Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 11 Articles
Background: The link between histologic acute chorioamnionitis and infection is well established in preterm deliveries, but\nless well-studied in term pregnancies, where infection is much less common.\nMethodology/Principal Findings: We conducted a secondary analysis among 195 low-risk women with term pregnancies\nenrolled in a randomized trial. Histologic and microbiologic evaluation of placentas included anaerobic and aerobic cultures\n(including mycoplasma/ureaplasma species) as well as PCR. Infection was defined as $1,000 cfu of a single known\npathogen or a $2 log difference in counts for a known pathogen versus other organisms in a mixed culture. Placental\nmembranes were scored and categorized as: no chorioamnionitis, Grade 1 (subchorionitis and patchy acute\nchorioamnionitis), or Grade 2 (severe, confluent chorioamnionitis). Grade 1 or grade 2 histologic chorioamnionitis was\npresent in 34% of placentas (67/195), but infection was present in only 4% (8/195). Histologic chorioamnionitis was strongly\nassociated with intrapartum fever .38uC [69% (25/36) fever, 26% (42/159) afebrile, P,.0001]. Fever occurred in 18% (n = 36)\nof women. Most febrile women [92% (33/36)] had received epidural for pain relief, though the association with fever was\npresent with and without epidural. The association remained significant in a logistic regression controlling for potential\nconfounders (OR = 5.8, 95% CI = 2.2,15.0). Histologic chorioamnionitis was also associated with elevated serum levels of\ninterleukin-8 (median = 1.3 pg/mL no histologic chorioamnionitis, 1.5 pg/mL Grade 1, 2.1 pg/mL Grade 2, P = 0.05) and\ninterleukin-6 (median levels = 2.2 pg/mL no chorioamnionitis, 5.3 pg/mL Grade 1, 24.5 pg/mL Grade 2, P = 0.02) at\nadmission for delivery as well as higher admission WBC counts (mean = 12,000cells/mm3 no chorioamnionitis, 13,400cells/\nmm3 Grade 1, 15,700cells/mm3 Grade 2, P = 0.0005).\nConclusion/Significance: Our results suggest histologic chorioamnionitis at term most often results from a noninfectious\ninflammatory process. It was strongly associated with fever, most of which was related to epidural used for pain relief. A\nmore ââ?¬Ë?activatedââ?¬â?¢ maternal immune system at admission was also associated with histologic chorioamnionitis....
In this study, the effect of dopamine as agonist dopaminergic receptor and alpha and beta adrenergic receptor \r\nwas studied both in vivo. The effect of tolazoline as an antagonist of alpha-2 adrenergic receptor was also studied \r\nin patients with bronchial asthma and persons with increased bronchial reactibility. Parameters of the lung function \r\nare determined by body plethysmography. Raw and ITGV were registered and SRaw was calculated as well. \r\nAerosolization is done with standard aerosolizing machines ââ?¬â?? Asema. Results gained in vivo shows that stimulation \r\nof alpha adrenergic receptor with dopamine (4 Ã?µg and 300 Ã?µg) causes significant contraction (p > 0.1) of the smooth \r\nbronchial musculature. Whereas, blockage of alpha-2 adrenergic receptor with tolazoline (20 mg by inhalator ways) \r\ndoes not change the bronchimotor tonus significantly (p>0.1) when compared to the stimulation of beta-2 adrenergic \r\nreceptor with hexoprenaline (2 inh. x 0.2 mg) and blocker of cholinergic receptor - ipratropium (2 inh. x 1 mg). Reaction \r\nof the smooth musculature to dopamine suggests that this substance may cause constriction through alpha adrenergic \r\nreceptors. Reaction may also be intermediated in indirect ways through dopaminergic receptor of the cholinergic \r\ntransmission, with intracellular inhibition of the creation of cAMP....
Tobacco smoke and radioactive radon gas impose a high risk for lung cancer. The radon-derived ionizing radiation and some components\r\nof cigarette smoke induce oxidative stress by generating reactive oxygen species (ROS). Respiratory lung cells are subject to\r\nthe ROS that causes DNA breaks, which subsequently bring about DNAmutagenesis and are intimately linked with carcinogenesis.\r\nThe damaged cells by oxidative stress are often destroyed through the active apoptotic pathway. However, the ROS also perform\r\ncritical signaling functions in stress responses, cell survival, and cell proliferation. Some molecules enhance radiation-induced\r\ntumor cell killing via the reduction in DNA repair levels. Hence the DNA repair levels may be a novel therapeutic modality in overcoming\r\ndrug resistance in lung cancer. Either survival or apoptosis, which is determined by the balance between DNA damage and\r\nDNA repair levels, may lender the major problems in cancer therapy. The purpose of this paper is to take a closer look at risk factor\r\nand at therapy modulation factor in lung cancer relevant to the ROS....
Morbidly obese patients may present a challenge during airway management. When airway tube exchange is required, it can even\r\nbe more challenging than the primary intubation. With the increasing prevalence of morbid obesity over the years, there will be\r\nincreasing numbers of these patients presenting for surgical procedures, including ones that require endotracheal tube exchanges.\r\nIt is therefore important for anesthesiologists to be familiar with options and limitations of the airway tube exchanger techniques....
Chronic Obstructive Pulmonary Disease (COPD) is increasingly recognized as a systemic disease characterized by progressive airfow limitation as well as respiratory and peripheral muscle weakness. oefciency in the levels of carnitine \"an essential nutrient for optimal muscle function\" has been associated with peripheral and respiratory muscle weakness in other diseases, but has not yet been examined in COPD patients. The aim of this study was to investigate whether plasma acyl carnitine fractions were reduced in patients with capo, and examine if the defciency correlated with COPD severity. \r\nPatients and methods: A prospective case control study to compare acyl carnitine levels and other parameters in 81 capo patients treated at the pulmonology oepartment, King Fahad Specialist Hospital oammam, with 48 age and sex matched healthy controls. All subjects participating in the study underwent a complete physical examination and detailed pulmonary function tests (pFTs). Blood samples were taken for acyl carnitine profles as well as a panel of other tests including albumin, total protein, Iron, cRp and pre-albumin. Acyl carnitine profle was determined using Lc-MS/MS analysis. \r\nResults: COPD patients had signifcantly lower total carnitine levels compared to controls (43.9�±6.5 and 22.7�±11.9 respectively). Furthermore there was a signifcantly greater reduction in carnitine levels in patients with very severe COPD compared to patients with mild COPD. \r\nConclusion: aur study demonstrated a signifcant defciency in carnitine levels in COPD patients, and the degree of defciency correlated with the severity of COPD....
Churg Straus syndrome is considered a systemic vasculitis in asthmatic patients with important diagnostic signs \r\nof hypereosinophilia, pulmonary infltration, vasculitic skin lesions and nasal polyps and mononeuritis multiplex also \r\nsupports this diagnosis. Here we present a patient with long history of asthma, polypectomy, abdominal pains and \r\ntreatment by different brands of monteleukast....
The clinical effects of environmental pollution and climate change on respiratory health is a contemporary debate \nissue. In this study, the sulfur dioxide (SO2\n), particulate matter (PM10\n) levels, and climate conditions in the city of \nIzmir, have been taken together with the patients with asthma or acute bronchiolitis, who admitted to the childrenâ��s \nemergency departments of the four university/education-research hospitals in Izmir. From September 1, 2007 until \nAugust 31, 2008, the 22,467 patients who admitted to these centers because of airway hyperreactivity, were of \nage 3.05�±1.57 on the average, and the male/female ratio was 1.7. Among the patients, 79.3% were having acute \nbronchiolitis, and 20.7% an asthma attack. As SO2\n and PM10\n levels increase, the daily asthma attacks, patients \nwith acute bronchiolitis, and total of patients with hyperactivity, were observed to increase (p<0.001). In addition, \nthe numbers in the following five days after the increase of air pollution rate, were observed to increase statistically \nsignificantly (p<0.001). The number of asthma and acute bronchiolitis patients applying to emergency, was negatively \ncorrelated with daily average temperature, but positively correlated with relative humidity, actual air pressure, and sealevel pressure levels (p<0.001). Reflecting on the increase of asthma and acute bronchiolitis in developed societies, \nthere is a necessity of effective reliefs such as effectively monitoring the within-city air quality, taking the industrial \ncenters out of the city, promoting public transportation, and preserving the natural life....
Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of\r\ncomplications during airway management. Access to the airway in the obese patient can be a challenge because they have\r\naltered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in\r\nthe pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by\r\nappropriate techniques for lung separation with the use of a single-lumen endotracheal tube and a bronchial blocker or another\r\nalternative is with the use of a double-lumen endotracheal tube. This review is focused on the use of lung isolation devices\r\nin the obese patient. The recommendations are based upon scientific evidence, case reports or personal experience. Fiberoptic\r\nbronchoscopy must be used to place and confirm proper placement of a single-lumen endotracheal tube, bronchial blocker or\r\ndouble-lumen endotracheal tube....
Pulmonary interstitial emphysema in mechanically ventilated premature infants is a serious complication that \r\nis diffcult to manage and is associated with a poor prognosis [1]. We describe a premature infant with respiratory \r\ninsuffciency secondary to severe pulmonary interstitial emphysema that was managed with nasopharyngeal high-\r\nfrequency oscillatory ventilation, as a non-invasive mode of ventilation. \r\nOur case report does not clearly differentiate whether the improvement in gas exchange and eventual resolution \r\nof PIE are attributable to the use of non-invasive HFOV or to the use more appropriate low frequency (7Hz) with the \r\nnon-invasive approach. Further studies of NP-HFOV use in infants with PIE are needed to support our report \r\nConclusion: NP-HFOV may be utilized in infants with PIE associated with compromised respiratory function. NP�¬HFOV may decrease the chance of further pulmonary complications, including pneumonia and lung atelectasis, and facilitate care of sick infants while on NP-HFOV....
The Mycobacterium terrae complex, consisting of three saprophytic species, (M. terrae, M. nonchromogenicum, \r\nand M. triviale), they rarely cause diseases in immunocompetent people. There are few case reports of lung \r\ninvolvement by Mycobacterium terrae complex. We reported a 13 years old immunompetent girl with a cavitary opacity \r\nseen on chest imaging and bronchoscopy revealed an endobronchial lesion, sputum and tissue specimens revealed \r\ngrowth of Mycobacterium triviale. Our patient is unique as it is the frst case reported in Saudi Arabia with this type \r\nof Mycobacteria, in addition there is no case reported in the literature with Mycobacterium triviale with endobronchial \r\nlesion, the patient treated with a combination of rifampicin, ciprofoxacin and ethambutol for six months, she showed \r\ngood response with resolution of radiological abnormalities and she did not have relapse after one year of follow up....
We conducted a randomised single-blind controlled trial comparing the LMA-Unique (LMAU) and theAMBUAuraOnce (AMBU)\ndisposable laryngeal mask in spontaneously breathing adult patients undergoing general anaesthesia. Eighty-two adult patients\n(ASA status Iââ?¬â??IV) were randomly allocated to receive the LMAU or AMBU and were blinded to device selection. Patients received\na standardized anesthetic and all airway devices were inserted by trained anaesthetists. Size selection was guided by manufacturer\nrecommendations. All data were collected by a single, unblinded observer.When compared with the LMAU, the AMBU produced\nsignificantly higher airway sealing pressures (AMBU 20Ã?±6; LMAU 15Ã?±7 cmH2O; P = 0.001). There was no statistical difference\nbetween the two devices for overall success rate, insertion time, number of adjustments, laryngeal alignment, blood-staining, and\nsore throat (P = 0.05). The AMBU AuraOnce disposable laryngeal mask provided a higher oropharyngeal leak pressure compared\nto the LMA Unique in spontaneously breathing adult patients....
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