phenylephrine-hydrochloride and Acute-Disease

Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.

Topics: Acute Disease; Bronchiolitis; Cannula; Humans; Nose; Oxygen Inhalation Therapy

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

Topics: Acute Disease; Adrenal Cortex Hormones; Cytokines; Humans; Matrix Metalloproteinases; Meningitis, Pneumococcal; Nose; Oxidative Stress; Streptococcus pneumoniae

Topics: Acute Disease; Chronic Disease; Female; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Pregnancy; Pregnancy Complications; Pulmonary Edema; Respiratory Insufficiency; Ventilator Weaning

Topics: Acute Disease; Child; Female; Humans; Hypoxia; Masks; Nose; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Insufficiency

Topics: Acute Disease; Asthma; Humans; Lung; Nose; Paranasal Sinuses; Reflex; Rhinitis; Sinusitis

Topics: Acute Disease; Ambulatory Care; Blood Pressure; Brain; Chronic Disease; Diphosphoglyceric Acids; Erythrocytes; Follow-Up Studies; Humans; Hypertension, Pulmonary; Hypoxia; Intubation; Lung Diseases, Obstructive; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Physical Exertion; Polycythemia; Prognosis; Psychology; Respiratory Insufficiency; Spirometry; Vascular Resistance

Most acute respiratory infection (ARI) research focuses on severe disease and overlooks the burden of community-managed illness. For community-based studies, home-based specimen collection by parents could be a resource-saving alternative to collection by healthcare workers (HCWs). In this study, we compared parent and HCW groups for their likelihood to collect specimens and the timeliness and quality of such collection.. In this unblinded randomized controlled trial, parents from Brisbane, Australia, were taught to identify new ARI episodes in their children aged <2 years. When their child had a new ARI, parents either collected a nasal swab from the child (P group) or contacted an HCW who visited to obtain a nasopharyngeal swab (HCW group). We compared the likelihood and timeliness of specimen collection and respiratory pathogen detection. A nested diagnostic study compared paired specimen collections from children in the HCW group.. Included were 76 incident ARI episodes from 31 children and 102 episodes from 33 children in the P and HCW groups, respectively. The proportions of ARIs for which a specimen was collected were similar (P group, 69.7%; HCW group, 72.5%; P = .77), and pathogens were detected in 93.8% and 77.5% of the specimens, respectively (P = .03). The period between ARI onset and specimen collection was shorter in the P group than in the HCW group (mean difference, 1.9 days [95% confidence interval, 0.7-3.0 days]; P < .001). For the 69 paired specimens, viral loads were lower in the parent-collected swabs (mean cycle threshold difference, 4.5 [95% confidence interval, 3.1-5.9]; P < .001).. Parents and HCWs obtained samples in similar proportions of ARI episodes, but the parents collected the samples fewer days after ARI onset and with a resulting higher likelihood of pathogen identification. This method can be used in population-based epidemiological studies of ARI as a resource-saving alternative.. ClinicalTrials.gov identifier NCT00966069.

Topics: Acute Disease; Bacteria; Female; Health Personnel; Humans; Infant; Male; Nose; Parents; Respiratory Tract Infections; Specimen Handling; Time Factors; Viral Load; Viruses

In acute respiratory failure, non-invasive ventilation (NIV) treatment is used to prevent the need for intubation. NIV applied through a face mask may contribute to the development of facial skin lesions. This study was conducted to compare the efficacy of protective dressings and of using no materials for pressure ulcer prevention.. There were 90 participants in this study. The participants were assigned into three groups: control group, tegasorb group, and tegaderm group.. The tegasorb group and tegaderm group, in contrast to the control group, had fewer pressure ulcers based on our statistics and occurrence duration time (p<.01). However, there were no significant difference in occurrence duration time between the tegasorb group and tegaderm group.. This result revealed that tegasorb and tegaderm could be used on the face of NIV patients to prevent pressure ulcers.

Topics: Acute Disease; Aged; Analysis of Variance; Bandages, Hydrocolloid; Clinical Nursing Research; Critical Care; Female; Humans; Incidence; Male; Masks; Nose; Pressure Ulcer; Respiration, Artificial; Respiratory Insufficiency; Risk Factors; Skin Care; Taiwan; Time Factors; Treatment Outcome

Noninvasive positive pressure techniques such as continuous and bilevel positive airway pressure avoid intubation and its attendant complications in selected patients with acute respiratory failure. However, mask intolerance remains a common cause for failure of noninvasive ventilatory techniques. The aim of our study was to assess patient tolerance of oronasal vs. nasal mask ventilation in acute respiratory failure.. Randomized, controlled trial.. Emergency department or intensive care units at a university hospital.. Seventy patients with acute respiratory failure as evidenced by clinical or blood gas criteria.. Patients randomly received either a disposable nasal or an oronasal mask (Respironics, Pittsburgh, PA) when they met study criteria.. Thirty-five patients were randomized into each arm of the study; most of the patients had acute cardiogenic pulmonary edema (48.6% of the nasal mask group and 42.8% of the facial mask group) or chronic obstructive airway disease (34.3% of the nasal mask group and 31.4% of the facial mask group). Baseline clinical characteristics of the two groups of patients were similar. Heart and respiratory rates and blood gases improved similarly for patients in both mask groups. Rates of intubation were also similar (eight in each group). However, mask intolerance was significantly higher in the nasal than the oronasal mask group (12 vs. 4, respectively, p=.023). Four patients in the nasal (11.4%) and two in the oronasal mask group (5.7%) died later during the hospitalization. The overall success rate tended to be greater in the oronasal (65.7%) than the nasal group (48.6%), but the difference was not statistically significant.. Although both masks performed similarly with regard to improving vital signs and gas exchange and avoiding intubation, the nasal mask was less well tolerated than the oronasal mask in patients with acute respiratory failure.

Topics: Acute Disease; Aged; Equipment Design; Female; Humans; Male; Masks; Mouth; Nose; Respiration, Artificial; Respiratory Insufficiency

Sinus puncture and aspiration is an invasive procedure that hinders patient enrollment in studies of acute bacterial maxillary sinusitis (ABMS). Pain and minor bleeding also limit its potential diagnostic utility in clinical practice. Cultures obtained by rigid nasal endoscopy were compared with those from sinus puncture and aspiration in 53 patients with ABMS; 46 patients were assessable. Considering recovery of Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae from puncture and aspiration as the gold standard, endoscopy cultures demonstrated a sensitivity of 85.7% (95% confidence interval, 56.2-97.5), specificity of 90.6% (73.8-97.5), positive predictive value of 80% (51.4-94.7), negative predictive value of 93.5% (77.2-98.9), and accuracy of 89.1% (75.6-95.9). Ten adverse events related to puncture and aspiration occurred in 5 (9.6%) of 52 patients; there were no endoscopy-related adverse events. In our study, the largest to date, endoscopic sampling compared favorably with puncture and aspiration for identifying H. influenzae, M. catarrhalis, and S. pneumoniae in ABMS and produced less morbidity.

Topics: Acute Disease; Adult; Aged; Bacteria; Bacterial Infections; Endoscopy; Female; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nose; Predictive Value of Tests; Punctures; Sensitivity and Specificity

Early complex treatment of a critical brain traumas should be aimed not only at men's life and personality saving, but also at their performance' rehabilitation. Complicity and to some degree individual nature of a critical trauma pathogenesis depend on the associative active methods of surgery interference and conservative pharmacotherapy. The article deals with well-practiced means and methods of symptomatic pharmacotherapy at the early and later stages of the brain traumas with vestibular and hearing system injures and with theoretical and clinical base for modern "quick-action adaptogens" usage in addition to psychoneurocorrectors.

Topics: Acute Disease; Adaptation, Physiological; Brain Injuries; Double-Blind Method; Drug Therapy, Combination; Ear; Humans; Military Personnel; Nose; Pharynx; Russia; Time Factors

Two double-blind, placebo-controlled, randomised, multicentre, multinational, parallel-group studies were carried out to identify the optimum dose of intranasal sumatriptan for the acute treatment of migraine. Study medication was taken as a single dose through one nostril in the first study, and as a divided dose through two nostrils in the second study. Totals of 245 and 210 patients with a history of migraine were recruited into the one- and two-nostril studies, respectively. In both studies, headache severity had significantly improved at 120 min after doses of 10-40 mg sumatriptan compared to placebo (P < 0.05) and the greatest efficacy rates were obtained with 20 mg sumatriptan. With 20 mg sumatriptan 78% and 74% of patients experienced headache relief in one- and two-nostril studies respectively. Sumatriptan was generally well tolerated, the most frequently reported event being taste disturbance. The results of the two studies are similar and indicate that administering sumatriptan as a divided dose via two nostrils confers no significant advantage over single-nostril administration.

Topics: Acute Disease; Administration, Intranasal; Adult; Double-Blind Method; Drug Tolerance; Female; Headache; Humans; Male; Middle Aged; Migraine Disorders; Nose; Sumatriptan

Clinical and experimental evidence has suggested that the use of cimetidine might be harmful to patients with acute pancreatitis. We conducted a randomized study comparing cimetidine to nasogastric (NG) suction in 95 patients with 103 episodes of mild to moderately severe, acute or relapsing pancreatitis (86.4% alcohol related). The groups were comparable on entry to the study, and daily evaluation of several clinical and laboratory criteria revealed no consistent differences between the two groups. When these same criteria were evaluated for time of return to normal, if abnormal on entry to the study, no differences were found. The cimetidine group had a significantly shorter stay in the hospital than did the NG group (6.8 +/- 2.7 vs 8.5 +/- 4.8 days). Neither the incidence of relapse or complication nor the duration and extent of hyperamylasemia were significantly different between patients treated with cimetidine or NG suction. We conclude that cimetidine is safe to use in patients with mild to moderately severe alcohol-related pancreatitis, but it offers minimal advantage over NG suction.

Topics: Acute Disease; Alcoholism; Cimetidine; Clinical Trials as Topic; Guanidines; Humans; Length of Stay; Nose; Pancreatitis; Random Allocation; Stomach; Suction

Fifty-eight patients with mild to moderately severe acute pancreatitis were randomly allocated to treatment with or without nasogastric suction (27 and 31 patients respectively). Intravenous fluids and pethidine hydrochloride were also given. The two groups were comparable clinically at the start of the study. There were no differences between the two groups in the mean duration of the following features: abdominal pain or tenderness; absence of bowel movements; raised serum amylase concentration; time to resumption of oral feeding; and days in hospital. Prolonged hyperamylasaemia (serum amylase greater than 0.33 mU/l) occurred in one patient in the suction group and in three patients in the non-suction group. A mild recurrence of abdominal pain after resumption of oral feeding occurred in three patients in the suction group and in two patients in the non-suction group. Two patients in the suction group developed overt consumption coagulopathy and two others pulmonary complications. No patient in the non-suction group had complications. The findings suggest that most patients with mild to moderately severe acute pancreatitis do not benefit from nasogastric suction. The procedure should be elective rather than mandatory in treating this condition.

Topics: Acute Disease; Adult; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Nose; Pancreatitis; Stomach; Suction; Time Factors

In 40 cases of acute epiglottitis in children, intubation was the chosen method for the management of airway obstruction. Six patients were treated without the establishment of an artificial airway, and no tracheostomies were done. No patients who were admitted to the hospital died of airway obstruction, although one sustained irreversible brain damage before admission, and two died of overwhelming infectionmthe average duration of intubation was 2.days and the average hospital stay was 5.days. Two children developed subglottic granulation tissue that was removed successfully and did not recur. Nasotracheal intubation is an acceptable method of management of epiglottitis.

Topics: Acute Disease; Airway Obstruction; Brain Damage, Chronic; Child; Child, Preschool; Clinical Trials as Topic; Epiglottis; Female; Granulation Tissue; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngitis; Laryngostenosis; Length of Stay; Male; Mouth; Nose; Pneumonia; Time Factors

Topics: Acute Disease; Adult; Alcoholism; Amylases; Clinical Enzyme Tests; Clinical Trials as Topic; Drainage; Evaluation Studies as Topic; Humans; Informed Consent; Intubation, Gastrointestinal; Meperidine; Methods; Nose; Pain; Pancreatitis; Prospective Studies; Time Factors

Currently, the problem of acute rhinosinusitis continues to be relevant due to the frequent occurrence of this pathology. A certain difficulty is caused by the differential diagnosis of viral, post-viral and bacterial forms of rhinosinusitis, which carries the risks of irrational therapy. The authors of the article discuss the role of a viral infection in the etiology and pathogenesis of acute rhinosinusitis, the stages in the development of an inflammatory reaction on the mucous membrane of the nose and paranasal sinuses, and the disruption of mucociliary clearance. The authors consider options for the pathogenetic therapy of postviral sinusitis, concluding that the use of local combined preparations containing the mucolytic acetylcysteine and the vasoconstrictor component of tuaminoheptane sulfate is effective.. Проблема острого риносинусита остается актуальной ввиду высокой частоты данной патологии. Определенную сложность вызывает дифференциальная диагностика вирусной, поствирусной и бактериальной форм риносинусита, что несет в себе риск нерациональной терапии. Авторы статьи обсуждают роль вирусной инфекции в этиологии и патогенезе острого риносинусита, этапы развития воспалительной реакции в слизистой оболочке носа и околоносовых пазух, нарушение работы мукоцилиарного клиренса. Авторы рассматривают варианты патогенетической терапии поствирусного синусита, делая вывод об эффективности использования местных комбинированных препаратов, содержащих муколитик ацетилцистеин и сосудосуживающий компонент туаминогептана сульфат.

Topics: Acute Disease; Diagnosis, Differential; Humans; Nose; Paranasal Sinuses; Rhinitis; Sinusitis

Acute respiratory infections (ARIs) are a major cause of morbidity among children. Respiratory viruses are commonly detected in both symptomatic and asymptomatic periods. The rates of infection and community epidemiology of respiratory viruses in healthy children needs further definition to assist interpretation of molecular diagnostic assays in this population. Children otherwise healthy aged 1 to 8 years were prospectively enrolled in the study during two consecutive winters, when ARIs peak in New Zealand. Parents completed a daily symptom diary for 8 weeks, during which time they collected a nasal swab from the child for each clinical ARI episode. A further nasal swab was collected by research staff during a clinic visit at the conclusion of the study. All samples were tested for 15 respiratory viruses commonly causing ARI using molecular multiplex polymerase chain reaction assays. There were 575 ARIs identified from 301 children completing the study, at a rate of 1.04 per child-month. Swabs collected during an ARI were positive for a respiratory virus in 76.8% (307 of 400), compared with 37.3% (79 of 212) of swabs collected during asymptomatic periods. The most common viruses detected were human rhinovirus, coronavirus, parainfluenza viruses, influenzavirus, respiratory syncytial virus, and human metapneumovirus. All of these were significantly more likely to be detected during ARIs than asymptomatic periods. Parent-administered surveillance is a useful mechanism for understanding infectious disease in healthy children in the community. Interpretation of molecular diagnostic assays for viruses must be informed by understanding of local rates of asymptomatic infection by such viruses.

Topics: Acute Disease; Asymptomatic Infections; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Male; Molecular Diagnostic Techniques; Multiplex Polymerase Chain Reaction; New Zealand; Nose; Population Surveillance; Prevalence; Respiratory Tract Infections; Seasons; Viruses

Acute wheezing is one of the most common hospital presentations for young children. Respiratory syncytial virus (RSV) and rhinovirus (RV) species A, B and the more recently described species C are implicated in the majority of these presentations. However, the relative importance and age-specificities of these viruses have not been defined. Hence, this study aimed to establish these relationships in a large cohort of prospectively recruited hospitalized children.. The study cohort was 390 children 0-16 years of age presenting with acute wheezing to a children's emergency department, 96.4% being admitted. A nonwheezing control population of 190 was also recruited. Nasal samples were analyzed for viruses.. For the first 6 months of life, RSV was the dominant virus associated with wheezing (P < 0.001). From 6 months to 2 years, RSV, RV-A and RV-C were all common but none predominated. From 2 to 6 years, RV-C was the dominant virus detected (50-60% of cases), 2-3 times more common than RV-A and RSV, RSV decreasing to be absent from 4 to 7 years. RV-B was rare at all ages. RV-C was no longer dominant in children more than 10 years of age. Overall, RV-C was associated with lower mean oxygen saturation than any other virus (P < 0.001). Controls had no clear age distribution of viruses.. This study establishes a clear profile of age specificity of virus infections causing moderate to severe wheezing in children: RSV as the dominant cause in the first 6 months and RV-C in preschool-age children.

Topics: Acute Disease; Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Nose; Oxygen Saturation; Picornaviridae Infections; Prospective Studies; Respiratory Sounds; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Rhinovirus

Human rhinoviruses (HRVs), human enteroviruses (HEVs) and human parechoviruses (HPeVs) have been linked to acute otitis media (AOM). We evaluated this association in a prospective birth cohort setting.. A total of 324 healthy infants were followed up from birth to age 3 years. Nasal swab samples were collected at age 3, 6, 12, 18, 24, and 36 months and screened for HRV and HEV using real-time reverse-transcription quantitative polymerase chain reaction. Stool samples were collected monthly and analyzed for HRV, HEV, and HPeV. AOM episodes diagnosed by physicians were reported by parents in a diary. The association of viruses with AOM was analyzed using generalized estimation equations, and their relative contributions using population-attributable risk percentages.. A clear association was found between AOM episodes and simultaneous detection of HEV (adjusted odds ratio for the detection of virus in stools, 2.04; 95% confidence interval, 1.06-3.91) and HRV (1.54; 1.04-2.30). HPeV showed a similar, yet nonsignificant trend (adjusted odds ratio, 1.44; 95% confidence interval, .81-2.56). HRV and HEV showed higher population-attributable risk percentages (25% and 20%) than HPeV (11%).. HEVs and HRVs may contribute to the development of AOM in a relatively large proportion of cases.

Topics: Acute Disease; Child, Preschool; Enterovirus; Enterovirus Infections; Feces; Female; Humans; Infant; Male; Nose; Otitis Media; Parechovirus; Picornaviridae Infections; Prospective Studies; Rhinovirus

Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes.. A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died.. In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC.. In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

Topics: Acute Disease; Aged; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Disseminated Intravascular Coagulation; Doxycycline; Female; Fingers; Gangrene; Humans; Hydroxychloroquine; Nasal Cavity; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Severity of Illness Index

Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain uncomplicated and those that precede an episode of sinusitis. We hypothesize that certain viruses are more likely to lead to acute sinusitis, and we compare viruses identified at the time of diagnosis of sinusitis with those identified early in the URI.. Children aged 48-96 months were followed longitudinally for 1 year. Nasal samples were obtained at surveillance visits, on Day 3-4 of the URI, and on Day 10, when sinusitis was diagnosed. Molecular diagnostic testing was performed on nasal washes for common respiratory viruses and pathogenic bacteria. A standardized score was used to quantify symptom severity.. We evaluated 519 URIs, and 37 illnesses in 31 patients met the criteria for sinusitis. Respiratory syncytial virus was detected more frequently in URI visits that led to sinusitis, compared to in uncomplicated URIs (10.8% vs 3.4%; P = .05). New viruses were detected in 29% of sinusitis episodes, and their pattern was different than those patterns observed at surveillance. The median number of URIs per subject per year was 1 (range 0-9) in uncomplicated URI subjects and 3 (range 1-9) in sinusitis subjects (P < .001).. Children who developed sinusitis experienced more frequent URIs, compared to children whose URIs remained uncomplicated. When nasal samples were obtained on the day of diagnosis of acute sinusitis, nearly 30% of children had a new virus identified, suggesting that some children deemed to have sinusitis were experiencing sequential viral infections.

Topics: Acute Disease; Bacteria; Bacterial Infections; Child; Child, Preschool; Female; Humans; Longitudinal Studies; Male; Nose; Respiratory Tract Infections; Sinusitis; Virus Diseases; Viruses

Internet-based participatory surveillance systems, such as the German GrippeWeb, monitor the frequency of acute respiratory illnesses on population level. In order to interpret syndromic information better, we devised a microbiological feasibility study (GrippeWeb-Plus) to test whether self-collection of anterior nasal swabs is operationally possible, acceptable for participants and can yield valid data.. We recruited 103 GrippeWeb participants (73 adults and 30 children) and provided them with a kit, instructions and a questionnaire for each sample. In the first half of 2016, participants took an anterior nasal swab and sent it to the Robert Koch Institute whenever an acute respiratory illness occurred. Reporting of illnesses through the GrippeWeb platform continued as usual. We analysed swabs for the presence of human c-myc-DNA and 22 viral and bacterial pathogens. After the study, we sent participants an evaluation questionnaire. We analysed timeliness, completeness, acceptability and validity.. One hundred and two participants submitted 225 analysable swabs. Ninety per cent of swabs were taken within 3 days of symptom onset. Eighty-nine per cent of swabs had a corresponding reported illness in the GrippeWeb system. Ninety-nine per cent of adults and 96% of children would be willing to participate in a self-swabbing scheme for a longer period. All swabs contained c-myc-DNA. In 119 swabs, we identified any of 14 viruses but no bacteria. The positivity rate of influenza was similar to that in the German physician sentinel.. Self-collection of anterior nasal swabs proofed to be feasible, was well accepted by participants, gave valid results and was an informative adjunct to syndromic data.

Topics: Acute Disease; Adult; Child; Epidemiological Monitoring; Feasibility Studies; Germany; Humans; Influenza, Human; Nose; Respiratory Tract Infections; Specimen Handling; Surveys and Questionnaires; Viruses

Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.. Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay.. EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred.. During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.

Topics: Acute Disease; Adolescent; Asthma; Child; Child, Preschool; Disease Outbreaks; Enterovirus D, Human; Enterovirus Infections; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Male; Medical Records; Nose; Ohio; Pharynx; Prospective Studies; Real-Time Polymerase Chain Reaction; Respiratory Tract Infections; Seasons

 Vaccines and antivirals against respiratory syncytial virus (RSV) are being developed, but there are scarce data on the full impact of RSV infection on outpatient children..  We analyzed the burden of RSV illness in a prospective cohort study of children aged ≤13 years during 2 consecutive respiratory seasons in Turku, Finland (2231 child-seasons of follow-up). We examined the children and obtained nasal swabs for the detection of RSV during each respiratory illness. The parents filled out daily symptom diaries throughout the study..  Of 6001 medically attended respiratory infections, 302 (5%) were caused by RSV. Per 1000 children, the average annual RSV infection incidence rates among children aged <3, 3-6, and 7-13 years were 275, 117, and 46 cases, respectively. In children aged <3 years, acute otitis media developed in 58%, and 66% of children in this age group received antibiotics. The mean duration of RSV illness was longest (13.0 days) and the rate of parental work absenteeism was highest (136 days per 100 children with RSV illness) in children aged <3 years..  The burden of RSV is particularly great among outpatient children aged <3 years. Young children are an important target group for the development of RSV vaccines and antivirals.

Topics: Acute Disease; Antiviral Agents; Child; Child, Preschool; Cost of Illness; Female; Finland; Hospitalization; Humans; Infant; Male; Nose; Otitis Media; Prospective Studies; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus Vaccines; Respiratory Syncytial Virus, Human; Risk Factors; Seasons; Socioeconomic Factors

Acute invasive fungal rhinosinusitis (AIFRS) represents a fulminant, potentially fatal, disease process in immunocompromised patients. The diagnosis often rests on high index of clinical suspicion, with relative paucity of data on the diagnostic and therapeutic implications of intraoperative frozen sections.. Retrospective review was performed for 18 cases undergoing endoscopic sinus surgery for AIFRS. Reliability of intraoperative frozen section diagnosis was evaluated for all patients using final pathology as the gold standard.. A total of 66 frozen sections were performed. Diagnostic accuracy of frozen sections illustrated sensitivity of 72.7% (95% confidence interval [CI], 0.57 to 0.85), specificity of 100% (95% CI, 0.85 to 1.00), positive predictive value (PPV) of 100% (95% CI, 0.89 to 1.00), and negative predictive value (NPV) of 64.7% (95% CI, 0.46 to 0.80). There was no statistically significant difference in sensitivity of frozen sections in cases of Mucor and Aspergillus at 68.8%% and 76.2%, respectively (p = 0.61).. This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. Frozen section analysis is an effective tool for guiding intraoperative decision making in patients with AIFRS with a high PPV. A Low NPV underscores the importance of clinical suspicion and intraoperative decision making based on endoscopic findings when negative frozen section results are encountered. Further, frozen section analysis appears to be equally effective in detecting either Mucor or Aspergillus.

Topics: Acute Disease; Adult; Aged; Aspergillosis; Aspergillus; Decision Making; Endoscopy; Female; Frozen Sections; Humans; Immunocompromised Host; Invasive Fungal Infections; Male; Middle Aged; Mucor; Mucormycosis; Nasal Surgical Procedures; Nose; Rhinitis; Sensitivity and Specificity; Sinusitis; Young Adult

The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).. We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2 /FIO2 of ≤300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy.. Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2 significantly increased from 83 (68-97) mm Hg to 108 (83-140) mm Hg using HFNC and to 125 (97-200) mm Hg using NIV (P<.01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27-127) h and NIV for 23 (8-31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥30 breaths/min was an early factor associated with intubation.. HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation.

Topics: Acute Disease; Aged; Catheters; Female; Humans; Hypoxia; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Patient Satisfaction; Pilot Projects; Prospective Studies; Respiratory Distress Syndrome; Respiratory Insufficiency; Respiratory Rate; Severity of Illness Index; Treatment Failure

Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS.. This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared.. Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (PaO2 /FIO2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P=.001), occurrence of additional organ failure (76% vs 26%, P=.002), mainly hemodynamic (50% vs 7%, P=.001) or neurological (22% vs 0, P=.01), and trends toward lower PaO2 /FIO2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis.. In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

Topics: Acute Disease; Adult; Aged; Catheters; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Respiratory Distress Syndrome; Respiratory Insufficiency; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Failure

The aim was to present the workup of patients with acute recurrent pancreatitis (ARP) for genetic analysis and electrophysiological testing.. Patients with ARP with unknown etiology were referred for genetic testing and evaluation of cystic fibrosis transmembrane conductor regulator (CFTR) function by nasal potential difference (NPD) testing.. A total of 67 patients were evaluated. The mean age was 23 ± 17 years (median 17.0 years, range 1.5-72 years); 90% were Jewish and 10% Arab. Ten (15%) patients carried PRSS1 gene mutation (K23R(7), R122H(2), and D21A(1)). One patient had K172E/- (chymotrypsin C [CTRC]) mutation, 1 had I42M (serine protease inhibitor Kazal type 1 [SPINK1])/V235I (CTRC) together with ΔF508/5T, 1 patient had R67H (SPINK1)/V235I (CTRC), and 1 patient had V235I (CTRC)/-. Ten of 67 (15%) patients submitted for CFTR gene testing carried mutations (ΔF508/L997F, ΔF508/5T(11TG), W1282/5T(12TG), W1282X/Y1014C, ΔF508/R31C, R117H/-, R117H/Y1014C, D1152H/-, 5T(11TG)/-, and L997F/-). Fifty-four (80%) patients underwent sweat testing. Of these, 5 had sweat chloride ≥60 mEq/L, and 22 patients had sweat chloride from 40 to 60 mEq/L. Of the 56 (83%) patients had nasal potential difference testing, 4 (6%) with abnormal results.. One-third (34%) of patients with ARP carry mutations for hereditary pancreatitis including rare mutations (K23R), and 12.5% have evidence of cftr mutations and 10% had CFTR dysfunction underscoring the importance of genetic and functional workup of these patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Arabs; Carrier Proteins; Child; Child, Preschool; Chlorides; Chymotrypsin; Cystic Fibrosis Transmembrane Conductance Regulator; Electrophysiological Phenomena; Female; Humans; Infant; Israel; Jews; Male; Membrane Potentials; Middle Aged; Nose; Pancreatitis; Recurrence; Respiratory Mucosa; Sweat; Trypsin; Trypsin Inhibitor, Kazal Pancreatic; Young Adult

Topics: Acute Disease; Aged; Drug Eruptions; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Methotrexate; Middle Aged; Nose; Severity of Illness Index; Skin Ulcer

In recent clinical practice, high-flow nasal cannula (HFNC) therapy has been used to improve oxygenation in adults with acute respiratory failure (ARF). However, bronchoscopy using HFNC in ARF has not yet been reported. Herein, we describe 5 cases of ARF where bronchoalveolar lavage (BAL) was employed successfully using an HFNC. We were able to discontinue or reduce the HFNC fraction of inspired oxygen (FiO2) 30 min after completion of the bronchoscopy. Only 1 patient needed non-invasive positive pressure ventilation for 16 h after bronchoscopy. The HFNC may be a useful tool for ARF patients who require bronchoscopy.

Topics: Acute Disease; Aged; Bronchoalveolar Lavage; Bronchoscopy; Catheters; Female; Humans; Male; Middle Aged; Nose; Respiratory Insufficiency; Treatment Outcome

Topics: Acute Disease; Emergency Treatment; Humans; Nasal Surgical Procedures; Nose; Nose Deformities, Acquired; Primary Health Care; Referral and Consultation

Topics: Acute Disease; Adolescent; Humans; Male; Nose; Polychondritis, Relapsing; Radiography; Respiratory Insufficiency; Trachea

This article discusses Down's syndrome and its effect on the child. Some common medical conditions that may necessitate a child with Down's syndrome attending hospital either as an inpatient or an outpatient are identified. These include cardiac disease, atlantoaxial instability, growth, thyroid function and eye, ear, nose and throat issues. The nurse's role in minimising the stress involved for the child and the family is discussed. Practical suggestions are offered for ways of enhancing practice and improving outcomes, specifically in the area of communicating with the child and family.

Topics: Acute Disease; Child; Communication; Down Syndrome; Eye; Growth; Heart Diseases; Humans; Joint Instability; Nose; Nurse's Role; Pharynx; Professional-Family Relations; Thyroid Gland

A new and potentially more pathogenic group of human rhinovirus (HRV), group C (HRVC), has recently been discovered. We hypothesised that HRVC would be present in children with acute asthma and cause more severe attacks than other viruses or HRV groups. Children with acute asthma (n = 128; age 2-16 yrs) were recruited on presentation to an emergency department. Asthma exacerbation severity was assessed, and respiratory viruses and HRV strains were identified in a nasal aspirate. The majority of the children studied had moderate-to-severe asthma (85.2%) and 98.9% were admitted to hospital. HRV was detected in 87.5% and other respiratory viruses in 14.8% of children, most of whom also had HRV. HRVC was present in the majority of children with acute asthma (59.4%) and associated with more severe asthma. Children with HRVC (n = 76) had higher asthma severity scores than children whose HRV infection was HRVA or HRVB only (n = 34; p = 0.018), and all other children (n = 50; p = 0.016). Of the 19 children with a non-HRV virus, 13 had HRV co-infections, seven of these being HRVC. HRVC accounts for the majority of asthma attacks in children presenting to hospital and causes more severe attacks than previously known HRV groups and other viruses.

Topics: Acute Disease; Adolescent; Asthma; Child; Child, Preschool; Disease Progression; Female; Humans; Male; Nasal Mucosa; Nose; Picornaviridae Infections; Rhinovirus; Severity of Illness Index

Various oxygenization methods are used in the treatment of respiratory failure in acute heart failure. Occasionally, after patients are stabilized by these ventilation methods, some maintain a degree of dyspnea or hypoxemia which does not improve and is unrelated to deterioration in the functional class or the need to optimize pharmacological treatment. High-flow oxygen systems administered via nasal cannula that are connected to heated humidifiers (HFT) are a good alternative for oxygenation, given that they are easy to use and have few complications. We studied a series of 5 patients with acute heart failure due to acute pulmonary edema with stable dyspnea or hypoxemia following noninvasive ventilation. All the patients were successfully treated with HFT, showing clinical and gasometric improvement and no complications or technical failures. We report our experience and discuss different aspects related to this oxygenation system.

Topics: Acute Disease; Aged, 80 and over; Catheters; Female; Heart Failure; Humans; Male; Nose; Oxygen Inhalation Therapy

Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate.. Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of which was pre-renal due to profound volume depletion. Renal failure was associated with marked hypochloremic metabolic alkalosis which only responded to high volume repletion and high dose blockade of gastric hypersecretion. Intestinal failure with stomal fluid losses of up to 5.7 litres per day required port implantation to commence parenteral nutrition. Fluid and electrolyte replacement rapidly improved renal function and acid base homeostasis.. This case highlights the important role of gastrointestinal function to maintain acid base status in patients with Crohn's disease.

Topics: Acrodermatitis; Acute Disease; Adult; Alkalosis; Crohn Disease; Deficiency Diseases; Digestive System Surgical Procedures; Gastrointestinal Transit; Humans; Lip; Male; Nose; Parenteral Nutrition; Recurrence; Renal Insufficiency; Severity of Illness Index; Zinc

To determine which respiratory viruses circulate among confined dogs, we analyzed nasal and pharyngeal swab specimens from shelter dogs with acute respiratory disease. An unknown virus was isolated. Monoclonal antibody testing indicated that it was probably a pneumovirus. PCR and sequence analysis indicated that it was closely related to murine pneumovirus.

Topics: Acute Disease; Animals; Cell Line; Disease Outbreaks; DNA, Viral; Dog Diseases; Dogs; Fluorescent Antibody Technique; Genes, Viral; Nose; Pharynx; Pneumovirus; Pneumovirus Infections; Respiratory Tract Infections; Sequence Analysis, DNA; Sequence Homology, Nucleic Acid

The case is described of a 50-year-old man, treated for 10 years in an outpatient psychiatric clinic for an obsessive compulsive disorder, who presented with acute loss of consciousness after forceful nose blowing. A CT scan revealed an intraparenchymal air collection with tension signs in the left frontal lobe and a bone defect in the roof of the ethmoid sinus. After emergency left frontal craniotomy and dura opening, the gaseous collection was evacuated by a ventricular catheter inserted into the brain and the bone defect was repaired with pericranium flap and muscle. The postoperative course was uneventful with neurocognitive improvement and regained motility. Spontaneous tension pneumocephalus is a rare life-threatening condition which is often caused by a bone defect near the tegmen tympani. This case illustrates both an unusual cause and a unique surgical treatment for spontaneous tension intraparenchymal pneumocephalus. It can be a dangerous entity with potential for early mortality and long-term morbidity if not promptly decompressed. The pathogenesis, diagnosis and surgical strategies for spontaneous tension pneumocephalus are briefly discussed.

Topics: Acute Disease; Ethmoid Sinus; Humans; Male; Middle Aged; Nose; Obsessive-Compulsive Disorder; Pneumocephalus; Skull Fractures; Tomography, X-Ray Computed; Unconsciousness

To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis.. A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses.. Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis.. In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.

Topics: Acute Disease; Asthma; Ear; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Nose; Pharynx; Physical Examination; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Endoscopic retrograde biliary drainage (ERBD) by using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) for temporary biliary drainage in acute suppurative cholangitis (ASC). However, there are few studies that compared ERBD and ENBD in ASC.. We compared the safety and efficacy of ERBD and ENBD for temporary biliary drainage in patients with ASC.. A case series.. A tertiary-referral center.. Eighty patients with ASC underwent endoscopic biliary drainage with ENBD (n = 41) and ERBD (n = 39).. Clinical outcomes, including complications related to ERCP and complications related to the type of the indwelling catheter.. Endoscopic biliary drainage was successfully achieved in all patients (100%). There were no significant differences in the demographic data between the 2 groups. There were no differences in the improvement of clinical and laboratory parameters between the 2 groups. Overall ERCP-related complication rates in the ENBD and ERBD groups were 31.7% and 38.5%, respectively (P = .527). Hyperamylasemia occurred in 18 patients, 12.2% in the ENBD group (5/41) and 33.3% in the ERBD group (13/39) (P = .024). Without endoscopic sphincterotomy (EST), there was no statistically significant difference in the incidence of hyperamylasemia between the 2 groups. However, with an EST, hyperamylasemia was more frequent in the ERBD group (12/28 [42.9%]) than in the ENBD group (3/27 [11.1%]) (P = .008).. A single-center experience.. Endoscopic biliary decompression, whether by ERBD or ENBD, is an effective treatment for patients with ASC. However, more frequent hyperamylasemia with ERBD and EST deserves further evaluation.

Topics: Acute Disease; Aged; Bile Ducts; Cholangitis; Decompression, Surgical; Drainage; Endoscopy, Digestive System; Female; Humans; Male; Nose; Prosthesis Design; Safety; Stents; Suppuration

Human bocavirus (HBoV) is a recently discovered parvovirus that has been detected in respiratory samples from children with acute respiratory tract infection (ARTI) and in feces from children with gastroenteritis. However, its role as a causative agent of respiratory disease is not determined.. We investigated the presence of HBoV by real-time polymerase-chain reaction of nasal swab specimens obtained from 228 healthy children followed in the community from birth to 1 year of age for a 2-year period from 2004 to 2006. Nasal swabs and symptom diaries were collected at monthly home visits.. HBoV was detected in 57 (8.2%) of 697 nasal swab specimens from children with ARTI, in 1 (2.3%) of 44 swabs from children with diarrhea, and in 13 (8.6%) of 152 swabs from asymptomatic children. HBoV was present mainly during the winter months. An additional respiratory virus was identified in 27 (47.4%) HBoV-positive samples. Thirty-four (68%) of 50 children with ARTI shed HBoV for less than 1 month, 13 (26%) for 2 months, 2 (4%) for 3 months, and 1 (2%) for 4 months. Seven asymptomatic children shed HBoV for less than 1 month, 2 children for 2 months, and 1 asymptomatic child had 5 HBoV-positive nasal swabs detected for 6 consecutive months. HBoV infection was associated with maternal smoking, being born in the winter, and predisposition to asthma.. Asymptomatic carriage of HBoV is common in infants <1 year of age, and an HBoV-positive test result does not imply that HBoV is the cause of the illness.

Topics: Acute Disease; Bocavirus; Child, Preschool; Cohort Studies; Denmark; Diarrhea; Female; Humans; Infant; Infant, Newborn; Male; Nose; Parvoviridae Infections; Polymerase Chain Reaction; Respiratory Tract Infections; Risk Factors; Virus Shedding

In young children with wheezing or bronchiolitis, especially with respiratory syncitial virus, blood eosinophilia and a high eosinophil cationic protein level in nasal secretions predicts subsequent wheezing in later childhood. However, whether eosinophil activation results from virus-induced inflammation or local eosinophilia per se precedes the onset of wheezing remains unknown. In the present study, we examined the association between the presence of nasal eosinophils during respiratory tract infection (RTI) and subsequent wheezing in young children.. A total of 35 young children less than 3 years of age who visited our outpatient clinic with rhinorrhea between April and July 2004 were enrolled in this prospective cohort study. Subjects who were given diagnoses of allergic rhinitis were excluded. In all the subjects, the presence of eosinophils in nasal secretions was determined. The subjects were followed, and the cumulative incidences of wheezing during the subsequent 2- and 12-month periods were examined.. According to a logistic regression analysis adjusted for age, sex, family history, allergies, and wheezing at entry, young children with nasal eosinophil infiltration during acute RTI had a significantly higher risk of wheezing during the subsequent 2 months, compared with those without nasal eosinophil infiltration (adjusted odds ratio, 27.618, p = 0.016).. Our findings not only suggest that nasal eosinophil testing may serve as a convenient clinical marker for identifying young children at risk for subsequent wheezing, but also shed new light on the role of eosinophils in the onset of wheezing in young children.

Topics: Acute Disease; Biomarkers; Bodily Secretions; Child, Preschool; Cohort Studies; Eosinophils; Female; Humans; Infant; Male; Nasal Mucosa; Nose; Predictive Value of Tests; Prognosis; Prospective Studies; Respiratory Sounds; Respiratory Tract Infections; Time Factors

hBoV, a recently discovered parvovirus, can be present in the respiratory tract of patients with acute respiratory diseases (ARD), but its etiologic involvement in the underlying diseases is still uncertain.. To determine in a retrospective study, the prevalence of hBoV, compared with common respiratory viruses (RV), in respiratory specimens from patients with ARD.. A total of 335 specimens obtained over 7 years were examined. Two hundred were nasal swabs from infants hospitalized for ARD, 84 were nasal swabs or bronchoalveolar lavages from adults with pneumonia, bronchopneumonia or asthma, and 51 were nasal swabs from healthy children.. The overall rate of hBoV detection in specimens from infants with ARD, which was 4.5%, varied slightly from year to year, except for the period 2000-2002, when no specimen was positive. Unlike other RV, no seasonal variation in hBoV incidence was noted. Infants with hBoV infection suffered either from bronchiolitis or from bronchopneumonia and 5 out of 9 cases yielded no co-infecting viral pathogen. Only one sample from an adult was hBoV positive. None of the nasal swabs from healthy subjects tested hBoV-positive.. The findings indicate that hBoV can cause ARD in infants.

Topics: Acute Disease; Adolescent; Adult; Aged; Asthma; Bocavirus; Bronchoalveolar Lavage Fluid; Bronchopneumonia; Child; Child, Preschool; DNA, Viral; Female; Humans; Infant; Italy; Male; Middle Aged; Molecular Sequence Data; Nose; Parvoviridae Infections; Phylogeny; Pneumonia; Prevalence; Respiratory Tract Diseases; Retrospective Studies; Seasons; Sequence Analysis, DNA

Our goal was to estimate the local prevalence of Streptococcus pneumoniae nonsusceptible to penicillin and amoxicillin after widespread use of the heptavalent pneumococcal vaccine and to revise community-specific recommendations for first-line antibiotic treatment of acute otitis media.. We conducted serial prevalence surveys between 2000 and 2004 in the offices of community pediatricians in St Louis, Missouri. Study participants were children <7 years of age with acute upper respiratory infections. Children treated with an antibiotic in the past 4 weeks were excluded. S pneumoniae was isolated from nasopharyngeal swabs using standard techniques. Isolates with a penicillin minimum inhibitory concentration >2 microg/mL were considered to be S pneumoniae nonsusceptible to amoxicillin.. There were 327 patients enrolled in the study. Between 2000 and 2004, vaccine coverage with > or =3 doses of heptavalent pneumococcal vaccine increased from 0% to 54%, but nasopharyngeal carriage of S pneumoniae was stable at 39%. The prevalence of S pneumoniae nonsusceptible to penicillin fell from 25% to 12% among patients, did not vary if <2 years of age, was reduced in children with > or =3 doses of heptavalent pneumococcal vaccine, and increased in child care attendees but reduced in attendees who had > or =3 doses of heptavalent pneumococcal vaccine. The prevalence of S pneumoniae nonsusceptible to amoxicillin in patients remained <5%.. In our community, widespread use of heptavalent pneumococcal vaccine has reduced the prevalence of S pneumoniae nonsusceptible to penicillin, and the prevalence of S pneumoniae nonsusceptible to amoxicillin remains low (<5%). If antibiotic treatment is elected for children with uncomplicated acute otitis media, we recommend treatment with standard-dose amoxicillin (40-45 mg/kg per day) for children with > or =3 doses of heptavalent pneumococcal vaccine, regardless of age and child care status. High-dose amoxicillin should be used for children with <3 doses of heptavalent pneumococcal vaccine and those treated recently with an antibiotic.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Male; Meningococcal Vaccines; Nose; Otitis Media; Penicillin Resistance; Pharynx; Pneumococcal Infections; Pneumococcal Vaccines; Streptococcus pneumoniae; Vaccines, Conjugate

To study the relationship between pathogenic bacteria in the nasal middle meatus and acute bacterial respiratory infection in children.. Three hundred and twenty eight children with respiratory infection (mean age 8 years) were included into the prospective cohort study. The mucosal fluid specimens from the nasal middle meatus were collected under an endoscope for bacterial culture. The patients with bacterial culture positive were defined as the Exposed group and those with bacterial culture negative as the Non-exposed group. The grouping of the patients was blinded to the patients, patients' parents and physicians. Both groups received anti-virus and symptomatic treatments, without antibiotic administration. Five days later, the patients were evaluated as to whether they had bacterial infection based on the leucocyte count and CRP results.. Of the 328 patients, 168 had a positive nasal bacterial culture. The incidence of bacterial respiratory infection in the Exposed group [51.2% (86/168)] was significantly higher than in the Non-exposed group [13.1% (21/160)] (P < 0.01). The relative risk of bacterial respiratory infection occurrence in patients with nasal bacterial culture positive was 3.9002.. The children with respiratory infection who had potential pathogenic bacteria in the nasal middle meatus were more prone to develop bacterial respiratory infection.

Topics: Acute Disease; Bacterial Infections; Child; Cohort Studies; Female; Humans; Male; Nose; Prospective Studies; Respiratory Tract Infections

In patients with poliomyelitis, respiratory failure requiring ventilatory support may occur during the acute illness. Some patients continue to require long-term nocturnal ventilatory support; others are weaned but subsequently require support because of a late deterioration in ventilatory function.. To assess the sensitivity of sniff nasal inspiratory pressure (SNIP) to post-poliomyelitis respiratory muscle weakness and to assess the relationship between the respiratory muscle strength and the need for ventilatory support in patients with previous poliomyelitis (post-polio patients).. Respiratory muscle strength was measured in 50 post-polio patients. Tests included forced vital capacity (FVC), maximum inspiratory and expiratory pressures (MIP and MEP), and SNIP.. Twenty-one patients used non-invasive nocturnal ventilatory support (NIV group) compared to 29 on no support (non-NIV group). The percentage predicted FVC was significantly lower in the NIV group compared to the non-NIV group (P=0.01). Similarly, the percentage predicted MIP was significantly lower in NIV group (P=0.007). Low SNIP values (both absolute value and percentage predicted) were associated with the need for ventilatory support (P<0.001). Of the patients requiring no support, those who had been ventilated during the acute episode of poliomyelitis had a significantly lower SNIP than those who had never been ventilated (P=0.04).. Post-polio patients who are currently on nocturnal ventilation have significantly lower FVC, MIP and SNIP compared to currently non-ventilated patients. Non-ventilated patients who were ventilated during the acute episode of poliomyelitis have significantly weaker respiratory muscle strength than patients who were never ventilated. This study indicates that SNIP is more sensitive to post-polio respiratory muscle weakness than other non-invasive tests. Thus measurement of SNIP is a valuable tool for monitoring the progression of respiratory muscle weakness due to previous poliomyelitis and this can be applied to other neuromuscular disorders.

Topics: Acute Disease; Adult; Aged; Female; Humans; Inhalation; Male; Middle Aged; Nose; Postpoliomyelitis Syndrome; Respiratory Muscles; Vital Capacity

Foley's catheter is used for post-nasal packing in severe epistaxis. Various methods have been described for securing the catheter in position, all of which can be associated with patient discomfort, risk of alar necrosis or unsightliness. We describe a new method to secure the Foley's catheter without these problems. The ribbon gauze used for anterior nasal packing is tied over the catheter in multiple knots to secure it in place. This has been successfully tried on over 50 patients.

Topics: Acute Disease; Cartilage Diseases; Catheterization; Epistaxis; Hemostasis, Surgical; Humans; Necrosis; Nose

To determine the outcomes for healthy children who require admission to hospital with acute epistaxis.. A 10-year retrospective review of admissions with acute epistaxis under the Otolaryngology Department in a tertiary pediatric centre was performed.. There were 14 cases (11 males, 3 females), with mean age 7.8 years (1.9-18.3 years). Three patients had a history of recent aspirin ingestion, and one had sustained nasal trauma. Mean hemoglobin at presentation was 105g/L (75-150), and no patient was diagnosed with a bleeding disorder. Four patients underwent surgical intervention, and one patient received a blood transfusion or blood product. The mean length of hospital stay was 3.6 days (2-14 days).. Acute epistaxis in healthy children that requires hospital admission is generally not a marker for an underlying bleeding disorder. It is associated with a short inpatient stay, and usually requires minimal intervention.

Topics: Acute Disease; Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child; Child, Preschool; Epistaxis; Female; Hospitalization; Humans; Infant; Length of Stay; Male; Nose; Patient Admission; Retrospective Studies

The natural history and pathogenic potential of the recently identified TT virus (TTV) are currently a matter of intensive investigation. In an attempt to shed some light on these issues, nasal and blood specimens of 1- to 24-month-old children hospitalized with a clinical diagnosis of acute respiratory disease (ARD) were examined for the presence, load, and genetic characteristics of TTV. The results have indicated that at least in young children, the respiratory tract not only represents a route by which abundant TTV can be shed into the environment but also may be a site of primary infection and continual replication. Although we found no compelling evidence that TTV was the direct cause of ARD in some of the children studied, the average loads of TTV were considerably higher in patients with bronchopneumonia (BP) than in those with milder ARD, raising interesting questions about the pathophysiological significance of TTV at this site. Furthermore, group 4 TTV was detected almost exclusively in children with BP.

Topics: Acute Disease; DNA Virus Infections; DNA, Viral; Female; Humans; Infant; Infant, Newborn; Male; Molecular Sequence Data; Mucus; Nose; Polymerase Chain Reaction; Respiratory Tract Diseases; Sequence Analysis, DNA; Severity of Illness Index; Specimen Handling; Torque teno virus; Viral Load; Viremia

Topics: Acute Disease; Adult; Cerebral Infarction; Diagnosis, Differential; Disease Progression; Eye; Facial Pain; Female; Humans; Hypesthesia; Lateral Medullary Syndrome; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Paresis; Pons

Following an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.. To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.. Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit. The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987-1988) to 12% (1999-2000) (P = .0009) for newly admitted patients and from 0% to 7% (P < .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.. The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal; Carrier State; Cross Infection; Disease Outbreaks; Female; Hospital Units; Hospitals, Community; Hospitals, Teaching; Humans; Infection Control; Male; Mass Screening; Methicillin Resistance; Middle Aged; Missouri; Nose; Patient Admission; Population Surveillance; Predictive Value of Tests; Prevalence; Prospective Studies; Rehabilitation; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

In this retrospective study Chlamydia pneumoniae and Mycoplasma pneumoniae infections were detected by polymerase chain reaction (PCR) in samples (n = 457) from children presenting with acute respiratory infection to general practitioners during 1992-97. Samples were collected in autumn and winter, and from 1994 onwards in spring and summer also. Overall, C. pneumoniae and M. pneumoniae were detected in throat or nasal samples by PCR in 3.1% and 2.4% of the cases, respectively. The proportion of both C. pneumoniae and M. pneumoniae infections varied between 0% and 6.9% over the years studied, whereas seasonal proportions varied from 1.8 to 9.1% and 1.2 to 4.5%, respectively. For both microorganisms the lowest proportion was detected during winter and the highest in summer. C. pneumoniae could already be detected by PCR in patients under 4 y of age, an observation not made in sero-epidemiological studies. In conclusion, both C. pneumoniae and M. pneumoniae infections play a minor role in children presenting with acute respiratory infection.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Chlamydophila pneumoniae; Family Practice; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Mycoplasma pneumoniae; Netherlands; Nose; Pharynx; Polymerase Chain Reaction; Respiratory Tract Infections; Retrospective Studies; Seasons

Topics: Acute Disease; Battered Child Syndrome; Child, Preschool; Gastric Dilatation; Humans; Male; Nose; Nutrition Disorders; Radiography; Stomach

132 patients with diagnosis acute or subacute exudative otitis media were treated conservatively (n = 79) or surgically (n = 53). Conservative treatment was effective in 41% of the cases, surgical treatment produced positive results in 62.3%. The operative treatment combined elements of endoscopic nasal surgery and methods used in tympanoplasty, plastic treatment of the auditory tube, surgery of the internal ear.

Topics: Acute Disease; Adult; Audiometry, Pure-Tone; Decision Making; Ear, Middle; Endoscopy; Eustachian Tube; Follow-Up Studies; Humans; Middle Aged; Nose; Otitis Media with Effusion; Plastic Surgery Procedures; Sympathectomy; Treatment Outcome; Tympanoplasty

A 68 yr old woman presented with acute respiratory failure. She was suspected of having a phrenic-diaphragmatic impairment, without evidence of an intrinsic lung disease or generalized neuromuscular disorder, after 3 weeks of prolonged mechanical ventilation. A series of studies, including fluoroscopy, phrenic nerve stimulation test and diaphragmatic electromyography, was performed before the diagnosis of bilateral diaphragmatic paralysis (BDP) was confirmed. The patient was successfully weaned from the conventional mechanical ventilator, and was placed on nasal mask bi-level positive airway pressure (BiPAP) ventilation. A high degree of clinical suspicion of bilateral diaphragmatic paralysis should always be raised in patients suffering respiratory failure without definite predisposing factors. Weaning with noninvasive nasal mask ventilation should be tried first instead of direct tracheostomy.

Topics: Acute Disease; Aged; Female; Humans; Masks; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Respiratory Paralysis

Endonasal dacryorhinocystostomy is a surgical procedure performed to re-establish continuity of the lacrimal duct by partial diversion followed by dilatation. A simultaneous rhinologic and ophthalmologic approach is used. This simple and elegant procedure that results in no residual scarring is indicated for any blockage of the lacrimal duct due to congenital or acquired causes. Except for children under 6 years of age and in patients in poor general condition, contra-indications are uncommon. Operative and postoperative complications are rare. After a review of the relevant anatomy the authors of this report describe the equipment and basic techniques used to perform dacryorhinocystostomy. Endonasal dacryorhinocystostomy was performed in 15 patients presenting chronic (n = 14) or acute (n = 1) dacryocystitis in Madagascar. At six months follow-up the procedure was successful in 14 cases and unsuccessful in one case due a cutaneous fistula. Because it is simple and well-tolerated and results in no residual scarring, endonasal dacryorhinocystostomy is the method of choice for treatment of lacrimal duct obstruction in tropical areas in general and in Black Africa in particular.

Topics: Acute Disease; Adult; Age Factors; Chronic Disease; Contraindications; Dacryocystitis; Dacryocystorhinostomy; Female; Follow-Up Studies; Humans; Madagascar; Male; Nose

The effects of heparin microdoses on vagal tone (the Bayevsky heart rate variability index) and blood coagulation time were examined in 15 healthy men and women and in 14 patients with acute facial neuropathy. Nasal inhalation of heparin solution vapour (thrice every 30 sec, interrupted by a 60-80 sec interval) without changes in olfactory sensation or nasal secretion prolongs the onset and completion of blood clotting and decreased heart rate (vagal activation) in normotony volunteers. The similar procedure of distilled water nasal inhalation appears to be ineffective.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Adult; Anticoagulants; Dose-Response Relationship, Drug; Facial Neuralgia; Female; Hemostasis; Heparin; Humans; Male; Nose; Stimulation, Chemical; Vagus Nerve

Topics: Abnormalities, Multiple; Acute Disease; Adult; Alkalosis; Diagnosis, Differential; Female; Humans; Infant; Microcephaly; Nose; Pyloric Stenosis; Respiration Disorders; Syndrome

During a 27-year period 295 patients in Copenhagen County were treated for acute epiglottitis. One hundred and eight-two were adults and 113 were children. Most children were treated by nasotracheal intubation while only a few adults required nasotracheal intubation in order to secure the airway. The incidence of acute epiglottitis in children less than five years old was calculated to be 8.7/100,000 with minor annual variation. Since vaccination against Haemophilus influenzae type b has been implemented in Denmark from May 1993, this figure will probably be markedly reduced, and the disease even may be even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b. It is emphasized that this reduced incidence will make it even more important that each department engaged in the treatment of suspected acute epiglottitis have a departmental protocol for management of the condition, so that the future rarity of acute epiglottitis does not cause the mortality rate to rise.

Topics: Acute Disease; Adolescent; Adult; Aged; Child; Child, Preschool; Epiglottitis; Humans; Intubation, Intratracheal; Middle Aged; Nose; Retrospective Studies

To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation.. Prospective case series.. Medical intensive care unit in Veterans Administration Medical Center.. Twelve chronic obstructive pulmonary disease patients treated during 14 episodes of hypercapnic respiratory failure.. Nasal mechanical ventilation in addition to conventional therapy to treat hypercapnic respiratory failure. Patients underwent nasal mechanical ventilation for at least 30 mins, or longer if the therapy was tolerated. Responses to therapy and arterial blood gases were monitored.. Half of the episodes were successfully treated with nasal mechanical ventilation. There were no differences in age, prior pulmonary function, baseline arterial blood gases, admission arterial blood gases, or respiratory rate between those patients successfully treated and those patients who failed nasal mechanical ventilation. Unsuccessfully treated patients appeared to have a greater severity of illness than successfully treated patients, as indicated by a higher Acute Physiology and Chronic Health Evaluation II score (mean 21 +/- 4 [SD] vs. 15 +/- 4; p = .02). Unsuccessfully treated patients were edentulous, had pneumonia or excess secretions, and had pursed-lip breathing, factors that prevented adequate mouth seal and contributed to greater mouth leaks than in successfully treated patients (the mean volume of the mouth leak was 314 +/- 107 vs. 100 +/- 70 mL; p < .01). Successfully treated patients were able to adapt more rapidly to the nasal mask and ventilator, with greater and more rapid reduction in PaCO2, correction of pH, and reduction in respiratory rate.. Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation.

Topics: Acute Disease; Aged; Blood Gas Analysis; Female; Forced Expiratory Volume; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Masks; Nose; Positive-Pressure Respiration; Prospective Studies; Respiration; Respiratory Insufficiency; Severity of Illness Index; Survival Rate; Tidal Volume; Treatment Outcome; Vital Capacity

Topics: Acute Disease; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Respiratory Insufficiency

We investigated the ultrastructure of nasal cilia in 27 children suffering from recurrent infections of the upper respiratory tract, during and after the onset of an acute respiratory infection, and after a convalescent period of 12 weeks. Our results demonstrated that in seven subjects after resolution of infection, the morphology of a large proportion of the cilia (32%) was not back to normal. These findings suggest a long-term residual effect of infection, or the inability to reestablish normal ciliary structure during the convalescent period in some subjects with recurrent upper respiratory tract infection.

Topics: Acute Disease; Case-Control Studies; Child; Child, Preschool; Cilia; Female; Humans; Male; Microscopy, Electron; Movement; Nose; Recurrence; Respiratory Tract Infections

Overall 219 ailing children aged 3 to 14 years were examined, using the disease history, clinical, morphological, immunological and cytochemical data. There were 115 patients with allergoses and 104 patients suffering from acute respiratory viral infections (ARVI). A retrospective analysis has demonstrated that in 52.6% of the children, respiratory allergosis diagnosis was late (3-5 years since its onset). It has been established that hereditary allergic load, food and drug allergy, local eosinophilia of the nasal mucosa as well as a decrease of E-RFC, a rise of EAC-RFC levels, a lower T/B index, dysgammaglobulinemia marked by significant stable alterations in patients with respiratory allergoses and transitory, obscure changes associated with ARVI can serve differential diagnostic criteria.

Topics: Acute Disease; Adolescent; Antibodies, Viral; Child; Child, Preschool; Diagnosis, Differential; Diagnostic Errors; Disease Susceptibility; Feces; Humans; Nose; Respiratory Hypersensitivity; Respiratory Tract Infections; Virus Diseases

Acute epiglottitis is a potentially fatal upper respiratory tract infection. In this paper, we describe the use of flexible nasoendoscopy, both in establishing the diagnosis and during the subsequent airway management of adults with acute epiglottitis.

Topics: Acute Disease; Adult; Endoscopes; Epiglottitis; Humans; Laryngismus; Laryngitis; Nose

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biliary Tract; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Drainage; Female; Humans; Intubation; Male; Middle Aged; Nose

Topics: Acute Disease; Craniocerebral Trauma; Humans; Intubation, Intratracheal; Nose; Sinusitis

IgA-antibodies to pneumococcal antigens were measured by enzyme immunoassay in saliva and nasal washings, obtained from 32 children aged 6 months to 14 years with acute pneumonia and from 25 healthy children aged 2.5-11 years. In the secretions of children with acute pneumonia an essential increase in the levels of IgA-antibodies in comparison with those observed in healthy children was detected. The levels of antibodies to pneumococci in saliva and in nasal washings were in direct correlation. These data are indicative of a protective role played, probably, by secretory antibodies at the portals of infection in pneumococcal pneumonia.

Topics: Acute Disease; Adolescent; Antibodies, Bacterial; Child; Child, Preschool; Convalescence; Humans; Immunoenzyme Techniques; Immunoglobulin A, Secretory; Infant; Mucus; Nose; Pneumonia, Pneumococcal; Saliva; Streptococcus pneumoniae

During a 28-month period, 84 children with acute otitis media were studied by viral and bacterial cultures of middle ear fluid and viral cultures of nasal lavage fluid. Viruses were isolated from the middle ear fluid of 17 (20%) patients. Evidence of viral infection was demonstrated by positive viral cultures of middle ear fluid and/or nasal lavage fluid in 33 (39%) patients. Rhinovirus in one patient and influenza b virus in another were the only pathogens isolated. Influenza virus, enterovirus, and rhinovirus were the most common viruses found in middle ear fluids. Parainfluenza virus, adenovirus, and respiratory syncytial virus were found less often. In 82% of cases, the virus isolated from middle ear fluid was also isolated from nasal lavage fluid, but only 44% of viruses found in nasal lavage fluid were also found in middle ear fluid. Mixed bacterial and combined viral-bacterial infections were common. Only 15% of patients had no pathogen isolated from middle ear fluids. Using tissue culture techniques, we demonstrated that enterovirus and rhinovirus are also common middle ear pathogens. Our data reemphasize the significance of viruses as etiologic agents of acute otitis media and propose several questions regarding the viral-bacterial interactions and the types of viruses involved in the pathogenesis of the disease.

Topics: Acute Disease; Bacteria; Child; Child, Preschool; Ear, Middle; Exudates and Transudates; Female; Humans; Infant; Infant, Newborn; Male; Nose; Otitis Media; Rotavirus; Therapeutic Irrigation; Virus Cultivation; Viruses

Topics: Acute Disease; Adolescent; Adult; Bacteria; Child; Child, Preschool; Female; Humans; Infant; Male; Nose; Otitis Media; Pharynx

In 9 patients with recurrent attacks of acute or chronic frontal sinusitis, interfrontal sinus septum resection was performed. In 5 patients there was unilateral disease and in 4 bilateral. As all patients had previously had their frontal sinus trephined, pre- and post-operative naso-frontal duct function tests were performed. Pre-operatively, of 11 naso-frontal ducts tested (2 patients bilaterally) not one showed air flow on spontaneous respiration. Passage of air was obtained at forced inspiration and expiration in one patient and by Valsalva's manoeuvre in 6. No flow of air whatsoever was obtained in 4 of the ducts, whatever the method used. At follow-up performed 1-8 years post-operatively 7 out of the 9 patients had no frontal sinus problems. The remaining 2 patients, who both had nasal allergy, were improved. Post-operative testing of the 9 patients showed flow of air on spontaneous respiration in 4 patients, whereas 4 needed forced inspiration or expiration and only one patient Valsalva's manoeuvre. The sinus septum resection, which is very simple to perform, is a good alternative to more extensive frontal sinus surgery but may be of less value in patients with nasal allergy.

Topics: Acute Disease; Adult; Chronic Disease; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Nasal Septum; Nose; Postoperative Period; Pulmonary Ventilation; Recurrence; Sinusitis

A brief review of surgery for severe posterior epistaxis has been outlined. Hundred and forty-five (27.3%) patients were treated by transnasal microsurgery in order to undergo ligation of the branches of the sphenopalatine artery in the nasal cavity. The rate of failure was 6.1%. It seems that by using this kind of operation, we can significantly decrease the morbidity in relation to other methods of controlling the posterior epistaxis.

Topics: Acute Disease; Arteries; Epistaxis; Humans; Ligation; Microsurgery; Nose

One hundred and forty-eight cases of acute epiglottitis in children treated at the University of Rochester's Strong Memorial Hospital and two affiliated community hospitals between 1965 and 1983 are reviewed retrospectively. Patients seen prior to 1975 were usually managed with tracheotomy and intravenous antibiotics, while those after 1975 with nasotracheal intubation, antibiotics and steroids. Tracheotomy and nasotracheal intubation were equally safe in controlling the upper airway. We compared our results with other series, primarily from children's hospitals, using nasotracheal intubation and found comparable results. Steroids provided no significant effect on the duration of intubation or infectious complications, but was associated with gastrointestinal bleeding. Long- and short-term complications of intubation, including self-extubation are discussed. We conclude that nasotracheal intubation is a safe method of management for acute epiglottitis in the community hospital.

Topics: Acute Disease; Anti-Bacterial Agents; Child; Child, Preschool; Combined Modality Therapy; Epiglottitis; Hospitals, Community; Humans; Intubation; Laryngitis; New York; Nose; Retrospective Studies; Steroids; Time Factors; Trachea; Tracheotomy

Human coronaviruses were found by enzyme linked immunosorbent assay in upper respiratory tract secretions taken during 30% of 108 acute respiratory infections experienced by 30 children under age 6 years with recurrent respiratory infections (index group), and during 29% of 51 acute infections experienced by their siblings. Lower respiratory tract infection--predominantly wheezy bronchitis--occurred in 30% of the index children's coronavirus positive infections but in none of their siblings' infections. Reinfections were common. Two peaks of infection were seen each year in the late autumn/early winter and in the early summer.

Topics: Acute Disease; Child; Child, Preschool; Coronaviridae; Coronaviridae Infections; England; Enzyme-Linked Immunosorbent Assay; Humans; Infant; Nose; Prospective Studies; Recurrence; Respiratory Tract Infections; Seasons

Middle ear fluid (MEF) aspirates and nasal swabs of children with acute otitis media (N = 255, age 2-6 yrs) were cultured by standard bacteriological methods. In addition, counterimmunoelectrophoresis and latex agglutination were applied to detect pneumococcal polysaccharide antigens (Pn-ag) in MEF. When the nasal culture grew Streptococcus pneumoniae (Pn), Pn was also present in 49% (73/148) and Pn-ag in 64% of the MEF cultures. If Haemophilus influenzae (Hi) appeared in the nasal culture. Hi was present in 41% (25/61) of the MEFs. There was a negative correlation between the growth of Pn or Hi in the nasal culture and the presence of other bacteria in the MEF. However, in spite of these correlations the nasal culture was concluded not to be useful in predicting the MEF bacteria.

Topics: Acute Disease; Antigens, Bacterial; Child; Child, Preschool; Counterimmunoelectrophoresis; Haemophilus influenzae; Humans; Nose; Otitis Media; Streptococcus pneumoniae

Management of the airway in acute epiglottitis is still controversial. One argument against intubation as opposed to tracheostomy is the increased complications from prolonged intubation. We describe a study of 26 children treated for acute epiglottitis from 1971 to 1979. Included in this series are 16 consecutive patients who were treated by nasotracheal intubation and simultaneous medical therapy. Fifteen of the 16 patients extubated safely in less than 48 hours, significantly decreasing the possibility for complications.

Topics: Acute Disease; Child; Child, Preschool; Emergency Medical Services; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Nose; Time Factors; Tracheotomy

Topics: Acute Disease; Axilla; Bacteria; Cross Infection; Enterobacteriaceae; Gingiva; Humans; Leukemia; Nose; Pseudomonas aeruginosa; Rectum; Sepsis

Topics: Acute Disease; Aged; Aspergillosis; Aspergillus fumigatus; Female; Humans; Leukemia; Nose; Paranasal Sinus Diseases

Topics: Acute Disease; Female; Humans; Infant; Intubation, Intratracheal; Nasal Mucosa; Nose; Respiration; Respiratory Insufficiency; Sodium Chloride

During the 20 year interval from 1958 to 1978 a change in the spectrum of disease, etiology, and diagnosis of mucormycosis was observed at The Mount Sinai Hospital. Although the rhinocerebral and pulmonary forms of mucormycosis were still the most frequent forms of disease, hospital acquired cutaneous and subcutaneous infections emerged. Since 1974, 14 of 15 cases of mucormycosis were diagnosed during life. Rizopus species, especially R. rhizopodoformis, have been the etiologic agents identified in 13 of 14 culturally proven cases. The presence or absence of antirhizopus fungistatic activity and antirhizopus antibody in the sera of six of the patients was correlated with the severity of clinical disease. Preliminary results showed a relationship between the extent of disease and the degree of serum fungistatic activity that was independent of antibody production.

Topics: Acute Disease; Adolescent; Adult; Aged; Antibodies, Fungal; Diabetes Complications; Female; Humans; Infant, Newborn; Leukemia; Lung; Male; Middle Aged; Mucormycosis; Nose; Rhizopus; Skin

Aspergillosis in cancer patients is a problem. Because not all patients can undergo invasive procedures, we sought other methods for diagnosis. We reviewed the data from all patients with acute nonlymphocytic leukemia treated at our center during a 3-year period. Of 125 patients, 18 had invasive aspergillosis (cases). Eleven patients had nose cultures growing Aspergillus flavus or A. fumigatus; 10 of these 11 had aspergillosis, whereas only eight of 114 without such nose cultures had invasive disease (P less than 0.000001). Thus, A. flavus on nose culture appears "predictive" for aspergillosis. Absence of such a culture does not preclude infection. Of 125 patients, 61 had sterile nose culture(s) and 14 of the 18 cases had such a sterile nose culture. Only four of the 64 patients without sterile nose cultures developed aspergillosis (P less than 0.008), suggesting a relation between sterile nose culture and aspergillosis. Carbenicillin was used for a longer period among cases and patients with predictive nose cultures than among patients without aspergillosis. These data may help identify patients at risk of aspergillosis and help determine antifungal therapy when invasive procedures are contraindicated.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Carbenicillin; Drug Therapy, Combination; Humans; Leukemia; Nose

Sputum, nasal swabs, and throat swabs were obtained from 22 children aged between 5 and 15 years during 72 attacks of wheezy bronchitis. A virus, most commonly a rhinovirus, was isolated in 49% of all episodes and in 64% of 22 severe episodes requiring treatment with corticosteroids; the isolation rate was higher early in the illness than later. Virus was recovered more often from sputum than from the nose or throat, suggesting that viral replication occurs freely in the lower respiratory tract: the cytological findings in sputum were compatible with an inflammatory response to viral infection. Pathogenic bacteria appeared to play a minor role compared with viruses, and routine antibiotic treatment was probably of little value in moost cases. The significance of the results is discussed in relation to the pathogenesis of childhood wheezy bronchitis.

Topics: Acute Disease; Adolescent; Bacteria; Bronchitis; Child; Child, Preschool; Female; Humans; Male; Nose; Pharynx; Respiratory Sounds; Sputum; Viruses

20 of 34 patients with acute epiglottitis were treated with nasotracheal intubation. One patient died because of pneumonia, one patient was clinically dead when he arrived at hospital. After successful reanimation she died some hours later. All other patients left the hospital without any symptoms after an average stay of 12 days. The average duration of nasotracheal intubation was 39 hours. Nasotracheal intubation and adequate antibiotic therapy offer the most effective and secure approach to acute epiglottitis. A protocol for diagnostic and therapeutic regimen is presented.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Length of Stay; Male; Nose; Time Factors

Topics: Acute Disease; Humans; Hypoxia; Infant; Infant, Newborn; Intubation; Nose; Positive-Pressure Respiration; Respiratory Distress Syndrome, Newborn; Risk

Topics: Acute Disease; Child, Preschool; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Mouth; Nose

Topics: Acute Disease; Child, Preschool; Epiglottis; Female; Foreign Bodies; Humans; Laryngitis; Nose

In the curves obtained from rhinomanometry a mid-cycle rest (M.C.R.) is sometimes found to occur. The aim of this study was then to analyse the frequency of the M.C.R both in normal subjects and in subjects who had had a myocardial infarction. Rhinomanometry was therefore performed on 3 different groups of people, viz. 1 .32 normal subjects without any respiratory, cardial or any pathological problems. 2. 44 subjects who had had a myocardial infarction. 3. 34 subjects without any cardial problems. Rhinomanometry revealed that 50-60% of the second and third group had a poor nasal respiration. In the first group no M.C.R. was found in any of the subjects. In the second group over 50% of the subjects had a M.C.R. In the third group less than 50% of the subjects had a M.C.R. The x2 test was used to analyse these results as to their statistical significance. The x2 parameter was 3,84 with a significance of 95%, and 6,64 with a significance of 99%. Our result was x2=5,34 which seems to justify further study.

Topics: Acute Disease; Adult; Aged; Female; Humans; Male; Manometry; Middle Aged; Myocardial Infarction; Nose; Pulmonary Ventilation; Respiration

Nasal problems in children are very common. The factors that affect the embryologic development have been discussed. Injuries that occur in prenatal, natal, and postnatal periods affect normal development. Prompt treatment of minor injuries is necessary to prevent airway problems later. The "wait and see" attitude toward nasal deformity is ill advised. X-ray findings are not conclusive, as the nasal pyramid in a child is largely cartilaginous. Obstructive nasal breathing can result in facial asymmetry, malocclusion, and cardiopulmonary problems. Allergy and sinusitis are frequently causes of obstruction.

Topics: Acute Disease; Adolescent; Airway Obstruction; Birth Injuries; Cartilage; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Infant, Newborn; Male; Malocclusion; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Pregnancy; Sinusitis; Skull Fractures; Wounds, Nonpenetrating; Wounds, Penetrating

A 16-mo-old girl is described with acute hemiplegia associated with virologic and serologic evidence of Coxsackie A9 infection. Possibilities of pathogenesis are discussed. It is suggested that the present hemiplegia may have been the result of a focal vasculitis due to Coxsachie A9 viral infection in the region of the middle cerebral artery.

Topics: Acute Disease; Antibodies, Viral; Cerebral Arterial Diseases; Cerebrospinal Fluid; Coxsackievirus Infections; Enterovirus; Female; Hemiplegia; Humans; Infant; Nose; Radionuclide Imaging; Technetium

The case histories of 150 children admitted to hospital with acute laryngotracheobronchitis (LTB) are reviewed. Relief of severe upper airway obstruction was achieved by nasotracheal intubation in 27 children (18%). There was no mortality in this series. Nasotracheal intubation is therefore a safe and effective means of treating severe LTB. In addition, the importance of meticulous nursing care is stressed.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Croup; Diagnosis, Differential; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Nose; Radiography; Tracheotomy

Topics: Acute Disease; Analgesics; Chlorpheniramine; Drug Combinations; Histamine H1 Antagonists; Imidazoles; Lung Compliance; Nasal Decongestants; Nasal Mucosa; Nose; Oxazines; Plethysmography, Whole Body; Pulmonary Ventilation; Rhinitis; Sympathomimetics

Topics: Acute Disease; Anaerobiosis; Corynebacterium diphtheriae; Haemophilus influenzae; Humans; Maxillary Sinus; Nose; Sinusitis; Staphylococcus; Streptococcus; Streptococcus pneumoniae; Therapeutic Irrigation

Topics: Acute Disease; Adult; Child, Preschool; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Nose; Polyvinyls; Postoperative Complications; Respiratory Insufficiency; Time Factors; Tracheotomy

Coxsackievirus B(4) was isolated from the throat, nose, blood, stools and urine of a 9-year-old boy with acute glomerulonephritis and a pneumonitis. Neutralization test showed a greater than fourfold rise in the antibody titre to coxsackievirus B(4). The antistreptolysin O titre was elevated, but the complement component was within the normal range. The importance of the coxsackievirus B(4) in the pathogenesis of acute glomerulonephritis is clearly indicated; however, further investigations are needed to understand the details of the virus-kidney interaction.

Topics: Acute Disease; Antistreptolysin; Blood; Child; Complement System Proteins; Coxsackievirus Infections; Enterovirus; Feces; Glomerulonephritis; Humans; Male; Neutralization Tests; Nose; Pharynx; Pneumonia; Streptococcal Infections; Urine

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Aged; Ampicillin; Animals; Candida; Clostridium perfringens; Cloxacillin; Electroencephalography; Enterobacteriaceae; Enterococcus faecalis; Escherichia coli; Feces; Female; Hepatic Encephalopathy; Humans; Inguinal Canal; Klebsiella; Liver; Male; Middle Aged; Neisseria meningitidis; Neomycin; Nose; Perfusion; Pharynx; Proteus; Pseudomonas aeruginosa; Sepsis; Skin; Staphylococcus; Swine

Topics: Acute Disease; Adolescent; Antibodies; Audiometry; Bacteria; Bacterial Infections; Child; Child, Preschool; Drainage; Ear, Middle; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Methods; Nasal Decongestants; Nose; Otitis Media; Penicillins; Rupture, Spontaneous; Streptococcus pneumoniae; Tympanic Membrane

Organ cultures of human embryonic trachea in test tubes were used as an adjunct to tissue cultures in the isolation of respiratory viruses from children in hospital. Fifty-one viruses were obtained from 127 specimens, giving an isolation rate of 40%. Fifteen viruses were isolated from the original tissue cultures and also after passage through organ culture. Thirty viruses were isolated from the original tissue culture only, and six viruses only from organ culture (three para-influenza, one influenza A, and one rhinovirus). An increase of 5% in virus isolation rate over that of standard tissue culture was obtained.

Topics: Acute Disease; Child; Culture Techniques; Embryo, Mammalian; Fibroblasts; HeLa Cells; Humans; Kidney; Nose; Organ Culture Techniques; Orthomyxoviridae; Pharynx; Respiratory Tract Diseases; Respirovirus; Rhinovirus; Trachea; Virus Cultivation; Viruses

Topics: Acute Disease; Antibodies; Bacteriological Techniques; Blood Sedimentation; Carrier State; Child; Female; Fluorescent Antibody Technique; Humans; Leukocyte Count; Male; Nose; Penicillin G Benzathine; Pharyngitis; Pharynx; Respiratory Tract Infections; Rheumatic Fever; Species Specificity; Streptococcal Infections; Streptococcus; Tonsillitis

Topics: Acute Disease; Antineoplastic Agents; Bacteria; Candida; Escherichia coli; Feces; Humans; Leukemia; Nose; Pharynx; Staphylococcus; Streptococcus

Topics: Acute Disease; Age Factors; Antibodies; Blood; Bronchiolitis, Viral; Cell Line; Child, Preschool; Complement Fixation Tests; Cytopathogenic Effect, Viral; Feces; Female; Hemadsorption Inhibition Tests; Humans; Infant; Laryngitis; Male; Mumps virus; Nose; Pharynx; Pneumonia; Population Surveillance; Sex Factors; Time Factors

Topics: Acute Disease; Adolescent; Antibody Formation; Asthma; Child; Chronic Disease; Exocrine Glands; Female; Hemagglutination Inhibition Tests; Humans; Immunization; Immunoglobulin A; Immunoglobulins; Influenza Vaccines; Injections; Injections, Subcutaneous; Male; Neutralization Tests; Nose; Orthomyxoviridae

Topics: Acute Disease; Child, Preschool; Female; Haemophilus influenzae; Humans; India; Infant; Infant, Newborn; Lung; Male; Methods; Mycoplasma; Nose; Pharynx; Poliovirus; Punctures; Respiratory Tract Infections; Trachea

Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Bacteria; Child; Child, Preschool; Complement Fixation Tests; Female; Haemophilus influenzae; Humans; Male; Middle Aged; Mycoplasma; Nasopharynx; Nose; Pharynx; Respiratory Tract Infections; Sputum; Staphylococcus; Streptococcus pneumoniae; Streptococcus pyogenes

Topics: Acute Disease; Adult; Air Microbiology; Anti-Bacterial Agents; Antisepsis; Candida; Ear; Escherichia coli; Humans; Infection Control; Infections; Leukemia; Male; Methods; Middle Aged; Nose; Patient Isolators; Skin; Urine

Topics: Acute Disease; Adult; Amphotericin B; Blood Cell Count; Blood Platelets; Candida; Candidiasis; Cytarabine; Feces; Fever; Humans; Hypersplenism; Leukemia; Leukemia, Myeloid, Acute; Leukocyte Count; Male; Nose; Pharynx; Prednisone; Skin; Spleen

Topics: Acute Disease; Anti-Infective Agents; Drug Therapy; Humans; Larynx; Nose; Respiratory Tract Infections

Topics: Acute Disease; Child, Preschool; Humans; Larynx; Nose; Respiratory Tract Diseases; Trachea

Topics: Abscess; Acute Disease; Disease; Ethmoid Sinus; Ethmoid Sinusitis; Humans; Nasal Septum; Nose; Paranasal Sinus Diseases; Sepsis