Development of the index system of the quality evaluation standard for pharmacist training in cough and wheeze pharmaceutical care outpatient department / 中国药房

OBJECTIVE To establish the index system of quality evaluation standard for pharmacist training in cough and wheeze pharmaceutical care （CWPC） outpatient department， and to provide a basis for the selection of CWPC pharmacist training teachers and the improvement of training plans. METHODS Based on Kirkpatrick model， using the Delphi method， a total of 15 experts from 13 tertiary hospitals in 10 provinces in China were consulted to establish the standard index system of the quality evaluation for CWPC pharmacists training. Analytic hierarchy process （AHP） was adopted to determine the weights of each indicator and quantify the index system according to the weights of indicators at all levels. RESULTS The coefficient of expert authority was 0.810， the judgment coefficient was 0.727， and the familiarity coefficient was 0.893. The Kendall coordination coefficient of each index was 0.308-0.687. The P values of χ2 test were all less than 0.05， which indicated that the degree of coordination of the experts was high. After two rounds of correspondence， Kirkpatrick model-based index system of quality evaluation standard for CWPC pharmacist training was determined. The index system included 4 first-level indexes （participants’ reaction layer， learning gain layer， behavior improvement layer， training outcome layer）， 12 second-level indexes （such as training needs， teaching methods， theoretical knowledge， practical skills， job abilities， patient benefits， etc.） and 44 third-level indexes （such as clear training objectives， core system of CWPC， special device operation and evaluation， professional knowledge related to the treatment of cough and wheeze patients， promoting the construction of CWPC， improving patient compliance）. CONCLUSIONS The constructed index system of quality evaluation standard for CWPC pharmacist training has a certain level of authority and scientificity， and provides a scientific theoretical basis for quality evaluation of CWPC pharmacist training.

Cumulative inactivated vaccine exposure and allergy development among children: a birth cohort from Japan

BACKGROUND@#Adjuvants used in inactivated vaccines often upregulate type 2 immunity, which is dominant in allergic diseases. We hypothesised that cumulative adjuvant exposure in infancy may influence the development of allergies later in life by changing the balance of type 1/type 2 immunity. We examined the relationship between immunisation with different vaccine types and later allergic disease development.@*METHODS@#We obtained information regarding vaccinations and allergic diseases through questionnaires that were used in The Japan Environment and Children's Study (JECS), which is a nationwide, multicentre, prospective birth cohort study that included 103,099 pregnant women and their children. We examined potential associations between the initial vaccination before 6 months of age and symptoms related to allergies at 12 months of age.@*RESULTS@#Our statistical analyses included 56,277 children. Physician-diagnosed asthma was associated with receiving three (aOR 1.395, 95% CI 1.028-1.893) or four to five different inactivated vaccines (aOR 1.544, 95% CI 1.149-2.075), compared with children who received only one inactivated vaccine. Similar results were found for two questionnaire-based symptoms, i.e. wheeze (aOR 1.238, 95% CI 1.094-1.401; three vaccines vs. a single vaccine) and eczema (aOR 1.144, 95% CI 1.007-1.299; four or five vaccines vs. a single vaccine).@*CONCLUSIONS@#Our results, which should be cautiously interpreted, suggest that the prevalence of asthma, wheeze and eczema among children at 12 months of age might be related to the amount of inactivated vaccine exposure before 6 months of age. Future work should assess if this association is due to cumulative adjuvant exposure. Despite this possible association, we strongly support the global vaccination strategy and recommend that immunisations continue.@*TRIAL REGISTRATION@#UMIN000030786 .

Wheezy adult with chicken bone in the chest

A large foreign body aspiration in a healthy adult is rare in the literature. It is a frequent problem in children and adolescents. Adults are affected in altered sensorium, either due to sedation or neurological problems. Acute upper airway obstruction though rare in adults requires establishment of an airway using Laryngoscope or rigid bronchoscope. At times we have to recourse to tracheostomy to save the life. Foreign body often travels down the right sided airways, here we present a case of 30mm Chicken bone being lodged in the left main bronchus. The patient presented with unremitting cough and normal chest skiagram. Monophonic wheeze on auscultation and focused attention on the patient narration made us clinch the diagnosis. New onset wheezy chest or unremitting chronic airway disease on adequate therapy, with history of choking needs special attention. The CT scan is a better modality of the investigation. Three dimensional CT with multi-slice virtual bronchoscopy is advantageous. We discussed foreign body aspirations in adults, the various causes and presentations. Fiber optic bronchoscopy is the ideal method for visualization and extraction of non-life-threatening foreign bodies in adults. Once a foreign body is identified, it has to be removed as early as possible. Retained foreign bodies can precipitate many complications related to infection and inflammation. At rare incidence we may have to resort to thoracotomy to remove a complicated foreign body.

Best time for detecting experiment of fractional exhaled nitric oxide in young wheezing children / 中华实用儿科临床杂志

Objective@#To study the correlation between fractional exhaled nitric oxide (FeNO) and lung function in young children for acute attack of wheezing, and to compare the FeNO in different stages in order to explore the best suitable time for the experiment of FeNO in young children by the method of on-line tidal breathing.@*Methods@#Recurrent wheezing children aged 1-5 year old were selected who were underwent the test at lung function laboratory from January 2016 to March 2018, at Guangzhou Women and Children′s Medical Center.The children aged less than 5 years old were detected for FeNO in both stages of acute exacerbation and 2 weeks after treatment, and the children aged less than 3 years were also detected for the tidal lung function in the acute exacerbation stage.According to time ratio of reaching tidal peak flow to total expiratory time(TPTEF/TE )and ratio of volume at tidal peak flow to total tidal volume (VPEF/VE), the children aged less than 3 years were divided into 4 groups (normal group, mild group, moderate group and severe group).@*Results@#The FeNO of the normal group[9.85(5.17, 19.62) ppb] and mild group[13.00(7.00, 23.30) ppb] were significantly higher than that of the severe group [3.10(2.20, 5.25) ppb], and the differences were statistically significant(all P<0.05). And there was a positive correlation between TPTEF/TE and FeNO(r=0.304, P<0.05), VPEF/VE and FeNO(r=0.320, P<0.05), tidal volume per kilogram(VT/kG)and FeNO(r=0.293, P<0.05)and a negative correlation between respiration rate(RR)and FeNO(r=-0.449, P<0.05). The FeNO in the stage of acute exacerbation was significantly lower than that in the stage of 2 weeks after treatment[(10.49±8.49) ppb vs.(20.41±9.13) ppb], and there was a significant difference among them(t=-5.79, P<0.01).@*Conclusions@#If researchers want to use the method of on-line breathing to test FeNO in young children with wheezing, they should choose the time of 2 weeks after treatment, and analyze the results combined with the lung function.

Best time for detecting experiment of fractional exhaled nitric oxide in young wheezing children / 中华实用儿科临床杂志

Objective To study the correlation between fractional exhaled nitric oxide (FeNO) and lung function in young children for acute attack of wheezing,and to compare the FeNO in different stages in order to explore the best suitable time for the experiment of FeNO in young children by the method of on-line tidal breathing.Methods Recurrent wheezing children aged 1-5 year old were selected who were underwent the test at lung function laboratory from January 2016 to March 2018,at Guangzhou Women and Children's Medical Center.The children aged less than 5 years old were detected for FeNO in both stages of acute exacerbation and 2 weeks after treatment,and the children aged less than 3 years were also detected for the tidal lung function in the acute exacerbation stage.According to time ratio of reaching tidal peak flow to total expiratory time(TPTEF/TE) and ratio of volume at tidal peak flow to total tidal volume (VPEF/VE),the children aged less than 3 years were divided into 4 groups (normal group,mild group,moderate group and severe group).Results The FeNO of the normal group [9.85 (5.17,19.62) ppb] and mild group[13.00 (7.00,23.30) ppb] were significantly higher than that of the severe group [3.10 (2.20,5.25)ppb],and the differences were statistically significant (all P ＜ 0.05).And there was a positive correlation between TPTEF/TE and FeNO(r =0.304,P ＜ 0.05),VPEF/VE and FeNO(r =0.320,P ＜ 0.05),tidal volume per kilogram (VT/kG) and FeNO(r =0.293,P ＜ 0.05)and a negative correlation between respiration rate(RR) and FeNO (r =-0.449,P ＜ 0.05).The FeNO in the stage of acute exacerbation was significantly lower than that in the stage of 2 weeks after treatment[(10.49± 8.49) ppb vs.(20.41 ± 9.13) ppb],and there was a significant difference among them(t =-5.79,P ＜ 0.01).Conclusions If researchers want to use the method of on-line breathing to test FeNO in young children with wheezing,they should choose the time of 2 weeks after treatment,and analyze the results combined with the lung function.

Progress on the relationship between infant body weight and wheezing / 国际儿科学杂志

Infancy is the peak stage of weight gain,and overweight or obesity during this period may be closely linked to wheezing in infancy and the development of asthma in the future.Obesity has been proven to be a risk factor for asthma in adults and children,and numerous studies have shown the rationality of the mechanism.However,the relationship between weight and wheezing in infancy has rarely been reported.This review summarizes the latest research progresses of the relationship between them.

Rhinovirus and asthma in children / 国际儿科学杂志

Rhinovirus(RV) infection can lead to asymptomatic,mild symptoms from the upper respiratory tract to severe symptoms from the lower respiratory tract.RV is dentified as an important contributor to wheezing illness in preschool children.Wheezing is a symptom of airway obstruction,and preschool children wheezing with RV is associated with the development of asthma at school age.There is a debate whether there is difference in response to RV infection or if wheezing with RV only reveals a preexisting impairment that promotes asthma mainly in predisposed children.The development of molecular diagnostics to detect respiratory viruses has provided new insights into the role of RV infections.The review aims to discuss the relationship between RV infection and asthma.

Maternal status of vitamin D and risk of childhood wheeze: a systematic review and meta-analysis / 国际儿科学杂志

Objective To assess the association between vitamin D levels during pregnancy and the risk of offspring's wheeze.Methods We searched electronic databases of PubMed and EMbasefrom published studies until July 2017.A random-effects meta-analysis was conducted among 11 birth cohort studies.Results Eleven studies on the association between maternal vitamin D status and childhood wheeze met our inclusion criteria.Maternal vitamin D status during pregnancy was associated with childhood wheeze(OR =0.97,95％ CI:0.96 ～ 0.99).Maternal intake of vitamin D(pooled OR =0.51,95 ％ CI:0.37 ～ 0.64),cord blood 25 (OH)D levels at birth (pooled OR =0.94,95％ CI:0.9 ～ 0.98) were associated with childhood wheeze.Furthermore,maternal vitamin D stasus were only associated with childhood early wheeze(OR =0.92,95％ CI:0.89 ～0.96),but not with late-onset or persistent wheeze.Conclusion High levels of vitamin D during pregnancy are inversely associated with the risk of wheeze during childhood.

Clinical characteristics of hospitalized infants with acute lower respiratory tract infections induced wheezing and their changes in lung function / 中华实用儿科临床杂志

Objective To determine the clinical characteristics of acute lower respiratory tract infections (ALRIs)induced wheezing,and to explore the impact of wheezing ALRIs on the subsequent respiratory diseases and lung function. Methods A total of 1726 hospitalized infants who were diagnosed with ALRIs in Children′s Hospital of Fudan University between March 2011 and February 2012 were enrolled and classified into wheezing group and non -wheezing group. Data were collected regarding demographic characteristics,family status,clinical presentations,respira-tory pathogens,and pulmonary function tests (PFTs). Subjects were followed up with questionnaires in 6 months and 1 year after discharge. PFTs were performed in 50 wheezing infants at 6 months after discharge. Results In the 1726 hospitalized infants,471 cases had a wheezing episode (27. 3％). The majority (262 / 471 cases,55. 6％)of infants with wheezing were reported with a family history of atopy. The total detection rate of viruses in wheezing group was 73. 7％ . The detection rate of respiratory syncytial virus (RSV)in wheezing group was higher than that of non-whee-zing group (68. 6％ vs. 47. 0％),and the difference was significant (P < 0. 001). For infants less than 3 months,the wheezing group had less time to peak tidal expiratory flow as a percentage of total expiratory time (TPTEF/ TE)and volume to peak tidal expiratory flow as a percentage of total expiratory volume (VPTEF/ VE),compared with the non -wheezing group [(22. 9 ± 9. 8)％ vs. (29. 2 ± 12. 3)％ and (25. 7 ± 8. 0)％ vs. (29. 8 ± 9. 6)％,respectively],and the differences were significant (all P < 0. 05). After 6 months,the wheezing group increased TPTEF/ TE and VPTEF/VE [(24. 0 ± 9. 0)％ vs. (19. 9 ± 6. 7)％,(25. 8 ± 7. 0)％ vs. (23. 2 ± 5. 0)％,respectively],and the differences were significant (all P < 0. 05),but still below normal level. Patients with wheezing were more likely to develop subse-quent wheezing during the following 1 year (20. 0％ vs. 10. 6％),and the difference was significant (P < 0. 001). Conclusion Wheezing in infants with ALRIs is related to family history of atopy and viral infections,especially to RSV. Hospitalization for wheezing ALRIs is associated with impaired lung function and a higher frequency of subsequent wheezing.

Etiology and clinical analysis of infant wheeze / 中国小儿急救医学

Due to infant′s special respiratory anatomy and physiology features,many airway diseases performed wheezing. Infant wheeze has a high incidence, a complex etiology and lacks of specific signs, which leads to difficulties in its etiological diagnosis and differential diagnosis. Clinicians need gather detailed medical history,do careful physical examination,make a comprehensive judgement and etiology analysis of wheezing combining with relevant auxiliary examination data.

Consenso chileno SER-SOCHINEP para el manejo del asma en el preescolar / Chilean consensus on management of asthma in preschool children

Preschool wheezing is one of the most common presenting symptoms in pediatric practice. The vast majority of these patients present wheeze triggered by viral respiratory infections and only a minority of them will have asthma in school age. The evaluation of these children begin with a detailed clinical history and physical examination and standard laboratory tests to rule out secondary causes of wheezing. The decision for controlling therapy will depend on the frequency and severity of the wheezing episodes, but should always be considered as a treatment trial, avoiding prolonged periods of time. It is recommended to start with low doses of inhaled corticosteroids, evaluating treatment effect with a close follow up. Inhaled bronchodilators remain the treatment of choice in acute exacerbations of wheezing, systemic corticosteroids should be reserved for severe exacerbations in hospitalized patients.

Las sibilancias recurrentes del preescolar es una condición frecuente a la que se ve enfrentado el pediatra. La gran mayoría de estos pacientes presentan sibilancias en relación a infecciones respiratorias virales y sólo una minoría de ellos tendrá diagnóstico de asma en la edad escolar. El enfrentamiento adecuado de estos niños se inicia con una detallada anamnesis y examen físico para descartar causas secundarias, lo que se complementa con algunos exámenes de laboratorio. La decisión de iniciar tratamiento de mantención dependerá principalmente de la frecuencia y gravedad de los episodios de sibilancias. Este tratamiento debe ser considerado como una prueba terapéutica, evitando su mantención por tiempos prolongados. Se recomienda el uso de corticoides inhalados en dosis bajas y realizar un seguimiento estrecho del paciente para objetivar la respuesta. En el caso de los episodios agudos los broncodilatadores son el tratamiento de elección, mientras que los corticoides sistémicos debieran reservarse sólo para los casos severos o que requieren hospitalización.

Efficacy of Bronchodilators in Wheeze Associated Respiratory Tract Infections.

To ascertain whether bronchodilators are indeed effective in WRTI and Compare efficacy of nebulised nonspecific adrenergic agonist (adrenaline) with beta2 specific agonist (salbutamol) for management of WRTI. Design: Randomized control trial. Setting: Urban tertiary care teaching hospital. Methods: 100 Children aged 2-24 months with clinical diagnosis of WRTI were enrolled in the study. Children were then randomly assigned to two groups and nebulised with adrenaline and salbutamol respectively. Three doses of each drug were given at 20 minute intervals. Respiratory rate, heart rate, RDAI score, clinical score and Pulse oxymetry was recorded before intervention and ten minutes after the first second and third doses of the drug. Results: The adrenaline group (Group A) had a significantly lower mean respiratory rate, RDAI score, clinical score as compared to the salbutamol group (Group B) after three doses of nebulisation. At the end of the intervention 6 out of 50 patients in the adrenaline group and 15 out of 50 patients in salbutamol group either shown no improvement or deteriorated and had to be admitted.

Tidal breathing pulmonary function test and clinical significance in infants with recurrent wheeze / 临床儿科杂志

Obiective To explore the dynamics of tidal breathing pulmonary function in infants with recurrent wheeze and its clinical signiifcance. Methods Eighty (80) infants with recurrent wheeze from October 2013 to February 2014 were enrolled and divided into asthma predictive index positive (n=25) and asthma predictive negative (n=55) groups, and another 20 healthy children were enrolled as control group. Tidal breath pulmonary function at the time of admission (acute phase), leaving hospital (remission phase), and a week after discharge (admission phase) were tested, the ratio of time taken to reach peak expiratory lfow to total expiratory time(TPTEF/TE)and ratio of peak expiratory volume to total expiratory volume(VPEF/VE) between groups were compared. Results From acute phase and remission phase to admission phase, TPTEF/TE, VPEF/VE were elevated in positive group and negative group showing signiifcant statistical difference between phases (P=0.000). In acute phase, TPTEF/TE, VPEF/VE showed no statistical difference (P>0.05) between positive group and negative group, when compared with control group, TPTEF/TE, VPEF/VE were signiifcantly lower in positive and negative groups than that in control group (P0.05), but significantly higher than that in positive group (P<0.05). Conclusions Lung function impairment duration was longer in asthma predictive index positive children than in asthma predictive index negative children. The tidal breathing pulmonary function test can provide objective clinical indicators for infants with recurrent wheeze to predict asthma.

The mRNA expression and clinical significance of ORMDL3 gene in the peripheral blood of recurrent wheeze children / 中华实用儿科临床杂志

Objective To study the mRNA expression levels and clinical significance of omsomucoid 1-like protein 3 (ORMDL3) gene in the peripheral blood of recurrent wheeze children under 3 years old.Methods Peripheral blood specimens of 25 recurrent wheeze children including 14 non-atopy patients (group A) and 11 atopy patients (group B) that were registered in the First Affiliated Hospital of Nanjing Medical University,from Sep.2010 to Sep.2012 were enrolled based on the inclusion criteria and 24 non-allergic controls(the children with food allergy,drug allergy or ectema was excepted).The mRNA expression levels of ORMDL3 gene were detected by reverse transcription (RT)-PCR and clinical features were analyzed.Results The expression levels of ORMDL3 were up-regulated in the peripheral blood specimens of group B compared with group A (t =14.12,P ＜ 0.01).Compared with peripheral blood specimens from normal subjects,mRNA expression of ORMDL3 were significantly increased in recurrent wheeze children(t =10.29,5.73,P ＜0.01).The incidence of wheeze groups exist gender differences,male ＞ female.Wheeze usually with a high incidence in winter and spring.Conclusions The increase of ORMDL3 gene expression levels were correlated with recurrent wheeze under 3 years old especially in atopy group and may be involved in the pathogenesis of recurrent wheeze.

Clinical analysis and follow-up of neonatal lower respiratory tract infection with respiratory syncytial virus / 中华实用儿科临床杂志

Objective To investigate the clinical features of neonatal lower respiratory tract infection (LRTI)with respiratory syncytial virus(RSV),and to explore the relationship between clinical features and recurrcnt cough or wheezing after discharge.Methods From May 2008 to May 2013,the data of 41 neonates diagnosed as LRTI with RSV infection in New Century International Children's Hospital were analyzed retrospectively.The clinical features and follow-up results were observed.Results All the neonates had cough,92.7％ (38/41 cases) had choking,85.4％ (35/41 cases) had runny nose and nasal obstruction,31.7％ (13/41 cases) had fever,65.9％ (27/41 cases) had wheezing sound during physical examination,29.3％ (12/41 cases)of the neonates were accompanied with bacterial infection(n=29),in which 50.0％ (6/12 cases) were infected by staphylococcus aureus.Compared to the neonates only with RSV infection,the proportion of fever was higher in those with RSV combined with bacterial infection (n =12)(x2 =6.034,P ＜ 0.05),and there were no statistical differences between the neonates with or without bacterial infection in white blood cell count and with or without shadow in chest X-ray(x2 =0.859,2.064,P =0.485,0.202).Compared with the neonates without family history of atopy,the neonates with the family history of atopy were more likely to get wheezing (88.2％ vs 57.1％,x2 =4.871,P ＜ 0.05) during primary infection.During the follow-up,there was higher proportion of children with family history of atopy in the group with subsequent recurrent cough and/or wheezing than in the group without subsequent recurrent cough and/or wheezing (71.4％ vs 26.3％,x2 =6.388,P ＜ 0.05).Conclusions Cough,choking are most common symptoms in neonatal LRTI with RSV,and there is no wheezing sound during phy-sical examination in some neonates.LRTI with RSV is likely combined with bacterial infection.Wheezing is more common in the neonates with family history of atopy.The RSV LTRI neonates with family history of atopy incline to get subsequent recurrent cough or wheeze after discharge.

Follow-up study of 1035 children with recurrent wheezing / 临床儿科杂志

Objective To investigate the long-term outcome of children with recurrent wheeze and to determine the effectiveness of inhaled hormone therapy. Methods One thousand and thirty-five children with recurrent wheezing were followed up for more than 4 years and the data were retrospectively evaluated. Results Of 1035 cases, 751 (72.56%) patients outgrew their wheeze during the follow-up period, whereas the other 284 (27.44%) patients had recurrence wheeze during the last two years. The age of wheezing onset was<3 years in 542 (52.37%) cases, from 3 to 7 years in 386 (37.29%) cases, and from 7 to 12 years in 107 (10.34%) cases. There was significant difference in clinical control rate among groups with different wheezing ages onset (χ2=45.27, P<0.001). Children with wheezing age onset from 7 to 12 years had the lowest clinical control rate. Among 1035 wheeze children, 343 (79.95%) children in 429 cases who received inhaled hormone therapy for more than one year outgrew their wheeze. Whereas 408 (67.35%) in 606 cases who did not receive inhaled hormone therapy outgrew their wheeze. There was significant difference of clinical control rate between inhaled group and non-inhaled group (P<0.01). Con-clusions The age of wheezing onset is<7 years in 89.66%of children with recurrent wheeze. Most of them can be clinicalycon-trolled. The long term inhaled hoemone therapy for children with recurrent wheeze can reduce the risk of developing adulthood asthma.

Interpreting international consensus on pediatric asthma in 2012 / 中华实用儿科临床杂志

In Jun.2012,the International Collaboration in Asthma Allergy and Immunology(iCAALL) committee published" International Consensus on Pediatric Asthma".This report is a conceptual framework for the diagnosis and management of asthma in children based on the pediatric asthma guidelines revised or promulgated internationally or regional representatively since 2006,which was written by professors from European Academy of Allergy and Clinical Immunology (EAACI),American Academy of Allergy,Asthma & Immunology (AAAAI),American College of Allergy,Asthma &Immunology(ACAAI),World Allergy Organization(WAO) and International Consensus on Pediatric Asthma (ICON) has made emphasis on that the target of asthma treatment is to control disease.To achieve the goal of asthma control,we need to evaluate and monitor regularly in order to adjust the treatment plan.Most children with rational drug therapy can control symptoms and reduce future risk.Phenotypic asthma therapy is the future development tendency.

Bacteria and viruses in hospitalized infants with community acquired pneumonia / 临床儿科杂志

To explore the associations between the presence of bacteria and virus in the nasopharyngeal secretions, and wheezing, condition and hospitalization period in infants with community acquired pneumonia. Methods Clinical data, inclu-ding detection of bacteria and viruses, conditions and hospitalization period, of 1106 hospitalized infants with community ac-quired pneumonia from March 2009 to February 2010 were retrospectively analyzed. The infants were classiifed into wheezing (697 cases) and non-wheezing (409 cases) groups. Results Viruses were detected in 540 infants (48.8%), and the total detection rate of viruses and detection rate of respiratory syncytial virus in wheezing group were signiifcantly higher than those of non-wheezing group (P=0.000). Bacteria were detected in 590 cases (53.3%) and no signiifcance was found between two groups (P=0.821). The detection rate of Streptococcus pneumonia was higher in wheezing group than that of non-wheezing group (P=0.038). Comparing to the infants detected with both viruses and bacteria, no signiifcances were found in the occurrence of severe pneumonia and hos-pitalization period in those infants detected with viruses only (P>0.05), as well as in the wheezing time of period (P>0.05). Con-clusions Wheezing in infants with community acquired pneumonia is related to the infection of viruses, especially to respiratory syncytial viruses. Virus infection accompanying bacterial infection has no impact on duration of hospitalization and wheezing. The infection of Streptococcus pneumonia may relate to wheezing in infants.

Tracheobronchomalacia Presenting as Infantile Wheeze.

We report six months old infant with a history of recurrent wheeze, admitted for foreign body aspiration like presentation, where fibreoptic bronchoscopy revealed the diagnosis of tracheobronchomalacia.

Wheeze among Pneumonia Patients in Paediatrics Department of Patan Hospital.

Background: Acute respiratory infections are major causes of morbidity and mortality in children in developing countries. It is estimated that 3.9 million children die annually from acute respiratary diseases and most of them in developing countries. In significant cases, wheeze is associated with Pneumonia. This study was done to find out the outcome of pneumonia patients admitted in the paediatric ward with wheeze and without wheeze in terms of hospital stay, age predominance, sex ratio, mortality and morbity of patients. Some comorbidies of patients were also studied, Methods: This was a retrospective study done in the paediatric ward of Patan Hospital from April-June 2004 to March-April 2006 AD with following inclusion and exclusion criteria. All the children presented to Emergency ward up to 14 years with symptoms and sign of pneumonia were included in the study(high grade fever with chills and rigor,cough,fast breathing,creps and wheeze in auscultation)Age more than 14 years,history of Asthma,Tuberculosis,Acute wheeze associated with cardiac problems were excluded from study.Pneumonia patients admitted not from Emergency department were also excluded from study. Pneumonia with wheeze, outcome, and the hospital stay were studied. The outcome was measured in terms of improvement, deterioration or death of patients. Co morbidities associated with Pneumonia were also studied. Results: Out of 4620 children admitted in pediatric ward eleven hundred and sixty four (Twenty five percent) cases were of pneumonia and among them two hundred eighty three(twenty four percent) had wheeze. Majority of patients with pneumonia having wheeze falls on age group in between 2 and 12 months, followed by 1-5 years. The male children were more frequently affected. The co morbidities were febrile seizure, acute gastroenteritis, sepsis and urinary tract infection. Conclusion: The children admitted in Paediatric ward with Pneumonia were eleven hundred and sixty four and with wheeze were two hundred and eight three. Among them male were more than females. Majority of patients falls on age group two to twelve months. and study showed that they had prolonged hospital stay in relation to without wheeze. Three percent of the cases had blood culture positive among eleven hundred and sixty four sample.