Asthma Severity: The Patient's Perspective

Background: Although asthma is a common condition, limited epidemiological data exists on the distribution or course of asthma severity. We know even less about how patients or parents rate the severity of their or their child's asthma or what factors they associate with more severe asthma. A large nationally diverse sample of asthma patients' self-assessment of severity is available but has not been analyzed to look at asthma severity from the patients' perspective. Method: Data from the “household” and “event” files from the 1999 Medical Expenditure Panel Survey were combined to obtain a distribution of patient-reported asthma severity and the health care utilization, medication usage, and personal characteristics associated with different levels of self-reported severity for that subgroup that answered the chronic disease portion of the survey. Results: Almost two thirds of patients (63% of adults) or parents (65% of children) described their or their child's asthma as very or somewhat serious. Among both children and adults, more severe asthma was associated with greater numbers of missed school and workdays, and lower overall health status. The associated differences in health utilization varied by age. Models of severity based on available NAEPP criteria explained less than 10% of the participant's variation in self-reported asthma severity. Conclusion: Parents and patients with asthma appear to use different metrics than physicians and researchers to define the more severe categories of asthma. This disparity suggests the need for an asthma measure that is more widely understood, and accepted by patients and clinicians to serve as a tool to improve asthma-related communications and the achievement of mutually determined therapy goals.     

Proflavine and light in the treatment of experimental herpetic ocular infections

The effect of purified proflavine and light exposure was assessed in rabbits whose eyes had been infected with one of two strains of herpesvirus. In comparing proflavine-light and placebo-light treatment, 0.1% proflavine administered twice daily for 5 days had a significant effect in suppressing herpetic eye disease, but 0.05% proflavine was less effective. In addition to being effective in infections with either virus strain, the 0.1% proflavine also suppressed intensity of corneal epithelial ulceration and stromal opacity in animals pretreated with subconjunctival corticosteroids to produce more severe disease. Proflavine or idoxuridine (IDU) alone or in combination showed no differences in suppressing herpetic ocular disease, but all were significantly more effective than placebo. Virus recovery rates were approximately the same from eyes treated with proflavine, IDU, or placebo, indicating that viral replication in the cornea and conjunctiva was not completely suppressed by either of the antiviral drugs alone or in combination.     

Association of Epstein-Barr virus with nasopharyngeal carcinoma in Alaskan native patients: serum antibodies and tissue EBNA and DNA

Biopsy specimens from Alaskan Native patients with nasopharyngeal carcinoma (NPC) and from other patients seen on the otolaryngology service were tested for Epstein-Barr virus-specific DNA and nuclear antigen (EBNA). Serum samples from both groups were tested for various EBV-related antibodies. EBV DNA and EBNA results were in agreement in 29 of 31 tissue specimens tested by the two methods. Ten of 11 biopsies containing NPC cells were positive for EBV DNA. Two NPC patients had biopsies that showed only atypical epithelium but were also positive for EBV DNA or EBNA. The other tissue specimens were negative except for biopsies from two patients: one with a parotid gland lymphoepithelial lesion; another with undifferentiated carcinoma of salivary gland origin.     

Tophaceous pseudogout

 We present an unusual case of tophaceous pseudogout in the atlantoaxial joint with progressive cervical cord compression symptoms and lack of additional clinical manifestations of CPPD crystal deposition disease. This represents only the fourth reported case in the medical literature.     

Application of Epstein-Barr virus serology to the diagnosis and staging of North American patients with nasopharyngeal carcinoma

From 1978 to 1981, 151 patients with nasopharyngeal carcinoma (NPC) were enrolled in a prospective, collaborative study of North American patients, most of them white. Thirty-seven had World Health Organization (WHO) type 1 tumors, and 114 had WHO types 2 and 3 tumors. The anti-Epstein-Barr virus (EBV) profile of elevated antibody titers directed against viral capsid antigen and early antigen was seen in 85% of the patients with WHO types 2 and 3 tumors but in only 16% of the patients with WHO type 1 tumors. Geometric mean titers tended to be higher in higher stages of the disease in several staging systems. Low antibody-dependent cellular cytotoxicity at diagnosis appears to reflect a poorer prognosis, and the determination of antibody titers by this assay may prove to be useful for identifying persons in whom recurrent disease is likely to develop after conventional therapy. Anti-EBV titers can aid in diagnosis and treatment planning in patients with NPC, particularly those with occult primary NPC.     

Axial length in keratoconus.

Axial length is a major determinant of ocular refractive power that has not been well established for keratoconus eyes. The purpose of this study was to establish the mean and range of axial length among both keratoconus eyes with no previous surgery and postkeratoplasty keratoconus eyes, and to determine if there is a significant reduction of axial length following variations in surgical techniques in penetrating keratoplasty. The axial length of 157 keratoconus eyes with no previous surgery was measured using applanation ultrasonography. The mean axial length measurement was 24.39 (+/- 1.13 mm), with a range of 21.82-28.69 mm. The axial length of 66 postkeratoplasty keratoconus eyes was similarly measured. The mean axial length measurement was 24.10 (+/- 1.22 mm), with a range of 21.83-26.87 mm. These values are not significantly different from the axial length mean and range found among emmetropic eyes. A significant shortening of the axial length (F = 5.2, p = 0.04) was obtained in the postoperative penetrating keratoplasty eye if the donor trephine was 0.3 mm smaller in diameter than the recipient trephine. The axial length of individual keratoconus eyes is a major factor in determining postoperative refractive error. It therefore becomes important when considering variations in surgical procedures to reduce postoperative myopia.     

Oesophageal cancer among Alaskan natives, 1955-1981

Forty-two patients with oesophageal cancer were identified among Alaskan Natives from 1955 through 1981. Based on rates for US whites, there were 1.3 and 3.8 times the number of Native men and women diagnosed with oesophageal cancer as expected. Forty of the patients were Eskimo or Aleut, resulting in an incidence for Eskimo-Aleuts of 10.9 for males and 8.3 for females per 100 000 adjusted to the world standard population. The distribution of cancer patients by residence at diagnosis showed marked regional clustering, which has been observed among oesophageal cancer patients in several other areas of the world.