|
.................................... Search the net .................................... |
|
Paediatric pulmonology and allergology
|
|
|
|
Genius A. Norvaisas, Marius Zolubas. The system of asthma education in Lithuania. Arturas Kiziela. Etiology of hospital-acquired pneumonia. Aldona Rainyte. Community-acquired bacterial pneumonia in children. Algimantas Vingras, Jovile Vingraite. Probiotics in paediatric practice. Review article. Lithuanian Paediatric Asthma Guidelines 2001. Consensus Report of paediatricians, family doctors, paediatric intensive care doctors, allergologists and pulmonologists |
|
The evaluation of Danish BCG by sensitivity to tuberculin and BCG scaring in relation to dose and time of vaccination
Elena Suciliene
The purpose of the trial is to compare Danish BCG with WHO International Referens Preparation (IRP) of BCG by sensitivity to tuberculin, BCG scaring, and to test dose and age factor. Groups of the study: 1) 0.05 ml Danish vaccine given to neonates at birth, 2) half of the normal Danish BCG given at birth, 3) IRPBCG given at birth, 4) 0.05 ml Danish BCG given at 3 month of age. The IPF vaccine resulted in borderline significant larger reactions. Halving the dose resulted in smaller reactions, but the difference is not significant. Larger tuberculin reactions, as well as large scars were seen when Danish BCG was given at 3 months of age. There was a significant correlation between the BCG scars and outcome of tuberculin test. |
|
Measurements of Respiratory System Resistance by the Interupter Technique
Migle Klimantaviciene, Arunas Valiulis
Rint (the interrupter technique for the respiratory resistance measurement) is one of the several methods for lung functions measurement suitable for young children who are unable to perform spirometry reliably. The device is small and potable so it is very useful in ambulatory setting. Rint measurement is made during quiet tidal breathing and requires minimal co-ordination with person. This means that even acutely ill or tired children, of all ages, should be able to undertake the test successfully. The interrupter technique is based on the assumption that, during transient occlusion of the airway at the mouth, alveolar pressure will equilibrate rapidly with the mouth pressure. Airways resistance can then be calculated from the ration of the mouth pressure (measured immediately after occlusion) to the airflow at the mouth (measured just prior to occlusion). Rint decreases normally when a child is growing up, and increases in case of airway obstruction. Rint measurement is useful for determination of bronchodilator response, exercise-induced bronchospasm or provocation test response. Although Rint measurement is acceptable and suitable for most of 2-5 years old children, there are no standards for the technique. This makes comparison of Rint studies difficult. Certain aspects of measuring Rint have become accepted, such as supporting the cheeks and pharynx to minimize upper airway compliance and criteria for acceptable mouth-pressure versus time transients. Standards for other aspects of Rint measurement need to be agreed upon in order to ensure normal values are widely applicable. |
|
Bronchoalveolar lavage for the diagnosis of eosinophilic pneumonia
Edvardas Danila, Remigijus Valgemaras Nargela, Regina Aleksoniene, Bronislovas Satkauskas
Eosinopholic pneumonia has been defined as pulmonary infiltration of eosinophils independently of peripheral blood eosinophilia. This pulmonary disorder includes clinically different types of eosinophilic pneumonia and different causes. Analysis of bronchoalveolar lavage fluid cells is fundamentally important in diagnosis of eosinophilic pneumonia. Aim of the study was to evaluate clinical symptoms, spirometric indices and changes of cell counts in peripheral blood and bronchoalveolar lavage fluid of 12 patients with eosinophilic pneumonia and healthy volunteers (control group). It was confirmed diagnostic significance of bronchoalveolar lavage for the diagnostics of eosinophilic pneumonia.
|
|
Influence of the risk factors on the results of treatment of the esophageal atresia
Pranas Gurskas, Benjaminas Siaurusaitis
Objectives: to evaluate the influence of various risk factors on the treatment. Materials and methods: during the period of 1986-2000 147 patients were treated in our surgical department due to congenital esophageal atresia. We have analyzed case histories, protocols of operations, results of the treatment. Results and conclusions: high influence for survival after the operation is birth weight. In our opinion the best is L.Spitz classification – 1500g and more. Also associated congenital anomalies influence the prognosis, especially heart anomalies, but congenital cardiac anomalies are not the main risk factor. Precisely patient’s condition and risk factors before the operation could be evaluated using. Y.Michiaki and all classification (birth weight, existence of congenital cardiac anomalies and respiratory complication). According to this classification surgeon can choose the operation tactic, with determines the results. If the patient has no respiratory distress syndrome or pneumonia, primary repair of the esophageal atresia could be done during the first 24 hours. If the patient has respiratory distress syndrome or pneumonia, he is on the medium or major risk, operation should be delayed until the patient’s condition is stabilized or are performed palliative operations. |
|
System of asthma education in Lithuania
Genius A. Norvaisas, Marius Zolubas
Asthma education system in Lithuania is described, purposes and methods of education are discussed and medical-statistical indices of asthma are analyzed. It becomes obvious, that since 1992 we have improvement in asthma diagnostics (and, probably, increasing morbidity), reduced hospitalization rated for asthma treatment and reduced hospital stay. Economic effect is discussed. We think, that these changes are effects of several factors, with educational activities being on of them.
|
|
Etiological diagnosis of hospital-acquired pneumonia
Arturas Kiziela
Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring 48 (72) hours after admission to the hospital and excluding those incubation at the time of admission. Crude mortality rates for this disease range from 20 perc. to 50 perc. but deaths are often due to other causes in critically ill patients and average to 90 perc. with high-risk pathogens such as Pseudomonas aeruginosa. The diagnosis of HAP is difficult and the role of invasive testing is controversial. Fiberoptic bronchoscopy itself lows direct sampling of the lower respiratory tract. However, the bronchoscope itself will be contamined by organisms found in the upper airway. Sampling is usually performed in the distal airways where contamination is less likely. Obtaining distal pulmonary specimens from the suspected area in the lung using bronchoscopy with protected brush specimen (PSB) and bronchoalveolar lavage (BAL) is relatively simple and save, and the techniques used to detect and quantitate bacteria present in specimens are easy to perform, inexpensive, and available in all hospial laboratories familiar with BAL fluid analysis. The results of quantitative BAL and PSB cultures were significantly correlated. Using a cut-off point on 104 colony-forming unit (cfu) mL-1 in BAL and cut-off point of 103 cfu mL-1 in PSB. The sensitivity and specificity of each test did not differ: BAL sensitivity ~ 74 perc., specificity ~ 80-96 perc., PSB sensitivity ~74 perc., specificity ~88 perc. The presence of prior antimicrobial treatment in patients clinically suspected of pneumonia is frequently presented as a major limitation to accurate diagnosis.
|
|
Diagnosis and treatment of childhood acute respiratory infectious diseases at outpatient department
Algimantas Vingras, Reda Trusiene, Rita Bubinaite, Elona Kozmeniene
Diagnosis and treatment of acute respiratory infectious diseases (including otitis media) were studied at 2 Vilnius outpatient departments in year 2000. Health histories of 420 0-16-year-old children were looked through (every third history). Among them 326 children were ill with acute respiratory illnesses. In total 835 cases were recorded. Various acute respiratory infectious diseases were diagnosed mainly on the basis of 4 symptoms: cough, fever, running nose and inflamed throat. Upper respiratory tract diseases were diagnosed 2.9 times more often than lower respiratory tract diseases. The diseases were usually treated with antibiotics, cough medications, nasal drops, systemic decongestants, antipyretics, antihistamines, vitamins and homeopathic medications.
|
|
The incidence of Mycoplasma pneumoniae infection in hospital treated children with acute respiratory illness
Ramune Mykolaitiene
Mycoplasma pneumoniae is a common cause of community acquired respiratory tract infection. The aim of this study was to determine the rate of mycoplasmal infection in hospitalized children with upper and lower respiratory tract infection. 183 children with respiratory tract infection, aged 1-16 years, were studied. The mean age of patients was 7 years. Acute upper respiratory tract infection had twenty-four (13%) patients and 159 (87%) children suffered from acute lower respiratory tract infection. One hundred (55%) patients were found to have raised specific antibody IgM titres against M.pneumoniae, using immunoenzyme method (ELISA), and 83 (45%) children suffered from other etiology upper andl ower respiratory tract infection. M.pneumoniae infection was determined in all age groups. M.pneumoniae was detected twice (31) more often than other etiology (13) respiratory tract infection in children from 5 to 7 years of age. Mycoplasmal infection was most common in children from 5 to 12 years of age. However, no statistically significant difference was detected between rates of infections in the different age groups. Study has showed that M.pneumoniae is common cause of acute respiratory tract infection in hospitalized children. M.pneumoniae infection serologically was proved in 46% of patients with upper respiratory tract infection and in 56% of patients with lower respiratory tract infection. The rate of M.pneuoniae bronchitis (51%) did not differ significantly form other etiology (67%) respiratory tract infection. While M.pneumoniae was significantly more often the cause of pneumonia than other respiratory pathogens. In order to implement appropriate treatment, hospitalized children with acute upper an lower respiratory tract infection should be investigated more often for M.pneumoniae infection. Retrospective analysis has showed that outpatients with M.pneuoniae respiratory tract infections were treated with macrolides seldomly (26%). The primarily treatment with penicillins and cefalosporins was switched to macrolides in 59% of cases and overall macrolides received 85% of patients with M.pneumoniae infection.
|
|
Community acquired pneumonia in children: outpatient and inpatient antimicrobial treatment
Irena Narkeviciute, Loreta Peciuliene, Rita Fabijonaviciene
The aim of this study was ascertain what kind of antibiotics usually are used for the treatment of children with community acquired pneumonia and to determine what kind of antibiotics are usually used hospital and outpatient doctors. 150 children with pneumonia were treated with 22 different antibiotics. 32,7 perc. (49 children) were treated with antibiotics before hospitalization. 47.7 perc. children with pneumonia received 2-3 courses of antibiotics. Aminopenicillines were prescribed more often in outpatients clinics, penicillines and macrolide – in the hospital.
|
|
Community-acquired bacterial pneumonia in children Aldona Rainyte Review article presents debatable data concerning community-acquired typical pneumonia in children, based on the publication of International Forum on Community Acquired Pneumonia (Cambridge Medical Publ.) and original investigations. Pneumonia definition, classification, diagnostics, etiology, criteria for hospitalization and treatment are discussed in this article.
|
|
Differential diagnostic of child’s cough caused by tuberculosis Dalia Steponavicienë, Edita Tamulaitiene, Daiva Urbonaviciene
Cough is protective reflex reaction of organism and one of the symptoms of children tuberculosis (TB). Cough can be dry, wet, wearing and can disturb biological functions of the patient. In the article we discussing about cough caused by tuberculosis and it’s differential diagnostic with the other diseases followed by cough and the criteria of TB diagnostic. |
|
Effectiveness of therapy of recurrent or persistent acute otitis media with cefprozil in children Irena Narkeviciute, Justina Cipkuviene
The aim of the study was to evaluate the effectiveness of therapy with cefprozil (Cefil®) in children with recurrent and persistent acute otitis media. Thirty children 6 mo – 7 y of age were included in the study in the period of 1999-2001. All children received cefzil® orally 15 mg/kg two times daily for 10 days. We conclude that cefzil is an effective and well-tolerated for recurrent and persistent acute otitis media in children. |
|
Probiotics in pediatric practice (review article) Algimantas Vingras, Jovile Vingraite
The article is devoted to current standpoint of probiotics in paediatric practice. More widely safety and efficacy of probiotics registered in Lithuania is discussed, mode of action of probiotics to non-specific immune response and metabolic activity of human intestinal flora. Up to now the most widely investigated and clinically proved is Lactobacillus GG. It was confirmed that probiotics are a good alternative to antibiotics for the treatment of diarrhoeal diseases. The authors present few treatment algorithms, including indications for probiotics, dosage for children of all age groups as well as adults. The authors describe the significance of probiotics in the prevention and treatment of diarrhoea of various origins in infants and children, recovery of the function of gastrointestinal tract after the treatment with antibiotics, complex treatment of atopic dermatitis. |
|
|
November, 2001, Vol. IV, No.4 (p. 1513-1640)
