Clinical efficacy of non-invasive ventilation combined with Chinese medicine for intestinal regulation in Chinese children with respiratory disorders.

Chinese medicine for intestinal regulation is an emerging method for pediatric respiratory disorders, which has better clinical value when combined with NIV (Non-invasive ventilation). This study aims to observe the clinical efficacy of NIV plus Chinese medicine for intestinal regulation in Chinese children with respiratory disorders. Thirty-nine patients admitted to Huaihua First People's Hospital, between March 2016 and July 2018 were enrolled, including 14 children with chronic hypercapnic respiratory failure, 19 with non-surgical OSAS, 5 with OB and 1 with central hypoventilation syndrome. After NIV, the blood gas carbon dioxide retention and labored breathing were improved, respiratory rate and heart rate were decreased and the feeding condition of some children improved. After NIV treatment, clinical symptoms of children with OSAS were significantly ameliorated. In polysomnography monitoring, the AHI, OAI and SpO2 were significantly enhanced following NIV. In addition, patients with OB and central hypoventilation had different degrees of improvement of their symptoms. NIV plus Chinese medicine for intestinal regulation alleviate the clinical symptoms and enhances the quality of life of children with chronic hypercapnic respiratory failure. Some children could be transferred out of the intensive care unit and into home mechanical ventilation.

Respiratory follow-up of patients with COVID-19 pneumonia.

The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation.

[Dysfunctional breathing in patients with asthma].

Dysfunctional breathing (DB) is a common comorbidity in adults with incomplete asthma control. The few available large-scale, randomized studies suggest efficacy of physiotherapy on symptom burden. In this article we discuss the current evidence including the need for systematic description of physiotherapeutic interventions. We also describe how access to physiotherapy service for DB (with or without asthma) is highly heterogeneous in Denmark, and that there is a need for increasing awareness of physiotherapy implementation for and research in DB (with or without concomitant asthma).

[Case Report - Really a diving accident?]. / Kasuistik - Tatsächlich ein Tauchunfall?

A 17 y old male SCUBA diver presents himself for hospital admission after a suspected diving accident. All clinical signs are favouring the initial diagnosis: loss of leg motor function, paresthesia, disturbed vision and headache. What are your further diagnostic and therapeutic steps? Can you proof the initial diagnosis? What differential diagnoses are relevant or even mimicked?

Ensayo clínico aleatorizado de la comparación entre método de enseñanza tradicional y escenario simulado para la adquisición de competencias en el reconocimiento de signos de enfermedad respiratoria aguda en pacientes pediátricos / Randomized clinical trial to compare the traditional teaching method and the simulated-scenario teaching © 2015 FEM method in the acquisition of skills for the identification of acute respiratory disease signs in paediatric patients

INTRODUCCIÓN: La infección respiratoria aguda es un problema de salud pública en menores de 5 años; la detección e identificación tempranas de sus signos disminuye la mortalidad en este grupo de edad y es una meta de la formación médica. OBJETIVO: Comparar en estudiantes de medicina el método educativo tradicional y el escenario simulado para el reconocimiento de signos de enfermedad respiratoria aguda en niños de 2 meses a 5 años. SUJETOS Y MÉTODOS: Se realizó un ensayo clínico para estudiantes de medicina, aleatorizados en dos grupos: A (clase teórica y ayudas audiovisuales) y B (escenario simulado). El desenlace primario fue el desempeño en la evaluación global. Se realizó prueba de Mann-Withney Wilcoxon para comparación entre grupos y Mann-Withney Wilcoxon pareada para análisis intragrupo (antes y después de la intervención). RESULTADOS: Mediante prueba de Mann-Withney Wilcoxon pareada intragrupo pre y postintervención, el grupo A mostró mejor un desarrollo de competencias en el desenlace primario (p = 0,02) y en la evaluación global del escenario simulado (p = 0,04). El grupo B logró cambios significativos en el desenlace primario (p = 0,00), la anamnesis (p = 0,00) y la evaluación global del escenario simulado (p = 0,00). En la evaluación postintervención no se encontraron diferencias significativas en el desenlace primario ni secundario. CONCLUSIONES. La comparación postintervención entre los grupos A y B no mostró diferencias significativas en ninguna de las variables estudiadas entre ambos grupos

INTRODUCTION: The acute respiratory infection is a public health problem in children under 5 years of age. The early detection and identification of its signs reduces the mortality rates in these age groups and is an objective in medical education. AIM. To compare the traditional teaching method with the simulated-scenario teaching method in the acquisition of skills necessary to recognize respiratory distress in children between 2 months and 5 years of age by medical students. SUBJECTS AND METHODS: A clinical trial was done for medical students and they were divided into two randomized groups: group A which used the traditional teaching method and group B, which used the simulated-scenario method. The primary outcomes were seen in the global evaluation performances. A Mann-Withney Wilcoxon test was used for the comparison among groups and a paired Mann-Withney Wilcoxon test was used for the intra-group analysis (before and after the intervention). RESULTS: When using the paired Mann-Withney Wilcoxon intragroup test pre and post intervention, group A showed a better skill development in the primary outcome (p = 0.02) and the global evaluation in simulated scenario (p = 0.04). On the other hand, group B reached significant changes on the primary outcomes (p = 0.00), anamnesis (p = 0.00) and global evaluation with the simulated-scenario method (p = 0.00). It was observed that in the post-intervention evaluation there weren’t any significant differences between the primary and secondary outcomes. CONCLUSIONS: The post-intervention comparison between groups A and B didn’t show significant differences in the studied variables between both groups

Short-term effects of combination of several physiotherapy methods on the respiratory function - a case report of adolescent idiopathic scoliosis.

UNLABELLED: The aim of the study was to evaluate the positive effects of combination of several physiotherapy methods on the respiratory function on example of a case report. MATERIAL AND METHODS: 14 years old girl with an adolescent idiopathic scoliosis (AIS), right thoracic (primary curve, Cobb angle = 40°, AVR = 12°) and left lumbar (secondary curve, Cobb angle = 33°, AVR = 24°) participated in the study. She was 2 years after menarche. She underwent stationary (in-patient) treatment for 3 weeks with use of standard medical care (DoboMed). Treatment also included manual therapy (OMT Kaltenborn-Evjenth) and Dynamic Brace System (DBC) device, produced by Meditrack. Then she continued exercises at home. Respiratory system function was analyzed with use of SpiroPro electronic spirometer (Jaeger) and the strength of respiratory muscles with use of portable digital pressure meter equipped with the Omega PX 25 ± 35 kPa pressure transducer. Range of movement of the spine was examined with Rippstein V plurimeter, angle of apical trunk rotation (ATR) with the Bunnell scoliometer. Measurement was performed 4 times: before treatment, after one week and 3 weeks after the beginning of the treatment and 3 months after finalization of the treatment period. RESULTS: Examination showed that DoboMed medical care treatment, manual therapy and use of DBC device in period of 3 weeks caused improvement of respiratory parameters (MIP - maximal inspiration pressure by 6.7%; MEP - maximal expiratory pressure by 12.6%, PEF - peak expiratory flow by 16.1%). Spinal range of lateral movement and angle of apical trunk rotation has also improved. CONCLUSION: In short term treatment, the manual therapy aided with DBC system has improved the respiratory parameters and trunk morphology values. Such a composition of various physiotherapy methods can help to conduct further specialized exercises of DoboMed method.

Breathing retraining - a five-year follow-up of patients with dysfunctional breathing.

INTRODUCTION: The term dysfunctional breathing (DB) has been introduced to describe patients who display divergent breathing patterns and have breathing problems that cannot be attributed to a specific medical diagnosis. Patients with DB are often misdiagnosed as having asthma. OBJECTIVES: To describe patients with DB, five years after a breathing retraining intervention. METHODS: Out of initially 25 patients with DB and 25 age and sex-matched patients with asthma, 22 patients with DB and 23 patients with asthma (ages 25-78 years) were followed up after five years. Data were collected from posted self-report questionnaires. Only patients with DB had received breathing retraining, consisting of information, advice and diaphragmatic breathing. Patients were evaluated regarding quality of life (SF-36), anxiety, depression, sense of coherence, hyperventilation, influence on daily life, emergency room (ER) visits, and symptoms associated with DB. RESULTS: Quality of life (SF-36), physical component summary scale (PCS), had improved in patients with DB from 43 to 47 (p = 0.03). The number of ER visits had decreased from 18 to 2 in patients with DB (p = 0.02). Symptoms associated with DB had decreased extensively, from a mean score of 6.9 to 2.7, on a DB criterion list (p < 0.001). Patients with DB were less impaired by their breathing problems both in daily life and when exercising (p < 0.001). The only difference found over time in the asthma group concerned quality of health, bodily pain, which had deteriorated, from 77 to 68 (p = 0.049). CONCLUSION: This five-year follow-up study indicates that patients with dysfunctional breathing benefit from breathing retraining.

Medically unexplained dyspnea: partly moderated by dysfunctional (thoracic dominant) breathing pattern.

BACKGROUND: Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction. OBJECTIVES: The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships. METHOD: 62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored. RESULTS: Mean NQ scores were elevated and mean MARM values for thoracic breathing were also elevated. There was a small correlation pre-treatment between MARM and NQ (r=0.26, p<0.05), but classification of subjects as normal/abnormal on both measurements agreed in 74% (p < 0.001) of patients. From the sub scores of NQ only the respiratory or 'dyspnea' items correlated with the MARM values. Dyspnea was only elevated for subjects with abnormal MARM. After treatment, both MARM and NQ returned to normal values (p< 0.0001). Changes in NQ were largest for subjects with abnormal MARM pre-treatment. There was a large interaction between the change in the NQ sub score dyspnea and initial MARM values. (p<0.001).

Relationships between measures of dysfunctional breathing in a population with concerns about their breathing.

BACKGROUND: Dysfunctional breathing (DB) is implicated in physical and psychological health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO(2), biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires and tests of breathing function such as breath holding time. AIM: This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality. METHOD: 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined. RESULTS: Significant correlations where found within categories of measures however correlations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels. CONCLUSION: DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction should include measures of breathing symptoms, breathing pattern, resting CO(2) and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO(2) monitoring.

[EBC: a new matrix for assessment of airway and lung inflammation. Current aspects of environmental and occupational medicine]. / Atemkondensat: Eine neue Matrix zur Erfassung entzündlicher Veränderungen der Atemwege/Lunge. Aktuelle Aspekte aus der Umwelt- und Arbeitsmedizin.

For many environmental and occupational pollutants the respiratory system represents the route of entry. Inflammation is a fundamental process in the pathophysiological cascade leading to respiratory diseases such as asthma or chronic obstructive pulmonary disease. Non-invasive inflammatory monitoring may assist in the diagnosis as well as assessments of severity and response to treatment. Of these, exhaled nitric oxide is the best validated constituent and is used for assessing airway inflammation in clinical practice, particularly in patients with asthma. Exhaled breath condensate (EBC) is the liquid phase of the exhaled breath sampled by cooling. EBC, like blood or urine, is not a marker itself but a matrix in which a wide variety of substances have already been detected. EBC biomarkers reflect acid stress, oxidative stress, or inflammation. There are still many methodological limitations and the interpretation of findings is hampered by the fact that the most widely used devices differ significantly in their collection efficiency for markers of interest and the analytical technology employed is often near the limit of detection. In spite of promising data, standardisation of the already existing procedures is required for the implementation of EBC in clinical practice. EBC might be of particular interest in preventive medicine since adverse inflammatory processes often precede changes in lung function. Concerning the adverse effects of air pollution, there is a special focus on markers reflecting oxidative stress since air pollutants have the ability to drive free radical reactions. This overview focuses on recent data on EBC obtained from articles concerning applications of exhaled breath analysis in environmental and occupational medical research.

Vagus nerve stimulation induces concomitant respiratory alterations and a decrease in SaO2 in children.

PURPOSE: To analyze respiratory alterations and effects on SaO(2) caused by vagus nerve stimulation (VNS) in children with epilepsy. METHODS: Polysomnographic recordings, including electroencephalography, thoracoabdominal distention, nasal airflow, SaO(2), and VNS artifact were evaluated in 10 children with pharmacoresistant epilepsy treated with VNS. RESULTS: Each VNS caused a significant increase in respiratory frequency (p < 0.05) throughout the stimulation period and a decrease in thoracoabdominal-distention amplitude (p < 0.05), especially at the beginning of the stimulation. These respiratory alterations induced a decrease in SaO(2) from 1 to 5%. The effects of VNS on respiration differed significantly between rapid-eye-movement (REM) and non-REM (NREM) sleep states. CONCLUSIONS: VNS caused a pronounced change in respiration in children with epilepsy, and this induced a decrease in SaO(2). It is possible that VNS has a neuroprotective effect, and this possibility calls for further investigation.

Changes of autonomic nervous system function in patients with breath-holding spells treated with iron.

To evaluate the autonomic nervous system of patients with breath-holding spells after iron treatment, we attempted to determine whether a dysregulation of the autonomic nervous system reflexes exists in children with severe cyanotic breathholding spells. An electrocardiogram for each subject was recorded for 24 hours in the subject's home and parasympathetic activity was investigated by the fast Fourier transform method. Hematologic data and clinical symptoms of all three patients treated with iron improved and attacks of severe breath-holding spells disappeared. After iron treatment was started, the heart rate variability increased during sleep. It appears that supplementation of iron is effective in improving the dysregulation of autonomic nervous system reflexes.

Pulmonary damage after modest exposure to zinc chloride smoke.

Thirteen soldiers (11 men and two women) were exposed to zinc chloride smoke (ZCS) during a combat exercise. Even though their initial symptoms were modest, a prolonged follow up with lung function testing and blood samples was undertaken due to previous cases with fatal outcome after exposure to ZCS. Four weeks after exposure there were statistically significant declines from baseline values in lung diffusion capacity and total lung capacity of 16.2% and 4.3%, respectively. At the same time plasma levels of fibrinogen and zinc were significantly elevated, though mainly within the normal range. All variables showed a tendency towards normalization at follow up 8 weeks and 6 months after exposure. These findings indicate an unexpected quantifiable damage to lung parenchyma with a remarkable delay after modest exposure to zinc chloride smoke despite sparse initial symptoms. Exposure to high concentrations of ZCS may induce adult respiratory distress syndrome (ARDS) after a symptom free period of up to 12 days from exposure. Even though none of the soldiers in the present study developed ARDS the assessment of lung diffusion capacity and acute phase reactants is proposed as a supplement when monitoring patients after exposure to ZCS.

Clinical and analytical studies of sheep dosed with various preparations of Astragalus lusitanicus.

Dosing different preparations and extracts of Astragalus lusitanicus to lambs showed the fresh plant or its dry powder were highly toxic while the ethyl acetate or methanol extract did not cause toxicosis, suggesting the toxic principle is an extremely water soluble compound. The animals alternated excitement and depression, with cardiac and respiratory disorders terminally. Alpha-mannosidase inhibition was not detected in blood of dosed lambs, but an inhibitory activity was in tissues from lambs given the fresh plant or its powder. There was increased aspartate aminotransferase and creatine kinase activity, suggesting skeletal muscle and neurological effects. Thin-layer chromatography and the alpha-mannosidase inhibition assay did not detect swainsonine in ethyl acetate, methanol or water: methanol plant extracts.

Development and evaluation of a CD-ROM computer program to teach residents telephone management.

OBJECTIVE: Under managed care, telephone management is crucial to pediatric practice, but an effective method is needed to teach residents telephone skills. Our objective was to design an interactive CD-ROM program to teach residents an organized, consistent approach to telephone complaints and to determine whether use of the program was associated with better subsequent telephone management than reading the same information. SETTING: The general pediatric ambulatory center of a tertiary care children's hospital. PARTICIPANTS: A total of 24 PL-2 and PL-3 pediatric residents. DESIGN: A randomized, prospective, controlled comparison was conducted of resident management of two telephone calls: a 5-year-old with cough and trouble breathing, and a 7-year-old with fever. Thirteen residents were randomized to the computer group and 11 to the reading control group. Intervention. Scripts, scoring, and feedback for 10 CD-ROM-simulated calls were developed from texts and pediatrician survey using a modified Delphi technique. Volunteers acted out the caller's role in scenario scripts and were recorded onto a CD-ROM. The computer simulated calls by recognizing questions typed in a free-form format and answering with a voice response. Feedback was provided for omissions in history-taking and errors in assessment, triage, and home management. The computer group worked through the CD-ROM calls while the control group had equal time to read the same information. Evaluation Measures. A trained, standardized patient acted as the mother in pretest calls placed at the beginning of the month and posttest calls at the end. Calls were recorded and scored in a blinded manner using scoring templates and on interpersonal skills using the Patient Perception Questionnaire. RESULTS: Pretest scores for the two calls were similar in the computer versus the control group (cough, 70.33% +/- 8.36 vs 68.46% +/- 6.73; fever, 75.64% +/- 9.82 vs 73.59% +/- 9.06). Posttest scores were significantly higher in the computer group than in the control group on both calls (cough, 79.08% +/- 8.17 vs 69 +/- 13.3; fever: 83.33% +/- 9.96 vs 70.35% +/- 9.66). Interpersonal skills also were similar pretest (19 +/- 3.4 vs 20 +/- 2.7). There was modest improvement in both groups without a statistically significant difference in posttest scores (24.2 +/- 2.9 vs 22.5 +/- 3.1). CONCLUSIONS: Use of this CD-ROM telephone management program was associated with better postintervention telephone management. The program augments faculty instruction by teaching a consistent, general approach to telephone management.