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Winckworth LC. Cheap, easily replicable neonatal chest drain model. Arch Dis Child Fetal Neonatal Ed 2023; 108:141. [PMID: 34493593 DOI: 10.1136/archdischild-2021-322744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022]
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Gaertner VD, Waldmann AD, Davis PG, Bassler D, Springer L, Tingay DG, Rüegger CM. Lung volume changes during apnoeas in preterm infants. Arch Dis Child Fetal Neonatal Ed 2023; 108:170-175. [PMID: 36038255 DOI: 10.1136/archdischild-2022-324282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Mechanisms of non-invasive high-frequency oscillatory ventilation (nHFOV) in preterm infants are unclear. We aimed to compare lung volume changes during apnoeas in preterm infants on nHFOV and nasal continuous positive airway pressure (nCPAP). METHODS Analysis of electrical impedance tomography (EIT) data from a randomised crossover trial comparing nHFOV with nCPAP in preterm infants at 26-34 weeks postmenstrual age. EIT data were screened by two reviewers to identify apnoeas ≥10 s. End-expiratory lung impedance (EELI) and tidal volumes (VT) were calculated before and after apnoeas. Oxygen saturation (SpO2) and heart rate (HR) were extracted for 60 s after apnoeas. RESULTS In 30 preterm infants, 213 apnoeas were identified. During apnoeas, oscillatory volumes were detectable during nHFOV. EELI decreased significantly during apnoeas (∆EELI nCPAP: -8.0 (-11.9 to -4.1) AU/kg, p<0.001; ∆EELI nHFOV: -3.4 (-6.5 to -0.3), p=0.03) but recovered over the first five breaths after apnoeas. Compared with before apnoeas, VT was increased for the first breath after apnoeas during nCPAP (∆VT: 7.5 (3.1 to 11.2) AU/kg, p=0.001). Falls in SpO2 and HR after apnoeas were greater during nCPAP than nHFOV (mean difference (95% CI): SpO2: 3.6% (2.7 to 4.6), p<0.001; HR: 15.9 bpm (13.4 to 18.5), p<0.001). CONCLUSION Apnoeas were characterised by a significant decrease in EELI which was regained over the first breaths after apnoeas, partly mediated by a larger VT. Apnoeas were followed by a considerable drop in SpO2 and HR, particularly during nCPAP, leading to longer episodes of hypoxemia during nCPAP. Transmitted oscillations during nHFOV may explain these benefits. TRIAL REGISTRATION NUMBER ACTRN12616001516471.
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Yamamoto Y, Shiroyama T, Hirata H, Matsumoto K, Kuge T, Yoneda M, Yamamoto M, Uchiyama A, Takeda Y, Kumanogoh A. Secondary subcutaneous abscess due to mixed infections by Peptoniphilus olsenii and Gleimia europaea after COVID-19. Clin Case Rep 2023; 11:e6844. [PMID: 36694652 PMCID: PMC9842775 DOI: 10.1002/ccr3.6844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/30/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
This report described a rare case of subcutaneous anaerobic bacterial abscess due to Peptoniphilus olsenii and Gleimia europaea after COVID-19. The patient received incision and drainage of the abscess and antibiotics, thereby achieving recovery. Immunodeficiency related to COVID-19 and its treatment might contribute to secondary skin and subcutaneous bacterial infections.
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Suzuki M, Fujimoto S, Sakamoto K, Tamura K, Ishii S, Iikura M, Izumi S, Takeda Y, Hojo M, Sugiyama H. Clinical usefulness of end-tidal CO 2 measured using a portable capnometer in patients with respiratory disease. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:96-104. [PMID: 36610049 PMCID: PMC9892695 DOI: 10.1111/crj.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate the correlation and agreement between end-tidal CO2 (EtCO2 ) measured with the novel portable capnometer (CapnoEye®) and partial pressure of arterial carbon dioxide (PaCO2 ) levels in patients with respiratory diseases and to compare the efficacy of EtCO2 and PvCO2 in predicting PaCO2 levels. METHODS We analyzed the correlation and the agreement between EtCO2 and PaCO2 and between PvCO2 and PaCO2 using Pearson's moment correlation coefficient in patients with type 1 and type 2 respiratory failure and both groups overall. RESULTS A total of 100 samples were included that comprised 67 men (67%). The mean age of the subjects was 77 ± 13 years. Chronic obstructive pulmonary disease (COPD) (43%) was the most common disease. There was a high correlation between EtCO2 and PaCO2 (r = 0.88; p < 0.0001). Sixty-six PvCO2 samples were obtained, and there was a high correlation between PvCO2 and PaCO2 (r = 0.81; p < 0.0001). Regarding type 2 respiratory failure, there was a high correlation between EtCO2 and PaCO2 (r = 0.81). The Bland-Altman analysis between PaCO2 and EtCO2 revealed a bias of 5.7 mmHg, with limits of agreement ranging from -5.1 mmHg to 16.5 mmHg. In contrast, the analysis between PaCO2 and PvCO2 revealed a bias of -6.8 mmHg, and the limits of agreement ranged from -22.13 mmHg to 8.53 mmHg. CONCLUSION EtCO2 measured by CapnoEye® was significantly correlated to PaCO2 levels in patients with respiratory diseases. Moreover, CapnoEye® may be more useful for predicting hypercapnia conditions in which respiratory diseases are compared with measure PvCO2 .
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Salverda HH, Dekker J, Lopriore E, Dargaville PA, Pauws SC, Te Pas AB. Comparison of two automated oxygen controllers in oxygen targeting in preterm infants during admission: an observational study. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324819. [PMID: 36599676 DOI: 10.1136/archdischild-2022-324819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To compare the effect of two different automated oxygen control devices on time preterm infants spent in different oxygen saturation (SpO2) ranges during their entire stay in the neonatal intensive care unit (NICU). DESIGN Retrospective cohort study of prospectively collected data. SETTING Tertiary level neonatal unit in the Netherlands. PATIENTS Preterm infants (OxyGenie 75 infants, CLiO2 111 infants) born at 24-29 weeks' gestation receiving at least 72 hours of respiratory support between October 2015 and November 2020. INTERVENTIONS Inspired oxygen concentration was titrated by the OxyGenie controller (SLE6000 ventilator) between February 2019 and November 2020 and the CLiO2 controller (AVEA ventilator) between October 2015 and December 2018 as standard of care. MAIN OUTCOME MEASURES Time spent within SpO2 target range (TR, 91-95% for either epoch) and other SpO2 ranges. RESULTS Time spent within the SpO2 TR when receiving supplemental oxygen was higher during OxyGenie control (median 71.5 [IQR 64.6-77.0]% vs 51.3 [47.3-58.5]%, p<0.001). Infants under OxyGenie control spent less time in hypoxic and hyperoxic ranges (SpO2<80%: 0.7 [0.4-1.4]% vs 1.2 [0.7-2.3]%, p<0.001; SpO2>98%: 1.0 [0.5-2.4]% vs 4.0 [2.0-7.9]%, p<0.001). Both groups received a similar FiO2 (29.5 [28.0-33.2]% vs 29.6 [27.7-32.1]%, p=not significant). CONCLUSIONS Oxygen saturation targeting was significantly different in the OxyGenie epoch in preterm infants, with less time in hypoxic and hyperoxic SpO2 ranges during their stay in the NICU.
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Jones R, Hiscock H, Shanthikumar S, Lei S, Sanci L, Chen K. Exploring gaps and opportunities in primary care following an asthma hospital admission: a multisite mixed-methods study of three data sources. Arch Dis Child 2023; 108:385-391. [PMID: 36599627 DOI: 10.1136/archdischild-2022-324114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Explore gaps and opportunities in primary care for children following a hospital admission for asthma. DESIGN Exploratory mixed-methods, using linked hospital and primary care administration data. SETTING Eligible children, aged 3-18 years, admitted to one of three hospitals in Victoria, Australia between 2017 and 2018 with a clinical diagnosis of asthma. RESULTS 767 caregivers of eligible children participated, 39 caregivers completed a semistructured interview and 277 general practitioners (GPs) caring for 360 children completed a survey. Over 90% (n=706) of caregivers reported their child had a regular GP. However, few (14.1%, n=108) attended a GP in the 24 hours prior to index admission or in the 7 days after (35.8%, n=275). Children readmitted for asthma (34.2%, n=263), compared with those not readmitted (65.8%, n=504), were less likely to have visited a GP in the non-acute phase of their asthma in the 12 months after index admission (22.1% vs 42.1%, respectively), and their GP was more likely to report not knowing the child had an asthma admission (52.8% vs 39.2%, respectively). Fewer GPs reported being extremely confident managing children with poorly controlled asthma (11.9%, n=43) or post-discharge (16.7%, n=60), compared with children with well-controlled asthma (36.4%, n=131), with no difference by child readmission status. CONCLUSIONS Given the exploratory design and descriptive approach, it is unknown if the differences by child readmission status have any causal relationship with readmission. Nonetheless, improving preventative patterns of primary care visits, timely communication between hospitals and primary care providers, and guideline concordant care by GPs are needed.
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Thomas H, Lugg R, James B, Geeroms C, Risbridger A, Bell R, Bartle DG. Survey of the use of videolaryngoscopy in neonatal units in the UK. Arch Dis Child Fetal Neonatal Ed 2023; 108:89-90. [PMID: 34667068 DOI: 10.1136/archdischild-2021-322813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/31/2022]
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Cognitive Deficits among Individuals Admitted to a Post-Acute Pneumological Rehabilitation Unit in Southern Italy after COVID-19 Infection. Brain Sci 2023; 13:brainsci13010084. [PMID: 36672066 PMCID: PMC9857316 DOI: 10.3390/brainsci13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 male, median age 67.5) consisted of patients who received non-invasive mechanical ventilation; Group-2 (n = 19; 16 male, median age 63) consisted of patients who received invasive mechanical ventilation. All patients underwent a neuropsychological assessment including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS) to evaluate the patients' cognition. Depression and anxiety were also measured at admission and discharge to rehabilitation. (3) Results: At admission, patients impaired at MMSE were 44% in Group-1 and 5% in Group-2, while patients impaired at FAB were 88% in Group-1 and 26% in Group-2. Wilcoxon's effect size revealed meaningful differences between groups for FAB, R-BANS global score, immediate and delayed memory, and attention-coding task, with Group-2 performing better than Group-1 across all measures. At discharge, 52% of the 25 patients re-assessed still had mild to moderate cognitive deficits, while 19% had depression and 35% had anxiety. (4) Conclusions: Patients who received oxygen therapy experienced higher levels of acute and chronic stress compared to those who benefitted from invasive mechanical ventilation. Despite patients showing a meaningful improvement at discharge, cognitive impairment persisted in a great number of patients; therefore, long-term neuropsychological follow-up and treatment for COVID-19 patients are recommended.
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Bellos I, Pandita A. SurE for surfactant: response to letter. Arch Dis Child Fetal Neonatal Ed 2023; 108:91-92. [PMID: 34844986 DOI: 10.1136/archdischild-2021-323394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/31/2022]
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Valencia-Ramos J, Ochoa Sangrador C, García M, Oyagüez P, Arnaez J. Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial. Arch Dis Child 2022; 107:1122-1127. [PMID: 36162958 DOI: 10.1136/archdischild-2021-323161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the hypothesis that greater comfort is achieved using a nebuliser integrated into a high-flow nasal cannula (nebulisation system integrated in high-flow nasal cannula (NHF)) than using a jet nebuliser (JN), and to explore differences in analgesia requirement and the possibility of feeding during nebulisation. DESIGN Randomised cross-over trial. SETTING Paediatric intensive care unit. PATIENTS Children aged <24 months diagnosed with bronchiolitis between November 2016 and May 2017. INTERVENTIONS Nebulisations using NHF and JN. MAIN OUTCOME MEASURES COMFORT-Behaviour Scale (CBS) and Numerical Rating Comfort Scale (NRSc) were used to measure comfort, and Numerical Rating Satisfaction Scale (NRSs) was used to assess satisfaction before, during and after nebulisation. Other variables included feeding, analgesia, need for being held and respiratory and heart rates. RESULTS Thirty-three children with 233 nebulisations were included in the study. The median age was 3.0 (IQR 2-9) months. Comfort and satisfaction were greater with NHF than with JN. The median staff-recorded CBS, NRSc and NRSs scores for NHF versus JN were 13 (IQR 9-15) vs 17 (IQR 13-23), 8 (IQR 7-0) vs 7 (IQR 4-8), and 4 (IQR 3-4) vs 2 (IQR 2-3), respectively; and caregiver-recorded scores were 12 (IQR 10-15) vs 19 (IQR 13-24), 9 (IQR 7-10) vs 4 (IQR 1-6), and 4 (IQR 3-4) vs 2 (IQR 1-3), respectively (p<0.001). Children who received NHF had lower cardiac and respiratory rates, needed to be held less often during therapy and required less analgesia (p<0.001). CONCLUSION Nebulisation through NHF appears to be a better alternative to JN in terms of comfort and satisfaction as well as making feeding possible during nebulisation.
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Hlavaty A, Roustit M, Montani D, Chaumais M, Guignabert C, Humbert M, Cracowski J, Khouri C. Identifying new drugs associated with pulmonary arterial hypertension: A WHO pharmacovigilance database disproportionality analysis. Br J Clin Pharmacol 2022; 88:5227-5237. [PMID: 35679331 PMCID: PMC9795981 DOI: 10.1111/bcp.15436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/11/2022] [Accepted: 05/29/2022] [Indexed: 12/30/2022] Open
Abstract
Since the 1960s, several drugs have been linked to the onset or aggravation of pulmonary arterial hypertension (PAH): dasatinib, some amphetamine-like appetite suppressants (aminorex, fenfluramine, dexfenfluramine, benfluorex) and recreational drugs (methamphetamine). Moreover, in numerous cases, the implication of other drugs with PAH have been suggested, but the precise identification of iatrogenic aetiologies of PAH is challenging given the scarcity of this disease and the potential long latency period between drug intake and PAH onset. In this context, we used the World Health Organization's pharmacovigilance database, VigiBase, to generate new hypotheses about drug associated PAH. METHODS We used VigiBase, the largest pharmacovigilance database worldwide to generate disproportionality signals through the Bayesian neural network method. All disproportionality signals were further independently reviewed by experts in pulmonary arterial hypertension, pharmacovigilance and vascular pharmacology and their plausibility ranked according to World Health Organization causality categories. RESULTS We included 2184 idiopathic PAH cases, yielding a total of 93 disproportionality signals. Among them, 25 signals were considered very likely, 15 probable, 28 possible and 25 unlikely. Notably, we identified 4 new protein kinases inhibitors (lapatinib, lorlatinib, ponatinib and ruxolitinib), 1 angiogenesis inhibitor (bevacizumab), and several chemotherapeutics (etoposide, trastuzumab), antimetabolites (cytarabine, fludarabine, fluorouracil, gemcitabine) and immunosuppressants (leflunomide, thalidomide, ciclosporin). CONCLUSION Such signals represent plausible adverse drug reactions considering the knowledge of iatrogenic PAH, the drugs' biological and pharmacological activity and the characteristics of the reported case. Although confirmatory studies need to be performed, the signals identified may help clinicians envisage an iatrogenic aetiology when faced with a patient who develops PAH.
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Wertheim D, Anton O, Olden C, Le Maistre SLV, Seddon PC. Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze. Arch Dis Child 2022; 107:1083-1087. [PMID: 35940849 DOI: 10.1136/archdischild-2021-323390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There is a lack of objective measures to assess children with acute wheezing episodes. Increased respiratory rate (RR) and pulsus paradoxus (PP) are recognised markers, but poorly recorded in practice. We examined whether they can be reliably assessed from a pulse oximeter plethysmogram ('pleth') trace and predict clinical outcome. PATIENTS AND METHODS We studied 44 children aged 1-7 years attending hospital with acute wheeze, following initial 'burst' bronchodilator therapy (BT), and used custom software to measure RR and assess PP from oximeter pleth traces. Traces were examined for quality, and the accuracy of the RR measurement was validated against simultaneous respiratory inductive plethysmography (RIP). RR and PP at 1 hour after BT were compared with clinical outcomes. RESULTS RR from pleth and RIP showed excellent agreement, with a mean difference (RIP minus pleth) of -0.5 breaths per minute (limits of agreement -3.4 to +2.3). 52% of 1 min epochs contained 10 s or more of pleth artefact. At 1 hour after BT, children who subsequently required intravenous bronchodilators had significantly higher RR (median (IQR) 63 (62-66) vs 43 (37-51) breaths per minute) than those who did not, but their heart rate and oxygen saturation were similar. Children with RR ≥55 per minute spent longer in hospital: median (IQR) 30 (22-45) vs 10 (7-21) hours. All children who subsequently required hospital admission had PP-analogous pleth waveforms 1 hour after BT. CONCLUSION RR can be reliably measured and PP detected from the pulse oximeter pleth trace in children with acute wheeze and both markers predict clinical outcome. TRIAL REGISTRATION NUMBER UKCRN15742.
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Twigg AJ, Wilkinson A, Smith JN. Local variation in low carbon footprint inhalers in pre-COVID pandemic primary care prescribing guidelines for adult asthma in England and its potential impact. Br J Clin Pharmacol 2022; 88:5083-5092. [PMID: 36002398 PMCID: PMC9825955 DOI: 10.1111/bcp.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
AIMS Pressurised metered-dose inhalers (MDIs) have a much higher carbon footprint than dry powder inhalers (DPIs). We aimed to describe variations of inhaler options in local adult asthma prescribing guidance. METHODS We reviewed local clinical commissioning group (CCG) adult asthma prescribing guidance for primary care in England in 2019 and recorded DPI and MDI inclusion. The relationship to prescribing data from OpenPrescribing.net was examined. RESULTS In total, 58 unique guidance documents were analysed covering 144 out of 191 CCGs in England. Only 3% of CCG guidelines expressed an overall preference for DPIs, while 12% explicitly preferred MDIs. The inclusion of DPIs first-line was 77% for short-acting β-agonists, 78% for low-dose inhaled corticosteroid (ICS) inhalers and 90-96% for combination long-acting β-agonist/ICS inhalers. MDIs were included first-line in 98-100% of these classes. In 26% of CCGs, there was no first-line DPI option for at least 1 asthma management step. Ten percent of CCGs had no DPI included first-line for any of the 5 classes examined. Many CCGs recommended higher carbon footprint options; Ventolin MDI (25.6%), inhalers containing HFA227ea (57.9%) and ICS regimes recommending 2 puffs of a lower dose over 1 puff of higher dose (94.2%). MDIs were prescribed more in CCGs that recommended them. CONCLUSION Before the COVID pandemic, there was substantial variation between CCGs in adult asthma prescribing guidance regarding higher and lower carbon footprint options. There may still be scope to amend local guidance to improve clinical and environmental outcomes. This study provides a method and baseline for further investigation of this.
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Fedidat R, Elia A, Hershko A, Fridlender Z. Recurrent haemoptysis: a rare diagnosis of kaposiform lymphangiomatosis and review of literature. BMJ Case Rep 2022; 15:e250825. [PMID: 36171013 PMCID: PMC9528592 DOI: 10.1136/bcr-2022-250825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kaposiform lymphangiomatosis (KLA) is a rare clinicopathological entity among lymphatic anomalies. The main involved sites are the mediastinum and the lungs but the disease can also affect multiple extrathoracic organs. Little is known about the pathophysiology, the natural history, the treatment response and the long-term outcome of this disorder. KLA is typically diagnosed in childhood. We present here the case of an adult man with 13 years recurrent episodes of haemoptysis who was finally found to suffer from KLA. Following this, we present a comprehensive review of the literature.
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Nacafaliyev V, Ortan P, Sayin SS. Relationship between obstructive sleep apnoea syndrome and silent brain infarction. Postgrad Med J 2022:7148069. [PMID: 37130819 DOI: 10.1136/pmj-2022-141911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The relationship between obstructive sleep apnea syndrome (OSAS) and ischaemic stroke is less known. OBJECTIVES This study aimed to investigate the relationship between OSAS and silent brain infarcts (SBI). METHODS Patients who applied to our clinic with the complaint of snoring, respiratory arrest during sleep, that underwent polysomnography were included. All patients were undergone cranial magnetic resonance imaging to detect SBI. RESULTS SBI was found in 176 (51.5%) of 270 patients in the group with OSAS and 94 (34.8%) patients without OSAS. The patients were evaluated according to their Apnea-Hypopnea Index(AHI) ratio, and those with were found to be significant in terms of SBI. SBI was detected in 56.56% in the moderate and severe (AHI ˃15) stage group and 39.94% in the normal and mild (AHI ≤15) OSAS group (p=0.009). CONCLUSIONS SBI was found to be significantly higher in patients with moderate and severe stage OSAS compared to the normal and mild OSAS group. Desaturations during sleep may influence the formation of these infarcts. Therefore, this study reported that patients with moderate and severe sleep apnea syndrome may have a higher risk of developing ischaemic cerebrovascular disease and that the treatment of these patients should be planned in this respect.
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Ko FWS, Smallwood N. Leading women in respiratory medicine: The role of the APSR in promoting gender equity and inclusiveness. Respirology 2022; 27:900-902. [PMID: 35959943 DOI: 10.1111/resp.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
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Doumit M, Ledwos R, Plush L, Chuang S, Gray M, Jaffe A, McBride J. Telehealth application of an ultrasonic home spirometer. Arch Dis Child 2022; 107:752-754. [PMID: 35277380 DOI: 10.1136/archdischild-2021-322536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the validity and home use of a personal ultrasonic spirometer. METHODS Supervised spirometry was performed using laboratory equipment and a personal ultrasonic spirometer. In addition, the ability of children to perform acceptable spirometry during supervised telehealth appointments at home was assessed. RESULTS 59 children completed spirometry on both devices. There was high between-device intraclass correlation coefficient (ICC) for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC): ICC 0.991 (95% CI 0.985 to 0.995) and 0.989 (95% CI 0.981 to 0.993), respectively. Bland-Altman analysis revealed mean bias and limits of agreement of -0.01 (-0.22 to 0.24) L for FEV1 and -0.02 (-0.30 to 0.33) L for FVC. 125 of 140 (89%) supervised telehealth spirometry sessions were acceptable. CONCLUSION There was excellent reliability in between-device measurements; however, the limits of agreement were wide. Therefore, caution is needed if the device is used interchangeably with laboratory equipment. High success rates of telehealth spirometry sessions indicate the device is suitable for this application.
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DeStefano IM, Wayne AS, Cudney SE, Rozanski EA. Successful treatment of suspect Babesia-induced ARDS in a dog using lung-protective positive-pressure ventilation and neuromuscular blockade. Clin Case Rep 2022; 10:e6234. [PMID: 35957771 PMCID: PMC9361806 DOI: 10.1002/ccr3.6234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/24/2022] [Indexed: 01/26/2023] Open
Abstract
A mixed breed dog was treated for severe hemolytic anemia secondary to Babesia canis infection. Within 14 hours of hospitalization, the dog developed respiratory distress and hypoxemia. The patient improved with lung-protective mechanical ventilation and neuromuscular blockade. The dog survived to discharge and was reportedly healthy at three-month follow-up.
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Boyle E, Roehr CC. Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:393-397. [PMID: 34686533 DOI: 10.1136/archdischild-2021-322890] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are no evidence-based recommendations for surfactant use in late preterm (LPT) and term infants with respiratory distress syndrome (RDS). OBJECTIVE To investigate the safety and efficacy of surfactant in LPT and term infants with RDS. METHODS Systematic review, meta-analysis and evidence grading. INTERVENTIONS Surfactant therapy versus standard of care. MAIN OUTCOME MEASURES Mortality and requirement for invasive mechanical ventilation (IMV). RESULTS Of the 7970 titles and abstracts screened, 17 studies (16 observational studies and 1 randomised controlled trial (RCT)) were included. Of the LPT and term neonates with RDS, 46% (95% CI 40% to 51%) were treated with surfactant. We found moderate certainty of evidence (CoE) from observational studies evaluating infants supported with non-invasive respiratory support (NRS) or IMV that surfactant use may be associated with a decreased risk of mortality (OR 0.45, 95% CI 0.32 to 0.64). Very low CoE from observational trials in which surfactant was administered at FiO2 >0.30-0.40 to infants on Continuous Positive Airway Pressure (CPAP) indicated that surfactant did not decrease the risk of IMV (OR 1.20, 95% CI 0.40 to 3.56). Very low to low CoE from the RCT and observational trials showed that surfactant use was associated with a significant decrease in risk of air leak, persistent pulmonary hypertension of the newborn (PPHN), duration of IMV, NRS and hospital stay. CONCLUSIONS Current evidence base on surfactant therapy in LPT and term infants with RDS indicates a potentially decreased risk of mortality, air leak, PPHN and duration of respiratory support. In view of the low to very low CoE and widely varying thresholds for deciding on surfactant replacement in the included studies, further trials are needed.
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Thomas R, Chang A, Masters IB, Grimwood K, Marchant J, Yerkovich S, Chatfield M, O'Brien C, Goyal V. Association of childhood tracheomalacia with bronchiectasis: a case-control study. Arch Dis Child 2022; 107:565-569. [PMID: 34649867 DOI: 10.1136/archdischild-2021-322578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis. DESIGN Single-centre, case-control study. SETTING AND PATIENTS 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT. INTERVENTIONS The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area). MAIN OUTCOME MEASURES AND RESULTS Cases were younger (median age=2.6 years, IQR 1.5-4.1) than controls (7.8 years, IQR 3.4-12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity). CONCLUSION Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.
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Hain RDW, Turner SW. Quality of life: what matters? Arch Dis Child 2022; 107:521-522. [PMID: 35210221 DOI: 10.1136/archdischild-2021-323726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Carr SB, Unger SA. Childhood bronchiectasis, so little is known. Arch Dis Child 2022; 107:523-524. [PMID: 35318195 DOI: 10.1136/archdischild-2021-323721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 11/04/2022]
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Sessions KL, Smith AG, Holmberg PJ, Wahl B, Mvalo T, Chisti MJ, Carroll RW, McCollum ED. Continuous positive airway pressure for children in resource-limited settings, effect on mortality and adverse events: systematic review and meta-analysis. Arch Dis Child 2022; 107:543-552. [PMID: 34880003 PMCID: PMC9125374 DOI: 10.1136/archdischild-2021-323041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Determine non-invasive ventilation with continuous positive airway pressure (CPAP) outcomes for paediatric respiratory distress in low-income and middle-income countries (LMICs). DESIGN Systematic review and meta-analysis. SETTING LMIC hospitals. PATIENTS One month to 15 year olds with respiratory distress. INTERVENTIONS We searched Medline, Embase, LILACS, Web of Science and Scopus on 7 April 2020. Included studies assessed CPAP safety, efficacy or effectiveness. All study types were included; neonatal only studies were excluded. Data were extracted by two reviewers and bias was assessed. Certainty of evidence was evaluated, and risk ratios (RR) were produced for meta-analyses. (PROSPERO protocol CRD42018084278). RESULTS 2174 papers were screened, 20 were included in the systematic review and 3 were included in two separate meta-analyses of mortality and adverse events. Studies suitable for meta-analysis were randomised controlled trials (RCTs) from Bangladesh, Ghana and Malawi. For meta-analyses comparing death or adverse events between CPAP and low-flow oxygen recipients, we found no clear CPAP effect on mortality (RR 0.75, 95% CI 0.33 to 1.72) or adverse events (RR 1.52, CI 0.71 to 3.26). We downgraded the certainty of evidence for both death and adverse events outcomes to 'low' due to design issues and results discrepancies across RCTs. CONCLUSIONS Evidence for CPAP efficacy against mortality and adverse events has low certainty and is context dependent. Hospitals introducing CPAP need to have mechanisms in place to optimise safety in the context it is being used; this includes the location (a high dependency or intensive care area), adequate numbers of staff trained in CPAP use, close monitoring and mechanisms for escalation, daily direct physician supervision, equipment that is age appropriate and user-friendly and continuous monitoring of outcomes and quality of care.
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Charles R, Brand PLP, Gilchrist FJ, Wildhaber J, Carroll W. Why are children with asthma bullied? A risk factor analysis. Arch Dis Child 2022; 107:612-615. [PMID: 34848397 DOI: 10.1136/archdischild-2021-321641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The links between bullying and asthma have not been explored in children. We wanted to determine the child/parent factors and attitudes associated with asthma-related bullying. Individual child/parent responses of children with asthma (N=943) from the Room to Breathe survey were analysed. 1 in 10 children reported asthma-related bullying/teasing (n=93). Children with well-controlled asthma were less likely to report being a victim of asthma-related bullying/teasing (OR 0.51, 95% CI 0.23 to 0.84, p=0.006). Being a victim of bullying/teasing was more common in children reporting activity restriction (OR 1.74, 95% CI 1.11 to 2.75, p=0.010), who described their asthma as 'bad' (OR 3.02, 95% CI 1.86 to 4.85, p<0.001) and those whose parents reported ongoing asthma-related health worries (OR 1.64, 95% CI 1.04 to 2.58, p=0.024). Asthma consultations should incorporate specific questions about bullying and be child-focused in order to gain a representative appreciation of asthma control and its impact on the child's life.
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Elswood TR, Turner C, Hornsby J. Idiopathic chronic eosinophilic pneumonia: a differential diagnosis of lower respiratory tract infection. BMJ Case Rep 2022; 15:e244458. [PMID: 35606034 PMCID: PMC9125709 DOI: 10.1136/bcr-2021-244458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old woman presented with a presumed lower respiratory tract infection, with symptoms of persistent cough, lethargy, fevers and night sweats. Initial general practitioner assessment revealed raised C reactive protein and a leucocytosis comprising both a neutrophilia and an eosinophilia. The patient was initially treated for bacterial pneumonia. Despite treatment, the patient's condition did not improve and hospital admission was arranged for further investigation. Initial physical examination was unremarkable. A chest X-ray revealed bilateral, symmetrical, peripheral consolidation with an upper zone predominance. Subsequently, endobronchial washings revealed abundant eosinophils. A diagnosis of idiopathic chronic eosinophilic pneumonia was made, and the patient responded well to oral corticosteroids with complete resolution of radiological appearances 1 month later.
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