Dyspnea reproducibility in a rural Bangladesh population

Background and Aims: Dyspnea may signal serious disease with increased morbidity/mortality. Dyspnea screening would only be valid if reproducible. The study aim was to determine the reliability (reproducibility) of assessing dyspnea through a simple questionnaire among a rural population. Methods: Participants were recruited from a Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh. Dyspnea assessment used a questionnaire among 129 participants at two time points: at baseline and after 2 weeks to 9 months by trained physicians. All subjects were asked about the presence/absence of dyspnea in the last 6 months. At the second interview, a physician (blinded to questionnaire) conducted a clinical heart/lung examination and obtained a pulse oximeter reading. Results: Dyspnea prevalence by baseline questionnaire was 2.4%. Overall dyspnea reliability was 94% (121 out of 129). If the initial response was ‘yes’ for the presence of dyspnea, reliability was 91% (49 out of 54). For an initial response of ‘no’ for the presence of dyspnea, reliability was 96% (72 out of 75). The pulmonary examination and pulse oximeter readings were significantly more likely to be abnormal in those with dyspnea (P < 0.01). Conclusions: The reliability of a simple question on dyspnea is very high when obtained by physicians. Although validity was not the primary outcome, the increased likelihood of an abnormal chest examination or low pulse oximeter saturation for those reporting ‘yes’ to the dyspnea question suggests more significant underlying cardiopulmonary disease in those reporting recent dyspnea. Please cite this paper as: Pesola GR, Parvez F, Jasmin S, Hasan AKM R and Ahsan H. Dyspnea reproducibility in a rural Bangladesh population. The Clinical Respiratory Journal 2009; 3: 222–228.     

Association of a Monoamine Oxidase-A Gene Promoter Polymorphism With ADHD and Anxiety in Boys With Autism Spectrum Disorder

The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism in the promoter region of the MAO-A gene and severity of ADHD and anxiety in boys with ASD. Parents and teachers completed a DSM-IV-referenced rating scale for 5- to 14-year-old boys with ASD (n = 43). Planned comparisons indicated that children with the 4- versus 3-repeat allele had significantly (p < 05) more severe parent-rated ADHD inattention and impulsivity, and more severe teacher-rated symptoms of generalized anxiety. Our results support a growing body of research indicating that concomitant behavioral disturbances in children with ASD warrant consideration as clinical phenotypes, but replication with independent samples is necessary to confirm this preliminary finding.     

HIV risk behavior patterns, predictors, and sexually transmitted disease prevalence in the social networks of young Roma (Gypsy) men in Sofia, Bulgaria

OBJECTIVES AND GOAL: This research studied predictors of high-risk sexual practices and sexually transmitted disease (STD) prevalence among Roma (Gypsy) men's social networks in Sofia, Bulgaria. STUDY DESIGN: Fifty-four socially active individuals, approached in Roma neighborhood venues, recruited members (n = 296) of their own networks into the study. Participants completed sociometric and risk behavior interviews and were tested for chlamydia, gonorrhea, syphilis, and trichomonas. RESULTS: Men had a mean of 7 partners in the past year. Fifty-nine percent had multiple partners in the past 3 months. Seventy-three percent reported recent unprotected vaginal and 51% unprotected anal intercourse. Fifty-nine percent of men had sex with other men in the past year. Twenty-two percent had one of the STDs. The social network to which an individual belonged accounted for 23% to 27% of variance in predicting sexual risk behavior. CONCLUSIONS: One's social network was the most powerful predictor of HIV risk behavior. HIV/STD prevention interventions directed toward entire social networks are especially promising.     

Two hundred intrauterine exchange transfusions in severe blood incompatibilities

Two hundred intrauterine exchange transfusions were performed under local anesthesia in 107 cases of blood incompatibilities (60 fetuses with severe anemia and 47 with hydrops). Under sonographic guidance, depending on fetal and placental position, an optimal puncturing site was selected along the umbilical vein: placental insertion, fetal insertion, or fetal intraabdominal segment. Tests were immediately performed to confirm fetal origin of blood obtained and estimate hemoglobin level. Blood used for exchange transfusion was compatible with maternal blood and had a hematocrit value of 75%. Exchange transfusion was continued until a hemoglobin level of 16 gm/dl was reached. This procedure was first associated with intraperitoneal transfusions and was subsequently used independently once a month to maintain an adequate hemoglobin level. In 4 fetuses with hydrops, antenatal regression of this sign was observed in 33 cases (70.2%). Overall outcome of 107 fetuses after exchanges was 84 living neonates (78.5%), 15 deaths in utero, and eight neonatal deaths. The survival rate was 91.6% for fetuses without hydrops and 61.7% for those with hydrops. The advantage of exchange transfusion appears to be rapid and efficient correction of anemia with elimination of incompatible fetal red blood cells.     

Lung structural remodeling and pulmonary hypertension after myocardial infarction: complete reversal with irbesartan

OBJECTIVES: The severity of pulmonary hypertension associated with heart failure carries a poor prognosis. The lungs are very sensitive to the constrictive and proliferative effects of angiotensin-II and could represent a preferential target for this peptide. METHODS: Rats with large myocardial infarcts or sham surgery received the angiotensin-II receptor antagonist irbesartan (40 mg/kg/day) or vehicle for 2 or 8 weeks (n=5 to 8 for each group). Hemodynamic and morphometric measurements were obtained followed by immunohistochemistry, immunofluorescence analysis and electron microscopic characterization of lung sections. RESULTS: The infarct groups developed progressive pulmonary hypertension and right ventricular hypertrophy with elevated left ventricular filling pressures (all P<0.01). Despite similar infarct size, filling pressures were lower (P<0.01) while pulmonary hypertension and right ventricular hypertrophy were completely normalized by irbesartan. Isolated lungs pressure-flow relationships were identical at 2 weeks. At 8 weeks it was steepest and shifted upward in the infarct group (P<0.001), and completely normalized by irbesartan. Lung weight doubled after infarct with no evidence of pulmonary edema and was also normalized by irbesartan. Important lungs structural remodeling evidenced by collagen and reticulin deposition, thickening of the alveolar septa and proliferation of cells with ultrastructural characteristics of myofibroblasts (pericytes) were identified after infarct. CONCLUSIONS: After large myocardial infarct there is important pulmonary structural remodeling in which myofibroblasts (pericytes) proliferation may play an important role. This initially protective mechanism against high filling pressures could eventually contribute to the development of pulmonary hypertension and right ventricular hypertrophy. Future studies are needed to determine if angiotensin-II directly modulates pulmonary remodeling after myocardial infarct.