|
.................................... Search the net .................................... |
|
Paediatric pulmonology and allergology
|
|
|
|
Marius Zolubas. Allergology in Lithuania: problems and perspectives Arunas Valiulis, Rima Sabaliene, Saulius Rocka. The prevalence of bronchial asthma in Vilnius and Utena (ISAAC) Alan F.Isles, C.Waiwright, E.Banks, N.Freezer, Craig Mellis, C.Robertson, P.Sly, R.Staugas, P. van Asperen. Current Issues In The Treatment of Childhood Asthma in Australia Jurgis Bojarskas, Vilija Bubnaitiene. Childhood pneumonia complicated by pleural effusion Edita Pikzirniene, Stase Manukian, Dane Slapkauskaite. Analysis of pediatric TB infection and disease after household exposure to adult culture-positive pulmonary TB in Kaunas in 1994-98 Sigitas Dumcius, Magnus Nilsson. To the question of antibiotic use in cystic fibrosis Ramune Mykolaitiene. Management of Respiratory Tract Infectious with Clarithromycin Andrew Bush. Bacteriology of cystic fibrosis Andrew Bush. Management of Respiratory complications of Cystic Fibrosis Mohamed Bartal, William Busse, Jean Bousquet, Edgardo Carrasco, Yu-Zhi Chen, Alexander Chuchalin. Pocket Guide for Asthma Management and Prevention (GINA) Lithuanian State Standard: Paediatric pulmonologist (orders, duties, competence and responsibilities) |
|
Allergology in Lithuania: problems and perspectives
Marius Zolubas
Prevalence of allergic diseases is constantly increasing during the last decades, especially in developed countries. Genetic predisposition can not explain this phenomenon. Current hypotheses of "western" lifestyle influence on allergic pathology are reviewed, possibilities for prevention discussed and inevitability of sharp increase of allergic diseases in our country, based on recent epidemiological studies, stressed. Structure and problems of allergology service in Lithuania are analyzed and possibilities for improvement to cope with increasing burden of allergic pathology are discussed.
|
|
The prevalence of bronchial asthma in Vilnius and Utena (ISAAC)
Arunas Valiulis, Rima Sabaliene, Saulius Rocka
Certainly, the International Study of Asthma and Allergies in Childhood (ISAAC) is the largest and most standardized study in the World. This program is active in Lithuania also. Epidemiological study was carries out on years 1998-1999 in Vilnius, the capital of Lithuania (570 000 inhabitants) and Utena, center of rural area of North-East Lithuania (36 000 inhabitants). Two age groups of children were involved. The first group included 6-7 years old children (Vilnius n=2634, Utena n=781), the second one - 13-14 years of old (n=3544 and 1012 respectively). Diagnosed bronchial asthma was found in 1.75 perc. of cases among younger children in Vilnius and 2.56 perc. in Utena, among the 13-14 years old children - 3.3 perc. in Vilnius and 2.7 perc. in Utena. There were no significant differences in diagnosed cases of bronchial asthma in these two cities.
|
|
Current Issues In The Treatment Of Childhood Asthma In Australia
Alan F.Isles, C.Waiweight, E.Banks, N.Freezer, Craig Mellis, C.Robertson, P.Sly, R.Staugas, P. van Asperen
Most children with asthma can be managed by their general practitioner. It is important, therefore, for general practitioners to be able to diagnose asthma, asses the pattern and severity of a child's asthma, know when to introduce regular preventative treatment and to be aware of the difference in approach when treating asthma in children compared with adults. There are differences in the approach to treatment of asthma in children compared with treating adults. It is important to recognise these differences and not regard children with asthma as 'little adults' and apply adult treatment regimens. It is, in fact, difficult to provide definitive clinical guidelines for making a diagnosis of asthma in infants and children. In 1992, an international consensus statement described asthma as "episodic wheeze and/or coughing in a clinical setting where asthma is likely and other rarer conditions have been excluded". The goals of asthma treatment in children are to: minimise asthma symptoms; maximise and maintain best lung function; identify trigger factors to allow for avoidance strategies to be planned; reduce the frequency of acute episodes; achieve the best quality of life for the child with asthma; and avoid unnecessary side-effects from medication. The treatment of childhood asthma involves four steps including: assessment of the pattern and severity of symptoms as well identifying trigger factors; prescribing appropriate treatment; prescribing an age-appropriate delivery device; and regular review.
|
|
Childhood pneumonia complicated by pleural effusion
Jurgis Bojarskas, Vilija Bubnaitiene
Bacterial pneumonia is often accompanied by pleural effusion. In order to determine the factors influencing the development and clinical characteristics of parapneumonic effusion we have analysed clinical findings in 15 children with prapneumonic effusion. More than half of children (10 children) suffering from pneumonia with pleural effusion were between the ages of 9 and 15 years. The majority of children were hospitalised in Clinic of Paediatrics of Kaunas Medicine University after one week from the first typical signs of pneumonia. Almost all of them were treated with antimicrobial agents in other hospitals or at home. An aetiology was established in 5 of 15 patients. Clinical response in patients with prapneumonic effusion was slow, even with optimal treatment - systemic antibiotic therapy and repeated thoracentesis. The mean duration of fever was 10.5 days.
|
|
Analysis of pediatric TB infection and disease after household exposure to adult culture-positive pulmonary TB in Kaunas in 1994-98
Edita Pikzirniene, Stase Manukian, Dane Slapkauskaite
The main question of our work was to determine risk factors for pediatric TB infection and active TB. We examined medical records from Hospital of Tuberculosis and Lung Diseases for 122 children younger than 16 years in Kaunas during the period 1994 to 98 who were household contacts of an adult with culture positive pulmonary TB. In 60% of adult cases TM were sensitive to all specific drugs. In 23% - were resistance to >2 drugs. The time, since TB adults started till we diagnosed it in children, is unknown. All children were kept on permanent control or had specific treatment. 94% of contact children had TB. Contact children have a large risk to became ill with TB - they need special attention.
|
|
To the question of antibiotic use in cystic fibrosis
Sigitas Dumcius, Magnus Nilsson
Antibiotics have been a key component of the treatment of patients with CF since medical intervention began for this illness and these drugs have contributed to increased survival for CF patients. Although it is difficult to separate the beneficial effect of the various aspects of treatment better prognosis for CF patients has been in particular associated with the use of antibiotics. Antibiotics administered to patients with CF very often have beneficial effect even though conventional antibiotic susceptibility testing of the organisms present in the lungs indicates resistance to the drugs. However, there are still considerable differences of opinion as to when and for how long antibiotics should be given. In this article are discussed intermittent and continuous regimes of antibiotic therapy in children, criteria of pulmonary exacerbations are proposed.
|
|
Management of Respiratory Tract Infectious with Clarithromycin
Ramune Mykolaitiene
The treatment of respiratory tract infections is great medical and social problem worldwide. A macrolide family antibiotics particularly clarithromycin has been used for the treatment of those infections, since it is effective against typical and atypical microorganisms: Mycoplasma pneumoniae, Chlamydia pneumoniae, Uraplasma urealyticum, Legionella spp., Haemophilus influenzae, Moraxella catarrhalis, and, perhaps most importantly, penicillin-resistant Strptococcus pneumoniae. Clinical efficacy and safety of the treatment with clarithromycin for respiratory tract infections have been demonstrated in previously published comparative trials. The efficacy of clarithromycin has been compared with other antibiotics such as azithromycin, erythromycin, amoxicillin/clavulanic acid. The efficacy and safety studies discussed in this article have demonstrated clarithromycin's appropriateness for the management of children and adults with variety of respiratory infections.
|
|
Bacteriology of cystic fibrosis
Andrew Bush
Staphylococcus aureus was the major pathogen in children dying of CF. This organism together with Haemophilus influenzae is still important, particularly early in life. More than 80 perc. CF patients will become chronically colonised with mucoid Pseudomonas aeruginosa, which is rarely seen in any other disease. More recently, Burkholderia cepacia and related species have emerged as a feared pathogen, particularly because of its propensity for systemic disease, transmissibility and multiple antibiotic resistance. Other emerging organisms include Aspergillus fumigatus, Stenotrophomonas maltophilia and atypical (non-tuberculous) mycobacteria (NTM). The pathogenicity of some of these latter organisms has yet to be determined. This presentation will focus on what is known about the fundamental biology of the airway and how this has helped us understand why CF patients are colonised by this peculiar range of microorganisms; general antibiotic policies in CF, including management of particular common infections; and what is known about some of the newer pathogens and how airway infections caused by them should be managed.
|
|
Management of Respiratory complications of Cystic Fibrosis
Andrew Bush
This paper will cover non-antibiotic respiratory treatments for cystic fibrosis with modalities of respiratory monitoring and will concentrate on non-infective respiratory complications of cystic fibrosis. Chest physiotherapy seems to be the mainstay of mucus clearance. It is of the first importance that all CF patients have access to an experienced physiotherapist, because airway clearance techniques change with age, and need constant review. There are increasing worries in the CF community about the possible person to person transmission of organisms such as B.cepacia and S.maltophilia. Co-habiting for any length of time increases the risk of cross-infection. The disappointing results with steroids have prompted the use of the non-steroidal anti-inflammatory drugs. Evidence of exposure to A.fumigatus is common, and allergic bronchopulmonary aspergillosis (ABPA) relatively less common, with a prevalence in most clinics of around 10%. Pneumothorax usually complicates severe lung disease, and carries a high subsequent mortality from respiratory failure. Haemoptysis is almost invariably from bronchial arteries hypertrophied as a result of chronic airway inflammation and bronchiectasis. Eventually, the majority of patents with CF will have severe lung damage, bronchiectasis, right ventricular hypertrophy and failure, and hypoxic respiratory failure.
|
|
|
December, 1999, Vol. II, No. 4 (p. 517-626)
