ABSTRACT
OBJECTIVE: To assess concordance in the measurement of peak expiratory flow (PEF) and forced expiratory volume ino ne second (FEV(1)) between the portable device Piko-1 (Ferraris) and a pneumotachograph. PATIENTS AND METHODS: Forced spirometry (Master Screen Jaeger) was performed according to ATS/ERS norms, selecting the best value of three curves, and three measurements with the Piko-1 were recorded the recommendations of the manufacturer. RESULTS: Eighty patients between 5-18 years of age were studied. Based on the Bland-Altman method, the mean differences obtained were 9.82 (95%Cl: 2.43-17.21) for PEF and 0.17 (95%CL: 0.12-0.21 for FEV(1). The intraclass correlation coefficient was 0.96 (p <0,001; 95%Cl: 0.93-0.97) for PEV(1) and 0.93 (p<0,0001; 95%Cl: 0.89-0.95) for PEF. CONCLUSIONS: Piko-1 offers FEV(1) measurements close to those obtained with forced spirometry, thus allowing more exact patient assessment in home-based follow-up emergency services, or hospital wards.
Subject(s)
Asthma/diagnosis , Diagnostic Equipment , Monitoring, Physiologic/instrumentation , Adolescent , Asthma/physiopathology , Child , Child, Preschool , Equipment and Supplies , Evaluation Studies as Topic , Female , Forced Expiratory Volume , Humans , Male , Monitoring, Physiologic/methods , Peak Expiratory Flow Rate , Reproducibility of ResultsABSTRACT
INTRODUCTION: The bronchodilator test (BDT) is an important tool used in pulmonary function. Changes in forced expiratory volume in one second (FEV1) can be expressed as absolute change, or per cent of initial or predicted value. When the initial value is used, there may be a bias, as the smaller this value is, the greater the response will be. The main objective of this study is to establish whether there is any difference in using per cent of the initial spirometry value or per cent of the predicted value in order to consider a bronchodilator test positive, and if the initial obstruction of the patient influences such differences. MATERIAL AND METHODS: A retrospective analysis of the BDT made between October 1997 and February 2008. The results using an increase of 9% from the predicted FEV1 were compared with using 12% from the initial FEV1. The patients were divided into three groups depending on initial obstruction: no obstruction (FEV1>80% of predicted), mild (FEV1=60-80% of predicted) and moderate-severe (FEV1<60% of predicted). The kappa index of agreement between both methods was calculated. RESULTS: A total of 4352 BDT were analysed. The agreement between both methods was high (k=0.832). In the group without initial obstruction (N=3007) the kappa index was 0.781, in the mild obstruction group (N=1067) the kappa index was 0.966 and in the moderate-severe group (N=278) it was 0.788. CONCLUSION: This study demonstrates that, although there is a good agreement between both methods, in patients with initial moderate-severe obstruction and in patients without initial obstruction this agreement tends to be lower.
Subject(s)
Asthma/diagnosis , Bronchodilator Agents , Adolescent , Asthma/physiopathology , Child , Child, Preschool , Forced Expiratory Volume/drug effects , Humans , Predictive Value of Tests , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate lung function abnormalities in children who underwent haematopoietic stem cell transplantation (HSCT) and to compare these abnormalities between autologous and allogenic transplantation. PATIENTS AND METHODS: Prospective observational study from 1996 to 2005. Ninety-three children receiving HSCT, 47 autologous and 46 allogenic, were included. Lung function tests were performed before transplantation and at 2, 6, 12 and 24 months afterwards. The following indices were determined: forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC), total lung capacity (TLC), and carbon monoxide diffusing capacity (DLCO). Paired Student's t-test was used for statistical analysis of data. RESULTS: Before HSCT, 6.8% of the children had FEV1<80%, 1% FEV1/FVC<80%, 7.8% TLC<80% and 13.5% DLCO<70%. At 2 months, FEV1/FVC, TLC and DLCO were significantly reduced, when compared to pre-transplantation values (p=0.05, 0.011 and p<0.001, respectively). Lung function gradually improved from 6 months post-transplantation, but did not reach pre-transplantation values at 24 months. No significant differences were found when comparing allogenic and autologous transplantation, apart from a lower FEV1/FVC value at 6 months (p=0.02) in the first group. CONCLUSIONS: An important proportion of children who undergo HSCT have early pulmonary abnormalities (at 2 and 6 months after transplantation) with partial recovery at 24 months.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/methods , Adolescent , Child , Child, Preschool , Female , Humans , Male , Prospective Studies , Respiratory Function Tests , Transplantation, Autologous , Transplantation, HomologousABSTRACT
Objetivos: Analizar las características clínicas y virológicas de las infecciones del tracto respiratorio inferior (ITRI) de los lactantes hospitalizados en nuestro medio y encontrar parámetros clínicos, analíticos o radiológicos que se relacionen, en el momento del ingreso, con una evolución más grave. Pacientes y métodos: Se realizó un estudio prospectivo de los niños menores de 24 meses ingresados por ITRI durante seis temporadas epidemiológicas consecutivas. Resultados: Se estudiaron 617 lactantes de los cuales el 64% presentaba bronquiolitis; el 24,6%, bronquitis espástica; el 4,4%, laringitis, y el 6,8%, neumonía. La edad media fue de 269 ± 188 días, la razón varón/mujer de 1,6 y la estancia media 6,6 ± 3,5 días. Se aisló al menos un agente viral en el 55,6% de los episodios, que en el 83,6% correspondió al virus respiratorio sincitial (VRS). Otros virus aislados con menor frecuencia fueron: para influenza (7 %), adenovirus (4,3%) e influenza (4%). Se detectaron coinfecciones en el 6,2% ciento de los casos VRS( ). Los niños VRS( ) tuvieron menor edad (p 38,5 °C y concentraciones de proteína C reactiva > 30 mg/l (p 6 (p < 0,003), SaO2 87 por ciento (p < 0,01) y aislamiento de VRS (p < 0,001). En el análisis multivariado sólo la SaO2 87% y la presencia de VRS se asociaron con hospitalización de más de 5 días. Conclusión: Las ITRI más frecuentes del lactante hospitalizado en nuestro medio son las bronquiolitis VRS( ), con características clínicas similares a las descritas en otros países. La hipoxia al ingreso y el aislamiento de VRS en aspirado nasofaríngeo son los factores de riesgo más importantes de hospitalización prolongada (AU)
Subject(s)
Male , Infant , Female , Humans , Risk Factors , Spain , Respiratory Tract Infections , HospitalizationABSTRACT
Clinical and laboratory findings in eight children seen in our department in the last seven years with Kawasaki's syndrome are described. Incidence in our area seems to be higher than it is in the whole country. Authors interested in transmitting their experience as general pediatricians, particularly on difficulties found to establish correct diagnosis in early stages of the disease. Therefore, they insist on the time at which signs, symptoms and laboratory data appeared. ECG was abnormal in five of our eight cases (62%). Bidimensional echocardiogram showed abnormalities in half of the patients in whom the procedure was performed. There were no deaths among our children. Bacteriological, serological and other laboratory investigations were not of help to diagnosis. They conclude that periungual descamation and thrombocytosis are the most useful data to confirm initial diagnostic suspicion.
Subject(s)
Mucocutaneous Lymph Node Syndrome/diagnosis , Child, Preschool , Female , Fever/etiology , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/etiologyABSTRACT
To asses the value of preoperative tests in pediatric patients, a retrospective study of 722 surgical patients was undertaken. No unsuspected abnormalities or underlying diseases leading to the cancellation or postposition of surgery were found. Neither anaesthesia nor postoperatory complications were prevented by means of this procedure. We conclude that detailed anamnesis and physical examination are the most effective screening procedures and that radiologic and laboratory tests should be restricted to help in diagnosis and evaluation of the patient in emergency surgery and when the anamnesis, physical examination or a specific kind of surgery recommend it.
