Lead toxicity and endoscopic removal of ingested firearm cartridges.

CONTEXT: Lead toxicity from the ingestion of a lead foreign body has been described in several case reports. Management of ingested live ammunition presents its own challenges due to the risk of accidental discharge. A safe and effective method of retrieving a live cartridge must be considered. CASE DETAILS: We present two cases of lead toxicity due to intact firearm cartridge ingestion with the removal of the cartridges via endoscopy. The first case is of severe pediatric lead toxicity due to the ingestion of 30-mm rifle cartridges. The second case is an adult ingestion of .22 caliber cartridges resulting in mild lead toxicity. DISCUSSION: These cases illustrate a diagnostic dilemma in both the diagnosis of lead toxicity and the removal of live ammunition from the stomach.

Poverty-associated risk factors for wheezing in the first year of life in Honduras and El Salvador

Background: Risk factors for wheezing specifically during the first year of life have been studied in well-developed countries, but the information from developing countries is very scarce. There are no such studies focusing on factors derived from poverty. The aim of the present study was to determine if risk factors related to poverty are associated to wheezing during the first year of life in infants from Honduras and El Salvador. Methods: A survey, using a validated questionnaire, was carried out in the metropolitan area of San Pedro Sula (Honduras) and in La Libertad (El Salvador) in centres where infants attended for a scheduled vaccination shot or a healthy child visit at 12 months of age. Fieldworkers offered questionnaires to parents and helped the illiterate when necessary. The main outcome variable was wheezing during the first year of life, as reported by parents. Results: A total of 1047 infants in El Salvador and 780 in Honduras were included in the analysis. The prevalence of wheeze in the first year was higher in El Salvador (41.2%) than in Honduras (27.7%), as was recurrent wheezing defined as three or more episodes (18.4% vs. 11.7%). Wheezing and recurrent wheezing was associated to unpaved floor in the household (summary odds ratios for both countries 1.55, p=0.036 and 1.72, p=0.054 for any wheeze and recurrent wheezing, respectively); dust entering from streets (1.30, p=0.052 and 1.67, p=0.008); living in a heavily polluted area (1.33, p=0.037 and 1.52, p=0.033); and having mould stains on the household walls (1.36, p=0.072 and 1.76, p=0.007). Furthermore, marginal associations were found for additional person at home and use of kerosene as cooking fuel. University studies in the mother (0.34, p=0.046 and 0.32, p=0.022) and a professional occupation in the father (0.34, p=0.046 and 0.26, p=0.047) were associated to a lower risk. Conclusions: The prevalence of wheezing and recurrent wheezing is notoriously high in El Salvador and Honduras. In those populations factors related to poverty are associated to a higher prevalence of wheezing and recurrent wheezing, whereas higher maternal education and paternal professional occupation behave as protective factors

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Poverty-associated risk factors for wheezing in the first year of life in Honduras and El Salvador.

BACKGROUND: Risk factors for wheezing specifically during the first year of life have been studied in well-developed countries, but the information from developing countries is very scarce. There are no such studies focusing on factors derived from poverty. The aim of the present study was to determine if risk factors related to poverty are associated to wheezing during the first year of life in infants from Honduras and El Salvador. METHODS: A survey, using a validated questionnaire, was carried out in the metropolitan area of San Pedro Sula (Honduras) and in La Libertad (El Salvador) in centres where infants attended for a scheduled vaccination shot or a healthy child visit at 12 months of age. Fieldworkers offered questionnaires to parents and helped the illiterate when necessary. The main outcome variable was wheezing during the first year of life, as reported by parents. RESULTS: A total of 1047 infants in El Salvador and 780 in Honduras were included in the analysis. The prevalence of wheeze in the first year was higher in El Salvador (41.2%) than in Honduras (27.7%), as was recurrent wheezing defined as three or more episodes (18.4% vs. 11.7%). Wheezing and recurrent wheezing was associated to unpaved floor in the household (summary odds ratios for both countries 1.55, p=0.036 and 1.72, p=0.054 for any wheeze and recurrent wheezing, respectively); dust entering from streets (1.30, p=0.052 and 1.67, p=0.008); living in a heavily polluted area (1.33, p=0.037 and 1.52, p=0.033); and having mould stains on the household walls (1.36, p=0.072 and 1.76, p=0.007). Furthermore, marginal associations were found for additional person at home and use of kerosene as cooking fuel. University studies in the mother (0.34, p=0.046 and 0.32, p=0.022) and a professional occupation in the father (0.34, p=0.046 and 0.26, p=0.047) were associated to a lower risk. CONCLUSIONS: The prevalence of wheezing and recurrent wheezing is notoriously high in El Salvador and Honduras. In those populations factors related to poverty are associated to a higher prevalence of wheezing and recurrent wheezing, whereas higher maternal education and paternal professional occupation behave as protective factors.

Norwegian adolescents with asthma are physical active and fit.

BACKGROUND: Evidence regarding habitual physical activity levels and aerobic fitness of asthmatic compared to nonasthmatic children and adolescents is contradictory, and it is unclear if low physical activity levels can contribute to asthma development. The present study therefore aimed to determine whether adolescents with asthma have reduced physical activity levels and aerobic fitness, or increased energy intake and body fat compared to controls. METHODS: From the environment and childhood asthma study in Oslo, 174 (13- to 14-year old) adolescents, 95 (66 boys) with and 79 (41 boys) without asthma performed maximal running on a treadmill with oxygen consumption measurement (aerobic fitness) and had the sum of four skinfolds and waist circumference recorded (body fat), followed by wearing an activity monitor and registering diet for four consecutive days. Asthma was defined by at least two of the following three criteria fulfilled: (1) dyspnoea, chest tightness and/or wheezing; (2) a doctor's diagnosis of asthma; (3) use of asthma medication. Participants with asthma used their regular medications. RESULTS: Neither aerobic fitness, total energy expenditure nor hours in moderate to very vigorous intensity physical activity during week and weekend differed between adolescents with and without asthma. Energy intake and body fat was similar in both groups. CONCLUSIONS: Total energy expenditure, aerobic fitness and hours in moderate to very vigorous intensity physical activity were not reduced and energy intake and body fat measured with skinfolds not increased among Norwegian adolescents with asthma.

[A phonogramic study of expiratory wheezing in the asthmatic patient]. / Estudio fonográfico de las sibilancias espiratorias en el asmático.

UNLABELLED: The quantitative analysis of expiratory wheezing may offer a new approach for study respiratory function in asthmatics. METHOD: The sound spectrum during expiration was analyzed in 9 asthmatics with wheezing and 5 normal subjects. Phonographic parameters were then correlated with spirometric results for baseline respiration and deep breathing. RESULTS: a) Expiratory wheezing is heard in a band of 210 to 280 Hz during deep breathing, and b) the volume in this band correlates positively with mean expiratory flow (VT/TE) and negatively with the slope of the volume/flow curve between 50 and 25% of FVC. CONCLUSIONS: The degree of air flow limitation in the peripheral airways correlates with the volume of pulmonary sound.

Pulmonary thromboembolism associated with superior vena cava thrombosis following permanent transvenous endocardial cardiac pacing.

The case of a 70 year old man with superior vena cava syndrome associated with transvenous pacemaker electrode and a 2 yr history of right ventricular failure is reported. Digital subtraction angiography demonstrated a major thrombus in the right pulmonary artery, and pulmonary thromboembolism was confirmed.