The determinants of chronic bronchitis in Aboriginal children and youth

BACKGROUND:

There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples.

OBJECTIVE:

To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age.

METHODS:

Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: “Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB.

RESULTS:

The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000/year versus ≥$85,000/year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural/urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex.

DISCUSSION:

The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income.     

Pain Intensity Variability and Its Relationship With Quality of Life in Youths With Juvenile Idiopathic Arthritis

Objective

To describe variability of pain intensity experienced by youths with juvenile idiopathic arthritis (JIA) and examine factors related to within‐day patterns of pain and the relationship between magnitude of pain variability and quality of life.

Methods

Pain intensity was self‐reported on a visual analog scale (VAS; range 0–100) by 112 youths with JIA ages 8–18 years using electronic diaries 3 times per day for 7 days. Average absolute change in pain (AAC) was computed as a measure of the magnitude of pain variability for each participant. Logistic regression was used to examine the relationship between demographic and disease characteristics and the probability of having high pain variability (AAC ≥10 VAS units). Linear regression was used to examine the relationship between quality of life (assessed by the Pediatric Quality of Life Inventory) and AAC. The generalized estimating equations approach was used to examine the relationship between the time of day and pain intensity.

Results

The mean ± SD AAC was 15.6 ± 10.5. The majority of youths (65%) had high AAC (≥10 VAS units). Disease severity predicted high pain variability (β = 0.02, P = 0.044). Higher AAC predicted lower quality of life (adjusted R² = 0.194, β = ?0.59, P = 0.003). Within‐day patterns of pain intensity varied by JIA subtype and sex.

Conclusion

This study characterized the pain intensity variability experienced by youths with JIA. Pain variability throughout the day was common, varied by JIA subtype and sex, and was related to quality of life. These findings have implications for future pain research, patient education, and development of clinical interventions for this population.

     

First-in-man evidence of the mechanistic effects of biventricular pacing on coronary physiology

BackgroundNormal coronary blood flow is principally determined by a diastolic backward travelling decompression (suction) wave. Dyssynchronous heart failure may attenuate suction. We hypothesised that biventricular pacing, by restoring left ventricular (LV) synchronisation and improving LV relaxation, might increase this suction wave and coronary flow.MethodsTen patients with congestive heart failure (nine men; mean age 65 years [SD 12]; mean ejection fraction 26% [SD 7] with left bundle branch block (LBBB, mean QRS duration 174 ms [SD 18]) underwent atriobiventricular pacing at 100 beats per min. LV pressure was measured and wave intensity calculated from invasive coronary flow velocity and pressure, with native conduction (LBBB) and during biventricular pacing at atrioventricular (AV) delays of 40 ms (BiV-40), 120 ms (BiV-120), and separately pre-identified haemodynamically optimal AV delay (BiV-Opt). Data are given as median (IQR).FindingsCompared with LBBB, BiV-Opt enhanced coronary flow velocity time integral (VTI) by 15% (7–25, p=0·007), LV dP/dt_max by 17% (9–22, p=0·005), and _negdP/dt_max by 17% (9–22, p=0·005). The cumulative intensity of the diastolic backward decompression (suction) wave increased by 26% (18–54, p=0·005). Much of the increase in coronary flow VTI occurred in diastole (69% [41–84], p=0·047). The systolic compression waves also increased: forward by 36% (6–49; p=0·022) and backward by 38% (20–55, p=0·022). BiV-120 generated a smaller LV dP/dt_max (by 12% [5–23], p=0·013) and _negdP/dt_max (by 15% [8–40], p=0·009) increase than did BiV-OPT, with LBBB as reference; BiV-Opt and BiV-120 were not significantly different in coronary flow VTI or waves. BiV-40 was no different from LBBB.InterpretationWhen biventricular pacing improves left ventricular contraction and relaxation, it increases coronary blood flow velocity, predominantly by increasing the dominant diastolic backward decompression wave.FundingBritish Heart Foundation.     

Phyto-oestrogen Intake and Breast Cancer Risk in South Asian Women in England: Findings from a Population-based Case-Control Study

OBJECTIVE: This study investigates whether intake of phyto-oestrogens is associated with breast cancer risk in South Asian women from the Indian subcontinent, whose diet is rich in pulses and vegetables but poor in soyfoods. METHODS: A total of 240 South Asian breast cancer cases living in England and 477 age-matched population-based controls were recruited into the study. Dietary intake was measured using a validated food frequency questionnaire. Conditional logistic regression models were used to estimate the effect of phyto-oestrogen intake on breast cancer risk. RESULTS: After adjustment for known breast cancer risk factors and total energy intake, there was moderate evidence of a dose-effect response in the odds of breast cancer with isoflavone intake (p-value for trend 0.08), with women in the top quartile having approximately half the odds of breast cancer of those in the bottom one (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.33, 1.00) but with no reductions in the odds for women in the second and third quartiles. The ORs for second, third and highest quartiles of total lignan intake compared to the lowest were 0.78 (95% CI 0.48, 1.26), 0.74 (0.46, 1.19) and 0.66 (0.41, 1.07), respectively, again with moderate evidence of a linear dose-effect response (p-value for trend 0.09). Further adjustment for non-startch polysaccharides (NSP) intake slightly weakened the phyto-oestrogens-breast cancer associations. CONCLUSIONS: These findings are consistent with the possibility that high phyto-oestrogen intake may protect against breast cancer, but further research is required to confirm this hypothesis.     

Brainstem auditory evoked responses in infants and children with AIDS.

Brainstem auditory evoked responses were measured in 16 infants and children with acquired immunodeficiency syndrome (AIDS) and in 9 normal infants and children. Two stimulation rates were used: a conventional rate of 10 Hz and a high rate of 50 Hz. Latencies of waves III, IV, and V on the left were significantly longer in the AIDS group when a stimulation rate of 10 Hz was used. With a higher stimulation rate of 50 Hz, significant differences between the two groups occurred in the latencies of waves I, III, and V bilaterally, but there were no significant differences in the interpeak latencies. A measure of the differential effect of the increasing stimulus rate on the two groups was significant for wave I latency and for I-III and I-V interpeak latencies on the left, revealing that increasing stimulation rate prolongs these measures more in the AIDS group. Increased brainstem auditory evoked response stimulation rate may unmask abnormalities in infants and children with AIDS that are not observed when the lower stimulation rate is used.     

Role of FNA cytology and immunochemistry in the diagnosis and management of medullary thyroid carcinoma: report of six cases and review of the literature

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine thyroid malignancy. This study retrospectively reviewed 10 fine-needle aspiration samples from six MTC patients. Aspirated specimens were from thyroid (3), cervical lymph nodes (5), left lung (1), and anterior chest wall (1). Cytomorphology consisted predominantly of plasmacytoid cells (3 cases), spindle cells (2 cases), and epithelioid cells (1 case). However, all specimens had a mixture of other cell types and "salt and pepper" chromatin. Only one specimen showed Congo-red-positive amyloid. Calcitonin was expressed in 7/7 specimens. Four patients underwent surgical excision and MTC was confirmed in all four. Follow-up studies included serum calcitonin (3/6 cases) and imaging (2/6 cases). One patient had MTC associated with multiple endocrine neoplasia IIA syndrome and one had familial MTC with a history of MTC in mother. In conclusion, the cytomorphology of MTC is typical and calcitonin immunostain is a reliable method for confirming primary or metastatic MTC. Early cytological diagnosis of MTC positively impacted patient management. Follow-up with serum calcitonin and imaging is helpful in the early detection of recurrences.     

Gene therapy for hemoglobinopathies: are we there yet?

beta-Thalassemia and sickle cell disease constitute the most common single gene defect in humans and are characterized by absent/reduced and abnormal beta-globin, respectively. Patients with these hemoglobinopathies require chronic blood transfusions and rely on bone marrow transplant for a potential cure. Gene therapy provides a viable alternative by permanent correction of the defect in hematopoietic stem cells, but it has suffered from problems of vector instability, low viral titers, and variable expression of globin genes for more than a decade. This paper reviews the field of gene therapy for hemoglobinopathies with emphasis on the complexities of the beta-globin gene and its regulation, obstacles that have impeded progress, and recent advances in vector technology that will take this field forward toward the goal of successful genetic correction of these devastating diseases.