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Introduction The Intermediate Neonatal Intensive Care Unit (I.N.C.U), which pertains to our Pediatric-Department, represents a stressful environment (for newborns), their families, and the staff alike. Aim Comparative record of all the newborns admitted to (I.N.C.U), (regardless of their origin), to present an overview of the patients’ summary (in relation to demographic and other factors), to comment on the cases of the newborns transferred to the regional Tertiary Hospital (TH). Material-method Informations from medical-records and the electronic database. Results In 2016, 611 births were recorded in the Obstetrics/Gynecology Department(O/G-D) of our Hospital and 131 admissions in (I.N.C.U)(21.4%):64.1% of them were Males, 35.9% Females. Causes of admission were, (descending order): Infections 41(31.3%), Jaundice 29(22.1%), Difficulty breathing 14(10.7%), Prematurity 12(9.2%), Perinatal stress 11(8, 4%), Feeding etc.The admissions came from the O/G-D 98(74.80%) of our Hospital, the Private Maternal Hospitals (PMHs) 9(6.9%), while the remaining 24 (18.3%) were come from their homes. Out of the 131 neonates admitted, 25(19.03%) were transferred, (18 of them to the TH-Larissa and 7 of these, in other THs. 6(24%) on Diffused O2, 2(8%) in a Head-Box,17(68%) without O2. In 2017, 603 births were recorded in the O/G-D.There were 131 neonate admissions (I.N.C.U)(21.7%):65% of them (M), 35% (F). 60 (45%) of them had no social insurance. Causes of admission were, (descending order): Infections 34(26%), Shortness of breath 30(23%), Jaundice 23(17.6%), Prematurity 12(9.2%), Perinatal stress 9(6.9%),Subdural hematoma 4(3.05%), syndromes-Feeding-Surgical-problems etc. 96(73.3%,%) admissions came from the O/G-D, 19(14.5%%) from the PMHs, while 16(12.2%) were come from their homes. Out of the 131 neonates admitted, 33 (25.2%) were transferred, 31 (93.3) of which to the TH-Larissa: 3 (9.7%) were intubated, 5 (16.1%) on Diffused O2:12 (38.7%) in a Head-Box and 11 (35.5%) without supportive O2. 2 cases, were transferred to other THs,without O2. Conclusions In our I.N.C.U, the care provided to the newborns and the overall support offered to their families are complex and variant. The medical staff handled the incidents properly, minimizing the need of transfer to a TH. Neonates that required transfer were mostly boys (p:0.037, Pearson chi-Square), with respiratory problems, prematurity, birth defects or infections. Most of the newborns(52.6%) of the (PMH), arrived in a critical condition, thus requiring urgent transfer to a TH.

espanolAntecedentes: la calidad de vida en pacientes asmaticos es de interes particular, y es uno de los aspectos que se ve afectado por la enfermedad. Los ninos con asma no solo padecen las consecuencias fisicas de la enfermedad, sino tambien el impacto en la esfera social, emocional y educativa. Objetivo: determinar la calidad de vida en pacientes con asma seguidos en la Consulta de neumologia del Hospital Infantil Dr. Robert Reid Cabral, periodo abril –mayo 2018. Metodo: estudio descriptivo para determinar la calidad de vida en pacientes con asma entre 6-17 anos de edad seguidos en la consulta de neumologia del Hospital Infantil Dr. Robert Reid Cabral, periodo abril –mayo 2018. Se utilizo el cuestionario PAQLQ por sus siglas en ingles (Pediatric Asthma Quality of Life Questionnaire) Resultados: se evaluaron 43 pacientes, 59% masculinos; 93% entre edad de 7-12 anos. 65% no practican deporte por molestias como tos (58%), aparicion de episodio agudo (49%), falta de aire o silbido (39.5%) y sensacion del “pecho apretado” en 37%. 77% sintio cansancio en algun momento de las actividades diarias, 60.4% sintio dificultad para respirar, 39.6% presento falta de aire, 32.6% desesperacion nocturna y 32.5% problemas para dormir. 56% se sintio incomodo en algun momento, 49% refirio algun grado de preocupacion, 37% presento mal humor, 30% enojo, 28% asustado y 11% refirio haber sentido algun grado de decepcion. Conclusion: se destaca un porcentaje significativo de pacientes con alguna alteracion de la calidad de vida. English Background: the quality of life in patients with asthma is of particular interest and one of the aspects that are affected by the disease. Children with asthma not only suffer the physical consequences of the disease, but also the impact in the social, emotional and educational sphere. Objective: to determine the quality of life in patients with asthma followed in the pulmonology clinic of the Dr. Robert Reid Cabral Children’s Hospital in the period of April-May 2018. Method: a descriptive study was conducted to determine the quality of life in patients with asthma between 6-17 years of age followed in the pulmonology clinic of the Dr. Robert Reid Cabral Children’s Hospital in the period April-May 2018. The PAQLQ questionnaire was used (Pediatric Asthma Quality of Life Questionnaire). Results: 43 patients were evaluated, 59% male sex; 93% between the age ranges of 7-12 years. 65% do not practice sports due to discomfort such as cough (58%), appearance of acute episode (49%), shortness of breath or whistle (39.5%) and feeling of “tight chest” in 37%. 77% felt tired at some point of daily activities, 60.4% felt difficulty breathing, 39.6% had shortness of breath, 32.6% nighttime desperation and 32.5% sleep problems. 56% felt uncomfortable at some point, 49% reported some degree of concern, 37% presented a bad mood, 30% angered, 28% scared and 11% reported having felt some degree of disappointment. Conclusion: it highlights a significant percentage of patients with some alteration of the quality of life.

Introduction The purpose of the case is to teach health care professionals to recognize Henoch-Schönlein purpura (HSP), including rare and serious complications. The case includes a review of epidemiology, classification, clinical manifestations, and treatment of HSP. Methods Utilizing an adolescent simulation mannequin, we present the case of an 11-year-old female who presents to a pediatric emergency department with HSP and respiratory symptoms requiring intubation. This case reinforces the appearance of the characteristic rash and helps learners develop an algorithm for HSP management that includes the identification and management of abdominal pain associated with HSP, as well as the rare and serious complication of pulmonary vasculitis. We focus learners on managing severe respiratory distress in the HSP patient. Learners are assessed using standardized forms, and the learner outcome measurements include the recognition of HSP and successful management of abdominal pain and respiratory failure in this unique setting. Results This module has been used with pediatric residents, emergency medicine residents, pediatric emergency medicine fellows, and pediatric emergency medicine nurse practitioners. Approximately 30 learners have completed this module during seven separate sessions. All learners felt the case provided the opportunity to identify HSP as well as to manage a serious and rare complication of the disease. Discussion Overall, we have had positive feedback from the learners about this case, and it provides them the opportunity to see more rare complications during their training period. Learners leave the session with enhanced knowledge of HSP, as well as a review of respiratory failure and intubation.

Background: Dyspnoea (shortness of breath) is a common excruciating symptom. Shortness of breath is a feeling associated with impaired respiratory function. As difficulty breathing, I can not breathe. It occurs in 64 % in Covid 19 patients. Objective: Our goal is to evaluate dyspnoea using Borg scale that assesses the functional state of respiratory function. Material–methods: We assessed (92) Covid 19 patients with a categorical ten-point rating, a corresponding verbal description (Table 1). Patients were aged between 44–78 years old. Fifty of them (50) were obese, body weight >greater than 90 kg with comorbidities (hypertension and diabetes mellitus). The assessment was performed by a specialist anaesthesiologist (pain clinic) on the Borg scale. Results: (12) Covid 19 patients with moderate dyspnoea. (30) Covid 19 patients with severe dyspnoea (hard). (46) Covid 19 patients very severe dyspnoea (really hard). (4) Covid 19 patients maximum intolerable dyspnoea (maximum). We immediately intubated them. There’s not internationally accepted way to assess shortness of breath. Scales are commonly used to assess respiratory difficulty (for example: respiratory distress observation scale). Conclusions: The Borg scale has been used successfully in Covid 19 patients. Every patient experiences dyspnoea differently, depending on the severity of the disease. However, it seems that the assessment of dyspnoea on the Borg scale, taking into account co-factors leads to safer monitoring of severely ill Covid 19 patients. © 2021, Pharmamed Mado Ltd. All rights reserved.

Objective: To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis. Design: Case Report Setting: Tertiary Private Hospital in Metro Manila Case Report: A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis. Conclusion: Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis. Keywords: Polychondritis, Relapsing; airway involvement; imaging

Objective Describe the prevalence of Bordetella pertussis via PCR in children under 5 years old hospitalized as probable cases of pertussis and report the most common clinical features among them. Results A positive PCR result for B. pertussis was observed in 20.5% of our samples (18/88), one-third of them were from infants between 2 and 3 months old. The most common symptoms were paroxysms of coughing (88.9%), difficulty breathing (72.2%), cyanosis (77.8%) and fever (50%). The mother was the most common symptomatic carrier (27.8%), followed by uncles/aunts (22.2%) among children with pertussis. Electronic supplementary material The online version of this article (10.1186/s13104-018-3405-7) contains supplementary material, which is available to authorized users.

Swaddling infants is a practice dating back many centuries, but the manner in which babies are swaddled has changed over the years. About 19% of babies in the UK are swaddled in the first few weeks of life. The benefits are said to include helping the baby to stay on its back, reducing crying and stress, and helping the baby to sleep more deeply. Risks include overheating and difficulty breathing, an increased risk of sudden infant death syndrome, and hip dysplasia if swaddling is too restrictive. If parents choose to swaddle their baby, it is important that they follow safe swaddling practice and understand the potential risks as well as the benefits.

We describe a case of a 24-year-old male presenting urgently with a juvenile nasopharyngeal angiofibroma (JNA) with difficulty breathing, inability to swallow, and respiratory distress following throat swelling. The swelling was reduced with administration of dexamethasone and the JNA was surgically resected within 48 hours. This presentation was atypical given the acuity of presentation and the patient’s older age.

PROBLEM: A 3-month-old baby girl was evaluated in an emergency department (ED) for a cough, congestion, difficulty breathing, and lethargy. A medication history was obtained from the baby's parents to begin the reconciliation process. According to the parents, the baby was receiving 8 mL of KEPP

During winter 2014–15, England experienced severe strains on acute health services. We investigated whether syndromic surveillance could contribute to understanding of the unusually high level of healthcare needs. We compared trends for several respiratory syndromic indicators from that winter to historical baselines. Cumulative and mean incidence rates were compared by winter and age group. All-age influenza-like illness was at expected levels; however, severe asthma and pneumonia levels were above those expected. Across several respiratory indicators, cumulative incidence rates during 2014–15 were similar to those of previous years, but higher for older persons; we saw increased rates of acute respiratory disease, including influenza like illness, severe asthma, and pneumonia, in the 65–74- and >75-year age groups. Age group–specific statistical algorithms may provide insights into the burden on health services and improve early warning in future winters.

Introduction: A 7-year-old female presented with a tongue lesion that was causing dysphagia and difficulty breathing at night. Work-up revealed symptomatic lingual thyroid tissue. Transora...

While DLIs can have a variety of clinical manifestations, drug-induced interstitial pneumonia has been found to occur at the highest frequency. The clinical feature of 165 cases of drug-induced interstitial pneumonia occurring in medical institutions across Japan was as follows. Common subjective symptoms included difficulty breathing, fever, and coughing, but there were also 17 cases that were asymptomatic. The most frequent causative drug was drug for malignant neoplasms in 92 cases. The period from the start of drug administration to the development of symptoms ranged from 2 to 8280 days, with a median of 69. The median serum KL-6 were elevated at 623 U/mL. With a normal upper limit for KL-6 of 400 U/mL, the number of cases exhibiting an elevated value was 138 cases. As treatment, the suspected drug was discontinued in 159 cases, and corticosteroids including pulse therapy were used in 132. The outcomes were relatively favorable, ranging from a complete cure to an improved condition in 142 cases, but there were 5 fatalities.

A 60-year-old woman presented to the emergency department with difficulty breathing and a nonproductive cough that worsened when she lay flat. The symptoms progressed from a previous mild respiratory tract illness despite the patient having received an empiric five-day course of azithromycin that

Perioperative personnel must clean and disinfect the perioperative environment numerous times throughout the day to help prevent the risk of exposing patients to pathogenic microorganisms. However, this practice exposes perioperative team members to chemicals that could be harmful to their health. Exposure to cleaning and disinfecting products has been associated with potential health problems such as skin irritation, burns, rashes, and difficulty breathing. This Back to Basics article offers strategies for perioperative team members to implement to decrease their risk of harmful exposure to these products.

Considered a primary alteration in brachycephalic dogs, the extension of the soft palate, can be observed in young animals but is considered a little problem diagnosed in practice. Dogs that exhibit prolonged respiratory disorders may be one of the clinical signs may be abdominal breathing and snoring. The extension correction palate occurs surgically, through a procedure called Staphylectomy which consists in removing the terminal portion of the soft palate. This report aims to present the case of a Pug dog, 7 years old, with a history of snoring, faintness, and difficulty breathing that was clinically diagnosed as suffering from this syndrome. The animal underwent surgery for excision of the caudal portion of the soft palate. Surgical recovery was quick and the clinical improvement of the animal was evident within a week after surgery.

Difficulty breathing or shortness of breath during exercise is a common complaint among athletes at all levels of participation. When individuals feel that their respiratory symptoms are interfering with their ability to perform to expectations, they may seek the advice of a health care provider. The differential diagnoses for exercise-induced dyspnea present a spectrum of conditions with varying degrees of risk. A careful evaluation is warranted in these cases to develop a plan of care appropriate for each patient. Objective diagnostic testing is critical to obtaining an accurate diagnosis.

This case describes a patient who presented with neuromuscular weakness culminating in respiratory failure and admission to the ICU. He was subsequently diagnosed with Lambert-Eaton myasthenic syndrome (LEMS), a rare autoimmune disease that presents with skeletal muscle weakness and autonomic dysfunction. Approximately 50 per cent of cases of LEMS are paraneoplastic; most frequently it is associated with a small-cell lung cancer. The diagnosis of LEMS is based on characteristic neurophysiological findings of small compound muscle action potential amplitudes that increase following maximal exercise or high-frequency stimulation, a process known as facilitation. In addition, approximately 85 per cent of patients have antibodies to voltage-gated calcium channels detectable on serology The treatment of LEMS depends on the presence of an underlying malignancy. If a tumour is present, treatment must be directed towards this. 3, 4-Diaminopyridine may provide symptomatic relief in both tumour and non-tumour LEMS and immunmodulatory therapy may also be required.

A woman in her 90s came to the ER because of acute unilateral ptosis. During the next 8 weeks, weakness of the neck, fatigue, choking, and difficulty breathing developed, progressing to respiratory failure and death. An autopsy was performed.

2009年10月から2010年4月までの当院小児科におけるパンデミックインフルエンザA（H1N1）2009入院症例を検討した．11月から12月にかけて流行のピークがあり，入院総数は114例（男61例，女53例）であった．年齢は5～7歳で特に多かった．入院理由としては呼吸障害が最も多く，発熱後早期に呼吸困難となる症例が目立った．ICU入院を要したのは2例であり，いずれも肺炎であった．酸素投与を要した重症肺炎は23例あり，うち半数で喘息の既往を認めた．治療としては酸素投与やイソプロテレノール持続吸入，ステロイド剤，抗インフルエンザ薬等を施行し，後遺症例・死亡例ともに認めなかった．新型インフルエンザ罹患児の大部分は入院加療を要さない軽症例であったが，中には急速に呼吸不全となり酸素投与を必要とする症例があった．24時間365日受診を断らない当院の存在は，新型インフルエンザ罹患児における救急医療に必要不可欠であったと考える．

Herbal mixtures are frequently used by some patients as treatment options due to the belief that they do not have any side effects. This case report presents a male patient who used clavis panax in order to ameliorate his diabetes mellitus. In the third week of his clavis panax use, he was admitted to the hospital with complaints of uncontrollable worries about almost everything, rest- lessness, difficulty breathing, fatigue, and sleep disorder. Clavis panax-induced anxiety disorder is presented in this case report. Herbal preparations should be carefully evaluated in terms of their side effects, as well as their possible benefits.

Novartis plans to acquire the neurological gene therapy firm AveXis for $8.7 billion. The purchase will bolster the Swiss giant’s standing as a big pharma leader in the emerging gene therapy field. AveXis’s leading drug candidate is its gene therapy to treat infants with spinal muscular atrophy type 1 (SMA1), a devastating genetic disease, sometimes called “floppy baby syndrome,” that causes weak muscles and difficulty breathing. Only 8% of afflicted infants survive to 20 months. In November, a study showed that all 15 infants treated with AveXis’s gene therapy for SMA1 were alive after 20 months (N. Engl. J. Med. 2017, DOI: 10.1056/nejmoa1706198). “Those kids were dying, and the outcomes look really good at this point,” Mark A. Kay, a director of the human gene therapy program at Stanford University School of Medicine, told C&EN in November when the study was released. Gene therapy enthusiasm grew even more in December

Scimitar syndrome is a rare congenital anomaly that can make pregnancy a complicated situation to deal with. A 29 year old women, 30 weeks pregnant, comes to the emergency room with complaints of chest pain and difficulty breathing. She has no known past medical history. A loud 4/6 systolic murmur

BACKGROUND More than 200,000 people in Norway have chronic obstructive pulmonary disease (COPD), but knowledge about their living conditions is insufficient. MATERIAL AND METHODS The Living Conditions Survey of 2002 (Statistics Norway) included specific questions about COPD. We have compared living conditions of people with self-reported chronic bronchitis, pulmonary emphysema or COPD with that of other groups with or without chronic disease. RESULTS People with chronic bronchitis, pulmonary emphysema or COPD have considerably worse living conditions than comparable groups. This is especially true in areas such as health, education, employment and income. Similar patterns are also seen in their social relationships. In a global index, where 1 indicates good living conditions and 0 bad living conditions, the COPD group scored 0.46, while people with other chronic diseases scored 0.60. Smokers with difficulty breathing have equally bad living conditions as those with self-reported COPD. The number of people stating they have COPD is considerably lower than shown in other recent studies of prevalence. INTERPRETATION Patients with COPD have larger problems within several areas of life than other groups with chronic diseases. In addition, the results indicate that many people have this disease without knowing it.

Objective To explore drugstore personnel's knowledge and practice on management of a suspected case of tuberculosis (TB). Method Seventy randomly selected drugstores in Songkhla province of Southern Thailand were visited by simulated clients (SCs) who asked for medication for relieving a one-month cough with fever. All questions asked by the drugstore personnel, advice given and drugs dispensed were noted and analysed. The drugstores were subsequently visited and the managers were interviewed. Key findings For the SC study, 55 out of 70 (79%) drugstore personnel took a history before dispensing drugs, but only 14 (20%) asked about cough duration. Only four drugstore personnel identified TB as a possible diagnosis for a case with one-month cough and fever, and only three recommended the SC to see a doctor. From the interviews, 46 (66%) perceived the probability of encountering TB at their workplace to be low. The knowledge on symptoms of suspected TB was poor. Sixty-eight (97%) would suspect TB if and only if the client with prolonged cough also had tiredness, weight loss, difficulty breathing or haemoptysis. In contrast to their practice with the SC, 46 (66%) claimed that they would recommend a client with one-month cough and fever to see a doctor. Conclusions The majority of drugstore personnel failed to detect suspected TB cases and did not give a proper referral. Interventions to educate drugstore personnel to recognise symptoms of suspected TB and to become aware in TB epidemics in this setting are urgently needed.

OBJETIVO: Verificar a prevalência da sibilância recorrente em lactentes na cidade de Curitiba (PR). MÉTODOS: Estudo transversal pela aplicação de questionários aos pais de lactentes, idade entre 12 e 15 meses, que procuraram unidades de saúde para imunização no período entre agosto de 2005 e dezembro de 2006. Este instrumento padronizado e validado consiste de perguntas sobre características demográficas, sibilância, infecções respiratórias e fatores de risco. Durante o período de estudo, a Secretaria Municipal de Saúde possuía 107 unidades de saúde, das quais 35 foram selecionadas por sorteio e distribuídas homogeneamente no território municipal. RESULTADOS: Um total de 1.364 lactentes (45,4%) apresentou um ou mais episódios de sibilância nos primeiros 12 meses de vida, com início aos 5,5±3,1 meses (média ± desvio padrão), e 678 (22,6%) tiveram três ou mais episódios. Utilizaram β2-agonistas, corticóides inalatórios, corticóides orais e antagonistas do receptor de leucotrienos 84,6, 18,5, 24,3 e 5,4% dos sibilantes, respectivamente. Sintomas noturnos, dificuldade intensa para respirar e visitas a emergência estiveram presente em 58,9, 46,2 e 57,6% dos lactentes que sibilaram; destes, 12,7% foram hospitalizados por asma e 10,9% tiveram diagnóstico médico de asma. Sintomas noturnos, visitas à emergência, gravidade dos sintomas, hospitalização por asma e diagnóstico médico de asma foram mais freqüentes entre os que apresentaram três ou mais crises (p < 0,001). CONCLUSÃO: A prevalência de lactentes sibilantes em Curitiba é elevada, com início precoce e alta morbidade. Possivelmente, esses lactentes representam um contingente expressivo de asmáticos. OBJECTIVE: To identify the prevalence of recurrent wheezing in infants in the city of Curitiba, PR, Brazil. METHODS: A cross-sectional study carried out by means of administering questionnaires to the parents of infants aged 12 to 15 months attending health centers for immunization during the period between August 2005 and December 2006. This is a standardized and validated instrument consisting of questions on demographic characteristics, wheezing, respiratory infections and risk factors. At the time of the study the City Health Department had 107 health centers, 35 of which were selected by lots and distributed homogeneously across the municipal territory. RESULTS: A total of 1,364 infants (45.4%) had episodes of wheezing during their first 12 months of life, with onset at 5.5±3.1 months (mean ± standard deviation), and 678 (22.6%) had had three or more episodes. In 84.6% of the wheezing children treatment was with β2-agonists, with inhaled corticosteroids in 18.5%, oral corticosteroids in 24.3% and leukotriene receptor antagonists were used with 5.4%. The wheezing children exhibited nocturnal symptoms, intense difficulty breathing and visits to emergency services in the proportions of 58.9, 46.2 and 57.6%, respectively; 12.7% were admitted to hospital for asthma and 10.9% had had a medical diagnosis of asthma. Nocturnal symptoms, visits to emergency, severity of symptoms, hospital admissions for asthma and medical diagnoses of asthma were all more common among those who had suffered three or more crises (p < 0.001). CONCLUSIONS: There is an elevated prevalence of wheezing among the infants of Curitiba, with early onset and elevated morbidity. It is possible that these infants represent a large contingent of asthmatics.

Multiple chemical sensitivity (MCS) is a condition in which people experience a broad array of symptoms in reaction to exposure to trace amounts of common chemicals. Symptoms are most often triggered by odors, typically affect many systems, and can range from a runny nose to difficulty breathing and heart palpitations. The cause of this condition is unclear and there is no universal consensus on how to diagnose or treat it. MCS afflicts millions of Americans, although its prevalence is difficult to establish reliably. Theories of causation include both the physical and the psychogenic. This article begins with a case study, describes the current research on MCS, and offers recommendations to guide nurses when treating these patients in the hospital.

Volatile organic compounds (VOCs) are ubiquitous in indoor environments. Inhalation of VOCs can cause irritation, difficulty breathing, and nausea, and damage the central nervous system as well as other organs. Formaldehyde is a particularly important VOC as it is even a carcinogen. Removal of VOCs is thus critical to control indoor air quality (IAQ). Photocatalytic oxidation has demonstrated feasibility to remove toxic VOCs and formaldehyde from indoor environments. The technique is highly-chemical stable, inexpensive, non-toxic, and capable of removing a wide variety of organics under light irradiation. In this paper, we review and summarize the traditional air cleaning methods and current photocatalytic oxidation approaches in both of VOCs and formaldehyde degradation in indoor environments. Influencing factors such as temperature, relative humidity, deactivation and reactivations of the photocatalyst are discussed. Aspects of the application of the photocatalytic technique to improve the IAQ are suggested.

In the present report, we describe an unusual presentation of post-infectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in a nine-year-old boy with persistent respiratory symptoms subsequent to an episode of acute bronchiolitis occurring at the age of seven months. After the episode, the persistent respiratory symptoms worsened significantly, and, by the age of seven, the patient began to have difficulty breathing after minimal exertion. Computed tomography of the chest presented findings consistent with bronchiolitis obliterans. Open lung biopsy revealed numerous hemosiderin-laden macrophages, as well as other findings consistent with bronchiolitis obliterans. Pulmonary hemosiderosis can occasionally be accompanied by bronchiolitis obliterans in children with severe sequelae after an episode of viral infection.

Objective Recent studies indicate that the U.S. Environmental Protection Agency (EPA) ozone standards may not protect sensitive individuals. In this study we examined respiratory effects of ozone in infants who may be vulnerable, particularly if they are children of asthmatic mothers. Design Women delivering babies at one of five hospitals in southwestern Virginia between 1994 and 1996 were invited to participate in a cohort study; 780 women enrolled. Ambient air quality data (ozone and particulate matter) were collected at a central monitoring site. Participants This analysis is of 691 infants followed for approximately 83 days between 10 June and 31 August 1995 and/or 1996; they contributed a total of 52,421 infant-days of follow-up. Mothers were interviewed at enrollment and approximately biweekly to report infants’ daily symptoms. Repeated measures logistic regression models were run separately for wheeze, difficulty breathing, and cough. Ozone metrics included 24-hr average, peak 1-hr, and maximum 8-hr average. Analyses were repeated for the 61 infants whose mothers had asthma. Results For every interquartile-range increase in same-day 24-hr average ozone, likelihood of wheeze increased 37% [95% confidence interval (CI), 2–84%]. Among infants of asthmatic mothers, same-day 24-hr average ozone increased likelihood of wheeze 59% (95% CI, 1–154%) and of difficulty breathing 83% (95% CI, 42–136%). Maximum 8-hr ozone and peak 1-hr ozone were associated with difficulty breathing, but not wheeze, in infants of asthmatic mothers. Ozone was not associated with cough. Conclusions At levels of ozone exposure near or below current U.S. EPA standards, infants are at increased risk of respiratory symptoms, particularly infants whose mothers have physician-diagnosed asthma.

Sometimes angioedema in the face, pharynx and larynx progresses so acutely that patient develops such difficulty breathing that it may become fatal. We report two cases of angioedema in the pharynx requiring tracheostomy. One case was caused by angiotensin converting enzyme (ACE) inhibitors that she was taking ACE inhibitors for hypertension and there was no rise of IgE in RAST and no decrease in C1-inhibitor. The other case was caused by oral allergy syndrome (OAS) with rising of IgE in RAST of soybean, radish, etc. that had been eaten just before swelling occurred.The numbers of persons of advanced age are increasing, which in turn generates a higher the demand for ACE inhibitors. Recently, the incidence of allergic diseases has also been increasing. We suspect these circumstances will increase the incidence of angioedema caused by ACE inhibitors and OAS. It is important to check the patient's medication and meals to determine the origin and it is necessary for otorhinolaryngologists to recognize angioedema.

To determine the diagnostic accuracy of paramedics treating patients who have called an ambulance for "difficulty breathing."A retrospective study of all ambulance call reports generated by one ambulance over a one-year period with the dispatch complaint of "difficulty breathing" taken to the hospital. The paramedic diagnosis on the call report was compared with the emergency department (ED) physician diagnosis, which was used as the "gold standard."A total of 244 ambulance reports were reviewed. For patients complaining of "difficulty breathing," paramedics achieved 86.4% sensitivity and 86.6% specificity for diagnosing cardiac disease, 71.4% sensitivity and 93.6% specificity for respiratory disease, and 82.1% sensitivity and 91% specificity for other disease processes. There was an interrater agreement of 81.1% between paramedic and ED physician, producing a kappa of 0.71, interpreted as good, approaching excellent, agreement.Paramedics are able to identify the disease process category in patients dispatched as having "difficulty breathing," with a moderate degree of accuracy.

Hintergrund: Die adenotonsillare Hyperplasie ist die haufigste Ursache der obstruktiven Schlafapnoe (OSA) im Kindesalter. Seit einigen Jahren wird zunehmend die Lasertonsillotomie als Alternative zur Tonsillektomie insbesondere bei Kindern ohne Tonsillitiden in der Vorgeschichte eingesetzt. In der Literatur finden sich zudem Hinweise auf eine geringere Schmerzhaftigkeit der Lasertonsillotomie und eine schnellere Erholung der Kinder im Vergleich zur konventionellen Tonsillektomie. Material und Methoden: Von Mai 2000 bis Mai 2004 wurden bei 50 Kindern (Mittelwert = 5,3 ± 1,7 Jahre) mit adenotonsillarer Hyperplasie und moglichem obstruktivem Schlafapnoesyndrom eine Lasertonsillotomie und Adenotomie als ambulanter Eingriff durchgefuhrt. Postoperativ erhielten alle Eltern der Kinder einen anonymisierten Fragebogen zur Ermittlung der pra- und postoperativen Symptome und des Brouillette-Scores, der postoperativen Schmerzen und der Erholungsdauer. Ergebnisse: Zur Auswertung kamen 36 Fragebogen uber einen Beobachtungszeitraum von 4 Wochen bis zu 4 Jahren (Mittelwert = 1,3 Jahre). Bei 32 Kindern (89 %) zeigten sich nach Lasertonsillotomie mit Adenotomie weder Schnarchen oder ziehende Atemgerausche, noch Apnoen. Der Therapieerfolg war hinsichtlich des Brouillette-Scores hochsignifikant (p = 0,001) und lag bezogen auf lautes Schnarchen bei 91 %, auf ziehende Atemgerauschen bei 93 % und bezogen auf Apnoen bei 100 %. Die Schmerzhaftigkeit des Eingriffes wurde durch die Eltern mit gering bis masig eingestuft, die post-operative Erholung erfolgte zu 92 % in den ersten 6 Tagen nach Operation (Mittelwert = 4,7 Tage). Eine Nachblutung wurde nicht beobachtet. Schlussfolgerung: Die Lasertonsillotomie kann in Verbindung mit der Adenotomie bei adenotonsillarer Hyperplasie und Symptomen einer obstruktiven Schlafapnoe beim Kind als schonendere und komplikationsarmere Alternative zur konventionellen Adenotonsillektomie empfohlen werden. Background: The adenotonsillar hyperplasia is the most relevant cause for the obstructive sleep apnea in children. Since several years laser-assisted tonsillotomy becomes more common as an alternative treatment especially in children having no tonsillitis history. The therapeutical effect of laser-assisted tonsillotomy in combination with the traditional adenotomy treating the obstructive sleep apnea in children has not yet been researched. In addition literature indicates less pain and fast recovery of the children compared to conventional tonsillectomy. Materials and methodology: Starting May 2000 until May 2004 laser-assisted tonsillotomy and adenotomy have been performed in 50 outpatient children, mean age of 5.3 ± 1.7 years, with adenotonsillar hyperplasia and possible sleep apnea. Postoperatively the parents of the patients were questioned with an anonymous questionnaire. Pre- and postoperative symptoms and Brouillette score, the degree of pain and the post-surgical time of recovery have been investigated. Results: 36 questionnaires have been evaluated. The follow-up time was between 4 weeks and 4 years (mean = 1.3 years). With regard to the symptoms snoring, difficulty breathing during sleep and apnea 32 of the children (89 %) were symptom-free after laser-assisted tonsillotomy with adenotomy. The Brouillette-score improved significantly (p = 0.001), snoring was reduced in 91 %, difficulty breathing in 93 % and apnea in 100 % of the children. The pain of the surgical intervention has been valued by the patient’s parents as mild to moderate. Postoperatively 91.6 % of the children recovered within 6 days (mean = 4.7 days), no bleeding occurred. Conclusion: Outpatient laser-assisted tonsillotomy with adenotomy can be recommended in children with adenotonsillar hyperplasia and possible obstructive sleep apnea. The surgical intervention is less painfull, the children recover more quickly and the results on snoring, difficulty breathing and apnea are equal in comparison to conventional tonsillectomy with adenotomy. In addition the recommended procedure shows less post-operative complications.

Patients presenting to the emergency department with heart failure are evaluated based on the subjective sensation of dyspnea. In this study, the authors sought to determine the change in dyspnea, measured by a visual analog scale (VAS), which is associated with a meaningful change in the patient's perception and the effect of dyspnea severity on the VAS. In this prospective, observational study the authors defined a meaningful change in VAS dyspnea as the difference between VAS scores when patients reported "a little less difficulty breathing" or "a little more difficulty breathing." Seventy-four patients were evaluated, and the mean for a meaningful change in VAS was 21.1 mm (95% confidence interval, 12.3-29.9 mm). Patients that recorded higher index VAS scores had a significantly greater change in VAS. VAS scores and the changes with treatment provide the treating physician with another means to assess the effects of their interventions.

Nocardia species are aerobic, Gram-positive bacteria with branched filaments reported as opportunistic microorganisms associated with infectious diseases of the skin. We report the isolation of N. wallacei in Mexico from a 43-year-old man, an HIV-positive construction worker who sought care for difficulty breathing and abundant sputum.

The patient, a four-month old female (corrected age 3 months), was born at 36 weeks of gestation on 30 May 2011 via emergency Caesarean section, due to pre-eclampsia toxaemia to a 47-year-old mother. She is the fourth child (gravida 4, para 4) of nonconsanguineous parents. She was admitted to hospital on 14 September with difficulty breathing, and was subsequently diagnosed with Treacher Collins syndrome (TCS) and failure to thrive.

A baby who was thought to have been shaken by one of her parents actually has a rare syndrome that affects her blood vessels, Ehlers-Danlos syndrome type IV, a family court has heard. Effie Stillwell was taken from her parents and placed with foster carers last September, after she collapsed, at nearly 3 months old, and was taken to hospital unresponsive and with difficulty breathing. Retinal haemorrhages and bleeding on the brain were identified, and police began a criminal investigation. But the medical evidence that emerged during the family court hearing persuaded Buckinghamshire County Council to drop its application for a care order. The baby was “the first child with a …

In an observational cohort study including 89 Ebola patients, predictive factors of death were analyzed. The crude mortality rate was 43.8%. Myalgia (adjusted odds ratio [OR], 4.04; P = .02), hemorrrhage (adjusted OR, 3.5; P = .02), and difficulty breathing (adjusted OR, 5.75; P = .01) were independently associated with death.

Objetivo comparar sinais de disfunção autônoma gerais e relacionados à voz em professores com e sem queixas vocais. Métodos aplicação do Protocolo de Disfunção Autônoma (PDA) em 83 professores, sendo 60 mulheres e 23 homens, com a média de idade de 37,6 anos. A amostra foi dividida em dois grupos, com e sem queixas vocais, definidas de acordo com o número de sintomas apresentados no Protocolo de Sinais e Sintomas Vocais. Resultados o grupo com queixa vocal apresentou a média de 13,7 sintomas no PDA e o grupo sem queixa 7,7 (p=0,001). Considerando apenas os sintomas neurovegetativos relacionados com a voz, o grupo com queixa obteve a média de 4,7 sintomas e o grupo sem queixa 1,8 (p

Purpose: We explored the effects of the sense of effort and accompanying perceptions of peripheral discomfort on self-selected cycle power output under two different inspired O2 fractions.Methods: On separate days, eight trained males cycled for 5 minutes at a constant subjective effort (sense of effort of ‘3’ on a modified Borg CR10 scale), immediately followed by five 4-s progressive submaximal (sense of effort of 4, 5, 6, 7 and 8; 40 s between bouts) and two 4-s maximal (sense of effort of 10; 3 min between bouts) bouts under normoxia (NM: fraction of inspired O2 [FiO2] 0.21) and hypoxia (HY: [FiO2] 0.13). Physiological (Heart Rate, arterial oxygen saturation (SpO2) and quadriceps Root Mean Square (RMS) electromyographical activity) and perceptual responses (overall peripheral discomfort, difficulty breathing and limb discomfort) were recorded.Results: Power output and normalized quadriceps RMS activity were not different between conditions during any exercise bout (p > 0.05) and remained unchanged across time during the constant-effort cycling. SpO2 was lower, while heart rate and ratings of perceived difficulty breathing were higher under HY, compared to NM, at all time points (p < 0.05). During the constant-effort cycling, heart rate, overall perceived discomfort, difficulty breathing and limb discomfort increased with time (all p < 0.05). All variables (except SpO2) increased along with sense of effort during the brief progressive cycling bouts (all p < 0.05). During the two maximal cycling bouts, ratings of overall peripheral discomfort displayed an interaction between time and condition with ratings higher in the second bout under HY vs. NM conditions. Conclusion: During self-selected, constant-effort and brief progressive, sub-maximal, and maximal cycling bouts, muscle activation and mechanical work are regulated in parallel to the sense of effort, independently from peripheral sensations of discomfort.

Although pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization's Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs).To assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions.At an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines.Fewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia.IMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care.

Purpose: The aim of this study was to examine the authors' experience with patients who have floating sternum after correction of pectus excavatum via the classical Ravitch procedure. A floating sternum is defined as a sternum in which the only attachment to the chest wall is its superior (cranial) border, and in which the body is secured only by the manubrium and whatever lateral and inferior fibrous bands are present. Typically, a floating sternum is caused by either extensive resection of the costal cartilages and perichondrium during correction of pectus excavatum or failure of proper regrowth of these cartilages. Methods: The authors retrospectively assessed the charts of all patients diagnosed with a floating sternum noting age at original correction of pectus excavatum, time from original correction of pectus excavatum to diagnosis of floating sternum, age at correction of floating sternum, complaints before stabilization of the sternum, methods of repair, and postoperative complications. Results: Between July 1993 and June 1999, floating sternum was diagnosed in 7 patients. The mean age of patients who underwent operative correction of a floating sternum was 28.9 years (range, 16 to 42 years). The mean time interval between original correction of pectus excavatum, or "redo," and diagnosis of a floating sternum was 9.9 years (range, 2 to 20 years). Complaints before correction of the floating sternum included sternal pain and instability, exercise intolerance, and difficulty breathing. Operative repair consisted of mobilizing the lateral and inferior edges of the sternum, detaching the fibrous perichondrium, performing anterior sternal osteotomies, and finally supporting the sternum with substernal Adkins struts. All 7 patients had successful stabilization of the sternum. Two of 7 patients underwent 2 procedures to successfully stabilize the sternum. One patient has Adkins struts still in place because of hematopoetic malignancy. Six of 7 patients are now without symptoms. Conclusions: A floating sternum is a morbid phenomenon that may manifest many years after the original procedure. It can cause significant sternal pain, chest wall instability, and respiratory dysfunction, which are the hallmark indications for correction. Repair of a floating sternum can be accomplished successfully. J Pediatr Surg 36:159-164. Copyright © 2001 by W.B. Saunders Company.

In this questionnaire study, the authors compared the prevalence of certain symptoms and signs associated with Sick Building Syndrome and perceptions relative to environmental discomfort of employees in a central-air-conditioned dropping center and in natural-ventilation commercial shops located on the streets of Niteroi, Rio de Janeiro, Brazil. There was a statistically significant higher prevalence of symptoms (e.g., water and itching of eyes, sore throat, nose irritation, difficulty breathing, skin irritation, sneezing) that were characteristic of Sick Building Syndrome in the air-conditioned building than in the naturally ventilated stores. The results indicated that there exists a continuing need for further research in Brazilian work environments.