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David M Lewinsohn, Michael K Leonard, Philip A LoBue, David L Cohn, Charles L Daley, Ed Desmond, Joseph Keane, Deborah A Lewinsohn, Ann M Loeffler, Gerald H Mazurek, Richard J O'Brien, Madhukar Pai, Luca Richeldi, Max Salfinger, Thomas M Shinnick, Timothy R Sterling, David M Warshauer, Gail L Woods
BACKGROUND: Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS: A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence...
December 8, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Matthew W Rehrer, Bella Liu, Marcela Rodriguez, Joseph Lam, Harrison J Alter
STUDY OBJECTIVE: Oral dexamethasone demonstrates bioavailability similar to that of oral prednisone but has a longer half-life. We evaluate whether a single dose of oral dexamethasone plus 4 days of placebo is not inferior to 5 days of oral prednisone in treatment of adults with mild to moderate asthma exacerbations to prevent relapse defined as an unscheduled return visit for additional treatment for persistent or worsening asthma within 14 days. METHODS: Adult emergency department patients (aged 18 to 55 years) were randomized to receive either a single dose of 12 mg of oral dexamethasone with 4 days of placebo or a 5-day course of oral prednisone 60 mg a day...
April 14, 2016: Annals of Emergency Medicine
Gabriele Saccone, Vincenzo Berghella
OBJECTIVE:  To evaluate the effectiveness of antenatal corticosteroids given at ≥34 weeks' gestation. DESIGN:  Systematic review with meta-analysis. DATA SOURCES:  Electronic databases were searched from their inception to February 2016. ELIGIBILITY CRITERIA FOR STUDY SELECTION:  Randomized clinical trials comparing antenatal corticosteroids with placebo or no treatment in women with a singleton pregnancy at ≥34 weeks' gestation...
October 12, 2016: BMJ: British Medical Journal
Andre C Kalil, Mark L Metersky, Michael Klompas, John Muscedere, Daniel A Sweeney, Lucy B Palmer, Lena M Napolitano, Naomi P O'Grady, John G Bartlett, Jordi Carratalà, Ali A El Solh, Santiago Ewig, Paul D Fey, Thomas M File, Marcos I Restrepo, Jason A Roberts, Grant W Waterer, Peggy Cruse, Shandra L Knight, Jan L Brozek
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia...
September 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
James J Cummings, Richard A Polin
The use of supplemental oxygen plays a vital role in the care of the critically ill preterm infant, but the unrestricted use of oxygen can lead to unintended harms, such as chronic lung disease and retinopathy of prematurity. An overly restricted use of supplemental oxygen may have adverse effects as well. Ideally, continuous monitoring of tissue and cellular oxygen delivery would allow clinicians to better titrate the use of supplemental oxygen, but such monitoring is not currently feasible in the clinical setting...
August 2016: Pediatrics
Eric L Scholten, Jeremy R Beitler, G Kim Prisk, Atul Malhotra
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning...
January 2017: Chest
Robin H Steinhorn
Persistent pulmonary hypertension of the newborn (PPHN) is a surprisingly common event in the neonatal intensive care unit, and affects both term and preterm infants. Recent studies have begun to elucidate the maternal, fetal and genetic risk factors that trigger PPHN. There have been numerous therapeutic advances over the last decade. It is now appreciated that oxygen supplementation, particularly for the goal of pulmonary vasodilation, needs to be approached as a therapy that has risks and benefits. Administration of surfactant or inhaled nitric oxide (iNO) therapy at a lower acuity of illness can decrease the risk of extracorporeal membrane oxygenation/death, progression of disease and duration of hospital stay...
2016: Neonatology
Corrado Moretti, Camilla Gizzi, Francesco Montecchia, Caterina Silvia Barbàra, Fabio Midulla, Manuel Sanchez-Luna, Paola Papoff
Although mechanical ventilation via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to development of many possible complications including bronchopulmonary dysplasia. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of noninvasive respiratory support beyond nasal continuous positive airway pressure, such as nasal intermittent positive pressure ventilation and synchronized nasal intermittent positive pressure ventilation, are also available and may reduce intubation rate...
2016: Neonatology
Fritz Horak, Daniel Doberer, Ernst Eber, Elisabeth Horak, Wolfgang Pohl, Josef Riedler, Zsolt Szépfalusi, Felix Wantke, Angela Zacharasiewicz, Michael Studnicka
This statement was written by a group of pulmonologists and pediatric pulmonologists belonging to the corresponding professional associations ÖGP (Austrian Society for Pulmonology) and ÖGKJ (Austrian Society for pediatric and adolescent medicine) to provide a concise overview of the latest updates in the 2015 GINA Guidelines and to include aspects that are specific to Austria.
August 2016: Wiener Klinische Wochenschrift
Elena C Cavallaro, Kar-Kate Liang, Mark D Lawrence, Kevin D Forsyth, Dani-Louise Dixon
BACKGROUND: Hospitalization with bronchiolitis is linked to the development of early childhood chronic wheeze and asthma. Viral etiology and severity of inflammation are potential contributing factors. Previously we observed reduced airway neutrophil infiltration in breastfed bronchiolitic infants, with a corresponding reduction in disease severity. This study aimed to examine whether respiratory viral etiology and co-infection alters the pattern of neutrophil influx, and the inflammatory mediator profile, resulting in epithelial damage in bronchiolitis...
July 13, 2016: Pediatric Pulmonology
Lars C Huber, Hannah Bye, Matthias Brock
Elevation of the mean pulmonary arterial pressure to ≥25 mm Hg within the low-pressure system of the pulmonary circulation is defined as pulmonary hypertension. Pulmonary hypertension may be the consequence of various clinical and pathophysiological entities. Many of these conditions, however, result in a final common pathway of pathogenesis. This pathway is characterised by the triad of excessive vasoconstriction, microthrombosis and remodelling of pulmonary arteries. Remodelling is arguably the most important factor: its complex pathogenesis is not completely understood and no specific treatment directly targets vascular remodelling...
2015: Swiss Medical Weekly
Andreas Pfleger, Ernst Eber
Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is usually heard on inspiration (typically resulting from supraglottic or glottic obstruction) but also can occur on expiration (originating from obstruction at or below glottic level and/or severe upper airway obstruction). Stridor due to congenital anomalies may exist from birth or may develop within days, weeks or months. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and have to be distinguished...
March 2016: Paediatric Respiratory Reviews
Niki Mitselou, Gunilla Hedlin, Carl-Axel Hederos
OBJECTIVE: To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children. METHODS: A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children who were admitted for virus induced wheezing or acute asthma exacerbation were randomly allocated to receive bronchodilator treatment by nebulizer or by metered dose inhaler...
December 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
David M Lang
Updated asthma care guidelines have recently been released. This review will focus on several elements in the Expert Panel Report (EPR) 3 guidelines that reflect substantial differences compared with recommendations of the EPR2 guidelines, issued in 1997 and updated in 2002. A major difference is the emphasis on asthma control. The revised paradigm for asthma management now recommends that asthma management decisions should be initially based on categorization of asthma severity, and subsequently on assessment of asthma control...
November 2007: Allergy and Asthma Proceedings:
Rebecca Normansell, Kayleigh M Kew, George Mansour
BACKGROUND: Asthma is a common long-term breathing condition that affects approximately 300 million people worldwide. People with asthma may experience short-term worsening of their asthma symptoms; these episodes are often known as 'exacerbations', 'flare-ups', 'attacks' or 'acute asthma'. Oral steroids, which have a potent anti-inflammatory effect, are recommended for all but the most mild asthma exacerbations; they should be initiated promptly. The most often prescribed oral steroids are prednisolone and dexamethasone, but current guidelines on dosing vary between countries, and often among different guideline producers within the same country...
May 13, 2016: Cochrane Database of Systematic Reviews
Richard Nowak, Charles Emerman, John P Hanrahan, Merdad V Parsey, Nicola A Hanania, Raymond Claus, Kendyl Schaefer, Rudolf A Baumgartner
UNLABELLED: This multicenter, randomized, double-blind trial compared nebulized levalbuterol (Lev) and racemic albuterol (Rac) in the treatment of acute asthma. METHODS: Adults with acute asthma exacerbations (FEV(1) 20%-55% predicted) received prednisone and either Lev (1.25 mg, n = 315) or Rac (2.5 mg, n = 312). Nebulized treatments were administered every 20 minutes in the first hour, then every 40 minutes for 3 additional doses, then as necessary for up to 24 hours...
May 2006: American Journal of Emergency Medicine
Richard Auten, Jurgen Schwarze, Clement Ren, Stephanie Davis, Terry L Noah
Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection. Pediatr Pulmonol. 2016;51:733-739...
July 2016: Pediatric Pulmonology
Herman T den Dekker, Agnes M M Sonnenschein-van der Voort, Vincent W V Jaddoe, Irwin K Reiss, Johan C de Jongste, Liesbeth Duijts
BACKGROUND: Breastfeeding is associated with a lower risk of asthma symptoms in early childhood, but its effect at older ages remains unclear. We examined the associations of duration and exclusiveness of breastfeeding with asthma outcomes in children aged 6 years, and whether these associations were explained by atopic or infectious mechanisms. METHODS: We performed a population-based prospective cohort study among 5675 children. Information about breastfeeding was collected by questionnaires...
2016: Pediatric Allergy and Immunology
Shyan Vijayasekaran, Janet Lioy, Kathryn Maschhoff
Differences between neonatal, pediatric and adult airway anatomy, structure and function are important to understand. Size, surface area, proportion, resistance and compliance are all very different between age groups and infants are certainly not small adults. Knowledge of these airway differences is essential in rapid correction of an emergency situation. Unanticipated airway emergencies are the most serious of all and may be classified into profiles such as the unanticipated emergency in the non-intubated patient, the unanticipated emergency in the intubated patient, and patients with tracheostomy...
August 2016: Seminars in Fetal & Neonatal Medicine
Jeffrey Baron, Gladys El-Chaar
Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy...
January 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
2016-04-14 01:51:01
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