57 results on '"Tom Kovesi"'
Search Results
2. Developing a core outcome set for the health outcomes for children and adults with congenital oesophageal atresia and/or tracheo-oesophageal fistula: OCELOT task group study protocol
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Nigel J Hall, Anna-may Long, Nick Lansdale, Sebastian King, Lucy Bray, Tom Kovesi, Alex Adams, Jonathan Ducey, Paul Cullis, Shireen A Nah, Lin Yin Ong, Victoria Gray, Paul D Losty, Usha Krishnan, Corne De Vos, Warwick J Teague, Rebecca Thursfield, Sarah Gorst, Nadine Teunissen, Julia Faulkner, Lucia Gutierrez Gammino, Graham Slater, Laura Baird, Julia Brendel, Adam Donne, Eniola Folaranmi, Laura Hopwood, Dan Benscoter, Mike Rutter, and Aaron M Zorn
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Pediatrics ,RJ1-570 - Abstract
Introduction Heterogeneity in reported outcomes of infants with oesophageal atresia (OA) with or without tracheo-oesophageal fistula (TOF) prevents effective data pooling. Core outcome sets (COS) have been developed for many conditions to standardise outcome reporting, facilitate meta-analysis and improve the relevance of research for patients and families. Our aim is to develop an internationally-agreed, comprehensive COS for OA-TOF, relevant from birth through to transition and adulthood.Methods and analysis A long list of outcomes will be generated using (1) a systematic review of existing studies on OA-TOF and (2) qualitative research with children (patients), adults (patients) and families involving focus groups, semistructured interviews and self-reported outcome activity packs. A two-phase Delphi survey will then be completed by four key stakeholder groups: (1) patients (paediatric and adult); (2) families; (3) healthcare professionals; and (4) researchers. Phase I will include stakeholders individually rating the importance and relevance of each long-listed outcome using a 9-point Likert scale, with the option to suggest additional outcomes not already included. During phase II, stakeholders will review summarised results from phase I relative to their own initial score and then will be asked to rescore the outcome based on this information. Responses from phase II will be summarised using descriptive statistics and a predefined definition of consensus for inclusion or exclusion of outcomes. Following the Delphi process, stakeholder experts will be invited to review data at a consensus meeting and agree on a COS for OA-TOF.Ethics and dissemination Ethical approval was sought through the Health Research Authority via the Integrated Research Application System, registration no. 297026. However, approval was deemed not to be required, so study sponsorship and oversight were provided by Alder Hey Children’s NHS Foundation Trust. The study has been prospectively registered with the COMET Initiative. The study will be published in an open access forum.
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- 2024
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3. Aerosol SARS-CoV-2 in hospitals and long-term care homes during the COVID-19 pandemic.
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Gary Mallach, Samantha B Kasloff, Tom Kovesi, Anand Kumar, Ryan Kulka, Jay Krishnan, Benoit Robert, Michaeline McGuinty, Sophia den Otter-Moore, Bashour Yazji, and Todd Cutts
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Medicine ,Science - Abstract
BackgroundFew studies have quantified aerosol concentrations of SARS-CoV-2 in hospitals and long-term care homes, and fewer still have examined samples for viability. This information is needed to clarify transmission risks beyond close contact.MethodsWe deployed particulate air samplers in rooms with COVID-19 positive patients in hospital ward and ICU rooms, rooms in long-term care homes experiencing outbreaks, and a correctional facility experiencing an outbreak. Samplers were placed between 2 and 3 meters from the patient. Aerosol (small liquid particles suspended in air) samples were collected onto gelatin filters by Ultrasonic Personal Air Samplers (UPAS) fitted with ResultsIn total, 138 samples were collected from 99 rooms. RNA samples were positive in 9.1% (6/66) of samples obtained with the UPAS 2.5μm samplers, 13.5% (7/52) with the UPAS 10μm samplers, and 10.0% (2/20) samples obtained with the Coriolis samplers. Culturable virus was not recovered in any samples. Viral RNA was detected in 15.1% of the rooms sampled. There was no significant difference in viral RNA recovery between the different room locations or samplers. Method development experiments indicated minimal loss of SARS-CoV-2 viability via the personal air sampler operation.
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- 2021
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4. Does specialist physician supply affect pediatric asthma health outcomes?
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Guido Filler, Tom Kovesi, Erik Bourdon, Sarah Ann Jones, Laurentiu Givelichian, Cheryl Rockman-Greenberg, Jason Gilliland, Marion Williams, Elaine Orrbine, Bruno Piedboeuf, and The Paediatric Chairs of Canada Mark Bernstein
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Health manpower/trends ,Physicians/supply and distribution ,Pediatric ,General practitioners ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. Methods This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into “peer groups” by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011. Results At the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p
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- 2018
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5. Food insecurity, vitamin D insufficiency and respiratory infections among Inuit children
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Sze Man Tse, Hope Weiler, and Tom Kovesi
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food security ,vitamin D ,Inuit ,bronchiolitis ,lower respiratory tract infections ,crowding ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Background: Food insecurity, vitamin D deficiency and lower respiratory tract infections are highly prevalent conditions among Inuit children. However, the relationship between these conditions has not been examined in this population. Objective: The objective of this study was to examine the relationship between food insecurity and severe respiratory infections before age 2 years and health centre visits for a respiratory problem in the past year. We also explored the relationship between serum vitamin D status and respiratory outcomes in this population. Design: We included children aged 3–5 years who participated in a cross-sectional survey of the health of preschool Inuit children in Nunavut, Canada, from 2007 to 2008 (n=388). Parental reports of severe respiratory infections in the first 2 years of life and health care visits in the past 12 months were assessed through a questionnaire. Child and adult food security were assessed separately and serum 25-hydroxyvitamin D3 levels were measured in a subgroup of participants (n=279). Multivariate logistic regression was performed to assess the association between food security, vitamin D and each of the 2 respiratory outcomes. Results: Child and adult food insecurity measures were not significantly associated with adverse respiratory outcomes. Household crowding [odds ratio (OR)=1.51, 95% confidence interval (CI) 1.09–2.09, p=0.01 for the child food security model] and higher birth weight (OR=1.21, 95% CI: 1.02–1.43, p=0.03) were associated with reported severe chest infections before age 2 years while increasing age was associated with decreased odds of reported health care visits for a respiratory problem (OR=0.66, 95% CI: 0.48–0.91, p=0.02). Neither vitamin D insufficiency nor deficiency was associated with these respiratory outcomes. Conclusions: Using a large cross-sectional survey of Inuit children, we found that household crowding, but not food security or vitamin D levels, was associated with adverse respiratory outcomes. Further studies are warranted to examine the impact of decreasing household crowding on the respiratory health of these children.
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- 2016
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6. Correction to: Does specialist physician supply affect pediatric asthma health outcomes?
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Guido Filler, Tom Kovesi, Erik Bourdon, Sarah Ann Jones, Laurentiu Givelichian, Cheryl Rockman-Greenberg, Jason Gilliland, Marion Williams, Elaine Orrbine, Bruno Piedboeuf, and The Paediatric Chairs of Canada
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Public aspects of medicine ,RA1-1270 - Abstract
In the original publication of this article [1], the institutional author’s name needs to be revised from The Paediatric Chairs of Canada Mark Bernstein to The Paediatric Chairs of Canada.
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- 2019
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7. Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
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Tahereh Haji, Adam Byrne, and Tom Kovesi
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pneumonia ,empyema ,pleural effusion ,child pneumococcal vaccines ,pneumococcal infections ,Pediatrics ,RJ1-570 - Abstract
Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
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- 2018
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8. Letter to the Editor
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Tom Kovesi
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Diseases of the respiratory system ,RC705-779 - Published
- 2008
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9. VACTERL-associated bilateral bronchial stenosis with concomitant spinal muscular atrophy
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Hugh McMillan J, Sarah Grace Buttle, Jorge Davila, Julia Bokhaut, Tom Kovesi, Sherri Katz, and Refika Ersu
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VACTERL association is linked to multiple congenital anomalies including tracheoesophageal fistula. In rare cases, VACTERL has been complicated by other airway malformations including severe bronchial stenosis or unilateral pulmonary agenesis. We report a child who developed episodes of oxygen desaturation during sleep associated with high pressure support requirements to maintain ventilation. He was known to have VACTERL association as well as spinal muscular atrophy (SMA) type II, a genetic neuromuscular disorder. Children with SMA can show progressive respiratory symptoms, including intercostal muscle weakness and accompanying paradoxical abdominal breathing with sparing of diaphragm function. Our patient was very difficult to ventilate non-invasively despite high pressures. CT chest with dynamic airway evaluation showed bilateral bronchial stenosis. High inspiratory pressures with non-invasive ventilation as seen in our case are required to overcome stenotic airways but are not expected in neuromuscular respiratory failure.
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- 2023
10. Resumption of pulmonary function testing during the COVID-19 pandemic
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Sanja Stanojevic, François Beaucage, Vikram Comondore, Marie Faughnan, Tom Kovesi, Carolyn McCoy, Colm McParland, David Pawluski, Farzad Refahi, Jeremy Road, and Micah Kooperberg
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Pulmonary and Respiratory Medicine ,Critical Care and Intensive Care Medicine - Published
- 2022
11. Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula
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Jonathan Popler, Yvonne Belessis, Sophie Laberge, Emily M. DeBoer, Anastassios C. Koumbourlis, Tom Kovesi, Renato Cutrera, Federica Porcaro, Mikhail Kazachkov, and Mary Cataletto
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Pulmonary and Respiratory Medicine ,Chronic bronchitis ,medicine.medical_specialty ,Fistula ,Tracheoesophageal fistula ,Positive-Pressure Respiration ,Bronchoscopy ,Positive airway pressure ,medicine ,Humans ,Intensive care medicine ,Esophageal Atresia ,Tracheomalacia ,Noninvasive Ventilation ,Bronchiectasis ,business.industry ,Infant, Newborn ,Respiration Disorders ,medicine.disease ,Atresia ,Pediatrics, Perinatology and Child Health ,Tomography, X-Ray Computed ,Airway ,business ,Tracheoesophageal Fistula - Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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- 2020
12. Resumption of pulmonary function testing during the post-peak phase of the COVID-19 pandemic
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Farzad Refahi, Colm McParland, Jeremy Road, Marie E. Faughnan, Vikram Comondore, Carolyn McCoy, Sanja Stanojevic, François Beaucage, Tom Kovesi, David Pawluski, and Micah Kooperberg
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Pulmonary and Respiratory Medicine ,Position statement ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Critical Care and Intensive Care Medicine ,Phase (combat) ,Pulmonary function testing ,Pandemic ,Emergency medicine ,medicine ,business - Abstract
This position statement aims to provide rapid guidance for resumption of pulmonary function services during the post-peak phase1 of the COVID-19 pandemic (i.e., period of low community prevalence)....
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- 2020
13. Aerosol SARS-CoV-2 in hospitals and long-term care homes during the COVID-19 pandemic
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Michaeline McGuinty, Sophia den Otter-Moore, Todd Cutts, Ryan Kulka, Samantha B Kasloff, Gary Mallach, Benoit Robert, Tom Kovesi, Anand Kumar, Jay Krishnan, and Bashour Yazji
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RNA viruses ,Veterinary medicine ,Viral Diseases ,Pulmonology ,Coronaviruses ,Air Microbiology ,Medical Conditions ,Animal Products ,Chlorocebus aethiops ,Materials ,Pathology and laboratory medicine ,Multidisciplinary ,Agriculture ,Medical microbiology ,Method development ,Hospitals ,Infectious Diseases ,Vesicular Stomatitis Virus ,Physical Sciences ,Viruses ,Medicine ,RNA, Viral ,SARS CoV 2 ,Pathogens ,Protein target ,Research Article ,Coronavirus disease 2019 (COVID-19) ,SARS coronavirus ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Science ,Materials Science ,complex mixtures ,Microbiology ,Rhabdoviruses ,Respiratory Disorders ,Animals ,Humans ,Viral rna ,Hospital ward ,Close contact ,Vero Cells ,Aerosols ,Medicine and health sciences ,Biology and life sciences ,SARS-CoV-2 ,Significant difference ,fungi ,Organisms ,Viral pathogens ,COVID-19 ,Covid 19 ,Long-Term Care ,Aerosol ,Microbial pathogens ,Health Care ,Health Care Facilities ,Mixtures ,Respiratory Infections ,Environmental science ,Gelatin - Abstract
BackgroundFew studies have quantified aerosol concentrations of SARS-CoV-2 in hospitals and long-term care homes, and fewer still have examined samples for viability. This information is needed to clarify transmission risks beyond close contact.MethodsWe deployed particulate air samplers in rooms with COVID-19 positive patients in hospital ward and ICU rooms, rooms in long-term care homes experiencing outbreaks, and a correctional facility experiencing an outbreak. Samplers were placed between 2 and 3 meters from the patient. Aerosol (small liquid particles suspended in air) samples were collected onto gelatin filters by Ultrasonic Personal Air Samplers (UPAS) fitted with 3), and with a Coriolis Biosampler over 10 minutes (total 1.5m3). Samples were assayed for viable SARS-CoV-2 virus and for the viral genome by multiplex PCR using the E and N protein target sequences. We validated the sampling methods by inoculating gelatin filters with viable vesicular stomatitis virus (VSV), and with three concentrations of viable SARS-CoV-2, operating personal samplers for 16hrs, and quantifying viable virus recovery by TCID50 assay.ResultsIn total, 138 samples were collected from 99 rooms. RNA samples were positive in 9.1% (6/66) of samples obtained with the UPAS 2.5µm samplers, 13.5% (7/52) with the UPAS 10µm samplers, and 10.0% (2/20) samples obtained with the Coriolis samplers. Culturable virus was not recovered in any samples. Viral RNA was detected in 10.9% of the rooms sampled. There was no significant difference in viral RNA recovery between the different room locations or samplers. Method development experiments indicated minimal loss of SARS-CoV-2 viability via the personal air sampler operation.Key FindingsAlthough a subset of aerosol samples exhibited detectable SARS-CoV-2 RNA at low titres, the presence of viable SARS-CoV-2 virus in aerosols appears to be infrequent at >2m distance.
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- 2021
14. Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group
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Anastassios Koumbourlis, Yvonne Belessis, Mary Cataletto, Renato Cutrera, Emily DeBoer, Mikhail Kazachkov, Sophie Laberge, Jonathan Popler, Federica Porcaro, and Tom Kovesi
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- 2020
15. Vocal cord paralysis appears to be an acquired lesion in children with repaired esophageal atresia/tracheoesophageal fistula
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Federica Porcaro, Marilena Trozzi, Tom Kovesi, Sergio Bottero, Renato Cutrera, and Francesca Petreschi
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Tracheoesophageal fistula ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Bronchoscopy ,030225 pediatrics ,Paralysis ,medicine ,Humans ,Vocal cord paralysis ,030223 otorhinolaryngology ,education ,Esophageal Atresia ,Retrospective Studies ,Surgical repair ,education.field_of_study ,Cordotomy ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Otorhinolaryngology ,Child, Preschool ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Airway ,Vocal cord paresis ,business ,Vocal Cord Paralysis ,Follow-Up Studies ,Tracheoesophageal Fistula - Abstract
Background: reports suggest that congenital esophageal atresia/tracheoesophageal fistula (EA/TEF) is associated with a number of upper airway anomalies [1,2]. Aims: it remains unclear whether vocal cord paresis or paralysis (VCP) is usually a primary anomaly, or is secondary to EA/TEF repair. Methods: a retrospective study was carried out in 105 patients with EA/TEF referred to the Department of Pediatric Medicine, Bambino Gesu Children’s Hospital (BGCH) for multidisciplinary follow-up following EA/TEF repair, between 2010 and 2015. Results: 64 of the 105 patients included in the study underwent EA/TEF repair and had pre-operative bronchoscopy in BGCH; the remaining patients had their initial surgery elsewhere. No patient included in the study had VCP detected pre-operatively. Six patients were diagnosed with VCP during the follow-up period (6/105, 5.7%), of whom 4 were surgically managed at the BGCH, and two were managed elsewhere. Four children with bilateral VCP initially required tracheostomy. The other two patients were treated with posterior cordotomy by CO2 laser, and one received a tracheostomy. Conclusion: we did not observe VCP in pre-operative bronchoscopy in patients undergoing EA/TEF repair, but observed VCP in 5.7% of patients during a post-operative re-evaluation, suggesting that VCP is an acquired lesion in TEF patients. Future studies are needed to determine whether VCP is present in some patients prior to EA/TEF repair, and if so, what the prevalence is. References: 1. Ann Otol Rhinol Laryngol. 2015; 124: 808-13. 2. Laryngoscope. 2015; 125: 469-74.
- Published
- 2018
16. Oral aspiration, type 1 laryngeal cleft, and respiratory tract infections in canadian inuit children
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Amisha Agarwal, Darcy Scott, Sarah Farrow, Nick Barrowman, Jeremy Saban, and Tom Kovesi
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Pulmonary and Respiratory Medicine ,Male ,Pediatrics ,medicine.medical_specialty ,Canada ,Population ,Rate ratio ,Congenital Abnormalities ,Swallowing ,Prevalence ,Medicine ,Humans ,education ,Respiratory Tract Infections ,Retrospective Studies ,education.field_of_study ,Respiratory tract infections ,business.industry ,Incidence (epidemiology) ,Incidence ,Respiratory Aspiration ,Infant ,Laryngeal cleft ,medicine.disease ,Confidence interval ,Deglutition ,Hospitalization ,Bronchiolitis ,Inuit ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Larynx ,business - Abstract
Canadian Inuit infants suffer the highest rate of lower respiratory tract infections (LRTI's) in the world. The causes of this are incompletely understood. The primary objective of this study was to determine whether there exists an association between respiratory morbidity and oral aspiration in Inuit children. A retrospective chart review was conducted including children from Nunavut who underwent Video Fluoroscopic Swallowing Study between the years of 2001 to 2015. The primary outcome was hospitalization for LRTI. We hypothesized that infants found to have aspiration would experience a higher rate of admissions for LRTI than those with normal swallowing studies. One-hundred and twenty-seven patients were identified, of whom 94 were included. Fifty-six percent of patients had an abnormal swallowing study. Compared with patients with normal swallowing, the incidence rate of LRTI was higher in patients with aspiration (incidence rate ratio [IRR] = 1.51; 95% confidence interval [CI] = 1.23-1.87) and in patients with penetration (IRR = 1.40; 95% CI = 1.11-1.76). Fourteen percent of patients had confirmed laryngeal cleft; patients with confirmed presence of this also had a higher incidence rate of LRTI (IRR = 1.66; 95% CI = 1.32-2.07). The incidence of abnormal swallowing study showed an 11-fold variation across the five regions in Nunavut, with the highest prevalence in west Qikiqtani Region (Baffin Island). We conclude that swallowing dysfunction is not only prevalent amongst Canadian Inuit but clinically significant. This is the first study to demonstrate an association between swallowing dysfunction and respiratory morbidity in this population. Geographic distribution patterns and high rates of laryngeal cleft may point to a potential genetic etiology for what remains at this point, idiopathic swallowing dysfunction.
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- 2019
17. Does specialist physician supply affect pediatric asthma health outcomes?
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Guido, Filler, Tom, Kovesi, Erik, Bourdon, Sarah Ann, Jones, Laurentiu, Givelichian, Cheryl, Rockman-Greenberg, Jason, Gilliland, Marion, Williams, Elaine, Orrbine, Bruno, Piedboeuf, Hervé, Walti, and University of Manitoba
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Male ,Databases, Factual ,Cross-sectional study ,physicians ,Dentists ,cross-sectional studies ,Pediatrics ,Health administration ,specialization ,0302 clinical medicine ,General practitioners ,Medicine ,pediatricians ,030212 general & internal medicine ,Child ,Pediatric ,Health Policy ,lcsh:Public aspects of medicine ,Manitoba ,Saskatchewan ,Hospitalization ,female ,Treatment Outcome ,Child, Preschool ,Workforce ,Physicians/supply and distribution ,factual ,Female ,geographic locations ,Cohort study ,Specialization ,Research Article ,medicine.medical_specialty ,databases ,Adolescent ,education ,preschool ,03 medical and health sciences ,Physicians ,Humans ,Social determinants of health ,Pediatricians ,Retrospective Studies ,business.industry ,Public health ,Correction ,Retrospective cohort study ,lcsh:RA1-1270 ,asthma ,Asthma ,Health manpower/trends ,Cross-Sectional Studies ,030228 respiratory system ,Family medicine ,business ,Specialist Physician - Abstract
Background Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. Methods This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into “peer groups” by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011. Results At the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p
- Published
- 2018
18. Inconclusive Diagnosis of Cystic Fibrosis After Newborn Screening
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Louise Taylor, Kylie-Ann Malitt, Sonia Volpi, Richard van Wylick, Melinda Solomon, Peter R. Durie, April Price, Margaret Boland, Steven Kent, Candice Bjornson, Tanja Gonska, Carlo Castellani, Tom Kovesi, Felix Ratjen, Katherine Keenan, Lenna Morgan, Julie Avolio, Chee Y. Ooi, Karen Tam, and Mark A. Chilvers
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Newborn screening ,medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,biology ,business.industry ,Trypsinogen ,medicine.disease ,biology.organism_classification ,Cystic fibrosis ,Gastroenterology ,chemistry.chemical_compound ,Stenotrophomonas maltophilia ,chemistry ,Interquartile range ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Genotype ,Medicine ,Immunoreactive trypsinogen ,business ,Sweat test - Abstract
OBJECTIVES: To prospectively study infants with an inconclusive diagnosis of cystic fibrosis (CF) identified by newborn screening (NBS; “CF screen positive, inconclusive diagnosis” [CFSPID]) for disease manifestations. METHODS: Infants with CFSPID and CF based on NBS from 8 CF centers were prospectively evaluated and monitored. Genotype, phenotype, repeat sweat test, serum trypsinogen, and microbiology data were compared between subjects with CF and CFSPID and between subjects with CFSPID who did (CFSPID→CF) and did not (CFSPID→CFSPID) fulfill the criteria for CF during the first 3 years of life. RESULTS: Eighty-two subjects with CFSPID and 80 subjects with CF were enrolled. The ratio of CFSPID to CF ranged from 1:1.4 to 1:2.9 in different centers. CFTR mutation rates did not differ between groups; 96% of subjects with CFSPID and 93% of subjects with CF had 2 mutations. Subjects with CFSPID had significantly lower NBS immunoreactive trypsinogen (median [interquartile range]:77 [61–106] vs 144 [105–199] μg/L; P Pseudomonas aeruginosa and Stenotrophomonas maltophilia were isolated in 12% and 5%, respectively, of subjects with CFSPID. CF was diagnosed in 9 of 82 (11%) subjects with CFSPID (genotype and abnormal sweat chloride = 3; genotype alone = 4; abnormal sweat chloride only = 2). Sweat chloride was abnormal in CFSPID→CF patients at a mean (SD) age of 21.3 (13.8) months. CFSPID→CF patients had significantly higher serial sweat chloride ( P P = .009) levels than did CFSPID→CFSPID patients. CONCLUSIONS: A proportion of infants with CFSPID will be diagnosed with CF within the first 3 years. These findings underscore the need for clinical monitoring, repeat sweat testing at age 2 to 3 years, and extensive genotyping.
- Published
- 2015
19. Triage Nurse Initiation of Corticosteroids in Pediatric Asthma Is Associated With Improved Emergency Department Efficiency
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Roger Zemek, Nicholas Perri, Martin H. Osmond, Rhonda Correll, Nick Barrowman, Amy C. Plint, and Tom Kovesi
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Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Nurses ,law.invention ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,Medical Staff, Hospital ,medicine ,Humans ,Child ,Glucocorticoids ,Retrospective Studies ,Asthma ,Practice Patterns, Nurses' ,business.industry ,Retrospective cohort study ,Odds ratio ,Emergency department ,medicine.disease ,Triage ,Confidence interval ,Upper respiratory tract infection ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Female ,Emergencies ,Emergency Service, Hospital ,business ,Follow-Up Studies - Abstract
OBJECTIVE:To assess the effectiveness of nurse-initiated administration of oral corticosteroids before physician assessment in moderate to severe acute asthma exacerbations in the pediatric ED.METHODS:A time-series controlled trial evaluated nurse initiation of treatment with steroids before physician assessment in children with Pediatric Respiratory Assessment Measure score ≥4. One-to-one periods (physician-initiated and nurse-initiated) were analyzed from September 2009 through May 2010. In both phases, triage nurses initiated bronchodilator therapy before physician assessment, per Pediatric Respiratory Assessment Measure score. We reviewed charts of 644 consecutive children aged 2 to 17 years for the following outcomes: admission rate; times to clinical improvement, steroid receipt, mild status, and discharge; and rate of return ED visit and subsequent admission.RESULTS:Nurse-initiated phase children improved earlier compared to physician-initiated phase (median difference: 24 minutes; 95% confidence interval [CI]: 1–50; P = .04). Admission was less likely if children received steroids at triage (odds ratio = 0.56; 95% CI: 0.36–0.87). Efficiency gains were made in time to steroid receipt (median difference: 44 minutes; 95% CI: 39–50; P < .001), time to mild status (median difference: 51 minutes; 95% CI: 17–84; P = .04), and time to discharge (median difference: 44 minutes; 95% CI: 17–68; P = .02). No differences were found in return visit rate or subsequent admission.CONCLUSIONS:Triage nurse initiation of oral corticosteroid before physician assessment was associated with reduced times to clinical improvement and discharge, and reduced admission rates in children presenting with moderate to severe acute asthma exacerbations.
- Published
- 2012
20. Severe Early Lower Respiratory Tract Infection is Associated with Subsequent Respiratory Morbidity in Preschool Inuit Children in Nunavut, Canada
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Grace M. Egeland, Zhirong Cao, Geraldine Osborne, and Tom Kovesi
- Subjects
Male ,Risk ,Pulmonary and Respiratory Medicine ,Canada ,Pediatrics ,medicine.medical_specialty ,Respiratory Tract Diseases ,Pregnancy ,Risk Factors ,Surveys and Questionnaires ,Lower respiratory tract infection ,Respiratory morbidity ,Ambulatory Care ,Prevalence ,medicine ,Humans ,Immunology and Allergy ,Respiratory system ,Respiratory Tract Infections ,Respiratory Sounds ,Asthma ,High rate ,business.industry ,Smoking ,Community Health Centers ,Pneumonia ,medicine.disease ,respiratory tract diseases ,Hospitalization ,Chronic cough ,Breast Feeding ,Cross-Sectional Studies ,Cough ,Inuit ,Child, Preschool ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Housing ,Bronchiolitis ,Bronchitis ,Female ,Tobacco Smoke Pollution ,Morbidity ,medicine.symptom ,business - Abstract
Inuit children in Nunavut, Canada, have high rates of lower respiratory tract infection (LRTI) early in life. Whether this commonly results in chronic respiratory symptoms later in life is unknown.A cross-sectional survey of 3- to 5-years-old Inuit children was conducted in all three regions of Nunavut, as part of the "Qanuippitali, what about us, how are we?" survey.Reported chronic cough and wheezing were common in preschool Inuit children, although reported asthma diagnosed by a healthcare professional was uncommon. The presence of smokers in the home tended to be associated with severe LRTI in the first 2 years of life. Reported wheezing as well as reported bronchitis or pneumonia in the previous 12 months was significantly associated with severe LRTI in the first 2 years of life. Reported wheezing was also strongly associated with reported bronchitis or pneumonia in the past 12 months. The prevalence of chronic moist cough could not be clearly assessed, due to limitations in the questionnaire.Severe LRTI in the first 2 years of life was associated with ongoing respiratory morbidity in preschool Inuit children, although symptoms appeared to lessen in severity over time.
- Published
- 2011
21. An Official American Thoracic Society Workshop Report: Tobacco Control Initiatives within the American Thoracic Society
- Author
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Mary Ellen, Wewers, William C, Bailey, Kai-Häkon, Carlsen, Mark D, Eisner, Patricia, Folan, Janie, Heath, Mary D, Klinnert, Tom, Kovesi, Grace W, Pien, Virginia C, Reichart, Arunabh, Talwar, and Katherine, Thompson
- Subjects
Pulmonary and Respiratory Medicine ,Gerontology ,medicine.medical_specialty ,business.industry ,Corporate governance ,Smoking ,Tobacco control ,Pulmonary disease ,Smoking Prevention ,Health Promotion ,Disease ,Risk factor (computing) ,United States ,Cigarette smoking ,Family medicine ,medicine ,Humans ,Organizational Objectives ,Smoking Cessation ,Professional association ,business ,Societies, Medical ,Cause of death - Abstract
Cigarette smoking represents the single most preventable cause of premature morbidity and mortality in the United States and the burden of tobacco use is apparent world-wide. Cigarette smoking is a major risk factor for chronic obstructive pulmonary disease, the third leading cause of death in the United States in 2004. The American Thoracic Society (ATS) and its members have contributed significantly to an understanding of the biological and pathophysiologic mechanisms responsible for the development and management of tobacco-attributable disease and disability. The society's active involvement in tobacco control advocacy and policy-related initiatives are central to its mission. Within the ATS, there is also increased interest in accelerating the society's efforts to understand the mechanisms responsible for the uptake, persistence, and cessation of tobacco use. Scientific, clinical, and educational activities that include an examination of these underlying mechanisms are warranted. This paper describes findings from an ATS initiative that developed a preliminary strategy for enhancing scientific, clinical, educational, and policy-related tobacco control efforts that are consistent with the vision of the ATS. The specific aims of this project included the identification of existing mechanisms, as well as the current governance in place within the ATS infrastructure, to address tobacco control issues related to scientific inquiry, policy initiatives, and advocacy for tobacco control. This assessment generated recommendations to inform the ATS leadership with regard to the future development of relevant tobacco control initiatives.
- Published
- 2010
22. Heat recovery ventilators prevent respiratory disorders in Inuit children
- Author
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N. L. Gilbert, Tom Kovesi, N. Barrowman, Robert Dales, J. D. Miller, Corinne Stocco, Ai Ni, D. Fugler, and C. Zaloum
- Subjects
Pediatrics ,medicine.medical_specialty ,Environmental Engineering ,Respiratory tract infections ,business.industry ,Public Health, Environmental and Occupational Health ,Placebo-controlled study ,Respiratory infection ,Building and Construction ,Odds ratio ,medicine.disease ,Placebo ,Bronchiolitis ,Wheeze ,medicine ,Breathing ,medicine.symptom ,business - Abstract
Inuit infants have high rates of reported hospitalization for respiratory infection, associated with overcrowding and reduced ventilation. We performed a randomized, double-blind, placebo controlled trial to determine whether home heat recovery ventilators (HRV) would improve ventilation and reduce the risk of respiratory illnesses in young Inuit children. Inuit children under 6 years of age living in several communities in Nunavut, Canada were randomized to receive an active or placebo HRV. We monitored respiratory symptoms, health center encounters, and indoor air quality for 6 months. HRVs were placed in 68 homes, and 51 houses could be analyzed. Subjects had a mean age of 26.8 months. Active HRVs brought indoor carbon dioxide con- centrations to within recommended concentrations. Relative humidity was also reduced. Use of HRV, compared with placebo, was associated with a progressive fall in the odds ratio for reported wheeze of 12.3% per week (95%CI 1.9-21.6%, P = 0.022). Rates of reported rhinitis were significantly lower in the HRV group than the placebo group in month 1 (odds ratio 0.20, 95%CI 0.058-0.69, P = 0.011) and in month 4 (odds ratio 0.24, 95%CI 0.054-0.90, P = 0.035). There were no significant reductions in the number of health center encounters, and there were no hospitalizations. Use of HRVs was associated with in improvement in air quality and reductions in reported respiratory symptoms in Inuit children.
- Published
- 2009
23. Exhaled Nitric Oxide Concentration Is Affected by Age, Height, and Race in Healthy 9- to 12-Year-Old Children
- Author
-
Robert Dales, Tom Kovesi, and Ryan Kulka
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Canada ,Pediatrics ,medicine.medical_specialty ,Population ,Black People ,Nitric Oxide ,Critical Care and Intensive Care Medicine ,White People ,Asian People ,Reference Values ,Humans ,Medicine ,Child ,education ,Asthma ,Body surface area ,Breath test ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Age Factors ,respiratory system ,medicine.disease ,Body Height ,Confidence interval ,respiratory tract diseases ,Surgery ,El Niño ,Exhaled nitric oxide ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
The fractional concentration of exhaled nitric oxide (Feno) is a useful indicator of airway inflammation in children and adults with asthma.We determined the range of Feno concentrations and the factors affecting it in a large sample of healthy school children attending grades 4 through 6, in Windsor, ON, Canada.Feno was measured in 657 children between 9.1 and 12.9 years of age. The range of Feno concentrations in healthy school children was 12.7 parts per billion (ppb) [95% confidence interval (CI), 11.8 to 13.7 ppb] in whites and 22.8 ppb [95% CI, 17.9 to 27.7 ppb] in Asian-Canadian children (p0.001). Feno values also appeared to be higher in African-Canadian children than in whites, although the CI was wide because of the small number of African-Canadian children sampled. Feno rose slightly but significantly with age (p = 0.007) and with height (p = 0.023). Body mass index and gender did not significantly alter the measured Feno. FVC had a nonsignificant effect on Feno. Participation in physical activity during the same day had a borderline-significant effect on measured Feno, but a reported history of a respiratory tract infection in the preceding 2 weeks did not.Feno concentrations in healthy school-aged children appeared to be affected by race, and, to a lesser extent, by age and height. These factors should be taken into consideration when interpreting clinical results.
- Published
- 2008
24. Indoor air quality and the risk of lower respiratory tract infections in young Canadian Inuit children
- Author
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Nicolas L. Gilbert, Don Fugler, Tom Kovesi, Corinne Stocco, Mireille Guay, Robert E. Dales, and J. David Miller
- Subjects
Male ,Canada ,Pediatrics ,medicine.medical_specialty ,Severity of Illness Index ,Age Distribution ,Indoor air quality ,Recurrence ,Surveys and Questionnaires ,Lower respiratory tract infection ,Humans ,Medicine ,Sex Distribution ,Respiratory Tract Infections ,Probability ,Analysis of Variance ,Respiratory tract infections ,business.industry ,Incidence ,Research ,Incidence (epidemiology) ,Infant ,Respiratory infection ,General Medicine ,Odds ratio ,medicine.disease ,Ventilation ,Confidence interval ,Hospitalization ,Cross-Sectional Studies ,Logistic Models ,Inuit ,Air Pollution, Indoor ,Child, Preschool ,Epidemiological Monitoring ,Housing ,Breathing ,Female ,Maximum Allowable Concentration ,business ,Environmental Monitoring ,Follow-Up Studies ,Demography - Abstract
Background: Inuit infants have the highest reported rate of hospital admissions because of lower respiratory tract infections in the world. We evaluated the prevalence of reduced ventilation in houses in Nunavut, Canada, and whether this was associated with an increased risk of these infections among young Inuit children. Methods: We measured ventilation in 49 homes of Inuit children less than 5 years of age in Qikiqtaaluk (Baffin) Region, Nunavut. We identified the occurrence of lower respiratory tract infections using a standardized questionnaire. Associations between ventilation measures and lower respiratory tract infection were evaluated using multiple logistic regression models. Results: The mean number of occupants per house was 6.1 people. The mean ventilation rate per person was 5.6 L/s (standard deviation [SD] 3.7); 80% (37/46) of the houses had ventilation rates below the recommended rate of 7.5 L/s per person. The mean indoor carbon dioxide (CO 2 ) concentration of 1358 (SD 531) ppm was higher than the recommended target level of 1000 ppm. Smokers were present in 46 homes (94%). Of the 49 children, 27 (55%) had a reported history of lower respiratory tract infection. Reported respiratory infection was significantly associated with mean CO 2 levels (odds ratio [OR] 2.85 per 500-ppm increase in mean indoor CO 2 , 95% confidence interval [CI] 1.23–6.59) and occupancy (OR 1.81 for each additional occupant, 95% CI 1.14–2.86). Interpretation: Reduced ventilation and crowding may contribute to the observed excess of lower respiratory tract infection among young Inuit children. The benefits of measures to reduce indoor smoking and occupancy rates and to increase ventilation should be studied.
- Published
- 2007
25. Elevated Carbon Dioxide Tension as a Predictor of Subsequent Adverse Events in Infants with Bronchopulmonary Dysplasia
- Author
-
Adel Abdurahman, Marc Blayney, and Tom Kovesi
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Neonatal intensive care unit ,Partial Pressure ,Gestational Age ,Patient Readmission ,Risk Factors ,Intensive Care Units, Neonatal ,Internal medicine ,Humans ,Medicine ,Adverse effect ,Prospective cohort study ,Bronchopulmonary Dysplasia ,Retrospective Studies ,business.industry ,Infant, Newborn ,Gestational age ,Retrospective cohort study ,Carbon Dioxide ,medicine.disease ,Respiration, Artificial ,Pulmonary hypertension ,Capillaries ,respiratory tract diseases ,Bronchopulmonary dysplasia ,Female ,medicine.symptom ,business ,Hypercapnia ,Follow-Up Studies ,circulatory and respiratory physiology - Abstract
Infants with bronchopulmonary dysplasia (BPD) are at risk for numerous complications following discharge from the Neonatal Intensive Care Unit (NICU). Few studies have evaluated risk factors for adverse events (AE). This retrospective study provided an initial evaluation of the use of capillary carbon dioxide (PCO2) tension as a predictor of infants with BPD at increased risk for AE. PCO2 was compared in patients who suffered, or avoided, severe AE, defined as pulmonary hypertension, death, or subsequent reintubation or tracheostomy for respiratory illness. One hundred twelve consecutive patients followed at the BPD clinic were evaluated, and data from 104 subjects were suitable for analysis. Mean PCO2, obtained shortly before or after discharge from NICU, was 47.2 mmHg (range, 31-83). PCO2 was significantly higher in patients who required reintubation and ventilation (54.7 vs. 46.7, p < 0.04). No cutoff value of PCO2 clearly distinguished patients with subsequent AE. PCO2 was not significantly higher in the group of patients who had a severe AE than in the group of patients who did not have a severe AE, but logistic regression showed a significant association between PCO2 and risk of both severe AE (p = 0.018), and readmission to hospital (p = 0.038). An elevated PCO2 is associated with an increased risk of AE, including reintubation, and readmission to hospital, in infants with BPD. Patients with an elevated discharge PCO2 may require closer monitoring during followup. Prospective studies will be needed to confirm these observations.
- Published
- 2006
26. Commentaries on ‘Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma’
- Author
-
Tom Kovesi and Helena Liira
- Subjects
Adult ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Child ,Workplace ,Intensive care medicine ,Respiratory Tract Infections ,Environmental Restoration and Remediation ,Asthma ,Evidence-Based Medicine ,Schools ,business.industry ,Fungi ,Humidity ,Child Day Care Centers ,General Medicine ,medicine.disease ,3. Good health ,Review Literature as Topic ,medicine.anatomical_structure ,Systematic review ,030228 respiratory system ,Air Pollution, Indoor ,Pediatrics, Perinatology and Child Health ,Housing ,business ,Respiratory tract - Abstract
These are commentaries on a Cochrane review, published in the issue of EBCH, first published as: Sauni R, Uitti J, Jauhiainen M, Kreiss K, Sigsgaard T, Verbeek JH. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007897. DOI: 10.1002/14651858.CD007897.pub2.
- Published
- 2013
27. The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study
- Author
-
Luis Guerra, Nick Barrowman, Victor M. Neira, Maria Campos, William M. Splinter, and Tom Kovesi
- Subjects
Male ,Respiratory rate ,Respiratory physiology ,Peak inspiratory pressure ,Anesthesia, General ,Sevoflurane ,Head-Down Tilt ,Positive-Pressure Respiration ,Pneumoperitoneum ,Cryptorchidism ,medicine ,Humans ,Prospective Studies ,Respiratory system ,Tidal volume ,Aged ,business.industry ,General Medicine ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia ,Orchiopexy ,Breathing ,Respiratory Mechanics ,business ,Pneumoperitoneum, Artificial ,medicine.drug - Abstract
The aim of this study was to describe the changes in respiratory system compliance and other measures of respiratory mechanics associated with peritoneal insufflation (12 mmHg pressure) with carbon dioxide (PNP12) and 20° Trendelenburg positioning (TDG20) in pediatric patients undergoing laparoscopic surgery for abdominal cryptorchidism. Twelve subjects with abdominal cryptorchidism undergoing orchiopexy were enrolled in the study. General anesthesia was conducted with sevoflurane/O2/air, fentanyl, and rocuronium. Pressure-controlled ventilation with a peak inspiratory pressure (PIP) of 10-15 cm H2O and a positive end-expiratory pressure of 5 cm H2O was titrated to achieve a tidal volume (VT/kg) of 6-10 mL·kg−1 and end-tidal carbon dioxide (EtCO2) of 35-40 mmHg. Adjustments of PIP and respiratory rate (RR) were made to maintain the initial VT/kg and EtCO2
- Published
- 2014
28. Reversal of Adrenal Suppression with Ciclesonide
- Author
-
Tom Kovesi, Jessica A Laks, Alexandra Ahmet, and Mariel Kupfert Heller
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Urology ,Inhaled corticosteroids ,Ciclesonide ,chemistry.chemical_compound ,Adrenal Cortex Hormones ,Pregnenediones ,Asthma control ,Adrenal Glands ,medicine ,Adrenal insufficiency ,Humans ,Immunology and Allergy ,Asthma ,Fluticasone ,business.industry ,Infant ,medicine.disease ,chemistry ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Adrenal suppression ,Corticosteroid use ,business ,medicine.drug - Abstract
Background. Adrenal suppression secondary to high-dose inhaled corticosteroid use has been reported in children. Methods. The authors report the use of ciclesonide to reverse adrenal suppression secondary to inhaled fluticasone use in four pediatric patients. Results. In these four children, hypothalamic-pituitary-adrenal axis function normalized after the patients were changed to ciclesonide, while good asthma control was maintained. Conclusions. Ciclesonide should be considered for the reversal of adrenal suppression secondary to the use of fluticasone, and perhaps other older inhaled corticosteroids as well.
- Published
- 2010
29. Pseudomonas aeruginosa andBurkholderia cepacia infection in cystic fibrosis patients treated in Toronto and Copenhagen
- Author
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Mary Corey, Niels Høiby, Christian Koch, Helle Krogh Johansen, Henry Levison, and Tom Kovesi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,business.industry ,Respiratory disease ,medicine.disease ,Cystic fibrosis ,Pulmonary function testing ,Surgery ,Pneumonia ,medicine.anatomical_structure ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Epidemiology ,Cohort ,Medicine ,business ,Antibacterial agent - Abstract
Differences in the course of pulmonary disease in cystic fibrosis (CF) may be altered by different treatment strategies in different CF centers. The Copenhagen clinic uses scheduled, regular and very aggressive treatment of lung infection. The Toronto clinic treats pulmonary infection with oral, inhaled, or intravenous antibiotics, and has emphasized aggressive nutritional therapy. This study compared the clinical status of CF patients treated in the two centers (Toronto, Canada, n=302, and Copenhagen, Denmark, n=214) using a cross-sectional design in terms of Pseudomonas aeruginosa (PA) and Burkholderia cepacia (BC) lung infections, pulmonary function, and levels of PA and BC precipitating antibodies (precipitins). Median ages were similar, but the age distribution was significantly different, with a higher proportion of patients under 10 and > or = 25 years in Toronto, and higher proportion of patients 11-24 years of age in Copenhagen. A higher number of female patients was observed in Copenhagen than in Toronto. Seventy-nine percent of Copenhagen patients, and 52% of Toronto patients were deltaF508 homozygous. Of all the patients, 20.1% of Copenhagen patients and 38% of Toronto patients were deltaF508 heterozygous. Ten percent of Toronto patients had two uncommon mutations. Pulmonary function and nutritional status in both groups were similar despite varying treatment strategies. The prevalence of PA was lower in Danish children and higher in Danish adults than in Canada. These differences are probably due to cohort isolation, which was introduced in Copenhagen in 1981. The prevalence of BC was higher in Toronto than in Copenhagen patients at all ages. In both centers, the number of PA and BC precipitins increased with age in patients chronically infected with PA and BC, respectively, and the number of both PA and BC precipitins rose with declining lung function. This study suggests that the clinic populations had similar pulmonary and nutritional statuses despite differing clinic antibiotic treatment strategies. Microbial colonization seemed to differ, at least in part, because of differences in cohort isolation strategies. Early, aggressive anti-pseudomonal chemotherapy may have reduced pseudomonal colonization among younger patients in Copenhagen. Future studies will be required to assess the impact of this on this cohort's outcome.
- Published
- 1998
30. Long-term management of asthma in First Nations and Inuit children: A knowledge translation tool based on Canadian paediatric asthma guidelines, intended for use by front-line health care professionals working in isolated communities
- Author
-
Brenda Louise Giles, Tom Kovesi, and Hans Pasterkamp
- Subjects
Spirometry ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Front line ,Airway obstruction ,medicine.disease ,Paediatric asthma ,Bronchiolitis ,Knowledge translation ,Pediatrics, Perinatology and Child Health ,Health care ,medicine ,Narrative Review ,Intensive care medicine ,business ,Asthma - Abstract
Asthma is a serious health problem for First Nations and Inuit children. In children younger than one year of age, asthma needs to be distinguished from viral bronchiolitis, which is unusually common in Canadian Aboriginal children. In children younger than six years of age, the diagnosis depends on the presence of typical symptoms, the absence of atypical features and the documentation of response to therapy - particularly a rapid, transient response to bronchodilators. In older children, the presence of reversible airway obstruction should be determined using spirometry whenever feasible to confirm the diagnosis. Environmental triggers should be evaluated and corrected whenever possible. Regular use of inhaled steroids is the most important measure for maintaining good asthma control in children with asthma. Clients and their families should receive asthma education. Control should be regularly reassessed at follow-up visits in health centres, with therapy adjusted to the lowest level capable of maintaining good control.L’asthme est un grave problème de santé pour les enfants inuits et des Premières nations. Chez les enfants de moins d’un an, il faut distinguer l’asthme de la bronchiolite virale, anormalement fréquente chez les enfants autochtones du Canada. Chez les enfants de moins de six ans, le diagnostic dépend de la présence de symptômes classiques, de l’absence de caractéristiques atypiques et de la consignation de la réponse au traitement, notamment la réponse rapide et transitoire aux bronchodilatateurs. Chez les enfants plus âgés, il faut, dans la mesure du possible, déterminer la présence d’une obstruction réversible des voies aériennes par spirométrie afin de confirmer le diagnostic ainsi qu’évaluer et corriger les déclencheurs environnementaux. L’utilisation régulière de corticoïdes en aérosol est la principale mesure à prendre pour maintenir un bon contrôle de l’asthme chez les enfants asthmatiques. Les clients et leur famille devraient recevoir une formation sur l’asthme. Il faut réévaluer régulièrement le contrôle aux visites de suivi dans des centres de santé et rajuster le traitement à la dose la plus basse possible pour le maintien de ce contrôle.
- Published
- 2012
31. Bronchial cast
- Author
-
Letizia Gardin and Tom Kovesi
- Subjects
Heart Defects, Congenital ,business.industry ,Dentistry ,Bronchi ,Bronchial Diseases ,Bronchography ,Diagnosis, Differential ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,business ,Child - Published
- 2011
32. Pneumomediastinum and subcutaneous emphysema associated with pandemic (H1N1) influenza in three children
- Author
-
Tahir Hameed, Sharmila Udupa, and Tom Kovesi
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Physical examination ,Disease Outbreaks ,Influenza A Virus, H1N1 Subtype ,immune system diseases ,Influenza, Human ,otorhinolaryngologic diseases ,Sore throat ,medicine ,Humans ,Pneumomediastinum ,Child ,Montelukast ,Mediastinal Emphysema ,Asthma ,Ontario ,Practice ,medicine.diagnostic_test ,business.industry ,General Medicine ,Emergency department ,medicine.disease ,Subcutaneous Emphysema ,respiratory tract diseases ,stomatognathic diseases ,Anesthesia ,Child, Preschool ,Vomiting ,Female ,medicine.symptom ,business ,Subcutaneous emphysema ,medicine.drug - Abstract
A nine-year-old girl presented to the emergency department in the fall of 2009 with a one-week history of cough, neck swelling, sore throat and mild diarrhea, but no fever or vomiting. She had a history of asthma, which was treated with montelukast. Her physical examination showed subcutaneous
- Published
- 2010
33. Cover concerns
- Author
-
Tom, Kovesi
- Subjects
Spirometry ,Humans ,Physicians, Family ,Adrenergic beta-2 Receptor Agonists ,Asthma ,Debates - Published
- 2010
34. Achieving control of asthma in preschoolers
- Author
-
Denis Bérubé, R. Andrew McIvor, Sheldon Spier, Stuart C. Carr, Tom Kovesi, Suzanne Schuh, and Wade T. A. Watson
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Anti-Inflammatory Agents ,Review ,Respiratory Syncytial Virus Infections ,Anti-Infective Agents ,medicine ,Humans ,Albuterol ,Asthma ,business.industry ,Beclomethasone ,Amoxicillin ,Infant ,General Medicine ,Emergency department ,medicine.disease ,Bronchodilator Agents ,Bronchiolitis ,Child, Preschool ,Practice Guidelines as Topic ,Drug Therapy, Combination ,Female ,business - Abstract
Billy, who is 2 years old, presents to the physician’s office with his fourth episode of wheezing in the past 18 months. He was admitted to hospital at 6 months of age with bronchiolitis caused by respiratory syncytial virus. At 9 months, he was seen in the local emergency department with a cold
- Published
- 2010
35. Pets in airplane cabins: an unnecessary allergic hazard
- Author
-
Matthew B. Stanbrook, Paul C. Hébert, and Tom Kovesi
- Subjects
Canada ,Travel ,Letter ,Aircraft ,business.industry ,Air ,Respiratory Hypersensitivity ,General Medicine ,Environmental exposure ,Environmental Exposure ,Hazard ,Editorial ,Environmental health ,Animals, Domestic ,Medicine ,Animals ,Humans ,business ,human activities ,Simulation ,Air travel - Abstract
Air travel has become increasingly difficult, with tightened security restrictions and a decreased number of services. It should not include easily avoidable health risks. But it does on some major airlines, at least for passengers with allergies to pets. Travellers in Canada lost their access to
- Published
- 2010
36. Effects of the indoor environment on the fraction of exhaled nitric oxide in school-aged children
- Author
-
Tom Kovesi and Robert E. Dales
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Respiratory Tract Diseases ,Fraction (chemistry) ,Nitric Oxide ,Heating ,Diseases of the respiratory system ,medicine ,Animals ,Humans ,Child ,Asthma ,Inflammation ,School age child ,RC705-779 ,business.industry ,Respiration ,Airway inflammation ,Fungi ,Environmental Exposure ,respiratory system ,medicine.disease ,respiratory tract diseases ,Cross-Sectional Studies ,Air Pollution, Indoor ,Animals, Domestic ,Exhaled nitric oxide ,Immunology ,Original Article ,Female ,Tobacco Smoke Pollution ,business - Abstract
BACKGROUND: The fractional concentration of exhaled nitric oxide (FeNO) appears to be a good marker for airway inflammation in children with asthma.OBJECTIVE: To evaluate the effect of environmental exposures on exhaled nitric oxide in a community sample of children.METHODS: The relationship among exhaled nitric oxide, underlying disease and home environmental exposures was examined using questionnaire data and measurement of exhaled nitric oxide in a cross-sectional study of 1135 children that included healthy children, and children with allergies and/or asthma who were attending grades 4 through 6 in Windsor, Ontario.RESULTS: Among healthy children, there was a positive association between FeNO and occupancy (PCONCLUSIONS: The type of heating system, but not previously reported environmental tobacco smoke or mold exposure appears to affect exhaled nitric oxide in children. Exposure to different types of pets may have disparate effects on airway inflammation.
- Published
- 2009
37. Exhaled nitric oxide and respiratory symptoms in a community sample of school aged children
- Author
-
Tom Kovesi and Robert E. Dales
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Allergy ,Pediatrics ,Eczema ,Disease ,Nitric Oxide ,Surveys and Questionnaires ,medicine ,Hypersensitivity ,Humans ,Child ,Asthma ,business.industry ,Respiratory disease ,respiratory system ,medicine.disease ,respiratory tract diseases ,Pneumonia ,Cross-Sectional Studies ,El Niño ,Breath Tests ,Exhalation ,Pediatrics, Perinatology and Child Health ,Exhaled nitric oxide ,Physical therapy ,Bronchitis ,Female ,business - Abstract
Objective To test the association between reported allergy and allergic diseases, respiratory symptoms, and the fractional concentration of exhaled nitric oxide (FeNO), in a community sample of school aged children. Methodology We administered a respiratory questionnaire and measured FeNO in a cross-sectional study of 1,135 children. Results FeNO was significantly greater in children with reported asthma (20.3 (standard deviation (SD) 21.3) parts per billion (ppb)) or allergies (18.1 (SD 18.0) ppb) than in healthy children (14.0 (SD 13.4) ppb). It was greater in children with asthma and reported allergies (22.8 (SD 23.6) ppb), than in children with asthma but no allergies (15.8 (SD 15.6) ppb) (overall P-value between disease groups = 0.002). FeNO was not related to respiratory symptoms in healthy children. Eczema was associated with an elevated FeNO concentration, even in the absence of respiratory symptoms. Some children with reported allergies but not asthma who had respiratory symptoms suggestive of asthma had elevated FeNO concentrations, and the proportion of healthy children with reported bronchitis or pneumonia in the past year who had an abnormally high FeNO concentration was significantly elevated. Conclusions In a community sample of children, FeNO concentrations appear to reflect allergic conditions, including allergic asthma, reported allergies, and eczema, rather than just asthma, particularly since asthma in children may be non-allergic. FeNO is similarly elevated in school aged children with reported asthma or reported allergies. FeNO is higher in children with asthma and allergies than in children with asthma alone. However, an elevated FeNO may help alert the clinician to the possibility of undiagnosed asthma. Pediatr. Pulmonol. 2008; 43:1198–1205. © 2008 Wiley-Liss, Inc.
- Published
- 2008
38. Indoor air quality risk factors for severe lower respiratory tract infections in Inuit infants in Baffin Region, Nunavut: a pilot study
- Author
-
N. Randhawa, D. Fugler, Nicolas L. Gilbert, D. Creery, J. D. Miller, Robert E. Dales, Tom Kovesi, and B. Thompson
- Subjects
Male ,Nicotine ,Environmental Engineering ,Epidemiologic study ,beta-Glucans ,Air changes per hour ,Nitrogen Dioxide ,Nunavut ,Arthropod Proteins ,Indoor air quality ,Environmental protection ,Air change ,Risk Factors ,Lower respiratory tract infection ,Environmental health ,Yeasts ,Medicine ,Humans ,Antigens, Dermatophagoides ,Respiratory Tract Infections ,Environmental tobacco smoke exposure ,Air Pollutants ,Respiratory tract infections ,business.industry ,Air exchange ,Public Health, Environmental and Occupational Health ,Fungi ,Temperature ,Infant ,Dust ,Humidity ,Building and Construction ,Carbon Dioxide ,medicine.disease ,Endotoxins ,Cysteine Endopeptidases ,Inuit ,Air Pollution, Indoor ,Housing ,Female ,Tobacco Smoke Pollution ,business - Abstract
Inuit infants have extremely high rates of lower respiratory tract infection (LRTI), but the causes for this are unclear. The aims of this study were to assess, in young Inuit children in Baffin Region, Nunavut, the feasibility of an epidemiologic study of the association between indoor air quality (IAQ) and respiratory health; to obtain data on IAQ in their housing; and to identify and classify risk factors for LRTI. Twenty houses in Cape Dorset, Nunavut with children below 2 years of age, were evaluated using a structured housing inspection and measurement of IAQ parameters, and a respiratory health questionnaire was administered. Twenty-five percent of the children had, at some time, been hospitalized for chest illness. Houses were very small, and had a median of six occupants per house. Forty-one percent of the houses had a calculated natural air change rate0.35 air changes per hour. NO(2) concentrations were within the acceptable range. Smokers were present in at least 90% of the households, and nicotine concentrations exceeded 1.5 microg/m(3) in 25% of the dwellings. Particulates were found to be correlated closely with nicotine but not with NO(2) concentrations, suggesting that their main source was cigarette smoking rather than leakage from furnaces. Mattress fungal levels were markedly increased, although building fungal concentrations were low. Dust-mites were virtually non-existent. Potential risk factors related to IAQ for viral LRTI in Inuit infants were observed in this study, including reduced air exchange and environmental tobacco smoke exposure. Severe lower respiratory tract infection is common in Inuit infants. We found reduced air change rates and high occupancy levels in houses in Cape Dorset, which may increase the risk of respiratory infections. This suggests the measures to promote better ventilation or more housing may be beneficial. Further health benefits may be obtained by reducing bed sharing by infants and greater turnover of mattresses, which were found to have high levels of fungi.
- Published
- 2006
39. Horseshoe lung and facio-auriculo-vertebral sequence: a previously unreported association
- Author
-
Alasdair G. W. Hunter, Lisa C.A. D'Alessandro, Joseph Reisman, Tom Kovesi, Jane Lougheed, and Sherief Massoud
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Goldenhar syndrome ,Ribs ,Scimitar syndrome ,medicine ,Diseases in Twins ,Humans ,Abnormalities, Multiple ,Lung ,business.industry ,Respiratory disease ,Infant, Newborn ,Dysostosis ,Anatomy ,Twins, Monozygotic ,respiratory system ,medicine.disease ,Hypoplasia ,Spine ,Vertebra ,Hemifacial microsomia ,medicine.anatomical_structure ,Face ,Pediatrics, Perinatology and Child Health ,Female ,Hemivertebrae ,business - Abstract
We describe a case of horseshoe lung in an infant with facio-auriculo-vertebral (FAV) sequence that included mild hemifacial microsomia, ear anomalies, a missing left rib, left hemivertebrae (T2-T4), and complex congenital heart disease. Of the approximately 40 cases of horseshoe lung described since 1962, most are reported in association with scimitar syndrome, and only four reported cases were associated with left lung hypoplasia. None of these cases included malformations consistent with a diagnosis of FAV sequence.
- Published
- 2006
40. Canadian Pediatric Asthma Consensus guidelines, 2003 (updated to December 2004): introduction
- Author
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Allan B. Becker, Cathy Gillespie, Sandeep Kapur, Alexander C. Ferguson, John Joseph Reisman, Mark Montgomery, Malcolm R. Sears, Tom Kovesi, Paul Pianosi, Estelle Simons, Sheldon Spier, Denis Bérubé, Barry Zimmerman, Zave Chad, Francine M. Ducharme, Brian Lyttle, Pierre Ernst, Tony D'urzo, Bruce Mazer, Robert Thivierge, Wade T. A. Watson, Søren Pedersen, and Myrna Dolovich
- Subjects
medicine.medical_specialty ,Pediatrics ,Canada ,Alternative medicine ,Asthma management ,Asthma care ,Diagnosis, Differential ,Pharmacotherapy ,Patient Education as Topic ,immune system diseases ,Adrenal Cortex Hormones ,Health care ,Administration, Inhalation ,medicine ,Humans ,Disease management (health) ,Child ,Pediatric asthma ,Asthma ,business.industry ,Disease Management ,General Medicine ,medicine.disease ,respiratory tract diseases ,Bronchodilator Agents ,Family medicine ,Practice Guidelines as Topic ,Immunotherapy ,business ,Supplement - Abstract
Background: Although guidelines for the diagnosis and management of asthma have been published over the last 15 years, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian asthma consensus report, important new studies, particularly in children, have highlighted the need to incorporate this new information into asthma guidelines. Objectives: To review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the Canadian Asthma Consensus Report, 1999 and its 2001 update with a major focus on pediatric issues. Methods: Diagnosis of asthma in young children, prevention strategies, pharmacotherapy, inhalation devices, immunotherapy and asthma education were selected for review by small expert resource groups. In June 2003, the reviews were discussed at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published up to December 2004 were subsequently reviewed by the individual expert resource groups. Results: This report evaluates early life prevention strategies and focuses on treatment of asthma in children. Emphasis is placed on the importance of an early diagnosis and prevention therapy, the benefits of additional therapy and the essential role of asthma education. Conclusion: We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This guide for asthma management is based on the best available published data and the opinion of health care professionals including asthma experts and educators.
- Published
- 2005
41. Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula
- Author
-
Steven Rubin and Tom Kovesi
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Tracheoesophageal fistula ,Critical Care and Intensive Care Medicine ,Pneumonia, Aspiration ,Gastroenterology ,Pulmonary Disease, Chronic Obstructive ,Recurrence ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Child ,Esophageal Atresia ,Tracheal Diseases ,business.industry ,Esophageal disease ,Respiratory disease ,Infant ,medicine.disease ,Dysphagia ,Surgery ,Pneumonia ,Tracheomalacia ,Child, Preschool ,embryonic structures ,Esophageal stricture ,GERD ,Esophageal Stenosis ,Gastroesophageal Reflux ,Female ,medicine.symptom ,Bronchial Hyperreactivity ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Tracheoesophageal Fistula - Abstract
Congenital esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) are common congenital anomalies. Respiratory and GI complications occur frequently, and may persist lifelong. Late complications of EA/TEF include tracheomalacia, a recurrence of the TEF, esophageal stricture, and gastroesophageal reflux. These complications may lead to a brassy or honking-type cough, dysphagia, recurrent pneumonia, obstructive and restrictive ventilatory defects, and airway hyperreactivity. Aspiration should be excluded in children and adults with a history of EA/TEF who present with respiratory symptoms and/or recurrent lower respiratory infections, to prevent chronic pulmonary disease.
- Published
- 2004
42. Quantitative tissue polymerase chain reaction for Epstein-Barr virus in pediatric solid organ recipients
- Author
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Laura Shaw, Christine Forget, Janusz Feber, Joe Reisman, Tom Kovesi, Francisco Diaz-Mitoma, Guido Filler, Blair Carpenter, and Monica Gupta
- Subjects
Pathology ,medicine.medical_specialty ,Epstein-Barr Virus Infections ,Herpesvirus 4, Human ,Virus Cultivation ,Mononucleosis ,Adolescent ,Cytomegalovirus ,medicine.disease_cause ,Polymerase Chain Reaction ,Herpesviridae ,hemic and lymphatic diseases ,Biopsy ,Living Donors ,Medicine ,Gammaherpesvirinae ,Humans ,Viremia ,Child ,Retrospective Studies ,biology ,medicine.diagnostic_test ,business.industry ,medicine.disease ,biology.organism_classification ,Epstein–Barr virus ,Kidney Transplantation ,Tissue Donors ,Liver Transplantation ,Transplantation ,medicine.anatomical_structure ,Nephrology ,Tonsil ,Child, Preschool ,Cytomegalovirus Infections ,DNA, Viral ,business ,Viral load - Abstract
Background: Infections caused by herpes virus, in particular, Epstein-Barr virus (EBV), remain a major challenge in solid organ transplantation. Little is known about the significance of tissue EBV load. Methods: Twenty-three tissue biopsy specimens (19 kidney, 3 gastrointestinal, and 1 tonsil specimen) and 2 bronchoalveolar lavage specimens from 14 pediatric transplant recipients (10 kidney, 3 liver, 1 combined transplant) were subject to tissue EBV polymerase chain reaction (PCR) semiquantitative analysis and enzyme-linked immunosorbent assay (ELISA) methods. Results of biopsies were correlated with clinical data. Results: Five of 14 patients had clinically diagnosed EBV disease: 2 patients presented with a septic picture with multiorgan failure and pneumonitis; 1 patient had mononucleosis; 1 patient had an increase in serum creatinine level, lymphadenopathy, and chronic fatigue; and 1 patient had EBV nephritis. These 5 patients underwent 12 biopsies at the time of clinically active infection; 8 biopsies had positive results (up to 111 copies/10 μL of extracted DNA). Conversely, 1 of the remaining 13 tissue biopsy specimens from asymptomatic patients had positive results on ELISA, but undetectable viral load, whereas 8 patients had a positive EBV immunoglobulin G titer with historic evidence of EBV replication in the blood. No patient without evidence of EBV had positive EBV tissue PCR results. Conclusion: Increased EBV load was found in more than 50% of patients, pointing to a previously underrecognized importance of EBV detection in tissues from transplant recipients. The presence of EBV in tissue correlated with the presence of viremia, whereas tissue PCR had 100% specificity. EBV load should be included in biopsy evaluation. Am J Kidney Dis 41:212-219. © 2003 by the National Kidney Foundation, Inc.
- Published
- 2002
43. Optimal biopsy techniques in the diagnosis of primary ciliary dyskinesia
- Author
-
Blair Carpenter, Johnna MacCormick, Tom Kovesi, and Ian A. Robb
- Subjects
Gynecology ,Male ,medicine.medical_specialty ,business.industry ,Kartagener Syndrome ,Ciliary activity ,Biopsy ,Infant ,Reproducibility of Results ,Bronchi ,General Medicine ,Anatomy ,Lung disease ,Child, Preschool ,Medicine ,Humans ,Female ,Cilia ,Prospective Studies ,Nasal Cavity ,business ,Child - Abstract
vuz nwrv Objectif: Il n'est pas toujours facile d'obtenir un echantillon montrant clairement les cils vibratils necessaires au diagnostic de dyskinesie ciliaire. Le but de cette etude est de determiner la meilleure technique d'echantillonnage dans ce contexte. Devis: Etude prospective de quatre techniques d'echantillonnage: le brossage nasal, la biopsie nasale, le brossage bronchique, et la biopsie tracheale. Localisation: L'Hopital pour enfants de l'Est Ontarien, un hopital de soins pediatriques tertiaires. Methode: Nous avons evalue au microscope la qualite des quatre types d'echantillons preleves sur 10 patients consecutifs anesthesies pour bronchoscopie et biopsie tracheale. Resultats: Le brossage nasal et la biopsie tracheale fournissent des echantillons de meilleure qualite mais le brossage est plus efficient. Les biopsies nasales sont souvent metaplasiques et sont donc inferieures au brossage de la meme region (p = .02). Conclusion: Son efficaciate demontree, le cout faible et la morbidite limitee font du brossage nasal la technique initiale optimale dans le diagnostic de la dyskinesie cilaire primaire.
- Published
- 2002
44. What is new since the last (1999) Canadian Asthma Consensus Guidelines?
- Author
-
Tony R. Bai, P Ernst, Denis Bérubé, F. E. R. Simons, JM FitzGerald, A.B. Becker, Rick Hodder, Dennis Bowie, Tom Kovesi, Johanne Côté, Kenneth R. Chapman, Francine M. Ducharme, Donald W. Cockcroft, L.-P. Boulet, Sheldon Spier, Brian H. Rowe, Malcolm R. Sears, R Beveridge, and Paul M. O'Byrne
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Canada ,Emergency Medical Services ,MEDLINE ,Anti-Inflammatory Agents ,Airflow obstruction ,Anti-asthmatic Agent ,Diseases of the respiratory system ,Patient Education as Topic ,immune system diseases ,medicine ,Emergency medical services ,Animals ,Humans ,Anti-Asthmatic Agents ,Intensive care medicine ,Glucocorticoids ,Asthma ,Mites ,Leukotriene Antagonists ,RC705-779 ,business.industry ,Emergency department ,Adrenergic beta-Agonists ,Allergens ,medicine.disease ,respiratory tract diseases ,Long acting ,Practice Guidelines as Topic ,Physical therapy ,Steroids ,business - Abstract
The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children’s Asthma Management Project (CAMP) study, are discussed.
- Published
- 2001
45. Plasma carnitine levels in cystic fibrosis
- Author
-
Denis C. Lehotay, Henry Levison, and Tom Kovesi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreatic disease ,Adolescent ,Cystic Fibrosis ,Urinary system ,Cystic fibrosis ,Pulmonary function testing ,Internal medicine ,Carnitine ,Blood plasma ,medicine ,Humans ,Child ,Free carnitine ,business.industry ,Respiratory disease ,Gastroenterology ,Infant ,Middle Aged ,medicine.disease ,Endocrinology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,medicine.drug - Abstract
Plasma carnitine concentrations were measured in 43 children and adults with cystic fibrosis (CF), and values were compared with those from normal controls. Clinically significant abnormalities of plasma carnitine concentration were not found in CF patients. The concentration of free carnitine was slightly but significantly elevated in CF patients, and the acylcarnitine concentration and acylcarnitine/free-carnitine ratio were slightly but significantly lower. Total carnitine concentrations were similar to those of controls. The CF patients did not have abnormal urinary acylcarnitines. Altered concentrations of free and esterified carnitine were not associated with nutritional status or with liver or pulmonary function.
- Published
- 1994
46. Changes in lactate dehydrogenase isoenzymes associated with relapse of childhood acute lymphocytic leukemia
- Author
-
Elizabeth Hsu and Tom Kovesi
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Central nervous system ,Gastroenterology ,Meninges ,Leukemic Infiltration ,Acute lymphocytic leukemia ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Child ,Childhood Acute Lymphocytic Leukemia ,Chemotherapy ,L-Lactate Dehydrogenase ,business.industry ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,medicine.disease ,Lactate dehydrogenase isoenzymes ,Neoplasm Proteins ,Isoenzymes ,Leukemia ,medicine.anatomical_structure ,Oncology ,El Niño ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Immunology ,Female ,Bone marrow ,Neoplasm Recurrence, Local ,business - Abstract
Twenty-eight children with high-risk acute lymphocytic leukemia underwent monthly serum lactate dehydrogenase (LDH) and LDH isoenzyme fraction determinations to examine whether LDH isoenzyme fractions change with an increase in the body burden of tumor cells. The 9 patients who relapsed and 5 patients who presented with leukemia during the study period had a slightly lower mean LDH-1 isoenzyme fraction. When the period from 3 months before to 3 months after relapse was examined, significant increases in the LDH-3 isoenzyme fraction and decreases in the LDH-1 and LDH-2 isoenzyme fractions were seen at the time of relapse. These results were highly significant when patients with non-T-cell and T-cell leukemia were combined and when bone marrow and central nervous system relapse was included. The changes at relapse appeared to revert with intensification of chemotherapy. The changes at relapse were not different in magnitude from random variation occurring in patients who remained in remission throughout the study. Although changes in LDH isoenzymes appeared to occur at the time of relapse compared with the periods immediately before and after relapse, these changes were not specific for relapse. LDH isoenzymes do not appear to be useful in predicting relapse in children with leukemia.
- Published
- 1994
47. Passive smoking and lung function in cystic fibrosis
- Author
-
Tom Kovesi, Mary Corey, and Henry Levison
- Subjects
Pulmonary and Respiratory Medicine ,Spirometry ,Percentile ,medicine.medical_specialty ,Passive smoking ,Adolescent ,Cystic Fibrosis ,Vital Capacity ,Maximal Midexpiratory Flow Rate ,medicine.disease_cause ,Cystic fibrosis ,Pulmonary function testing ,Forced Expiratory Volume ,medicine ,Cigarette smoke ,Humans ,Longitudinal Studies ,Child ,Lung function ,medicine.diagnostic_test ,business.industry ,Nutritional status ,medicine.disease ,Physical therapy ,Respiratory Mechanics ,Tobacco Smoke Pollution ,business ,Demography - Abstract
The relationship between passive exposure to cigarette smoking and objective measures of health was examined in 340 patients with cystic fibrosis attending a large hospital-based clinic. Patients who came from households with smokers did not differ from those living in smoke-free households in terms of nutritional status, clinical scores, spirometry, or colonization with Pseudomonas. The number of cigarettes smoked in the household was not significantly related to nutritional status, clinical score, spirometry, or hospitalization. Similar results were found when children 6 to 11 yr of age were analyzed separately, except that height percentile was negatively related to the number of cigarettes smoked in the household. The effects of household exposure to cigarette smoke were further evaluated by analyzing changes in nutritional status, clinical score, and spirometry over a 15-yr period among patients whose families never, always, stopped, or started smoking during this time. Height percentile increased slightly during this interval among those whose households never smoked, whereas no change occurred among patients whose households always smoked, and a decline was seen among patients whose households quit. These differences were statistically significant. Patients whose households never smoked had consistently higher pulmonary function measurements than did patients whose families always smoked, although the differences were not statistically significant. The rates of decline were similar in these two groups. Patients whose households stopped smoking had significantly lower pulmonary functions at the end of the study than did subjects whose households never smoked.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
48. Qallunaat
- Author
-
Tom Kovesi
- Subjects
business.industry ,media_common.quotation_subject ,Economic shortage ,General Medicine ,News ,Dozen ,Family member ,Shock (economics) ,Nursing ,Unemployment ,Town hall ,Medicine ,Street hockey ,business ,Simulation ,Front (military) ,media_common - Abstract
Our research team landed in Igloolik, Nunavut, to find the village in shock. A young high-school student had just committed suicide in the girls' washroom. I too was stunned by the unexpected violence, and sheer desperation of her act. It was made worse by the enormity of the problem: of about a dozen research assistants helping us in various communities in Nunavut, 2 stopped work after a friend or family member committed suicide, and another temporarily stopped working after a family member was murdered. I see Inuit society as one turned upside down by rapid change. With families tied down in villages, rather than following the migratory patterns of the wildlife, people have yet to find sufficient employment or a new purpose, and despair is all too common. The elders — the traditional sources of wisdom — have no answers. The loss of research assistants was becoming a major problem for our study. Despite high levels of unemployment, there are few individuals able to assist with research, and the core of such individuals in each community are sought after by numerous other investigators and organizations. Our study was also facing other significant obstacles. Developing ventilation units for houses when the outside temperature, at least unofficially, was –72°C, was challenging. Igloolik is a community where the kids play street hockey — wearing skates. A shortage of trained technicians meant that the Heat Recovery Ventilators we had installed, to evaluate whether they could prevent respiratory infections, had not been balanced according to specifications. Some study participants felt the units were drafty, and had unplugged the units or boarded them up. Fortunately, our study also had crucial supports. At a town hall meeting I'd held in Cape Dorset several years earlier, I'd asked the elders whether babies used to get sick in years past, and was told “only when the Qallunaat [southerners] arrive in their ships.” A group of mothers in Igloolik had banded together to help infants avoid the now-annual community outbreaks of respiratory syncytial virus infection by helping ensure our study would succeed. Next year, we'll fine-tune our heat recovery ventilators, and plan to recruit high-school students to assist our researchers with the health surveys and to introduce them to research. Hopefully, the day will come when respiratory syncytial virus season no longer means rows of nebulizer masks labelled with each child's name, in nearly every community's nursing station. — Tom Kovesi MD, Ottawa Figure. Igloolik is a community where the kids play street hockey — wearing skates. Photo by: Dr. Tom Kovesi
- Published
- 2007
49. Horseshoe lung and facio‐auriculo‐vertebral sequence: A previously unreported association.
- Author
-
Lisa D'Alessandro, Tom Kovesi, Sherief Massoud, Jane Lougheed, Alasdair Hunter, and Joseph Reisman
- Published
- 2006
- Full Text
- View/download PDF
50. EFFICACY OF ADDITION OF NEBULIZED IPRATROPIUM BROMIDE TO NEBULIZED ALBUTEROL THERAPY IN ACUTE BRONCHIOLITIS
- Author
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Tom Kovesi, S. Cehuh, David M. Jaffe, David W. Johnson, J. Reisman, E. Karem, Gerard J. Canny, Lea Bentur, and Henry Levison
- Subjects
Acute Bronchiolitis ,business.industry ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,medicine ,General Medicine ,Ipratropium bromide ,business ,medicine.drug - Published
- 1991
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