Search

Introduction: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. Methods: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC‐6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. Results: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810–0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730–0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826–0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C‐reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. Conclusion: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis‐related mortality. [ABSTRACT FROM AUTHOR]

Parainfluenza virus (PIV) is a respiratory pathogen in young children and is second only to the respiratory syncytial virus (RSV) as a cause of lower respiratory tract infection. PIV type 3 (PIV3) is the most severe. Herein we describe an outbreak of PIV3 in three infants in a neonatal intensive care unit. They were diagnosed on virus culture from pharyngeal swabs. We prevented the spread of the virus using standard infection control procedures and isolation of the symptomatic infants. One infant had severe chronic lung disease and was complicated with recurrent wheezing for a long time. Because RSV and PIV have many structural, pathogenic, epidemiologic, and clinical similarities, we speculate that PIV infection causes recurrent wheezing, as observed with RSV infection. Therefore, physicians must consider recurrent wheezing at the time of treatment of PIV infection early in life. [ABSTRACT FROM AUTHOR]

Background: Acute fire smoke inhalation injury involves inflammatory mediators whose roles are poorly understood. We carried out a prospective observational study of fire smoke victims to identify clinical and biochemical markers that may predict pulmonary dysfunction and investigated possible correlations between dysfunction and cytokines in bronchoalveolar lavage (BAL) fluid and blood.Methods: Forty patients with respiratory and/or neurological symptoms following acute fire smoke inhalation had pulmonary function tests and blood gas analyses performed on admission, at discharge, and after 3 months. Cytokines were measured using BioPlex/XMap technology.Results: On admission, 30 (75%) patients had dyspnea. Patients presenting with bronchial wheezing (n = 14) had significantly lower PEF (201 l/min, 82-360) than non-wheezing patients (406 l/min, 100-683) (n = 16, P = 0.03). Bronchial wheezing predicted need for ICU treatment with OR = 93.3 at 95% CI (P < 0.001) and was associated with gas exchange impairment, with mean pa O2 /FiO2 ratio 34.4 (11.8-49.8) kPa on admission and 21.3 (8.3-44.5) kPa 48 h later. Blood HbCO also predicted ICU treatment, with OR = 1.58 at 95% CI (P < 0.001). Serum CRP, IL-6, IL-8, and MCP-1 were significantly higher in wheezing patients after 12-24 h compared with non-wheezing patients and study controls. Cytokine levels were still elevated after 3 months. BAL fluid had significantly higher levels of IL-8, MCP-1, IL-1β, and G-CSF compared with healthy controls.Conclusion: In victims of fire smoke inhalation, pulmonary wheezing predicts inflammation, pulmonary dysfunction, respiratory failure, and need for intensive care. [ABSTRACT FROM AUTHOR]

Background Vascular rings may cause pressure on the trachea and/or esophagus of varying degree, resulting in symptoms. This study assessed the presentation symptoms, diagnostic methods and treatment results after surgery in children with vascular ring. Methods Symptomatic vascular ring patients undergoing surgery between January 2010 and August 2014 at Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, were retrospectively assessed. The presentation symptoms, demographic characteristics, and diagnostic tests were evaluated. Operative data and postoperative follow up, complications and problems were also examined in detail. Results Twenty-one patients underwent surgery, 13 (63%) of whom were male. Median age was 12 months (range, 1 month-8 years). Among these patients, 62% ( n = 13) had double aortic arch, 24% ( n = 5) had right-sided aortic arch + ligamentum arteriosum, 10% ( n = 2) had left-sided aortic arch + aberrant right subclavian artery, and 4% ( n = 1) had pulmonary sling abnormality. Computed tomography ( CT) angiography was performed in 17/21 patients. All the patients were successfully operated on. In the early postoperative period, two patients had chylothorax and one had nerve paralysis of nervus laryngeus recurrens. One patient died in the early period, and two patients had ongoing stridor on follow up. Conclusions CT angiography is effective for the differential diagnosis and visualization of vascular ring abnormality. In such cases, full recovery can be assured with early diagnosis and surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective Respiratory symptoms including wheezing are common in adults with sickle cell anaemia ( SCA), even in the absence of asthma. However, the prevalence of spirometry changes and respiratory symptoms in adults with SCA is unknown. Methods Using a cross-sectional study design, we tested the hypothesis that adults with SCA (cases) would have higher rates of lower airway obstruction and wheezing than those without SCA (controls) using the American Thoracic Society Division of Lung Diseases' questionnaire. Patients were adults with SCA aged between 18 and 65 years. Controls were consecutive unselected individuals without SCA who presented to an outpatient general medicine clinic. Results We enrolled 150 adults with SCA and 287 consecutive controls without SCA. The median age was 23.0 and 27.0 years for adults with and without SCA, respectively. Cases were more likely to report cough without a cold (35.0% vs 18.6%, P < 0.001), lower forced expiratory volume in 1 s ( FEV1 ) % predicted (70.1% vs 82.1%, P = 0.001) and lower forced vital capacity ( FVC) % predicted (67.4% vs 74.9%, P = 0.001) than controls. In the multivariable model, wheezing was significantly associated with SCA status ( OR = 1.69, 95% CI = 1.08-2.65, P = 0.024). Similarly, FEV1 % predicted was significantly associated with SCA status and wheezing ( P = 0.001 for both). Conclusion Adults with SCA experience a higher rate of wheezing and impaired respiratory functions compared with controls from the same region. [ABSTRACT FROM AUTHOR]

The article describes three cases of plastic bronchitis in children with influenza B virus Yamagata lineage in the 2015/2016 and 2017/2018 influenza seasons. The three patients were aged 11, 7, and 6 years, in which the two patients had allergies, patient 3 had bronchial asthma, and patient 2 had a food allergy with atopic dermatitis. The patients' progressive dyspnea and hypoxia showing decreased breath sounds in the unilateral lung during physical examination.

Neonatal stridor is a rare condition usually caused by laryngomalacia. Congenital laryngeal cyst represents an uncommon cause of stridor in the neonatal population and may be misinterpreted as laryngomalacia, leading to serious morbidity and mortality if diagnosis and treatment are delayed. Herein we report the case of a full-term infant with stridor, feeding problems and failure to thrive. Initially, direct laryngoscopy diagnosed only laryngomalacia. As stridor worsened, however, and respiratory distress appeared, repeat laryngoscopy showed vallecular laryngeal cyst, visible macroscopically. The patient was successfully treated with endoscopic marsupialization. There was no evidence of recurrence at follow up after 3 months. This case highlights the importance of laryngoscopic assessment for suspected laryngeal abnormalities in infants with stridor. If symptoms worsen, endoscopy should be repeated, because congenital laryngeal cysts may not be immediately visible macroscopically. [ABSTRACT FROM AUTHOR]

The article describes the case of a 4-week-old ex-36.5-week female presented for evaluation and management of worsening stridor and feeding difficulty after 6 days of coryzal symptoms. Topics covered include the findings of flexible bronchoscopy which led to the diagnosis of subglottic infantile haemangioma, the results of the characterization of the lesion with a post-intravenous contrast computed tomography (CT), and the response of the patient to propranolol.

Objective: To estimate the prevalence of asthma among pregnant women with dyspnea.Methods: Pregnant women referred for prenatal care visits who had complaints of dyspnea were included. All pregnant women were evaluated by a respiratory specialist. Spirometry was performed by a single trained physician.Results: Asthma was diagnosed in 38.8% of participants. Dyspnea was diagnosed as being physiologic in 36.4% of cases, but 24.8% of cases were of probable asthma (spirometric values were within normal range but symptoms and signs were suggestive of asthma). Cough, wheezing, and post-exercise symptoms were significantly more prevalent in asthmatic and probable-asthmatic women than in women without asthma.Conclusion: Dyspnea in pregnancy can be physiologic, but when it is accompanied by other symptoms such as cough or wheezing it is likely to be caused by asthma. Because of the high prevalence of asthma during pregnancy, it seems logical to evaluate dyspnea via physical examination and response to bronchodilators. [ABSTRACT FROM AUTHOR]

The article presents information on the condition called wheeze in children. Topics include the causes of wheezing such as asthma, preschool wheeze, and bronchiolitis, the use of nebulised hypertonic saline (HS) to treat bronchiolitis, and the updating of the National Asthma Council Australia's Australian Asthma Handbook. It also discusses the European Respiratory Task Force's classification of wheezes like the episodic viral wheeze (EVW) and the multiple trigger wheeze (MTW).

Background: The western world's increase in childhood asthma is suggested to level off. We aimed to investigate asthma prevalence in 10-year-old children within the prospective birth cohort Environment and Childhood Asthma (ECA) Study in Oslo established in 1992/1993. Subjects and methods: Six hundred and sixteen (77%) of 803 children (mean age 10.9 ± 0.9 (SD) years) with lung function measurements at birth were reinvestigated at age 10 years. At birth they corresponded to the entire birth cohort ( n = 3754) regarding gender, socio-demographic factors, parental allergic diseases, pet keeping and maternal smoking. Results from structured parental interview, spirometry, and skin prick test for inhalant and food allergens are presented. Asthma definition required minimum two positive criteria, (i) doctor's diagnosis of asthma, (ii) wheeze and/or chest tightness, (iii) use of anti-asthmatic treatment. Current asthma required asthma definition plus either (ii) and/or (iii) in the last 12 months, and/or ≥10% fall in forced expired volume in 1 s after treadmill running. Results: Lifetime prevalence of asthma was 20.2%; current asthma 11.1%, doctor diagnosis of asthma 16.1% and wheezes ever 30.3%. Allergic sensitization (29.3% overall) was more common among children with current (56.3%) compared to asymptomatic (last 12 months) (26.0%) or no asthma (27.6%) ( P < 0.001). Boys more often than girls had current asthma (14.4 vs 7.1%, P = 0.004), wheeze ever (36.9 vs 22.5%, P = 0.002) and allergic sensitization (36.2 vs 22.1%, respectively, P < 0.001). Conclusion: Childhood asthma apparently continues to increase in Oslo, having affected every fifth 10-year-old child. [ABSTRACT FROM AUTHOR]

The article presents a case study of a nine-month-old boy who was diagnosed with esophageal foreign body in the form of a thin vinyl object after experiencing sudden-onset cough and dry heaving while playing near a toy box. It notes the boy had put something small into his mouth based on the statement from his elder brother. It states that the condition may result in mortality in children if not diagnosed appropriately.

The article discusses case study of a 5-month-old boy presented to the emergency department with cough and dyspnea, and was diagnosed with bridging bronchus with left pulmonary artery sling and stenosis of the right upper lobe bronchus. It has been stated that chest radiography is vital in identification of the cause of the first episode of wheezing in young infants.

The article presents a case study of a boy weighing 2940 gram who was born at 36 weeks' gestation by cesarean section due to hypertension in pregnancy at a local hospital. Topics discussed include retractive breathing, stridor and wheezing shown by infant on the first oral feeding, visibility of the top of the cyst on physical examination with tongue depressor, and difficult airway management caused by laryngeal cyst.

The article offers the authors insights on transfer- appropriate processing (TAP), a model that help address the challenge in the transfer of students. Topics discussed include the cognitive process of learning, aspects of leveraging TAP for teaching, and the method of facilitating the model involves exposing learners to contextual variation through providing examples of the same concept.