Magnetic resonance imaging of inflammatory lung disorders: preliminary studies in children

Magnetic resonance(MR) scans were performed on 14 children with a variety of inflammatory disorders of the lungs. MR successfully identified disease in all of the children and accurately localized the disease within the lung fields. In patients with pneumonia and lung abscesses the acute inflammation was associated with a marked increase in signal intensity on T2 when compared with T1 weighted images. One patient with an inflammatory pseudotumor demonstrated a smaller increase in signal intensity on T2 weighted images than was seen in acute pneumonia. Abscess cavities were well identified along with the wall thickness. In patients with diffuse lung disease (diffuse histoplasmosis, miliary tuberculosis, Letterer-Siwe disease, and allergic alveolitis), each disease appeared different on the MR images. These preliminary studies indicate that magnetic resonance imaging is effective for identifying pulmonary disease in children and may improve the radiologist's ability to differentiate pulmonary disorders.     

成人和儿童纤维支气管镜治疗支气管结核病的初步疗效比较

目的比较成人和儿童纤维支气管镜治疗支气管结核病（EBTB）的初步疗效。方法 46例确诊的EBTB分为全身化疗＋成人纤支镜局部治疗组（A组）和全身化疗＋儿童纤支镜局部治疗组（A组）,A组和B组均为23例。结果根据临床表现、胸部X片检查、支气管镜检查、痰检评价疗效A组和B组的有效率分别为69.6%和95.7%（P=0.047）、78.3%和100%（P=0.047）、73.9%和95.7%（P=0.096）、87.0%和91.3%（P=0.665）。结论联合全身化疗和儿童支气管镜内给药治疗EBTB的疗效、患者耐受性和可行性均较好。     

Predictors of health-related quality of life among older adults living with HIV in Thailand: results from the baseline and follow-up surveys

ABSTRACT

The current longitudinal study consisted of baseline and follow-up surveys among older adults living with HIV (OALHIV) in Thailand. The health-related quality of life (HRQoL) was assessed using the Medical Outcomes Study HIV (MOS-HIV) questionnaire. We performed multiple linear regression analysis to document correlates of HRQoL at baseline and the predictors of the changes in HRQoL at follow-up. Of the 364 participants recruited at baseline; 327 (89.9%) completed the follow-up survey. The mean (SD) Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were respectively 49.8 (7.3) and 53.2 (6.4). There was a significant increase in the mean score of most of the MOS-HIV domains, ranging between 1.3 for the PHS and 26.9 for the energy/fatigue dimension. In contrast, the mean score significantly decreased by 4.1 and 10.3 points, respectively for the cognitive and social functioning. Female gender was a predictor of the decline in social (β?=??11.37; P?=?0.031) and cognitive (β?=??8.05; P?=?0.002) functioning at follow-up, while being married was related to an increase of in the score of energy/fatigue (vitality) (β?=?5.98; P?=?0.011) at follow-up. Physical exercise was associated with an increase in social functioning (β?=?9.38; p?=?0.042). Overall the HRQoL of OALHIV improved or was maintained over time.     

Performance of the DIDGET blood glucose monitoring system in children, teens, and young adults

Background

This study evaluated the performance of the DIDGET® blood glucose monitoring system (BGMS) in the hands of its intended users: children, teens, and young adults with diabetes.

Methods

Finger stick capillary blood samples were tested in duplicate by subjects (with parent/guardian assistance, if needed) and health care professionals using the DIDGET BGMS, and results were compared with those obtained using a Yellow Springs Instruments (YSI) glucose analyzer. Modified venous blood samples (i.e., glycolyzed or spiked with glucose) were used to analyze meter performance under extreme glucose concentrations. Accuracy was assessed using International Organization for Standardization (ISO) 15197:2003 guidelines (i.e., 95% of meter results within ±15 mg/dl or ±20% of reference values).

Results

A total of 123 subjects aged 4 to 24 years with type 1 or type 2 diabetes were enrolled. The DIDGET meter achieved accuracy according to ISO 15197:2003 criteria: >97% of meter results were within ±15 mg/dl or ±20% of reference values. Regression analyses showed a high degree of correlation between meter and YSI results: coefficient of determination (R²) = 98.2% for all samples combined and 97.2% for capillary samples only. Clinical accuracy for combined samples was demonstrated by Parkes consensus error grid analyses; 100% of meter results were in zone A (98.5%) or zone B (1.5%). There was no difference in performance or accuracy across age subsets. Hematocrit values did not affect meter blood glucose results.

Conclusion

The DIDGET BGMS provided accurate test results across all age ranges in children, teens, and young adults with diabetes.     

Burden of asthma among children in a developing megacity: childhood asthma study,Pakistan

Objectives: Global burden of childhood asthma has increased in the past few decades, particularly in low-income countries. In Pakistan, there is a lack of community-based epidemiological studies estimating the burden of asthma among children. This study determined the prevalence and predictors of asthma among children 3–17 years of age in Karachi, Pakistan. Methods: A two-stage community-based representative cross-sectional survey was conducted in Karachi from March 2012 to April 2013 comprising 1046 children aged 3–17 years. Of 7500 clusters, 80 were randomly selected, and of these, 15 children per cluster were enrolled randomly. A translated and pre-tested version of International Study of Asthma and Allergies in Children questionnaire was administered. Results: The overall prevalence of asthma among study participants was 10.2% (95% CI: 8.4–12.0). Asthma was more likely to occur among boys (adj. OR: 2.5, 95% CI: 1.6–4.0), children in the younger age group (3–7 years) (adj. OR: 2.9, 95% CI: 1.7–4.8), those living in households with ill-ventilated kitchens (adj. OR: 1.8, 95% CI: 1.1–3.1), having family history of asthma (adj. OR: 2.3, 95% CI: 1.3–3.9) and those of the Sindhi ethnicity (adj. OR: 2.2, 95% CI: 1.1–4.4). Conclusion: This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.     

Prognosis of children with transposition of the great arteries, treated in a regional heart centre between 1967 and 1979

In an attempt to assess the changing prognosis of babies withtransposition of the great arteries, the clinical data of 121children diagnosed between January 1967 and December 1979 werereviewed. One hundred and four patients initially had balloon atrial septostomy;in 34 infants palliative operations (resection of ductus orcoarctation, banding of the pulmonary artery or aortic-pulmonaryanastomosis) were needed. Corrective surgery was performed accordingto the techniques of Mustard (43 patients), Senning (seven patients),Rastelli (five patients), or as an anatomic correction (twopatients). While 80% of the infants survived the first month of life, 25%died between then and corrective surgery. The mortality of theintra-atrial operations decreased from 28% before 1976 to 12%subsequently. Postoperative cardiac rhythm disturbances occurred in 39.4%of the children after Mustard's operation, hemodynamic complicationsin 24.2%. Neurological complications developed more frequently in childrenwith simple transposition (27.3%) than in children with complextransposition (18.2%). As a result of improvement in therapeutic and surgical regimens,the two-year survival rate showed a clear trend of increasefrom 48.5% between 1967–70 to 62.5% between 1977–79.     

Clinical significance of airway responsiveness in children of low birthweight

We report a prospective study of airway responsiveness in a cohort of 121 children of low birthweight (under 2,000 g) at 7 years and a random sample of 100 local schoolchildren of the same age. A positive airway response was defined as a 20% fall in peak expiratory flow rate in response to a cumulative histamine dose of 3 mumol or less. We found a moderate increase in airway responsiveness to inhaled histamine in the cohort (44%) compared with the reference group (22%). There was no significant association between airway responsiveness and any perinatal variables including the level of respiratory support. The findings suggested that neonatal respiratory illness or its treatment did not play a major role in determining the long-term airway responsiveness in these children. Amongst all factors examined, reduced airway function at the age of 7 was most strongly associated with airway responsiveness, independent of perinatal and familial factors. Airway responsiveness was associated with significantly more chest symptoms. We suggest that increased airway responsiveness to inhaled histamine in low birthweight children is a consequence rather than the cause of reduced airway function and argue against the presence of any other form of airway dysfunction as a cause of airway responsiveness.     

Prognostic value of different dead space indices in mechanically ventilated patients with acute lung injury and ARDS

STUDY OBJECTIVE: The aim of this prospective observational study was to evaluate the utility of derived dead space indexes to predict survival in mechanically ventilated patients with acute lung injury (ALI) and ARDS. Study population: Thirty-six patients with ALI (Murray score, > or =1; Pao(2)/fraction of inspired oxygen [Fio(2)] ratio, < 300) in critical care departments at two separate hospitals entered the study. MEASUREMENTS: At ICU admission, 24 h, and 48 h, we measured the following: simplified acute physiologic score II; Pao(2)/Fio(2) ratio; respiratory system compliance; and capnographic indexes (Bohr dead space) and physiologic dead space (Enghoff dead space [Vdphys/Vt]), expired normalized CO(2) slope, carbon dioxide output, and the alveolar ejection volume (Vae)/tidal volume fraction (Vt) ratio. RESULTS: The best predictor was the Vae/Vt ratio at ICU admission (Vae/Vt-adm) and after 48 h (Vae/Vt-48 h) [p = 0.013], with a sensitivity of 82% and a specificity of 64%. The difference between Vae/Vt-48 h and Vae/Vt-adm show a sensitivity of 73% and a specificity of 93% with a likelihood ratio (LR) of 10.2 and an area under the receiver operating characteristic (ROC) curve of 0.83. The interaction between the Pao(2)/Fio(2) ratio and Vae/Vt-adm predict survival (p = 0.003) with an area under the ROC curve of 0.84, an LR of 2.3, a sensitivity of 100%, and a specificity of 57%. The Vdphys/Vt after 48 h predicted survival (p = 0.02) with an area under the ROC curve of 0.75, an LR of 8.8, a sensitivity of 63%, and a specificity of 93%. Indexes recorded 24 h after ICU admission were not useful in explaining outcome. CONCLUSIONS: Noninvasive measures of Vae/Vt at ICU admission and after 48 h of mechanical ventilation, associated with Pao(2)/Fio(2) ratio provided useful information on outcome in critically ill patients with ALI.