Prevalence of asthma and its symptoms in Sri Lankan adults.

BACKGROUND: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and its symptoms in adult Sri Lankans.  METHODS: A cross-sectional study using a translated version of the European Community Respiratory Health Survey screening questionnaire on subjects ≥ 18 years from 7 provinces in Sri Lanka was conducted. The asthma was defined as "wheezing in the past 12 months (current wheeze)", self-reported asthma attack in the past 12 months or on current asthma medication use. RESULTS: Among 1872 subjects (45.1% males, 48.8% between 18-44 years of age), the prevalence of current wheeze was 23.9% (95%CI: 22.0%-25.9%), self-reported asthma was 11.8% (95%CI: 10.3%-13.2%) and current asthma medication use was 11.1% (95% CI: 9.6%-12.5%). The prevalences were higher in adults > 44 years, 31.4% positively responded to any of the above questions (95%CI: 29.3%-33.4%) and 60.9% of current wheezers did not report having asthma whilst 38.2% used asthma medication. Among current wheezers, 80.1% had at least one other symptom, cough being the commonest. Those with no current wheeze, self-reported asthma and on current asthma medication use, 30%, 35.9% and 36.6%, respectively, reported at least one other symptom. Smokers comprises 22% current wheezers, 20.6% of self-reported asthmatics and 18.7% of current asthma medication users. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is higher than the other South Asian countries and higher in the older age group. A significant percentage of symptomatic individuals did not report having asthma or being on medication.

Smoking and HIV associated with subclinical tuberculosis: analysis of a population-based prevalence survey.

BACKGROUND: Despite multiple tuberculosis (TB) prevalence surveys reporting a relatively high frequency of bacteriologically confirmed, active TB among individuals reporting no typical symptoms of disease, our understanding of this phenomenon is limited.OBJECTIVE: To quantify the epidemiological burden and estimate associations between individual-level variables and this "subclinical" presentation.METHODS: We performed a secondary analysis of TB prevalence survey data from the South African communities of the Zambia, South Africa Tuberculosis and AIDS Reduction trial. Generalized estimating equations were used to estimate the association between individual-level demographic, behavioral, socio-economic, and medical variables and the risk of bacteriologically positive TB among participants not reporting any symptoms consistent with active TB.RESULTS: The crude prevalence of TB was 2222.1 cases per 100 000 population (95% CI 2053.4-2388.5); 44.7% (295/660) of all documented prevalent cases of TB were subclinical. Current tobacco smoking (OR 2.37, 95% CI 1.41-3.99) and HIV-positive status (OR 3.26, 95% CI 2.31-4.61) were significantly associated with subclinical TB.CONCLUSION: Individuals who smoke or have HIV may be at increased risk of active TB and not report typical symptoms consistent with disease. This suggests possible shortcomings of symptom-based case finding which may need to be addressed in similar settings.

Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment. OBJECTIVE: To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup. METHODS: Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis. RESULTS: Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score. CONCLUSION: Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.

Crucial effect of melt homogenization on the fragility of non-stoichiometric chalcogenides.

The kinetics of homogenization of binary AsxSe100 - x melts in the As concentration range 0% < x < 50% are followed in Fourier Transform (FT)-Raman profiling experiments, and show that 2 g sized melts in the middle concentration range 20% < x < 30% take nearly two weeks to homogenize when starting materials are reacted at 700 °C. In glasses of proven homogeneity, we find molar volumes to vary non-monotonically with composition, and the fragility index M displays a broad global minimum in the 20% < x < 30% range of x wherein M < 20. We show that properly homogenized samples have a lower measured fragility when compared to larger under-reacted melts. The enthalpy of relaxation at Tg, ΔHnr(x) shows a minimum in the 27% < x < 37% range. The super-strong nature of melt compositions in the 20% < x < 30% range suppresses melt diffusion at high temperatures leading to the slow kinetics of melt homogenization.

Superstrong nature of covalently bonded glass-forming liquids at select compositions.

Variation of fragility (m) of specially homogenized Ge(x)Se(100-x) melts is established from complex specific heat measurements and shows that m(x) has a global minimum at an extremely low value (m = 14.8(0.5)) in the 21.5% < x < 23% range of Ge. Outside of that compositional range, m(x) then increases first rapidly and then slowly to about m = 25-30. By directly mapping melt stoichiometry as a function of reaction time at a fixed temperature T > Tg, we observe a slowdown of melt-homogenization by the super-strong melt compositions, 21.5% < x < 23%. This range furthermore appears to be correlated to the one observed between the flexible and stressed rigid phase in network glasses. These spectacular features underscore the crucial role played by topology and rigidity in the properties of network-forming liquids and glasses which are highlighted when fragility is represented as a function of variables tracking the effect of rigidity. Finally, we investigate the fragility-glass transition temperature relationship, and find that reported scaling laws do not apply in the flexible phase, while being valid for intermediate and stressed rigid compositions.

Pediatric asthma control in Asia: phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey.

BACKGROUND: We conducted Phase 2 of the Asthma Insights and Reality in the Asia-Pacific (AIRIAP 2) survey in 2006 to determine the level of asthma control in this region and the validity of the Asthma Control Test (ACT) and childhood ACT (C-ACT) in relation to asthma control. METHODS: Pediatric participants (0 to <16 years; N = 988) with diagnosed asthma and current asthma symptoms or taking anti-asthma medications were recruited from 12 geographic areas in Asia. The survey consisted of the AIRIAP 2 questionnaire (asthma symptoms, use of urgent healthcare services and anti-asthma medication) and the ACT or C-ACT (English or Chinese translations only), both administered in the participant's preferred language. A symptom control index based on the Global Initiative for Asthma criteria (except lung function) was used to classify asthma control status. RESULTS: Most participants had inadequately controlled asthma ('uncontrolled' = 53.4%, 528/988; 'partly controlled' = 44.0%, 435/988). Only 2.5% (25/988) had 'controlled' asthma. Demand for urgent healthcare services (51.7%, 511/988) and use of short-acting beta-agonists (55.2%, 545/988) was high. The optimal ACT and C-ACT cutoff score for detecting uncontrolled asthma (compared with controlled or partly controlled asthma) was determined to be ≤19 (receiver operating characteristic analysis) with good agreement between the ACT and C-ACT and the symptom control index. CONCLUSIONS: Findings from this survey show that asthma control is suboptimal in many children in the Asia-Pacific region. Practical tools, such as the ACT or C-ACT, may help clinicians assess asthma control and facilitate adjustment of asthma medication.

A collinear self-emission and laser-backlighting imaging diagnostic.

In this work we demonstrate a design for obtaining laser backlighting (e.g., interferometry) and time-resolved extreme ultraviolet self-emission images along the same line-of-sight. This is achieved by modifying a single optical component in the laser collection optics with apertures and pinhole arrangements suitable for single or multiple frame imaging onto a gated detector, such as a microchannel plate. Test results for exploding wire experiments show that machining of the optic does not affect the overall quality of the recovered laser images, and that, even with a multiple frame system, the area sacrificed to achieve collinear imaging is relatively small. The diagnostics can therefore allow direct correlation of laser and self-emission images and their derived quantities, such as electron density in the case of interferometry. Simple methods of image correlation are also demonstrated.

Polyester prostheses as substitutes in the thoracic aorta of dogs. II. Evaluation of albuminated polyester grafts stored in ethanol.

In an attempt to find an alternative procedure to the preclotting of porous textile vascular prostheses, the feasibility of an albumin coating and ethanol preservation technique has been evaluated by implanting albuminated polyester prostheses as substitutes in the thoracic aorta of dogs. Nine different grafts representing woven, knitted, and velour constructions were implanted for periods ranging from 4 h to 6 months. At the sacrifice, the grafts were excized for measurement of the thrombogenicity of the flow surface, for pathological examination by light microscopy and SEM, and for quantifying the changes in the textile structure during implantation. Also the kidneys were removed and examined for infarcts caused by trapped circulating emboli. The healing characteristics of the nine different grafts proved similar and followed the same sequence of events as preclotted control grafts. The albumin coating and ethanol preservation resulted in a somewhat slower rate of healing. Yet, given sufficient time, a more completely healed graft was achieved as evidenced by the presence of endothelial-like cells throughout the length of the graft. In addition, the albumin is believed to reinforce the textile structure by reducing the tendency to stretch and dilate in vivo.

Polyester prostheses as substitutes in the thoracic aorta of dogs. I. Evaluation of commercial prostheses.

Using canine models, a representative selection of polyester or Dacron vascular prostheses, including woven, knitted, and velour types, were evaluated for their relative healing characteristics and for their structural changes during implantation. Following residence periods ranging from 4 h to 6 months at the site of the thoracic aorta, the dogs were sacraficed, and the grafts were excized for measurement of the thrombogenicity of the flow surface and for pathological examination by light microscopy and SEM. The kidneys were also removed and examined for infarcts caused by any trapped circulating emboli. The extent of healing, the presence of embolizing nuclei, and the thrombogenicity and morphology of the lumen surface were also assessed. The healing characteristics of each type of device proved similar. Velour fabrics exhibited more extensive encapsulation, but frequently their internal capsules failed to incorporate all the fibers. In all cases, cellular development on the lumen was limited to areas contiguous to the anastomoses. The initial porosity of the devices as measured by water permeability did not appear to influence the healing sequence to a significant extent. The grafts did exhibit differences in structural stability depending on whether they were of a knitted or woven construction. We suggest that users consider these different mechanical and structural properties when making their choice of a graft. Despite these differences, we believe that the healing process is far more host dependent than graft dependent.

Pathology of the skeleton and tendons of broiler chickens reared to roaster weights. II. Normal chickens.

Broiler chickens were raised to 74 days of age under different feeding and housing regimens. Conformation, growth plates and tendon strength were studied in clinically normal chickens of various ages. A change with age from slight valgus deviation of the metatarsal bones to varus deviation was recorded. Separation of the proximal femoral epiphysis from the femur on disarticulation of the coxofemoral joint was a common post-mortem artifact. It was more common in chickens on full feed than in chickens fed a restricted amount of feed. Two distinct growth-plate abnormalities were recognized. Dyschondroplasia was most common in the proximal tibiotarsus and was almost completely absent in chickens fed a restricted amount of feed. Eosinophilic streaks were found in growth plates of the proximal femur and the thoracic vertebral bodies. The incidence of these streaks was not affected by feed restriction. It is suggested that these streaks represent microscopic tears in growth plates exposed to shear forces and that they may be similar to osteochondrosis in mammals. The tensile strength of the flexor digitus perforatus and perforans tendon to the third digit increased with age. It was not affected by housing or feeding regimen, but the ratio of tensile strength over body weight was less in chickens fed ad libitum than in those fed a restricted amount of feed.

Designing polyester vascular prostheses for the future.

For 30 years polyester textile materials in tubular form have been used in vascular surgery for the replacement and by-pass of arteries. Initially such medical devices were implanted to maintain the distal blood flow of atherosclerotic patients for a number of months. Today, with prognoses in excess of 10 or 15 years, and with implantation in younger and younger patients, this particular end use is possibly one of the most demanding applications for a textile product. The paper describes the current manufacturing techniques and provides detailed information about the wide variety of filaments, yarns and fabrics used in the production of current commercial devices. By reviewing the mechanical and clinical performance of available designs against the criteria of an 'ideal' prosthesis, the objective of this paper is to assist surgeons in making clinical decisions, to provide the textile and medical products industries with directions for future design improvements, and to support standards writers in their formidable task of establishing a rational standard for vascular repair devices.

[Aneurysm formation on dacron prosthesis after 84 months of use. Pathology, structural and chemical evaluation of the explanted device (author's transl)]. / Formation anévrismale sur prothèse artérielle synthétique. Analyse pathologique, structurale et chimique d'une greffe en polyester après 84 mois d'implantation.

A 56 year old patient fitted with a femoro-popliteal Dacron prosthesis (Weavenit-Meadox Medical) 84 months earlier, presented with a severe palpable dilation in the middle part of the graft. The dilated segment of the prosthesis was resected locally and spliced to a new fabric device. The explanted section of prosthesis was analyzed; the dilation was found to extend only over several centimeters near the centre of the prosthesis. The degree of "healing" was found to be satisfactory except in the part which was most distended; this area also revealed mild bacterial colonization. Physico-chemical analysis of the fabric revealed that the dilation had taken place subsequently to hydrolytic degradation of the polyester fibres. Manufacturing conditions may have contributed to predisposing parts of the prosthesis to accelerated biodeterioration in vivo.