The top 50 most-cited articles about COVID-19 and the complications of COVID-19: A bibliometric analysis.

Background: This bibliometric analysis examines the top 50 most-cited articles on COVID-19 complications, offering insights into the multifaceted impact of the virus. Since its emergence in Wuhan in December 2019, COVID-19 has evolved into a global health crisis, with over 770 million confirmed cases and 6.9 million deaths as of September 2023. Initially recognized as a respiratory illness causing pneumonia and ARDS, its diverse complications extend to cardiovascular, gastrointestinal, renal, hematological, neurological, endocrinological, ophthalmological, hepatobiliary, and dermatological systems. Methods: Identifying the top 50 articles from a pool of 5940 in Scopus, the analysis spans November 2019 to July 2021, employing terms related to COVID-19 and complications. Rigorous review criteria excluded non-relevant studies, basic science research, and animal models. The authors independently reviewed articles, considering factors like title, citations, publication year, journal, impact factor, authors, study details, and patient demographics. Results: The focus is primarily on 2020 publications (96%), with all articles being open access. Leading journals include The Lancet, NEJM, and JAMA, with prominent contributions from Internal Medicine (46.9%) and Pulmonary Medicine (14.5%). China played a major role (34.9%), followed by France and Belgium. Clinical features were the primary study topic (68%), often utilizing retrospective designs (24%). Among 22,477 patients analyzed, 54.8% were male, with the most common age group being 26-65 years (63.2%). Complications of COVID-19 affected 13.9% of patients, with a recovery rate of 57.8%. Conclusion: Analyzing these top-cited articles offers clinicians and researchers a comprehensive, timely understanding of influential COVID-19 literature. This approach uncovers attributes contributing to high citations and provides authors with valuable insights for crafting impactful research. As a strategic tool, this analysis facilitates staying updated and making meaningful contributions to the dynamic field of COVID-19 research.

A Case of Balo Concentric Sclerosis: A Multiple Sclerosis Mimic.

Balo Concentric Sclerosis (BCS) is a rare neurological demyelinating disorder similar to Multiple Sclerosis. Both present with progressive neurological debility but differences on brain imaging help with distinction. The lack of prevalence and general diagnostic information about BCS makes it an underdiagnosed disease which can sometimes delay treatment. This case of BCS was initially treated as an infectious brain mass, leading to unnecessary interventions. Early recognition and differentiation from other neurological conditions are crucial for appropriate management and prognosis. We hope that by presenting this case, we can aid in creating diagnostic criteria and promote awareness of this chronic debilitating disease.

A Case With Twists and Turns: A Report of Vertebrobasilar Dolichoectasia.

Vertebrobasilar dolichoectasia (VBD) is a rare anatomical abnormality of the vertebral artery system, defined as irregular expansion, elongation, and tortuosity of vertebral arteries. Anomalies of the vertebrobasilar artery can have a wide variety of clinical presentations, ranging from simple headaches to debilitating strokes. We present the case of an atypical presentation of VBD which mimicked trigeminal neuralgia by compressing the trigeminal nerve. There are currently no guidelines concerning the management of VBD, nor is there evidence of a definitive cure. This case invoked discussions among the medical team as to whether management should be medically or surgically focused, as well as long-term outcomes for patients with VBD. The superiority of medical versus surgical treatment of this issue is still a debated topic. This patient trialed medical management with dexamethasone and carbamazepine with no improvement in symptoms. He then underwent surgical gamma knife treatment but even this invasive measure was unsuccessful at relieving his symptoms. We hope that by presenting this case, we can display how the therapies available for VBD are limited and often unsuccessful in relieving the disease burden in patients with VBD.

A Difficult Differential Diagnosis in New Neck Masses: Retropharyngeal Abscess or Malignancy?

Retropharyngeal abscesses (RPAs) are rare in the adult population and rarer without an inciting event or comorbidity such as recent oral surgery, neck infection, or pharyngeal trauma. The definitive treatment is incision and drainage of the abscess. Clinical researchers have recently questioned whether invasive surgical intervention is necessary and posed the question of what role antibiotics play in management. Sequelae of RPAs are severe and include rupture of the abscess, erosion of the carotid artery, thrombophlebitis, and most seriously, airway compromise. We present a case where an atypical presentation of an RPA caused a disagreement among specialists, and the debate of whether the described case represented an abscess or malignancy caused a delay in diagnosis and treatment for the patient. Only after invasive and emergent surgical intervention was a final diagnosis able to be made. This case demonstrates the need for more research and official guidance on the management of new neck masses to hasten diagnosis and prevent devastating outcomes.

A Case of Secondary Autoimmune Hemolytic Anemia Successfully Treated With Rituximab.

Secondary cold agglutinin autoimmune hemolytic anemia (AIHA) occurs most commonly due to infectious causes like Mycoplasma pneumonia and, more rarely, Epstein-Barr virus(EBV). Here we present a case of a 69-year-old female presenting with generalized weakness, who was found to have cold agglutinin hemolytic anemia. She unfortunately experienced some of the most severe complications of the disease including encephalopathy, hypoxia, and dry necrosis of peripheral extremities. Further investigation revealed an EBV infection, the rarest infectious cause of cold AIHA. She was started on steroids, the mainstay of treatment, but continued to worsen over the course of her extensive stay in the intensive care unit (ICU). Given the severity of the disease, the decision was made to use plasmapheresis and rituximab, the monoclonal antibody directed against CD20, as an experimental therapy. After adjunctive therapy was initiated, the patient began to clinically improve and ultimately made a full recovery. Rituximab is historically only effective in primary cold AIHA, but it appeared to elicit significant clinical improvement with our use in secondary cold AIHA. While there have been a handful of studies demonstrating its successful use in secondary cold AIHA, we propose that this medication be further studied to prevent the significant morbidity and mortality associated with the disease.

Acyclovir as a Novel Treatment for Severe Chronic Active Epstein-Barr Virus.

Epstein-Barr virus (EBV) is a widely infectious pathogen affecting most of the global population at some point in their life. While, typically, primary infections are subclinical, chronic persistence of the virus due to T-cell proliferation can cause severe complications. Acute hepatitis due to chronic active EBV (CAEBV) has rarely been documented. This case details a previously healthy 81-year-old woman who presented with complaints of diffuse abdominal pain, nausea, and vomiting. Her diagnostic workup demonstrated an EBV infection with worsening thrombocytopenia, transaminitis, and hepatocellular liver injury with acute ascites. Her hospitalization was resistant to the traditional supportive treatment of EBV, requiring intensive care management and unorthodox therapy. Although antivirals have demonstrated limited utility in the treatment of CAEBV, the severity of her illness and refractory hospital course necessitated the use of acyclovir. She made a complete recovery with no deficits. The case demonstrates the presentation of acute hepatitis and ascites as a result of CAEBV, the clinical sequelae, and acyclovir as a potential new treatment option.

Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students.

The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.

Comparison of Two Clinical Laboratory Assays for Measuring Serum Adalimumab and Antibodies to Adalimumab.

BACKGROUND: Adalimumab is a fully human monoclonal antibody developed against tumor necrosis factor (TNF), used for the treatment of autoimmune and chronic inflammatory diseases. Immunogenicity to this drug may lead to therapeutic failure. Various laboratory assays are used for measuring serum adalimumab and anti-drug antibodies (ADA) to adalimumab, for therapeutic monitoring and evaluation of clinical non-responsiveness. This study compared the performance of 2 clinical assays used by different reference laboratories. METHODS: In total, 120 residual clinical samples were tested at both laboratories. A sandwich ELISA for adalimumab detecting free drug and a bridging ELISA capable of detecting both free and bound ADA were performed at the Mayo Clinic. A functional cell-based reporter gene assay (RGA) was used at ARUP Laboratories for measuring bioactive serum drug concentrations, and neutralizing ADA. RESULTS: Seventy-eight samples had measurable concentrations of adalimumab by both methods and yielded a correlation coefficient r = 0.93, slope = 0.886, and intercept = 0.950. Overall agreement of 92.5% was observed between the assays, with most discrepant drug results being attributed to a higher positivity rate with ELISA (8/9). One outlier positive with RGA and negative with ELISA was confirmed by LC-MS/MS to be attributed to infliximab. Overall agreement of 79.2% was observed between the ADA assays. Differences in ADA results may be due to the bridging ELISA detecting total ADA (free, drug-bound, neutralizing, and non-neutralizing), while RGA detects free, neutralizing ADA only. CONCLUSIONS: Although the assays are fundamentally different, the results show significant concordance between the clinically validated tests performed in different laboratories.

Neurological Manifestations of Coronavirus Disease 2019 and Mpox in Pediatric Patients and Their Management: A State-of-the-Art Systematic Review.

BACKGROUND: There is an increasing number of cases being reported of neurological manifestations of Coronavirus disease 2019 (COVID-19) infection and Monkeypox (Mpox), both during the course of the infection and as a presenting symptom. We aim to review the neurological manifestations of COVID-19 and monkeypox in pediatric patients and their management. METHODS: We conducted a systematic review that included cohort studies and case series or reports involving a pediatric population of patients with a confirmed COVID-19 or Mpox infection and their neurological manifestations. We searched the following electronic databases: PubMed, EMBASE, and Scopus. RESULTS: From 1136 articles identified, 127 studies were included. Headache, stroke, Guillain-Barré syndrome, seizure, nerve palsies, and multisystem inflammatory syndrome in children were the most common neurological symptoms caused by COVID-19, whereas encephalitis was commonly seen in patients with Mpox. Rare neurological manifestations of COVID-19 included cerebral venous sinus thrombosis, plexopathies, demyelinating disorders, encephalitis, etc., and rare neurological manifestations of Mpox included headache. CONCLUSIONS: Our review highlights the importance of investigating possible neurological manifestations and closely monitoring these patients to develop a better understanding of the treatment strategies that can be adopted.

Profile of Secondary Bacterial and Fungal Infections in Hospitalized COVID-19 Patients in a Tertiary Care Centre.

Introduction: SARS CoV-2, a novel corona virus, has emerged in December 2019. The COVID-19 associated mortality is documented in elderly with co morbidities. To have better insight on this issue, the secondary bacterial infections with multi-drug-resistant bacteria in COVID-19 patients need to be studied to evaluate the impact of these infections on the outcome. Aim and objectives: To determine the proportion of secondary infections in COVID-19 patients. To study the spectrum of pathogens and antibiogram of the bacteria isolated from secondary infections in such patients. To evaluate the co-existing co-morbidities, treatment and outcome in these patients. Methodology: The retrospective study was conducted in Departments of Medicine and Microbiology, KMC hospitals Attavara and Ambedkar circle, Mangaluru, including all the hospitalized microbiologically confirmed cases of SARS CoV-2 infection. Details pertaining to the study population were collected using a structured proforma. Descriptive data were entered in the form of mean, median and proportions. The categorical values were analyzed using Chi square test. Values of p < 0.05 were considered as statistically significant. Results: Two hundred COVID-19 hospitalized patients were included.28 out of 200 patients (14%) studied developed secondary infections. The types of secondary infections were Respiratory infections (50%), blood stream infections (17%), UTI (14%), Rhinocerebral Zygomycosis (17%). The predominant organisms were Klebsiella pneumoniae (44%), Zygomycetes (17%). The rates of antibiotic resistance in Gram negative bacilli were 33% to Cefuroxime,25% to aminoglycosides and fluoroquinolones and 16% to carbapenems. The mortality of 42.8% was observed in patients with secondary infections. Conclusion: Close monitoring and follow up especially in high-risk group of severe COVID 19 patients is crucial for better management and outcome.

Estimating staffing requirements using workload indicators of staffing need at Braun District Hospital in Morobe Province, Papua New Guinea.

BACKGROUND: Papua New Guinea has seen some improvements in health indicators over the past years, but the pace of improvements is not as robust as expected. The Health Services Plan for Braun District Hospital redevelopment identified the importance of reflecting the hospital's role in the broader health system, particularly in upgrading the services to service a bigger population. In August 2020, the hospital was upgraded from a health centre-level 3 to a district hospital level 4. The need for assessing human resources for health requirements for this level of care was thus necessary. METHODS: The National Department of Health approved the use of the workload indicators of staffing need as the best tool to support in estimating staff requirements for the newly upgraded hospital. The focus was on clinical and non-clinical staff. Using already developed workload components and activity standards by the expert working groups for level 4 facilities, we visited the facility and collected data through interviews with the Lutheran Health Services representative, hospital management and staff. The technical task force reviewed daily registers, monthly reports and the data in the electronic national health information systems. The information collected was analysed using the workload indicators of staffing need software and interpreted. RESULTS: There were staffing shortages among the clinical staff like the medical officers, nursing officers, health extension officers, pharmacists, radiology staff unit and in the laboratory staff. Shortages among the non-clinical staff were recorded by the cashiers, security officers, drivers and boat skippers. The results showed that the facility lacks a medical laboratory technologist, pharmacists and a medical imaging technologist. The community health workers in this facility are utilized in all the areas where shortages are registered to multitask. CONCLUSION: The results from this WISN study provide evidence for basing staffing decisions on. The WISN results from Braun District Hospital show that the facility requires a total of 33 inpatient nurses against the existing 21 inpatient nurses thus giving a staff gap of - 12 and a WISN ratio of 0.67. It is thus recommended that the hospital management prioritizes recruitment of nurses or if no resources, reassign one of the outpatient nurses to alleviate the pressure among the inpatient nurses or the extra theatre nurses to offer some services in the inpatient wards. WISN results can help managers make decisions such as change of health facility status from a health centre to a district hospital.

Corneal injury secondary to silver nitrate stick mistaken for cotton bud.

PURPOSE: This case report highlights the potential for error when removing corneal foreign bodies in a shared speciality area in Accident and Emergency (A&E). OBSERVATIONS: This case presents the accidental use of a silver nitrate stick rather than a cotton bud to remove a corneal foreign body. This resulted in a corneal injury requiring ophthalmological referral and management with topical antibiotics, topical steroids and lubricants. CONCLUSIONS: Mistaking a silver nitrate stick for a cotton bud is a tangible risk in a busy A&E and can result in significant corneal injury. Clinicians and departments can greatly reduce this risk by having separate and secure storage of similar consumables, as well as keeping consumables in original packaging and discarding of the remainder after a pack has been opened. Minimizing the risk for error will better safeguard and improve patient safety.

Recalibrated scales: The use of low-dose Isotretinoin in a case of Epidermolytic Ichthyosis-NPS1 in a Filipino child

@#Epidermolytic Ichthyosis (EI) is a rare non-syndromic keratinopathic ichthyosis without definitive treatment. This is a case of EI in a 5-year-old Filipino female who presented with hyperkeratotic scales sparing the palms and soles. Histopathology revealed epidermolytic hyperkeratosis. A trial of treatment with isotretinoin 0.3 mg/kg/day, together with keratolytic agents, urea lotion and lactic acid lotion, resulted in a marked decrease in the thickness of the scales and odor. Interestingly, rebound effects were noted at 0.6 mg/kg/day. Taking into account that EI presents with more skin fragility compared to non-EHK ichthyosis, the authors surmise that there may be a smaller treatment window for patients with EI, which is notably lower than recommended for ichthyosis in general.

Risk factors in predicting mortality among children admitted for PCAP C and D at Philippine Children’s Medical Center

OBJECTIVE@#The study aimed to identify risk factors associated with mortality among patients admitted for PCAP C and D.@*METHODOLOGY@#The study was a cross-sectional study involving children admitted for PCAP C and D at PCMC from January 2017 to December 2019. Univariate and multivariate analyses through binomial logistic regression were used to determine significant predictors of mortality.@*RESULTS@#A total of 472 patients were included in the study, of whom 77% had PCAP C and 23% had PCAP D. More than half in each patient group were infants; male; and of normal nutritional status. Most common comorbidities in both groups were neurologic and cardiovascular in nature. Leukocytosis, thrombocytosis, and anemia were the most common hematologic findings. Overall mortality rate among patients was 5.08%. On univariate analysis, being severely underweight (cOR 8.28 [95% CI 2.52–27.23]), with history of antibiotic use (cOR 3.01 [95% CI 1.18–7.62], neurologic comorbidities (cOR 4.04 [95% CI 1.42–11.43]), cardiac comorbidities (cOR 5.33 [95% CI 1.31–21.75]), Down syndrome (cOR 22.11 [95% CI 2.44- 200.30]), and thrombocytopenia (cOR 22.11 [95% CI 2.44-200.30]) were associated with greater odds of mortality among PCAP-D patients. On multivariate analysis, the odds of mortality were 5.02 (95% CI 1.05-23.96) for severely underweight patients, 4.51 (95% CI 1.13-17.95) in patients with neurologic disease, and 73.62 (95% CI 3.63–1491.10) in patients with Down syndrome.@*CONCLUSION@#Patients with PCAP D who have severe malnutrition, Down syndrome, cardiac and neurologic abnormalities, and thrombocytopenia should be managed more aggressively to decrease mortality in these patients.

Evaluation of a Mental and Behavioral Health Patient Room Mockup at a VA Facility.

OBJECTIVE: The primary goal of this research was to evaluate a physical full-scale, high-fidelity mockup of a mental and behavioral health (MBH) inpatient room and bathroom. BACKGROUND: There is minimal research on design for MBH and no published research using mockups to evaluate a MBH design proposal. To address this gap, an interdisciplinary team developed an ideal Patient-Centered MBH Patient Room, which was built as a mockup at a Veterans Administration (VA) facility and evaluated by patients and staff in situ. METHOD: The mock-up was evaluated using a structured mixed methods process that incorporates feedback using Feedback Forms and facilitated Listening Sessions. Our two primary hypotheses were that the design, as represented by the mock-up, would be positively evaluated and that there would be a difference between staff and patient perceptions, with patients rating the design higher than staff. RESULTS: Quantitative analysis confirmed our hypotheses, revealing an overall positive response, with a difference between patients and staff. Contrary to hypothesis, staff consistently rated the design higher than patients. Qualitative analysis found mixed reception of the design and three primary themes: safety, homeyness/deinstitutionalization, and positive distraction/nature. CONCLUSIONS: Physical mock-ups may be an effective tool for evaluation of a proposed design; however, staff perceptions of the environment may differ from those of patients. One drawback of using a physical high-fidelity mock-up is the expectation that the mock-up perfectly represents the proposed design. With this project, even small unfinished details were distracting to the participants and may have negatively affected the evaluation.

A comparison of the clinical outcome of late preterm neonates with versus without antenatal corticosteroids / Philippine Journal of Obstetrics and Gynecology

Background@#Preterm birth remains to be the largest cause of neonatal deaths worldwide. Improvement in preterm neonatal outcomes with antenatal corticosteroids (ACS) given to mothers at 24 to 34 weeks gestation who are at risk for preterm birth is well established. Nevertheless, the use of ACS in the late preterm, which comprises the majority of preterm births, remains an area of discussion. Recent international studies have recommended the use of ACS on the late preterm group. However, such studies in a low-income setting are lacking. Moreover, there has been no local studies and guidelines supporting the use of ACS in the late preterm. @*Objective@#To determine the difference in late preterm neonatal outcomes between neonates of mothers given versus those not given antenatal corticosteroids. @*Materials and Methods@#This was a cross sectional study done at a tertiary hospital on all singleton late preterm deliveries from 2016 to 2018. The population was divided into the no ACS and with ACS group. Data were presented in means and proportions. T test and Z test were used to determine the significant difference. Test statistic with p value less than 0.05 was considered significant.@*Results@#The need for intubation was higher in neonates without ACS compared to the those with ACS, whether the course was completed or not (p value=0.024). Furthermore, respiratory distress syndrome and need for surfactant was significantly higher in the no ACS group when compared to those who completed the ACS course (p value=0.024 and 0.044, respectively). Though, no significant difference was noted in the other neonatal outcomes (p values >0.05). @*Conclusion@#ACS, whether completed or not, resulted in a lesser need for intubation. Furthermore, a complete ACS course results in a decreased risk of respiratory distress syndrome and need for surfactant among late preterm neonates.

Impacts of small vestibular schwannoma on community ambulation, postural, and ocular control.

OBJECTIVES/HYPOTHESIS: To investigate balance, community mobility, gaze instability, and dizziness handicap and assess falls risk in people who are conservatively managed with small vestibular schwannoma (VS). STUDY DESIGN: Cross-sectional study with controls. METHODS: The study involved 18 people (mean age 58.7 ± 12.2 years) diagnosed with VS (<12 mm) and 22 age-matched controls (mean age 56.9 ± 8.0 years). Measures included standing on firm and foam surfaces with feet apart, then together with eyes open and closed, Timed Up and Go (TUG) test and dual TUG test, Dynamic Gait Index, 6-Minute Walk Test, Halmagyi Impulse Test, Dynamic Visual Acuity Test, and the Dizziness Handicap Inventory. RESULTS: The clinical group failed more trials standing feet together on foam with eyes closed (P < .05); had inferior mobility and walked more slowly with divided attention (P < .05); had more difficulty walking with head movement, negotiating obstacles, and using stairs (P < .01); and walked shorter distances (P < .001) than controls. Reduced gaze stability (P < .01) and higher total (P = .007) and subcategory dizziness handicap scores (P < .05) were revealed compared to age-matched controls. CONCLUSIONS: Although outcomes for the clinical group are inferior to the control group across all measures and the dizziness impact is higher, the results fall in the low-risk category for falls. Preliminary data (level 4 evidence) support using a suite of clinical measures to monitor people with VS during conservative management. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1147-1152, 2017.

Tidal breathing analysis as a tool for asthma diagnosis in children aged six months to five years

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The diagnosis of asthma is difficult to establish using spirometry in children below 5 years old. Tidal breathing analysis (TBA) can provide useful information about lung function in infants and young children, as it is effort-independent. </p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine if baseline and post-bronchodilator ratios of the time and volume until peak expiratory flow to the total expiratory time and volume, (tPEF/tE and V PEF/V E) can distinguish asthmatics from normal children.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional study wherein 146 children ages 6 months to 5 years old completed TBA before and 15 minutes after administration of 250?g of salbutamol via nebulization. Children 3 years old and below who did not cooperate were given sedation with oral diphenhydramine (1mg/kg/dose). The tPEF/tE and VPEF/VE were compared between the controls and asthmatics.</p><p style="text-align: justify;"><strong>RESULTS:</strong> In children below 2 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 29.6  ± 13.8and 22.0 ± 6.6. The area under the curve (AUC) was 0.649 attPEF/tEof 32.250, with a sensitivity and specificity of 50% and 97%. The baseline VPEF/VE of asthmatics and non-asthmatics were 32.7 ±12.4 and 26.0 ± 4.9.AUC was 0.661 at VPEF/VEof34.500, with a sensitivity and specificity of 50% and 97%.In subjects 2 to 5 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 35.3 ± 14.7 and 35.0 ± 13.1. The baseline VPEF/VE were 37.0 ± 12.3 and 36.7 ± 10.7. After salbutamol nebulization, the tPEF/tE of asthmatics and non-asthmatics in all ages were 30.9±13.7 and 27.9± 10.8. The VPEF/VE were 34.1± 11.4 and 30.9± 9.0.</p><p style="text-align: justify;"><strong>CONCLUSION</strong>: Baseline tPEF/tE and VPEF/VE can distinguish asthmatics from non-asthmatics in children below 2 years old. However, baseline tPEF/tE and VPEF/VE in children 2 to 5 years old and post-bronchodilator tPEF/tE and VPEF/VE in all ages could not distinguish asthmatics from non-asthmatics after nebulization with 250?g of salbutamol.</p>