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Clowns Benefit Children Hospitalized for Respiratory Pathologies
Mario Bertini,Elena Isola,Giuseppe Paolone,Giuseppe Curcio
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1093/ecam/neq064
Abstract: The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG) and 22 children to the control group (CG). During their hospitalization, the children of the EG interacted with two clowns who were experienced in the field of pediatric intervention. All participants were evaluated with respect to clinical progress and to a series of physiological and pain measures both before and after the clown interaction. When compared with the CG, EG children showed an earlier disappearance of the pathological symptoms. Moreover, the interaction of the clown with the children led to a statistically significant lowering of diastolic blood pressure, respiratory frequency and temperature in the EG as compared with the control group. The other two parameters of systolic pressure and heart frequency yielded results in the same direction, without reaching statistical significance. A similar health-inducing effect of clown presence was observed on pain parameters, both by self evaluation and assessment by nurses. Taken together, our data indicate that the presence of clowns in the ward has a possible health-inducing effect. Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings.
Regulation of TB Vaccine-Induced Airway Luminal T Cells by Respiratory Exposure to Endotoxin  [PDF]
Xuerong Chen, Fangming Xiu, Carly N. Horvath, Daniela Damjanovic, Niroshan Thanthrige-Don, Mangalakumari Jeyanathan, Zhou Xing
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041666
Abstract: Tuberculosis (TB) vaccine-induced airway luminal T cells (ALT) have recently been shown to be critical to host defense against pulmonary TB. However, the mechanisms that maintain memory ALT remain poorly understood. In particular, whether respiratory mucosal exposure to environmental agents such as endotoxin may regulate the size of vaccine-induced ALT population is still unclear. Using a murine model of respiratory genetic TB vaccination and respiratory LPS exposure, we have addressed this issue in the current study. We have found that single or repeated LPS exposure increases the number of antigen-specific ALT which are capable of robust secondary responses to pulmonary mycobacterial challenge. To investigate the potential mechanisms by which LPS exposure modulates the ALT population, we have examined the role of ALT proliferation and peripheral T cell recruitment. We have found that LPS exposure-increased ALT is not dependent on increased ALT proliferation as respiratory LPS exposure does not significantly increase the rate of proliferation of ALT. But rather, we find it to be dependent upon the recruitment of peripheral T cells into the airway lumen as blockade of peripheral T cell supplies markedly reduces the initially increased ALT. Thus, our data suggest that environmental exposure to airborne agents such as endotoxin has a profound modulatory effect on TB vaccine-elicited T cells within the respiratory tract. Our study provides a new, M.tb antigen-independent mechanism by which the respiratory mucosal anti-TB memory T cells may be maintained.
CARDIOGUI: An Interface Guide to Simulate Cardiovascular Respiratory System during Physical Activity  [PDF]
Jean Marie Ntaganda, Benjamin Mampassi
Applied Mathematics (AM) , 2012, DOI: 10.4236/am.2012.312275
Abstract: This paper aims at the presentation of an interface to simulate cardiovascular respiratory system. The authors are interested in the resolution of optimal control problem related to the performance of a 30 years old woman. The results show in the most case the determinant parameters of cardiovascular respiratory system reach the equilibrium value due to its controls that is heart rate and alveolar ventilation.
Respiratory Support in Meconium Aspiration Syndrome: A Practical Guide  [PDF]
Peter A. Dargaville
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/965159
Abstract: Meconium aspiration syndrome (MAS) is a complex respiratory disease of the term and near-term neonate. Inhalation of meconium causes airway obstruction, atelectasis, epithelial injury, surfactant inhibition, and pulmonary hypertension, the chief clinical manifestations of which are hypoxaemia and poor lung compliance. Supplemental oxygen is the mainstay of therapy for MAS, with around one-third of infants requiring intubation and mechanical ventilation. For those ventilated, high ventilator pressures, as well as a relatively long inspiratory time and slow ventilator rate, may be necessary to achieve adequate oxygenation. High-frequency ventilation may offer a benefit in infants with refractory hypoxaemia and/or gas trapping. Inhaled nitric oxide is effective in those with pulmonary hypertension, and other adjunctive therapies, including surfactant administration and lung lavage, should be considered in selected cases. With judicious use of available modes of ventilation and adjunctive therapies, infants with even the most severe MAS can usually be supported through the disease, with an acceptably low risk of short- and long-term morbidities. 1. Introduction Meconium aspiration syndrome (MAS) is complex respiratory disease of the term and near-term neonate that continues to place a considerable burden on neonatal intensive care resources worldwide. The condition has features that make it stand alone amongst neonatal respiratory diseases—the unique combination of airflow obstruction, atelectasis, and lung inflammation, the high risk of coexistent pulmonary hypertension, and the fact of these occurring in a term infant with a relatively mature lung structurally and biochemically. For all these reasons, management of MAS, and in particular the ventilatory management of MAS, has been a difficult challenge for neonatologists down the years. This paper focuses on application of mechanical respiratory support in MAS, as well as the role of adjunctive respiratory therapies. For the purpose of the paper, MAS is defined as respiratory distress occurring soon after delivery in a meconium-stained infant, which is not otherwise explicable and is associated with a typical radiographic appearance [1]. 2. Pathophysiology and Effects on Gas Exchange and Lung Compliance Lung dysfunction in MAS is a variable interplay of several pathophysiological disturbances, chief amongst which are airway obstruction, atelectasis, and pulmonary hypertension. Meconium, the viscid pigmented secretion of the fetal intestinal tract [2], is a noxious substance when inhaled, producing one of
Self Reported Incidence and Morbidity of Acute Respiratory Illness among Deployed U.S. Military in Iraq and Afghanistan  [PDF]
Bryony W. Soltis, John W. Sanders, Shannon D. Putnam, David R. Tribble, Mark S. Riddle
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0006177
Abstract: Background Historically, respiratory infections have had a significant impact on U.S. military missions. Deployed troops are particularly at high risk due to close living conditions, stressful work environments and increased exposure to pathogens. To date, there are limited data available on acute respiratory illness (ARI) among troops deployed in support of ongoing military operations, specifically Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Methods Using self-report data from two sources collected from troops deployed to Iraq, Afghanistan and the surrounding region, we analyzed incidence and risk factors for ARI. Military personnel on mid-deployment Rest & Recuperation (R&R) or during redeployment were eligible to participate in the voluntary self-report survey. Results Overall, 39.5% reported having at least one ARI. Of these, 18.5% sought medical care and 33.8% reported having decreased job performance. The rate of self-reported ARI was 15 episodes per 100 person-months among those taking the voluntary survey, and 24.7 episodes per 100 person-months among those taking the clinic health questionnaire. Negative binomial regression analysis found female sex, Navy branch of service and lack of flush toilets to be independently associated with increased rates of ARI. Deployment to OIF, increasing age and higher rank were also positively associated with ARI risk. Conclusions The overall percentage of deployed military personnel reporting at least one acute respiratory illness decreased since earlier parts of OIF/OEF. However, the reported effect on job performance increased tremendously. The most important factors associated with increased respiratory infection are female sex, Navy branch of service, lack of improved latrine facilities, deployment to OIF, increasing age and higher rank.
Respiratory Support in Meconium Aspiration Syndrome: A Practical Guide  [PDF]
Peter A. Dargaville
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/965159
Abstract: Meconium aspiration syndrome (MAS) is a complex respiratory disease of the term and near-term neonate. Inhalation of meconium causes airway obstruction, atelectasis, epithelial injury, surfactant inhibition, and pulmonary hypertension, the chief clinical manifestations of which are hypoxaemia and poor lung compliance. Supplemental oxygen is the mainstay of therapy for MAS, with around one-third of infants requiring intubation and mechanical ventilation. For those ventilated, high ventilator pressures, as well as a relatively long inspiratory time and slow ventilator rate, may be necessary to achieve adequate oxygenation. High-frequency ventilation may offer a benefit in infants with refractory hypoxaemia and/or gas trapping. Inhaled nitric oxide is effective in those with pulmonary hypertension, and other adjunctive therapies, including surfactant administration and lung lavage, should be considered in selected cases. With judicious use of available modes of ventilation and adjunctive therapies, infants with even the most severe MAS can usually be supported through the disease, with an acceptably low risk of short- and long-term morbidities.
Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso
Paolo Miotto, Nuccia Saleri, Mathurin Dembelé, Martial Ouedraogo, Gisèle Badoum, Gabriele Pinsi, Giovanni B Migliori, Alberto Matteelli, Daniela M Cirillo
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-142
Abstract: Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType? MTBDRplus.We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients.Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the rpoB gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%).All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the katG gene. In 41.7% of cases, a mutation affecting the promoter region of the inhA gene was also detected.The GenoType? MTBDRplus assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.Emergence of drug-resistant Mycobacterium tuberculosis (MTB) strains is considered a real threat to achieving tuberculosis (TB) control [1-3]. Furthermore, multidrug-resistant TB (MDR-TB) a
Cost Analysis of a Nucleic Acid Amplification Test in the Diagnosis of Pulmonary Tuberculosis at an Urban Hospital with a High Prevalence of TB/HIV  [PDF]
Max W. Adelman, Ekaterina Kurbatova, Yun F. Wang, Michael K. Leonard, Nancy White, Deborah A. McFarland, Henry M. Blumberg
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100649
Abstract: Introduction The Centers for Disease Control and Prevention has recommended using a nucleic acid amplification test (NAAT) for diagnosing pulmonary tuberculosis (TB) but there is a lack of data on NAAT cost-effectiveness. Methods We conducted a prospective cohort study that included all patients with an AFB smear-positive respiratory specimen at Grady Memorial Hospital in Atlanta, GA, USA between January 2002 and June 2008. We determined the sensitivity, specificity, and positive and negative predictive value of a commercially available and FDA-approved NAAT (amplified MTD, Gen-Probe) compared to the gold standard of culture. A cost analysis was performed and included costs related to laboratory tests, hospital charges, anti-TB medications, and contact investigations. Average cost per patient was calculated under two conditions: (1) using a NAAT on all AFB smear-postive respiratory specimens and (2) not using a NAAT. One-way sensitivity analyses were conducted to determine sensitivity of cost difference to reasonable ranges of model inputs. Results During a 6 1/2 year study period, there were 1,009 patients with an AFB smear-positive respiratory specimen at our public urban hospital. We found the NAAT to be highly sensitive (99.6%) and specific (99.1%) on AFB smear-positive specimens compared to culture. Overall, the positive predictive value (PPV) of an AFB smear-positive respiratory specimen for culture-confirmed TB was 27%. The PPV of an AFB smear-positive respiratory specimen for culture-confirmed TB was significantly higher for HIV-uninfected persons compared to those who were HIV-seropositive (152/271 [56%] vs. 85/445 [19%]; RR = 2.94, 95% CI 2.36–3.65, p<0.001). The cost savings of using the NAAT was $2,003 per AFB smear-positive case. Conclusions Routine use of the NAAT on AFB smear-positive respiratory specimens was highly cost-saving in our setting at a U.S. urban public hospital with a high prevalence of TB and HIV because of the low PPV of an AFB smear for culture-confirmed TB.
DO LARGE PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME BENEFIT FROM EARLY SURFACTANT?
N Khosravi,p Mohagheghi
Acta Medica Iranica , 2008,
Abstract: "nLarge preterm infants are generally not considered good candidates for surfactant treatment until they have been intubated for progressing respiratory distress. This study has been done to detect the effect of electively providing early single-dose surfactant to large preterm babies with mild to moderate respiratory distress syndrome (RDS). A randomized clinical trial was performed on 45 infants with birth weight > 1250 grams, gestational age < 36 weeks, postnatal age 0-12 hours, FiO2 > 40% and no immediate need for intubation. They were randomly divided into two interventional (n = 22) and control (n = 23) groups. Interventional group infants were intubated and received surfactant in the first 12 hours of life with signs of mild to moderate RDS and were extubated as soon as possible. The control group infants were only intubated and received surfactant when clinically or radiographically indicated. The primary outcome was duration of assisted ventilation. Interventional group infants had a median duration of assisted ventilation of 4.45 hours compared to 1.02 hours in the control group in the first 24 hours of life, since only 8 of 23 infants in the control group (34%) needed intubation and mechanical ventilation. There were no differences in the two groups for need of subsequent retreatment with surfactant and requirement for supplemental oxygen or mechanical ventilation, hospital stay and adverse outcomes. Results of this study indicate that elective intubation for administration of early single-dose surfactant to large preterm infants is not necessary.
Effectiveness of Non-Adjuvanted Pandemic Influenza A Vaccines for Preventing Pandemic Influenza Acute Respiratory Illness Visits in 4 U.S. Communities  [PDF]
Marie R. Griffin, Arnold S. Monto, Edward A. Belongia, John J. Treanor, Qingxia Chen, Jufu Chen, H. Keipp Talbot, Suzanne E. Ohmit, Laura A. Coleman, Gerry Lofthus, Joshua G. Petrie, Jennifer K. Meece, Caroline Breese Hall, John V. Williams, Paul Gargiullo, LaShondra Berman, David K. Shay, for the U.S. Flu-VE Network
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0023085
Abstract: We estimated the effectiveness of four monovalent pandemic influenza A (H1N1) vaccines (three unadjuvanted inactivated, one live attenuated) available in the U.S. during the pandemic. Patients with acute respiratory illness presenting to inpatient and outpatient facilities affiliated with four collaborating institutions were prospectively recruited, consented, and tested for influenza. Analyses were restricted to October 2009 through April 2010, when pandemic vaccine was available. Patients testing positive for pandemic influenza by real-time RT-PCR were cases; those testing negative were controls. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, patient age, timing of illness, insurance status, enrollment site, and presence of high-risk medical conditions. Pandemic virus was detected in 1,011 (15%) of 6,757 enrolled patients. Fifteen (1%) of 1,011 influenza positive cases and 1,042 (18%) of 5,746 test-negative controls had record-verified pandemic vaccination >14 days prior to illness onset. Adjusted effectiveness (95% confidence interval) for pandemic vaccines combined was 56% (23%, 75%). Adjusted effectiveness for inactivated vaccines alone (79% of total) was 62% (25%, 81%) overall and 32% (?92%, 76%), 89% (15%, 99%), and ?6% (?231%, 66%) in those aged 0.5 to 9, 10 to 49, and 50+ years, respectively. Effectiveness for the live attenuated vaccine in those aged 2 to 49 years was only demonstrated if vaccination >7 rather than >14 days prior to illness onset was considered (61%: 12%, 82%). Inactivated non-adjuvanted pandemic vaccines offered significant protection against confirmed pandemic influenza-associated medical care visits in young adults.
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