children and adults. Objective: To present a revision on the neurophysiology and the methods for study of the consequence of the cough, as well as the pharmacotherapy and phonoaudiology therapy of the cough, based on the works published between 2005 and 2010 and indexed in the bases Medline, Lilacs and Library Cochrane under them to keywords "cough" or "anti-cough". Synthesis of the data: The consequence of the cough involves activation of receiving multiples becomes vacant in the aerial ways and of neural projections of the nucleus of the solitary treatment for other structures of the central nervous system. Experimental techniques allow studying the consequence of the cough to the cellular and molecular level to develop new anti-cough agents. It does not have evidences of that anti-cough exempt of medical lapsing they have superior effectiveness to the one of placebo for the relief of the cough. The phonoaudiology therapy can benefit patients with refractory chronic cough to the pharmacological treatment, over all when paradoxical movement of the vocal folds coexists. Final Comments: The boarding to multidiscipline has basic paper in the etiological diagnosis and treatment of the cough. The otolaryngologist must inform the patients on the risks of the anti-cough of free sales in order to prevent adverse poisonings and effect, especially in children.

  7. The acoustic reflex threshold in aging ears. (United States)

    Silverman, C A; Silman, S; Miller, M H


    This study investigates the controversy regarding the influence of age on the acoustic reflex threshold for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators between Jerger et al. [Mono. Contemp. Audiol. 1 (1978)] and Jerger [J. Acoust. Soc. Am. 66 (1979)] on the one hand and Silman [J. Acoust. Soc. Am. 66 (1979)] and others on the other. The acoustic reflex thresholds for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators were evaluated under two measurement conditions. Seventy-two normal-hearing ears were drawn from 72 subjects ranging in age from 20-69 years. The results revealed that age was correlated with the acoustic reflex threshold for BBN activator but not for any of the tonal activators; the correlation was stronger under the 1-dB than under the 5-dB measurement condition. Also, the mean acoustic reflex thresholds for broadband noise activator were essentially similar to those reported by Jerger et al. (1978) but differed from those obtained in this study under the 1-dB measurement condition.

  8. Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough

    Directory of Open Access Journals (Sweden)

    Xianghuai Xu


    Full Text Available Gastroesophageal reflux (GER is one of the most common causes of chronic cough, and chronic cough due to GER represents a subtype of GER-related diseases. Gastroesophageal reflux-induced chronic cough (GERC can be divided into two subgroups based on the pH of the GER. Nonacid GERC is less common than acid GERC, and its diagnosis and treatment strategy have not been standardized. However, nonacid GERC usually presents with its unique set of characteristics and features upon diagnosis and treatment in the clinic. Although the underlying molecular mechanism of nonacid GERC is not fully understood, it is considered to be associated with reflux theory, reflex theory and airway hypersensitivity. Multi-channel intraluminal impedance combined with pH monitoring is a promising new technique that can detect both acid and nonacid reflux, and our findings as well as those of others have shown its usefulness in diagnosing nonacid GERC. Development of new diagnostic techniques has led to an increased rate of nonacid GERC diagnosis. We summarize our experience in the diagnosis and treatment of nonacid GERC and provide a guide for future therapeutic approaches.

  9. [Development of cough-relieving herbal teas]. (United States)

    Puodziūniene, Gene; Janulis, Valdimaras; Milasius, Arvydas; Budnikas, Vytautas


    Cough-relieving medicinal herbs in tea are used from ancient times. Mucilage present in them or secretion produced under the influence of the active substances covers the oral and throat mucosa soothing its irritability and relieving dry, tiresome cough. It is known that the mixtures of medicinal herbs (Specias) have a complex influence on the human organism and the rational combination of medicinal herbs can improve their curative action and decrease the undesirable side effects. Having summarized the properties of those medicinal herbs we decided to create two formulations of cough-relieving herbal tea. The first formulation consists of marshmallow roots, liquorice roots and lime flowers, the second -- of marshmallow roots, Iceland moss and lime flowers. The methods for identification and assay of the active substances in the compounds were applied. The purity of the mixtures was regulated by limitation of the loss on drying, total ash, microbial contamination, contamination with radionuclides, heavy metals, pesticides and foreign matter. The expiry date of both cough-relieving herbal teas was approved to be 2 years.

  10. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... thimerosal vaccine safety q & a videos chickenpox (varicella) hepatitis b hib hpv pertussis (whooping cough) pneumococcal rotavirus shingles media room Flu's Gonna Lose M.O.V.E. newsfeeds PSAs publications infectious disease workshop pediatric hepatitis report someone you know has hbv/hcv standard ...

  11. Born with Protection against Whooping Cough

    Centers for Disease Control (CDC) Podcasts

    This podcast provides information about whooping cough, a disease that can be deadly for babies, and CDC’s recommendation that all women receive the Tdap vaccine during the third trimester of every pregnancy so their babies can be born with protection from this serious disease.

  12. Recognizing and Preventing Whooping Cough 2 (Pertussis)

    Centers for Disease Control (CDC) Podcasts


    This podcast encourages everyone to get vaccinated against whooping cough (pertussis), especially those who will have close contact with an infant.  Created: 9/16/2010 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 9/16/2010.

  13. One Family's Struggles with Pertussis (Whooping Cough)

    Medline Plus

    Full Text Available ... immunizations about immunizations current news Flu's Gonna Lose hepatitis a & b vaccines im/sq how to do kids ... abcs of mmr & dtp thimerosal vaccine safety q & a videos chickenpox (varicella) hepatitis b hib hpv pertussis (whooping cough) pneumococcal rotavirus ...

  14. Face Masks and Cough Etiquette Reduce the Cough Aerosol Concentration of Pseudomonas aeruginosa in People with Cystic Fibrosis. (United States)

    Wood, Michelle E; Stockwell, Rebecca E; Johnson, Graham R; Ramsay, Kay A; Sherrard, Laura J; Jabbour, Nassib; Ballard, Emma; O'Rourke, Peter; Kidd, Timothy J; Wainwright, Claire E; Knibbs, Luke D; Sly, Peter D; Morawska, Lidia; Bell, Scott C


    People with cystic fibrosis (CF) generate Pseudomonas aeruginosa in droplet nuclei during coughing. The use of surgical masks has been recommended in healthcare settings to minimize pathogen transmission between patients with CF. To determine if face masks and cough etiquette reduce viable P. aeruginosa aerosolized during coughing. Twenty-five adults with CF and chronic P. aeruginosa infection were recruited. Participants performed six talking and coughing maneuvers, with or without face masks (surgical and N95) and hand covering the mouth when coughing (cough etiquette) in an aerosol-sampling device. An Andersen Cascade Impactor was used to sample the aerosol at 2 meters from each participant. Quantitative sputum and aerosol bacterial cultures were performed, and participants rated the mask comfort levels during the cough maneuvers. During uncovered coughing (reference maneuver), 19 of 25 (76%) participants produced aerosols containing P. aeruginosa, with a positive correlation found between sputum P. aeruginosa concentration (measured as cfu/ml) and aerosol P. aeruginosa colony-forming units. There was a reduction in aerosol P. aeruginosa load during coughing with a surgical mask, coughing with an N95 mask, and cough etiquette compared with uncovered coughing (P masks during coughing; yet, participants rated the surgical masks as more comfortable (P = 0.013). Cough etiquette provided approximately half the reduction of viable aerosols of the mask interventions during voluntary coughing. Talking was a low viable aerosol-producing activity. Face masks reduce cough-generated P. aeruginosa aerosols, with the surgical mask providing enhanced comfort. Cough etiquette was less effective at reducing viable aerosols.

  15. Efficacy of face shields against cough aerosol droplets from a cough simulator. (United States)

    Lindsley, William G; Noti, John D; Blachere, Francoise M; Szalajda, Jonathan V; Beezhold, Donald H


    Health care workers are exposed to potentially infectious airborne particles while providing routine care to coughing patients. However, much is not understood about the behavior of these aerosols and the risks they pose. We used a coughing patient simulator and a breathing worker simulator to investigate the exposure of health care workers to cough aerosol droplets, and to examine the efficacy of face shields in reducing this exposure. Our results showed that 0.9% of the initial burst of aerosol from a cough can be inhaled by a worker 46 cm (18 inches) from the patient. During testing of an influenza-laden cough aerosol with a volume median diameter (VMD) of 8.5 μm, wearing a face shield reduced the inhalational exposure of the worker by 96% in the period immediately after a cough. The face shield also reduced the surface contamination of a respirator by 97%. When a smaller cough aerosol was used (VMD = 3.4 μm), the face shield was less effective, blocking only 68% of the cough and 76% of the surface contamination. In the period from 1 to 30 minutes after a cough, during which the aerosol had dispersed throughout the room and larger particles had settled, the face shield reduced aerosol inhalation by only 23%. Increasing the distance between the patient and worker to 183 cm (72 inches) reduced the exposure to influenza that occurred immediately after a cough by 92%. Our results show that health care workers can inhale infectious airborne particles while treating a coughing patient. Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled. Thus, face shields provide a useful adjunct to respiratory protection for workers caring for patients with respiratory infections. However, they cannot be used as a substitute for respiratory protection when it is needed. [Supplementary materials are

  16. Comparative analysis of case screening with varying cough duration ...

    African Journals Online (AJOL)

    Conclusion: The sensitivity analysis of the study showed that using .2 weeks cough with two sputum samples gives almost similar values as .3 weeks cough with three sputum samples, but this needs further confirmatory results of culture sensitivity. Hence, using .2 weeks cough with two sputum samples as the diagnostic ...

  17. Reflex responses of lip muscles in young and older women. (United States)

    Wohlert, A B


    The perioral reflex in response to innocuous mechanical stimulation of the lip vermilion was studied in 20 young and 20 older women. Responses to stimuli at the right and left sides of both the upper and lower lips were recorded. Results show significant specificity of response, especially for upper lip sites. Reflex response at the site of stimulation was greatest in amplitude and shortest in latency, followed by response at sites ipsilateral to the site of stimulation. Younger subjects showed greater localizing tendency than older subjects. Stimulation was significantly less likely to produce a reflex response in the older group. When reflex responses did occur, they were significantly lower in amplitude and longer in latency than the responses of the younger group. Nonetheless, reflex responses were common in both groups, with responses at the site of stimulation occurring 78% of the time in older women and 90% of the time in younger women. Every participant showed at least one reflex response to lip stimulation. Results suggest decreasing complexity of synaptic drive to the perioral system in old age but also show that reflexive response does not deteriorate completely, remaining an available element for motor control in normal older women.


    Directory of Open Access Journals (Sweden)

    T.V. Spichak


    Full Text Available Cough in children: new decision of old problem the mechanism of development of cough, classification of its types and main reasons of it are described in this article. Special attention was given to the problem of diagnostics of chronic cough, to peculiarities of modern instrumental diagnostic methods and to principles of therapeutic tactics. The results of treatment with anti inflammatory medication fenspiride (eurespal are presented. Russian and foreign literature data and information from american guideline in cough treatment was used in this article.Key words: cough, children, fenspiride.

  19. Radiographic assessment of laryngeal reflexes in ketamine-anesthetized cats

    International Nuclear Information System (INIS)

    Robinson, E.P.; Johnston, G.R.


    The competence of the laryngeal closure reflexes of cats anesthetized with ketamine was assessed. Radiographic evaluations of the respiratory and digestive tracts were made after colloidal barium suspension was instilled into the pharynges of conscious and ketamine-anesthetized cats. There was a significant ketamine dose-related response of spread of contrast medium into the supraglottic laryngeal area and into the stomach 2 minutes after contrast medium was instilled into the pharynx (P less than 0.05). Cats did not aspirate contrast medium into the lower respiratory tract. Three ketamine-anesthetized cats aspirated contrast medium into the subglottic area of the larynx, and 2 of these cats also aspirated the material into the cranial part of the trachea. This material was coughed up and swallowed within 5 minutes. Transit time of contrast medium into the stomach seemed to be increased in 11 of the 15 cats given the larger dosages of ketamine (24, 36, 48 mg/kg of body weight), compared with that in conscious cats and those given ketamine at 12 mg/kg. Competent laryngeal protective reflexes in cats can be maintained with ketamine anesthesia. Contrast radiography could be used as a diagnostic aid in ketamine-anesthetized cats suspected of laryngeal reflex abnormalities

  20. Reflexive Dressing: Rethinking Retro

    Directory of Open Access Journals (Sweden)

    Stella North


    Full Text Available This article undertakes a philosophical exploration of the act we know, or think we know, as ‘dressing’. Inhabiting, in thought, the moment in which we dress, I examine some of its constituent mechanisms, attending to the impulses by which dressing is generated out of subjective experience.  When those impulses are temporally marked, as they are in the case of retro dress, this generation is a two-pronged process, in which the holding of the body in time, and the holding of time in the body, recalibrate one another. The process of ‘dressing,’ in this understanding, has a reflexivity which is double; it entails the turning of the body, with dress as medium, towards itself, and the turning of present experience towards some felt notion of the past. Reflexively dressing, we are always becoming ourselves, and becoming other than ourselves, at once; a movement of circuitous internalisation and externalisation by which the ambiguation inherent in material experience is realised.


    NARCIS (Netherlands)


    Reflex sympathetic dystrophy is a chronic pain syndrome characterized by chronic burning pain, restricted range of motion, oedema and vasolability. Patients are difficult to treat and the prognosis is very often poor. This report emphasizes that an amputation in case of a reflex sympathetic

  2. Effect of straining on diaphragmatic crura with identification of the straining-crural reflex. The "reflex theory" in gastroesophageal competence

    Directory of Open Access Journals (Sweden)

    El Sibai Olfat


    Full Text Available Abstract Background The role of the crural diaphragm during increased intra-abdominal pressure is not exactly known. We investigated the hypothesis that the crural diaphragm undergoes reflex phasic contraction on elevation of the intra-abdominal pressure with a resulting increase of the lower esophageal pressure and prevention of gastro-esophageal reflux. Methods The esophageal pressure and crural diaphragm electromyographic responses to straining were recorded in 16 subjects (10 men, 6 women, age 36.6 ± 11.2 SD years during abdominal hernia repair. The electromyogram of crural diaphragm was recorded by needle electrode inserted into the crural diaphragm, and the lower esophageal pressure by a saline-perfused catheter. The study was repeated after crural anesthetization and after crural infiltration with saline. Results The crural diaphragm exhibited resting electromyographic activity which showed a significant increase on sudden (coughing, p Conclusions Straining effected an increase of the electromyographic activity of the crural diaphragm and of the lower esophageal pressure. This effect is suggested to be reflex in nature and to be mediated through the "straining-crural reflex". The crural diaphragm seems to play a role in the lower esophageal competence mechanism. Further studies are required to assess the clinical significance of the current results in gastro-esophageal reflux disease and hiatus hernia.

  3. Effect of acid suppression therapy on gastroesophageal reflux and cough in idiopathic pulmonary fibrosis: an intervention study. (United States)

    Kilduff, Claire E; Counter, Melanie J; Thomas, Gareth A; Harrison, Nicholas K; Hope-Gill, Benjamin D


    Chronic cough affects more than 70 percent of patients with Idiopathic Pulmonary Fibrosis and causes significant morbidity. Gastroesophageal reflux is the cause of some cases of chronic cough; and also has a postulated role in the aetiology of Idiopathic Pulmonary Fibrosis. A high prevalence of acid; and more recently non-acid, reflux has been observed in Idiopathic Pulmonary Fibrosis cohorts. Therefore, gastroesophageal reflux may be implicated in the pathogenesis of cough in Idiopathic Pulmonary Fibrosis. Eighteen subjects with Idiopathic Pulmonary Fibrosis underwent 24-hour oesophageal impedance and cough count monitoring after the careful exclusion of causes of chronic cough other than gastroesophageal reflux. All 18 were then treated with high dose acid suppression therapies. Fourteen subjects underwent repeat 24-hour oesophageal impedance and cough count monitoring after eight weeks. Total reflux and acid reflux frequencies were within the normal range in the majority of this cohort. The frequencies of non-acid and proximal reflux events were above the normal range. Following high dose acid suppression therapy there was a significant decrease in the number of acid reflux events (p = 0.02), but an increase in the number of non-acid reflux events (p = 0.01). There was no change in cough frequency (p = 0.70). This study confirms that non-acid reflux is prevalent; and that proximal oesophageal reflux occurs in the majority, of subjects with Idiopathic Pulmonary Fibrosis. It is the first study to investigate the effect of acid suppression therapy on gastroesophageal reflux and cough in patients with Idiopathic Pulmonary Fibrosis. The observation that cough frequency does not improve despite verifiable reductions in oesophageal acid exposure challenges the role of acid reflux in Idiopathic Pulmonary Fibrosis associated cough. The finding that non-acid reflux is increased following the use of acid suppression therapies cautions against the widespread use

  4. [Reflex seizures, cinema and television]. (United States)

    Olivares-Romero, Jesús


    In movies and television series are few references to seizures or reflex epilepsy even though in real life are an important subgroup of total epileptic syndromes. It has performed a search on the topic, identified 25 films in which they appear reflex seizures. Most seizures observed are tonic-clonic and visual stimuli are the most numerous, corresponding all with flashing lights. The emotions are the main stimuli in higher level processes. In most cases it is not possible to know if a character suffers a reflex epilepsy or suffer reflex seizures in the context of another epileptic syndrome. The main conclusion is that, in the movies, the reflex seizures are merely a visual reinforcing and anecdotal element without significant influence on the plot.

  5. Chest radiography in supporting the diagnosis of asthma in children with persistent cough. (United States)

    Halaby, Claudia; Feuerman, Martin; Barlev, Dan; Pirzada, Melodi


    To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting. 180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease. Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001). This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.

  6. Reflex epileptic mechanisms in humans: Lessons about natural ictogenesis. (United States)

    Wolf, Peter


    The definition of reflex epileptic seizures is that specific seizure types can be triggered by certain sensory or cognitive stimuli. Simple triggers are sensory (most often visual, more rarely tactile or proprioceptive; simple audiogenic triggers in humans are practically nonexistent) and act within seconds, whereas complex triggers like praxis, reading and talking, and music are mostly cognitive and work within minutes. The constant relation between a qualitatively, often even quantitatively, well-defined stimulus and a specific epileptic response provides unique possibilities to investigate seizure generation in natural human epilepsies. For several reflex epileptic mechanisms (REMs), this has been done. Reflex epileptic mechanisms have been reported less often in focal lesional epilepsies than in idiopathic "generalized" epilepsies (IGEs) which are primarily genetically determined. The key syndrome of IGE is juvenile myoclonic epilepsy (JME), where more than half of the patients present reflex epileptic traits (photosensitivity, eye closure sensitivity, praxis induction, and language-induced orofacial reflex myocloni). Findings with multimodal investigations of cerebral function concur to indicate that ictogenic mechanisms in IGEs largely (ab)use preexisting functional anatomic networks (CNS subsystems) normally serving highly complex physiological functions (e.g., deliberate complex actions and linguistic communication) which supports the concept of system epilepsy. Whereas REMs in IGEs, thus, are primarily function-related, in focal epilepsies, they are primarily localization-related. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic". Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Reflex muscle contraction in anterior shoulder instability. (United States)

    Wallace, D A; Beard, D J; Gill, R H; Eng, B; Carr, A J


    Reduced proprioception may contribute to recurrent anterior shoulder instability. Twelve patients with unilateral shoulder instability were investigated for evidence of deficient proprioception with an activated pneumatic cylinder and surface electromyography electrodes; the contralateral normal shoulder was used as a control. The latency between onset of movement and the detection of muscle contraction was used as an index of proprioception. No significant difference in muscle contraction latency was detected between the stable and unstable shoulders, suggesting that there was no significant defect in muscular reflex activity. This study does not support the use proprioception-enhancing physiotherapy in the treatment of posttraumatic anterior shoulder instability.

  8. Born with Protection against Whooping Cough

    Centers for Disease Control (CDC) Podcasts


    This podcast provides information about whooping cough, a disease that can be deadly for babies, and CDC’s recommendation that all women receive the Tdap vaccine during the third trimester of every pregnancy so their babies can be born with protection from this serious disease.  Created: 1/22/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPDB).   Date Released: 1/22/2015.

  9. Pharmacology of Bradykinin-Evoked Coughing in Guinea Pigs


    Hewitt, Matthew M.; Adams, Gregory; Mazzone, Stuart B.; Mori, Nanako; Yu, Li; Canning, Brendan J.


    Bradykinin has been implicated as a mediator of the acute pathophysiological and inflammatory consequences of respiratory tract infections and in exacerbations of chronic diseases such as asthma. Bradykinin may also be a trigger for the coughing associated with these and other conditions. We have thus set out to evaluate the pharmacology of bradykinin-evoked coughing in guinea pigs. When inhaled, bradykinin induced paroxysmal coughing that was abolished by the bradykinin B2 receptor antagonis...

  10. A Whooping Cough Education Module for WIC Clients in Utah. (United States)

    Luthy, Karlen E; Anderson, Alicia; Macintosh, Janelle; Beckstrand, Renea L; Eden, Lacey M; Amy, Ryan; Macintosh, Christopher I

    Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included development of a whooping cough education module and evaluation of learning. Learning was evaluated using a pre- and posttest design. Client feedback was solicited via open-ended questions. Quantitative analysis was performed on visual analog-type questions with paired t-tests and a Cohen's d. Content analysis was conducted on open-ended items. The module was designed by a team of vaccination experts and included general definitions, signs and symptoms during the three stages of disease, recommendations to prevent whooping cough, and vaccination recommendations. Learning of users of the module was then evaluated. After using the module, clients indicated they were significantly more likely to vaccinate themselves and their child against whooping cough, and to recommend the vaccination to their family members. The greatest concern of participants about whooping cough was how it affected infants. Participants reported they learned new information on disease seriousness, recognition of symptoms, and treatment options but still requested additional information on the whooping cough disease and vaccine. A whooping cough education module is an effective strategy to improve whooping cough knowledge and promote the whooping cough vaccine.

  11. Evaluation of Methacholine Challenge Test Results in Chronic Cough Patients Referring to Clinic of Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Derakhshan Deilami Gholamreza


    Full Text Available Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks, who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a

  12. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough? (United States)

    Swenson, Carolyn W; Kolenic, Giselle E; Trowbridge, Elisa R; Berger, Mitchell B; Lewicky-Gaupp, Christina; Margulies, Rebecca U; Morgan, Daniel M; Fenner, Dee E; DeLancey, John O


    We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m 2 ); overweight (25.0-29.9 kg/m 2 ); and obese (≥30 kg/m 2 ). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p continence mechanism.

  13. Management of Reflex Anoxic Seizures

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available Investigators at the Roald Dahl EEG Unit, Alder Hey Children’s NHS Foundation, Liverpool, UK, review the definition, pathophysiology, clinical presentation, and management of reflex anoxic seizures (RAS in children.

  14. Symptom research on chronic cough: a historical perspective. (United States)

    Irwin, R S; Madison, J M


    This review provides a perspective on how research on the management of cough has evolved, looks at key methodologic lessons that have been learned from this research and how they may relate to the management of other symptoms, identifies important methodologic challenges that remain to be solved, and lists important questions that still need to be answered. Three important methodologic lessons have been learned. First, cough must be evaluated systematically and according to a neuroanatomic framework. Second, the response to specific therapy must be noted to determine the cause or causes of cough and to characterize the strengths and limitations of diagnostic testing. Third, multiple conditions can simultaneously cause cough. Among the three methodologic challenges that still need to be solved are 1) definitively determining the diagnostic accuracy and reliability of 24-hour esophageal pH monitoring and how best to interpret pH test results, 2) definitively determining the role of nonacid reflux in cough due to gastroesophageal reflux disease, and 3) developing reliable and reproducible subjective and objective methods with which to assess the efficacy of cough therapy. Numerous important clinical questions are still unanswered: What role do empirical therapeutic trials play in diagnosing the cause of chronic cough? What is the most cost-effective approach to the diagnosis and treatment of chronic cough: empirical therapeutic trials or laboratory testing-directed therapeutic trials? How often is environmental air pollution, unrelated to allergies or smoking, responsible for chronic cough?

  15. Psychological profile of individuals presenting with chronic cough

    Directory of Open Access Journals (Sweden)

    Katrin Hulme


    Full Text Available Chronic refractory cough (CRC is a common problem in respiratory clinics. Adverse effects on quality of life are documented in the literature, but relatively little is known about the underlying psychological factors in this patient population. We aimed to investigate the association of psychological factors with chronic cough, comparing CRC to explained cough and non-cough groups. 67 patients attending a specialist cough clinic (CRC, n=25; explained cough, n=42 and 22 non-cough individuals participated. All participants completed the Hospital Anxiety & Depression Scale, Big Five Inventory (Personality, Chalder Fatigue Scale and Patient Health Questionnaire-15. Cough patients also completed the Illness Perception Questionnaire-Revised. Appropriate statistical analyses were used to compare participant groups. Chronic refractory coughers displayed significantly higher levels of anxiety, depression, fatigue and somatic physical symptoms than non-cough participants. Compared to explained coughers, there were higher depression and fatigue scores and significantly more negative illness representations (specifically, strong beliefs regarding negative consequences, lower illness coherence and higher emotional representations. “Explained” coughers reported significantly increased fatigue and somatic symptoms in comparison to non-coughers. The prevalence of fatigue, low mood, negative illness beliefs and increased physical symptom reporting should be considered in consultations and in developing novel interventions for CRC patients.

  16. Preliminary Evidence of Reduced Urge to Cough and Cough Response in Four Individuals following Remote Traumatic Brain Injury with Tracheostomy

    Directory of Open Access Journals (Sweden)

    Erin Silverman


    Full Text Available Cough and swallow protect the lungs and are frequently impaired following traumatic brain injury (TBI. This project examined cough response to inhaled capsaicin solution challenge in a cohort of four young adults with a history of TBI within the preceding five years. All participants had a history of tracheostomy with subsequent decannulation and dysphagia after their injuries (resolved for all but one participant. Urge to cough (UTC and cough response were measured and compared to an existing database of normative cough response data obtained from 32 healthy controls (HCs. Participants displayed decreased UTC and cough responses compared to HCs. It is unknown if these preliminary results manifest as a consequence of disrupted sensory (afferent projections, an inability to perceive or discriminate cough stimuli, disrupted motor (efferent response, peripheral weakness, or any combination of these factors. Future work should attempt to clarify if the observed phenomena are borne out in a larger sample of individuals with TBI, determine the relative contributions of central versus peripheral nervous system structures to cough sensory perceptual changes following TBI (should they exist, and formulate recommendations for systematic screening and assessment of cough sensory perception in order to facilitate rehabilitative efforts. This project is identified with the National Clinical Trials NCT02240329.

  17. Cough mixtures: rational or irrational prescribing in Hong Kong? (United States)

    Wong, William C W; Dickinson, James; Chan, Cynthia


    To investigate the extent and how cough mixtures are prescribed, and what conditions or specific groups of people would contribute to its prescription in Hong Kong. Using diagnosis and drug data obtained from logbooks submitted by participants in the diploma in family medicine course between 1999 and 2003, we selected and analysed all patients with a diagnosis of cough or cough-related illnesses as well as cough mixtures that were used to treat them. This study confirmed that cough-related illnesses were common in the Hong Kong primary care setting and cough mixtures were used quite liberally irrespective of the patients' age and sex. Combination preparations accounted for over half of the prescriptions and cough mixture was used less in severe cases when antibiotics were given. Private doctors working in the public sector. Given the current health care system, inappropriate and over-prescribing of cough mixtures can be improved by promoting health education and awareness among patients seeking medical help for this common medical condition.

  18. Modelling of coughed droplets in a hospital ward

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Nielsen, Peter Vilhelm


    Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively ...

  19. Evaluation of Fractioned Nitric Oxide in Chronic Cough Patients

    African Journals Online (AJOL)


    Feb 7, 2018 ... Nigerian Journal of Clinical Practice ¦ Volume 21 ¦ Issue 1 ¦ January 2018 bronchitis (PBB), upper airway cough syndrome, and natural healing. ... chronic cough and NO in asthmatic patients, none have investigated FeNO in ...

  20. Changes in soleus H-reflex during walking in middle-aged, healthy subjects

    DEFF Research Database (Denmark)

    Raffalt, Peter C; Alkjær, Tine; Simonsen, Erik B


    INTRODUCTION: To assess the effect of aging on stretch reflex modulation during walking, soleus H-reflexes obtained in 15 middle-aged (mean age 56.4±6.9 years) and 15 young (mean age 23.7±3.9 years) subjects were compared. METHODS: The H-reflex amplitude, muscle activity (EMG) of the soleus...... and tibialis anterior muscles, and EMG/H-reflex gain were measured during 4-km/h treadmill walking. RESULTS: The normalized H-reflex amplitude was lower in the swing phase for the middle-aged group, and there was no difference in muscle activity. EMG/H-reflex gain did not differ between groups. CONCLUSIONS: H......-reflex amplitude during walking was affected by aging, and changes during the swing phase could be seen in the middle-aged subjects. Subdividing the 2 age groups into groups of facilitated or suppressed swing-phase H-reflex revealed that the H-reflex amplitude modulation pattern in the group with facilitated swing...

  1. Proximally evoked soleus H-reflex to S1 nerve root stimulation in sensory neuronopathies (ganglionopathies). (United States)

    Zhu, Dong-Qing; Zhu, Yu; Qiao, Kai; Zheng, Chao-Jun; Bradley, Scott; Weber, Robert; Chen, Xiang-Jun


    Sensory neuronopathy (SNN) mimics distal sensory axonopathy. The conventional H-reflex elicited by tibial nerve stimulation (tibial H-reflex) is usually abnormal in both conditions. We evaluated the proximally evoked soleus H-reflex in response to S1 nerve root stimulation (S1 foramen H-reflex) in SNN. Eleven patients with SNN and 6 with distal sensory axonopathy were studied. Tibial and S1 foramen H-reflexes were performed bilaterally in each patient. Tibial and S1 foramen H-reflexes were absent bilaterally in all patients with SNN. In the patients with distal sensory axonopathy, tibial H-reflexes were absent in 4 and demonstrated prolonged latencies in 2, but S1 foramen H-reflexes were normal. Characteristic absence of the H-reflex after both proximal and distal stimulation reflects primary loss of dorsal root ganglion (DRG) neurons and the distinct non-length-dependent impairment of sensory nerve fibers in SNN. Copyright © 2013 Wiley Periodicals, Inc.

  2. Human Syngamosis as an Uncommon Cause of Chronic Cough

    Directory of Open Access Journals (Sweden)

    Pulcherio, Janaína Oliveira Bentivi


    Full Text Available Introduction: Chronic cough may represent a diagnostic challenge. Chronic parasitism of upper airways is an unusual cause. Objective: To describe a case of human syngamosis as an uncommon cause of dry cough. Case Report: An endoscopic exam performed in a woman suffering of chronic cough revealed a Y-shaped worm in the larynx identified as Syngamus laryngeus. Discussion: This nematode parasitizes the upper respiratory tract of many animals including humans. The diagnosis is performed by the examination of the worm expelled by cough or by endoscopy. Endoscopic exam is easy to perform and is essential in the diagnosis of causes of chronic cough, even uncommon entities. Removal is the only efficient treatment.

  3. Impact of chronic cough on quality of life. (United States)

    French, C L; Irwin, R S; Curley, F J; Krikorian, C J

    Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean +/- SD of 8.6 +/- 4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (PSIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.

  4. Plasticity of the human otolith-ocular reflex (United States)

    Wall, C. 3rd; Smith, T. R.; Furman, J. M.


    The eye movement response to earth vertical axis rotation in the dark, a semicircular canal stimulus, can be altered by prior exposure to combined visual-vestibular stimuli. Such plasticity of the vestibulo-ocular reflex has not been described for earth horizontal axis rotation, a dynamic otolith stimulus. Twenty normal human subjects underwent one of two types of adaptation paradigms designed either to attenuate or enhance the gain of the semicircular canal-ocular reflex prior to undergoing otolith-ocular reflex testing with horizontal axis rotation. The adaptation paradigm paired a 0.2 Hz sinusoidal rotation about a vertical axis with a 0.2 Hz optokinetic stripe pattern that was deliberately mismatched in peak velocity. Pre- and post-adaptation horizontal axis rotations were at 60 degrees/s in the dark and produced a modulation in the slow component velocity of nystagmus having a frequency of 0.17 Hz due to putative stimulation of the otolith organs. Results showed that the magnitude of this modulation component response was altered in a manner similar to the alteration in semicircular canal-ocular responses. These results suggest that physiologic alteration of the vestibulo-ocular reflex using deliberately mismatched visual and semicircular canal stimuli induces changes in both canal-ocular and otolith-ocular responses. We postulate, therefore, that central nervous system pathways responsible for controlling the gains of canal-ocular and otolith-ocular reflexes are shared.

  5. Interpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosing and treating cough-variant asthma. (United States)

    Irwin, R S; French, C T; Smyrnios, N A; Curley, F J


    In diagnosing cough due to asthma, methacholine chloride inhalation challenge (MIC) interpreted in a traditional fashion has been shown to have positive predictive values from 60% to 82%. To determine whether any features of positive results of an MIC or the results of a 1-week trial of inhaled beta-agonist therapy were helpful in predicting when the cough was due to asthma. The study design was a prospective, randomized, double-blind, placebo-controlled, crossover format performed in adult, nonsmoking subjects, who were referred for diagnosis and treatment of chronic cough. The subjects had no other respiratory complaints or medical conditions for which they were taking medications, the results of baseline spirometry and chest roentgenograms were normal, and the results of MIC were positive. After obtaining baseline data, including MICs on 2 separate days, objective cough counting, and self-assessment of cough severity using a visual analog scale, subjects were randomized to receive 2 inhalations (1.3 mg) of metaproterenol sulfate or placebo by metered dose inhaler attached to a spacer device every 4 hours while awake. At 1 week, data identical to baseline were collected, and subjects received the other metered dose inhaler for 7 days. At 1 week, data identical to baseline were collected. After completion of the protocol, subjects were followed up in the clinic to observe the final response of the cough to specific therapy. Based on the disappearance of the cough with specific therapy, the cough was due to asthma in 9 of 15 subjects and nonasthma in 6 of 15 subjects. Baseline data were similar between groups. With respect to MICs, there were no significant differences between groups in the cumulative dose of methacholine that provoked a 20% decrease in forced expiratory volume in 1 second from the postsaline baseline value (PD20 values), slopes of dose-response curves, and maximal-response plateaus. Cough severity significantly improved after 1 week of

  6. Reflexive fatherhood in everyday life

    DEFF Research Database (Denmark)

    Westerling, Allan


    This article looks at fathering practices in Denmark, using the findings from a research project on everyday family life in Denmark. It takes a social psychological perspective and employs discursive psychology and theories about reflexive modernisation. It shows how fathers orient towards intimacy...... in their relationships with their children. Moreover, it discusses how fathers’ relatedness reflects individualisation and detraditionalisation. It is argued that reflexive modernisation entails subjective orientations that enable novel pathways to intimacy in contemporary father–child relationships. Through...... this analysis and discussion, the article offers a way to understand the complexities of fathering in everyday life from the perspective of fathers....

  7. Outside home. Notes on reflexivity

    Directory of Open Access Journals (Sweden)

    Mara Clemente


    The paper proffers the idea in which a “reflexive process” on subjectivity can involve and/or hopefully involve the entire experience of the researcher, going beyond the borders of a single research. In the process, unexpected elements of subjectivity can come into play; in other cases the meaning attributed to them can change in time or can have a role different from what had been expected. Some elements, objects of epistemological analyses, as imposed by a reflexive approach, can become objects of attention also on the phenomenological level.

  8. Educating the Reflexive Practitioner

    Directory of Open Access Journals (Sweden)

    Marc J. Neveu


    wearing any clothes.Notwithstanding such issues, I do believe the studio holds the potentialto be an empowering learning experience. The intention of this article is to question the mode of instruction in an architectural studio. I’ve structured the paper in three parts. First, I will briefly describe the findingsof the study made by the Carnegie Foundation for the Advancementof Teaching known as the Boyer Report.2 To develop and support the findings of the Boyer Report, I introduce the work of the educator Donald Schön. Though I see much merit in the Boyer Report, and Schön’sproposals, I argue that a more nuanced approach is required. I will recommend, therefore, in the second section of this paper that a meansof architectural education as based on the Socratic method may be amore productive approach. My reading of the Socratic method is basedprimarily on early Socratic dialogues and I will specifically use Charmidesto illustrate the issues that I believe are relevant to studio pedagogy.3 From my analysis of Charmides I will, in the third section of the essay,describe how the Socratic method is beneficial to studio pedagogy threeways: reflexive, non-propositional, and finally how Socrates’ approachmay indeed be practical. This last section will be illustrated with a studentproject. It is my conjecture that the Socratic method offers insight intocurrent discussions of educational theory, namely student-centered,project-based learning.

  9. Neurodevelopmental Reflex Testing in Neonatal Rat Pups. (United States)

    Nguyen, Antoinette T; Armstrong, Edward A; Yager, Jerome Y


    Neurodevelopmental reflex testing is commonly used in clinical practice to assess the maturation of the nervous system. Neurodevelopmental reflexes are also referred to as primitive reflexes. They are sensitive and consistent with later outcomes. Abnormal reflexes are described as an absence, persistence, reappearance, or latency of reflexes, which are predictive indices of infants that are at high risk for neurodevelopmental disorders. Animal models of neurodevelopmental disabilities, such as cerebral palsy, often display aberrant developmental reflexes, as would be observed in human infants. The techniques described assess a variety of neurodevelopmental reflexes in neonatal rats. Neurodevelopmental reflex testing offers the investigator a testing method that is not otherwise available in such young animals. The methodology presented here aims to assist investigators in examining developmental milestones in neonatal rats as a method of detecting early-onset brain injury and/or determining the effectiveness of therapeutic interventions. The methodology presented here aims to provide a general guideline for investigators.

  10. Importance of placebo effect in cough clinical trials. (United States)

    Eccles, Ron


    Cough is a unique symptom because, unlike sneeze and other symptoms, it can be under voluntary control and this complicates clinical trials on cough medicines. All over-the-counter cough medicines (OTC) are very effective treatments because of their placebo effect. The placebo effect is enhanced by expectancy related to advertising, brand, packaging, and formulation. This placebo effect creates a problem for the conduct of clinical trials on OTC cough medicines that attempt to demonstrate the efficacy of a pharmacological agent above that of any placebo effect. Up to 85% of the efficacy of some cough medicines can be attributed to a placebo effect. The placebo effect apparent in clinical trials consists of several components: natural recovery, regression of cough response toward mean, demulcent effect, effect of sweetness, voluntary control, and effects related to expectancy and meaning of the treatment. The placebo effect has been studied most in the pain model, and placebo analgesia is reported to depend on the activation of endogenous opioid systems in the brain; this model may be applicable to cough. A balanced placebo design may help to control for the placebo effect, but this trial design may not be acceptable due to deception of patients. The placebo effect in clinical trials may be controlled by use of a crossover design, where feasible, and the changes in the magnitude of the placebo effect in this study design are discussed.

  11. Pharmacology of Bradykinin-Evoked Coughing in Guinea Pigs. (United States)

    Hewitt, Matthew M; Adams, Gregory; Mazzone, Stuart B; Mori, Nanako; Yu, Li; Canning, Brendan J


    Bradykinin has been implicated as a mediator of the acute pathophysiological and inflammatory consequences of respiratory tract infections and in exacerbations of chronic diseases such as asthma. Bradykinin may also be a trigger for the coughing associated with these and other conditions. We have thus set out to evaluate the pharmacology of bradykinin-evoked coughing in guinea pigs. When inhaled, bradykinin induced paroxysmal coughing that was abolished by the bradykinin B2 receptor antagonist HOE 140. These cough responses rapidly desensitized, consistent with reports of B2 receptor desensitization. Bradykinin-evoked cough was potentiated by inhibition of both neutral endopeptidase and angiotensin-converting enzyme (with thiorphan and captopril, respectively), but was largely unaffected by muscarinic or thromboxane receptor blockade (atropine and ICI 192605), cyclooxygenase, or nitric oxide synthase inhibition (meclofenamic acid and N(G)-nitro-L-arginine). Calcium influx studies in bronchopulmonary vagal afferent neurons dissociated from vagal sensory ganglia indicated that the tachykinin-containing C-fibers arising from the jugular ganglia mediate bradykinin-evoked coughing. Also implicating the jugular C-fibers was the observation that simultaneous blockade of neurokinin2 (NK2; SR48968) and NK3 (SR142801 or SB223412) receptors nearly abolished the bradykinin-evoked cough responses. The data suggest that bradykinin induces coughing in guinea pigs by activating B2 receptors on bronchopulmonary C-fibers. We speculate that therapeutics targeting the actions of bradykinin may prove useful in the treatment of cough. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

  12. Consumer attitudes on cough and cold: US (ACHOO) survey results. (United States)

    Blaiss, M S; Dicpinigaitis, P V; Eccles, R; Wingertzahn, M A


    The Attitudes of Consumers Toward Health, Cough, and Cold (ACHOO) survey was developed to better inform health care providers on the natural history and impact of common cold and cough, and related consumer experience and behaviors. Randomly selected US Internet/mobile device users were invited to participate in an online survey (N = 3333) in October 2012. Response quotas modeled upon 2010 US Census data ensured a demographically representative sample. To reduce potential bias from the quota design, 75% of the completed surveys were randomly selected as the primary analysis pool. Survey questions assessed participant demographics, frequency and duration of cough/cold symptoms, impact of symptoms on daily life, treatment preferences, and knowledge about cough/cold pathophysiology. In the past year, 84.6% of respondents had experienced at least one cold. Colds typically started with sore/scratchy throat (39.2%), nasal congestion (9.8%), and runny nose (9.3%) and lasted 3-7 days. Cough, the most common cold symptom (73.1%), had a delayed onset (typically 1-5 days after cold onset) and a long duration (>6 days in 35.2%). Nasal congestion and cough were the most bothersome symptoms. Many respondents waited until symptoms were 'bad enough' (42.6%) or multiple symptoms were present (20.2%) before using nonprescription medications. Drivers of choice included effectiveness in relieving symptoms, safety, and past experience. Respondents rarely consulted clinicians regarding treatment, and more than three-quarters had never received instructions from a clinician on how to choose a nonprescription cough/cold medication. Misperceptions regarding etiology and treatment of the common cold were prevalent. The main limitation is potential recall bias, since respondents had to recall cough/cold episodes over the prior year. The ACHOO survey confirms that cold is a common, bothersome experience and that there are gaps in consumers' knowledge of pathophysiology and appropriate

  13. Characteristics of Chinese patients with cough in primary care centre

    Directory of Open Access Journals (Sweden)

    Bai Chunxue


    Full Text Available Abstract Background Cough is one of the most common respiratory symptoms and is well characterized in specialized cough clinics with high success rates of diagnosis and treatment. However, there is a paucity of data regarding cough in primary care settings. The present study aimed at investigating clinical epidemiology of cough through a national study of two questionnaire surveys sent to primary care physicians in China. Methods Approximately 18,000 subjects recruited were having daytime or night symptoms of cough and diagnoses of respiratory disease from February 2005 to April 2006 as Survey 1 and from June 2007 to December 2007 as Survey 2. Patients suffering from respiratory malignancy, hyperthyroidism, hypertension, heart disease, diabetes, severe hypohepatia or renal dysfunction, pregnancy, possible pregnancy or lactation, neutropenia were not eligible. Information regarding demography, history of allergies, symptomatic profile, treatment and curative effects for cough was elicited. Results 8216 questionnaires were collected in Survey 1 and 9711 in Survey 2. The mean values of ages were 25.7 and 22.3 years old, respectively. Symptoms included expectoration (74% and 76%, wheeze (59% and 74%, breathlessness (22% and 26%, chest pain (9% and 13% and fever (15% and 18%. About 15% and 23% patients had hypersusceptibility, of whom 6% to 17% had a family history. More than 50% of the cases had histories of allergic rhinitis, asthma, conjunctivitis or atopic dermatitis. Asthma, COPD, and bronchitis were dominant etiologies of cough. Procaterol or the combination of antibiotics and steroids were used as the treatment. Conclusion Causes and outcomes of cough differed with ages and time in this particular national study, while successful and precise diagnosis and management of cough in primary care settings need to be further improved in China.

  14. Fundamental Principles underlying Motor Reflexes

    NARCIS (Netherlands)

    K. Zhou (Kuikui)


    markdownabstractThe cerebellum has been suggested to be involved in motor control ever since the early 19th century. The motor control ranges from timing and strength of simple reflexes to multiple joint/limb coordination and complex motor sequence acquisition. The current thesis discusses the

  15. Soleus stretch reflex during cycling

    DEFF Research Database (Denmark)

    Grey, Michael James; Pierce, C. W.; Milner, T. E.


    The modulation and strength of the human soleus short latency stretch reflex was investigated by mechanically perturbing the ankle during an unconstrained pedaling task. Eight subjects pedaled at 60 rpm against a preload of 10 Nm. A torque pulse was applied to the crank at various positions durin...

  16. The reflexive case study method

    DEFF Research Database (Denmark)

    Rittenhofer, Iris


    This paper extends the international business research on small to medium-sized enterprises (SME) at the nexus of globalization. Based on a conceptual synthesis across disciplines and theoretical perspectives, it offers management research a reflexive method for case study research of postnational...

  17. Increase of weakly acidic gas esophagopharyngeal reflux (EPR) and swallowing-induced acidic/weakly acidic EPR in patients with chronic cough responding to proton pump inhibitors. (United States)

    Kawamura, O; Shimoyama, Y; Hosaka, H; Kuribayashi, S; Maeda, M; Nagoshi, A; Zai, H; Kusano, M


    Gastro-esophageal reflux disease (GERD)-related chronic cough (CC) may have multifactorial causes. To clarify the characteristics of esophagopharyngeal reflux (EPR) events in CC patients whose cough was apparently influenced by gastro-esophageal reflux (GER), we studied patients with CC clearly responding to full-dose proton pump inhibitor (PPI) therapy (CC patients). Ten CC patients, 10 GERD patients, and 10 healthy controls underwent 24-h ambulatory pharyngo-esophageal impedance and pH monitoring. Weakly acidic reflux was defined as a decrease of pH by >1 unit with a nadir pH >4. In six CC patients, monitoring was repeated after 8 weeks of PPI therapy. The number of each EPR event and the symptom association probability (SAP) were calculated. Symptoms were evaluated by a validated GERD symptom questionnaire. Weakly acidic gas EPR and swallowing-induced acidic/weakly acidic EPR only occurred in CC patients, and the numbers of such events was significantly higher in the CC group than in the other two groups (P pump inhibitor therapy abolished swallowing-induced acidic/weakly acidic EPR, reduced weakly acidic gas EPR, and improved symptoms (all P gas EPR and swallowing-induced acidic/weakly acidic EPR. A direct effect of acidic mist or liquid refluxing into the pharynx may contribute to chronic cough, while cough may also arise indirectly from reflux via a vago-vagal reflex in some patients. © 2011 Blackwell Publishing Ltd.

  18. Automatic cough episode detection using a vibroacoustic sensor. (United States)

    Mlynczak, Marcel; Pariaszewska, Katarzyna; Cybulski, Gerard


    Cough monitoring is an important element of the diagnostics of respiratory diseases. The European Respiratory Society recommends objective assessment of cough episodes and the search for methods of automatic analysis to make obtaining the quantitative parameters possible. The cough "events" could be classified by a microphone and a sensor that measures the vibrations of the chest. Analysis of the recorded signals consists of calculating the features vectors for selected episodes and of performing automatic classification using them. The aim of the study was to assess the accuracy of classification based on an artificial neural networks using vibroacoustic signals collected from chest. Six healthy, young men and eight healthy, young women carried out an imitated cough, hand clapping, speech and shouting. Three methods of parametrization were used to prepare the vectors of episode features - time domain, time-frequency domain and spectral modeling. We obtained the accuracy of 95% using artificial neural networks.

  19. Cough and Cold Medicine (DXM and Codeine Syrup) (United States)

    ... causing a range of effects from lack of motivation to serious health problems. Repeatedly seeking to experience ... misuse cough and cold medicines. Swipe left or right to scroll. Monitoring the Future Study: Trends in ...

  20. Whooping Cough Vaccine Recommendation for Babies and Young Children

    Centers for Disease Control (CDC) Podcasts

    This podcast provides information about whooping cough and the recommendation that all children receive the DTaP vaccine, according to CDC’s recommended schedule, to help protect them from this serious disease.

  1. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. (United States)

    Weinberger, Miles; Abu-Hasan, Mutasim


    Although asthma is the most common cause of cough, wheeze, and dyspnea in children and adults, asthma is often attributed inappropriately to symptoms from other causes. Cough that is misdiagnosed as asthma can occur with pertussis, cystic fibrosis, primary ciliary dyskinesia, airway abnormalities such as tracheomalacia and bronchomalacia, chronic purulent or suppurative bronchitis in young children, and habit-cough syndrome. The respiratory sounds that occur with the upper airway obstruction caused by the various manifestations of the vocal cord dysfunction syndrome or the less common exercise-induced laryngomalacia are often mischaracterized as wheezing and attributed to asthma. The perception of dyspnea is a prominent symptom of hyperventilation attacks. This can occur in those with or without asthma, and patients with asthma may not readily distinguish the perceived dyspnea of a hyperventilation attack from the acute airway obstruction of asthma. Dyspnea on exertion, in the absence of other symptoms of asthma or an unequivocal response to albuterol, is most likely a result of other causes. Most common is the dyspnea associated with normal exercise limitation, but causes of dyspnea on exertion can include other physiologic abnormalities including exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, and exercise-induced supraventricular tachycardia. A careful history, attention to the nature of the respiratory sounds that are present, spirometry, exercise testing, and blood-gas measurement provide useful data to sort out the various causes and avoid inappropriate treatment of these pseudo-asthma clinical manifestations.

  2. Cough event classification by pretrained deep neural network. (United States)

    Liu, Jia-Ming; You, Mingyu; Wang, Zheng; Li, Guo-Zheng; Xu, Xianghuai; Qiu, Zhongmin


    Cough is an essential symptom in respiratory diseases. In the measurement of cough severity, an accurate and objective cough monitor is expected by respiratory disease society. This paper aims to introduce a better performed algorithm, pretrained deep neural network (DNN), to the cough classification problem, which is a key step in the cough monitor. The deep neural network models are built from two steps, pretrain and fine-tuning, followed by a Hidden Markov Model (HMM) decoder to capture tamporal information of the audio signals. By unsupervised pretraining a deep belief network, a good initialization for a deep neural network is learned. Then the fine-tuning step is a back propogation tuning the neural network so that it can predict the observation probability associated with each HMM states, where the HMM states are originally achieved by force-alignment with a Gaussian Mixture Model Hidden Markov Model (GMM-HMM) on the training samples. Three cough HMMs and one noncough HMM are employed to model coughs and noncoughs respectively. The final decision is made based on viterbi decoding algorihtm that generates the most likely HMM sequence for each sample. A sample is labeled as cough if a cough HMM is found in the sequence. The experiments were conducted on a dataset that was collected from 22 patients with respiratory diseases. Patient dependent (PD) and patient independent (PI) experimental settings were used to evaluate the models. Five criteria, sensitivity, specificity, F1, macro average and micro average are shown to depict different aspects of the models. From overall evaluation criteria, the DNN based methods are superior to traditional GMM-HMM based method on F1 and micro average with maximal 14% and 11% error reduction in PD and 7% and 10% in PI, meanwhile keep similar performances on macro average. They also surpass GMM-HMM model on specificity with maximal 14% error reduction on both PD and PI. In this paper, we tried pretrained deep neural network in

  3. Intravenous lidocaine suppresses fentanyl-induced cough in Children


    Gecaj-Gashi, Agreta; Nikolova-Todorova, Zorica; Ismaili-Jaha, Vlora; Gashi, Musli


    Objective Fentanyl-induced cough is usually mild and transitory, but it can be undesirable in patients with increased intracranial pressure, open wounds of the eye, dissecting aortic aneurism, pneumothorax, and reactive airway disease. The aim of this study is to evaluate the efficacy of lidocaine in suppressing fentanyl-induced cough in children during induction in general anesthesia. Methods One hundred and eighty-six children of both sexes, aged between 4?10?years, ASA physical status I an...

  4. Habit-tic cough: Presentation and outcome with simple reassurance. (United States)

    Wright, Marie F A; Balfour-Lynn, Ian M


    Our therapeutic approach to a habit/tic cough is simple reassurance in a single consultation. To quality assure our practice, we followed up children to determine outcomes at least 3 months after diagnosis. Consecutive children diagnosed over 6 years were studied. Medical records were analyzed retrospectively and parents answered a scripted verbal survey. Fifty-five patients were diagnosed (median age 9.9 years), with a median cough duration of 3 months (IQR 2-7.5 months, range up to 3 years). In 51/55 (93%) cases, cough was absent during sleep. 51/55 (93%) received prior medications with median 3 therapeutic trials, none of which resolved the cough. Follow-up was possible in 39/55 (71%) children after a median duration of 1.9 years. In 32/39 (82%), the cough had resolved completely (59% within 4 weeks, including 12% on the day), and it improved in 6/39 (15%). In the 26/39 (67%) parents who said they believed the diagnosis, there was 96% resolution of the cough, versus the 13/39 (33%) who were sceptical or disbelieving, when there was only 54% resolution. 7/39 (18%) children were later diagnosed with a tic disorder, functional symptoms, or a behavioural/psychiatric disorder. Habit cough can be diagnosed from the characteristic history; the crucial question is whether the cough disappears during sleep. We have shown successful long term outcomes following a single consultation with simple reassurance, but it is important that the child and parents believe the explanation. It is not uncommon for subsequent tic disorders or behavioral issues to emerge. © 2018 Wiley Periodicals, Inc.

  5. Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care. (United States)

    Teepe, Jolien; Broekhuizen, Berna D L; Ieven, Margareta; Loens, Katherine; Huygen, Kris; Kretzschmar, Mirjam; de Melker, Hester; Butler, Chris C; Little, Paul; Stuart, Beth; Coenen, Samuel; Goossens, Herman; Verheij, Theo J M


    Most cases of adult pertussis probably remain undiagnosed. To explore the prevalence, diagnosis, and disease course of acute pertussis infection in adult patients presenting with acute cough. Prospective observational study between 2007 and 2010 in primary care in 12 European countries. Adults presenting with acute cough (duration of ≤28 days) were included. Bordetella pertussis infection was determined by polymerase chain reaction (from nasopharyngeal flocked swabs and sputa) and by measurement of immunoglobulin G antibodies to pertussis toxin (PT) in venous blood at day 28. An antibody titre to PT of ≥125 IU/ml or PCR positive result in a respiratory sample defined recent infection. Patients completed a symptom diary for 28 days. Serum and/or respiratory samples were obtained in 3074 patients. Three per cent (93/3074) had recent B. pertussis infection. Prior cough duration >2 weeks discriminated to some extent between those with and without pertussis (adjusted odds ratio 1.89, 95% confidence interval = 1.17 to 3.07; P = 0.010). Median cough duration after presentation was 17 and 12 days in patients with and without pertussis, respectively (P = 0.008). Patients with pertussis had longer duration of phlegm production (P = 0.010), shortness of breath (P = 0.037), disturbed sleep (P = 0.013) and interference with normal activities or work (P = 0.033) after presentation. Pertussis infection plays a limited role among adults presenting with acute cough in primary care, but GPs should acknowledge the possibility of pertussis in uncomplicated lower respiratory tract infection. As in children, pertussis also causes prolonged symptoms in adults. However, pertussis is difficult to discern from other acute cough syndromes in adults at first presentation. © British Journal of General Practice 2015.

  6. Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough

    Directory of Open Access Journals (Sweden)

    Angela Jinsook Oh


    Full Text Available Purpose: Midline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease. Observations: A 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Examination revealed a 1–2 Hz down-beating nystagmus in primary gaze that worsened with left, right, and down gazes. Gaze evoked nystagmus and mild paresis were also seen with up gaze. There was an incomitant left hypertropia due to skew deviation that worsened with right and up gazes and improved with down gaze. She also had a right-sided ptosis and a 3 mm anisocoria not due to cranial nerve 3 paresis or Horner's syndrome. Brain magnetic resonance imaging showed a 1.5 mm × 11.7 mm × 6 mm midline cleft in the ventral midbrain communicating with the cerebral aqueduct, consistent with keyhole aqueduct syndrome. Her nystagmus and diplopia improved with oral acetazolamide treatment, at high doses of 2500–3000 mg per day. Conclusions and importance: We report the first case of midbrain keyhole aqueduct syndrome with ocular motor and other neuro-ophthalmic manifestations associated with severe cough. Although her cough was effectively treated and intracranial pressure measurement was normal, her ophthalmic symptoms continued to progress, which is common in previous cases reported. Treatment with acetazolamide led to significant improvement, supporting the use of acetazolamide in this rare condition. Keywords: Keyhole aqueduct syndrome, Midbrain cleft, Mesencephalic cleft, Syrinx, Syringobulbia, Down-beating nystagmus, Cerebrospinal fluid

  7. Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough. (United States)

    Oh, Angela Jinsook; Lanzman, Bryan Alexander; Liao, Yaping Joyce


    Midline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease. A 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Examination revealed a 1-2 Hz down-beating nystagmus in primary gaze that worsened with left, right, and down gazes. Gaze evoked nystagmus and mild paresis were also seen with up gaze. There was an incomitant left hypertropia due to skew deviation that worsened with right and up gazes and improved with down gaze. She also had a right-sided ptosis and a 3 mm anisocoria not due to cranial nerve 3 paresis or Horner's syndrome. Brain magnetic resonance imaging showed a 1.5 mm × 11.7 mm × 6 mm midline cleft in the ventral midbrain communicating with the cerebral aqueduct, consistent with keyhole aqueduct syndrome. Her nystagmus and diplopia improved with oral acetazolamide treatment, at high doses of 2500-3000 mg per day. We report the first case of midbrain keyhole aqueduct syndrome with ocular motor and other neuro-ophthalmic manifestations associated with severe cough. Although her cough was effectively treated and intracranial pressure measurement was normal, her ophthalmic symptoms continued to progress, which is common in previous cases reported. Treatment with acetazolamide led to significant improvement, supporting the use of acetazolamide in this rare condition.

  8. Managing patients with chronic cough: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Perotin JM


    Full Text Available Jeanne-Marie Perotin,1,2 Claire Launois,1 Maxime Dewolf,1 Antoine Dumazet,1 Sandra Dury,1 François Lebargy,1 Valérian Dormoy,2 Gaëtan Deslee1,2 1Department of Respiratory Diseases, University Hospital of Reims, Reims, France; 2INSERM UMRS 1250, University Hospital of Reims, Reims, France Abstract: Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy. Keywords: asthma, gastroesophageal reflux, upper airway cough syndrome, chronic hypersensitivity syndrome, refractory chronic cough, speech pathology therapy

  9. Influence of stimulus intensity on the soleus H-reflex amplitude and modulation during locomotion

    DEFF Research Database (Denmark)

    Simonsen, Erik B; Alkjær, Tine; Raffalt, Peter C


    -reflex methodology itself. Accordingly, the purpose of the present study was to study the effect on the soleus H-reflex during walking and running using stimulus intensities normally considered too high (up to 45% Mmax). Using M-waves of 25-45% Mmax as opposed to 5-25% Mmax showed a significant suppression...... of the peak H-reflex during the stance phase of walking, while no changes were observed during running. No differences were observed regarding modulation pattern. So a possible use of too high stimulus intensity cannot explain the differences mentioned. The surprising result in running may be explained...

  10. Pre-emptive oral dexmethorphan reduces fentanyl-induced cough as well as immediate postoperative adrenocortico-tropic hormone and growth hormone level

    Directory of Open Access Journals (Sweden)

    Avik Mukherjee


    Full Text Available Background : Fentanyl-induced cough is not always benign and brief and can be remarkably troublesome, spasmodic, and explosive. Dextromethorphan, an opioid derivative with an antitussive action, may be effective in reducing the fentanyl-induced cough. Dextromethorphan, a N-methyl D aspartate receptor antagonist, may have some effect on diminishing the stress response to surgery. This study was undertaken to determine whether preoperative dextromethorphan could effectively attenuate its incidence, severity, and effect on postoperative stress hormone levels. Materials and Methods : Three hundred and twenty patients of American society of anesthesiologists I-II, aged 18-60 years, undergoing elective laparoscopic cholecystectomy or appendicectomy were randomly allocated into two groups (Group C, control; Group D, dextromethorphan consisting of 160 patients each. Patients in Group D received dextromethorphan 40 mg orally and in Group C received placebo tablets 60 minutes before induction of anesthesia. The incidence of cough was recorded for 1 minute after fentanyl injection and graded as none (0, mild (1-2, moderate (3-5, and severe (>5 cough. Blood samples were collected for estimation of stress hormone levels before surgery and again at 1 hour and 24 hours postoperatively and compared. The appearance of adverse reactions was recorded. Results : The incidence of reflex fentanyl cough was lower in dextromethorphan group (3.9% in comparison to placebo (59.8%. Five patients developed mild and one moderate cough in the dextromethorphan group. In the control group, 31 patients developed mild, 29 moderate, and 32 severe cough. The stress hormones were significantly higher at 1 hour and 24 hours postoperatively in both groups in comparison to its preoperative values. However, at 1 hour postoperatively, adrenocorticotropic hormone, epinephrine, and growth hormone values were significantly low in the dextromethorphan group (61.5 ± 21.1 pg/ ml, 142.1 ± 11

  11. Role of the brain stem in tibial inhibition of the micturition reflex in cats. (United States)

    Ferroni, Matthew C; Slater, Rick C; Shen, Bing; Xiao, Zhiying; Wang, Jicheng; Lee, Andy; Roppolo, James R; de Groat, William C; Tai, Changfeng


    This study examined the role of the brain stem in inhibition of bladder reflexes induced by tibial nerve stimulation (TNS) in α-chloralose-anesthetized decerebrate cats. Repeated cystometrograms (CMGs) were performed by infusing saline or 0.25% acetic acid (AA) to elicit normal or overactive bladder reflexes, respectively. TNS (5 or 30 Hz) at three times the threshold (3T) intensity for inducing toe movement was applied for 30 min between CMGs to induce post-TNS inhibition or applied during the CMGs to induce acute TNS inhibition. Inhibition was evident as an increase in bladder capacity without a change in amplitude of bladder contractions. TNS applied for 30 min between saline CMGs elicited prolonged (>2 h) poststimulation inhibition that significantly (P reflexes but are not involved in inhibition of normal bladder reflexes. Copyright © 2015 the American Physiological Society.

  12. Being reflexive in qualitative grounded theory: discussion and application of a model of reflexivity. (United States)

    Engward, Hilary; Davis, Geraldine


    A discussion of the meaning of reflexivity in research with the presentation of examples of how a model of reflexivity was used in a grounded theory research project. Reflexivity requires the researcher to make transparent the decisions they make in the research process and is therefore important in developing quality in nursing research. The importance of being reflexive is highlighted in the literature in relation to nursing research, however, practical guidance as to how to go about doing research reflexively is not always clearly articulated. This is a discussion paper. The concept of reflexivity in research is explored using the Alvesson and Skoldberg model of reflexivity and practical examples of how a researcher developed reflexivity in a grounded theory project are presented. Nurse researchers are encouraged to explore and apply the concept of reflexivity in their research practices to develop transparency in the research process and to increase robustness in their research. The Alvesson and Skoldberg model is of value in applying reflexivity in qualitative nursing research, particularly in grounded theory research. Being reflexive requires the researcher to be completely open about decisions that are made in the research process. The Alvesson and Skolberg model of reflexivity is a useful model that can enhance reflexivity in the research process. It can be a useful practical tool to develop reflexivity in grounded theory research. © 2015 John Wiley & Sons Ltd.

  13. Integrating Reflexivity in Livelihoods Research

    DEFF Research Database (Denmark)

    Prowse, Martin


    Much poverty and development research is not explicit about its methodology or philosophical foundations. Based on the extended case method of Burawoy and the epistemological standpoint of critical realism, this paper discusses a methodological approach for reflexive inductive livelihoods research...... that overcomes the unproductive social science dualism of positivism and social constructivism. The approach is linked to a conceptual framework and a menu of research methods that can be sequenced and iterated in light of research questions....

  14. Reflex syncope: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Richard Sutton


    Full Text Available For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED, the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years, tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient. Keywords: Cardiac pacing, Catheter ablation, Diagnosis, Drugs, Management, Reflex syncope

  15. [Parental representations of children's cough and expectations on its management]. (United States)

    Ventaja, G; Steyer, E; Machu, J-L; Boivin, J-M


    Providing medications for the management of acute cough in infants less than 24 months, a frequent reason for medical consultation, has recently been reduced by the contraindication of various antitussive specialties in France. The objective of this study was to assess the expectations and fears of coughing infants' parents, to determine their representations of coughing, and to quantify the use of self-medication and the risk of a deferral requests to prescribe other drug classes. An opinion and cross-survey was carried out with parents of infants under 24 months of age. A multiple-choice questionnaire was proposed to them in day care centers and Mother and Infant Welfare centers. The data collected were analyzed descriptively and using the Chi(2) test. Logistic regression enabled us to interpret some of the results. Sixty-four percent of parents expect an antitussive treatment from the doctor. For most parents, lifestyle modifications are well integrated (nasal irrigation, considered effective cough relief, hydration, smoking cessation). For 33 % of parents, corticosteroids are an alternative therapy to stop cough. Nearly half (43 %) of parents have sought treatment from their doctor, usually nasal suspensions, corticosteroids, and saline irrigation. Regarding self-medication, 30 % of parents have already given cough syrup or an antitussive suppository without a prescription, in order to stop the cough rapidly for 66 % of them. These parents seem more worried by coughing than other parents (P=0.0110, CI: 0.217; 1.751) as did those who had only one child (P=0.0029, CI: 0.120; 0.582). This study suggests that a large majority of parents understand and accept the new recommendations. But one-third of parents are still worried, not knowing what to do without prescribed medications, which led them to give nonprescription cough syrups and ask for inappropriate treatments. It seems essential to inform parents about the natural history of infant coughing and educate them

  16. Measurement of the Maximum Frequency of Electroglottographic Fluctuations in the Expiration Phase of Volitional Cough as a Functional Test for Cough Efficiency. (United States)

    Iwahashi, Toshihiko; Ogawa, Makoto; Hosokawa, Kiyohito; Kato, Chieri; Inohara, Hidenori


    The hypotheses of the present study were that the maximum frequency of fluctuation of electroglottographic (EGG) signals in the expiration phase of volitional cough (VC) reflects the cough efficiency and that this EGG parameter is affected by impaired laryngeal closure, expiratory effort strength, and gender. For 20 normal healthy adults and 20 patients diagnosed with unilateral vocal fold paralysis (UVFP), each participant was fitted with EGG electrodes on the neck, had a transnasal laryngo-fiberscope inserted, and was asked to perform weak/strong VC tasks while EGG signals and a high-speed digital image of the larynx were recorded. The maximum frequency was calculated in the EGG fluctuation region coinciding with vigorous vocal fold vibration in the laryngeal HSDIs. In addition, each participant underwent spirometry for measurement of three aerodynamic parameters, including peak expiratory air flow (PEAF), during weak/strong VC tasks. Significant differences were found for both maximum EGG frequency and PEAF between the healthy and UVFP groups and between the weak and strong VC tasks. Among the three cough aerodynamic parameters, PEAF showed the highest positive correlation with the maximum EGG frequency. The correlation coefficients between the maximum EGG frequency and PEAF recorded simultaneously were 0.574 for the whole group, and 0.782/0.717/0.823/0.688 for the male/female/male-healthy/male-UVFP subgroups, respectively. Consequently, the maximum EGG frequency measured in the expiration phase of VC was shown to reflect the velocity of expiratory airflow to some extent and was suggested to be affected by vocal fold physical properties, glottal closure condition, and the expiratory function.

  17. Reflex control of the spine and posture: a review of the literature from a chiropractic perspective

    Directory of Open Access Journals (Sweden)

    Schlappi Mark


    Full Text Available Abstract Objective This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics of the postural reflexes by reporting previous observations of subjects during periods of microgravity or weightlessness. Background Historically, chiropractic has centered around the concept that the nervous system controls and regulates all other bodily systems; and that disruption to normal nervous system function can contribute to a wide variety of common ailments. Surprisingly, the chiropractic literature has paid relatively little attention to the importance of neurological regulation of static upright human posture. With so much information available on how posture may affect health and function, we felt it important to review the neuroanatomical structures and pathways responsible for maintaining the spine and posture. Maintenance of static upright posture is regulated by the nervous system through the various postural reflexes. Hence, from a chiropractic standpoint, it is clinically beneficial to understand how the individual postural reflexes work, as it may explain some of the clinical presentations seen in chiropractic practice. Method We performed a manual search for available relevant textbooks, and a computer search of the MEDLINE, MANTIS, and Index to Chiropractic Literature databases from 1970 to present, using the following key words and phrases: "posture," "ocular," "vestibular," "cervical facet joint," "afferent," "vestibulocollic," "cervicocollic," "postural reflexes," "spaceflight," "microgravity," "weightlessness," "gravity," "posture," and "postural." Studies were selected if they specifically tested any or

  18. Soleus and lateral gastrocnemius H-reflexes during standing with unstable footwear. (United States)

    Friesenbichler, Bernd; Lepers, Romuald; Maffiuletti, Nicola A


    Unstable footwear has been shown to increase lower extremity muscle activity, but the reflex response to perturbations induced by this intervention is unknown. Twenty healthy subjects stood in stable and unstable footwear conditions (presented randomly) while H-reflex amplitude and background muscle activity were measured in the soleus and lateral gastrocnemius (LG) muscles. Wearing unstable footwear resulted in larger H-reflexes (normalized to the maximal M-wave) for the LG (+12%; P = 0.025), but not for the soleus (+4%; P > 0.05). Background activity of both muscles was significantly higher in the unstable condition. The H-reflex facilitation observed with unstable footwear was unexpected, as challenging postural conditions usually result in reflex depression. Increased muscle activity, decreased presynaptic inhibition, and/or more forward postural position may have (over-)compensated the expected reflex depression. Differences between LG and soleus H-reflex modulation may be due to diverging motor unit recruitment thresholds. © 2015 Wiley Periodicals, Inc.

  19. Two ways to support reflexivity

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine; Knudsen, Hanne


    A current challenge to public managers is the lack of a well-defined role. How can master’s programmes prepare managers to live up to an undefined function? In this paper we argue that the lack of role description enhances the need for reflexivity and show how it is done at Master in Educational...... Management (MEM). MEM provides the participating managers with a new language that can give them a critical distance to the overload of expectations they meet at work and MEM teaches the participants to translate this new language into practice. The pedagogy used for this is labelled ‘experimental management...

  20. Bernstein Lethargy Theorem and Reflexivity


    Aksoy, Asuman Güven; Peng, Qidi


    In this paper, we prove the equivalence of reflexive Banach spaces and those Banach spaces which satisfy the following form of Bernstein's Lethargy Theorem. Let $X$ be an arbitrary infinite-dimensional Banach space, and let the real-valued sequence $\\{d_n\\}_{n\\ge1}$ decrease to $0$. Suppose that $\\{Y_n\\}_{n\\ge1}$ is a system of strictly nested subspaces of $X$ such that $\\overline Y_n \\subset Y_{n+1}$ for all $n\\ge1$ and for each $n\\ge1$, there exists $y_n\\in Y_{n+1}\\backslash Y_n$ such that ...

  1. Cough Recognition Based on Mel Frequency Cepstral Coefficients and Dynamic Time Warping (United States)

    Zhu, Chunmei; Liu, Baojun; Li, Ping

    Cough recognition provides important clinical information for the treatment of many respiratory diseases, but the assessment of cough frequency over a long period of time remains unsatisfied for either clinical or research purpose. In this paper, according to the advantage of dynamic time warping (DTW) and the characteristic of cough recognition, an attempt is made to adapt DTW as the recognition algorithm for cough recognition. The process of cough recognition based on mel frequency cepstral coefficients (MFCC) and DTW is introduced. Experiment results of testing samples from 3 subjects show that acceptable performances of cough recognition are obtained by DTW with a small training set.

  2. Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis


    Martinak, Bridgette; Bolis, Ramy A.; Black, Jeffrey Ryne; Fargason, Rachel E.; Birur, Badari


    Dextromethorphan (3-methoxy-N-methylmorphinan), also known as “DXM” and “the poor man’s PCP,” is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psych...

  3. How Can Hypnodontics Manage Severe Gag Reflex for Root Canal Therapy? A Case Report (United States)

    Ramazani, Mohsen; zarenejad, Nafiseh; Parirokh, Masoud; Zahedpasha, Samir


    In endodontics, severe involuntary gagging can have a severe impact on treatment procedure. There are many ways to ease the gag reflex, one of which is hypnosis. A 34-year-old male was referred for root canal treatment of a molar tooth. He had not received any dental treatments for the past nine years due to fear of severe gag reflex. Three hypnotic sessions based upon eye fixation, progressive muscle relaxation and guided imagery techniques were spent for psychosomatic management. The gag reflex was controlled and reduced to a normal level, and the required dental treatments including root canal therapy and restoration were performed successfully. This report shows that hypnosis can control gag reflex for dental treatments. PMID:27141226

  4. Indoor risk factors for cough and their relation to wheeze and sensitization in Chilean young adults. (United States)

    Potts, James F; Rona, Roberto J; Oyarzun, Manuel J; Amigo, Hugo; Bustos, Patricia


    We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Our sample was composed of 1232 men and women residing in a semirural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity.

  5. Indoor risk factors for cough and their relation to wheeze and sensitization in Chilean young adults

    Energy Technology Data Exchange (ETDEWEB)

    Potts, J.F.; Rona, R.J.; Oyarzun, M.J.; Amigo, H.; Bustos, P. [Kings College London, London (United Kingdom). Dept. for Public Health Science


    We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Our sample was composed of 1232 men and women residing in a semi-rural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity.

  6. Indoor Risk Factors for Cough and Their Relation to Wheeze and Sensitization in Chilean Young Adults (United States)

    Potts, James F.; Rona, Roberto J.; Oyarzun, Manuel J.; Amigo, Hugo; Bustos, Patricia


    Objectives. We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Methods. Our sample was composed of 1232 men and women residing in a semirural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Results. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Conclusions. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity. PMID:17666696

  7. Reflexive Aero Structures for Enhanced Survivability, Phase I (United States)

    National Aeronautics and Space Administration — Cornerstone Research Group Inc. (CRG) proposes to develop an advanced reflexive structure system to increase the survivability of aerostructures. This reflexive...

  8. Caring for cough : guiding diagnosis in primary care

    NARCIS (Netherlands)

    van Vugt, S.F.


    Proper diagnosis in the very common presented acute cough or other LRTI-like symptoms allows GPs to adequately treat and inform their patients about the expected course of their disease. Management depends on the assumed cause of the LRTI, which includes potentially life threatening pneumonia, as

  9. Evaluation of Fractioned Nitric Oxide in Chronic Cough Patients

    African Journals Online (AJOL)


    Feb 7, 2018 ... due to its high positive predictive value, its practical nature, the fact that it is a ..... Eosinophilia at complete blood count. 37. 41.1. 8 .... REFERENCES. 1. Massie J. Cough in children: When does it matter? Paediatr. Respir Rev 2006;7:9-14. 2. Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson.

  10. A Cough-Based Algorithm for Automatic Diagnosis of Pertussis (United States)

    Pramono, Renard Xaviero Adhi; Imtiaz, Syed Anas; Rodriguez-Villegas, Esther


    Pertussis is a contagious respiratory disease which mainly affects young children and can be fatal if left untreated. The World Health Organization estimates 16 million pertussis cases annually worldwide resulting in over 200,000 deaths. It is prevalent mainly in developing countries where it is difficult to diagnose due to the lack of healthcare facilities and medical professionals. Hence, a low-cost, quick and easily accessible solution is needed to provide pertussis diagnosis in such areas to contain an outbreak. In this paper we present an algorithm for automated diagnosis of pertussis using audio signals by analyzing cough and whoop sounds. The algorithm consists of three main blocks to perform automatic cough detection, cough classification and whooping sound detection. Each of these extract relevant features from the audio signal and subsequently classify them using a logistic regression model. The output from these blocks is collated to provide a pertussis likelihood diagnosis. The performance of the proposed algorithm is evaluated using audio recordings from 38 patients. The algorithm is able to diagnose all pertussis successfully from all audio recordings without any false diagnosis. It can also automatically detect individual cough sounds with 92% accuracy and PPV of 97%. The low complexity of the proposed algorithm coupled with its high accuracy demonstrates that it can be readily deployed using smartphones and can be extremely useful for quick identification or early screening of pertussis and for infection outbreaks control. PMID:27583523

  11. Proton pump inhibitor-responsive chronic cough without acid reflux: a case report

    Directory of Open Access Journals (Sweden)

    Nobata Kouichi


    Full Text Available Abstract Background Because 24-h esophageal pH monitoring is quite invasive, the diagnosis of gastroesophageal reflux disease (GERD-associated cough has usually been made based merely on the clinical efficacy of treatment with proton pump inhibitor (PPI. Case presentation We recently encountered two patients with PPI-responsive chronic non-productive cough for whom switching from bronchodilators and glucocorticosteroids to PPI resulted in improvement of cough. The cough returned nearly to pre-administration level a few weeks after discontinuation of PPI. Though GERD-associated cough was suspected, 24-h esophageal pH monitoring revealed that the cough rarely involved gastric acid reflux. Following re-initiation of PPI, the cough disappeared again. Conclusion PPI may improve cough unrelated to gastric acid reflux.

  12. The Clinical Value of Deflation Cough in Chronic Coughers With Reflux Symptoms. (United States)

    Lavorini, Federico; Chellini, Elisa; Bigazzi, Francesca; Surrenti, Elisabetta; Fontana, Giovanni A


    Patients with deflation cough (DC), the cough-like expulsive effort(s) evoked by maximal lung emptying during a slow vital capacity maneuver, also present symptoms of gastroesophageal reflux. DC can be inhibited by prior intake of antacids. We wished to assess DC prevalence and association between DC and chemical characteristics of refluxate in patients with gastroesophageal reflux symptoms. A total of 157 consecutive outpatients underwent DC assessment and 24-h multichannel intraluminal impedance pH (MII-pH) monitoring; 93/157 also had chronic cough. Patients performed two to four slow vital capacity maneuvers and DC was detected aurally. Subsequently, they underwent 24-h MII-pH monitoring, the outcomes of which were defined as abnormal when acid or non-acid reflux events were > 73. DC occurred in 46/157 patients, 18 of whom had abnormal MII-pH outcomes; 28 of the remaining 111 patients without DC also had abnormal MII-pH findings. Thus, in the patients as a group, there was no association between DC and MII-pH outcomes. DC occurred in 40/93 of the chronic coughers; 15 of whom had acid reflux. All but 2 of the 53 patients without DC had normal MII-pH outcomes (P < .001), and the negative predictive value of DC for excluding acid reflux was 96.2%. At follow-up, 65% of coughers showed significant improvement after treatment. The overall prevalence of DC was 29%, increasing to 43% in chronic coughers in whom the absence of DC virtually excludes acid reflux. Therefore, DC assessment may represent a useful screening test for excluding acid reflux in chronic coughers with reflux symptoms. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  13. Cough in Children: Current Approaches to the Treatment

    Directory of Open Access Journals (Sweden)

    O.O. Rechkina


    Full Text Available Introduction. Cough is one of the most common symptoms in the practice of doctors of various specialties, including pediatricians. Cough treatment should be started with the identification of its cause and correct diagnosis. Most often, cough in children is due to the increased viscosity of bronchial secretions, i.e. violation of sputum transport in the bronchial tree, and insufficient activity of ciliated epithelium. The main objective of the treatment of productive cough is dilution of sputum, bronchial secretion and excretion, thus necessitating the administration of mucolytics. Currently, one of the most famous mucolytics is acetylcysteine, cysteine amino acid product, such as ACC®. However, today the question of ACC® (acetylcysteine application in infants and young children is still debatable. This article presents a study whose objective was to evaluate the therapeutic efficacy and tolerability of ACC® (20 mg/ml solution in the treatment of bronchopulmonary diseases in children aged 2 to 6 years. Materials and methods. The study involved 60 children with acute tracheitis, simple bronchitis, acute obstructive bronchitis, recurrent bronchitis in the acute phase, community-acquired pneumonia, asthma exacerbation, cystic fibrosis. Patients of the main groups (n = 40 received ACC® (20 mg/ml solution at the age-specific dosage 3 times a day in combined treatment. Therapy of patients in the control group (n = 20 was conducted without ACC®. Results. During follow-up, patients who received ACC® had significant positive changes in the nature of cough, sputum viscosity and its amount as opposed to a comparison group of patients. Complete disappearance of cough was achieved on day 5–8 from the beginning of treatment, while in the control group patients, this time was longer. The evaluation of the effectiveness of the study drug showed that very good efficacy was achieved in 75 % of patients and good — in 20 %, and among patients who

  14. Reflexive criteria of sociological research

    Directory of Open Access Journals (Sweden)

    R T Ubaydullaeva


    Full Text Available The article is devoted to the sociological criteria of explaining the way of thinking and actions of subjects, their spiritual and moral positions and intellectual forces that form the laws of social life. The author seeks to adapt such categories as ‘meaning of life’, ‘human dignity’, ‘rationality’ etc. for the purposes of sociological analysis by methodological construction of some real life dichotomies such as ‘subjective meaning and social function’, ‘the real and the ideal’, ‘the demanded and the excluded’. Thus, the author studies economic, political and technical processes in terms of both positivity and negativity of social interaction and states that given the increasing differentiation of the society and the contradictory trends of social development the reflexive criteria that take into account the socio-cultural nature of the man help to find one’s own model of development.

  15. Test-retest reliability of the soleus H-reflex excitability measured during human walking

    DEFF Research Database (Denmark)

    Simonsen, Erik B; Dyhre-Poulsen, Poul


    The purpose of the study was to investigate with what accuracy the soleus H-reflex modulation and excitability could be measured during human walking on two occasions separated by days. The maximal M-wave (Mmax) was measured at rest in the standing position. During treadmill walking every stimulus...... elicited an M-wave of 25+/-10% of Mmax in the soleus muscle and a supra-maximal stimulus elicited a maximal M-wave 60ms after the first stimulus. Both Mmax during rest and during walking were later used for normalization. When normalized to resting Mmax, the peak reflex amplitude during walking was 5...

  16. The lateralizing and localizing value of peri-ictal cough in epileptic seizures


    Korkmaz, Bektaş; Erşen, Gülsün; Delil, Şakir; Özkara, Çiğdem; Yeni, S. Naz


    Introduction. Coughing may be observed as an epiphenomenon during or after epileptic seizures. Aim. In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon. Material and Methods. Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients. Results. Six out of these seven patients were multidrug resistant temporal lobe epilepsy patient...

  17. pH and Titratable Acidity of different Cough Syrups in Nigeria ...

    African Journals Online (AJOL)

    Background: Cough linctuses are liquid oral medicines widely used in children to treat cough and related conditions. Some of their constituents are acidic and dental erosive. Objectives: This in vitro study aimed to evaluate the endogenous pH and titratable acidity of Nigerian cough syrups and also determine their erosive ...

  18. Description of nighttime cough epochs in patients with stable COPD GOLD II-IV. (United States)

    Fischer, Patrick; Gross, Volker; Kroenig, Johannes; Weissflog, Andreas; Hildebrandt, Olaf; Sohrabi, Keywan; Koehler, Ulrich

    Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD. Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II-IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive). Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%). We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.

  19. The medial olivocochlear reflex in children during active listening. (United States)

    Smith, Spencer B; Cone, Barbara


    To determine if active listening modulates the strength of the medial olivocochlear (MOC) reflex in children. Click-evoked otoacoustic emissions (CEOAEs) were recorded from the right ear in quiet and in four test conditions: one with contralateral broadband noise (BBN) only, and three with active listening tasks wherein attention was directed to speech embedded in contralateral BBN. Fifteen typically-developing children (ranging in age from 8 to14 years) with normal hearing. CEOAE levels were reduced in every condition with contralateral acoustic stimulus (CAS) when compared to preceding quiet conditions. There was an additional systematic decrease in CEOAE level with increased listening task difficulty, although this effect was very small. These CEOAE level differences were most apparent in the 8-18 ms region after click onset. Active listening may change the strength of the MOC reflex in children, although the effects reported here are very subtle. Further studies are needed to verify that task difficulty modulates the activity of the MOC reflex in children.

  20. Effect of betel nut chewing on the otolithic reflex system. (United States)

    Lin, Chuan-Yi; Young, Yi-Ho


    This study investigated the effect of betel nut chewing on the otolithic reflex system. Seventeen healthy volunteers without any experience of chewing betel nut (fresh chewers) and 17 habitual chewers underwent vital sign measurements, ocular vestibular-evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests prior to the study. Each subject then chewed two pieces of betel nut for 2min (dosing). The same paradigm was repeated immediately, 10min, and 20min after chewing. On a different day, 10 fresh chewers masticated chewing gum as control. Fresh chewers exhibited significantly decreased response rates of oVEMP (53%) and cVEMP (71%) after dosing compared with those from the predosing period. These abnormal VEMPs returned to normal 20min after dosing. In contrast, 100% response rates of oVEMP and cVEMP were observed before and after masticating chewing gum. In habitual chewers, the response rates of oVEMP and cVEMP were 32% and 29%, respectively, 20min after dosing. Chewing betel nuts induced a transient loss of the otolithic reflexes in fresh chewers but may cause permanent loss in habitual chewers. Chewing betel nuts can cause a loss of otholitic reflex function. This creates a risk for disturbed balance and malfunction, for instance, during driving. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Short-term plasticity in a monosynaptic reflex pathway to forearm muscles after continuous robot-assisted passive stepping

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Nakajima


    Full Text Available Both active and passive rhythmic limb movements reduce the amplitude of spinal cord Hoffmann (H- reflexes in muscles of moving and distant limbs. This could have clinical utility in remote modulation of the pathologically hyperactive reflexes found in spasticity after stroke or spinal cord injury. However, such clinical translation is currently hampered by a lack of critical information regarding the minimum or effective duration of passive movement needed for modulating spinal cord excitability. We therefore investigated the H-reflex modulation in the flexor carpi radialis (FCR muscle during and after various durations (5, 10, 15, and 30 min of passive stepping in 11 neurologically normal subjects. Passive stepping was performed by a robotic gait trainer system (Lokomat® while a single pulse of electrical stimulation to the median nerve elicited H-reflexes in the FCR. The amplitude of the FCR H-reflex was significantly suppressed during passive stepping. Although 30 minutes of passive stepping was sufficient to elicit a persistent H-reflex suppression that lasted up to 15 minutes, 5 minutes of passive stepping was not. The duration of H-reflex suppression correlated with that of the stepping. These findings suggest that the accumulation of stepping-related afferent feedback from the leg plays a role in generating short-term interlimb plasticity in the circuitry of the FCR H-reflex.

  2. The Multiple Faces of Reflexive Research Designs

    Directory of Open Access Journals (Sweden)

    Karl H. Müller


    Full Text Available Reflexive research can be grouped into five clusters with circular relations between two elements x ↔ x, namely circular relations between observers, between scientific building blocks like concepts, theories or models, between systemic levels, between rules and rule systems or as circular relations or x ↔ y between these four components. By far the most important cluster is the second cluster which becomes reflexive through a re-entry operation RE into a scientific element x and which establishes its circular formation as x(x. Many of the research problems in these five clusters in reflexivity research are still unexplored and pose grand challenges for future research.

  3. Ontogeny of mouse vestibulo-ocular reflex following genetic or environmental alteration of gravity sensing.

    Directory of Open Access Journals (Sweden)

    Mathieu Beraneck

    Full Text Available The vestibular organs consist of complementary sensors: the semicircular canals detect rotations while the otoliths detect linear accelerations, including the constant pull of gravity. Several fundamental questions remain on how the vestibular system would develop and/or adapt to prolonged changes in gravity such as during long-term space journey. How do vestibular reflexes develop if the appropriate assembly of otoliths and semi-circular canals is perturbed? The aim of present work was to evaluate the role of gravity sensing during ontogeny of the vestibular system. In otoconia-deficient mice (ied, gravity cannot be sensed and therefore maculo-ocular reflexes (MOR were absent. While canals-related reflexes were present, the ied deficit also led to the abnormal spatial tuning of the horizontal angular canal-related VOR. To identify putative otolith-related critical periods, normal C57Bl/6J mice were subjected to 2G hypergravity by chronic centrifugation during different periods of development or adulthood (Adult-HG and compared to non-centrifuged (control C57Bl/6J mice. Mice exposed to hypergravity during development had completely normal vestibulo-ocular reflexes 6 months after end of centrifugation. Adult-HG mice all displayed major abnormalities in maculo-ocular reflexe one month after return to normal gravity. During the next 5 months, adaptation to normal gravity occurred in half of the individuals. In summary, genetic suppression of gravity sensing indicated that otolith-related signals might be necessary to ensure proper functioning of canal-related vestibular reflexes. On the other hand, exposure to hypergravity during development was not sufficient to modify durably motor behaviour. Hence, 2G centrifugation during development revealed no otolith-specific critical period.

  4. Portraying Reflexivity in Health Services Research. (United States)

    Rae, John; Green, Bill


    A model is proposed for supporting reflexivity in qualitative health research, informed by arguments from Bourdieu and Finlay. Bourdieu refers to mastering the subjective relation to the object at three levels-the overall social space, the field of specialists, and the scholastic universe. The model overlays Bourdieu's levels of objectivation with Finlay's three stages of research (pre-research, data collection, and data analysis). The intersections of these two ways of considering reflexivity, displayed as cells of a matrix, pose questions and offer prompts to productively challenge health researchers' reflexivity. Portraiture is used to show how these challenges and prompts can facilitate such reflexivity, as illustrated in a research project. © The Author(s) 2016.

  5. Sequential voluntary cough and aspiration or aspiration risk in Parkinson's disease. (United States)

    Hegland, Karen Wheeler; Okun, Michael S; Troche, Michelle S


    Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia. Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration-aspiration score observed was used to determine whether the patient had dysphagia. There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia. The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.

  6. Personal Construction of Cough Medicine among Young Substance Abusers in Hong Kong

    Directory of Open Access Journals (Sweden)

    Daniel T. L. Shek


    Full Text Available Although cough medicine abuse is a growing problem in many places, there is no study examining the views of young substance abusers toward cough medicine. The objective of this study was to examine personal constructions of cough medicine abusers via the repertory grid tests (=11. Several observations are highlighted from the study. First, personal constructions of cough medicine were mixed, including the benefits and harmful effects of its abuse. Second, although the informants perceived cough medicine to be addictive and harmful, they perceived cough medicine to be less addictive and less harmful than did heroin. Third, while the informants construed cough medicine to be similar to ketamine and marijuana, they also perceived cough medicine to possess some characteristics of heroin. Fourth, relative to the construed similarity between heroin and the gateway drugs (cigarette, beer, and liquor, the informants construed cough medicine to be more similar to the gateway drugs. Finally, a higher level of perceived dissimilarity between cough medicine and gateway drugs was related to a higher level of perceived harm of cough medicine abuse.

  7. Butorphanol suppresses fentanyl-induced cough during general anesthesia induction


    Cheng, Xiao-Yan; Lun, Xiao-Qin; Li, Hong-Bo; Zhang, Zhi-Jie


    Abstract Fentanyl-induced cough (FIC) is unwanted in the patients requiring stable induction of general anesthesia. This study was designed to evaluate the suppressive effects of butorphanol pretreatment on the incidence and severity of FIC during the induction of general anesthesia. A total of 315 patients of American Society of Anesthesiologists physical status I and II, scheduled for elective surgery under general anesthesia were randomized into 3 equally sized groups (n = 0105). Two minut...

  8. Use of cough and cold preparations during breastfeeding. (United States)

    Mitchell, J L


    Adverse reactions in infants from maternal drug ingestion depend largely on the amount of milk consumed by the infant, timing of breastfeeding in relation to dosing, dose of the medication, dosing interval, and duration of therapy. When taking medications, breastfeeding mothers should be instructed to take their medication after breastfeeding, at the lowest effective dose and for the shortest duration. Overall, there are few data from human studies on the use of antihistamines, decongestants, and cough products during breastfeeding. Studies of pseudoephedrine, triprolidine, and loratadine in humans conclude that low levels of each drug would reach a breastfed infant. Since triprolidine and pseudoephedrine are also considered compatible with breastfeeding by the AAP, these 2 drugs should be the first-line choices. Codeine is considered compatible with breastfeeding by the AAP, and would be an acceptable choice for short-term use as a cough suppressant. It is important to note that many of the liquid cough and cold products contain alcohol. In addition, many of the combination products are a mixture of an antihistamine and a decongestant and may also contain aspirin, acetaminophen, ibuprofen, or caffeine. It is preferable for nursing mothers to only take medications that are necessary and to avoid such combination products. The AAP considers alcohol, acetaminophen, ibuprofen, and caffeine compatible with breastfeeding. Aspirin has been associated with significant negative effects on some nursing infants, and the AAP recommends giving aspirin to nursing mothers with caution. Mothers taking cough and cold products should watch for adverse events in their breastfed infants. Infants may experience paradoxical central nervous stimulation from antihistamines and irritability and insomnia from decongestants.

  9. Whooping Cough Vaccine Recommendation for Preteens and Teens

    Centers for Disease Control (CDC) Podcasts


    This podcast provides information about whooping cough and the recommendation that all preteens receive the Tdap vaccine when they are 11 or 12 to help protect them from this serious disease.  Created: 1/22/2015 by National Center for Infectious and Respiratory Disease (NCIRD), Division of Bacterial Disease (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPD).   Date Released: 1/22/2015.

  10. Whooping Cough Vaccine Recommendation for Babies and Young Children

    Centers for Disease Control (CDC) Podcasts


    This podcast provides information about whooping cough and the recommendation that all children receive the DTaP vaccine, according to CDC’s recommended schedule, to help protect them from this serious disease.  Created: 1/22/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPDB).   Date Released: 1/22/2015.

  11. Evaluation of etiology of chronic cough in children

    Directory of Open Access Journals (Sweden)

    Yasin Yildiz


    Conclusion: The patients who was admitted with chronic cough should be questioned in history for exposure to smoke, nutrition, atopy in the family and postnasal drip, the length of expiration, wheezing like symptoms should be examined in physical examination. Thus, by preventing the delay in the diagnosis of patients with stage the rates of unnecessary diagnostic procedures will be reduced. Also we would be able to prevent the excessive use of drugs. [Cukurova Med J 2017; 42(1.000: 66-72

  12. The passive of reflexive verbs in Icelandic

    Directory of Open Access Journals (Sweden)

    Hlíf Árnadóttir


    Full Text Available The Reflexive Passive in Icelandic is reminiscent of the so-called New Passive (or New Impersonal in that the oblique case of a passivized object NP is preserved. As is shown by recent surveys, however, speakers who accept the Reflexive Passive do not necessarily accept the New Passive, whereas conversely, speakers who accept the New Passive do also accept the Reflexive Passive. Based on these results we suggest that there is a hierarchy in the acceptance of passive sentences in Icelandic, termed the Passive Acceptability Hierarchy. The validity of this hierarchy is confirmed by our diachronic corpus study of open access digital library texts from Icelandic journals and newspapers dating from the 19th and 20th centuries (tí Finally, we sketch an analysis of the Reflexive Passive, proposing that the different acceptability rates of the Reflexive and New Passives lie in the argument status of the object. Simplex reflexive pronouns are semantically dependent on the verbs which select them, and should therefore be analyzed as syntactic arguments only, and not as semantic arguments of these verbs.

  13. Accuracy of portable devices in measuring peak cough flow

    International Nuclear Information System (INIS)

    Kulnik, Stefan Tino; Kalra, Lalit; MacBean, Victoria; Birring, Surinder Singh; Moxham, John; Rafferty, Gerrard Francis


    Peak cough flow (PCF) measurements can be used as indicators of cough effectiveness. Portable peak flow meters and spirometers have been used to measure PCF, but little is known about their accuracy compared to pneumotachograph systems. The aim of this study was to compare the accuracy of four portable devices (Mini–Wright and Assess peak flow meters, SpiroUSB and Microlab spirometers) in measuring PCF with a calibrated laboratory based pneumotachograph system. Twenty healthy volunteers (mean (SD) age 45 (16) years) coughed through a pneumotachograph connected in series with each portable device in turn, and the differences in PCF readings were analysed. In addition, mechanically generated flow waves of constant peak flow were delivered through each device both independently and when connected in series with the pneumotachograph. Agreement between PCF readings obtained with the pneumotachograph and the portable devices was poor. Peak flow readings were on average lower by approximately 50 L min −1 when measured using the portable devices; 95% limits of agreement spanned approximately 150 L min −1 . The findings highlight the potential for inaccuracy when using portable devices for the measurement of PCF. Depending on the measurement instrument used, absolute values of PCF reported in the literature may not be directly comparable. (paper)

  14. Exposure to coughed airborne pathogens in a double bed hospital patient room with overhead mixing ventilation: impact of posture of coughing patient and location of doctor

    DEFF Research Database (Denmark)

    Kierat, W.; Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor


    The exposure of a doctor and a patient to air coughed by a second infected patient was studied in a mock-up of two-bed hospital infectious ward with mixing ventilation at 22oC (71.6 F) room air temperature. The effect of posture of the coughing patient lying sideways or on back), position...

  15. Reflex and Non-Reflex Torque Responses to Stretch of the Human Knee Extensors

    National Research Council Canada - National Science Library

    Mrachacz-Kersting, N


    .... The quadriceps muscles were stretched at various background torques, produced either voluntarily or electrically and thus the purely reflex-mediated torque could be calculated. The contribution of the reflex mediated stiffness initially low, increased with increasing background torques for the range of torques investigated.

  16. "On Becoming a Critically Reflexive Practitioner" Redux: What Does It Mean to "Be" Reflexive? (United States)

    Cunliffe, Ann L.


    In this commentary, Cunliffe states that is convinced that reflexivity offers a way of foregrounding our moral and ethical responsibility for people and for the world around us. To "BE" reflexive was defined as embracing "subjective understandings of reality as a basis for thinking more critically about the impact of our…

  17. Are the unken reflex and the aposematic colouration of Red-Bellied Toads efficient against bird predation? (United States)

    Caorsi, Valentina Zaffaroni; Colombo, Patrick; Abadie, Michelle; Brack, Ismael Verrastro; Dasoler, Bibiana Terra; Borges-Martins, Márcio


    Aposematic signals as well as body behaviours may be important anti-predator defences. Species of the genus Melanophryniscus are characterised by having toxic lipophilic alkaloids in the skin and for presenting a red ventral colouration, which can be observed when they perform the behaviour called the unken reflex. Both the reflex behaviour and the colouration pattern are described as defence mechanisms. However, there are currently no studies testing their effectiveness against predators. This study aimed to test experimentally if both ventral conspicuous colouration and the unken reflex in Melanophryniscus cambaraensis function as aposematic signals against visually oriented predators (birds). We simulated the species studied using three different clay toad models as follows: (a) in a normal position with green coloured bodies, (b) in the unken reflex position with green coloured body and extremities and (c) in the unken reflex position with a green body and red extremities. Models were distributed on a known M. cambaraensis breeding site and in the adjacent forest. More than half of the attacks on the models were from birds; however, there was no preference for any model type. Thus, just the presence of the red colour associated with the motionless unken reflex position does not seem to prevent attacks from potential predators. It is possible that the effective aposematic signal in Melanophryniscus is achieved through the unken reflex movement together with the subsequent exhibition of the warning colouration and the secretion of toxins. PMID:29596437

  18. Using ESO Reflex with Web Services (United States)

    Järveläinen, P.; Savolainen, V.; Oittinen, T.; Maisala, S.; Ullgrén, M. Hook, R.


    ESO Reflex is a prototype graphical workflow system, based on Taverna, and primarily intended to be a flexible way of running ESO data reduction recipes along with other legacy applications and user-written tools. ESO Reflex can also readily use the Taverna Web Services features that are based on the Apache Axis SOAP implementation. Taverna is a general purpose Web Service client, and requires no programming to use such services. However, Taverna also has some restrictions: for example, no numerical types such integers. In addition the preferred binding style is document/literal wrapped, but most astronomical services publish the Axis default WSDL using RPC/encoded style. Despite these minor limitations we have created simple but very promising test VO workflow using the Sesame name resolver service at CDS Strasbourg, the Hubble SIAP server at the Multi-Mission Archive at Space Telescope (MAST) and the WESIX image cataloging and catalogue cross-referencing service at the University of Pittsburgh. ESO Reflex can also pass files and URIs via the PLASTIC protocol to visualisation tools and has its own viewer for VOTables. We picked these three Web Services to try to set up a realistic and useful ESO Reflex workflow. They also demonstrate ESO Reflex abilities to use many kind of Web Services because each of them requires a different interface. We describe each of these services in turn and comment on how it was used

  19. Dissociative identity disorder and prepulse inhibition of the acoustic startle reflex (United States)

    Dale, Karl Yngvar; Flaten, Magne Arve; Elden, Åke; Holte, Arne


    A group of persons with dissociative identity disorder (DID) was compared with a group of persons with other dissociative disorders, and a group of nondiagnosed controls with regard to prepulse inhibition (PPI) of the acoustic startle reflex. The findings suggest maladaptive attentional processes at a controlled level, but not at a preattentive automatic level, in persons with DID. The prepulse occupied more controlled attentional resources in the DID group compared with the other two groups. Preattentive automatic processing, on the other hand, was normal in the DID group. Moreover, startle reflexes did not habituate in the DID group. In conclusion, increased PPI and delayed habituation is consistent with increased vigilance in individuals with DID. The present findings of reduced habituation of startle reflexes and increased PPI in persons with DID suggest the operation of a voluntary process that directs attention away from unpleasant or threatening stimuli. Aberrant voluntary attentional processes may thus be a defining characteristic in DID. PMID:18830396

  20. Abnormal reflex activation of hamstring muscles in dogs with cranial cruciate ligament rupture. (United States)

    Hayes, Graham M; Granger, Nicolas; Langley-Hobbs, Sorrel J; Jeffery, Nick D


    The mechanisms underlying cranial cruciate ligament rupture (CCLR) in dogs are poorly understood. In this study hamstring muscle reflexes in response to cranial tibial translation were analysed to determine whether these active stabilisers of the stifle joint are differently activated in dogs with CCLR compared to control dogs. In a prospective clinical study reflex muscle activity from the lateral and medial hamstring muscles (biceps femoris and semimembranosus) was recorded using surface electrodes in control dogs (n=21) and dogs with CCLR (n=22). These electromyographic recordings were analysed using an algorithm previously validated in humans. The hamstring reflex was reliably and reproducibly recorded in normal dogs. Both a short latency response (SLR, 17.6±2.1ms) and a medium latency response (MLR, 37.7±2.7ms) could be identified. In dogs with unilateral CCLR, the SLR and MLR were not significantly different between the affected and the unaffected limbs, but the MLR latency of both affected and unaffected limbs in CCLR dogs were significantly prolonged compared to controls. In conclusion, the hamstring reflex can be recorded in dogs and the MLR is prolonged in dogs with CCLR. Since both affected and unaffected limbs exhibit prolonged MLR, it is possible that abnormal hamstring reflex activation is a mechanism by which progressive CCL damage may occur. The methodology allows for further investigation of the relationship between neuromuscular imbalance and CCLR or limitations in functional recovery following surgical intervention. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. F response and H reflex analysis of physiological unity of gravity and antigravity muscles in man. (United States)

    García, H A; Fisher, M A


    Observational differences between reflex (H reflex) and antidromic (F response) activation of segmental motoneurons by a peripheral electrical stimulus are described. In contrast to H reflexes, the percentage of F responses found after a series of stimuli is directly related to the pick-up field of the recording electrode consistent with this response being due to the variable activation of a small fraction of the available motoneuron pool. Despite the differing physiological mechanisms, both F responses and H reflexes can be used to demonstrate similar relative "central excitatory states" for antigravity muscles (i.e. extensors in the lower extremity and flexors in the upper extremity) and their antagonist gravity muscles. H reflexes were elicited not only in their usual location in certain antigravity muscles but also in unusual locations by length/tension changes in agonist and antagonist groups as well as by passive stretch. The data argue for the physiological unity of similarly acting gravity and antigravity muscles as well as supporting a meaningful role of group II afferents in normal segmental motoneuron pool excitability.

  2. Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases. (United States)

    Karakaya, Işık; Şişmanlar, Şahika Gülen


    Chronic cough is a frequent reason for medical referrals in childhood. In patients who do not have signs or symptoms of an underlying respiratory system disease and who do not respond to experimental treatment, psychogenic cough should be considered. In this paper, four patients who were referred to our department with a prediagnosis of psychogenic cough, found to have tic disorder as a result of the assessments performed and improved with antipsychotic medication are presented. The differantial diagnosis of chronic cough in children should include tic disorders as well as psychogenic cough. Tic disorders can be diagnosed easily with detailed history and their response to medical treatment is rather satisfactory. Recognition of these disorders by pediatricians will minimize erroneous diagnoses and inappropriate therapies in children with a complaint of chronic cough.

  3. High frequency of pertussis in older children and adolescents with prolonged cough in Turkey. (United States)

    Aslan, Aslı; Kurugöl, Zafer; Aydemir, Şöhret; Gürsel, Derya; Koturoğlu, Güldane


    This study aimed to determine the frequency of B. pertussis infection among Turkish children with prolonged cough. Nasopharyngeal specimens were collected from 7-18 year old children, presenting with prolonged cough of two to four weeks' duration. Specimens were examined for B. pertussis by PCR. Of 101 children with prolonged cough, 20 (19.8%) had a positive PCR testing for B. pertussis. Children who were vaccinated ≥5 years previously had a 6.13-fold higher risk of PCR-confirmed pertussis than those who were vaccinated pertussis (paroxysmal cough, whooping and post-tussive vomiting) were seen in 30%, 15% and 25% of the patients with positive PCR, respectively; 55% of them had only a prolonged cough without any classic symptoms. Pertussis is common among Turkish children with prolonged cough, even after implementation of a fifth dose of pertussis vaccination and despite high vaccination coverage.

  4. Anatomy and neurophysiology of cough: CHEST Guideline and Expert Panel report. (United States)

    Canning, Brendan J; Chang, Anne B; Bolser, Donald C; Smith, Jaclyn A; Mazzone, Stuart B; McGarvey, Lorcan


    Bronchopulmonary C-fibers and a subset of mechanically sensitive, acid-sensitive myelinated sensory nerves play essential roles in regulating cough. These vagal sensory nerves terminate primarily in the larynx, trachea, carina, and large intrapulmonary bronchi. Other bronchopulmonary sensory nerves, sensory nerves innervating other viscera, as well as somatosensory nerves innervating the chest wall, diaphragm, and abdominal musculature regulate cough patterning and cough sensitivity. The responsiveness and morphology of the airway vagal sensory nerve subtypes and the extrapulmonary sensory nerves that regulate coughing are described. The brainstem and higher brain control systems that process this sensory information are complex, but our current understanding of them is considerable and increasing. The relevance of these neural systems to clinical phenomena, such as urge to cough and psychologic methods for treatment of dystussia, is high, and modern imaging methods have revealed potential neural substrates for some features of cough in the human.

  5. Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations. (United States)

    Pérez-Villa, Yolanda E; Mena-Ramírez, María E; Aguirre, Laura E Chamlati; Mora-Magaña, Ignacio; Gutiérrez-Farfán, Ileana S


    The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  6. Long-term depression-like plasticity of the blink reflex for the treatment of blepharospasm. (United States)

    Kranz, Gottfried; Shamim, Ejaz A; Lin, Peter T; Kranz, George S; Hallett, Mark


    Our previous work showed a beneficial therapeutic effect on blepharospasm using slow repetitive transcranial magnetic stimulation, which produces a long-term depression (LTD)-like effect. High-frequency supraorbital electrical stimulation, asynchronous with the R2 component of the blink reflex, can also induce LTD-like effects on the blink reflex circuit in healthy subjects. Patients with blepharospasm have reduced inhibition of their blink recovery curves; therefore, a LTD-like intervention might normalize the blink reflex recovery (BRR) and have a favorable therapeutic effect. This is a randomized, sham-controlled, observer-blinded prospective study. In 14 blepharospasm patients, we evaluated the effects of high-frequency supraorbital stimulation on three separate treatment days. We applied 28 trains of nine stimuli, 400 Hz, either before or after the R2 or used sham stimulation. The primary outcome was the blink rate, number of spasms rated by a blinded physician and patient rating before, immediately after and 1 hour after stimulation while resting, reading, and talking; secondary outcome was the BRR. Stimulation "before" and "after" the R2 both showed a similar improvement as sham stimulation in physician rating, but patients felt significantly better with the before condition. Improvement in recovery of the blink reflex was noted only in the before condition. Clinical symptoms differed in the three baseline conditions (resting, reading, and talking). Stimulation before R2 increased inhibition in trigeminal blink reflex circuits in blepharospasm toward normal values and produced subjective, but not objective, improvement. Inhibition of the blink reflex pathway by itself appeared to be insufficient for a useful therapeutic effect. Copyright © 2013 Movement Disorder Society.

  7. Reflexive Planning as Design and Work

    DEFF Research Database (Denmark)

    Lissandrello, Enza; Grin, John


    in planning emerges as a new tool for generating critical knowledge and dialogue that can synthesise the perspectives of multiple actors in a common understanding, existing structural constraints and a collective imagination of alternative future possibilities. Such research highlights the potential......In recent years, planning theorists have advanced various interpretations of the notion of reflexivity, inspired by American pragmatism, complexity theory, hermeneutics, discursive and collaborative planning. Scholars agree that “reflexivity” has a strong temporal dimension: it not only aims...... to solve present planning problems, but to imagine and understand alternative trajectories for future action. This article explores the practical utility of reflexivity for planners, through a case study that focuses on a project to promote sustainable development in the Port of Amsterdam. Reflexivity...

  8. Cerebellar interaction with the acoustic reflex. (United States)

    Jastreboff, P J


    The involvement of the cerebellar vermis in the acoustic reflex was analyzed in 12 cats, decerebrated or in pentobarbital anesthesia. Anatomical data suggested the existence of a connection of lobules VIII with the ventral cochlear nucleus. Single cell recording and evoked potential techniques demonstrated the existence of the acoustic projection to lobulus VIII. Electrical stimulation of this area changed the tension of the middle ear muscle and caused evoked potential responses in the caudal part of the ventral cochlear nucleus. Electrical stimulation of the motor nucleus of the facial nerve evoked a slow wave in the recording taken from the surrounding of the cochlear round window. A hypothesis is proposed which postulates the involvement of the acoustic reflex in space localization of acoustic stimuli and the action of cerebellar vermis in order to assure the stability and plasticity of the acoustic reflex arc.

  9. Safety Profile of Cough and Cold Medication Use in Pediatrics. (United States)

    Green, Jody L; Wang, George Sam; Reynolds, Kate M; Banner, William; Bond, G Randall; Kauffman, Ralph E; Palmer, Robert B; Paul, Ian M; Dart, Richard C


    The safety of cough and cold medication (CCM) use in children has been questioned. We describe the safety profile of CCMs in children pediatric (75.5%), and single-ingredient (77.5%) formulations were most commonly involved. AEs occurring in >20% of all cases included tachycardia, somnolence, hallucinations, ataxia, mydriasis, and agitation. Twenty cases (0.6%) resulted in death; most were in children pediatric liquid formulations were the most commonly reported products. These characteristics present an opportunity for targeted prevention efforts. Copyright © 2017 by the American Academy of Pediatrics.

  10. Whooping Cough: A Brief History to the 19th Century. (United States)

    Weston, Robert


    This paper examines the history of whooping cough (pertussis) from its first recorded mention in 1190 to the time when its microbial cause was identified. The historical records of the disease are complicated by the variation in the nomenclature employed and through using the same name for disorders with different symptoms. During the early-modern period it was considered to be a disease new to Europe-contagious, dangerous, and potentially epidemic. Believed to be confined to children, its significance was limited until the 18th century when its incidence increased markedly. This essay argues pertussis may have occurred in the late medieval period in individual, though not epidemical, cases.

  11. Mucociliary and cough clearance as a biomarker for therapeutic development

    DEFF Research Database (Denmark)

    Bennett, William D; Daviskas, Evangelia; Hasani, Amir


    or therapeutic evaluation presented details of their methodologies. Attendees participating in the workshop discussions included those interested in the physiology of MCC/CC, some of who use in vitro or animal methods for its study, pharmaceutical companies developing muco-active therapies, and many who were......A workshop/symposium on “Mucociliary and Cough Clearance (MCC/CC) as a Biomarker for Therapeutic Development” was held on October 21–22, 2008, in Research Triangle Park, NC, to discuss the methods for measurement of MCC/CC and how they may be optimized for assessing new therapies designed...



    Wairagkar, Niteen S.; Das, J.; Kumar, S.; Mahanta, J.; Satyanarayana, K.; Phukan, R.K.; Chetia, M.; Goswami, S.K.


    The drug abuse monitoring study of Regional Medical Research Center, Dibrugarh, reported 181 and 395 addicts from the states of Assam and Nagaland respectively in one year. Of these, 48 (26.5%) and 49(12.4%) cases were contributed by the primary abuse of codeine containing cough syrups. A11 addicts were males in their early twenties. Most of the addicts were unmarried and educated up to matriculation. The majority of addicts in Assam were Hindus (85.4%) and in Nagaland Christians (81.63%). Un...

  13. Intranasal vaccine trial for canine infectious tracheobronchitis (kennel cough). (United States)

    Glickman, L T; Appel, M J


    Two field trials were conducted during periods of endemic (summer) and epizootic (winter) canine infectious tracheobronchitis activity to evaluate the efficacy of three intranasal vaccines in a closed commercial beagle breeding kennel. A trivalent vaccine containing Bordetella bronchiseptica, canine parainfluenza, and canine adenovirus-2 was administered at 3 weeks of age. The vaccine was 71.2% and 81.8% effective in decreasing the incidence of coughing during the winter and summer trials, respectively. The number of deaths was lower in each of the vaccine groups than in the placebo groups. No adverse reactions were observed with any of the intranasal vaccines.

  14. Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough. (United States)

    Bouchez, Valérie; Guiso, Nicole


    Whooping cough is a vaccine-preventable disease due to Bordetella pertussis and B. parapertussis. This highly contagious respiratory disease occurs through epidemic cycles every 3-5 years and vaccination did not change this frequency. Models suggest that the cyclic increase of susceptibles is linked to demographic differences and different vaccine coverage. However, differences in surveillance of the disease as well as adaptation of the agents of the disease to their human hosts and to vaccine pressure might also play an important role. These parameters are discussed in this review. © FEMS 2015. All rights reserved. For permissions, please e-mail:

  15. Cough aerosol in healthy participants: fundamental knowledge to optimize droplet-spread infectious respiratory disease management. (United States)

    Zayas, Gustavo; Chiang, Ming C; Wong, Eric; MacDonald, Fred; Lange, Carlos F; Senthilselvan, Ambikaipakan; King, Malcolm


    The Influenza A H1N1 virus can be transmitted via direct, indirect, and airborne route to non-infected subjects when an infected patient coughs, which expels a number of different sized droplets to the surrounding environment as an aerosol. The objective of the current study was to characterize the human cough aerosol pattern with the aim of developing a standard human cough bioaerosol model for Influenza Pandemic control. 45 healthy non-smokers participated in the open bench study by giving their best effort cough. A laser diffraction system was used to obtain accurate, time-dependent, quantitative measurements of the size and number of droplets expelled by the cough aerosol. Voluntary coughs generated droplets ranging from 0.1 - 900 microns in size. Droplets of less than one-micron size represent 97% of the total number of measured droplets contained in the cough aerosol. Age, sex, weight, height and corporal mass have no statistically significant effect on the aerosol composition in terms of size and number of droplets. We have developed a standard human cough aerosol model. We have quantitatively characterized the pattern, size, and number of droplets present in the most important mode of person-to-person transmission of IRD: the cough bioaerosol. Small size droplets (< 1 μm) predominated the total number of droplets expelled when coughing. The cough aerosol is the single source of direct, indirect and/or airborne transmission of respiratory infections like the Influenza A H1N1 virus. Open bench, Observational, Cough, Aerosol study. © 2012 Zayas et al; licensee BioMed Central Ltd.

  16. Protease-activated receptor-2 activation exaggerates TRPV1-mediated cough in guinea pigs. (United States)

    Gatti, Raffaele; Andre, Eunice; Amadesi, Silvia; Dinh, Thai Q; Fischer, Axel; Bunnett, Nigel W; Harrison, Selena; Geppetti, Pierangelo; Trevisani, Marcello


    A lowered threshold to the cough response frequently accompanies chronic airway inflammatory conditions. However, the mechanism(s) that from chronic inflammation results in a lowered cough threshold is poorly understood. Irritant agents, including capsaicin, resiniferatoxin, and citric acid, elicit cough in humans and in experimental animals through the activation of the transient receptor potential vanilloid 1 (TRPV1). Protease-activated receptor-2 (PAR2) activation plays a role in inflammation and sensitizes TRPV1 in cultured sensory neurons by a PKC-dependent pathway. Here, we have investigated whether PAR2 activation exaggerates TRPV1-dependent cough in guinea pigs and whether protein kinases are involved in the PAR2-induced cough modulation. Aerosolized PAR2 agonists (PAR2-activating peptide and trypsin) did not produce any cough per se. However, they potentiated citric acid- and resiniferatoxin-induced cough, an effect that was completely prevented by the TRPV1 receptor antagonist capsazepine. In contrast, cough induced by hypertonic saline, a stimulus that provokes cough in a TRPV1-independent manner, was not modified by aerosolized PAR2 agonists. The PKC inhibitor GF-109203X, the PKA inhibitor H-89, and the cyclooxygenase inhibitor indomethacin did not affect cough induced by TRPV1 agonists, but abated the exaggeration of this response produced by PAR2 agonists. In conclusion, PAR2 stimulation exaggerates TRPV1-dependent cough by activation of diverse mechanism(s), including PKC, PKA, and prostanoid release. PAR2 activation, by sensitizing TRPV1 in primary sensory neurons, may play a role in the exaggerated cough observed in certain airways inflammatory diseases such as asthma and chronic obstructive pulmonary disease.

  17. Multi-centre retrospective analysis of clinical diagnosis and treatment for chronic cough

    Directory of Open Access Journals (Sweden)

    Xiao-ming CHENG


    Full Text Available Objective To explore the clinical characteristics and the present status of diagnosis and treatment of chronic cough.Methods The clinical data of 238 in-patients and out-patients of Departments of Respiratory Diseases from 4 teaching hospitals of Chongqing Municipality were collected from Oct.2008 to Dec.2009,and their clinical characteristics,diagnosis and therapeutic effects were retrospectively analyzed.Results A total of 238 patients were enrolled,most of them complained of dry cough and night cough.Throat symptoms were most common,including itching or foreign body sensation,throat discomfort and gastro-oesophageal reflux.Congestion of pharynx and cobblestone like changes in posterior pharyngeal wall were the most common signs in patients with chronic cough.Among all the supplementary examinations,bronchial provocation test resulted in highest positive rate.Etiological diagnosis was done in a total of 254 case-times for diseases leading to chronic cough,among them upper airway cough syndrome(UACS was suspected in 115 case-times.cough variant asthma(CVA in 42 case-times,and cough due to gastroesophageal reflux(GERC in 53 case-times.After the specific treatment targeting UACS,CVA and GERC,in 152 case-times improvement was found after follow-up,including 56,27 and 21 case-times,respectively,with an effective rate of 68.4%(104/152.The final diagnosis for the other 44 case-times with chronic cough was chronic tonsillitis,chronic bronchitis,eosinophilic bronchitis and angiotensin converting enzyme inhibitor(ACEI induced cough.A definite diagnosis was finally made in 148 out of a total of 254 casses,with a diagnostic rate of 58.3%(148/254.Conclusion The final diagnostic rate in etiology of chronic cough is still poor nowadays in our country,and empirical treatment is still the main practice for chronic cough.

  18. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report. (United States)

    Tarlo, Susan M; Altman, Kenneth W; Oppenheimer, John; Lim, Kaiser; Vertigan, Anne; Prezant, David; Irwin, Richard S


    In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  19. Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh


    Rukhsana Parvin; Shekhar Bhattacharjee; Swapna Bhattacharjee


    Background: Cough variant asthma (CVA) is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional...

  20. The stretch reflex and the contributions of C David Marsden

    Directory of Open Access Journals (Sweden)

    Kalyan B Bhattacharyya


    Full Text Available The stretch reflex or myotatic reflex refers to the contraction of a muscle in response to its passive stretching by increasing its contractility as long as the stretch is within physiological limits. For ages, it was thought that the stretch reflex was of short latency and it was synonymous with the tendon reflex, subserving the same spinal reflex arc. However, disparities in the status of the two reflexes in certain clinical situations led Marsden and his collaborators to carry out a series of experiments that helped to establish that the two reflexes had different pathways. That the two reflexes are dissociated has been proved by the fact that the stretch reflex and the tendon reflex, elicited by stimulation of the same muscle, have different latencies, that of the stretch reflex being considerably longer. They hypothesized that the stretch reflex had a transcortical course before it reached the spinal motor neurons for final firing. Additionally, the phenomenon of stimulus-sensitive cortical myoclonus lent further evidence to the presence of the transcortical loop where the EEG correlate preceded the EMG discharge. This concept has been worked out by later neurologists in great detail , and the general consensus is that indeed, the stretch reflex is endowed with a conspicuous transcortical component.

  1. Orthodoxy and reflexivity in international comparative analysis

    DEFF Research Database (Denmark)

    Lind, Jens; Valkenburg, Ben


    This contribution aims at four points.First we want to argue why we think a reflexive social science is more adequate than the orthodox consensus. In current practice much of the criticism on the orthodox consensus is shared on a theoretical level, without considering the implications and acting...... upon the consequences on the level of empirical research. We want to avoid that, so our second and third subject will be the practical implications of reflexivity for empirical research as well as for social policy. Our discussion on these subjects is based on the practical experiences in the INPART...

  2. Probabilities on Streams and Reflexive Games

    Directory of Open Access Journals (Sweden)

    Andrew Schumann


    Full Text Available Probability measures on streams (e.g. on hypernumbers and p-adic numbers have been defined. It was shown that these probabilities can be used for simulations of reflexive games. In particular, it can be proved that Aumann's agreement theorem does not hold for these probabilities. Instead of this theorem, there is a statement that is called the reflexion disagreement theorem. Based on this theorem, probabilistic and knowledge conditions can be defined for reflexive games at various reflexion levels up to the infinite level. (original abstract

  3. High frequency analysis of cough sounds in pediatric patients with respiratory diseases. (United States)

    Kosasih, K; Abeyratne, U R; Swarnkar, V


    Cough is a common symptom in a range of respiratory diseases and is considered a natural defense mechanism of the body. Despite its critical importance in the diagnosis of illness, there are no golden methods to objectively assess cough. In a typical consultation session, a physician may briefly listen to the cough sounds using a stethoscope placed against the chest. The physician may also listen to spontaneous cough sounds via naked ears, as they naturally propagate through air. Cough sounds carry vital information on the state of the respiratory system but the field of cough analysis in clinical medicine is in its infancy. All existing cough analysis approaches are severely handicapped by the limitations of the human hearing range and simplified analysis techniques. In this paper, we address these problems, and explore the use of frequencies covering a range well beyond the human perception (up to 90 kHz) and use wavelet analysis to extract diagnostically important information from coughs. Our data set comes from a pediatric respiratory ward in Indonesia, from subjects diagnosed with asthma, pneumonia and rhinopharyngitis. We analyzed over 90 cough samples from 4 patients and explored if high frequencies carried useful information in separating these disease groups. Multiple regression analysis resulted in coefficients of determination (R(2)) of 77-82% at high frequencies (15 kHz-90 kHz) indicating that they carry useful information. When the high frequencies were combined with frequencies below 15kHz, the R(2) performance increased to 85-90%.

  4. Effectiveness of a personalized ventilation system in reducing personal exposure against directly released simulated cough droplets. (United States)

    Pantelic, J; Tham, K W; Licina, D


    The inhalation intake fraction was used as an indicator to compare effects of desktop personalized ventilation and mixing ventilation on personal exposure to directly released simulated cough droplets. A cough machine was used to simulate cough release from the front, back, and side of a thermal manikin at distances between 1 and 4 m. Cough droplet concentration was measured with an aerosol spectrometer in the breathing zone of a thermal manikin. Particle image velocimetry was used to characterize the velocity field in the breathing zone. Desktop personalized ventilation substantially reduced the inhalation intake fraction compared to mixing ventilation for all investigated distances and orientations of the cough release. The results point out that the orientation between the cough source and the breathing zone of the exposed occupant is an important factor that substantially influences exposure. Exposure to cough droplets was reduced with increasing distance between cough source and exposed occupant. The results from this study show that an advanced air distribution system such as personalized ventilation reduces exposure to cough-released droplets better than commonly applied overhead mixing ventilation. This work can inform HVAC engineers about different aspects of air distribution systems’ performance and can serve as an aid in making critical design decisions. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Effectiveness of a personalized ventilation system in reducing personal exposure against directly released simulated cough droplets

    DEFF Research Database (Denmark)

    Pantelic, J.; Tham, K. W.; Licina, Dusan


    manikin at distances between 1 and 4m. Cough droplet concentration was measured with an aerosol spectrometer in the breathing zone of a thermal manikin. Particle image velocimetry was used to characterize the velocity field in the breathing zone. Desktop personalized ventilation substantially reduced......The inhalation intake fraction was used as an indicator to compare effects of desktop personalized ventilation and mixing ventilation on personal exposure to directly released simulated cough droplets. A cough machine was used to simulate cough release from the front, back, and side of a thermal...

  6. Cough quality in children: a comparison of subjective vs. bronchoscopic findings

    Directory of Open Access Journals (Sweden)

    Cox Nancy C


    Full Text Available Abstract Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1 cough quality (wet/dry and brassy/non-brassy to bronchoscopic findings of secretions and tracheomalacia respectively and, (2 parent's vs clinician's evaluation of the cough quality (wet/dry. Methods Cough quality of children (without a known underlying respiratory disease undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6. Kappa (K statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls enrolled was 2.6 years (IQR 5.7. Parent's assessment of cough quality (wet/dry agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93. When compared to bronchoscopy (bronchoscopic secretion grade 4, clinicians' cough assessment had the highest sensitivity (0.75 and specificity (0.79 and were marginally better than parent(s. The area under the ROC curve was 0.85 (95%CI 0.77–0.92. Intra-observer (K = 1.0 and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94 was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1. Sensitivity and specificity for brassy cough (for tracheomalacia were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86. Conclusions Dry and wet cough in children, as determined by clinicians and

  7. Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study. (United States)

    Wang, Kay; Fry, Norman K; Campbell, Helen; Amirthalingam, Gayatri; Harrison, Timothy G; Mant, David; Harnden, Anthony


    To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination. Prospective cohort study (November 2010 to December 2012). General practices in Thames Valley, UK. 279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks' duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously. Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis. 56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours. Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom. UK

  8. Charitable giving and reflexive individuals: How personal reflexivity mediates between structure and agency. (United States)

    Sanghera, Balihar


    This article examines how individuals are reflexive beings who interpret the world in relation to things that matter to them, and how charitable acts are evaluated and embedded in their lives with different degrees of meaning and importance. Rather than framing the discussion of charitable practices in terms of an altruism/egoism binary or imputing motivations and values to social structures, the article explains how reflexivity is an important and neglected dimension of social practices, and how it interacts with sympathy, sentiments and discourses to shape giving. The study also shows that there are different modes of reflexivity, which have varied effects on charity and volunteering.

  9. Dextromethorphan in Cough Syrup: The Poor Man's Psychosis. (United States)

    Martinak, Bridgette; Bolis, Ramy A; Black, Jeffrey Ryne; Fargason, Rachel E; Birur, Badari


    Dextromethorphan (3-methoxy-N-methylmorphinan), also known as "DXM" and "the poor man's PCP," is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psychosis characterized by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia. We report a noteworthy case of severe dextromethorphan use disorder with dextromethorphan-induced psychotic disorder in a 40-year-old Caucasian female, whose symptoms remitted only following treatment with a combination of an antipsychotic and mood stabilizer. While some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18-years of age, there is currently no federal ban or restriction on DXM. Abuse of DXM, a readily available and typically inexpensive agent that is not detected on a standard urine drug screen, may be an under-recognized cause of substance-induced psychosis. It is imperative that clinicians are aware of the potential psychiatric sequelae of recreational DXM use.

  10. Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis (United States)

    Martinak, Bridgette; Bolis, Ramy A.; Black, Jeffrey Ryne; Fargason, Rachel E.; Birur, Badari


    Dextromethorphan (3-methoxy-N-methylmorphinan), also known as “DXM” and “the poor man’s PCP,” is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psychosis characterized by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia. We report a noteworthy case of severe dextromethorphan use disorder with dextromethorphan-induced psychotic disorder in a 40-year-old Caucasian female, whose symptoms remitted only following treatment with a combination of an antipsychotic and mood stabilizer. While some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18-years of age, there is currently no federal ban or restriction on DXM. Abuse of DXM, a readily available and typically inexpensive agent that is not detected on a standard urine drug screen, may be an under-recognized cause of substance-induced psychosis. It is imperative that clinicians are aware of the potential psychiatric sequelae of recreational DXM use. PMID:28936010

  11. Pertussis-associated persistent cough in previously vaccinated children. (United States)

    Principi, Nicola; Litt, David; Terranova, Leonardo; Picca, Marina; Malvaso, Concetta; Vitale, Cettina; Fry, Norman K; Esposito, Susanna


    To evaluate the role of Bordetella pertussis infection, 96 otherwise healthy 7- to 17-year-old subjects who were suffering from a cough lasting from 2 to 8 weeks were prospectively recruited. At enrolment, a nasopharyngeal swab and an oral fluid sample were obtained to search for pertussis infection by the detection of B. pertussis DNA and/or an elevated titre of anti-pertussis toxin IgG. Evidence of pertussis infection was found in 18 (18.7 %; 95 % confidence interval, 11.5-28.0) cases. In 15 cases, the disease occurred despite booster administration. In two cases, pertussis was diagnosed less than 2 years after the booster injection, whereas in the other cases it was diagnosed between 2 and 9 years after the booster dose. This study used non-invasive testing to show that pertussis is one of the most important causes of long-lasting cough in school-age subjects. Moreover, the protection offered by acellular pertussis vaccines currently wanes more rapidly than previously thought.

  12. A Prototype Analysis of Spanish Indeterminate Reflexive Constructions. (United States)

    Turley, Jeffrey S.


    Discussion of the Spanish indeterminate reflexive construction, the impersonal reflexive, finds that prototype theory allows this subjectless Spanish construction to be included within the category of generally subject-bearing indeterminates in Romance languages. (MSE)

  13. Comparison of Stretch Reflex Torques in Ankle Dorsiflexors and Plantarflexors

    National Research Council Canada - National Science Library

    Tung, J


    ...) ankle muscles, Pulse, step, and a combination of random perturbation and step inputs were used to identify the reflex and intrinsic contributions to the measured torque, TA reflex torques were very...

  14. Biological Motion Cues Trigger Reflexive Attentional Orienting (United States)

    Shi, Jinfu; Weng, Xuchu; He, Sheng; Jiang, Yi


    The human visual system is extremely sensitive to biological signals around us. In the current study, we demonstrate that biological motion walking direction can induce robust reflexive attentional orienting. Following a brief presentation of a central point-light walker walking towards either the left or right direction, observers' performance…

  15. Dilemmas and Deliberations in Reflexive Ethnographic Research (United States)

    Robinson, Janean Valerie


    This paper traces insights into the challenges and dilemmas experienced whilst researching students' interpretations and understandings of the Behaviour Management in Schools policy in Western Australia. Journal records, supported by student transcripts, are woven together in a reflexive ethnographic journey--from the beginning phase of searching…

  16. Reflex epilepsy: triggers and management strategies

    Directory of Open Access Journals (Sweden)

    Okudan ZV


    Full Text Available Zeynep Vildan Okudan,1 Çiğdem Özkara2 1Department of Neurology, Bakirkoy Dr Sadi Konuk Education and Research Hospital, 2Department of Neurology and Clinical Neurophysiology, Cerrahpasa Faculty of Medicine, University of Istanbul, Istanbul, Turkey Abstract: Reflex epilepsies (REs are identified as epileptic seizures that are consistently induced by identifiable and objective-specific triggers, which may be an afferent stimulus or by the patient’s own activity. RE may have different subtypes depending on the stimulus characteristic. There are significant clinical and electrophysiologic differences between different RE types. Visual stimuli-sensitive or photosensitive epilepsies constitute a large proportion of the RE and are mainly related to genetic causes. Reflex epilepsies may present with focal or generalized seizures due to specific triggers, and sometimes seizures may occur spontaneously. The stimuli can be external (light flashes, hot water, internal (emotion, thinking, or both and should be distinguished from triggering precipitants, which most epileptic patients could report such as emotional stress, sleep deprivation, alcohol, and menstrual cycle. Different genetic and acquired factors may play a role in etiology of RE. This review will provide a current overview of the triggering factors and management of reflex seizures. Keywords: seizure, reflex epilepsy, photosensitivity, hot water, reading, thinking

  17. A reflexive perspective in problem solving


    Chio, José Angel; Álvarez, Aida; López, Margarita


    The objective of this paper is to favour the methodological process of reflexive analysis in problem solving in the general teaching methods that concentrates in strengthening the dimensional analysis, to gain a greater preparation of the students for the solution of mathematical problems.

  18. Refixation saccades with normal gain values

    DEFF Research Database (Denmark)

    Korsager, Leise Elisabeth Hviid; Faber, Christian Emil; Schmidt, Jesper Hvass


    -ocular reflex. However, this partial deficit is in conflict with the current way of interpreting vHIT results in which the vestibular function is classified as either normal or pathological based only on the gain value. Refixation saccades, which are evident signs of vestibulopathy, are not considered...

  19. Intraesophageal pressure recording improves the detection of cough during multichannel intraluminal impedance testing in children. (United States)

    Rosen, Rachel; Amirault, Janine; Giligan, Emily; Khatwa, Umakanth; Nurko, Samuel


    One of the primary reasons for referral for reflux testing is to correlate reflux events with symptoms such as cough. Adult studies have suggested that symptom recording is flawed and pediatricians feel this is an even more significant problem because there may be errors in both parental and patient reports. We hypothesize that intraesophageal pressure recording (IEPR) provides an objective method to identify coughs during reflux testing in children. We recruited 20 children undergoing multichannel intraluminal impedance with pH (pH-MII) testing for the evaluation of cough. We placed simultaneous intraesophageal pressure and pH-MII catheters. Tracings were blindly scored by 2 observers without knowledge of patient/parent symptom report. After the blinded scoring, patient/parent report of symptoms was recorded. Ninety-four percent of all coughs were detected by IEPR and only 48% of all coughs were reported by patients/parents. The mean time from the IEPR cough to the patient/parent cough was 11±16 seconds. Using IEPR as the criterion standard for the detection of cough, the sensitivity of patient report for the detection of cough is 46%. Using varying symptom windows because of the increased precision of IEPR, the number of patients with a positive symptom index could be reduced from 30% to 0%, preventing children from being falsely categorized as having reflux-related lung disease. Parental and patient symptom recording in children is inadequate for making the diagnosis of reflux-related lung disease. If patients undergo pH-MII testing for reflux-related cough, IEPR should become the new standard by which to correlate reflux with cough.

  20. Snout and Visual Rooting Reflexes in Infantile Autism. Brief Report. (United States)

    Minderaa, Ruud B.; And Others


    The authors conducted extensive neurological evaluations of 42 autistic individuals and were surprised to discover a consistently positive snout reflex in most of them. Difficulties with assessing the reflex are noted. The authors then reassessed the Ss for a series of primitive reflexes which are interpreted as signs of diffuse cortical brain…

  1. Effect of chronic and acute cigarette smoking on the pharyngo-upper oesophageal sphincter contractile reflex and reflexive pharyngeal swallow


    Dua, K; Bardan, E; Ren, J; Sui, Z; Shaker, R


    Background—Cigarette smoking is known to affect adversely the defence mechanisms against gastro-oesophageal reflux. The effect of smoking on the supraoesophageal reflexes that prevent aspiration of gastric contents has not been previously studied. 
Aims—To elucidate the effect of cigarette smoking on two of the supraoesophageal reflexes: the pharyngo-upper oesophageal sphincter (UOS) contractile reflex; and the reflexive pharyngeal swallow. 
Methods—Ten chronic smokers and 10 non-...

  2. Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents.

    Directory of Open Access Journals (Sweden)

    Parviz Ayazi

    Full Text Available Coughing in a child induced by upper respiratory tract infections (URTIs can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013. The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran (n = 42, Group 2, Honey type 2 (Shahde-Golha, Iran (n = 25, and Group 3, DPH (n = 20. Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents.

  3. Successful use of guanfacine in a patient with chronic refractory cough: A case report

    Directory of Open Access Journals (Sweden)

    Gregory W. Kirschen


    Full Text Available Chronic idiopathic cough is a common and often frustrating complaint for patients as well as providers. When common etiologies of cough are ruled out and/or do not respond to usual treatments, neurogenic cough should be considered as a diagnosis of exclusion. Here, we report on a 58-year-old woman with an 8-year history of chronic, treatment-refractory cough of unknown etiology that we diagnosed as neurogenic cough and successfully treated with guanfacine monotherapy, with rapid and durable improvement in symptoms. This case was particularly challenging for a number of reasons, including a distant past smoking history and previous pneumonia, a significant psychiatric history, and a mildly deviated nasal septum and nasal osteophyte, all or some of which could have contributed to the etiology of the cough. This case illustrates that neurogenic cough should be a diagnostic consideration in patients presenting with chronic cough in whom other treatment modalities have failed, and also suggests that the therapeutic use of guanfacine in this clinical setting warrants future investigation.

  4. Voluntary Cough Production and Swallow Dysfunction in Parkinson’s Disease (United States)

    Bolser, Donald; Rosenbek, John; Troche, Michelle; Sapienza, Christine


    Cough is important for airway clearance, particularly if penetration/aspiration of foreign material occurs during swallow. Measures of voluntary cough production from ten male participants with stage II–III Parkinson’s disease (PD) who showed no videofluorographic evidence of penetration/aspiration (Group 1) were examined and compared with those of ten male participants with stage II–III PD who showed videofluorographic evidence of penetration/aspiration (Group 2). The degree of penetration/ aspiration was expertly judged from the videofluorographic examinations of the participants’ sequential swallow of a thin, 30-cc bolus. Measured cough parameters included inspiratory phase duration, inspiratory peak flow, compression phase duration, expiratory peak flow, expiratory rise time, and cough volume acceleration. Results indicated significant group differences for the majority of cough measures, except for inspiratory phase duration and inspiratory peak flow. A modest relationship existed between voluntary cough parameters and penetration/aspiration scores. Decreased ability to adequately clear material from the airway with voluntary cough may exacerbate symptoms resulting from penetration/aspiration, particularly for those with neurodegenerative disease. Measurement of voluntary cough may be useful for the evaluation of airway clearance ability. PMID:18483823

  5. Improved voluntary cough immediately following office-based vocal fold medialization injections. (United States)

    Ruddy, Bari H; Pitts, Teresa E; Lehman, Jeff; Spector, Brian; Lewis, Vicki; Sapienza, Christine M


    This study examined changes in voluntary cough airflow measures immediately following in-office injection of Radiesse in patients diagnosed with glottic insufficiency. Due to significant comorbidities, these patients were poor candidates for medialization under general anesthesia. Each patient presented with dysphonia and dysphagia and ineffective voluntary cough, resulting in a poor clearing of secretions and a presence of ingested fluids on examination. Prospective cohort and case series study. Three patients with a diagnosis of glottic insufficiency were included for study based on flexible endoscopy and laryngostroboscopic examination. Voluntary cough airflow measures were obtained approximately 30 minutes before and after the Radiesse injections. The airflow measures were: compression phase duration (CPD), expiratory rise time (EPRT), expiratory phase peak airflow (EPPF), and cough volume acceleration (CVA). Injection of Radiesse was found to improve voluntary cough airflow measures. The immediate increase in the objective airflow measures obtained from voluntary cough production after Radiesse injections can be used to document airway protection improvements. Cough airflow is a straightforward measure to obtain and is considered an objective measure of cough function. 4. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Analysis of Dextromethorphan in Cough Drops and Syrups: A Medicinal Chemistry Laboratory (United States)

    Hamilton, Todd M.; Wiseman, Frank L., Jr.


    Fluorescence spectroscopy is used to determine the quantity of dextromethorphan hydrobromide (DM) in over-the-counter (OTC) cough drops and syrups. This experiment is appropriate for an undergraduate medicinal chemistry laboratory course when studying OTC medicines and active ingredients. Students prepare the cough drops and syrups for analysis,…

  7. Chronic cough management: dealing with a sensation of irritation in the throat. (United States)

    Ogawa, Haruhiko; Fujimura, Masaki; Ohkura, Noriyuki; Makimura, Koichi


    Among the various types of laryngeal paraesthesia suffered by chronic cough patients, we often encounter 'a sensation of irritation in the throat (SIT)'. Our study indicated that capsaicin cough threshold was significantly (P sensation. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  8. The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia. (United States)

    Suntrup-Krueger, S; Kemmling, A; Warnecke, T; Hamacher, C; Oelenberg, S; Niederstadt, T; Heindel, W; Wiendl, H; Dziewas, R


    Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. In all, 200 acute stroke cases were investigated applying flexible endoscopic evaluation of swallowing within 96 h from admission. Lesions were mapped using patients' computed tomography/magnetic resonance images and these were registered to a standard space. The percentage of lesioned volume of 137 anatomically defined brain regions was determined on a voxel basis (FSL5.0). Region-specific odds ratios (ORs) were calculated with respect to the presence of oropharyngeal residue, delayed swallow response, insufficient cough reflex and occurrence of pneumonia during hospital stay. Colour-coded lesion location maps of brain regions with significant ORs were created (P pneumonia, but substantial overlap between the last two conditions. This study gives new insights on the cortical representation of single components of swallowing and airway protection behaviours. The lesion model may help to risk-stratify patients for dysphagia and pneumonia based on their brain scan. © 2017 EAN.

  9. Epidemiology of whooping cough & typing of Bordetella pertussis. (United States)

    Hegerle, Nicolas; Guiso, Nicole


    Bordetella pertussis is a Gram-negative human-restricted bacterium that evolved from the broad-range mammalian pathogen, Bordetella bronchiseptica. It causes whooping cough or pertussis in humans, which is the most prevalent vaccine-preventable disease worldwide. The introduction of the pertussis whole-cell vaccination for young children, followed by the introduction of the pertussis acellular vaccination (along with booster vaccination) for older age groups, has affected the bacterial population and epidemiology of the disease. B. pertussis is relatively monomorphic worldwide, but nevertheless, different countries are facing different epidemiological evolutions of the disease. Although it is tempting to link vaccine-driven phenotypic and genotypic evolution of the bacterium to epidemiology, many other factors should be considered and surveillance needs to continue, in addition to studies investigating the impact of current clinical isolates on vaccine efficacy.

  10. Concordance and discriminatory power of cough measurement devices for individuals with Parkinson disease. (United States)

    Silverman, Erin P; Carnaby-Mann, Giselle; Pitts, Teresa; Davenport, Paul; Okun, Michael S; Sapienza, Christine


    Dysphagia and aspiration pneumonia are two causes of morbidity in Parkinson disease (PD). In PD, impaired airway clearance can lead to penetration of foreign material, resulting in a high prevalence of aspiration pneumonia and death. This study examines three different devices for measurement of peak airflow during voluntary cough in healthy control subjects and those with PD. Two simple and low-cost devices for measuring peak cough airflow were compared with the "gold standard" pneumotachograph. Thirty-five healthy control subjects and 35 individuals with PD produced voluntary cough at three perceived strengths (weak, moderate, and strong cough) for each of the three devices. A significant difference in mean peak cough airflow was demonstrated for disease (F[1,56] = 4.0, P < .05) and sex (F[1,56] = 9.59, P < .003) across devices. The digital and analog meters were comparable to the gold standard demonstrating no significant difference (statistical) by device (digital vs analog) in receiver operating characteristic curve analysis. Both devices were discriminative of the presence of PD. The analog and digital peak airflow meters are suitable alternatives to the gold standard pneumotachograph due to their low cost, portability, ease of use, and high sensitivity relative to normative peak cough airflows. Voluntary cough airflow measures may serve as a noninvasive means of screening for aspiration risk in target populations. Additionally, quantification of cough strength through use of predetermined limens for weak, moderate, and strong cough may assist clinicians in better describing and tracking cough strength as a contributing factor to aspiration risk.

  11. Effectiveness of assisted and unassisted cough capacity in amyotrophic lateral sclerosis patients. (United States)

    Sancho, Jesús; Servera, Emilio; Bañuls, Pilar; Marín, Julio


    Decreased cough capacity during a respiratory infection is one of the main causes of acute respiratory failure and hospitalisation in amyotrophic lateral sclerosis (ALS). To determine whether a respiratory measurement could identify the effectiveness of cough capacity in ALS during a respiratory infection. This was a prospective study of all ALS patients who were treated at a respiratory care unit due to a respiratory infection from 2012 to 2016. The effectiveness of unassisted and assisted coughing was evaluated and respiratory function tests were performed during the acute episode. Forty-eight ALS patients were enrolled, with only four having an effective unassisted cough. The variable which predicted unassisted cough effectiveness was peak cough flow (PCF) (OR 4499.27; 95%CI 3.60-3219086.19; p = 0.022) with a cut-off point of 2.77 L/s (166 L/min). For manually assisted coughing, the predictor of cough effectiveness was manually assisted PCF (cut-off point of 2.82-169 L/min) (OR 2198.602; 95% CI 3.750-1351691.42; p = 0.019). Mechanically assisted PCF (cut-off point of 2.95-177 L/min) was found to be the predictor of mechanically assisted coughing effectiveness (OR 23.40; 95% CI 2.11-258.96; p = 0.010). During a respiratory infection in ALS patients, the effectiveness of assisted and unassisted cough capacity depends on the PCF generated.

  12. Nerve growth factor enhances cough via a central mechanism of action. (United States)

    El-Hashim, Ahmed Z; Jaffal, Sahar M; Al-Rashidi, Fatma T; Luqmani, Yunus A; Akhtar, Saghir


    The mechanisms involved in enhanced cough induced by central and inhaled NGF in guinea pigs were investigated. Cough and airway function were assessed by plethysmography following inhaled or intracerebroventricular (i.c.v.) NGF treatment. Expression of TrkA and/or TRPV1 was determined in bronchi and/or brainstem by real-time PCR and immunoblotting. I.c.v. and inhaled NGF enhanced citric acid induced-cough and airway obstruction. Pretreatment (i.c.v.) with antagonists of TrkA (K252a) or TRPV1 (IRTX) significantly reduced both the NGF (i.c.v.) enhanced cough and airway obstruction whereas the NK1 antagonist (FK888) inhibited only cough. The H1 antagonist (cetirizine) did not affect either. Inhaled NGF increased phosphorylation of TrkA receptors in the bronchi but not the brainstem at 0.5h post-treatment. TrkA mRNA was elevated at 0.5h in the bronchi and at 24h in the brainstem while TRPV1 mRNA was elevated from 0.5h to 24h in brainstem and at 24h in the bronchi. Pretreatment (i.c.v.) with IRTX, but not K252a, significantly inhibited the inhaled NGF-enhanced cough. Central NGF administration enhances cough and airway obstruction by mechanisms dependent on central activation of TrkA, TRPV1 and NK1 receptors while inhaled NGF enhances cough via a mechanism dependent on central TRPV1 and not TrkA receptors. These data show that NGF, in addition to its effects on the airways, has an important central mechanism of action in the enhancement of cough. Therefore, therapeutic strategies targeting NGF signaling in both the airways and CNS may be more effective in the management of cough. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Modulation of the Fibularis Longus Hoffmann Reflex and Postural Instability Associated With Chronic Ankle Instability (United States)

    Kim, Kyung-Min; Hart, Joseph M.; Saliba, Susan A.; Hertel, Jay


    Context: Individuals with chronic ankle instability (CAI) present with decreased modulation of the Hoffmann reflex (H-reflex) from a simple to a more challenging task. The neural alteration is associated with impaired postural control, but the relationship has not been investigated in individuals with CAI. Objective: To determine differences in H-reflex modulation and postural control between individuals with or without CAI and to identify if they are correlated in individuals with CAI. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 15 volunteers with CAI (9 males, 6 females; age = 22.6 ± 5.8 years, height = 174.7 ± 8.1 cm, mass = 74.9 ± 12.8 kg) and 15 healthy sex-matched volunteers serving as controls (9 males, 6 females; age = 23.8 ± 5.8 years, height = 171.9 ± 9.9 cm, mass = 68.9 ± 15.5 kg) participated. Intervention(s): Maximum H-reflex (Hmax) and motor wave (Mmax) from the soleus and fibularis longus were recorded while participants lay prone and then stood in unipedal stance. We assessed postural tasks of unipedal stance with participants' eyes closed for 10 seconds using a forceplate. Main Outcome Measure(s): We normalized Hmax to Mmax to obtain Hmax : Mmax ratios for the 2 positions. For each muscle, H-reflex modulation was quantified using the percentage change scores in Hmax : Mmax ratios calculated from prone position to unipedal stance. Center-of-pressure data were used to compute 4 time-to-boundary variables. Separate independent-samples t tests were performed to determine group differences. Pearson product moment correlation coefficients were calculated between the modulation and balance measures in the CAI group. Results: The CAI group presented less H-reflex modulation in the soleus (t26 = −3.77, P = .001) and fibularis longus (t25 = −2.59, P = .02). The mean of the time-to-boundary minima in the anteroposterior direction was lower in the CAI group (t28 = −2.06, P = .048

  14. Radiologic diagnosis of Hirschsprung's disease utilizing rectosphincteric reflex

    Energy Technology Data Exchange (ETDEWEB)

    Nagasaki, A.; Ikeda, K.; Hayashida, Y.


    Artificial balloon distension of the rectum caused a reflex opening of the anal canal as seen during barium enema in 10 out of 10 normal children and in 7 of 7 children with idiopathic constipation. Reflex opening of the anal canal was not observed in any of 15 children with proven Hirschsprung's disease. This lack of response was independent of the length of aganglionosis or previous diverting colostomy and corresponded to the fact that on manometric study the intraluminal pressure of the anal canal fell in normal children but not in the children with Hirschsprung's disease. This finding greatly improves the reliability of barium enema in the diagnosis of Hirschsprung's disease.

  15. Reflexive cartography a new perspective in mapping

    CERN Document Server

    Casti, Emanuela


    Reflexive Cartography addresses the adaptation of cartography, including its digital forms (GIS, WebGIS, PPGIS), to the changing needs of society, and outlines the experimental context aimed at mapping a topological space. Using rigorous scientific analysis based on statement consistency, relevance of the proposals, and model accessibility, it charts the transition from topographical maps created by state agencies to open mapping produced by citizens. Adopting semiotic theory to uncover the complex communicative mechanisms of maps and to investigate their ability to produce their own messages and new perspectives, Reflexive Cartography outlines a shift in our way of conceptualizing maps: from a plastic metaphor of reality, as they are generally considered, to solid tools that play the role of agents, assisting citizens as they think and plan their own living place and make sense of the current world. Applies a range of technologies to theoretical perspectives on mapping to innovatively map the world's geogr...

  16. The Reflexive Principle of Sociological Theorization

    Directory of Open Access Journals (Sweden)

    R T Ubaidullayeva


    Full Text Available The article attempts to describe the reflexive principle in theory-making, which integrates the basic modern methodological paradigms and lays the foundation for the development of sociology. On the basis of the theoretical ideas of P. Bourdieu, A. Giddens and P. Ricoeur the author defines the concept of social reflexion and reveals its peculiarities in sociology as compared to reflexion in philosophy. According to the author, the fulfillment of reflexive functions in sociology is connected with the task of analyzing the complex structure of the polysemantic object, considering the specific quality of the subjects and their various trends of development. The presence of the poles — objectivity-subjectivity, rationality-irrationality, consciousness-unconsciousness etc, requires a reproduction of the dichotomies engendering them in social life and development of cognitive methods for their study in sociology.

  17. Human investigations into the exercise pressor reflex

    DEFF Research Database (Denmark)

    Secher, Niels H; Amann, Markus


    During exercise, neural input from skeletal muscles reflexly maintains or elevates blood pressure (BP) despite a maybe fivefold increase in vascular conductance. This exercise pressor reflex is illustrated by similar heart rate (HR) and BP responses to electrically induced and voluntary exercise....... The importance of the exercise pressor reflex for tight cardiovascular regulation during dynamic exercise is supported by studies using pharmacological blockade of lower limb muscle afferent nerves. These experiments show attenuation of the increase in BP and cardiac output when exercise is performed...... with attenuated neural feedback. Additionally, there is no BP response to electrically induced exercise with paralysing epidural anaesthesia or when similar exercise is evoked in paraplegic patients. Furthermore, BP decreases when electrically induced exercise is carried out in tetraplegic patients. The lack...

  18. Otolith and canal reflexes in human standing (United States)

    Cathers, Ian; Day, Brian L; Fitzpatrick, Richard C


    We used galvanic vestibular stimulation (GVS) to identify human balance reflexes of the semicircular canals and otolith organs. The experiment used a model of vestibular signals arising from GVS modulation of the net signal from vestibular afferents. With the head upright, the model predicts that the GVS-evoked canal signal indicates lateral head rotation while the otolith signal indicates lateral tilt or acceleration. Both signify body sway transverse to the head. With the head bent forward, the model predicts that the canal signal indicates body spin about a vertical axis but the otolith signal still signifies lateral body motion. Thus, we compared electromyograms (EMG) in the leg muscles and body sway evoked by GVS when subjects stood with the head upright or bent forward. With the head upright, GVS evoked a large sway in the direction of the anodal electrode. This response was abolished with the head bent forward leaving only small, oppositely directed, transient responses at the start and end of the stimulus. With the head upright, GVS evoked short-latency (60–70 ms), followed by medium-latency (120 ms) EMG responses, of opposite polarity. Bending the head forward abolished the medium-latency but preserved the short-latency response. This is compatible with GVS evoking separate otolithic and canal reflexes, indicating that balance is controlled by independent canal and otolith reflexes, probably through different pathways. We propose that the short-latency reflex and small transient sway are driven by the otolith organs and the medium-latency response and the large sway are driven by the semicircular canals. PMID:15618274

  19. Evolutionary problems in non-reflexive spaces

    Czech Academy of Sciences Publication Activity Database

    Kružík, Martin; Zimmer, J.


    Roč. 16, č. 1 (2010), s. 1-22 ISSN 1262-3377 R&D Projects: GA AV ČR IAA1075402 Institutional research plan: CEZ:AV0Z10750506 Keywords : concentrations * energetic solution * energies with linear growth * oscillations * relaxation Subject RIV: BA - General Mathematics Impact factor: 1.084, year: 2009 problems in non-reflexive spaces.pdf

  20. Grounded theory research: literature reviewing and reflexivity. (United States)

    McGhee, Gerry; Marland, Glenn R; Atkinson, Jacqueline


    This paper is a report of a discussion of the arguments surrounding the role of the initial literature review in grounded theory. Researchers new to grounded theory may find themselves confused about the literature review, something we ourselves experienced, pointing to the need for clarity about use of the literature in grounded theory to help guide others about to embark on similar research journeys. The arguments for and against the use of a substantial topic-related initial literature review in a grounded theory study are discussed, giving examples from our own studies. The use of theoretically sampled literature and the necessity for reflexivity are also discussed. Reflexivity is viewed as the explicit quest to limit researcher effects on the data by awareness of self, something seen as integral both to the process of data collection and the constant comparison method essential to grounded theory. A researcher who is close to the field may already be theoretically sensitized and familiar with the literature on the study topic. Use of literature or any other preknowledge should not prevent a grounded theory arising from the inductive-deductive interplay which is at the heart of this method. Reflexivity is needed to prevent prior knowledge distorting the researcher's perceptions of the data.

  1. Arakeri’s Reflex: an Alternative Pathway for Dento-Cardiac Reflex Mediated Syncope

    Directory of Open Access Journals (Sweden)

    Veena Arali


    Full Text Available Introduction: Dentocardiac reflex, a variant of trigeminocardiac reflex elicited specifically during tooth extraction procedures in den-tal/maxillofacial surgery and is believed to cause syncope with an afferent link mediated by posterior superior alveolar nerve. Another variant of trigeminocardiac reflex which is also of interest to the oral and maxillofacial surgeon is oculocardiac reflex which can be triggered by direct or indirect manipulation of eye globe or muscles around it.The hypothesis: Excessive or injudicious pressure or manipulations around the maxillary first molars during extraction procedure are as-sociated with maximum incidence of bradycardia and hypotension than around incisor/ canine/ third molars. This is because; the pressure on eye globe and ophthalmic rectus muscle is maximum during extraction of first molar than incisor/canine and third molars. This observation led us to postulate an alternative pathway for dentocardiac reflex mediated syncope which may possibly justify the maxillary first molar region as a prone factor for the trigger. Evaluation of the hypothesis: Present hypothesis may not confer the specific factor responsible for switch in autonomic response in syncope origin during the tooth extraction procedure, but may provide a clue to where we should be looking.

  2. Is Bjerkandera adusta Important to fungus-associated chronic cough as an allergen? Eight cases' reports. (United States)

    Ogawa, Haruhiko; Fujimura, Masaki; Takeuchi, Yasuo; Makimura, Koichi


    Recently, we have reported a new clinical disease concept called fungus-associated chronic cough (FACC), which entailed the following manifestations: (1) chronic cough; (2) the presence of environmental fungi, particularly basidiomycetous (BM) fungi, in the sputum; and (3) good clinical response to antifungal drugs. To clarify the relationship between the exposure to environmental fungi and the development of cough attacks, we reviewed the clinical records of patients with FACC and performed a molecular biological analysis of the BM fungi. We successfully selected 8 patients with chronic cough, wherein a sputum culture yielded B. adusta beforehand; moreover, we conducted allergological tests such as the immediate-type skin test, a serological test, bronchoprovocation test, and lymphocyte stimulation test (LST), using the antigenic solution of B. adusta. The efficacy of individualized therapy and the clinical manifestations in the eight patients were examined. All the eight patients were diagnosed with FACC. Although three patients who did not show a positive reaction to the bronchoprovocation test or LST showed excellent clinical response to anti-fungal drugs; other 5 patients who showed a positive reaction to the bronchoprovocation test and/or LST seemed to be more intractable because of taking a longer time for complete remission and more frequent recurrence of cough. It was suggested that so-called allergic fungal cough (AFC), which is characterized by sensitization to B. adusta, may be included in a part of chronic intractable cough.

  3. Coordination of cough and swallow: a meta-behavioral response to aspiration. (United States)

    Pitts, Teresa; Rose, Melanie J; Mortensen, Ashley N; Poliacek, Ivan; Sapienza, Christine M; Lindsey, Bruce G; Morris, Kendall F; Davenport, Paul W; Bolser, Donald C


    Airway protections is the prevention and/or removal of material by behaviors such as cough and swallow. We hypothesized these behaviors are coordinated to respond to aspiration. Anesthetized animals were challenged with simulated aspiration that induced both coughing and swallowing. Electromyograms of upper airway and respiratory muscles together with esophageal pressure were recorded to identify and evaluate cough and swallow. During simulated aspiration, both cough and swallow intensity increased and swallow duration decreased consistent with rapid pharyngeal clearance. Phase restriction between cough and swallow was observed; swallow was restricted to the E2 phase of cough. These results support three main conclusions: 1) the cough and swallow pattern generators are tightly coordinated so as to generate a protective meta-behavior; 2) the trachea provides feedback on swallow quality, informing the brainstem about aspiration incidences; and 3) the larynx and upper esophageal sphincter act as two separate valves controlling the direction of positive and negative pressures from the upper airway into the thorax. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. The Assessment of Postural Control, Reflex Integration, and Bilateral Motor Coordination of Young Handicapped Children. Final Report. (United States)

    DeGangi, Georgia; Larsen, Lawrence A.

    A measurement device, Assessment of Sensorimotor Integration in Preschool Children, was developed to assess postural control, reflex integration and bilateral motor integration in developmentally delayed children (3 to 5 years old). The test was administered to 113 normal children and results were compared with data collected on 23 developmentally…

  5. A Porous, Morphing, and Circulatory Mode of Self-Other: Decolonizing Identity Politics by Engaging Transnational Reflexivity (United States)

    Subreenduth, Sharon; Rhee, Jeong-eun


    As im/migrant researchers of color working and living in the USA, we begin this article by discussing how our own transnational selves and research have created tensions with the normalized use of socially constructed and theorized categories and differences in US qualitative research practices. We theorize an alternative reflexive mode of…

  6. Establishment and clinical applications of a portable system for capturing influenza viruses released through coughing. (United States)

    Hatagishi, Etsuko; Okamoto, Michiko; Ohmiya, Suguru; Yano, Hisakazu; Hori, Toru; Saito, Wakana; Miki, Hiroshi; Suzuki, Yasushi; Saito, Reiko; Yamamoto, Taro; Shoji, Makoto; Morisaki, Yoshihisa; Sakata, Soichiro; Nishimura, Hidekazu


    Coughing plays an important role in influenza transmission; however, there is insufficient information regarding the viral load in cough because of the lack of convenient and reliable collection methods. We developed a portable airborne particle-collection system to measure the viral load; it is equipped with an air sampler to draw air and pass it through a gelatin membrane filter connected to a cone-shaped, megaphone-like device to guide the cough airflow to the membrane. The membrane was dissolved in a medium, and the viral load was measured using quantitative real-time reverse transcriptase-polymerase chain reaction and a plaque assay. The approximate viral recovery rate of this system was 10% in simulation experiments to collect and quantify the viral particles aerosolized by a nebulizer. Using this system, cough samples were collected from 56 influenza A patients. The total viral detection rate was 41% (23/56), and the viral loads varied significantly (from <10, less than the detection limit, to 2240 viral gene copies/cough). Viable viruses were detected from 3 samples with ≤18 plaque forming units per cough sample. The virus detection rates were similar among different groups of patients infected with different viral subtypes and during different influenza seasons. Among patients who did not receive antiviral treatment, viruses were detected in one of six cases in the vaccinated group and four of six cases in the unvaccinated group. We found cases with high viral titers in throat swabs or oral secretions but very low or undetectable in coughs and vice versa suggesting other possible anatomical sites where the viruses might be mixed into the cough. Our system is easy to operate, appropriate for bedside use, and is useful for comparing the viral load in cough samples from influenza patients under various conditions and settings. However, further large-scale studies are warranted to validate our results.

  7. [Effects of morphine on pupillary light reflex in monkeys]. (United States)

    Meng, Zhi-Qiang; Zhang, Yu-Hua; Chen, Nan-Hui; Miao, Ying-Da; Hu, Xin-Tian; Ma, Yuan-Ye


    The pupil size of both human and other animals can be affected by light. Many kinds of psychiatrical and psychological disorders, such as drug abuse, associate with abnormal properties of pupillary light reflex. Thus, the properties of pupillary light reflex could serve as an indicator for drug abuse detection. However, the effect of drug abuse on pupillary light reflex is till unclear. To assess the effects of addictive drugs on pupillary light reflex quantificationally, in the present study, we examined the effects of morphine on pupil diameter and pupillary light reflex in rhesus monkeys. By measuring the pupil diameter at different timing points before and after the administration of morphine, we found that morphine administration reduced the diameter of pupil and decreased the constriction rate. Our present results provide an experimental support for applying the properties of pupillary light reflex as a reference in addicts' detection.

  8. A causal relationship between cough and gastroesophageal reflux disease (GERD) has been established: a pro/con debate. (United States)

    Kahrilas, Peter J; Smith, Jaclyn A; Dicpinigaitis, Peter V


    Along with upper airway cough syndrome (formerly, postnasal drip syndrome) and eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), gastroesophageal reflux disease (GERD) is generally considered among the most common etiologies of chronic cough. Indeed, cough management guidelines published by numerous respiratory societies worldwide recommend evaluation and treatment of GERD as an integral component of the diagnostic/therapeutic algorithm for the management of chronic cough. However, a significant number of patients with chronic cough presumed due to GERD do not report improvement despite aggressive acid-suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of nonacid or weakly acidic reflux. Further contributing to the controversy are recent studies that demonstrate that patients with chronic cough do not have excessive reflux events relative to healthy volunteers. Although a temporal relationship between cough and reflux events has been suggested by studies utilizing impedance-pH monitoring of reflux events and objective cough recording, consensus is lacking in terms of whether this temporal relationship proves a causal link between reflux and cough. The fourth American Cough Conference (New York, June 2013) provided an ideal forum for the debate of this issue between two internationally recognized experts in the field of reflux and chronic cough.

  9. Pertussis vaccination and whooping cough: and now what? (United States)

    Guiso, Nicole


    Pertussis or whooping cough is a respiratory disease caused by Bordetella pertussis or Bordetella parapertussis that are only known to infect humans. This severe and acute respiratory disease presents epidemic cycles and became a vaccine-preventable disease in the 1940s/1950s when developed countries introduced vaccination. The first type of vaccine developed against this disease was a whole-cell pertussis (wP) vaccine containing inactivated B. pertussis bacteria. Most developed countries produced their own vaccine and given the pediatric nature of the disease at the time of licensure, infants and toddlers were the primary targets and were thus massively vaccinated. The characterization of few virulence factors produced by B. pertussis enabled the development of second-generation pertussis vaccines called the acellular pertussis (aP) vaccines. These only contain 1-5 purified, detoxified B. pertussis proteins and were first introduced in Japan around 30 years ago. Australia, Europe and North America introduced aP vaccines approximately 15 years later, which replaced wP vaccines since then.

  10. Relationship between vomiting reflex during esophagogastroduodenoscopy and dyspepsia symptoms. (United States)

    Enomoto, Shotaro; Watanabe, Mika; Yoshida, Takeichi; Mukoubayashi, Chizu; Moribata, Kosaku; Muraki, Yosuke; Shingaki, Naoki; Deguchi, Hisanobu; Ueda, Kazuki; Inoue, Izumi; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Kato, Jun; Fujishiro, Mitsuhiro; Oka, Masashi; Mohara, Osamu; Ichinose, Masao


    Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD. Subjects included 488 consecutive adults (mean age, 56.1 ± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded. Of the 488 subjects, 271 (56%) developed vomiting reflexes (mean, 4.2 times). This reflex-positive group was younger (54.3 ± 9.5 years) than the reflex-negative group (58.3 ± 7.7 years, P reflex-positive group with a high FSSG dyspepsia score (2.27 ± 2.57 vs 1.23 ± 1.84; P acid reflux symptom score (1.96 ± 2.22 vs 1.34 ± 2.14; P reflex-negative group. Multivariate analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes. Using an FSSG dyspepsia score of 1 as the cut-off offered 68% sensitivity and 57% specificity for predicting the occurrence of vomiting reflexes. Based on FSSG questionnaire responses on upper gastrointestinal symptoms, dyspepsia symptoms, in particular, are related to presence of vomiting reflexes during EGD. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

  11. The legacy of care as reflexive learning. (United States)

    García, Marta Rodríguez; Moya, Jose Luis Medina


    to analyze whether the tutor's use of reflexive strategies encourages the students to reflect. The goal is to discover what type of strategies can help to achieve this and how tutors and students behave in the practical context. a qualitative and ethnographic focus was adopted. Twenty-seven students and 15 tutors from three health centers participated. The latter had received specific training on reflexive clinical tutoring. The analysis was developed through constant comparisons of the categories. the results demonstrate that the tutors' use of reflexive strategies such as didactic questioning, didactic empathy and pedagogical silence contributes to encourage the students' reflection and significant learning. reflexive practice is key to tutors' training and students' learning. analisar se o uso de estratégias reflexivas por parte da tutora de estágio clínico estimula a reflexão nos estudantes. A intenção é descobrir qual tipo de estratégias podem ajudar a fazê-lo e como as tutoras e os estudantes se comportam no contexto prático. foi adotado um enfoque qualitativo de cunho etnográfico em que participaram 27 estudantes e 15 tutores de três centros de saúde que haviam recebido formação específica sobre tutoria clínica reflexiva. A análise foi realizada por meio de comparações constantes das categorias. os resultados demonstram que o uso de estratégias reflexivas como a interrogação didática, a empatia didática e o silêncio pedagógico por parte das tutoras, contribui para fomentar a reflexão do estudante e sua aprendizagem significativa. a prática reflexiva é a chave para a formação dos tutores e para a aprendizagem dos estudantes. analizar si el uso de estrategias reflexivas por parte de la tutora de prácticas clínicas fomenta la reflexión en los estudiantes. Se trata de conocer qué tipo de estrategias pueden ayudar a hacerlo y cómo se comportan tutoras y estudiantes en el contexto práctico. se ha utilizado un enfoque

  12. Reflexive Aero Structures for Enhanced Survivability, Phase II (United States)

    National Aeronautics and Space Administration — Cornerstone Research Group Inc. (CRG) will develop an advanced reflexive structure technology system to increase the survivability of future systems constructed of...

  13. Cough associated with gastro-oesophageal reflux disease (GORD): Japanese experience. (United States)

    Niimi, Akio


    Differences in the aetiology as well as patient background of chronic cough have been recognised among US, UK, and Japan. One of the marked differences has been the prevalence of gastro-oesophageal reflux disease (GORD), which has been one of the top three causes in Western countries. It was indeed uncommon or rare in Japan, but, with the increasing prevalence of GOR itself, chronic cough associated with GORD seems to have become more common. In this article, cough associated with GORD will be reviewed based on literature and our Japanese experience. Further, potentially broader relevance of GORD in chronic cough will also be mentioned, highlighting the potential importance of dysmotiliy/non-acid reflux. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Dos and Don'ts of Giving OTC Cough and Cold Medicines to Your Child (United States)

    ... workers, extended family members, or babysitters) knows what medicines your child is taking and when he or she should ... ts Don’t give OTC cough and cold medicines to a child younger than 4 years of age unless your ...

  15. Diagnostic utility of fractional exhaled nitric oxide in prolonged and chronic cough according to atopic status

    Directory of Open Access Journals (Sweden)

    Takamitsu Asano


    Conclusions: Although high FeNO levels suggested the existence of AC, lower FeNO levels had limited diagnostic significance. Atopic status affects the utility of FeNO levels in the differential diagnosis of prolonged and chronic cough.

  16. Developing control algorithms of a voluntary cough for an artificial bioengineered larynx using surface electromyography of chest muscles: A prospective cohort study. (United States)

    Banus, M S; Birchall, M A; Graveston, J A


    This prospective cohort study investigates the prediction of a voluntary cough using surface electromyography (EMG) of intercostal and diaphragm muscles, to develop control algorithms for an EMG-controlled artificial larynx. The Ear Institute, London. Electromyography onset compared to voluntary cough exhalation onset and to 100 ms (to give the artificial larynx the time to close the bioengineered vocal cords) before voluntary cough exhalation onset, in twelve healthy participants. In the 189 EMG of intercostal muscle-detected voluntary coughs, 172 coughs (91% CI 70-112) were detected before onset of cough exhalation and 128 coughs (67.6% CI 33.7-101.7) 100 ms before onset of cough exhalation. In the 158 EMG of diaphragm muscle-detected voluntary coughs, 149 coughs (94.3% CI 76.3-112.3) were detected before onset of cough exhalation and 102 coughs (64.6% CI 26.6-102.6) 100 ms before onset of cough exhalation. More coughs were detected before onset of cough exhalation when combining EMG activity of intercostal and diaphragm muscles and comparing this to intercostal muscle activity alone (183 coughs [96.8% CI 83.8-109.8] vs 172 coughs, P = .0294). When comparing the mentioned combination to diaphragm muscle activity alone, the higher percentage of detected coughs before cough exhalation onset was not found to be significant (183 coughs vs 149 coughs, P = .295). In addition, more coughs were detected 100 ms before onset of cough exhalation with the mentioned combination of EMG activity and comparing this to intercostal muscles alone (149 coughs [78.8% CI 48.8-108.8] vs 128 coughs, P = .0198) and to diaphragm muscles alone (149 coughs vs 102 coughs, P = .0038). Most voluntary coughs can be predicted based on combined EMG signals of intercostal and diaphragm muscles, and therefore, these two muscle groups will be useful in controlling the bioengineered vocal cords within the artificial larynx during a voluntary cough. © 2017 John Wiley & Sons Ltd.

  17. The Disappearing Audience and Reflexive Visibility


    Katerina Girginova


    Contrary to popular opinion and some academic writing that celebrates the renewed visibility of new media audiences, this essay argues that they are increasingly going into retreat. To understand how new media audiences “disappear” from view of one another, I borrow from Brighenti’s typology of visibility and develop the idea of “reflexive visibility.” The latter describes the ability to socially orient ourselves in a digital environment through the textual and contextual cues of others—an ac...

  18. Scrutinizing the Reflexive Ethnography of Urban Outcast

    DEFF Research Database (Denmark)

    Schultz Larsen, Troels


    The core of Bourdieu and Wacquant’s ‘epistemic reflexivity’ demands an embodied reflexivity which takes up the point of view of the practice and the social problems under study via a reflection and reconstruction of the point of view of the ethnographer as an agent embedded in a scientific practice...... in the scientific field. This must be done to cast light over the social conditions and conditionings that have a possible effect on the construction of the given scientific object under study. However, measured by these standards, Urban Outcasts remains not as pedagogical as one might wish. Despite all...

  19. Clarifying Normalization (United States)

    Carpenter, Donald A.


    Confusion exists among database textbooks as to the goal of normalization as well as to which normal form a designer should aspire. This article discusses such discrepancies with the intention of simplifying normalization for both teacher and student. This author's industry and classroom experiences indicate such simplification yields quicker…

  20. Regulating cough through modulation of sensory nerve function in the airways. (United States)

    Spina, D; Page, C P


    Whilst local anaesthetics when applied directly to laryngeal nerves or topically to the lung can suppress cough, their chronic use is constrained because of dose limiting side effects. However, the effectiveness of local anaesthetics suggests that selectivity targeting nerves in the airway may provide novel approaches for the treatment of cough in the future. There is a considerable wealth of evidence showing that there are different afferent nerve subtypes in the airways. Traditionally C-fibres have been the focus of much research in the cough field since the stimulation of these afferents by capsaicin is able to elicit cough in guinea-pigs and in man, and drugs targeting various proteins expressed in these nerves (e.g. mu-opioid, NOP1, TRPV1, sodium channels) have been shown to be anti-tussive in preclinical models of cough. However, interest in Aδ fibres has increased recently in light of the discovery of a specific cough receptor in the guinea-pig that is provoked by citric acid and punctate stimulation, but not capsaicin and which has been anatomically linked to Aδ fibres. There is also some evidence that as a result of inflammation in the airways, Aδ fibres can begin to express neuropeptides and TRPV1 receptors so that they can become responsive to endogenous activators of this ion channel and to irritants like capsaicin. Consequently, there is considerable interest in targeting either one or both afferent nerve types for the treatment of chronic cough. However, to date the translation of preclinical studies into man has largely been disappointing and certainly there is a need for better preclinical models in this field. There also remain many challenges to overcome at a clinical level, such as what patient group(s) should be used to assess anti-tussive drugs and whether the use of irritants that induce cough in healthy volunteers (such as citric acid or capsaicin) is of any value in the assessment of novel anti-tussive drugs. The development of several

  1. Reflexivity in the Interstices: A Tale of Reflexivity at Work in, during, and behind the Scenes (United States)

    Wickens, Corrine M.; Cohen, James A.; Walther, Carol S.


    This article is a story of how the authors came to make sense of the significance of those words in relation to gender, race/ethnicity, and citizenship in writing a manuscript about L[subscript 1]L[subscript 2] acquisition. It is a tale about how Reflexivity wove itself into the conversations, into the writing, into the in-between spaces, the…

  2. Effects of brainstem lesions on the masseter inhibitory reflex. Functional mechanisms of reflex pathways

    NARCIS (Netherlands)

    Ongerboer de Visser, B. W.; Cruccu, G.; Manfredi, M.; Koelman, J. H.


    The masseter inhibitory reflex (MIR) was investigated in 16 patients with localized brainstem lesions involving the trigeminal system. The MIR consists of two phases of EMG silence (S1 and S2) evoked by stimulation of the mental nerve during maximal clenching of the teeth. The extent of the lesions

  3. Musicogenic reflex seizures in epilepsy with glutamic acid decarbocylase antibodies. (United States)

    Falip, M; Rodriguez-Bel, L; Castañer, S; Miro, J; Jaraba, S; Mora, J; Bas, J; Carreño, M


    Musicogenic reflex seizures (MRS) are a rare form of seizures described in patients with temporal lobe epilepsy (TLE), mainly of unknown etiology. Epilepsy with antibodies against glutamic acid decarboxylase (GAD-ab) is a form of autoimmune epilepsy for which no specific semiology has been described. To retrospectively review the incidence of MRS in the general epileptic population and in the series of patients with epilepsy and GAD-ab and to describe its clinical and paraclinical characteristics. Patients recorded between January 2010 and January 2016 in the Database of Bellvitge Hospital Epilepsy Unit were reviewed. From a group of 1510 epileptic patients, three reported MRS (0.0019%) (two patients with epilepsy and GAD-ab and one patient with cryptogenic TLE). The incidence of MRS in patients with epilepsy and GAD-ab was 2 of 22 (9%). Both patients had a normal magnetic resonance Imaging (MRI), but FDG-PET showed medial temporal lobe hypometabolism (unilateral or bilateral) in both and also in the insula in one of them. MRS (recorded via video-EEG[electroencephalography] in one patient) arose from the right temporal lobe. MRS may be a distinctive seizure type in patients with epilepsy and antiGADab. Determination of GAD-ab should be carried out in all cases of MRS, even those with normal structural MRI. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Frequency of cough during therapy with ACE inhibitors in Greek hypertensives. (United States)

    Efstratopoulos, A D; Meikopoulos, M; Voyaki, S


    Persistent dry cough is one of the most common side-effects during therapy with ACE inhibitors. The frequency of cough ranges widely (from 0.2% to 15%) in different series, being higher in small studies and smaller in retrospective studies with large number of patients. The aim of the present study was to evaluate the true frequency of cough induced by treatment with ACE inhibitors in Greek hypertensives and to determine various possibly correlated parameters, including sex, duration of therapy and kind and dose of ACE inhibitors. All hypertensive patients followed in our Hypertension Clinic and treated with ACE inhibitors participated in the study. A total of 228 patients, 103 males and 125 females, 24-80 years of age, were treated with ACE inhibitors for a period of 1-41 months: 121 with enalapril, 40 with captopril, 39 with lisinopril, 25 with perindopril and 3 with ramipril. During treatment with ACE inhibitors persistent dry cough occurred in 15 patients, 12 women and 3 men, giving a frequency of 6.58%. Eleven patients (4.82%) volunteered the information and three after questioning. The mean age of these 15 patients with cough was significantly higher from that of the group (n = 213) without cough (64.27 +/- 2.5 vs. 57.9 +/- 0.74 years, mean +/- SEM, P = 0.024). The 12 women with cough were significantly older than the 113 without cough (67.77 +/- 2.8 vs. 57.8 +/- 1.04 years, P = 0.032).(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough


    Nin, Carlos Shuler; Marchiori, Edson; Irion, Klaus Loureiro; Paludo, Artur de Oliveira; Alves, Giordano Rafael Tronco; Hochhegger, Daniela Reis; Hochhegger, Bruno


    OBJECTIVE: To assess the routine use of barium swallow study in patients with chronic cough.METHODS: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological...

  6. Patient education about cough: effect on the consulting behaviour of general practice patients. (United States)

    Rutten, G; Van Eijk, J; Beek, M; Van der Velden, H


    The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

  7. Pertussis prevalence and its determinants among children with persistent cough in urban Uganda.

    Directory of Open Access Journals (Sweden)

    Vincent Kayina

    Full Text Available We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control.In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting ≥14 days were enrolled and evaluated for pertussis using DNA polymerase chain reaction (PCR and ELISA serology tests.Pertussis prevalence was 67 (15% (95% Confidence Interval (CI: 12-18 and 81 (20% (95% CI: 16-24 by PCR and ELISA, respectively among 449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination coverage of 94% in this age group. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30% had a coughing household member and 316 (70% did not. Among 133 children that had a coughing household member, sex of child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR 7.16 (95% CI: 1.24-41.44. Among the 316 children that did not have a coughing household member, age 40 years of age were the factors associated with pertussis. Age 59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.

  8. Classification of voluntary coughs applied to the screening of respiratory disease. (United States)

    Infante, Christian; Chamberlain, Daniel B; Kodgule, Rahul; Fletcher, Richard Ribon


    Pulmonary and respiratory diseases (e.g. asthma, COPD, allergies, pneumonia, tuberculosis, etc.) represent a large proportion of the global disease burden, mortality, and disability. In this context of creating automated diagnostic tools, we explore how the analysis of voluntary cough sounds may be used to screen for pulmonary disease. As a clinical study, voluntary coughs were recorded using a custom mobile phone stethoscope from 54 patients, of which 7 had COPD, 15 had asthma, 11 had allergic rhinitis, 17 had both asthma and allergic rhinitis, and four had both COPD and allergic rhinitis. Data were also collected from 33 healthy subjects. These patients also received full auscultation at 11 sites, given a clinical questionnaire, and underwent full pulmonary function testing (spirometer, body plethysmograph, DLCO) which culminated in a diagnosis provided by an experienced pulmonologist. From machine learning analysis of these data, we show that it is possible to achieve good classification of cough sounds in terms of Wet vs Dry, yielding an ROC curve with AUC of 0.94, and show that voluntary coughs can serve as an effective test for determining Healthy vs Unhealthy (sensitivity=35.7% specificity=100%). We also show that the use of cough sounds can enhance the performance of other diagnostic tools such as a patient questionnaire and peak flow meter; however voluntary coughs alone provide relatively little value in determining specific disease diagnosis.

  9. The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency. (United States)

    Litts, Juliana K; Fink, Daniel S; Clary, Matthew S


    To determine the effect of injection augmentation of the vocal folds on chronic cough symptoms in patients with glottic insufficiency. Medical records from 146 consecutive patients who underwent vocal fold injection augmentation by a fellowship-trained laryngologist between 2013 and 2015 were reviewed. Twenty-three patients (12 male) met inclusion criteria of a vocal fold augmentation injection, cough symptoms lasting more than 8 weeks, and glottic insufficiency as determined by shortened closed phase on stroboscopy. Exclusion criteria included lack of cough complaints, diagnosis of vocal fold immobility, previous history of vocal fold augmentation, and incomplete data sets. Data collected included age, gender, pre- and 1-month postinjection Cough Severity Index (CSI) scores, location of injection (unilateral or bilateral), and patient statement of percent change in symptoms that was recorded at 1-month postinjection visit. Paired t test indicated a significant decrease in CSI scores from pre- (m = 18.5) to 1-month postinjection (m = 12.1) (P = 0.004). Eighteen patients (78.2%) reported a 50% or greater improvement in cough symptoms at the 1-month postinjection visit. Injection augmentation of the vocal folds in the presence of glottic insufficiency appears to improve cough symptoms, as was reported by CSI in patients who are refractory to other medical and behavioral treatments. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Cough-variant asthma: a diagnostic dilemma in the occupational setting. (United States)

    Lipińska-Ojrzanowska, A; Wiszniewska, M; Walusiak-Skorupa, J


    Cough-variant asthma (Corrao's syndrome) is defined as the presence of chronic non-productive cough in patients with bronchial hyperresponsiveness (BHR) and response to bronchodilator therapy. This variant of asthma may present a diagnostic problem in occupational medicine. To describe additional evaluation of cough-variant asthma in a cyanoacrylate-exposed worker in whom standard diagnostic testing was negative. A female beautician was evaluated for suspected occupational allergic rhinitis and asthma. A specific inhalation challenge test (SICT) was performed with cyanoacrylate glues used for applying artificial eyelashes and nails. Spirometry and peak expiratory flow (PEF) measurements were recorded hourly for 24h; methacholine challenge testing was performed and nasal lavage (NL) samples were analysed for eosinophilia. After SICT, the patient developed sneezing, nasal airflow obstruction and cough. Declines in forced expiratory volume in 1 s and PEF were not observed. Eosinophil proportions in NL fluid increased markedly at 4 and 24h after SICT. A significant increase in BHR also occurred 24h after SICT. Clinical symptoms, post-challenge BHR and increased NL eosinophil counts confirmed a positive response to SICT and validated the diagnosis of cough-variant occupational asthma. SICT may be useful in cases where history and clinical data suggest cough-variant asthma and spirometric indices are negative. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email:

  11. [Features of Bordetella pertussis, Bordetella spp. infection and whopping cough in Córdoba province, Argentina]. (United States)

    Giayetto, Víctor O; Blanco, Sebastián; Mangeaud, Arnaldo; Barbás, María G; Cudolá, Analía; Gallego, Sandra V


    Whooping cough is a re-emerging infection in the world and Latin America. It was considered relevant to investigate the clinical and epidemiological profile of Bordetella spp. and Bordetella pertussis infection in Córdoba province, Argentina; evaluating, at the same time, the co-infection with virus producing respiratory infections that may be confused with whooping cough. All whooping cough suspected cases were studied by Polimerase Chain Reaction, amplifying the repeated insertion sequence (IS) 481 and the promoter gene encoding pertussis toxin, between 2011 and 2013. The data were obtained from the clinical and epidemiological records. From 2,588 whooping cough suspected cases, 11.59% was infected by Bordetella spp. and 9.16% was confirmed as Bordetella pertussis infection. The rate of infection was 7.22 and 1.84 per 100,000 for 2011 and 2012, respectively. The infection presented a seasonal tendency and it was mainly found on the group of children between 13 and 24 months old. The co-infection with virus producing respiratory infections, were uncommon. Paroxysmal cough, cyanosis and/or vomiting were predictors of the infection for Bordetella pertussis. To deal with the re-emergence of whooping cough is important the knowledge of the regional epidemiological situation. This paper shows the situation of these infections in the regional clinical and epidemiological context, and makes the information available for health decision-making.

  12. Wh-filler-gap dependency formation guides reflexive antecedent search

    Directory of Open Access Journals (Sweden)

    Michael eFrazier


    Full Text Available Prior studies on online sentence processing have shown that the parser can resolve non-local dependencies rapidly and accurately. This study investigates the interaction between the processing of two such non-local dependencies: wh-filler-gap dependencies (WhFGD and reflexive-antecedent dependencies. We show that reflexive-antecedent dependency resolution is sensitive to the presence of a WhFGD, and argue that the filler-gap dependency established by WhFGD resolution is selected online as the antecedent of a reflexive dependency. We investigate the processing of constructions like (1, where two NPs might be possible antecedents for the reflexive, namely which cowgirl and Mary. Even though Mary is linearly closer to the reflexive, the only grammatically licit antecedent for the reflexive is the more distant wh-NP, which cowgirl. 1. Which cowgirl did Mary expect to have injured herself due to negligence?Four eye-tracking text-reading experiments were conducted on examples like (1, differing in whether the embedded clause was non-finite (1 and 3 or finite (2 and 4, and in whether the tail of the wh-dependency intervened between the reflexive and its closest overt antecedent (1 and 2 or the wh-dependency was associated with a position earlier in the sentence (3 and 4.The results of Experiments 1 and 2 indicate the parser accesses the result of WhFGD formation during reflexive antecedent search. The resolution of a wh-dependency alters the representation that reflexive antecedent search operates over, allowing the grammatical but linearly distant antecedent to be accessed rapidly. In the absence of a long-distance WhFGD (Exp. 3 and 4, wh-NPs were not found to impact reading times of the reflexive, indicating that the parser's ability to select distant wh-NPs as reflexive antecedents crucially involves syntactic structure.

  13. [PCR testing for Bordetella pertussis in household contacts as a diagnostic tool for atypical whooping cough in unvaccinated young infants]. (United States)

    Cosnes-Lambe, Cecile; Raymond, Josette; Vallet, Christelle; Armengaud, Jean-Baptiste; Bosdure, Emmanuelle; Catalano-Pons, Charlotte; Chalumeau, Martin; El Hajje, Marie-Joelle; Moulin, Florence; de Suremain, Nathalie; Reglier-Poupet, Hélène; Poyart, Claire; Gendrel, Dominique


    False-negative findings of polymerase chain reaction (PCR) for genuine pertussis as well as the numerous atypical forms of whooping cough make it difficult to diagnose this disease in young babies. For two years, real-time PCR was performed to test for Bordetella pertussis in 86 infants younger than 6 months hospitalized for apnea or paroxysmal and/or vomiting cough and in 205 of their household contacts, whether or not they coughed. Group 1 included 30 infants for whom PCR detected B. pertussis (25 of whom were also RSV+). PCR was also positive for at least one household contact in 25/30 families. This group included 16 babies with apnea and 12 who developed a whooping cough during follow-up. Group 2 comprised 12 infants whose PCR was negative while at least one household contact had positive results. Five of these infants had severe apnea and 6 developed a whooping cough. Group 3 included 44 infants (28 RSV +) for whom PCR was negative in the index case and in the household contacts: none developed a whooping cough during follow-up. Only 3 of the 54 positive household contacts had a paroxysmal cough or a typical whooping cough and 12 had no cough at all. Positive PCR in a household contact, symptomatic or not, is helpful for the diagnosis of atypical whooping cough in young infants.

  14. Evaluation of Occupational and Environmental Factors in the Assessment of Chronic Cough in Adults: A Systematic Review. (United States)

    Tarlo, Susan M; Altman, Kenneth W; French, Cynthia T; Diekemper, Rebecca L; Irwin, Richard S


    Several recent cough guidelines have advised consideration of occupational or environmental causes for chronic cough, but it is unclear how frequently this recommendation has been routinely applied. Therefore, we undertook a systematic review to address this aspect. Cough guidelines and protocols were reviewed to identify recommendations for assessment of occupational and environmental aspects of chronic cough. The systematic search previously used to identify intervention fidelity to the use of protocols for diagnosis and management of chronic cough in adults was used for this review after extension to June 2015. PubMed, Scopus, and the Cochrane Library were searched using the same search terms and inclusion criteria as previously. Papers that met our criteria were then reviewed to identify methods used to assess occupational and environmental aspects of chronic cough and the outcomes of these assessments. Among the 10 general chronic cough guidelines and protocols identified, only the three published since 2006 included details advising detailed occupational and environmental assessments. One additional cough statement focused entirely on occupational cough. Of the 28 cohort studies of patients with chronic cough that specifically noted that they followed guidelines or protocols, none provided details of occupational and environmental assessments. Despite published recommendations, it is not apparent that occupational and environmental causes for chronic cough are addressed in detail during assessments of patients with chronic cough. This leaves open to speculation whether lack of recognition of an occupational cause may delay important preventive measures, put additional workers at risk, and/or be the reason why a chronic cough may remain unexplained. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  15. Change in Psychological, Physiological, and Situational Factors in Adults After Treatment of Chronic Cough. (United States)

    French, Cynthia L; Crawford, Sybil L; Bova, Carol; Irwin, Richard S


    We hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL). Major tenets of the theory of unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8 weeks' duration treated in our cough clinic. At baseline and 3 and 6 months, subjects completed 3 Punum Ladders rating cough severity, the CQOL Questionnaire, the Depression, Anxiety, and Stress Scales-21, and the Duke Functional Social Support Questionnaire. Cross-sectional baseline and longitudinal regression analyses were conducted. Eighty subjects (55 women) with a mean age of 58.5 ± 11.1 years and a cough duration of 86.0 ± 123.7 months were enrolled. At baseline, worse cough severity was significantly associated with less education and worse ability to speak bothered by cough and the urge to cough. Worse CQOL was significantly associated with worse depression symptoms, urinary incontinence, and ability to speak; use of self-prescribed remedies; and younger age. Significant improvements in depression and stress symptoms occurred at 3 and 6 months. Anxiety symptoms improved, particularly in the first 3 months. Improvement in cough severity was significantly associated with less education, male sex, and improvement in ability to speak and urge to cough. Improvement in CQOL was significantly associated with improvement in urinary incontinence, urge to cough, anxiety symptoms, and use of self-prescribed remedies. Using the theory of unpleasant symptoms, we have come to appreciate that managing psychological, physiological, and situational factors in addition to focusing on identifying the cause of cough is important to maximize improvement in CQOL. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  16. Exposure of health care workers and occupants to coughed air in a hospital room with displacement air distribution: impact of ventilation rate and distance from coughing patient

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Bolashikov, Zhecho Dimitrov; Kostadinov, Kamen

    above background concentration (ppm), for the three measured distances was at 6 h-1. PCL decreased with distance. The exposure of the second patient was low when the doctor was at 0.55 or 1.1 m downstream the cough (blocking effect), but was quite high when at 2.8 m. 6 h-1, recommended in present...

  17. A stepwise protocol for the treatment of refractory gastroesophageal reflux-induced chronic cough (United States)

    Xu, Xianghuai; Lv, Hanjing; Yu, Li; Chen, Qiang; Liang, Siwei


    Background Refractory gastroesophageal reflux-induced chronic cough (GERC) is difficult to manage. The purpose of the study is to evaluate the efficacy of a novel stepwise protocol for treating this condition. Methods A total of 103 consecutive patients with suspected refractory reflux-induced chronic cough failing to a standard anti-reflux therapy were treated with a stepwise therapy. Treatment commences with high-dose omeprazole and, if necessary, is escalated to subsequent sequential treatment with ranitidine and finally baclofen. The primary end-point was overall cough resolution, and the secondary end-point was cough resolution after each treatment step. Results High-dose omeprazole eliminated or improved cough in 28.1% of patients (n=29). Further stepwise of treatment with the addition of ranitide yielded a favorable response in an additional 12.6% (n=13) of patients, and subsequent escalation to baclofen provoked response in another 36.9% (n=38) of patients. Overall, this stepwise protocol was successful in 77.6% (n=80) of patients. The diurnal cough symptom score fell from 3 [1] to 1 [0] (Z=6.316, P=0.000), and the nocturnal cough symptom score decreased from 1 [1] to 0 [1] (Z=–4.511, P=0.000), with a corresponding reduction in the Gastroesophageal Reflux Diagnostic Questionnaire score from 8.6±1.7 to 6.8±0.7 (t=3.612, P=0.000). Conversely, the cough threshold C2 to capsaicin was increased from 0.49 (0.49) µmol/L to 1.95 (2.92) µmol/L (Z=–5.892, P=0.000), and the cough threshold C5 was increased from 1.95 (2.92) µmol/L to 7.8 (5.85) µmol/L (Z=–5.171, P=0.000). Conclusions Sequential stepwise anti-reflux therapy is a useful therapeutic strategy for refractory reflux-induced chronic cough. PMID:26904227

  18. (Re)constructing Reflexivity: A Relational Constructionist Approach

    NARCIS (Netherlands)

    Hosking, D.M.; Pluut, B.


    This article distinguishes three discourses of reflexivity in relation to human inquiry. One of these arises from a post-modern, relational constructionist perspective which radically re-conceptualizes reflexivity: (a) as a local and co-constructed process oriented towards the question (b) how are

  19. 21 CFR 890.1450 - Powered reflex hammer. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Powered reflex hammer. 890.1450 Section 890.1450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... hammer. (a) Identification. A powered reflex hammer is a motorized device intended for medical purposes...

  20. The Role of Transformational Leadership in Enhancing Team Reflexivity

    NARCIS (Netherlands)

    M.C. Schippers (Michaéla); D.N. den Hartog (Deanne); P.L. Koopman (Paul); D.L. van Knippenberg (Daan)


    textabstractTeam reflexivity, or the extent to which teams reflect upon and modify their functioning, has been identified as a key factor in the effectiveness of work teams. As yet, however, little is known about the factors that play a role in enhancing team reflexivity, and it is thus important to

  1. The role of transformational leadership in enhancing team reflexivity

    NARCIS (Netherlands)

    Schippers, M.C.; den Hartog, D.N.; Koopman, P.L.; van Knippenberg, D.


    Team reflexivity, or the extent to which teams reflect upon and modify their functioning, has been identified as a key factor in the effectiveness of work teams. As yet, however, little is known about the factors that play a role in enhancing team reflexivity, and it is thus important to develop

  2. The influence of reflexive educational environment on students ...

    African Journals Online (AJOL)

    The influence of reflexive educational environment on students' reflection development in ... based on them) from which, as they integrate, a reflexive personality style is developed. ... (narrative, dialogical, cognitive and axiological) are the factors influencing the outcome of social adaptation. ... AJOL African Journals Online.

  3. Reflexivity as a control factor of personal coping behavior




    The article deals with the issue of coping behavior control. The author defines the criteria, levels and aspects of reflexivity within the framework of personal coping behavior. In conclusion the author describes the key facets of coping behavior control and how reflexivity affects them.

  4. Low Incidence Of Extensor Plantar Reflex In Newborns In An ...

    African Journals Online (AJOL)

    Healthy term newborns with Apgar score of 8 and above at one minute were recruited into the study consecutively in a maternity hospital in Ibadan, Nigeria. The plantar reflex was elicited by stroking the lateral side of the sole with firm pressure, between 24 - 48 hours after delivery. Results Of 461 newborns, the plantar reflex ...

  5. Ultimate concerns in late modernity: Archer, Bourdieu and reflexivity. (United States)

    Farrugia, David; Woodman, Dan


    Through a critique of Margaret Archer's theory of reflexivity, this paper explores the theoretical contribution of a Bourdieusian sociology of the subject for understanding social change. Archer's theory of reflexivity holds that conscious 'internal conversations' are the motor of society, central both to human subjectivity and to the 'reflexive imperative' of late modernity. This is established through critiques of Bourdieu, who is held to erase creativity and meaningful personal investments from subjectivity, and late modernity is depicted as a time when a 'situational logic of opportunity' renders embodied dispositions and the reproduction of symbolic advantages obsolete. Maintaining Archer's focus on 'ultimate concerns' in a context of social change, this paper argues that her theory of reflexivity is established through a narrow misreading and rejection of Bourdieu's work, which ultimately creates problems for her own approach. Archer's rejection of any pre-reflexive dimensions to subjectivity and social action leaves her unable to sociologically explain the genesis of 'ultimate concerns', and creates an empirically dubious narrative of the consequences of social change. Through a focus on Archer's concept of 'fractured reflexivity', the paper explores the theoretical necessity of habitus and illusio for understanding the social changes that Archer is grappling with. In late modernity, reflexivity is valorized just as the conditions for its successful operation are increasingly foreclosed, creating 'fractured reflexivity' emblematic of the complex contemporary interaction between habitus, illusio, and accelerating social change. © London School of Economics and Political Science 2015.

  6. Voluntary Control of the Near Reflex: A Case Report

    Directory of Open Access Journals (Sweden)

    Serpil Akar


    Full Text Available Spasm of the near reflex is a rare disorder that involves intermittent and variable episodes of esotropia, pseudomyopia, and pupillary myosis. It is usually functional in origin and is seen mainly in young patients. Treatment options for spasm of the near reflex have had variable success. In instances where the etiology of spasm of the near reflex was suspected to be hysteria, psychotherapy has proven beneficial. We report the case of an 11-year-old girl who had functional spasm of the near reflex. The symptoms persisted for two years. Symptomatic relief was achieved by cycloplegia and spectacle correction (added plus lenses at near. The patient also underwent psychological counseling. In our case, the functional spasm of the near reflex spontaneously resolved after 2 years. (Turk J Ophthalmol 2014; 44: 161-3

  7. Prevalence of family history in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Benn, Marianne; Kaijer, Michelle Nymann


    Reflex syncope is defined by a rapid transient loss of consciousness caused by global cerebral hypoperfusion resulting from vasodilatation and/or bradycardia attributable to inappropriate cardiovascular reflexes. A hereditary component has been suggested, but prevalence of family history may differ...... among subtypes of reflex syncope, as these have different autonomic responses and pathogeneses may be diverse. The present study aimed to assess the prevalence of a positive family history of syncope and cardiovascular characteristics in patients with cardioinhibitory and vasodepressor reflex syncope....... Patients (n=74) were classified into subtypes of reflex syncope - cardioinhibition/asystole (Vasovagal Syncope International Study subtypes II-B [VASIS II-B], n=38) or vasodepressor (VASIS III, n=36) - using the head-up tilt test. Family history was obtained by questionnaires supplemented by interview...

  8. Sympathetic reflex control of blood flow in human peripheral tissues

    DEFF Research Database (Denmark)

    Henriksen, O


    Sympathetic vasoconstrictor reflexes are essential for the maintenance of arterial blood pressure in upright position. It has been generally believed that supraspinal sympathetic vasoconstrictor reflexes elicited by changes in baroreceptor activity play an important role. Recent studies on human...... sympathetic vasoconstrictor reflexes are blocked. Blood flow has been measure by the local 133Xe-technique. The results indicate the presence of spinal as well as supraspinal sympathetic vasoconstrictor reflexes to human peripheral tissues. Especially is emphasized the presence of a local sympathetic veno...... skeletal muscle, cutaneous and subcutaneous tissues of the limbs indicate that the situation is more complex. Measurements have been carried out during acute as well as chronic sympathetic denervation. Spinal sympathetic reflex mechanisms have been evaluated in tetraplegic patients, where supraspinal...

  9. A Longitudinal Study of Association between Heavy Metals and Itchy Eyes, Coughing in Chronic Cough Patients: Related with Non-Immunoglobulin E Mediated Mechanism

    Directory of Open Access Journals (Sweden)

    Thao Thi Thu Nguyen


    Full Text Available The association between heavy metals exposure and respiratory diseases or allergic sensitization showing high serum immunoglobulin E (IgE has been suggested. However, previous findings have been inconsistent and the mechanisms responsible remain unclear. We evaluated heavy metal exposure and its association with coughing, itchy eyes in chronic cough patients with different IgE levels. Ninety outpatients in Kanazawa University Hospital were recruited between January–June 2011. Subjects whose total IgE measured by radioimmunosorbent test were asked to record their daily symptoms. We collected daily total suspended particles (TSP from which concentrations of calcium (Ca, cadmium (Cd, chromium (Cr, iron (Fe, manganese (Mn, nickel (Ni, and lead (Pb were determined then divided into high and low level groups. Generalized estimating equations were applied to compute the relationship between concentrations of these metals and symptoms. All metals at high levels were significantly associated with itchy eyes compared with low levels, with exception of Ca, the six others were significant in patients with IgE < 250 IU/mL. Cd, Fe, Mn had association with coughing (odds ratio-OR (95% confidence interval-CI: 1.13 (1.03, 1.24, 1.22 (1.05, 1.42, and 1.13 (1.01, 1.27, respectively, this relationship remained significant for Cd (OR (95% CI: 1.14 (1.03, 1.27 and Mn (OR (95% CI: 1.15 (1.00, 1.31 in patients with lower IgE. Our findings demonstrate the relationship between aerial heavy metals and itchy eyes, coughing in chronic cough patients, suggesting these symptoms may be due to a non-IgE mediated mechanism.

  10. Comparison of voice quality in patients with GERD-related dysphonia or chronic cough. (United States)

    Domeracka-Kołodziej, Anna; Grabczak, Elżbieta M; Dąbrowska, Marta; Arcimowicz, Magdalena; Lachowska, Magdalena; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz


    The aim was to compare a voice quality in patients with GERD-related dysphonia or chronic cough and to determine whether there is a relationship between the main symptom reported and voice quality. 249 consecutive patients diagnosed with GERD-related chronic cough or dysphonia were involved in this retrospective study and were divided into two main groups of men and women, and furthermore into groups of chronic cough and dysphonia. Laryngeal lesions were evaluated with videolaryngostroboscopy using Reflux Finding Score. Voice quality was assessed using GRBAS scale, sonograms, and multidimensional voice program (MDVP). All subjects were found to have vocal abnormalities both in subjective and objective voice analysis. Perceptual assessment of voice (GRBAS) did not reveal any differences between analyzed groups depending on the reported symptom. In MDVP analysis, the group of women with cough as the main symptom demonstrated significantly less abnormalities in VTI value. In men with cough as their main complaint, significantly less MDVP abnormalities were found in Jita, Jitt, RAP, PPQ, and sPPQ parameters. The comparison of voice perceptual assessment in patients with GERD-related dysphonia or chronic cough revealed no differences between analyzed groups. In objective voice analysis, the latter group presented lower degree of hoarseness in Yanagihara's scale. In objective MDVP analysis, the chronic cough group presented lower degree of abnormalities only in one of the noise related parameters in females and five frequency perturbation parameters in males. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  11. Mast cells in citric acid-induced cough of guinea pigs

    International Nuclear Information System (INIS)

    Lai, Y.-L.; Lin, T.-Y.


    It was demonstrated previously that mast cells play an important role in citric acid (CA)-induced airway constriction. To investigate the role of mast cells in CA-induced cough, three experiments were carried out in this study. In the first experiment, 59 guinea pigs were employed and we used compound 48/80 to deplete mast cells, cromolyn sodium to stabilize mast cells, MK-886 to inhibit leukotriene synthesis, pyrilamine to antagonize histamine H 1 receptor, methysergide to antagonize serotonin receptor, and indomethacin to inhibit cyclooxygenase. In the second experiment, 56 compound 48/80-pretreated animals were divided into two parts; the first one was used to test the role of exogenous leukotriene (LT) C 4 , while the second one to test the role of exogenous histamine in CA-induced cough. Each animal with one of the above pretreatments was exposed sequentially to saline (baseline) and CA (0.6 M) aerosol, each for 3 min. Then, cough was recorded for 12 min using a barometric body plethysmograph. In the third experiment, the activation of mast cells upon CA inhalation was investigated by determining arterial plasma histamine concentration in 17 animals. Exposure to CA induced a marked increase in cough number. Compound 48/80, cromolyn sodium, MK-886 and pyrilamine, but not indomethacin or methysergide, significantly attenuated CA-induced cough. Injection of LTC 4 or histamine caused a significant increase in CA-induced cough in compound 48/80-pretreated animals. In addition, CA inhalation caused significant increase in plasma histamine concentration, which was blocked by compound 48/80 pretreatment. These results suggest that mast cells play an important role in CA aerosol inhalation-induced cough via perhaps mediators LTs and histamine

  12. Identification of genetic factors associated with susceptibility to angiotensin-converting enzyme inhibitors-induced cough. (United States)

    Grilo, Antonio; Sáez-Rosas, María P; Santos-Morano, Juan; Sánchez, Elena; Moreno-Rey, Concha; Real, Luis M; Ramírez-Lorca, Reposo; Sáez, María E


    Angiotensin-converting enzyme inhibitors (ACEi) are the first selected drugs for hypertensive patients because of its protective properties against heart and kidney diseases. Persistent cough is a common adverse reaction associated with ACEi, which can bind to the treatment cessation, but its etiology remains an unresolved issue. The most accepted mechanism is that the inhibition of ACEi increases kinins levels, resulting in the activation of proinflammatory mechanisms and nitric oxide generation. However, relatively little is known about the genetic susceptibility to ACEi-induced cough in hypertensive patients. We carried out a monogenic association analysis of 39 polymorphisms and haplotypes in genes encoding key proteins related to ACEi activity with the occurrence of ACEi-induced cough. We also carried out a digenic association analysis and investigated the existence of epistatic interactions between the analyzed polymorphisms using a logistic regression procedure. Finally, we investigated the predictive value of the identified associations for ACEi-induced cough. We found that genetic polymorphisms in MME [rs2016848, P=0.002, odds ratio (OR)=1.795], BDKRB2 (rs8012552, P=0.012, OR=1.609), PTGER3 (rs11209716, P=0.002, OR=0.565), and ACE (rs4344) genes are associated with ACEi-related cough. For the latter, the effect is sex specific, having a protective effect in males (P=0.027, OR=0.560) and increasing the risk in females (P=0.031, OR=1.847). In addition, genetic interactions between peptidases involved in kinins levels (CPN1 and XPNPEP1) and proteins related to prostaglandin metabolism (PTGIS and PTGIR) strongly modify the risk of ACEi-induced cough presentation (0.102≤OR≤0.384 for protective combinations and 2.732≤OR≤7.216 for risk combinations). These results are consistent with the hypothesis that the mechanism of cough is related to the accumulation of bradykinin, substance P, and prostaglandins.

  13. Pilot study for home monitoring of cough capacity in amyotrophic lateral sclerosis: A case series. (United States)

    Paneroni, M; Trainini, D; Winck, J C; Vitacca, M


    Cough capacity derangement is associated with a high risk of pulmonary complications in amyotrophic lateral sclerosis patients when cough assistance is not routinely performed at home. The primary aim of this study was to evaluate the feasibility of a long-term home based daily self-monitoring cough capacity. Eighteen subjects were enrolled in a 9-month study at home. Changes in peak cough expiratory flow, oxygen saturation, respiratory discomfort and incidence of respiratory deterioration events were evaluated. In subjects presenting respiratory deterioration events, decline in the abovementioned respiratory variables was evaluated (#NCT00613899). During an average follow-up of 125±102 days, a total of 1175 measures were performed on 12 subjects. Mean compliance to proposed evaluations was 37±32% which worsened over time. Peak cough expiratory flow decreased by 15.08±32.43L/min monthly. Five subjects reported 6 episodes of respiratory deterioration events, after a mean period of 136±108 days. They had poor respiratory function and more years of disease. There was no difference in peak cough expiratory flow and its decline whether subjects presented respiratory deterioration events or not. In 4 subjects the respiratory discomfort score significantly worsened after respiratory deterioration events from 3.0±1.41 to 4.25±1.71. Daily self-monitoring of peak cough expiratory flow, oxygen saturation and respiratory discomfort seems difficult to obtain because of poor adherence to measures; this protocol does not seem to add anything to current practice of advising on clinical derangements. Confirmatory larger studies are necessary. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  14. Comparison of clinical characteristics of chronic cough due to non-acid and acid gastroesophageal reflux. (United States)

    Xu, Xianghuai; Yang, Zhongmin; Chen, Qiang; Yu, Li; Liang, Siwei; Lü, Hanjing; Qiu, Zhongmin


    Little is known about non-acid gastroesophageal reflux-induced chronic cough (GERC). The purpose of the study is to explore the clinical characteristics of non-acid GERC. Clinical symptoms, cough symptom score, capsaicin cough sensitivity, gastroesophageal reflux diagnostic questionnaire (GerdQ) score, findings of multichannel intraluminal impedance-pH monitoring (MII-pH) and response to pharmacological anti-reflux therapy were retrospectively reviewed in 38 patients with non-acid GERC and compared with those of 49 patients with acid GERC. Non-acid GERC had the similar cough character, cough symptom score, and capsaicin cough sensitivity to acid GERC. However, non-acid GERC had less frequent regurgitation (15.8% vs 57.1%, χ(2)  = 13.346, P = 0.000) and heartburn (7.9% vs 32.7%, χ(2)  = 7.686, P  = 0.006), and lower GerdQ score (7.4 ± 1.4 vs 10.6 ± 2.1, t = -6.700, P = 0.003) than acid GERC. Moreover, MII-pH revealed more weakly acidic reflux episodes, gas reflux episodes and a higher symptom association probability (SAP) for non-acid reflux but lower DeMeester score, acidic reflux episodes and SAP for acid reflux in non-acid GERC than in acid GERC. Non-acid GERC usually responded to the standard anti-reflux therapy but with delayed cough resolution or attenuation when compared with acid GERC. Fewer patients with non-acid GERC needed an augmented acid suppressive therapy or treatment with baclofen. There are some differences in the clinical manifestations between non-acid and acid GERC, but MII-pH is essential to diagnose non-acid GERC. © 2014 John Wiley & Sons Ltd.

  15. Prevalence of chronic cough, chronic phlegm & associated factors in Mysore, Karnataka, India. (United States)

    Mahesh, P A; Jayaraj, B S; Prabhakar, A K; Chaya, S K; Vijayasimha, R


    Chronic cough and chronic phlegm are important indicators of respiratory morbidity, accelerated lung function decline, increased hospitalization and mortality. This study was planned to estimate the prevalence of chronic cough and phlegm in the absence of dyspneoa and wheezing and to study its associated factors in a representative population of Mysore district. A cross-sectional survey was planned in a representative population of Mysore taluk. Eight villages were randomly selected based on the list of villages from census 2001. Trained field workers using the Burden of Obstructive Diseases questionnaire carried out a house-to-house survey. A total of 4333 adult subjects were enrolled in the study with 2333 males and 2000 females. The prevalence of chronic cough in the community was 2.5 per cent and that of chronic phlegm was 1.2 per cent. A significant association was observed between chronic cough and age, gender, occupation and smoking and chronic phlegm with age, gender, occupation, indoor animals and smoking. A multivariate analysis confirmed independent association of age, occupation and smoking for chronic cough and age and smoking for chronic phlegm. On sub-group analysis of males, heavy smokers had higher prevalence of chronic cough and chronic phlegm as compared to light smokers and non smokers. The prevalence of chronic cough was 2.5 per cent and chronic phlegm was 1.2 per cent in the general population in Mysore which is lower than that observed in other studies. Heavy smoking was an important preventable risk factor identified in this study and efforts towards smoking cessation are crucial to achieve good respiratory health in the community.

  16. Birkhoff normalization

    NARCIS (Netherlands)

    Broer, H.; Hoveijn, I.; Lunter, G.; Vegter, G.


    The Birkhoff normal form procedure is a widely used tool for approximating a Hamiltonian systems by a simpler one. This chapter starts out with an introduction to Hamiltonian mechanics, followed by an explanation of the Birkhoff normal form procedure. Finally we discuss several algorithms for

  17. Reflex sympathetic dystrophy syndrome: MR imaging study

    International Nuclear Information System (INIS)

    Masciocchi, C.; Fascetti, E.; Bonanni, G.; Calvisi, V.; Buoni, C.; Passariello, R.


    Reflex sympathetic dystrophy syndrome (RSDS) is characterized by pain, swelling, and limitation of motion. The etiology and pathophysiology mechanism have not yet been identified. We considered eight patients with clinical signs of RSDS, in five cases located at the knee joint and in three cases in the hip. In all cases conventional radiography and radionuclide bone scanning were performed before MR imaging. Conventional radiography was negative in three cases while scintigraphy demonstrated the lesion in all patients. MR imaging showed an area of low intensity signal on T1-weighted scans and an increased signal intensity on T2-weighted images. This area is located at the bone marrow and its regular and homogeneous. This specific finding on MR images is due to reflect edema by hyperemia of the bone marrow. The MR imaging diagnosis was confirmed on clinical and radiological follow-up. MR imaging can have a role in the differential diagnosis when other studies are nondiagnostic or nonspecific for RSDS

  18. Is there a hierarchy of survival reflexes? (United States)

    Macphail, Kieran


    A hierarchy of survival reflexes for prioritising assessment and treatment in patients with pain of insidious onset is hypothesised. The hierarchy asserts that some systems are more vital than others and that the central nervous system (CNS) prioritises systems based on their significance to survival. The hypothesis suggests that dysfunction in more important systems will cause compensation in less important systems. This paper presents studies examining these effects for each system, arguing that each section of the hierarchy may have effects on other systems within the hierarchy. This concept is untested empirically, highly speculative and substantial research is required to validate the suggested hierarchical prioritisation by the CNS. Nonetheless, the hierarchy does provide a theoretical framework to use to exclude contributing systems in patients with pain of insidious onset. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Vestibular-ocular accommodation reflex in man (United States)

    Clark, B.; Randle, R. J.; Stewart, J. D.


    Stimulation of the vestibular system by angular acceleration produces widespread sensory and motor effects. The present paper studies a motor effect which has not been reported in the literature, i.e., the influence of rotary acceleration of the body on ocular accommodation. The accommodation of 10 young men was recorded before and after a high-level deceleration to zero velocity following 30 sec of rotating. Accommodation was recorded continuously on an infrared optometer for 110 sec under two conditions: while the subjects observed a target set at the far point, and while they viewed the same target through a 0.3-mm pinhole. Stimulation by high-level rotary deceleration produced positive accommodation or a pseudomyopia under both conditions, but the positive accommodation was substantially greater and lasted much longer during fixation through the pinhole. It is hypothesized that this increase in accommodation is a result of a vestibular-ocular accommodation reflex.

  20. Reflexive regulation of CSR to promote sustainability

    DEFF Research Database (Denmark)

    Buhmann, Karin


    and the EU CSR Alliance. Focusing on human rights based in international law, it analyses the patterns of negotiation in the MSF and the background for the launch of the CSR Alliance. It shows that analysing public-private regulation of CSR from the perspective of reflexive law theory assists us......This article discusses Corporate Social Responsibility (CSR) from the perspective of governmental regulation as a measure to promote public policy interests through public-private regulation intended to influence firms’ self-regulation. Presenting a ‘government case’ for CSR, the connection between...... climate change and environmental sustainability, and social, economic and other human rights lend human rights as part of CSR a potential for meeting some environmental and climate concerns and handling adverse side-effects. The article analyses two EU initiatives: The EU Multi-Stakeholder (MSF) on CSR...

  1. Reflexive regulation of CSR to promote sustainablility

    DEFF Research Database (Denmark)

    Buhmann, Karin

    and the EU CSR Alliance. Focusing on human rights based in international law, it analyses the patterns of negotiation in the MSF and the background for the launch of the CSR Alliance. It shows that analysing public-private regulation of CSR from the perspective of reflexive law theory assists us......This article discusses Corporate Social Responsibility (CSR) from the perspective of governmental regulation as a measure to promote public policy interests through public-private regulation intended to influence firms’ self-regulation. Presenting a ‘government case’ for CSR, the connection between...... climate change and environmental sustainability, and social, economic and other human rights lend human rights as part of CSR a potential for meeting some environmental and climate concerns and handling adverse side-effects. The article analyses two EU initiatives: The EU Multi-Stakeholder (MSF) on CSR...

  2. Reflexivity and vulnerability in collaborative knowledge production

    DEFF Research Database (Denmark)

    Jakobsen, Helle Nordentoft; Olesen, Birgitte Ravn

    -reports of positive learning outcomes and fails to illuminate how power is always at play leaving certain participants exposed and potentially vulnerable (Fenwick, 2008). As such, it remains unclear how power relations unfold in moment-by-moment interactions including how the researcher’s position matters...... because their voices are subjugated and they appear to be vulnerable. The extent of this development in the peer interactions and the reproductive nature of the knowledge produced were unexpected. In other words we – the researchers – became struck in the analytical process. In the final part of the paper......, we discuss how the reproduction of power relations invokes ethical concerns and raises critical perspectives on the undeniable common good of collaborative research in which participants’ vulnerability may be overlooked in potentially reflexive moments (Nordentoft and Kappel, 2011). Still, we find...

  3. The Disappearing Audience and Reflexive Visibility

    Directory of Open Access Journals (Sweden)

    Katerina Girginova


    Full Text Available Contrary to popular opinion and some academic writing that celebrates the renewed visibility of new media audiences, this essay argues that they are increasingly going into retreat. To understand how new media audiences “disappear” from view of one another, I borrow from Brighenti’s typology of visibility and develop the idea of “reflexive visibility.” The latter describes the ability to socially orient ourselves in a digital environment through the textual and contextual cues of others—an activity that is of utmost importance not only to researchers wishing to “see” various audiences but also for audiences writ large, wishing to know themselves.

  4. Study of the Reflex-Klystron

    International Nuclear Information System (INIS)

    Valencia A, R.


    The main purpose of this paper is the theoretical study and the development of a technique for designing. A low power Reflex-Klystron, in order to construct it in the graduated section laboratories of the Instituto Politecnico Nacional. It is pretended to attain a power of 15-45 m W in frequencies of 8-10 GHz with low acceleration potentials (300-400 V) and electric current of 15-25 m A; the device will be mechanically tuned and will have a fine tuning through the potential of the reflector (150-180 V negative with respect to the resonator). The International System of Units is used in this thesis. (Author)

  5. Ward Round – Cough, painful throat and progressive hoarseness of ...

    African Journals Online (AJOL)


    Mar 30, 2010 ... appetite, no abdominal pains and normal bowel habits. There was no history of ... what are the important differential diagnoses to consider? 2. What investigations ... or elsewhere. Among the risk factors identified for laryngeal.

  6. The influence of iris color on the pupillary light reflex. (United States)

    Bergamin, O; Schoetzau, A; Sugimoto, K; Zulauf, M


    This study was carried out to investigate the effect of iris color on the pupillary light reflex (PLR) in normal healthy volunteers. Pupil perimetry was performed on 50 healthy volunteers with the Octopus 1-2-3 automated perimeter. Within the 30-deg visual field, 33 test locations were investigated four times. Stimulus parameters were Goldmann size V (1.72 degrees), intensity 1632 cd/m2, stimulus time 200 ms, background illumination 0 cd/m2, and interstimulus interval 3 s. Pupillometric parameters studied were initial pupil size, amplitude (magnitude of pupillary contraction), latency time, contraction time, pre-PLR movement, contraction velocity, and redilation velocity. Pupillometric parameters were investigated by analysis of variance by the independent variables blue and brown irides. Iris color (blue vs brown) influenced statistically significantly (P movement (0.328 mm2/s vs 0.325 mm2/s). Pupillary contraction amplitude and velocity depended on iris color, whereas pupil size and latency time were independent of iris color. Therefore, iris color might be considered when, evaluating pupillary movements in pupil perimetry.

  7. Natural products for chronic cough: Text mining the East Asian historical literature for future therapeutics. (United States)

    Shergis, Johannah Linda; Wu, Lei; May, Brian H; Zhang, Anthony Lin; Guo, Xinfeng; Lu, Chuanjian; Xue, Charlie Changli


    Chronic cough is a significant health burden. Patients experience variable benefits from over the counter and prescribed products, but there is an unmet need to provide more effective treatments. Natural products have been used to treat cough and some plant compounds such as pseudoephedrine from ephedra and codeine from opium poppy have been developed into drugs. Text mining historical literature may offer new insight for future therapeutic development. We identified natural products used in the East Asian historical literature to treat chronic cough. Evaluation of the historical literature revealed 331 natural products used to treat chronic cough. Products included plants, minerals and animal substances. These natural products were found in 75 different books published between AD 363 and 1911. Of the 331 products, the 10 most frequently and continually used products were examined, taking into consideration findings from contemporary experimental studies. The natural products identified are promising and offer new directions in therapeutic development for treating chronic cough. © The Author(s) 2015.

  8. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough

    Directory of Open Access Journals (Sweden)

    Carlos Shuler Nin


    Full Text Available OBJECTIVE: To assess the routine use of barium swallow study in patients with chronic cough.METHODS: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons.RESULTS: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6% of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6% of the patients, whereas the treatment was ineffective in 1 (8.4%. We observed no complications related to barium swallow, such as contrast aspiration.CONCLUSIONS: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.

  9. Voluntary Cough Airflow Differentiates Safe versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis (United States)

    Plowman, Emily K.; Watts, Stephanie A.; Robison, Raele; Tabor, Lauren; Dion, Charles; Gaziano, Joy; Vu, Tuan; Gooch, Clifton


    Dysphagia and aspiration are prevalent in amyotrophic lateral sclerosis (ALS) and contribute to malnutrition, aspiration pneumonia and death. Early detection of at risk individuals is critical to ensure maintenance of safe oral intake and optimal pulmonary function. We therefore aimed to determine the discriminant ability of voluntary cough airflow measures in detecting penetration/aspiration status in ALS patients. Seventy individuals with ALS (El-Escorial criteria) completed voluntary cough spirometry testing and underwent a standardized videofluoroscopic swallowing evaluation (VFSE). A rater blinded to aspiration status derived six objective measures of voluntary cough airflow and evaluated airway safety using the Penetration Aspiration Scale (PAS). A between groups ANOVA (safe vs. unsafe swallowers) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. VFSE analysis revealed 24 penetrator/aspirators (PAS ≥3) and 46 non-penetrator/aspirators (PAS ≤2). Cough volume acceleration (CVA), peak expiratory flow rise time (PEFRT), and peak expiratory flow rate (PEFR) were significantly different between airway safety groups (p 76ms had sensitivities of 91.3%, 82.6% and 73.9% respectively and specificities of 82.2%, 73.9%, and 78.3% for identifying ALS penetrator/aspirators. Voluntary cough airflow measures identified ALS patients at risk for penetration/aspiration and may be a valuable screening tool with high clinical utility. PMID:26803772

  10. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough. (United States)

    Nin, Carlos Shuler; Marchiori, Edson; Irion, Klaus Loureiro; Paludo, Artur de Oliveira; Alves, Giordano Rafael Tronco; Hochhegger, Daniela Reis; Hochhegger, Bruno


    To assess the routine use of barium swallow study in patients with chronic cough. Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.

  11. Analysing the causes of chronic cough: relation to diesel exhaust, ozone, nitrogen oxides, sulphur oxides and other environmental factors

    Directory of Open Access Journals (Sweden)

    Wagner Ulrich


    Full Text Available Abstract Air pollution remains a leading cause of many respiratory diseases including chronic cough. Although episodes of incidental, dramatic air pollution are relatively rare, current levels of exposure of pollutants in industrialized and developing countries such as total articles, diesel exhaust particles and common cigarette smoke may be responsible for the development of chronic cough both in children and adults. The present study analyses the effects of common environmental factors as potential causes of chronic cough. Different PubMed-based researches were performed that related the term cough to various environmental factors. There is some evidence that chronic inhalation of diesel can lead to the development of cough. For long-term exposure to nitrogen dioxide (NO2, children were found to exhibit increased incidences of chronic cough and decreased lung function parameters. Although a number of studies did not show that outdoor pollution directly causes the development of asthma, they have demonstrated that high levels pollutants and their interaction with sunlight produce ozone (O3 and that repeated exposure to it can lead to chronic cough. In summary, next to the well-known air pollutants which also include particulate matter and sulphur dioxide, a number of other indoor and outdoor pollutants have been demonstrated to cause chronic cough and therefore, environmental factors have to be taken into account as potential initiators of both adult and pediatric chronic cough.

  12. Dissociative identity disorder and prepulse inhibition of the acoustic startle reflex

    Directory of Open Access Journals (Sweden)

    Karl Yngvar Dale


    Full Text Available Karl Yngvar Dale1, Magne Arve Flaten1, Åke Elden1, Arne Holte21Department of Psychology, University of Tromsø, Norway; 2The Norwegian Institute of Public Health, Department of Mental Health, Oslo, Norway and University of Oslo, NorwayAbstract: A group of persons with dissociative identity disorder (DID was compared with a group of persons with other dissociative disorders, and a group of nondiagnosed controls with regard to prepulse inhibition (PPI of the acoustic startle reflex. The findings suggest maladaptive attentional processes at a controlled level, but not at a preattentive automatic level, in persons with DID. The prepulse occupied more controlled attentional resources in the DID group compared with the other two groups. Preattentive automatic processing, on the other hand, was normal in the DID group. Moreover, startle reflexes did not habituate in the DID group. In conclusion, increased PPI and delayed habituation is consistent with increased vigilance in individuals with DID. The present findings of reduced habituation of startle reflexes and increased PPI in persons with DID suggest the operation of a voluntary process that directs attention away from unpleasant or threatening stimuli. Aberrant voluntary attentional processes may thus be a defining characteristic in DID.Keywords: dissociation, DID, PPI, startle, habituation

  13. [Human physiology: images and practices of the reflex]. (United States)

    Wübben, Yvonne


    The essay examines the function of visualizations and practices in the formation of the reflex concept from Thomas Willis to Marshall Hall. It focuses on the specific form of reflex knowledge that images and practices can contain. In addition, the essay argues that it is through visual representations and experimental practices that technical knowledge is transferred to the field of human reflex physiology. When using technical metaphors in human physiology authors often seem to feel obliged to draw distinctions between humans, machines and animals. On closer scrutiny, these distinctions sometimes fail to establish firm borders between the human and the technical.

  14. Rib fractures induced by coughing: an unusual cause of acute chest pain. (United States)

    De Maeseneer, M; De Mey, J; Debaere, C; Meysman, M; Osteaux, M


    We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

  15. Cough urethrocystography: The best radiological evaluation of female stress urinary incontinence?

    International Nuclear Information System (INIS)

    Varpula, M.; Maekinen, J.; Kiilholma, P.


    Urethrocystography and simultaneous urethrocystometry were performed on 40 women with primary urinary incontinence. The posterior urethrovesical angle, inclination angle, urethropelvic angle, and an orifice descent angle, not earlier described, were measured on radiographs obtained at rest, during coughing and during straining. The orifice descent angle was used to describe the descent of the internal urethral orifice in the cough radiographs, and was the only measurement that provided a significant correlation with urethrocystometry. The other angles measured, and radiographs obtained at rest or during straining were not useful in the evaluation of female stress urinary incontinence. The authors conclude that the best imaging method for the evaluation of female stress urinary incontinence is urethrocystography employing a single lateral view taken during coughing, with measurement of the orifice descent angle. (orig.)

  16. Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens. (United States)

    Weinberger, Raphael; Riffelmann, Marion; Kennerknecht, Nicole; Hülße, Christel; Littmann, Martina; O'Brien, Judith; von Kries, Rüdiger; von König, Carl Heinz Wirsing


    Studies of the incidence of pertussis in adults have shown that it accounts for only 5-15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan-Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4-11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.

  17. The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study

    Directory of Open Access Journals (Sweden)

    Zakir Arslan

    Full Text Available Abstract Background and objectives: There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. Methods: This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Results: Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5% and lidocaine group (15% (Fischer exact test, p = 0.0007 and p = 0.0188, respectively. There was no significant change in cough incidence between pheniramine group (5% and lidocaine group (15% (Fischer exact test, p = 0.4325. Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p < 0.0001 and p = 0.009, respectively. There was no significant change in cough severity between pheniramine group and lidocaine group (p = 0.856. Conclusion: Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.

  18. ANSYS-MATLAB co-simulation of mucus flow distribution and clearance effectiveness of a new simulated cough device. (United States)

    Ren, Shuai; Shi, Yan; Cai, Maolin; Zhao, Hongmei; Zhang, Zhaozhi; Zhang, Xiaohua Douglas


    Coughing is an irritable reaction that protects the respiratory system from infection and improves mucus clearance. However, for the patients who cannot cough autonomously, an assisted cough device is essential for mucus clearance. Considering the low efficiency of current assisted cough devices, a new simulated cough device based on the pneumatic system is proposed in this paper. Given the uncertainty of airflow rates necessary to clear mucus from airways, the computational fluid dynamics Eulerian wall film model and cough efficiency (CE) were used in this study to simulate the cough process and evaluate cough effectiveness. The Ansys-Matlab co-simulation model was set up and verified through experimental studies using Newtonian fluids. Next, model simulations were performed using non-Newtonian fluids, and peak cough flow (PCF) and PCF duration time were analyzed to determine their influence on mucus clearance. CE growth rate (λ) was calculated to reflect the CE variation trend. From the numerical simulation results, we find that CE rises as PCF increases while the growth rate trends to slow as PCF increases; when PCF changes from 60 to 360 L/min, CE changes from 3.2% to 51.5% which is approximately 16 times the initial value. Meanwhile, keeping a long PCF duration time could greatly improve CE under the same cough expired volume and PCF. The results indicated that increasing the PCF and PCF duration time can improve the efficiency of mucus clearance. This paper provides a new approach and a research direction for control strategy in simulated cough devices for airway mucus clearance. Copyright © 2018 John Wiley & Sons, Ltd.

  19. Plantar flexor stretch reflex responses to whole body loading/unloading during human walking

    DEFF Research Database (Denmark)

    Grey, Michael James; van Doornik, Johannes; Sinkjær, Thomas


    Numerous animal and human studies have shown that afferent information from the periphery contributes to the control of walking. In particular, recent studies have consistently shown that load receptor input is an important element of the locomotion control mechanism. The objective of this study...... perturbation during human walking. Three body load conditions were investigated: normal body load, a 30% increase in body load, and a 30% decrease in body load. Healthy subjects walked on a treadmill at approximately 3.6 km/h with the left ankle attached to a portable stretching device. Dorsiflexion...... strongly to the corrective response of the stretch reflex in the plantar flexor muscles during walking....

  20. A Comparison of Risk Factors for Wheeze and Recurrent Cough in Preschool Children

    DEFF Research Database (Denmark)

    Hermann, Christian; Westergaard, T.; Pedersen, B. V.


    the same etiology. Data were obtained 1) by a mailed parental questionnaire (International Study of Asthma and Allergies in Childhood questions and supplementary questions on cough, sociodemography, perinatal factors, and environmental exposure); 2) through general practitioners (familial allergic disease......In a study of 2,978 Danish children aged 5 years from two suburban counties of Copenhagen, carried out in 1998, the authors compared risk factor profiles for wheeze and recurrent cough without wheeze by using polytomous logistic regression to clarify whether the two conditions are likely to have...

  1. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation

    Directory of Open Access Journals (Sweden)

    Wurl Peter


    Full Text Available Abstract Cough can be associated with many complications. In this article, we present a 59 year old male patient with a very rare combination of a cough related stress fracture of the ninth rib, a traumatic rupture of the diaphragm, and an abdominal wall herniation. The hernia was repaired through surgical treatment without bowel resection, the diaphragm and the internal and oblique abdominal muscle were adapted, and the abdomen was reinforced with a prolene net. Although each individual injury is well documented in the literature, the combination of rib fracture, abdominal herniation and diaphragm rupture has not been reported.


    Yong, Chew Chin; Islahudin, Farida; Shah, Noraida Mohamed


    This study investigated the knowledge, attitude and perception of parents on the use of cough and cold medications in children. Questionnaires were distributed to parents of children aged parents (n=248) was satisfactory with a mean score of 5.87 +/- 1.70 (from a total of 10) and the overall attitude was positive with a mean score of 41.15 +/- 6.72 (from a total of 50). Ten percent of parents admitted administering cough and cold medications in children aged parents, education level and monthly income were found to significantly influence knowledge level (pchildren from the parents' perspectives.

  3. Honey with Coffee: A new finding in the treatment of Persistent Postinfectious Cough


    Mohammad-Ali Raeessi; Jafar Aslani; Homa Gharaie; Ali-Akbar Karimi Zarchi; Neda Raeessi; Shervin Assari


    Introduction: Persistent postinfectious cough (PPC) is a cough that persists longer than 3 weeks or perhaps for many months after a common cold or an upper respiratory tract infection (URTI). PPC has poor response to routine treatment modalities, so it can be a vexing problem for the patient and the physician alike. Our hypothesis was that honey and/or coffee have some beneficial effects in the treatment of PPC. The aim of this study was to evaluate the therapeutic effects of coffee and/or ho...

  4. Delayed latency of peroneal reflex to sudden inversion with ankle taping or bracing. (United States)

    Shima, N; Maeda, A; Hirohashi, K


    The purpose of the present study was to examine the effects of ankle taping and bracing based on the peroneal reflex in the hypermobile and normal ankle joints with and without history of ankle injury. Thirty-six ankle joints of 18 collegiate American football athletes with and without previous history of injury were studied. The angle of talar tilt (TT) was measured by stress radiograph for classifying normal (TT5 degrees ) ankles. They were tested with taping, bracing, and without any supports as a control. The latency of peroneus longus muscle was measured by a sudden inversion of 25 degrees using surface EMG signals. The results of the present study show no significant three-way Group (hypermobile or normal ankles) by History (previously injured or uninjured ankles) by Condition (control, taping, or bracing) interaction, while Condition main effect was significant (p0.05). In conclusion, ankle taping and bracing delayed the peroneal reflex latency not only for hypermobile ankles and/or injured ankle joints but also for intact ankle joints.

  5. The Danish CSR Reporting Requirement as Reflexive Law

    DEFF Research Database (Denmark)

    Buhmann, Karin


    With effect for financial years beginning January 2009 or later, the Danish Financial Statements Act and related governmental regulations require large Danish companies and institutional investors to submit an annual Corporate Social Responsibility (CSR) report. Through application of reflexive law...

  6. Increased Auditory Startle Reflex in Children with Functional Abdominal Pain

    NARCIS (Netherlands)

    Bakker, Mirte J.; Boer, Frits; Benninga, Marc A.; Koelman, Johannes H. T. M.; Tijssen, Marina A. J.


    Objective To test the hypothesis that children with abdominal pain-related functional gastrointestinal disorders have a general hypersensitivity for sensory stimuli. Study design Auditory startle reflexes were assessed in 20 children classified according to Rome III classifications of abdominal

  7. Increased Auditory Startle Reflex in Children with Functional Abdominal Pain

    NARCIS (Netherlands)

    Bakker, Mirte J.; Boer, Frits; Benninga, Marc A.; Koelman, Johannes H. T. M.; Tijssen, Marina A. J.

    Objective To test the hypothesis that children with abdominal pain-related functional gastrointestinal disorders have a general hypersensitivity for sensory stimuli. Study design Auditory startle reflexes were assessed in 20 children classified according to Rome III classifications of abdominal

  8. Bone mineral density in reflex sympathetic dystrophy

    International Nuclear Information System (INIS)

    Saghaphi, M.; Azarian, A.


    Objectives: Reflex Sympathetic Dystrophy (RSD) is a complex of symptoms that produce pain burning sensation, swelling, tenderness, autonomic and physical dysfunction in joint areas, particularly distal of a limb. Osteopenia or osteoporosis is an important finding that is produced gradually in involved limb. Three phase bone can scan help to diagnosis of RSD. The disease may be bilateral but is mostly unilateral. As it is believed that bone densitometry will show osteopenia more accurate than plain comparative radiographs of the involved limbs, we investigated in patients with RSD. Methods: During last three years, 8 patients with RSD were admitted. Bone mineral density was measured for 5 patients by DEXA method. The patients were 3 males and 2 females with age range of 20 to 48 years (mean 32 years). The involved areas were ankle and foot in 4, and wrist and hand in one patient. Results: Mean Bone Mineral Content (BMC) of 4 involved lower limbs were 475 +-73 grams comparing with 516+-72 grams of uninvolved limbs (p t h patient was not significant. conclusion: comparative bone mineral density in patients with RSD of the lower limbs contributes to more accurate diagnosis than plain radiographs

  9. A tapetal-like fundus reflex in a healthy male

    DEFF Research Database (Denmark)

    Schatz, Patrik; Bregnhøj, Jesper; Arvidsson, Henrik


    To report on the retinal function and structure in a 37-year-old male who presented with a tapetal-like reflex (TLR) indistinguishable from that seen in female carriers of X-linked retinitis pigmentosa (XLRP).......To report on the retinal function and structure in a 37-year-old male who presented with a tapetal-like reflex (TLR) indistinguishable from that seen in female carriers of X-linked retinitis pigmentosa (XLRP)....

  10. The Reflexive Nature of Reading as Ethnographic Practice: Editorial Note

    Directory of Open Access Journals (Sweden)

    Wolff-Michael Roth


    Full Text Available In this editorial, I suggest that not only is reading published texts a way of doing ethno­graph­ic research, but also reading concretely realizes itself in the productions of new texts that reproduce the cultural practices that are analyzed in the published text. Reading as ethnographic method is therefore a reflexive project. I provide a dialectical framework for theorizing the reflexive nature of reading. URN: urn:nbn:de:0114-fqs0401390


    NARCIS (Netherlands)


    The relation between citric acid cough threshold and airway hyperresponsiveness was investigated in 11 non-smoking patients with allergic asthma (mean FEV1 94% predicted) and 25 non-atopic smokers with chronic airflow obstruction (mean FEV1 65% predicted). Cough threshold was determined on two

  12. The Abuse of Dextromethorphan-Based Cough Syrup: A Pilot Study of the Community of Waynesboro, Pennsylvania. (United States)

    Momodou, N. Darboe; And Others


    Discusses the emergence of a new type of abused drug, dextromethorphan, which is used in cough syrup. Presents the results of the first phase of a comprehensive investigation of this phenomenon in the Waynesboro, Pa. school district. Survey data indicate abuse of cough syrup has increased over the years and is increasingly perceived as a problem…

  13. Evaluation of Chlamydia pneumoniae and Mycoplasma pneumoniae as etiologic agents of persistent cough in adolescents and adults. (United States)

    Wadowsky, Robert M; Castilla, Elias A; Laus, Stella; Kozy, Anita; Atchison, Robert W; Kingsley, Lawrence A; Ward, Joel I; Greenberg, David P


    Chlamydia pneumoniae and Mycoplasma pneumoniae were evaluated as agents of persistent cough in adolescents and adults (n = 491). Tests of 473 respiratory specimens by culture or PCR or both identified four episodes (0.8%) of M. pneumoniae-associated illness and no episodes of C. pneumoniae illness, suggesting that these bacteria do not frequently cause persistent cough.

  14. Anticausatives are weak scalar expressions, not reflexive expressions

    Directory of Open Access Journals (Sweden)

    Florian Schäfer


    Full Text Available We discuss conceptual and empirical arguments from Germanic, Romance and Slavic languages against an analysis treating anticausative verbs as derived from their lexical causative counterparts under reflexivization. Instead, we defend the standard account to the semantics of the causative alternation according to which anticausatives in general, and anticausatives marked with reflexive morphology in particular, denote simple one-place inchoative events that are logically entailed by their lexical causative counterparts. Under such an account, anticausative verbs are weak scalar expressions that stand in a semantico-pragmatic opposition to their strong lexical causative counterparts. Due to this scalar relation, the use of an anticausative can trigger the implicature that the use of its lexical causative counterpart is too strong. As usual with implicatures, they can be ‘metalinguistically’ denied, cancelled, or reinforced and we argue that these mechanisms explain all central empirical facts brought up in the literature in favor of a treatment of anticausatives as semantically reflexive predicates. Our results reinforce the view that the reflexive morphemes used in many (Indo-European languages to mark anticausatives do not necessarily trigger reflexive semantics. However, we also show that a string involving a reflexively marked (anti-causative verb can be forced into a semantically reflexive construal under particular conceptual or grammatical circumstances.

  15. Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal. (United States)

    Sharma, Shilpee Bhatia; Janakiram, Trichy Narayanan; Baxi, Hina; Chinnasamy, Balamurugan


    Juvenile nasopharyngeal angiofibroma is a locally aggressive benign tumour which has propensity to erode the skull base. The tumour spreads along the pathways of least resistance and is in close proximity to the extracranial part of trigeminal nerve. Advancements in expanded approaches for endoscopic excision of tumours in infratemporal fossa and pterygopalatine fossa increase the vulnerability for the trigeminocardiac reflex. The manipulation of nerve and its branches during tumour dissection can lead to sensory stimulation and thus inciting the reflex. The aim of our study is to report the occurrence of trigeminocardiac reflex in endoscopic excision of juvenile nasopharyngeal angiofibroma. To describe the occurence of trigeminocardiac reflex during endoscopic endonasal excision of juvenile nasopharyngeal angiofibroma. We studied the occurrence of TCR in 15 patients (out of 242 primary cases and 52 revision cases) operated for endoscopic endonasal excision of JNA. The drop in mean arterial blood pressure and heart rate were observed and measured. To the best of our knowledge of English literature, this is the first case series reporting TCR as complication in endoscopic excision of JNA. occurence of this reflex has been mentioned in various occular, maxillofacial surgeries but its occurence during endoscopic excision of JNA has never been reported before. Manifestation of trigeminocardiac reflex during surgery can alter the course of the surgery and is a potential threat to life. It is essential for the anesthetist and surgeons to be familiar with the presentations, preventive measures and management protocols.

  16. Avian reflex and electroencephalogram responses in different states of consciousness. (United States)

    Sandercock, Dale A; Auckburally, Adam; Flaherty, Derek; Sandilands, Victoria; McKeegan, Dorothy E F


    Defining states of clinical consciousness in animals is important in veterinary anaesthesia and in studies of euthanasia and welfare assessment at slaughter. The aim of this study was to validate readily observable reflex responses in relation to different conscious states, as confirmed by EEG analysis, in two species of birds under laboratory conditions (35-week-old layer hens (n=12) and 11-week-old turkeys (n=10)). We evaluated clinical reflexes and characterised electroencephalograph (EEG) activity (as a measure of brain function) using spectral analyses in four different clinical states of consciousness: conscious (fully awake), semi-conscious (sedated), unconscious-optimal (general anaesthesia), unconscious-sub optimal (deep hypnotic state), as well as assessment immediately following euthanasia. Jaw or neck muscle tone was the most reliable reflex measure distinguishing between conscious and unconscious states. Pupillary reflex was consistently observed until respiratory arrest. Nictitating membrane reflex persisted for a short time (power (PTOT) significantly increased, whereas median (F50) and spectral edge (F95) frequencies significantly decreased. This study demonstrates that EEG analysis can differentiate between clinical states (and loss of brain function at death) in birds and provides a unique integration of reflex responses and EEG activity. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Student Mobility and Transnational Social Ties as Factors of Reflexivity

    Directory of Open Access Journals (Sweden)

    Tea Golob


    Full Text Available The article seeks to develop and apply new quantitative measurement instruments capable of significantly improving understanding of the relationship between the transnational mobility and transnational social ties of students, along with their reflexive capacities. With a focus on students building their personal networks, educational and professional activities that extend beyond the nation’s borders and organising their day-to-day routines in transnational social spaces, we analyse the role of mobility in their reflexive capacities. Applying a tool that is line with Archer’s theory and indicators to measure reflexivity, and transnational social ties as proposed by Molina et al., we analyse data collected via an on-line survey questionnaire administered to Slovenian students. In addition, students from the Middle East (Lebanon and the USA (Hawai’i are added for comparative purposes. The results of path analysis show the Slovenian students’ mobility as such implies higher scores for meta reflexivity, combined with lower scores for communicative and fractured reflexivity. Further, social transactions reaching beyond one’s physical localities in terms of transnational social ties implies they have higher levels of reflexivity in general.

  18. Malware Normalization


    Christodorescu, Mihai; Kinder, Johannes; Jha, Somesh; Katzenbeisser, Stefan; Veith, Helmut


    Malware is code designed for a malicious purpose, such as obtaining root privilege on a host. A malware detector identifies malware and thus prevents it from adversely affecting a host. In order to evade detection by malware detectors, malware writers use various obfuscation techniques to transform their malware. There is strong evidence that commercial malware detectors are susceptible to these evasion tactics. In this paper, we describe the design and implementation of a malware normalizer ...

  19. Acoustic reflex measurements and the loudness function in sensorineural hearing loss

    Directory of Open Access Journals (Sweden)

    Sheila Uliel


    Full Text Available The suprathreshold acoustic reflex responses of forty two ears affected by sensorineural hearing loss of cochlear origin and fifty-eight ears demonstrating normal hearing, were recorded by means of an electro-acoustic impedance meter and attached X-Y recorder. The recordings were done in ascending and descending fashion,  at successively increasing and decreasing 5dB intensity levels from 90-120-90 dB HL respectively, for the individual pure-tone frequencies of 500, 1 000, 2 000 and 4 000 Hz. The contralateral mode of measurement was employed. Analysis of  these recordings indicated that the acoustic reflex  responses could be differentiated into five  characteristic patterns of  growth, which could be depicted upon a continuum of peaked, peaked-rounded, rounded, rounded-flat,  and flat  shapes. The peaked and peaked-rounded patterns were found  to predominate at all four pure-tone frequencies  in the normal ears, while the rounded-fiat  and flat  patterns were found  to predominate only at the higher pure-tone frequencies of 2 000 and 4 000 Hz in the ears affected  by sensorineural hearing loss. This latter relationship was also able to be applied to two disorders of  the loudness functio— loudness recruitment and hyperacusis. It was concluded that the flattened  acoustic reflex  patterns at the higher pure-tone frequencies  constituted a potential diagnostic cue related to the differential  diagnosis of sensorineural hearing loss, and to disorders of  the loudness function.

  20. The central corneal light reflex ratio from photographs derived from a digital camera in young adults. (United States)

    Duangsang, Suampa; Tengtrisorn, Supaporn


    To determine the normal range of Central Corneal Light Reflex Ratio (CCLRR) from photographs of young adults. A digital camera equipped with a telephoto lens with a flash attachment placed directly above the lens was used to obtain corneal light reflex photographs of 104 subjects, first with the subject fixating on the lens of the camera at a distance of 43 centimeters, and then while looking past the camera to a wall at a distance of 5.4 meters. Digital images were displayed using Adobe Photoshop at a magnification of l200%. The CCLRR was the ratio of the sum of distances between the inner margin of cornea and the central corneal light reflex of each eye to the sum of horizontal corneal diameter of each eye. Measurements were made by three technicians on all subjects, and repeated on a 16% (n=17) subsample. Mean ratios (standard deviation-SD) from near/distance measurements were 0.468 (0.012)/0.452 (0.019). Limits of the normal range, with 95% certainty, were 0.448 and 0.488 for near measurements and 0.419 and 0.484 for distance measurements. Lower and upper indeterminate zones were 0.440-0.447 and 0.489-0.497 for near measurements and 0.406-0.418 and 0.485-0.497 for distance measurements. More extreme values can be considered as abnormal. The reproducibility and repeatability of the test was good. This method is easy to perform and has potential for use in strabismus screening by paramedical personnel.

  1. Increasing Efficiency in Evaluation of Chronic Cough: A Multidisciplinary, Collaborative Approach. (United States)

    Patton, Cynthia M; Lim, Kaiser G; Ramlow, Luke W; White, Kathleen M


    Chronic cough is the most common reason for medical office visits in the United States. The typical patient has coughed more than 8 years and seen many specialists. This quality improvement project is an ambulatory clinic redesign to deliver efficient, patient-centered care with interspecialty collaboration. Methodology included the Institute for Healthcare Improvement collaborative model focused on Lean/Six Sigma and ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) Change Management. Interventions targeted education to referring providers, implementation of software changes, building a collaborative interdepartmental scheduling decision tree, and an interclinic dashboard enhancing communication and decision support. Outcome measures compare group resource utilization, evidenced by the total number of specialist referrals for same indication of chronic cough (International Classification of Diseases, Ninth Revision: 786.2), and length of time to complete evaluation. A retrospective review of 165 medical records yielded 2 groups, "current care" (n = 67) and "intervention" (n = 68). The number of specialist referrals per patient was reduced in the intervention group (M = 1.22, SD = 0.48) compared with the current care group (M = 3.33, SD = 1.02). Length of itinerary was reduced in the intervention group (M = 11.90, SD = 12.13, GM = 6.82) compared with the current care group (M = 126.93, SD = 158.13, GM = 54.8). Multidisciplinary collaboration, communication, coordinating diagnosis, and management of multifactorial conditions, such as chronic cough, are associated with lower costs and decreased utilization of health care resources.

  2. Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period. (United States)

    Pimentel, Analíria Moraes; Baptista, Paulo Neves; Ximenes, Ricardo Arraes de Alencar; Rodrigues, Laura Cunha; Magalhães, Vera; Silva, Andrea Rosane Sousa; Souza, Nadjla Ferreira; Matos, Deize Gomes Cavalcanti de; Pessoa, Ana Kelly Lins


    This study was aimed to evaluate the prevalence of pertussis in adolescents and adults with cough lasting more than 14 days and less than 30 days. This is a prospective observational study in interepidemic period of pertusis. Ten public health outpatient clinics in the city of Recife, Brazil, were randomly selected for the study. The study population consisted of individuals aged 10 years and over with cough that had lasted between 14 and 30 days. Nasopharyngeal swabs were collected for culture and PCR in order to identify Bordetella pertussis. We adopted the Centers for Disease Control and Prevention in the US (CDC) definition of cases of pertussis. A total of 192 individuals were identified as suspected cases. Their mean age was 40.7 years. Pertussis was confirmed in 10 of the 192 suspected cases, with an estimated prevalence of 5.21% (95% confidence interval 2.03-8.38). All cases met the clinical case definition for pertussis; one suspect had both culture and PCR positive. PCR confirmed 100% of the cases, 7/10 by PCR and 3/10 by epidemiological linkage with a case confirmed by PCR. During an interepidemic period, 1 in 20 cases of prolonged cough had pertussis, suggesting this is an important cause of prolonged cough in adolescents and adults. Copyright © 2014. Published by Elsevier Editora Ltda.

  3. Bordetella Pertussis virulence factors in the continuing evolution of whooping cough vaccines for improved performance.

    NARCIS (Netherlands)

    Dorji, Dorji; Mooi, Frits; Yantorno, Osvaldo; Deora, Rajendar; Graham, Ross M; Mukkur, Trilochan K

    Despite high vaccine coverage, whooping cough caused by Bordetella pertussis remains one of the most common vaccine-preventable diseases worldwide. Introduction of whole-cell pertussis (wP) vaccines in the 1940s and acellular pertussis (aP) vaccines in 1990s reduced the mortality due to pertussis.

  4. A method of reflexive balancing in a pragmatic, interdisciplinary and reflexive bioethics. (United States)

    Ives, Jonathan


    In recent years there has been a wealth of literature arguing the need for empirical and interdisciplinary approaches to bioethics, based on the premise that an empirically informed ethical analysis is more grounded, contextually sensitive and therefore more relevant to clinical practice than an 'abstract' philosophical analysis. Bioethics has (arguably) always been an interdisciplinary field, and the rise of 'empirical' (bio)ethics need not be seen as an attempt to give a new name to the longstanding practice of interdisciplinary collaboration, but can perhaps best be understood as a substantive attempt to engage with the nature of that interdisciplinarity and to articulate the relationship between the many different disciplines (some of them empirical) that contribute to the field. It can also be described as an endeavour to explain how different disciplinary approaches can be integrated to effectively answer normative questions in bioethics, and fundamental to that endeavour is the need to think about how a robust methodology can be articulated that successfully marries apparently divergent epistemological and metaethical perspectives with method. This paper proposes 'Reflexive Bioethics' (RB) as a methodology for interdisciplinary and empirical bioethics, which utilizes a method of 'Reflexive Balancing' (RBL). RBL has been developed in response to criticisms of various forms of reflective equilibrium, and is built upon a pragmatic characterization of Bioethics and a 'quasi-moral foundationalism', which allows RBL to avoid some of the difficulties associated with RE and yet retain the flexible egalitarianism that makes it intuitively appealing to many. © 2013 John Wiley & Sons Ltd.

  5. Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation

    Directory of Open Access Journals (Sweden)

    Masters IB


    Full Text Available Abstract Background Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. Methods/Design We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250 fulfilling inclusion criteria (new patients with chronic cough are randomised (allocation concealed to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks or usual care (existing care until review by specialist at 6 weeks. Cough diary, cough-specific quality of life (QOL and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses. A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. Discussion The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years. This study will provide additional evidence on the optimal management of chronic cough in children. Trial registration ACTRN12607000526471

  6. The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study. (United States)

    Arslan, Zakir; Çalık, Eyup Serhat; Kaplan, Bekir; Ahiskalioglu, Elif Oral


    There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.0007 and p=0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (ppheniramine group and lidocaine group (p=0.856). Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. [The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study]. (United States)

    Arslan, Zakir; Çalık, Eyup Serhat; Kaplan, Bekir; Ahiskalioglu, Elif Oral


    There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.0007 and p=0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (ppheniramine group and lidocaine group (p=0.856). Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Regional cerebral perfusion in cardiovascular reflex syncope

    International Nuclear Information System (INIS)

    Toeyry, J.P.; Kuikka, J.T.; Laensimies, E.A.


    Little is known about the regional cerebral perfusion in subjects with presyncope or syncope, and the impact that autonomic nervous dysfunction has on it. Seven subjects with cardiovascular vasodepressor reflex syncope were studied. A baseline test was performed with the patients standing in the 70 upright position, while the passive head-up tilt table test with and without isoprenaline infusion was employed for provocation. Regional cerebral perfusion was assessed by means of single-photon emission tomography with technetium-99m labelled V-oxo-1,2-N,N 1 -ethylenedylbis-l-cysteine diethylester (baseline, and during blood pressure decline in the provocation test) and the autonomic nervous function by means of spectral analysis of heart rate variability (baseline, and before blood pressure decline in the provocation test). Every subject showed an abrupt decline in blood pressure in the provocation test (five with presyncope and two with syncope). The systolic and diastolic blood pressures decreased significantly (P<0.001) between the baseline and the provocation study time points (radiopharmaceutical injection and lowest systolic blood pressure). Mean cerebral perfusion as average count densities decreased upon provocation as compared with baseline (190±63 vs 307±90 counts/voxel, respectively, P=0.013). Hypoperfusion was most pronounced in the frontal lobe. These results suggest that cerebral perfusion decreases markedly during presyncope or syncope with systemic blood pressure decline in subjects with cardiovascular vasodepressor syncope. Furthermore, the autonomic nervous function remains unchanged before the systemic blood pressure decline. (orig.). With 3 figs., 2 tabs

  9. Simplification and Validation of Leicester Cough Questionnaire in Mandarin-Chinese

    Directory of Open Access Journals (Sweden)

    Rongjia LIN


    Full Text Available Background and objective Patients often have cough after lung surgery, and there is a lack of tools to specifically assess postoperative coughs. LCQ-MC (Leicester Cough Questionnaire in Mandarin-Chinese was revised and validated to explore its value on clinical application. Methods A total of 250 patients undergone the lung operation of single medical team, from September 2015 to December 2016 in the Department ofThoracic Surgery, West China Hospital, Sichuan University, were investigated. Among them, 121 patients completed LCQ-MC and 129 patients completed simplified LCQ-MC, we verified the reliability and validity. Results The new questionnaire was not changed in terms of content layout and the scoring method of LCQ-MC, consisting of 12 items and three domains (physical, psychological and social. There was good content validity (S-CVI/UA=0.83. Concurrent validity was high when the simplified LCQ-MC was compared with daytime cough symptom score (r=-0.578, P<0.001. There was a moderate relationship with response to night-time cough symptom score (r=-0.358, P=-0.004 and SF36 total score (r=0.346, P=0.030, and weak relationship with the Hospital Anxiety and Depression Scale total score (r=-0.241, P=0.046. Cronbach’s alpha coefficients of simplified LCQ-CM total and three domains varied between 0.79 and 0.89. One week apart test-retest reliability (n=30 was high (r=0.88-0.96. Conclusion Simplified LCQ-MC has good reliability and validity that can be used for clinical applications.

  10. ESO Reflex: a graphical workflow engine for data reduction (United States)

    Hook, Richard; Ullgrén, Marko; Romaniello, Martino; Maisala, Sami; Oittinen, Tero; Solin, Otto; Savolainen, Ville; Järveläinen, Pekka; Tyynelä, Jani; Péron, Michèle; Ballester, Pascal; Gabasch, Armin; Izzo, Carlo

    ESO Reflex is a prototype software tool that provides a novel approach to astronomical data reduction by integrating a modern graphical workflow system (Taverna) with existing legacy data reduction algorithms. Most of the raw data produced by instruments at the ESO Very Large Telescope (VLT) in Chile are reduced using recipes. These are compiled C applications following an ESO standard and utilising routines provided by the Common Pipeline Library (CPL). Currently these are run in batch mode as part of the data flow system to generate the input to the ESO/VLT quality control process and are also exported for use offline. ESO Reflex can invoke CPL-based recipes in a flexible way through a general purpose graphical interface. ESO Reflex is based on the Taverna system that was originally developed within the UK life-sciences community. Workflows have been created so far for three VLT/VLTI instruments, and the GUI allows the user to make changes to these or create workflows of their own. Python scripts or IDL procedures can be easily brought into workflows and a variety of visualisation and display options, including custom product inspection and validation steps, are available. Taverna is intended for use with web services and experiments using ESO Reflex to access Virtual Observatory web services have been successfully performed. ESO Reflex is the main product developed by Sampo, a project led by ESO and conducted by a software development team from Finland as an in-kind contribution to joining ESO. The goal was to look into the needs of the ESO community in the area of data reduction environments and to create pilot software products that illustrate critical steps along the road to a new system. Sampo concluded early in 2008. This contribution will describe ESO Reflex and show several examples of its use both locally and using Virtual Observatory remote web services. ESO Reflex is expected to be released to the community in early 2009.

  11. Trigeminal cardiac reflex and cerebral blood flow regulation

    Directory of Open Access Journals (Sweden)

    Dominga Lapi


    Full Text Available The stimulation of some facial regions is known to trigger the trigemino-cardiac reflex: the main stimulus is represented by the contact of the face with water. This phenomenon called diving reflex induces a set of reactions in the cardiovascular and respiratory systems occurring in all mammals, especially marine (whales, seals. During the immersion of the face in the water, the main responses are aimed at reducing the oxygen consumption of the organism. Accordingly reduction in heart rate, peripheral vasoconstriction, blood pooling in certain organs, especially the heart and brain, and an increase in blood pressure have been reported. Moreover, the speed and intensity of the reflex is inversely proportional to the temperature of the water: more cold the water, more reactions as described are strong. In the case of deep diving an additional effect, such as blood deviation, has been reported: the blood is requested within the lungs, to compensate for the increase in the external pressure, preventing them from collapsing.The trigeminal-cardiac reflex is not just confined to the diving reflex; recently it has been shown that a brief proprioceptive stimulation (10 min by jaw extension in rats produces interesting effects both at systemic and cerebral level, reducing the arterial blood pressure and vasodilating the pial arterioles. The arteriolar dilation is associated with rhythmic diameter changes characterized by an increase in the endothelial activity. Fascinating the stimulation of trigeminal nerve is able to activated the nitric oxide release by vascular endothelial. Therefore the aim of this review was to highlight the effects due to trigeminal cardiac reflex induced by a simple mandibular extension, because produced opposite effects compared to those elicited by the diving reflex as it induces hypotension and modulation of cerebral arteriolar tone.

  12. Changes in Peak Airflow Measurement During Maximal Cough After Vocal Fold Augmentation in Patients With Glottic Insufficiency. (United States)

    Dion, Gregory R; Achlatis, Efstratios; Teng, Stephanie; Fang, Yixin; Persky, Michael; Branski, Ryan C; Amin, Milan R


    Compromised cough effectiveness is correlated with dysphagia and aspiration. Glottic insufficiency likely yields decreased cough strength and effectiveness. Although vocal fold augmentation favorably affects voice and likely improves cough strength, few data exist to support this hypothesis. To assess whether vocal fold augmentation improves peak airflow measurements during maximal-effort cough following augmentation. This case series study was conducted in a tertiary, academic laryngology clinic. Participants included 14 consecutive individuals with glottic insufficiency due to vocal fold paralysis, which was diagnosed via videostrobolaryngoscopy as a component of routine clinical examination. All participants who chose to proceed with augmentation were considered for the study whether office-based or operative augmentation was planned. Postaugmentation data were collected only at the first follow-up visit, which was targeted for 14 days after augmentation but varied on the basis of participant availability. Data were collected from June 5, 2014, to October 1, 2015. Data analysis took place between October 2, 2015, and March 3, 2017. Peak airflow during maximal volitional cough was quantified before and after vocal fold augmentation. Participants performed maximal coughs, and peak expiratory flow during the maximal cough was captured according to American Thoracic Society guidelines. Among the 14 participants (7 men and 7 women), the mean (SD) age was 62 (18) years. Three types of injectable material were used for vocal fold augmentation: carboxymethylcellulose in 5 patients, hyaluronic acid in 5, and calcium hydroxylapatite in 4. Following augmentation, cough strength increased in 11 participants and decreased cough strength was observed in 3. Peak airflow measurements during maximal cough varied from a decrease of 40 L/min to an increase of 150 L/min following augmentation. When preaugmentation and postaugmentation peak airflow measurements were compared, the

  13. Normal accidents

    International Nuclear Information System (INIS)

    Perrow, C.


    The author has chosen numerous concrete examples to illustrate the hazardousness inherent in high-risk technologies. Starting with the TMI reactor accident in 1979, he shows that it is not only the nuclear energy sector that bears the risk of 'normal accidents', but also quite a number of other technologies and industrial sectors, or research fields. The author refers to the petrochemical industry, shipping, air traffic, large dams, mining activities, and genetic engineering, showing that due to the complexity of the systems and their manifold, rapidly interacting processes, accidents happen that cannot be thoroughly calculated, and hence are unavoidable. (orig./HP) [de

  14. Linear time delay methods and stability analyses of the human spine. Effects of neuromuscular reflex response. (United States)

    Franklin, Timothy C; Granata, Kevin P; Madigan, Michael L; Hendricks, Scott L


    Linear stability methods were applied to a biomechanical model of the human musculoskeletal spine to investigate effects of reflex gain and reflex delay on stability. Equations of motion represented a dynamic 18 degrees-of-freedom rigid-body model with time-delayed reflexes. Optimal muscle activation levels were identified by minimizing metabolic power with the constraints of equilibrium and stability with zero reflex time delay. Muscle activation levels and associated muscle forces were used to find the delay margin, i.e., the maximum reflex delay for which the system was stable. Results demonstrated that stiffness due to antagonistic co-contraction necessary for stability declined with increased proportional reflex gain. Reflex delay limited the maximum acceptable proportional reflex gain, i.e., long reflex delay required smaller maximum reflex gain to avoid instability. As differential reflex gain increased, there was a small increase in acceptable reflex delay. However, differential reflex gain with values near intrinsic damping caused the delay margin to approach zero. Forward-dynamic simulations of the fully nonlinear time-delayed system verified the linear results. The linear methods accurately found the delay margin below which the nonlinear system was asymptotically stable. These methods may aid future investigations in the role of reflexes in musculoskeletal stability.

  15. Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review. (United States)

    Miceli Sopo, S; Greco, M; Monaco, S; Varrasi, G; Di Lorenzo, G; Simeone, G


    Honey is recommended for non-specific acute paediatric cough by the Australian guidelines. Current available randomised clinical trials evaluated the effects of a single evening dose of honey, but multiple doses outcomes have never been studied. To evaluate the effects of wildflower honey, given for three subsequent evenings, on non-specific acute paediatric cough, compared to dextromethorphan (DM) and levodropropizine (LDP), which are the most prescribed over-the-counter (OTC) antitussives in Italy. 134 children suffering from non-specific acute cough were randomised to receive for three subsequent evenings a mixture of milk (90ml) and wildflower honey (10ml) or a dose of DM or LDP adjusted for the specific age. The effectiveness was evaluated by a cough questionnaire answered by parents. Primary end-point efficacy was therapeutic success. The latter was defined as a decrease in cough questionnaire score greater than 50% after treatment compared with baseline values. Three children were excluded from the study, as their parents did not complete the questionnaire. Therapeutic success was achieved by 80% in the honey and milk group and 87% in OTC medication group (p=0.25). Milk and honey mixture seems to be at least as effective as DM or LDP in non-specific acute cough in children. These results are in line with previous studies, which reported the health effects of honey on paediatric cough, even if placebo effect cannot be totally excluded. Copyright © 2014 SEICAP. Published by Elsevier Espana. All rights reserved.

  16. Nociceptive flexion reflexes during analgesic neurostimulation in man. (United States)

    García-Larrea, L; Sindou, M; Mauguière, F


    Nociceptive flexion reflexes of the lower limbs (RIII responses) have been studied in 21 patients undergoing either epidural (DCS, n = 16) or transcutaneous (TENS, n = 5) analgesic neurostimulation (AN) for chronic intractable pain. Flexion reflex RIII was depressed or suppressed by AN in 11 patients (52.4%), while no modification was observed in 9 cases and a paradoxical increase during AN was evidenced in 1 case. In all but 2 patients, RIII changes were rapidly reversible after AN interruption. RIII depression was significantly associated with subjective pain relief, as assessed by conventional self-rating; moreover, in 2 patients it was possible to ameliorate the pain-suppressing effects of AN by selecting those stimulation parameters (intensity and frequency) that maximally depressed nociceptive reflex RIII. We recorded 2 cases of RIII attenuation after contralateral neurostimulation. AN appeared to affect nociceptive reflexes rather selectively, with no or very little effect on other cutaneous, non-nociceptive responses. Recording of RIII reflexes is relatively simple to implement as a routine paraclinical procedure. It facilitates the objective assessment of AN efficacy and may help to choose the most appropriate parameters of neurostimulation. In addition, RIII behavior in patients could be relevant to the understanding of some of the mechanisms involved in AN-induced pain relief.

  17. Reconstructing Normality

    DEFF Research Database (Denmark)

    Gildberg, Frederik Alkier; Bradley, Stephen K.; Fristed, Peter Billeskov


    Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study...... was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal....... The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staff's endeavours to change, halt, or support the patient's behaviour or perception in relation to staff's perception of normality. The intention is to support and teach the patient...

  18. Pursuing Normality

    DEFF Research Database (Denmark)

    Madsen, Louise Sofia; Handberg, Charlotte


    implying an influence on whether to participate in cancer survivorship care programs. Because of "pursuing normality," 8 of 9 participants opted out of cancer survivorship care programming due to prospects of "being cured" and perceptions of cancer survivorship care as "a continuation of the disease......BACKGROUND: The present study explored the reflections on cancer survivorship care of lymphoma survivors in active treatment. Lymphoma survivors have survivorship care needs, yet their participation in cancer survivorship care programs is still reported as low. OBJECTIVE: The aim of this study...... was to understand the reflections on cancer survivorship care of lymphoma survivors to aid the future planning of cancer survivorship care and overcome barriers to participation. METHODS: Data were generated in a hematological ward during 4 months of ethnographic fieldwork, including participant observation and 46...

  19. Faroese long-distance reflexives face off against Icelandic long-distance reflexives

    Directory of Open Access Journals (Sweden)

    Tania E. Strahan


    Full Text Available Long-distance reflexives (LDRs in Faroese are often compared to those in Icelandic, and are even considered to have the same distribution (Thráinsson et al., 2004. In this paper I evaluate the extent to which this is true. The results from recent fieldwork show that there are clear differences between the LDR in the two closely related languages, in particular that Faroese speakers often reject LDR sentences that contain a non-third person, and that Faroese LDR is often completely acceptable out of a non-complement clause. In addition, initial findings suggest that there may be dialectal variation with respect to at least these two aspects of LDR in Faroese.

  20. Dry night cough as a marker of allergy in preschool children: the PARIS birth cohort. (United States)

    Rancière, Fanny; Nikasinovic, Lydia; Momas, Isabelle


    Early detection of children at risk for developing allergy is an important challenge. Our first analyses in infants from the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort suggested that dry night cough was associated with parental-reported allergic disorders. The aim of the present study was to refine this finding by investigating the time course of dry night cough from birth to age 4 yr in relation to blood markers of atopy and allergic morbidity. Health outcomes were regularly assessed by parental self-administered questionnaires. Blood markers of atopy were measured at age 18 months. Children with similar patterns of dry night cough over the first 4 yr of life were grouped together using k-means clustering. Associations with atopy/allergy were studied using multinomial logistic regression. Three trajectories of dry night cough were identified in 1869 children. Besides the never/infrequent pattern (72.4%), the transient pattern (8.8%) was composed of children who coughed in the first year and recovered by age 4 yr, while the rising pattern (18.8%) included all symptomatic children at age 4 yr, whether they were persistent or late coughers. Compared with the never/infrequent pattern, the rising pattern was significantly associated with elevated total immunoglobulin E (IgE) level (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.39) and inhalant allergens sensitization (OR = 2.66, 95% CI = 1.26-5.61) at age 18 months, and with doctor-diagnosed allergic diseases over the first 4 yr such as hay fever (OR = 2.52, 95% CI = 1.49-4.26) and eczema (OR = 1.29, 95% CI = 1.00-1.66). This study provides evidence that persistent/late dry night cough may indicate allergy in preschool children. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  1. Simultaneous characterizations of reflex and nonreflex dynamic and static changes in spastic hemiparesis (United States)

    Chung, Sun G.; Ren, Yupeng; Liu, Lin; Roth, Elliot J.; Rymer, W. Zev


    This study characterizes tonic and phasic stretch reflex and stiffness and viscosity changes associated with spastic hemiparesis. Perturbations were applied to the ankle of 27 hemiparetic and 36 healthy subjects under relaxed or active contracting conditions. A nonlinear delay differential equation model characterized phasic and tonic stretch reflex gains, elastic stiffness, and viscous damping. Tendon reflex was characterized with reflex gain and threshold. Reflexively, tonic reflex gain was increased in spastic ankles at rest (P hemiparesis may help to evaluate and treat them more effectively. PMID:23636726

  2. Single Canonical Model of Reflexive Memory and Spatial Attention (United States)

    Patel, Saumil S.; Red, Stuart; Lin, Eric; Sereno, Anne B.


    Many neurons in the dorsal and ventral visual stream have the property that after a brief visual stimulus presentation in their receptive field, the spiking activity in these neurons persists above their baseline levels for several seconds. This maintained activity is not always correlated with the monkey’s task and its origin is unknown. We have previously proposed a simple neural network model, based on shape selective neurons in monkey lateral intraparietal cortex, which predicts the valence and time course of reflexive (bottom-up) spatial attention. In the same simple model, we demonstrate here that passive maintained activity or short-term memory of specific visual events can result without need for an external or top-down modulatory signal. Mutual inhibition and neuronal adaptation play distinct roles in reflexive attention and memory. This modest 4-cell model provides the first simple and unified physiologically plausible mechanism of reflexive spatial attention and passive short-term memory processes. PMID:26493949

  3. Spasm of the near reflex: a spectrum of anomalies. (United States)

    Goldstein, J H; Schneekloth, B B


    Spasm of the near reflex has been characterized as the variable appearance of pseudomyopia, convergent strabismus and miosis. These characteristics may appear together or separately. In addition, abnormalities of accommodation may appear not only as pseudomyopia, but may also be manifest in cases with significant hypermetropia in which the patient is unable to relax accommodation even when plus lenses are used. The intent of this review is to identify the various clinical presentations of anomalies of the entire near reflex as well as the component parts. The relationship to functional and organic disorders are discussed as well as the related neuroanatomy. We suggest that one may more readily understand the clinical manifestations as a spectrum of anomalies of the near reflex rather than a multitude of disconnected entities.

  4. Single Canonical Model of Reflexive Memory and Spatial Attention. (United States)

    Patel, Saumil S; Red, Stuart; Lin, Eric; Sereno, Anne B


    Many neurons in the dorsal and ventral visual stream have the property that after a brief visual stimulus presentation in their receptive field, the spiking activity in these neurons persists above their baseline levels for several seconds. This maintained activity is not always correlated with the monkey's task and its origin is unknown. We have previously proposed a simple neural network model, based on shape selective neurons in monkey lateral intraparietal cortex, which predicts the valence and time course of reflexive (bottom-up) spatial attention. In the same simple model, we demonstrate here that passive maintained activity or short-term memory of specific visual events can result without need for an external or top-down modulatory signal. Mutual inhibition and neuronal adaptation play distinct roles in reflexive attention and memory. This modest 4-cell model provides the first simple and unified physiologically plausible mechanism of reflexive spatial attention and passive short-term memory processes.

  5. A critical reflexive Perspective on othering in collaborative knowledge production

    DEFF Research Database (Denmark)

    Jakobsen, Helle Nordentoft; Olesen, Birgitte Ravn


    Purpose The purpose of the article is to show power mechanisms of in- and exclusion in moments where certain participants appeared to be othered in two collaborative research and development projects in a health care setting. Design/methodology/approach The article contributes to critical......-reflexive analyses of reflexive processes within collaborative knowledge production We use an analytical framework combining Bakhtin and Foucault to investigate processes of inclusion and exclusion in the interplay between dominant and subordinated voices in a moment-by-moment analysis of two incidents from...... interdisciplinary workshops. Findings The analysis illuminates how differences between voices challenge participants’ reflexive awareness and lead to the reproduction of contextual power and knowledge hierarchies and the concomitant silencing of particular participants. Thus, the findings draw attention...

  6. Effects of postural changes of the upper limb on reflex transmission in the lower limb. Cervicolumbar reflex interactions in man. (United States)

    Delwaide, P J; Figiel, C; Richelle, C


    The influence of passive changes in upper limb position on the excitability of three myotatic arc reflexes (soleus, quadriceps, and biceps femoris) of the lower limb has been explored on 42 volunteers. The results indicate that the excitability of the three myotatic arcs can be influenced at a distance by postural modifications of the upper limb. When the ipsilateral upper limb is forwards or the contralateral backwards, a facilitation of both soleus and quadriceps tendon reflexes is observed while the biceps femoris reflexes are reduced. This pattern of facilitation and inhibition is reversed when the ipsilateral upper limb is backwards or the contralateral forwards. The facilitations as well as inhibitions of proximal myotatic arc reflexes are quantitatively more marked than that of the soleus reflex. Facilitation and inhibition are not linearly related to the angle of the arm with the trunk. Effects begin at a considerable angle, become maximal at 45 degrees, and progressively disappear for greater values. It is suggested that the distinct pattern of facilitation and inhibition which is exerted in reciprocal fashion on extensor and flexor motor nuclei might depend on the long propriospinal neurones connecting cervical and lumbar enlargements.

  7. A 47-Year-Old Man With Fever, Dry Cough, and a Lung Mass After Redo Lung Transplantation. (United States)

    Chaddha, Udit; Patil, Pradnya D; Omar, Ashraf; Walia, Rajat; Panchabhai, Tanmay S


    A 47-year-old man who was a redo double lung transplant recipient (cytomegalovirus [CMV] status: donor positive/recipient positive; Epstein-Barr virus status: donor positive/recipient positive) presented to the hospital with 1 week of generalized malaise, low-grade fevers, and dry cough. His redo lung transplantation was necessitated by bronchiolitis obliterans syndrome, and his previous lung transplantation 5 years earlier was for silicosis-related progressive massive fibrosis. He denied any difficulty breathing or chest pain. There was no history of GI or urinary symptoms, and the patient had no anorexia, weight loss, night sweats, sick contacts, or history of travel. He had a history of 1 earlier episode of CMV viremia that was treated with valganciclovir. His immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisone, and his infection prophylaxis included trimethoprim-sulfamethoxazole, itraconazole, and valganciclovir. Results of a chest radiograph 8 weeks earlier were normal. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. Vestibular control of sympathetic activity. An otolith-sympathetic reflex in humans. (United States)

    Kaufmann, H; Biaggioni, I; Voustianiouk, A; Diedrich, A; Costa, F; Clarke, R; Gizzi, M; Raphan, T; Cohen, B


    It has been proposed that a vestibular reflex originating in the otolith organs and other body graviceptors modulates sympathetic activity during changes in posture with regard to gravity. To test this hypothesis, we selectively stimulated otolith and body graviceptors sinusoidally along different head axes in the coronal plane with off-vertical axis rotation (OVAR) and recorded sympathetic efferent activity in the peroneal nerve (muscle sympathetic nerve activity, MSNA), blood pressure, heart rate, and respiratory rate. All parameters were entrained during OVAR at the frequency of rotation, with MSNA increasing in nose-up positions during forward linear acceleration and decreasing when nose-down. MSNA was correlated closely with blood pressure when subjects were within +/-90 degrees of nose-down positions with a delay of 1.4 s, the normal latency of baroreflex-driven changes in MSNA. Thus, in the nose-down position, MSNA was probably driven by baroreflex afferents. In contrast, when subjects were within +/-45 degrees of the nose-up position, i.e., when positive linear acceleration was maximal along the naso-ocipital axis, MSNA was closely related to gravitational acceleration at a latency of 0.4 s. This delay is too short for MSNA changes to be mediated by the baroreflex, but it is compatible with the delay of a response originating in the vestibular system. We postulate that a vestibulosympathetic reflex, probably originating mainly in the otolith organs, contributes to blood pressure maintenance during forward linear acceleration. Because of its short latency, this reflex may be one of the earliest mechanisms to sustain blood pressure upon standing.

  9. FEFsem neuronal response during combined volitional and reflexive pursuit. (United States)

    Bakst, Leah; Fleuriet, Jérome; Mustari, Michael J


    Although much is known about volitional and reflexive smooth eye movements individually, much less is known about how they are coordinated. It is hypothesized that separate cortico-ponto-cerebellar loops subserve these different types of smooth eye movements. Specifically, the MT-MST-DLPN pathway is thought to be critical for ocular following eye movements, whereas the FEF-NRTP pathway is understood to be vital for volitional smooth pursuit. However, the role that these loops play in combined volitional and reflexive behavior is unknown. We used a large, textured background moving in conjunction with a small target spot to investigate the eye movements evoked by a combined volitional and reflexive pursuit task. We also assessed the activity of neurons in the smooth eye movement subregion of the frontal eye field (FEFsem). We hypothesized that the pursuit system would show less contribution from the volitional pathway in this task, owing to the increased involvement of the reflexive pathway. In accordance with this hypothesis, a majority of FEFsem neurons (63%) were less active during pursuit maintenance in a combined volitional and reflexive pursuit task than during purely volitional pursuit. Interestingly and surprisingly, the neuronal response to the addition of the large-field motion was highly correlated with the neuronal response to a target blink. This suggests that FEFsem neuronal responses to these different perturbations-whether the addition or subtraction of retinal input-may be related. We conjecture that these findings are due to changing weights of both the volitional and reflexive pathways, as well as retinal and extraretinal signals.

  10. Automated data reduction workflows for astronomy. The ESO Reflex environment (United States)

    Freudling, W.; Romaniello, M.; Bramich, D. M.; Ballester, P.; Forchi, V.; García-Dabló, C. E.; Moehler, S.; Neeser, M. J.


    Context. Data from complex modern astronomical instruments often consist of a large number of different science and calibration files, and their reduction requires a variety of software tools. The execution chain of the tools represents a complex workflow that needs to be tuned and supervised, often by individual researchers that are not necessarily experts for any specific instrument. Aims: The efficiency of data reduction can be improved by using automatic workflows to organise data and execute a sequence of data reduction steps. To realize such efficiency gains, we designed a system that allows intuitive representation, execution and modification of the data reduction workflow, and has facilities for inspection and interaction with the data. Methods: The European Southern Observatory (ESO) has developed Reflex, an environment to automate data reduction workflows. Reflex is implemented as a package of customized components for the Kepler workflow engine. Kepler provides the graphical user interface to create an executable flowchart-like representation of the data reduction process. Key features of Reflex are a rule-based data organiser, infrastructure to re-use results, thorough book-keeping, data progeny tracking, interactive user interfaces, and a novel concept to exploit information created during data organisation for the workflow execution. Results: Automated workflows can greatly increase the efficiency of astronomical data reduction. In Reflex, workflows can be run non-interactively as a first step. Subsequent optimization can then be carried out while transparently re-using all unchanged intermediate products. We found that such workflows enable the reduction of complex data by non-expert users and minimizes mistakes due to book-keeping errors. Conclusions: Reflex includes novel concepts to increase the efficiency of astronomical data processing. While Reflex is a specific implementation of astronomical scientific workflows within the Kepler workflow

  11. A 29-Year-Old Man With Nonproductive Cough, Exertional Dyspnea, and Chest Discomfort. (United States)

    Halpenny, Darragh; Suh, James; Garofano, Suzette; Alpert, Jeffrey


    A 29-year-old man presented with a 5-month history of worsening dry cough, exertional dyspnea, chest tightness, and palpitations. He had been treated by his primary care physician with trials of guaifenesin/codeine, azithromycin, albuterol, and omeprazole without improvement. He denied wheezing, fever, sweats, anorexia, joint pain, swelling, or rash. He had no past medical history. He denied a history of tobacco smoking or IV drug use. He kept no pets, worked as a manager in an office environment, and had no history of occupational inhalational exposure. He reported using aerosolized insect spray to eradicate bed bugs in his house shortly before the cough began but did not report any acute symptoms when using the spray.


    Directory of Open Access Journals (Sweden)

    S.I. Bardenikova


    Full Text Available An open controlled comparative research was conducted on 263 children with acute respiratory infection (ARI in order to evaluate the clinical effectiveness, acceptability and safety of plant based preparation that contains ivy leaf extract. It was established that prescribing the preparation during the first days of disease reduced the duration of dry and inefficient cough, improved sputum rheology and bronchial tree drainage function, reduced bronchial obstruction intensity, reduced the need for prescribing bronchial spasmolitics less necessary and decreased Staybin term. Compared to other antibcough medicines, plant based preparation with ivy leaf extract has quicker effect (effective on the 1st–3rd day.Key words: children, acute respiratory infections, cough, treatment.

  13. Whooping cough in Pakistan: Bordetella pertussis vs Bordetella parapertussis in 2005-2009. (United States)

    Bokhari, Habib; Said, Fahad; Syed, Muhammad A; Mughal, Amjad; Kazi, Yasmeen F; Heuvelman, Kees; Mooi, Frits R


    Pertussis, or whooping cough, is an acute respiratory disease mainly affecting infants and children and is caused by Bordetella pertussis and Bordetella parapertussis. The aim of this study was to investigate the share of Bordetella species from potential whooping cough cases during 2005-2009. Eight hundred and two samples from suspected pertussis cases were collected, mainly from 2 provinces of Pakistan. Bacterial culture, identification, DNA extraction and routinely used polymerase chain reaction (PCR) methods using IS1001, IS1002 and IS481 were used to identify the Bordetella species. The results were unexpected, because all of the isolates collected from the different cities were identified as B. parapertussis (7.4%); B. pertussis was not isolated from any sample. However, PCR results indicated the presence of a small percentage (0.6%) of B. pertussis among the total cases studied. This study suggests that vaccines to protect against both B. pertussis and B. parapertussis should be considered.

  14. Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial. (United States)

    P S, Loh; Miskan, M M; Y Z, Chin; Zaki, R A


    Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. ANZCTR Number ACTRN12616000116426 . Retrospectively registered on 2nd February 2016.

  15. Fat Dogs and Coughing Horses: K-12 Programming for Veterinary Workforce Development


    San Miguel, Sandra F.; Parker, Loran Carleton; Adedokun, Omolola A.; Burgess, Wilella D.; Cipriani Davis, Kauline S.; Blossom, Thaddaeus D.; Schneider, Jessica L.; Mennonno, Ann M.; Ruhl, Joseph D.; Veatch, Jennifer H.; Wackerly, Amy J.; Shin, Soo Yeon; Ratliff, Timothy L.


    Workforce development strategies to educate, inform, and diversify the veterinary profession of the future must begin with children in elementary school. This manuscript provides a description of the Fat Dogs and Coughing Horses program, which takes a multifaceted approach toward informing young students, beginning in first grade, about the interesting work and career opportunities available in the field of veterinary medicine. The program, a collaboration among Purdue University and Indiana ...

  16. Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis.


    Andersen, Tiina Maarit; Sandnes, Astrid; Brekka, Anne Kristine; Hilland, Magnus; Clemm, Hege; Fondenes, Ove; Tysnes, Ole Bjørn; Heimdal, John-Helge; Halvorsen, Thomas; Vollsæter, Maria; Røksund, Ola Drange


    Background: Most patients with amyotrophic lateral sclerosis (ALS) are treated with mechanical insufflation–exsufflation (MI-E) in order to improve cough. This method often fails in ALS with bulbar involvement, allegedly due to upper-airway malfunction. We have studied this phenomenon in detail with laryngoscopy to unravel information that could lead to better treatment. Methods: We conducted a cross-sectional study of 20 patients with ALS and 20 healthy age-matched and sex-matched v...

  17. Geographical differences in whooping cough in Catalonia, Spain, from 1990 to 2010 (United States)


    Background Whooping cough is a communicable disease whose incidence has increased in recent years in some countries with vaccination. Since 1981, in Catalonia (Spain), cases must be reported to the Public Health Department. In 1997, surveillance changed from aggregated counts to individual report and the surveillance system was improved after 2002. Catalan public health is universal with equal coverage geographically. The aim of this study was to determine whether there are differences in whooping cough incidence in rural and urban counties. Methods Cases in 1990–2010 were classified as rural or urban. Incidences and risk ratios (RR) between urban and rural counties and 95% CI were calculated. Associations between rural and urban counties and structural changes during the study period were analysed. Results Twelve years of the whole study period showed differences in incidence between rural and urban counties. The incidence was higher in urban counties in seven years and rural counties in five years. There was a positive association of whooping cough incidence in rural and urban counties in four-week periods. Structural changes were detected in the following four-week periods: 4th in 1993, 7th in 1996 and 3rd 2005 in rural counties and 5th 1993, 9th in 1996 and 8th in 2007 in urban counties. Conclusions Differences in whooping cough between rural and urban counties were found. In most years, the incidence was higher in urban than in rural counties. Rural and urban counties show similar cyclic behaviour when four-week periods were considered. PMID:24649975

  18. A 68-Year-Old Man With Dyspnea on Exertion and Cough. (United States)

    Agrawal, Abhinav; Sikachi, Rutuja R; Koenig, Seth; Khanijo, Sameer


    A 68-year-old man with a history of chronic lymphocytic leukemia well controlled on ibrutinib, hypertension, obesity, and a remote history of smoking (10 pack-years) presented with increasing dyspnea on exertion and cough. He had previously finished two courses of oral antibiotics for his symptoms without significant improvement. On presentation, he had no fevers or sputum production. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  19. Grey Turner's and Cullen's signs induced by spontaneous hemorrhage of the abdominal wall after coughing. (United States)

    Fan, Zhe; Zhang, Yingyi


    Grey Turner's and Cullen's signs are rare clinical signs, which most appear in patients with severe acute pancreatitis. The present patient complained of abdominal pain after coughing. However, contrast-enhanced CT revealed a hemorrhage of the abdominal wall. Therefore, spontaneous hemorrhage of the abdominal wall was diagnosed. The patient recovered through immobilization and hemostasis therapy. This case report and literature review aims to remind clinicians of manifestations and treatment of spontaneous hemorrhage.

  20. Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study

    DEFF Research Database (Denmark)

    Pisinger, Charlotta; Godtfredsen, Nina; Jørgensen, Torben


    % CI: 1.7-8.0), respectively, compared with unchanged smoking habits. It was also significantly more likely not to report phlegm at 1-year follow-up for those who had quit (OR: 7.1; 95% CI: 2.8-18.0), whereas SR was not significantly associated with termination of phlegm (OR: 2.5; 95% CI: 0.9-6.4) when......Background: Chronic cough can be the first sign of chronic obstructive disease. A few, and mostly selected, studies exploring the effect of reduced daily tobacco consumption have shown a small effect on pulmonary symptoms. Aim: The aim of this study was to examine if smoking reduction (SR) (>= 50......% of daily tobacco consumption) or smoking cessation (SC) had an effect on chronic cough and phlegm. Methods: A total of 2408 daily smokers were included in a Danish population-based intervention study, Inter99. In the analyses, we included smokers with self-reported chronic cough or phlegm at baseline who...

  1. Differentiation of Lung Cancer, Empyema, and Abscess Through the Investigation of a Dry Cough. (United States)

    Urso, Brittany; Michaels, Scott


    An acute dry cough results commonly from bronchitis or pneumonia. When a patient presents with signs of infection, respiratory crackles, and a positive chest radiograph, the diagnosis of pneumonia is more common. Antibiotic failure in a patient being treated for community-acquired pneumonia requires further investigation through chest computed tomography. If a lung mass is found on chest computed tomography, lung empyema, abscess, and cancer need to be included on the differential and managed aggressively. This report describes a 55-year-old Caucasian male, with a history of obesity, recovered alcoholism, hypercholesterolemia, and hypertension, presenting with an acute dry cough in the primary care setting. The patient developed signs of infection and was found to have a lung mass on chest computed tomography. Treatment with piperacillin-tazobactam and chest tube placement did not resolve the mass, so treatment with thoracotomy and lobectomy was required. It was determined through surgical investigation that the patient, despite having no risk factors, developed a lung abscess. Lung abscesses rarely form in healthy middle-aged individuals making it an unlikely cause of the patient's presenting symptom, dry cough. The patient cleared his infection with proper management and only suffered minor complications of mild pneumoperitoneum and pneumothorax during his hospitalization.

  2. Relation of the Timing of Onset of Rhinitis and Cough to Asthma Attack in Children. (United States)

    Sugimura, Tetsu; Ozaki, Yukiko; Tananari, Yoshifumi; Yamakawa, Rumi; Hirata, Rumiko


    If the risk of progression to asthma could be predicted in patients with rhinitis, prevention of asthma might become possible. The purpose of this study was to clarify the relationship between the duration of rhinitis symptoms and acute asthma attacks in children with a history of asthma who were not on treatment for asthma. In 94 children with a history of asthma who were asymptomatic after completing asthma treatment, we investigated the onset and duration of nasal discharge and cough related to allergic rhinitis. Then the children were followed up for 2 weeks and were classified into either an asthma attack group (Group A) or non-asthma group(Group B). A total of 78 subjects were evaluated after 16 were excluded. The duration of nasal discharge was significantly shorter in Group A than in Group B (5.5±1.9 days vs. 10.4±3.1 days, Pasthma attack may be higher when the onset of cough precedes nasal discharge or when nasal discharge has a short duration and cough shows an early onset. These results may provide assistance when selecting patients for early anti-allergy therapy from among those presenting with upper respiratory tract symptoms.

  3. Right sided arcus aorta as a cause of dyspnea and chronic cough

    Directory of Open Access Journals (Sweden)

    Ozkaya Sevket


    Full Text Available Abstract Background Right sided arcus aorta (RSAA is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. Methods The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. Results A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54% were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. Conclusions The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

  4. [Whooping cough in an urban high school in Hungary. Conclusions of a local pertussis outbreak]. (United States)

    Schneider, Ferenc; Stánitz, Eva; Kalácska, Judit; Tompity, Tünde; Gábor, Beáta


    Although incidence of pertussis has been gradually decreased with the introduction of active immunization, total eradication is not possible. This has been shown by national and international data, as well. In the early 2000's, slow increase in incidence of pertussis was observed. To demonstrate the presence of Bordetella pertussis in the Hungarian population by presenting 17 cases of adolescent pertussis. Etiology of pertussis was confirmed by quantification of pertussis-antibodies in blood samples taken from permanently coughing patients in the firstly identified subject's vicinity which latter was explored by retrospective data collection. In the vicinity of the first identified patient epidemiologic research identified another 16 patients all of which were confirmed by serological tests. If permanent coughing is present, pertussis needs to be ruled out. Immunity against pertussis obtained by vaccination fades by the end of childhood. Bordetella pertussis circulates in the national population. A booster-vaccination against pertussis in the regular vaccination course for the 11-year old children is recommended. Pertussis in adolescents and in adults is mild and atypical, but in case of prolonged coughing it needs to be considered.

  5. A study of ′cough trick′ technique in reducing vaccination prick pain in adolescents

    Directory of Open Access Journals (Sweden)

    Vikram S. Kumar


    Full Text Available Background: The ′cough trick′ (CT technique is used in reducing intramuscular prick (IMP pain during vaccinations and also for brief painful procedures like subcutaneous injection, intravenous cannulation, and so forth. We present the utility study of this technique in male adolescents. Materials and Methods: A Randomized Crossover Volunteer Study of 50 early adolescent male children (age 11-13 receiving immunizations was performed. Participants were recruited from four outpatient pediatric clinics. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain. Results: Paired ′t′ test revealed that the procedure was effective at a statistically and clinically significant level for participants. Children found the procedure acceptable and effective. Conclusions: The results of this study suggest that the CT can be an effective strategy for the reduction of pain for male adolescent children undergoing routine immunizations. However, additional research is needed with a larger sample size with different age groups and also including girl children.

  6. Post-activation depression of soleus stretch reflexes in healthy and spastic humans

    DEFF Research Database (Denmark)

    Grey, Michael James; Klinge, Klaus; Crone, Clarissa


    Reduced depression of transmitter release from Ia afferents following previous activation (post-activation depression) has been suggested to be involved in the pathophysiology of spasticity. However, the effect of this mechanism on the myotatic reflex and its possible contribution to increased...... reflex excitability in spastic participants has not been tested. To investigate these effects, we examined post-activation depression in Soleus H-reflex responses and in mechanically evoked Soleus stretch reflex responses. Stretch reflex responses were evoked with consecutive dorsiflexion perturbations...... of the soleus stretch reflex and H-reflex decreased as the interval between the stimulus/perturbation was decreased. Similarly, the stretch-evoked torque decreased. In the spastic participants, the post-activation depression of both reflexes and the stretch-evoked torque was significantly smaller than...

  7. Prevalence of chronic cough and phlegm among male cigar and pipe smokers: results of the Scottish Heart Health Study.


    Brown, C. A.; Woodward, M.; Tunstall-Pedoe, H.


    BACKGROUND--Previous studies investigating the effect of cigar or pipe smoking on the occurrence of chronic cough and chronic phlegm have reported prevalences among cigar and pipe smokers lying between those of non-smokers and current cigarette smokers. This study uses data on previous cigarette consumption, current cigar or pipe consumption, and biochemical markers of smoking to provide a detailed analysis of chronic cough and chronic phlegm among cigar and pipe smokers. METHODS--A total of ...

  8. Theobromine for the treatment of persistent cough: a randomised, multicentre, double-blind, placebo-controlled clinical trial. (United States)

    Morice, Alyn H; McGarvey, Lorcan; Pavord, Ian D; Higgins, Bernard; Chung, Kian Fan; Birring, Surinder S


    To investigate the effect of BC1036 on health-related quality of life (QOL) in subjects with persistent cough. The secondary objective was to investigate the effect of BC1036 on subjective cough severity. This was a randomised, multicentre, double-blind, placebo-controlled, parallel-group study in 289 subjects with persistent cough. Subjects received BC1036 or placebo twice daily for 14 days. The primary endpoint comprised cough-related QOL assessed using the validated Leicester Cough Questionnaire (LCQ) at Day 14. Secondary endpoints comprised the LCQ scores at Day 7 and Day 28, cough severity VAS scores at each visit and pulmonary function tests. At baseline, mean total LCQ score in the BC1036 group was lower (i.e., worse QOL) than placebo (P<0.001), indicating significant between-group heterogeneity. Mean baseline-adjusted change in LCQ score at Day 14 was greater for BC1036 [mean (SD) 2.4±3.5] compared to placebo [mean (SD) score 2.2±3.0], but did not reach statistical significance (P=0.60). Mean cough severity VAS score decreased to a greater extent in the BC1036 group compared to placebo, but again the results were not statistically significant (-12.2±23.28 in BC1036 group and -11.0±21.34 in placebo group at Day 14, P=0.688). There was no significant change in pulmonary function measurements. The adverse event (AE) profile was similar in both groups. This study showed that BC1036 was well tolerated and, although the primary endpoint did not achieve statistical significance, the magnitude of improvement was greater with BC1036 compared to placebo with respect to improving QOL and reducing cough severity. NCT01656668.

  9. Subjectivity and Reflexivity in the Social Sciences: Epistemic Windows and Methodical Consequences

    Directory of Open Access Journals (Sweden)

    Franz Breuer


    Full Text Available We sketch four basic epistemological assumptions that imply a constructionist orientation to knowledge including (a perspectivity, positionality; (b horizonality, dynamic observer position; (c the structuring of knowledge through instruments of knowledge production; and (d interactivity and interventionist nature of research. Although social scientists often adopt a constructionist epistemology to frame their research object, the methodological consequences of such an epistemology for the production of social scientific knowledge are not normally drawn. Instead of dealing with the four assumptions as a productive epistemic window, many researchers exhibit a defensive tendency and continue the quest for objectivity in their own writing. We propose a different methodological position conceptualized in the dialectic of the always embodied, individual, and social researcher-in-interaction. Beginning with the concept of a decentered (self- observation we develop the idea of the reflexive nature that relates the epistemic subject and object. We propose a way systematizing methodological considerations and procedures that follows the research process, beginning with the identification of a research topic to the final presentation of the results. The contributions to the two present FQS volumes on "Subjectivity and Reflexivity in Qualitative Research" provide answers and possible solutions to the questions and problems raised in this introduction. URN: urn:nbn:de:0114-fqs0302258

  10. Right hemispheric dominance and interhemispheric cooperation in gaze-triggered reflexive shift of attention. (United States)

    Okada, Takashi; Sato, Wataru; Kubota, Yasutaka; Toichi, Motomi; Murai, Toshiya


    The neural substrate for the processing of gaze remains unknown. The aim of the present study was to clarify which hemisphere dominantly processes and whether bilateral hemispheres cooperate with each other in gaze-triggered reflexive shift of attention. Twenty-eight normal subjects were tested. The non-predictive gaze cues were presented either in unilateral or bilateral visual fields. The subjects localized the target as soon as possible. Reaction times (RT) were shorter when gaze-cues were congruent toward than away from targets, whichever visual field they were presented in. RT were shorter in left than right visual field presentations. RT in mono-directional bilateral presentations were shorter than both of those in left and right presentations. When bi-directional bilateral cues were presented, RT were faster when valid cues were presented in the left than right visual fields. The right hemisphere appears to be dominant, and there is interhemispheric cooperation in gaze-triggered reflexive shift of attention. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

  11. [The lombard reflex as a test of vocal function (author's transl)]. (United States)

    Schultz-Coulon, H J; Fues, C P


    Any impairment of audio-phonatory control by background noise is followed by an increase in both the intensity and pitch of the speaking voice (Lombard reflex, 1911), thus increasing vocal strain. As a consequence, it might be anticipated that persons reacting to noise with marked changes in voice might be more liable to develop dysphonia. 22 singers, 34 normal controls, and 22 patients with hyperfunctional dysphonia where studied. In all patients, both ears were gradually masked with white noise. The change of the mean intensity level and of the mean pitch level of the speaking voice were then measured objectively with a special fundamental frequency analyzer (Fedders and Schultz-Coulon, 1975). Results show that the increase of intensity is comparable in all subjects, whereas the elevation of the mean pitch level differs significantly: trained voices (singers) react with the least pitch increment whereas dysphonic patients react with the most. The following conclusions were made from the present investigation: 1. Extreme increments in pitch level can be considered to be a more significant etiological factor of dysphonia than intensity increments; 2. Vocal therapy and voice training may have a favorable effect on the Lombard reflex (probably by improvement of the kinesthetic control mechanism) so that the speaking voice in a noisy environment is raised less with less vocal strain. The study also indicates that measurement of pitch changes during binaural masking can provide important information for the diagnosis, therapy and prophylaxis of dysphonia.

  12. Acoustic startle reflex and pre-pulse inhibition in tinnitus patients

    Institute of Scientific and Technical Information of China (English)

    Kelly Shadwick; Wei Sun


    Gap induced pre-pulse inhibition (Gap-PPI) of acoustic startle reflex has been used as a measurement of tinnitus in animal models. However, whether this test is sensitive to detect tinnitus in humans is still unclear. Based on the testing procedure used in animal studies, a human subject testing method was formulated and conducted to investigate if a similar result could be found in tinnitus patients. Audiologic and tinnitus assessments and acoustic startle reflex measurements were performed on seven tinnitus subjects and nine age matched subjects without tinnitus. There was no significant difference found between the control and tinnitus group on the Gap-PPI across the frequencies evaluated. The amplitude of the startle response in the tinnitus group with normal hearing thresholds was significantly higher than the control group and those with tinnitus and hearing loss. This preliminary result suggests that hyperexcitability in the central auditory system may be involved in tinnitus. There was no correlation between hearing thresholds and the increased amplitude of startle response.

  13. Acid-sensing ion channels contribute to the metaboreceptor component of the exercise pressor reflex


    McCord, Jennifer L.; Tsuchimochi, Hirotsugu; Kaufman, Marc P.


    The exercise pressor reflex is evoked by both mechanical and metabolic stimuli arising in contracting skeletal muscle. Recently, the blockade of acid-sensing ion channels (ASICs) with amiloride and A-316567 attenuated the reflex. Moreover, amiloride had no effect on the mechanoreceptor component of the reflex, prompting us to determine whether ASICs contributed to the metaboreceptor component of the exercise pressor reflex. The metaboreceptor component can be assessed by measuring mean arteri...

  14. Recommendations for the proper use of nonprescription cough suppressants and expectorants in solid-organ transplant recipients. (United States)

    Gabardi, Steven; Carter, Danielle; Martin, Spencer; Roberts, Keri


    To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions. Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed. Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined. Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.

  15. Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter. (United States)

    Gobert, Florent; Yonis, Hodane; Tapponnier, Romain; Fernandez, Raul; Labaune, Marie-Aude; Burle, Jean-François; Barbier, Jack; Vincent, Bernard; Cleyet, Maria; Richard, Jean-Christophe; Guérin, Claude


    Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (V T ) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and V T was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and V T were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was -67.7 L/min, and median V T was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was -57.3 L/min, and median V T was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/V T combined. After dichotomization (CPF 0.55 L), there was a synergistic effect to predict early extubation success ( P meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. ( registration NCT02847221.). Copyright © 2017 by Daedalus Enterprises.

  16. Practicing Reflexivity in the Study of Italian Migrants in London (United States)

    Seganti, Francesca Romana


    This article discusses the centrality of reflexivity in qualitative research through examples from my study on the role new media play in the lives of Italians in London. My hypothesis was that Italians were "in transit" in London and they were using new media to build "temporary" communities. I conducted in-depth interviews…

  17. Teaching Reflexivity: Undoing or Reinscribing Habits of Gender? (United States)

    Bondi, Liz


    This paper outlines an approach used in a course designed to teach reflexivity as a research skill and explores what kind of gender intervention such teaching might constitute. Although inspired by feminist debates about the complex power dynamics of research relationships, the course in question does not focus specifically on gender issues.…

  18. Caught in Uncertain Futures, Now: A Reflexive Moment (United States)

    Reyes, Reynaldo, III


    This reflexive vignette reveals the emotional risks of ethnographic work by a Chicano researcher, educator, and advocate doing work in the Texas-Mexico Borderlands, caught at the intersection of vulnerable Latina/o youth and their possible futures. Data in this creative piece are derived from field notes of one classroom observation from an…

  19. Spasm of the near reflex associated with head injury. (United States)

    Knapp, Christopher; Sachdev, Arun; Gottlob, Irene


    Spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.

  20. Polyphony in the Classroom: Reporting Narrative Action Research Reflexively (United States)

    Niemi, Reetta; Heikkinen, Hannu L. T.; Kannas, Lasse


    In this article we will present a reflexive way of producing a narrative analysis on teaching and learning that involves all participants of the pedagogical process. Our theoretical contribution rests on the concept "lived pedagogy", adapted from Max van Manen's term "lived experience". Like van Manen, we start by asking the…

  1. Vestibulo-ocular reflex and the head impulse test

    Directory of Open Access Journals (Sweden)

    Eliana T. Maranhão


    Full Text Available The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.

  2. Team performance in the Italian NHS: the role of reflexivity. (United States)

    Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico


    Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

  3. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

    African Journals Online (AJOL)


    with MRI every 3 months and the bone marrow oedema disappeared after 6 months. Introduction ... SA JOURNAL OF RADIOLOGY • August 2004. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1 ... may be either trauma of external origin or iatrogenic, post surgery. In some patients particularly children ...

  4. Soleus H-reflex excitability during pedaling post-stroke

    DEFF Research Database (Denmark)

    Schindler-Ivens, Sheila; Brown, David A.; Lewis, Gwyn N.


    A major contributor to impaired locomotion post-stroke is abnormal phasing of paretic muscle activity, but the mechanisms remain unclear. Previous studies have shown that, in the paretic limb of people post-stroke, Group Ia reflexes are abnormally elevated and fail to decrease in amplitude during...

  5. Approaching Reflexivity through Reflection: Issues for Critical Management Education (United States)

    Hibbert, Paul


    This conceptual article seeks to develop insights for teaching reflexivity in undergraduate management classes through developing processes of critical reflection. Theoretical inferences to support this aim are developed and organized in relation to four principles. They are as follows: first, preparing and making space for reflection in the…

  6. Modulation of the masseteric reflex by gastric vagal afferents. (United States)

    Pettorossi, V E


    Several investigations have shown that the vagal nerve can affect the reflex responses of the masticatory muscles acting at level either of trigeminal motoneurons or of the mesencephalic trigeminal nucleus (MTN). The present experiments have been devoted to establish the origin of the vagal afferent fibres involved in modulating the masseteric reflex. In particular, the gastric vagal afferents were taken into consideration and selective stimulations of such fibres were performed in rabbit. Conditioning electrical stimulation of truncus vagalis ventralis (TVV) reduced the excitability of the MTN cells as shown by a decrease of the antidromic response recorded from the semilunar ganglion and elicited by MTN single-shock electrical stimulation. Sympathetic and cardiovascular influences were not involved in these responses. Mechanical stimulation of gastric receptors, by means of gastric distension, clearly diminished the amplitude of twitch tension of masseteric reflex and inhibited the discharge frequency of proprioceptive MTN units. The effect was phasic and depended upon the velocity of distension. Thus the sensory volleys originating from rapid adapting receptors reach the brain stem through vagal afferents and by means of a polysynaptic connection inhibits the masseteric reflex at level of MTN cells.

  7. Pure nuclear reflexes and combined hyperfine interactions in YIG

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, H; Eisberg, R; Alp, E; Rueffer, R; Gerdau, E; Lauer, S; Trautwein, A X; Grodzicki, M; Vera, A


    Moessbauer spectra of oriented YIG single crystals were taken and the numerical analysis using the transmission integral yielded a consistent set of hyperfine interaction parameters. They are in good agreement with theoretical values obtained by MO-calculations which included clusters up to 62 ions. Finally pure nuclear reflexes are predicted for single crystals and two theoretical spectra are given.

  8. Reconceptualizing reflexivity and dissonance in professional and personal domains. (United States)

    Brooks, Ann


    Debates around 'reflexivity' and the construction of the gendered self within late modernity have occupied the attention of both 'reflexive modernization' theorists (Beck, Giddens and Lash 1994; Beck and Beck-Gernsheim 1996; Giddens 1991, 1992) as well as gender and feminist theorists. While theorists such as Beck and Giddens have been preoccupied with establishing the connection between reflexivity and the construction of the 'non-gendered' self, gender and feminist theorists have sought to amplify the debate by exploring the intersecting nexus of contemporary theorizing, more fully within this context. This paper explores the theoretical underpinnings of these debates and their application to specific professional and personal domains. I consider three case studies to assess these issues as outlined in my own work, Brooks 2006, and in the work of Wajcman and Martin 2002, and McDowell 1997, which draw on empirical research and explore changes to gender identity within professional and personal domains. I conclude that there is little evidence in the research presented here of any systematic reconfiguring of gender identities leading to a detraditionalization of gender as suggested by the 'reflexive modernization' theorists.

  9. Neural reflex pathways in intestinal inflammation: hypotheses to viable therapy

    NARCIS (Netherlands)

    Willemze, Rose A.; Luyer, Misha D.; Buurman, Wim A.; de Jonge, Wouter J.


    Studies in neuroscience and immunology have clarified much of the anatomical and cellular basis for bidirectional interactions between the nervous and immune systems. As with other organs, intestinal immune responses and the development of immunity seems to be modulated by neural reflexes.

  10. PhD Students, Interculturality, Reflexivity, Community and Internationalisation (United States)

    Holliday, Adrian


    Interviews with a small group of doctoral students at a British university indicate that the students feel that the programme provides an environment within which they develop interculturality through reflexive engagement with the PhD community and in some cases with the participants in their research. Significant here is that they are…

  11. A reflexing electron microwave amplifier for rf particle accelerator applications

    International Nuclear Information System (INIS)

    Fazio, M.V.; Hoeberling, R.F.


    The evolution of rf-accelerator technology toward high-power, high-current, low-emittance beams produces an ever-increasing demand for efficient, very high power microwave power sources. The present klystron technology has performed very well but is not expected to produce reliable gigawatt peak-power units in the 1- to 10-GHz regime. Further major advancements must involve other types of sources. The reflexing-electron class of sources can produce microwave powers at the gigawatt level and has demonstrated operation from 800-MHz to 40-GHz. The pulse length appears to be limited by diode closure, and reflexing-electron devices have been operated in a repetitively pulsed mode. A design is presented for a reflexing electron microwave amplifier that is frequency and phase locked. In this design, the generated microwave power can be efficiently coupled to one or several accelerator loads. Frequency and phase-locking capability may permit parallel-source operation for higher power. The low-frequency (500-MHz to 10-GHz) operation at very high power required by present and proposed microwave particle accelerators makes an amplifier, based on reflexing electron phenomena, a candidate for the development of new accelerator power sources. (author)

  12. Supporting relationships in reflexive movements in leadership and organisational research

    DEFF Research Database (Denmark)

    Mortensen, Ann Rubens

    , and the actions in these relationships have profound and long-lasting effects above and beyond the immediate context, i.e., the organisation. I am offering a systemic social constructionist perspective on reflexivity in leadership and organisational research, bringing forth a way of creating connections...


    Directory of Open Access Journals (Sweden)

    Maryna Mavrina


    Full Text Available Development of theoretical approaches of demand management is conducted from the moment of awareness of the importance of this concept. Many models of individual consumers were developed. However, to predict the reaction of consumers to the commercial policy of the enterprise, exact methods do not exist yet because the available ones are mostly empirical in nature. Models of behaviour often do not provide the expected result because they use an erroneous approach to the analysis of the mechanism of demand formation. The subject of the research is the theoretical and methodological basis, methods of assessment, and reflexive management of consumer demand of commercial enterprises. The purpose of the paper is developing a concept of reflexive management of consumer demand. To achieve the research goal, the following tasks are set and solved: to substantiate the theoretical and methodological foundations of reflexive consumer management, to analyse existing approaches to the modelling of consumer behaviour; to improve the model of consumer behaviour; to develop a concept of reflexive management of consumer behaviour. Methodology. In the paper, we use such methods and approaches to research as: reflexive approach (phenomenological method, behavioural economic theory, marketing approach, abstract-logical analysis, analysis of theoretical approaches to the modelling of consumer behaviour. Results. Modern approaches to modelling of consumer behaviour are mostly empirical in nature and have shortcomings of general models. In them, there is no description of specific situations of the purchase of goods. They cannot be quantified. Therefore, they cannot be practical models. But they have a weighty advantage in a comprehensive look at motivated purchases, what makes it possible to evaluate the relevance of individual variables and to understand the fundamental processes of consumer behaviour. It makes possible to identify the variables necessary for the

  14. Isometric and Dynamic Control of Neck Muscles : Reflexive contributions and muscle synergies

    NARCIS (Netherlands)

    De Bruijn, E.


    It is well established that the central nervous system (CNS) stabilizes the head using reflexive feedback and cocontraction. The major reflexive pathways in the neck are through muscle spindles generating the cervicocollic reflex (CCR) and through the vestibular organ generating the vestibulocollic

  15. Affective Modulation of the Startle Eyeblink and Postauricular Reflexes in Autism Spectrum Disorder (United States)

    Dichter, Gabriel S.; Benning, Stephen D.; Holtzclaw, Tia N.; Bodfish, James W.


    Eyeblink and postauricular reflexes to standardized affective images were examined in individuals without (n = 37) and with (n = 20) autism spectrum disorders (ASDs). Affective reflex modulation in control participants replicated previous findings. The ASD group, however, showed anomalous reflex modulation patterns, despite similar self-report…

  16. A task dependent change in the medium latency component of the soleus stretch reflex

    DEFF Research Database (Denmark)

    Grey, Michael James; Larsen, Birgit; Sinkjær, Thomas


    In comparison to the H-reflex, the task dependency of the human stretch reflex during locomotive and postural tasks has not received a great deal of attention in the literature. The few studies on reflex task dependency that have been performed to date have concentrated on either the group Ia...

  17. Reflexive intergroup bias in third-party punishment. (United States)

    Yudkin, Daniel A; Rothmund, Tobias; Twardawski, Mathias; Thalla, Natasha; Van Bavel, Jay J


    Humans show a rare tendency to punish norm-violators who have not harmed them directly-a behavior known as third-party punishment. Research has found that third-party punishment is subject to intergroup bias, whereby people punish members of the out-group more severely than the in-group. Although the prevalence of this behavior is well-documented, the psychological processes underlying it remain largely unexplored. Some work suggests that it stems from people's inherent predisposition to form alliances with in-group members and aggress against out-group members. This implies that people will show reflexive intergroup bias in third-party punishment, favoring in-group over out-group members especially when their capacity for deliberation is impaired. Here we test this hypothesis directly, examining whether intergroup bias in third-party punishment emerges from reflexive, as opposed to deliberative, components of moral cognition. In 3 experiments, utilizing a simulated economic game, we varied participants' group relationship to a transgressor, measured or manipulated the extent to which they relied on reflexive or deliberative judgment, and observed people's punishment decisions. Across group-membership manipulations (American football teams, nationalities, and baseball teams) and 2 assessments of reflexive judgment (response time and cognitive load), reflexive judgment heightened intergroup bias, suggesting that such bias in punishment is inherent to human moral cognition. We discuss the implications of these studies for theories of punishment, cooperation, social behavior, and legal practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  18. Greater general startle reflex is associated with greater anxiety levels: a correlational study on 111 young women

    Directory of Open Access Journals (Sweden)

    Eleonora ePoli


    Full Text Available Startle eyeblink reflex is a valid non-invasive tool for studying attention, emotion and psychiatric disorders. In the absence of any experimental manipulation, the general (or baseline startle reflex shows a high inter-individual variability, which is often considered task-irrelevant and therefore normalized across participants. Unlike the above view, we hypothesized that greater general startle magnitude is related to participants’ higher anxiety level. 111 healthy young women, after completing the State-Trait Anxiety Inventory, were randomly administered 10 acoustic white noise probes (50 ms, 100 dBA acoustic level while integrated EMG from left and right orbicularis oculi was recorded. Results showed that participants with greater state anxiety levels exhibited larger startle reflex magnitude from the left eye (r109=0.23, p<0.05. Furthermore, individuals who perceived the acoustic probe as more aversive reported the largest anxiety scores (r109=0.28, p<0.05 and had the largest eyeblinks, especially in the left eye (r109 = 0.34, p<0.001. Results suggest that general startle may represent a valid tool for studying the neural excitability underlying anxiety and emotional dysfunction in neurological and mental disorders.

  19. Specific brainstem and cortico-spinal reflex abnormalities in coexisting essential tremor and Parkinson's disease (ET-PD). (United States)

    Yavuz, D; Gündüz, A; Ertan, S; Apaydın, H; Şifoğlu, A; Kiziltan, G; Kiziltan, M E


    We aimed to analyze functional changes at brainstem and spinal levels in essential tremor (ET), Parkinson's disease (PD) and coexisting essential tremor and Parkinson's disease (ET-PD). Age- and gender-matched patients with tremor (15 ET, 7 ET with resting tremor, 25 ET-PD and 10 PD) and 12 healthy subjects were enrolled in the study. Diagnosis was established according to standardized clinical criteria. Electrophysiological studies included blink reflex (BR), auditory startle reaction (ASR) and long latency reflex (LLR). Blink reflex was normal and similar in all groups. Probability of ASR was significantly lower in ET-PD group whereas it was similar to healthy subjects in ET and PD (PET, PD and ET-PD groups. LLR III was far more common in the PD group (n=3, 13.6% in ET; n=4, 16.0% in ET-PD and n=7, 46.7% in PD; p=0.037). Despite the integrity of BR pathways, ASR and LLR show distinctive abnormalities in ET-PD. In our opinion, our electrophysiological findings support the hypothesis that ET-PD is a distinct entity. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. O conceito de reflexão de Hegel como crítica aos conceitos de essência e de reflexão tradicionais

    Directory of Open Access Journals (Sweden)

    Christian Iber


    Full Text Available O presente artigo ilumina o específico do conceito de reflexão de Hegel em cinco momentos. Em um primeiro momento, delineia-se um esboço do conceito de reflexão na lógica da essência de Hegel. Em um segundo momento, o conceito de reflexão de Hegel é apresentado como estrutura lógica objetiva em contraste com a reflexão subjetiva da consciência e do entendimento, com a qual, ao mesmo tempo, o conceito de essência ontológica independente da reflexão é submetido a uma crítica. Do novo conceito de reflexão de Hegel resulta, em terceiro lugar, uma adaptação radical do círculo vicioso na teoria tradicional da reflexão da autoconsciência. Num quarto momento, lança-se um olhar sobre o conceito de reflexão anterior de Hegel como pensar do entendimento que separa, do qual o conceito de reflexão posterior se distingue. Por fim, apresenta-se, em quinto lugar, a lógica da reflexão de Hegel como crítica à fundação ontológica da reflexão em Schelling. O conceito de reflexão de Hegel se mostra, com isto, como crítica da metafísica ontológica tradicional e como fundação de uma metafísica da relacionalidade absoluta que supera a relatividade do pensar moderno do entendimento.

  1. A new hypothesis of cause of syncope: trigeminocardiac reflex during extraction of teeth. (United States)

    Arakeri, Gururaj; Arali, Veena


    Transient Loss Of Consciousness (TLOC) or vasovagal syncope is well known phenomenon in dental/maxillofacial surgery. Despite considerable study of vasovagal syncope, its pathophysiology remains to be fully elucidated. After having encountered a case of trigeminocardiac reflex after extraction of maxillary first molar we observed and studied 400 extractions under local anesthesia to know the relation between trigeminocardiac reflex and syncope. We make hypothesis that trigeminocardiac reflex which is usually seen under general anesthesia when all sympathetic reflexes are blunted can also occur under local anesthesia during extractions of maxillary molars (dento-cardiac reflex) and mediate syncope.

  2. Whooping Cough (United States)

    ... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

  3. Impact of current cough on health-related quality of life in patients with COPD

    Directory of Open Access Journals (Sweden)

    Deslee G


    Full Text Available Gaëtan Deslee,1 Pierre-Régis Burgel,2 Roger Escamilla,3 Pascal Chanez,4 Isabelle Court-Fortune,5 Pascale Nesme-Meyer,6 Graziella Brinchault-Rabin,7 Thierry Perez,8 Gilles Jebrak,9 Denis Caillaud,10 Jean-Louis Paillasseur,11 Nicolas Roche2On behalf of the Initiatives BPCO Scientific Committee 1Department of Respiratory Diseases, INSERM UMR 903, Maison Blanche Hospital, University Hospital of Reims, Reims, 2Department of Respiratory Diseases, Cochin Hospital, AP-HP and University Paris Descartes, Sorbonne Paris Cité, Paris, 3Department of Respiratory Diseases, Larrey Hospital, Toulouse, 4Department of Respiratory Diseases, APHM, INSERM U1077, CNRS UMR 7733 Aix Marseille Université, Marseille, 5Department of Respiratory Diseases, University Hospital of St Etienne, 6Department of Respiratory Diseases, La Croix Rousse Hospital, Lyon, 7Department of Respiratory Diseases, Pontchaillou Hospital, University Hospital of Rennes, Rennes, 8Department of Respiratory Diseases, Calmette Hospital, University Hospital of Lille, Lille, 9Department of Respiratory Diseases, Bichat Hospital, AP-HP, Paris, 10Department of Respiratory Diseases, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, 11EFFI-STAT, Paris, FranceBackground: Cough and sputum production are frequent in chronic obstructive pulmonary disease (COPD. The objective of this study was to examine the relationship between cough and sputum production and health-related quality of life in COPD.Methods: A cross-sectional study was conducted in the French Initiatives COPD cohort and assessed cough and sputum production within the past 7 days using the cough and sputum assessment questionnaire (CASA-Q, health-related quality of life, spirometry, smoking status, dyspnea, exacerbations, anxiety and depression, and comorbidities.Results: One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69] years, 128 male, forced expiratory volume in 1 second

  4. [Serological evaluation of Bordetella pertussis infection in adults with prolonged cough]. (United States)

    Sönmez, Cemile; Çöplü, Nilay; Gözalan, Ayşegül; Yılmaz, Ülkü; Bilekli, Selen; Demirci, Nilgün Yılmaz; Biber, Çiğdem; Erdoğan, Yurdanur; Esen, Berrin; Çöplü, Lütfi


    Pertussis is a vaccine-preventable disease that is transmitted from infected to susceptible individuals by respiratory route. Bordetella pertussis infection may occur at any age as neither vaccine nor natural infection induced immunity lasts life-long. This study was planned to demonstrate the serological evidence of infection among adults, to raise awareness among clinicians and to provide data for the development of strategies to protect vulnerable infants. A total of 538 patients (345 female, 193 male) ages between 18-87 years who had a complain of prolonged cough for more than two weeks were included in the study. Anti-pertussis toxin (PT) IgG and anti-filamentous hemagglutinin (FH) IgG levels from single serum samples were measured by an in-house ELISA test which was standardized and shown to be efficient previously. Anti-PT IgG antibody levels of ≥ 100 EU/ml were considered as acute/recent infection with B.pertussis. In our study, 9.7% (52/538) of the patients had high levels of anti-PT IgG (≥ 100 EU/ml) and among those patients 43 (43/52; 82.7%) also had high (≥ 100 EU/ml) anti-FHA IgG levels. There were no statistically significant differences in terms of age, gender, education level, DPT (diphtheria-pertussis-tetanus) vaccination history, smoking history or average daily cigarette consumption (p> 0.05) between the cases with high antibody levels (n= 52). When the symptoms and the presence of cases with high antibody levels were evaluated, it was detected that no one parameter was significantly different from others, except that 24.1% of the cases with inspiratory whooping had high anti-PT levels. There was also no statistically significant difference between high anti-PT levels ≥ 100 EU/ml and the patients with risk factors [smoking (21/200; 10.5%), presence of disease that cause chronic cough and/or drug usage (19/171; %11.1), and whole factors which cause chronic cough (32/306; %10.5)] and without risk factors (p= 0.581; p= 0.357; p= 0

  5. Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial. (United States)

    O'Grady, Kerry-Ann F; Grimwood, Keith; Toombs, Maree; Sloots, Theo P; Otim, Michael; Whiley, David; Anderson, Jennie; Rablin, Sheree; Torzillo, Paul J; Buntain, Helen; Connor, Anne; Adsett, Don; Meng Kar, Oon; Chang, Anne B


    Acute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care. A multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (Ethics Committees have approved the study. The study will inform best-practice management of cough in children. ACTRN12615000132549. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. Bordetella Pertussis virulence factors in the continuing evolution of whooping cough vaccines for improved performance. (United States)

    Dorji, Dorji; Mooi, Frits; Yantorno, Osvaldo; Deora, Rajendar; Graham, Ross M; Mukkur, Trilochan K


    Despite high vaccine coverage, whooping cough caused by Bordetella pertussis remains one of the most common vaccine-preventable diseases worldwide. Introduction of whole-cell pertussis (wP) vaccines in the 1940s and acellular pertussis (aP) vaccines in 1990s reduced the mortality due to pertussis. Despite induction of both antibody and cell-mediated immune (CMI) responses by aP and wP vaccines, there has been resurgence of pertussis in many countries in recent years. Possible reasons hypothesised for resurgence have ranged from incompliance with the recommended vaccination programmes with the currently used aP vaccine to infection with a resurged clinical isolates characterised by mutations in the virulence factors, resulting in antigenic divergence with vaccine strain, and increased production of pertussis toxin, resulting in dampening of immune responses. While use of these vaccines provide varying degrees of protection against whooping cough, protection against infection and transmission appears to be less effective, warranting continuation of efforts in the development of an improved pertussis vaccine formulations capable of achieving this objective. Major approaches currently under evaluation for the development of an improved pertussis vaccine include identification of novel biofilm-associated antigens for incorporation in current aP vaccine formulations, development of live attenuated vaccines and discovery of novel non-toxic adjuvants capable of inducing both antibody and CMI. In this review, the potential roles of different accredited virulence factors, including novel biofilm-associated antigens, of B. pertussis in the evolution, formulation and delivery of improved pertussis vaccines, with potential to block the transmission of whooping cough in the community, are discussed.

  7. Síndrome coqueluchoide y tos ferina Pertussis-like syndrome and whooping cough

    Directory of Open Access Journals (Sweden)

    Carlos Dotres Martínez


    Full Text Available El síndrome coqueluchoide, cuadro parecido a la tos ferina, es uno de los síndromes respiratorios bajos más comunes en la práctica pediátrica sobre todo en los últimos años. La tos ferina sigue siendo la enfermedad inmunoprevenible más antigua de la infancia que aún causa brotes importantes, principalmente en niños, pero también en adolescentes y adultos. El objetivo de esta revisión es proporcionar información a todos los médicos generales y pediatras de atención primaria y secundaria de salud sobre este problema epidemiológico y de su actual reemergencia. El control de esta enfermedad es un problema de salud tanto en países desarrollados como en vías de desarrollo. Uno de los mayores obstáculos que ha contribuido a una tardía intervención epidemiológica y tratamiento de la tos ferina en varios países del mundo, ha sido la baja sospecha clínica de esta enfermedad en los médicos y trabajadores de la salud, y el desconocimiento de la familia, en la mayoría de las veces. En el momento actual existe una reemergencia mundial de la tos ferina, situación que es necesario conocer y aceptar para un oportuno diagnóstico y tratamiento.Pertussis-like syndrome, a clinical picture similar to whooping cough, is one of the most common lower respiratory syndromes in the pediatric practice in recent years. Whooping cough continues to be one of the oldest preventable diseases in infants, which still causes significant outbreaks mainly in children, but also in adolescents and adults. The objective of this review was to provide general physicians and pediatricians at the primary and the secondary health care levels with information about this present re-emerging epidemiological problem. The management of this disease is difficult for both the developed and the developing countries. One of the major obstacles that lead to delayed epidemiological intervention and treatment of whooping cough in several countries has been the poor clinical

  8. Incidence of Mycobacterium tuberculosis in the sputa of coughing inmates in selected Ghanaian prisons

    International Nuclear Information System (INIS)

    Gyamfi, O.K.; Bedzra, K.D.; Biney, E.; Marfo, K.; Khan, B.K.; Bonsu, F.A.; Addo, K. K.


    One hundred and ninety-five (195) inmates, from eight (8) selected prisons within Ghana's penal system, each with an active cough of at least one week (as the inclusion criterion) were made to submit two sputum samples each for screening for Mycobacterium tuberculosis (MTB) using culture and subsequent microscopy and biochemical speciation tests. This sampling population was made up of 111 convicts and 84 remand prisoners. Forty eight (48) or 24.6% of these sputum samples returned a positive growth of MTB on Loweinstein-Jensen (LJ) slants. All growths harvested were also acid-fast on Ziehl-Neelsen (ZN) microscopy. Out of the 111 convicted prisoners, 26 (or 23.4%) gave sputum samples which returned a positive growth on culture. On the other hand out of the 84 remanded inmates, 22 (or 26.2%) were positive on culture. Of all the total sputum samples returning a positive growth on culture, 54.2% (26/48) was from convicted inmates who made up 56.9% (111/195) of the sampling population whilst remanded inmates who made up only 39.3% (84/195) of our sampling population were responsible for 43.1% (22/54) of all positive culture growths. The percentage of MTB growths on culture in the sputa from coughing inmates domiciled in individual cells of selected prisons are interesting and instructive. The highest number of coughing inmates sampled in a single individual cell was 9 out of which 55.6% (5/9) had sputa giving a positive growth of MTB on culture. The percentage of positive growths of sputa obtained from coughing inmates in individual cells ranged from 20% (1/5) to 100% (1/1 and 2/2) for the selected prisons. A batch of samples (N=19) obtained from isolated inmates symptomatic for TB and at various stages of the DOTS chemotherapy were also analysed. Six (6) samples were positive on culture. Four (4) of these samples emanated from inmates on DOTS chemotherapy for periods between 69 and 290 days whilst the other 2 emanated from inmates on treatment for a period less than 60

  9. Teacher education and the challenges of the reflexive practice

    Directory of Open Access Journals (Sweden)

    Maria Regina Peres


    Full Text Available This article approaches the importance of teacher practice and their initial and continuing education in the light of the challenges offered by the critical reflexive proposal. The aims of this study were to investigate the underlying assumptions regarding teachers’ current education and practice, to research and analyze the major difficulties found in the development of teaching practice, to comprehend and analyze the complexity inherent to the teacher’s performance in the initial years of elementary school. A bibliographic research and a qualitative research with elementary school teachers were therefore developed. The results indicate that although teachers believe the learning process to be continuous, they do not invest in this type of education. Furthermore it was found that teachers’ critical reflexive attitudes are blended with eproductivist attitudes.

  10. Correlation of gastroesophageal reflex with aspiration pneumonia after surgery

    International Nuclear Information System (INIS)

    Hirashima, Tokuji; Hashimoto, Hajime; Noro, Toshio; Takahashi, Tadao; Hino, Yasunori; Kuroiwa, Kouzirou


    In order to elucidate the correlation of gastroesophageal reflex (GER) with aspiration pneumonia after surgery, 48 patients (mean, 75.6 years) with gastric cancer treated at the hospital from March, 1994 to December, 1994 were subjected to this prospective study. The pharyngeal stimulation test, nutritional assessment, radionuclide esophageal scintigraphy (34 cases) were performed before surgery and relationship between those results and aspiration pneumonia were studied. Aspiration pneumonia occurred in 3 cases, and all of them were in, significantly, poor nutritional status, compared with other. A significant increase in the frequency of GER was observed when a naso-gastric tube (NGT) was placed, but surprisingly, all the patients with aspiration pneumonia were 3 out of 4 patients who had continuous GER without NGT. It is noteworthy, continuous GER without NGT was significantly (p<0.001) affected postoperative aspiration pneumonia and impaired phalyngeal reflex was frequently correlated with development of aspiration pneumonia, when malnutritional status existed. (author)

  11. [Spasm of the near reflex. Treatment with botulinum toxin]. (United States)

    Merino, P; Rojas, P; Gómez de Liaño, P; Franco Iglesias, G


    A 38-year old female with diplopia and esotropia, with limitation of ocular abduction in both eyes, with full abduction after doll's head rotation also being observed. She was diagnosed with spasm of the near reflex. Treatment with injections of botulinum toxin in both medial rectus has temporally resolved the convergence spasm. Near reflex spasm is characterized as miosis, pseudomyopia, and convergent strabismus that lead to diplopia, blurred vision, headache, and variable, progressive, and intermittent esotropia. As the spasm worsens there will be limited ocular versions and ductions simulating a sixth nerve palsy. Botulinum toxin may be effective in some cases. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Explicating Positionality: A Journey of Dialogical and Reflexive Storytelling

    Directory of Open Access Journals (Sweden)

    Celina Carter MN


    Full Text Available Qualitative researchers must be aware of and explicit about their social background as well as political and ideological assumptions. To facilitate this awareness, we believe that researchers need to begin with their own story as they seek to understand the stories of others. Taking into account the vulnerable act of storytelling, it is salient to consider how to share personal narratives in an authentic way within academic settings. In this article, we share our process and reflections of engaging in reflexive and dialogical storytelling. The focus of the article is the re-storying of one researcher's experience as she and her research team explore her emotions and positionality prior to conducting research on First Nations men's narratives of identity. We integrate a series of methodological lessons concerning reflexivity throughout the re-storying.

  13. Creating safety by strengthening clinicians' capacity for reflexivity (United States)


    This commentary explores the nature of creating safety in the here-and-now. Creating safety encompasses two dimensions: revisiting specific behaviours by focusing on substandard performance (reflection), and a more broad-ranging attention to everyday behaviours that are taken as given (reflexivity). The piece pays particular attention to this second dimension of creating safety. Two techniques that promote reflexivity are discussed: video-filming real-time, everyday clinical practice and inviting clinicians' feedback about their own footage, and reflecting on the knowledge and questions that patients and families have about their care, and about unexpected outcomes and clinical incidents. The piece concludes that feedback about everyday practice using these methods is critical to enhancing the safety of everyday activity. PMID:21450780

  14. Review Essay: Grenzgänger Seeks Reflexive Methodology

    Directory of Open Access Journals (Sweden)

    Wolff-Michael Roth


    Full Text Available Reflexive Methodology reviews major strands of current thought in epistemology, philosophy, social science, and interpretive methods. The book falls short in that it neither does a thorough job reviewing the literature nor does it provide method-related advice useful to students. Grenzgängerin constitutes a collection of essays on a broad range of topics, but which are only loosely connected if at all. Drawing on DERRIDA and the notion of a historical science of the historical subject, I attempt to practice method, something I missed in both texts. I make explicit the historical nature of my own writing and the historical nature of my subject. I make explicit intertextuality and in the process practice reflexivity in the particular way I am writing. URN: urn:nbn:de:0114-fqs020328

  15. Cortical tremor: a variant of cortical reflex myoclonus. (United States)

    Ikeda, A; Kakigi, R; Funai, N; Neshige, R; Kuroda, Y; Shibasaki, H


    Two patients with action tremor that was thought to originate in the cerebral cortex showed fine shivering-like finger twitching provoked mainly by action and posture. Surface EMG showed relatively rhythmic discharge at a rate of about 9 Hz, which resembled essential tremor. However, electrophysiologic studies revealed giant somatosensory evoked potentials (SEPs) with enhanced long-loop reflex and premovement cortical spike by the jerk-locked averaging method. Treatment with beta-blocker showed no effect, but anticonvulsants such as clonazepam, valproate, and primidone were effective to suppress the tremor and the amplitude of SEPs. We call this involuntary movement "cortical tremor," which is in fact a variant of cortical reflex myoclonus.

  16. Impact of cough and common cold on productivity, absenteeism, and daily life in the United States: ACHOO Survey. (United States)

    Dicpinigaitis, Peter V; Eccles, Ron; Blaiss, Michael S; Wingertzahn, Mark A


    Although the common cold is among the most frequent ailments encountered in clinical practice, little is known about its impact on productivity, absenteeism, and daily life. The United States Attitudes of Consumers Toward Health, Cough, and Cold (ACHOO) survey was developed to inform healthcare providers on patients' experience of cough/cold. This analysis focuses on the impact of cough/cold on daily activity, productivity, and absenteeism; other results are reported elsewhere. ACHOO was a 36-question online survey. US adult Internet/mobile device users (N = 3333) were recruited in October 2012. Response quotas modeled on 2010 US Census data ensured a demographically representative sample; 75% of completed surveys were randomized as the primary analysis pool. Demographics and impact of cough/cold were reported using means, frequencies, and percentages. Weighted least squares regression or weighted paired t-test were used to identify factors associated with greater impact. The analysis pool (N = 2505) included 1342 (53.6%) women and 1163 (46.4%) men (mean ages, 46.7 and 45.9 years). A majority (84.7%) had ≥1 cold in the past year. Fifty-two percent said cough/cold impacted daily life a fair amount to a lot. Productivity decreased by a mean 26.4%, and 44.5% of respondents reported work/school absenteeism (usually 1-2 days) during a cold. Overall, 93% of survey participants reported sleep difficulty (slight to extreme) during a cough/cold. Among all respondents, 57% reported cough or nasal congestion as the symptoms making sleep difficult. Higher frequency of colds, more cold symptoms, difficulty sleeping, and worse overall health status correlated with greater impact on productivity, absenteeism, and daily life. Study limitations include the potential for recall bias given the retrospective nature of the self-reports. Furthermore, no attempt was made to distinguish treatment effects, if any, from those of the underlying cough/cold. To our knowledge, this is

  17. ESO Reflex: A Graphical Workflow Engine for Data Reduction (United States)

    Hook, R.; Romaniello, M.; Péron, M.; Ballester, P.; Gabasch, A.; Izzo, C.; Ullgrén, M.; Maisala, S.; Oittinen, T.; Solin, O.; Savolainen, V.; Järveläinen, P.; Tyynelä, J.


    Sampo {} (Hook et al. 2005) is a project led by ESO and conducted by a software development team from Finland as an in-kind contribution to joining ESO. The goal is to assess the needs of the ESO community in the area of data reduction environments and to create pilot software products that illustrate critical steps along the road to a new system. Those prototypes will not only be used to validate concepts and understand requirements but will also be tools of immediate value for the community. Most of the raw data produced by ESO instruments can be reduced using CPL {} recipes: compiled C programs following an ESO standard and utilizing routines provided by the Common Pipeline Library. Currently reduction recipes are run in batch mode as part of the data flow system to generate the input to the ESO VLT/VLTI quality control process and are also made public for external users. Sampo has developed a prototype application called ESO Reflex {} that integrates a graphical user interface and existing data reduction algorithms. ESO Reflex can invoke CPL-based recipes in a flexible way through a dedicated interface. ESO Reflex is based on the graphical workflow engine Taverna {} that was originally developed by the UK eScience community, mostly for work in the life sciences. Workflows have been created so far for three VLT/VLTI instrument modes ( VIMOS/IFU {}, FORS spectroscopy {} and AMBER {}), and the easy-to-use GUI allows the user to make changes to these or create workflows of their own. Python scripts and IDL procedures can be easily brought into workflows and a variety of visualisation and display options, including custom product inspection and validation steps, are available.

  18. Peripheral δ-opioid receptors attenuate the exercise pressor reflex. (United States)

    Leal, Anna K; Yamauchi, Katsuya; Kim, Joyce; Ruiz-Velasco, Victor; Kaufman, Marc P


    In rats with ligated femoral arteries, the exercise pressor reflex is exaggerated, an effect that is attenuated by stimulation of peripheral μ-opioid receptors on group IV metabosensitive afferents. In contrast, δ-opioid receptors are expressed mostly on group III mechanosensitive afferents, a finding that prompted us to determine whether stimulation of these opioid receptors could also attenuate the exaggerated exercise pressor reflex in "ligated" rats. We found femoral arterial injection of [D-Pen2,D-Pen5]enkephalin (DPDPE; 1.0 μg), a δ-opioid agonist, significantly attenuated the pressor and cardioaccelerator components of the exercise pressor reflex evoked by hindlimb muscle contraction in both rats with ligated and patent femoral arteries. DPDPE significantly decreased the pressor responses to muscle mechanoreflex activation, evoked by tendon stretch, in ligated rats only. DPDPE (1.0 μg) had no effect in either group on the pressor and cardioaccelerator responses to capsaicin (0.2 μg), which primarily stimulates group IV afferents. DPDPE (1.0 μg) had no effect on the pressor and cardioaccelerator responses to lactic acid (24 mM), which stimulates group III and IV afferents, in rats with patent femoral arteries but significantly decreased the pressor response in ligated rats. Western blots revealed the amount of protein comprising the δ-opioid receptor was greater in dorsal root ganglia innervating hindlimbs with ligated femoral arteries than in dorsal root ganglia innervating hindlimbs with patent femoral arteries. Our findings support the hypothesis that stimulation of δ-opioid receptors on group III afferents attenuated the exercise pressor reflex.

  19. Spinal mechanism of micturition reflex inhibition by naftopidil in rats. (United States)

    Sugaya, Kimio; Nishijima, Saori; Kadekawa, Katsumi; Ashitomi, Katsuhiro; Ueda, Tomoyuki; Yamamoto, Hideyuki


    We investigated the spinal mechanism through which naftopidil inhibits the micturition reflex by comparing the effects of noradrenaline and naftopidil in rats. The following were investigated: the influence of oral naftopidil on plasma monoamine and amino acid levels, the distribution of oral 14C-naftopidil, the effects of intravenous (IV) or intrathecal (IT) injection of noradrenaline or naftopidil on isovolumetric bladder contractions, amino acid levels in the lumbosacral spinal cord after IT noradrenaline or naftopidil, and the effects of IT naftopidil and strychnine and/or bicuculline on isovolumetric bladder contractions. Oral naftopidil decreased the plasma adrenaline level, while it increased the serotonin and glycine levels. After oral administration, 14C-naftopidil was detected in the spinal cord and cerebrum, as well as in plasma and the prostate gland. When the bladder volume was below the threshold for isovolumetric reflex contractions, IV (0.1mg) or IT (0.1μg) noradrenaline evoked bladder contractions, but IV (1mg) or IT (0.01-1μg) naftopidil did not. When the bladder volume was above the threshold for isovolumetric reflex contractions, IV or IT noradrenaline transiently abolished bladder contractions. IT noradrenaline decreased the levels of glycine and gamma-aminobutyric acid (GABA) in the lumbosacral cord, while IT naftopidil increased the GABA level. IT strychnine and/or bicuculline blocked the inhibitory effect of IT naftopidil on bladder contractions. Naftopidil inhibits the micturition reflex by blocking α1 receptors, as well as by the activation of serotonergic, glycinergic, and GABAergic neurons in the central nervous system. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. In vivo antitussive activity of Coccinia grandis against irritant aerosol and sulfur dioxide-induced cough model in rodents

    Directory of Open Access Journals (Sweden)

    Shakti Prasad Pattanayak and Priyashree Sunita


    Full Text Available Coccinia grandis (Cucurbitaceae has extensively used to get relief from asthma and cough by the indigenous people of India. The antitussive effect of aerosols of two different concentrations (2.5%, 5% w/v of methanol extract of C. grandis fruits were tested by counting the numbers of coughs produced due to aerosols of citric acid, 10 min after exposing the male guinea pigs to aerosols of test solutions for 7 min. In another set of experiment methanol extract was investigated for its therapeutic efficacy on a cough model induced by sulfur dioxide gas in mice. The results showed significant reduction of cough number obtained in the presence of both concentrations of methanol extract as that of the prototype antitussive agent codeine phosphate. Also, methanol extract exhibited significant antitussive effect at 100, 200 and 400 mg/kg, per orally by inhibiting the cough by 20.57, 33.73 and 56.71% within 90 min of performing the experiment respectively.