A 43-year-old African American woman presented to the emergency department with severe dyspnea, wheeze, and cough productive of white sputum. Three years earlier, she had been given a diagnosis of asthma based on symptoms of wheeze and cough; her treatment regimen included intermittent use of albuterol.
A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.
A 6-month-old boy has a 1-week history of dry cough that worsens at night. He has been wheezing intermittently for the past month. A 2-year-old girl has had severe nighttime cough, congestion, and fever for 2 days. She recently recovered from a respiratory illness of 1 month's duration. Chest radiographs of both patients are shown… Read More
Patients with asthma may be reluctant to exercise for fear of triggering an attack. You can reassure them that adequate control can allow them to participate in almost any physical activity they wish. Recommendations from the NIH offer guidance on prevention of exercise-induced bronchospasm… Read More
A 61-year-old man was admitted with the diagnosis of right lower lobe (RLL) pneumonia on the basis of RLL consolidation on his radiograph. He was treated with intravenous ceftriaxone and azithromycin. However, there was no improvement in his symptoms... Read More
PEDIATRIC SPIROMETRY OVERVIEW
Prof. Dominic Fitzgerald, a pediatric respiratory and sleep physician, reviews the basics about spirometry, and explains its use in children.
ABSTRACT: Recent advances in the management of hepatitis C virus (HCV) infection have improved the response to therapy. Predictors of a favorable response include infection with HCV genotype 2 or 3 (rather than genotype 1), low viral load, no fibrosis or only portal fibrosis, female sex, and... More »
To detect wheezing during forced
expiration in patients with dyspnea,
asthma, or reactive airway disease,
ask the patient to take a big breath
and exhale as if he or she were blowing
out the candles on a birthday
cake. More »
Long-term oxygen therapy (LTOT) improves both the length and quality
of life of hypoxemic patients with COPD. It is the only therapy that
clearly increases survival for selected patients with advanced stable COPD. More »
Is there a meaningful percentage of patients who contract Lyme disease but have
none of the early symptoms—neither the rash nor the flu-like symptoms (eg, fever,
myalgia, headache, and stiff neck)—and in whom the disease only becomes clinically
evident in a later stage when it is much harder to... More »
This condition, which accounts for
about 30% of cases of intestinal obstruction
among neonates, is characterized
by the inspissation of thick,
tenacious meconium in the bowel.
The most common cause is cystic fibrosis;
approximately 6% to 20% of infants
with cystic fibrosis have meconium
ileus.... More »
Inspissated, sticky, immobile meconium
causes this transient form of distal
colonic or rectal obstruction in newborns.
The incidence has been estimated
at 1 in 500 to 1000 live births.
The condition is thought to result
from dehydration of the meconium. More »
For 2 months, a 31-year-old woman had had dyspnea and
dull, continuous retrosternal pain. She was admitted to the
hospital, and a helical CT scan of the thorax identified a
saddle pulmonary embolism. An ultrasonogram revealed
deep venous thrombosis (DVT) in the left leg. Intravenous
heparin was... More »
This condition involves the invagination of a proximal
segment of bowel (the intussusceptum) into a more distal
segment (the intussuscipiens) (A). It occurs most
frequently in infants between the ages of 5 and 12
months and is a leading cause of intestinal obstruction
in children aged 2 months to 5... More »
Physicians are being under-reimbursed for vaccinations nearly half the time, according to new data released by athenahealth. Most physicians are properly reimbursed for the cost of the vaccine itself, but getting paid for administration of the vaccine is another matter.
A 56-year old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.
Purpose of review: This overview highlights recent experimental and epidemiological evidence for the programming effects of outdoor air pollution exposures during early development on lung function and chronic respiratory disorders, such as a
It is not known how many stroke patients die from fatal pulmonary complications such as aspiration pneumonia (AP) and choking each year in the United States. This study aimed to determine the frequency of reporting of AP or choking as a cause of death on death certificates with mention of stroke in the United States as a proxy measure of the incidence of dying from AP or choking among patients with stroke.
Respiratory syncytial virus (RSV) remains the leading cause of serious viral bronchiolitis and pneumonia in infants and young children throughout the world. The burden of disease is significant, with 70% of all infants being infected with RSV within the first year of their life. 40% of those children discharged from hospital have recurrent, repeated respiratory symptoms and wheezing for at least 10 years. The infection is also an important illness in the elderly and immunocompromised individuals. Ongoing symptoms relate to continued lung inflammation. One cytokine that is associated with RSV infection is IL-1, but the mechanism of activation remain unclear.|In the current study, we set out to decipher the molecular mechanisms of RSV-induced inflammasome activation.|Using deletion mutants of the virus and measuring IL-1 secretion, as well as caspase 1 expression via western blotting, we demonstrate that the NLRP3 inflammasome is activated through the small hydrophobic (SH) RSV
Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There is little data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries. The aim of our study was to analyze the epidemiology of NRVG in a pediatric hospital in Warsaw, Poland, where the majority of children was admitted due to respiratorytract infections. Retrospective chart analysis of 49,697 patients aged 0-18 hospitalized during 2006-2009 was performed. NRVG was defined as acute gastroeneterocolitis (>3 loose stools in 24 h or vomiting), confirmed with A rapid immunochromatographic test, if symptoms developed >48 h after admission. In total, 469 cases of NRVG were diagnosed. The cumulative attack rate of NRVG for the hospital was calculated as 0.97% (CI 0.86-1.02), the cumulative incidence density was 2.07/1000 bed-days (CI 2.01-2.13). The majority of NRVG were diagnosed at the General Pediatrics Ward (206 cases, 44%)
The purpose of this study was to estimate the incidence of postoperative pulmonary complications after hysterectomy for benign indications.|This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at the Cleveland Clinic from Jan. 1, 2001, to Dec. 31, 2009. Exclusion criteria incorporated patients who underwent hysterectomy for premalignant or malignant conditions. Pulmonary complications were defined as postoperative pneumonia, respiratory failure, atelectasis, and pneumothorax based on International classification of diseases, ninth revision, codes.|In the 9-year study period, 3226 women underwent hysterectomy for benign indications (abdominal, 38.4%; vaginal, 39.3%; laparoscopic, 22.3%). Ten of the 3226 women (0.3%; 95% confidence interval, 0.17-0.57%) who underwent hysterectomy were identified with postoperative pulmonary complications. Among the different types of hysterectomy, the incidence of pulmonary complications was not different
Specific International Classification of Diseases, Ninth Revision, codes for laparoscopic procedures introduced in 2008 allow a more accurate evaluation of laparoscopic colorectal surgery.|Using the Nationwide Inpatient Sample 2009, a retrospective analysis of surgical colorectal cancer and diverticulitis patients was conducted. Logistic regression was used to estimate odds ratios comparing the outcomes of laparoscopic, open, and converted surgery.|A total of 121,910 patients underwent resection for cancer and diverticulitis, 35.41% of whom underwent laparoscopic surgery. Compared with open surgery, laparoscopic surgery had lower postoperative complication rates, lower mortality, shorter hospital stays, and lower costs. Compared to open surgery, laparoscopic surgery independently decreased mortality, postoperative anastomotic leak, urinary tract infection, ileus or obstruction, pneumonia, respiratory failure, and wound infection. Converted surgery was independently associated with
Obstructive respiratory diseases, mainly the chronic obstructive pulmonary disease (COPD) and asthma, are associated with functional polymorphisms of xenobiotic-metabolizing enzymes (XMEs). To date, association for obstructive bronchitis has not been described.|In this study, we investigated the genotypes from 26 functional polymorphisms of 20 XMEs in children (n, 1028) at the age of 6 years from the German prospective birth cohort study (LISAplus) and analyzed the associations between genotypes and obstructive bronchitis.|For the first time, we found noteworthy gene-disease associations for the functional PON1 M55L and EPHX1 H139R polymorphisms and gene-environment associations for the functional COMT V158M and NQO1 P187S polymorphisms after stratification for maternal active smoking behaviour during pregnancy. The noteworthy associations were substantiated by the biological findings that all the risk genotypes belong to genes involved in oxidative stress and code for proteins with a
These include, but are not limited to, asthma, emphysema, chronic bronchitis, pneumonia irrnormal and immunocompromised hosts, pulmonary emboli, sleep-related breathing disorders, lung nodules and masses, tuberculosis, fungal infections, and
Another clue that a respiratorytract infection is due to a cold or flu is that these types of infections are very contagious, and can be spread from person-to-person. ... Anthrax is not contagious. Therefore, if family members and co-workers have