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Biomedical subjects

V Backer

Publications and source records attributed to V Backer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prevalence and predictors of rhinitis in Danish children and adolescents.

BACKGROUND: The prevalence of self-reported symptoms of allergic rhinitis is increasing in many countries, but the reasons for this trend are not well understood. Data from a 6-year follow-up study of a population sample of children and adolescents (n=408), aged 7-17 years at enrolment in 1986, were analyzed to investigate the prevalence and predictors of self-reported rhinitis. METHODS: Case history was used to assess the presence or absence of rhinitis (sneezing and running or blocked nose not associated with a cold), asthma, and eczema. Pulmonary function, skin prick test reactivity, and airway responsiveness to histamine were measured in all participants; a screening test for IgE antibodies to common allergens (Magic Lite SQ, Allergy Screen, ALK, Denmark) was performed in 237 (58%) of the participants. RESULTS: The point prevalence of rhinitis increased from the first to the second survey, 14% and 22%, respectively; 54 (13%) of the subjects reported rhinitis only at the second survey (new rhinitis). Confining the analysis to participants without symptoms of rhinitis at the first survey showed that self-reported eczema (relative risk [RR] 2.3, 95% confidence interval [CI] 1.2-4.7), airway hyperresponsiveness (RR 2.5, CI 1.8-3.0), atopy to grass pollen (RR 2.6, CI 1.7-3.3), atopy to dog dander (RR 2.4, CI 1.6-3.3), and atopy to house-dust mite (RR 2.7, CI 1.4-5.2) at the first survey predicted an increased risk of the presence of rhinitis at the second survey. A positive Allergy Screen test at enrollment was associated with an increased risk of self-reported rhinitis at follow-up (RR 2.4, CI 1.4-3.4). CONCLUSIONS: This longitudinal population study of children and adolescents showed an age-related increase in the point prevalence of self-reported rhinitis; furthermore, sensitization to common aeroallergens, airway hyperresponsiveness, and the presence of self-reported eczema were significantly associated with an increased risk of subsequent development of rhinitis.

Adolescent↗
PubMed1999

[Smoking intervention among hospital staff at the H:S Bispebjerg Hospital. Toward a non-smoking hospital--short-term results].

As part of aiming towards a non-smoking hospital environment, staff at a Copenhagen university hospital were offered participation in a differentiated smoking cessation programme. This consisted of lectures, group therapy, follow-up visits and individually tailored nicotine replacement therapy free-of-charge for six weeks. Three hundred and seventy-four employees started the programme, with 353 continuing for the full six weeks. They were moderately nicotine dependent with a Fagerström score of 5 (0-10). Almost all smoked daily and smoked at work, with 87% having a CO measurement above 5 at the first visit. At six weeks follow-up 209 (59%) were still not smoking and a further seven (2%) had reduced their tobacco consumption substantially. The remainder had started smoking again. Only 10% had a CO measurement > 5 at the end of the study. In conclusion, a combination of theoretical education, individual follow-up visits and nicotine replacement therapy is useful and worthwhile in the effort to support hospital staff in smoking cessation.

Adolescent↗
PubMed1999

Nonreversible airflow obstruction in life-long nonsmokers with moderate to severe asthma.

The aim of this longitudinal study was to assess the frequency of nonreversible airflow obstruction (NRAO) among adults with moderate to severe asthma, and to compare the decline of forced expiratory volume in one second (FEV1) in asthmatics with reversible and nonreversible airflow obstruction. Ninety-two (31 males) life-long nonsmokers with asthma participated in a 10-yr follow-up study; mean age 37 yrs (range 18-64) and duration of asthma 16 yrs (range 2-60) at enrolment. Case history, including use of asthma medication, was obtained, and pulmonary function, including diffusion capacity, was measured using standard techniques. At enrolment, all patients had typical symptoms and reversible airflow obstruction. (NRAO) was defined as FEV1 <80% predicted and change in deltaFEV1 after 5 mg salbutamol <9% pred. A total of 21 (23%) patients (mean age at enrolment 32 yrs) fulfilled the criteria for NRAO at the time of follow-up; current therapy was inhaled steroids (n=21, mean daily dose 1.5 mg), oral steroids (n=14), theophylline (n=20), oral beta2-agonist (n=6) and inhaled beta2-agonist. The patients with NRAO (n=21) had a steeper decline in FEV1 than the remaining patients (n=71, reversible airflow obstruction (RAO)), mean+/-SD 53+/-23 mL x yr(-1) and 36+/-21 mL x yr(-1), respectively (p<0.003). Increasing degree of bronchodilator reversibility (deltaFEV1% pred) at enrolment (p=0.002) and long-term treatment with oral corticosteroids (p=0.009) were associated with an increased risk for the presence of NRAO at follow-up. The comparison of data for NRAO and RAO patients (at follow-up) revealed no significant differences in mean values for total diffusion capacity (TL,CO), diffusion constant (KCO), or total lung capacity. The findings suggest that a subgroup of asthmatics may experience very steep rates of decline in forced expiratory volume in one second leading to severe nonreversible airflow obstruction, whereas no indication was found that long-standing asthma may lead to the development of emphysema.

Adolescent↗
PubMed1999

A longitudinal study of serum ferritin in 319 adolescent Danish boys and girls examined in 1986 and 1992.

This study examined trends in iron status in adolescents. Serum ferritin was measured in 1986 and 1992 in 319 Danes (161 males) stratified into 5 groups: I. median age 9 yr in 1986 vs. 15 yr in 1992; II. 11 vs. 17 yr; III. 13 vs. 19 yr; IV. 15 vs. 21 yr; V. 17 vs. 23 yr. Males in group I demonstrated no change in ferritin or estimated iron stores in mg/kg; groups II-V displayed an increase in iron status parameters. All groups showed an increase in estimated total iron stores. Changes in iron status parameters were inversely correlated with height velocity in group III, and positively correlated with height velocity in group V. Females in age groups I and II demonstrated a fall in ferritin and estimated iron stores in mg/kg in association with menarche; values were unchanged in groups III and IV, and increased in group V. All groups showed an increase in estimated total iron stores. Changes in iron status parameters were inversely correlated with height velocity in groups I and II. In conclusion, ferritin levels in adolescents display great variation during growth spurt and at menarche. Changes in ferritin showed no consistent association with growth velocity. In both genders, estimated total iron stores increased with age.

Adolescent↗
PubMed1999

Markers of impaired growth of pulmonary function in children and adolescents.

Our knowledge about the age-related growth of pulmonary function is incomplete. The purpose of this study was to describe the relation of various factors to the growth of pulmonary function in children and adolescents. A population sample comprising 408 children and adolescents (7-17 yr of age at enrollment) was reexamined after a 6-yr interval. Case history was obtained by interview and questionnaire. Pulmonary function, skin prick test reactivity to common allergens, and airway responsiveness (AR) were measured using standard techniques; airway hyperresponsiveness (AHR) was defined as a concentration of histamine causing a 20% decline in FEV1 < 8 mg/ml. The cross-sectional analyses of data from the two surveys showed that the presence of asthma (p < 0.02), atopy to house dust mite (HDM) (p = 0.03), and increasing degree of AR (p < 0.002) were associated with a lower level of FEV1 %pred. The longitudinal analysis revealed that asthma (p = 0.0001) and a lower level of FEV1 (p < 0.0001) at enrollment were associated with a lower level of FEV1 at follow-up. Further, an increase in the degree of AR (p = 0. 0001), new asthma (p = 0.0002), and new atopy to HDM (p = 0.03) also predicted a lower level of FEV1 at the end of the observation period. Confining the analysis to subjects without asthma and without evidence of AHR (n = 271) showed that both persistent (p = 0.04) and new (p = 0.03) atopy to HDM predicted a lower level of FEV1 at follow-up; compared with subjects with a negative skin reaction to HDM, those subjects who were sensitized to HDM had on average a 5%pred lower level of FEV1. The growth of FEV1 in children and adolescents appears to be impaired not only by symptomatic asthma but also by an increase in the degree of AR and atopy to HDM; sensitization to HDM appears to have a negative impact on the age-related growth in FEV1 even in nonasthmatic subjects without evidence of AHR.

Adolescent↗
PubMed1998

[Surgical treatment of obstructive sleep apnea syndrome. An evidence-based agreement].

OBJECTIVES: To determine the current efficacy of type of surgery in the treatment of obstructive sleep apnoea. SEARCH STRATEGY: Electronic searches of the Cochrane Airways Group Sleep Apnoea RCT Register, MEDLINE, EMBASE and Cinahl. The references of relevant review articles were handsearched. Experts in the field were contacted to identify unpublished studies. SELECTION CRITERIA: The inclusion criteria were all randomised or quasi-randomised controlled comparisons of any surgical intervention for obstructive sleep apnoea versus other surgical or non-surgical intervention for obstructive sleep apnoea or no intervention. DATA COLLECTION AND ANALYSIS: No completed RCTs were identified by the search. MAIN RESULTS: A total of 666 articles were identified and assessed. No articles fulfilled the inclusion criteria. CONCLUSIONS: A thorough search with broad inclusion criteria yielded no evidence from randomised controlled trials to support the use of surgery in the treatment of obstructive sleep apnoea. Patients should be made aware of the lack of good trial-based evidence for the operations. An urgent need for high quality RCTs in this area was identified.

Controlled Clinical Trials as Topic↗
PubMed1998

[Risk factors for the development of asthma in children and adolescents. Results of a longitudinal study].

To investigate risk factors for the development of asthma, a population sample of children and adolescents, aged 7 to 17 yrs at enrollment, were studied twice, with a six year interval; complete data was available for 408 subjects (199 males). Obtained case history was used to assess the presence of asthma; pulmonary function, skin prick test reactivity, total serum IgE and bronchial responsiveness to inhaled histamine (BHR) were measured using standard techniques. The 12-month period prevalence of asthma increased significantly from the first to the second examination in both males (p < 0.001) and females (p < 0.001), whereas the number of subjects with a positive histamine challenge test declined in both sexes. The prevalence of a positive skin prick test was higher at the second examination (26% and 44%, respectively, p < 0.001); the proportion of subjects with a positive skin reaction to house dust mite (HDMpos) increased from 14% to 26%. Confining the analysis to subjects without a history of asthma at the first examination showed that asymptomatic BHR (Odds Ratio [OR] 3.8 [95% Confidence Interval (CI) 2.5-5.1], p = 0.0002), HDMpos (OR 2.6 [CI 1.9-3.3], p = 0.005), a history of wheezy bronchitis before the age of two yrs (OR 3.8 [CI 2.4-5.2], p = 0.006) and a history of rhinitis and/or eczema (OR 2.8 [CI 1.7-3.9], p = 0.007) at first examination were associated with an increased risk for development of symptomatic asthma at some point between the two examinations. No significant relationship could be demonstrated between smoking (passive or active) and the risk for development of asthmatic symptoms. In conclusion, this longitudinal population study showed an increase in the 12-month period prevalence of asthma with sensitization to HDM and asymptomatic BHR as important risk factors for development of asthma.

Adolescent↗
PubMed1998

Longitudinal determinants of bronchial responsiveness to inhaled histamine.

BACKGROUND AND STUDY OBJECTIVE: The point prevalence of bronchial hyperresponsiveness (BHR) is imperfectly associated with current asthma, possibly due to changes over time in bronchial responsiveness (BR). To evaluate cross-sectional and longitudinal determinants of BR, a population sample comprising 408 children and adolescents, aged 7 to 17 years at enrollment, was examined twice, 6 years apart. METHODS: Case history was obtained by interview and questionnaire. BR to inhaled histamine, pulmonary function, and skin prick test reactivity were measured using standard techniques. RESULTS: The point prevalence of BHR (the concentration of histamine causing a 20% decline in FEV1 <8 mg/mL) declined from childhood to early adulthood (25% and 6%, respectively; p<0.001); and similarly a decline in histamine dose-response slope was observed. At both surveys, prechallenge FEV1 percent predicted, asthma, and atopy, especially atopy to house dust mite (HDM), were important determinants for the degree of BR. After adjustment for prechallenge FEV1 percent predicted, no male-female difference was observed in degree of BR. Lower FEV1 percent predicted (p=0.003), asthma (p<0.001), higher degree of BR (p=0.003), and atopy to HDM (p=0.007) at enrollment predicted a higher degree of BR at the second survey (degree of BR at second survey adjusted for prechallenge FEV1). Furthermore, new asthma (p<0.001) and/or atopy to HDM (p=0.003) were associated with higher BR at the second survey. Confining the analysis to nonasthmatics showed that subjects with new or persistent atopy to HDM had significantly increased BR compared with nonatopic subjects; and, moreover, prechallenge FEV1 percent predicted was significantly correlated with BR. CONCLUSIONS: BR declines from childhood to early adulthood, possibly reflecting the increase in airway caliber. The level of FEV1 and atopy, especially to HDM, are important determinants for changes over time in level of BR, also in nonasthmatic subjects.

Administration, Inhalation↗
PubMed1997

Acute meningococcal meningitis: analysis of features of the disease according to the age of 255 patients. Copenhagen Meningitis Study Group.

Clinical and laboratory features of acute meningococcal meningitis according to age were studied in 255 patients. Whereas males accounted for three out of five patients aged 0-4 years, females accounted for three out of four patients older than 50 years of age. All patients had clinical signs of nuchal rigidity and fever. Patients older than 30 years of age had less frequent petechiae (62%) than younger patients (81%). Furthermore, elderly patients above 50 years of age were prone to an obtunded mental state and a prolonged disease course with fever. Without relation to age, 2/3 had purulent meningitis and 2/3 had marked peripheral leucocytosis (> 15 x 10(9) cells/l); 90% of patients had at least one of these findings. The cellular inflammatory response in peripheral blood indicated a bacterial aetiology in > 95% of the cases. More than 80% of children and adults had abnormal CSF biochemical findings, but the level of protein and the glucose ratio (CSF/serum) were positively and negatively correlated to increasing age of the patient, respectively: thus, in children these biochemical markers may be unreliable in the differentiation between a bacterial and non-bacterial aetiology. Thrombocytopenia (< 100.000 x 10(9)/I) was not associated with age, though the lowest platelet count was found in elderly patients. The case fatality rate was 7.5%, but neither age, sex nor sign of septicaemia was associated with fatality. Thrombocytopenia, a lowered coagulation index (< 0.5, factors II, VII, X), a moderate anaemia (haemoglobin < 11 g/dl), an obtunded mental state and a history of convulsions were poor prognostic factors; only anaemia was independently correlated to fatality so this should be considered as an important prognostic marker in the acute phase of meningococcal meningitis.

Acute Disease↗
PubMed1996

[Extrinsic and intrinsic asthma from childhood to early adult age. A 10-year follow-up].

The purpose of this study was to describe factors of potential importance for the outcome in children with intrinsic and extrinsic asthma. Of 85 consecutive children, five to 15 years of age, with asthma, 70 (82%) participated in a ten year follow up examination. At the time of referral all children underwent certain tests for asthma (case history, total IgE, skin prick tests, radioallergosorbent tests (RAST) and specific bronchial provocations). On the basis of these tests 24 children had intrinsic asthma and 46 extrinsic asthma. At the follow up examination 60 of the 70 adults (86%; 20 with intrinsic asthma) had current symptoms; 54 of the 60 (90%; 18 with intrinsic asthma) were receiving maintenance therapy. Both FEV1 %pred (from 73% +/- 19% to 92% +/- 17%) and FEV1/FVC (from 75% +/- 13% to 80% +/- 12%) increased significantly from childhood to early adulthood (p < 0.0002 and p < 0.001, respectively); a corresponding amelioration of symptoms was also observed (p < 0.0001). In children with intrinsic asthma the outcome seems to be predicted by a combination of the initial frequency of symptoms (p = 0.04), initial FEV1 (p = 0.001), active smoking (p = 0.001) and age at onset of respiratory symptoms (p = 0.001), whereas the initial FEV1 (p < 0.001) seems to be a strong predictor for the outcome in children with extrinsic asthma. These findings suggest that the pathogenetic mechanisms underlying intrinsic and extrinsic asthma in children may differ.

Adolescent↗
PubMed1996

Risk factors for development of asthma in children and adolescents: findings from a longitudinal population study.

BACKGROUND: The prevalence of asthma appears to be on the increase, and risk factors are not well established. To investigate risk factors for the development of asthma, a population sample of children and adolescents, aged 7-17 years at enrolment, were studied in 1986. Initial examinations were repeated at follow-up in 1992; complete data was available for 408 subjects (199 males). METHODS: Obtained case histories were used to assess the presence of asthma; pulmonary function, skin prick test reactivity, total serum IgE and bronchial responsiveness to inhaled histamine were measured using standard techniques. RESULTS: The 12-month period prevalence of asthma increased significantly from the first to the second examination in both males (P < 0.001) and females (P < 0.001), whereas the number of subjects with a positive histamine challenge test declined in both sexes, although this was only statistically significant in males (P < 0.001). The prevalence of a positive skin prick test was higher at the second examination (26% and 44%, respectively, P < 0.001); the proportion of subjects with a positive skin reaction to house dust mite (HDM pos) increased from 14% to 26%. Bronchial hyper-responsiveness to inhaled histamine (BHR), HDM allergy, a history of wheezy bronchitis and symptoms of asthma at first examination were more prevalent among subjects reporting asthma at the second examination than among subjects without respiratory symptoms. Confining the analysis to subjects without a history of asthma at the first examination showed that asymptomatic BHR ¿Odds ratio [OR] 3.8 [95% confidence interval (CI) 2.5-5.1], P = 0.0002¿, HDM pos [OR 2.6 (95% CI 1.9-3.3), P = 0.005], a history of wheezy bronchitis before the age of 2 years [OR 3.8 (95% CI 2.4-5.2), P = 0.006] and a history of rhinitis and/or eczema [OR 2.8 (95% CI 1.7-3.9), P = 0.007] at first examination were associated with an increased risk for development of symptomatic asthma at some point between the two examinations. No significant relationship could be demonstrated between smoking (passive or active) and the risk for development of asthmatic symptoms. CONCLUSIONS: In conclusion, this longitudinal population study showed an increase in the 12-month period prevalence of asthma with sensitization to HDM and asymptomatic BHR as important risk factors for development of asthma; the temporal relationship between sensitization to HDM and presence of airway abnormalities needs to be explored further.

Adolescent↗
PubMed1996

Serum YKL-40 levels in healthy children and adults. Comparison with serum and synovial fluid levels of YKL-40 in patients with osteoarthritis or trauma of the knee joint.

YKL-40 is a recently discovered human glycoprotein which is related in amino acid sequence to the chitinase protein family. YKL-40 is a major secretory protein of human chondrocytes and synoviocytes, and could play a role in tissue remodelling. The aim of the study was to establish the serum YKL-40 level in normal subjects and to evaluate serum YKL-40 as a marker for osteoarthritis. Serum YKL-40 was 80 micrograms/l in healthy children (n = 476) and 102 micrograms/l in healthy adults (n = 260). No age or sex differences were found in serum YKL-40 in subjects younger than 70 yr, but thereafter serum YKL-40 increased significantly. Patients with late-stage osteoarthritis of the knee (n = 37) had significantly higher serum YKL-40 (1.5-fold; P < 0.01) compared to healthy age-matched subjects, whereas patients with early-stage osteoarthritis of the knee or recent torn cruciate ligaments or menisci did not have elevated serum YKL-40. The level of YKL-40 in serum and synovial fluid correlated significantly, and 10-fold higher values were found in synovial fluid. YKL-40 levels in serum and synovial fluid of patients with acute severe synovial inflammation were significantly higher (P < 0.05-P < 0.001) than those in patients with no, light or moderate synovitis of the knee joint. Furthermore, YKL-40 correlated significantly (P < 0.01) with the amino-terminal propeptide of type III procollagen, but not with serum C-reactive protein. Our data indicate that YKL-40 in synovial fluid and serum may reflect human articular cartilage degradation and the degree of synovial inflammation in the knee joint.

Adipokines↗
PubMed1996

Increased bronchial responsiveness to exercise as a risk factor for symptomatic asthma: findings from a longitudinal population study of children and adolescents.

The prevalence of asthma seems to be on the increase and risk factors are not well-established. To investigate the relationship between asymptomatic increased bronchial responsiveness to exercise (BRE) and subsequent development of asthma, we studied a population sample of children and adolescents, aged 7-17 yrs at enrollment, examined twice 6 yrs apart (54 and 68%, respectively, of the original sample participated in the two examinations). Complete information was available for 383 subjects (191 males and 192 females). Case history and questionnaire data were obtained and were used to assess the presence or absence of symptomatic asthma. Exercise testing, performed at enrolment only, consisted of steady running on a 10% sloping treadmill for 6 min in a climate chamber. BRE was recorded as percentage fall in forced expiratory volume in one second (FEV1) from pre-exercise FEV1, within 15 min after exercise. Twenty subjects (5%) had asthma at enrolment, whereas 58 subjects (15%) had current asthma (i.e. symptoms within the preceding 12 months) at the time of follow-up, of whom 40 were asymptomatic at enrolment (new asthma). In general, increased BRE at enrolment was significantly associated with symptomatic asthma at follow-up. Analysing the data for subjects who were asymptomatic at enrolment (n=363), showed that new asthma at follow-up was not predicted by increased BRE at enrolment, whether BRE was evaluated as a continuous (R2=0.06, p=0.13) or dichotomous (cut-off: BRE =10% decline in FEV1; odds ratio (OR) 0.8 (0.4-1.2); p=0.11) variable. However, the data do not exclude the possibility that asymptomatic subjects with BRE >15% have an increased risk for subsequent development of asthma. The findings of the present study suggest that increased bronchial responsiveness to exercise in asymptomatic children and adolescents is not a strong predictor for subsequent development of symptomatic asthma. Further studies, preferably of larger samples, are needed to confirm these findings.

Adolescent↗
PubMed1995

Extrinsic and intrinsic asthma from childhood to adult age: a 10-yr follow-up.

BACKGROUND: Asthma constitutes one of the most common chronic diseases in childhood, yet little is known about the factors that determine the outcome in childhood asthma. The purpose of this study was to describe various factors of potential importance for the outcome in children with intrinsic and extrinsic asthma. METHODS: Of 85 consecutive children, 5-15 years of age with asthma, 70 (82%) participated in a 10-yr follow-up examination. At the time of referral, all children underwent certain tests for asthma (case history, total IgE, skin prick tests, radioallergosorbent (RAST) tests and specific bronchial provocations). On the basis of these tests, 24 children had intrinsic asthma and 46 children had extrinsic asthma. RESULTS: At the follow-up examination, 60 of the 70 adults (86%, 20 with intrinsic asthma) had current symptoms; 54 of the 60(90%; 18 with intrinsic asthma) were receiving maintenance therapy. Both FEV1 %predicted and FEV1/FVC increased significantly (from 73% +/- 19% to 92% +/- 17% and from 75% +/- 13% to 80% +/- 12% respectively) from childhood to early adulthood (P < 0.0001 and P < 0.001), respectively); a matching amelioration of symptoms was observed (P < 0.0001). Adults with current symptoms had a significantly lower FEV1 %predicted at the time of follow-up (90% +/- 2% vs. 100% +/- 4%, P < 0.02) but not in childhood (73% +/- 20% vs. 71% +/- 10%) than adults who had ceased wheezing. CONCLUSIONS: In children with intrinsic asthma, the outcome seems to be predicted by a combination of the initial frequency of symptoms (P = 0.04), initial FEV1 (P = 0.002), active smoking (P = 0.001) and age at onset of respiratory symptoms (P = 0.001), whereas the initial FEV1 (P < 0.001) seems to be a strong predictor for the outcome in children with extrinsic asthma. These findings suggest that the pathogenic mechanisms underlying intrinsic and extrinsic asthma in children may differ.

Adolescent↗
PubMed1995

Acute meningitis of unknown aetiology: analysis of 219 cases admitted to hospital between 1977 and 1990.

Clinical and biochemical parameters in 219 patients with meningitis of unknown aetiology were analyzed according to their initial CSF leucocyte count. The male/female ratio was 1.1 and the median age 30 years,(males = 22 years/females = 42 years). Pre-admission antibiotic, which may inhibit bacterial growth, was given to 28% patients. On admission symptoms of meningitis were predominant: 96% had fever, 91% neck rigidity and 19% a severely affected mental state. In addition, 10% had a petechial rash. A bacterial aetiology was likely, as 91% had a predominance of polymorphonuclear leucocytes in the CSF and in 50% it was frankly purulent. The CSF leucocyte count correlated positively with age, the period of fever and the length of hospitalization, but did not relate to the 10.1% in-patient mortality rate. Mortality was related to advancing age, but not to the antibiotic regimen chosen. Patients admitted directly from their homes had the least complicated disease course and all survived. A low CSF leucocyte count, mainly found in young patients so admitted, could indicate either a non-bacterial self-limiting aetiology or diagnosis at an early stage of the disease. We found, however, that bacterial meningitis cannot be excluded on the basis of the CSF leucocyte count in combination with any clinical and biochemical parameters. Rapid hospital admission, regardless of age, is of major importance for prognosis. Improvement of non-cultural diagnostics tests and adjunctive therapy regimens are essential.

Acute Disease↗
PubMed1995

Persistent reduction in lung function after Pneumocystis carinii pneumonia in AIDS patients.

By means of serial lung function tests we examined the changes in lung function and possible pulmonary long-term sequelae in AIDS patients with a primary episode of Pneumocystis carinii pneumonia (PCP). A total of 19 patients had lung function tests performed prospectively from the time of PCP diagnosis, at 7 days, 14 days, 1, 2, 3, 4.5, 6 and 9 months after PCP. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were both reduced to a median of 61% of predicted at PCP diagnosis, and were normalized within 1 month and 1 week respectively. The median pulmonary diffusing capacity for carbon monoxide (DLCO) was severely reduced to 43% of predicted during the acute infection. Although DLCO improved significantly during the first 2 months, it remained reduced at a median DLCO of 64% of predicted 9 months after PCP. We conclude that despite a general improvement in lung function during the first 2 months following the PCP diagnosis, ther was a persistent reduction in DLCO up to 9 months following PCP. The pathological mechanisms causing this reduction remain to be established.

AIDS-Related Opportunistic Infections↗
PubMed1995

Bronchial hyperresponsiveness in children and adolescents.

The frequency distribution of bronchial responsiveness to both inhaled histamine and exercise both exhibit a unimodal distribution, different from a normal distribution, whereas PC20 values exhibited a lognormal distribution. BHR to both inhaled histamine (PC20 < or = 8.0 mg/ml (21 (II))) and exercise (delta % FEV1 < or = 10% (22 (III)) was found in 16% of the children and adolescents, while 6% of the population had BHR to both stimuli (22 (III)). Although a significant relationship between responsiveness to inhaled histamine and exercise existed (rs = 0.3, p < 0.001), the lack of overlap indicates that the association between the two stimuli is more complex (20 (I)). Worldwide, considerable differences in the prevalence of children with BHR to both inhaled agents and exercise have been observed. The prevalence of BHR to histamine and exercise observed in the present study was similar to findings in other industrialized countries, while the prevalence of BHR in e.g. Africa is low. All subjects with asthma had BHR to histamine and 77% had BHR to exercise, but only 35% of those with BHR to histamine (20 (I)) and 25% of those with BHR to exercise (delta FEV1 > or = 10%) (22 (III)) had symptomatic asthma. Thus low PVpos indicates that bronchial challenges are inadequate tools for screening in epidemiologic studies of asthma. The present study, however, showed that the predictive values of a negative test (PVneg) was high (100% (23 (IV) and 99% (22 (III)), respectively) supporting that bronchial challenge testing can exclude the diagnosis of asthma. Furthermore, asymptomatic subjects with BHR had reduced increase in height and lung function (FEV1) during the follow-up period of 18 months. The present observation indicate that BHR may induce permanent impairment of the lung function. The degree of responsiveness was significantly influenced by the presence of asthmatic symptoms and atopy of which house-dust mites and horse epithelium were of specific importance, whereas no association was demonstrated between BHR and recent viral infection, smoke or level of lung function. In conclusion, BHR is frequently observed in population samples and the degree of responsiveness was closely related to asthma and atopy. In children and adolescents with BHR, the increased responsiveness remained unchanged and those who developed asthma had a preexisting asymptomatic BHR.

Administration, Inhalation↗