Some children with severe asthma develop frequent exacerbations despite intensive treatment.We sought to assess the outcome (severe exacerbations and healthcare use, lung function, quality of life and maintenance treatment) of a strategy based on daily home spirometry with teletransmission to an expert medical centre and whether it differs from that of a conventional strategy.50 children with severe uncontrolled asthma were enrolled in a 12-month prospective study and were randomised into two groups: 1) treatment managed with daily home spirometry and medical feedback (HM) and 2) conventional treatment (CT).The children's mean age was 10.9 yrs (95% confidence interval 10.2-11.6). 44 children completed the study (21 in the HM group and 23 in the CT group). The median number of severe exacerbations per patient was 2.0 (interquartile range 1.0-4.0) in the HM group and 3.0 (1.0-4.0) in the CT group (p50.38 with adjustment for age). There were no significant differences between the two groups for unscheduled visits (HM 5.0 (3.0-7.0), CT 3.0 (2.0-7.0); p50.30), lung function (pre-b 2 -agonist forced expiratory volume in 1 s (FEV1) p50.13), Paediatric Asthma Quality of Life Questionnaire scores (p50.61) and median daily dose of inhaled corticosteroids (p50.86).A treatment strategy based on daily FEV1 monitoring with medical feedback did not reduce severe asthma exacerbations.
A quality improvement initiative applied to thoracostomy tube insertion in hospital inpatients can reduce complications and improve procedure documentation. This article is protected by copyright. All rights reserved.
RESUMONa última década o raquitismo tem ressurgido nos países desenvolvidos, devido a alterações no estilo de vida e hábitos alimentares. Descrevemos o caso de uma criança de 28 meses, raça negra, antecedentes de aleitamento materno exclusivo até aos nove meses sem suplementação vitamínica e ausência de ingestão de produtos lácteos por suspeita de intolerância às proteínas de leite de vaca, internado por má progressão estaturo-ponderal. Apresentava varismo acentuado, rosário costal e punhos de boneca. Analiticamente destacava-se elevação da paratormona intacta e fosfatase alcalina, com diminuição do calcidiol. O estudo radiológico evidenciava desmineralização óssea generalizada, com alargamento das extremidades e metáfises do rádio e cúbito distais em forma de taça. Admitido o diagnóstico de raquitismo carencial, foi instituída terapêutica com colecalciferol e carbonato de cálcio, com progressiva melhoria clínica, laboratorial e radiológica. Neste caso destacam-se vários fatores que, conjugados, contribuíram para um raquitismo carencial grave, alertando para o ressurgir desta patologia. Palavras-chave: Criança; Deficiência de Vitamina D; Raquitismo; Transtornos da Nutrição Infantil. ABSTRACTIn the past decade rickets has re-emerged in developed countries due to changes in lifestyles and dietary habits. We describe a case of a 28-month-old black infant with failure to thrive. He was exclusively breastfed until nine months of age, without vitamin supplementation, and never ingested milk products due to alleged cow's milk intolerance. His examination revealed bowlegs, rachitic rosary and wide wrists. Alkaline phosphatase and intact parathyroid hormone levels were elevated, and calcidiol was decreased. Radiographic images showed bone demineralization, fraying and cupping of the distal radius and ulna. Nutritional rickets was considered and treatment with colecalciferol and calcium carbonate was initiated, with clinical, laboratory and radiologic improvement. In this case, a group of factors contributed to severe nutritional rickets, alerting to the re-emergence of this disease. Keywords: Child; Child Nutrition Disorders; Rickets; Vitamin D Deficiency. INTRODUÇÃOO raquitismo é uma patologia resultante de um defeito de mineralização do tecido osteoide do osso em crescimento.1 De acordo com a etiologia pode classificar-se em três grupos: carencial (défice de aporte), primário (defeitos congénitos do metabolismo da vitamina D), ou secundário (sendo o raquitismo hipofosfatémico familiar o mais frequente). 1Com elevada prevalência até há três décadas, o raquitismo carencial permanece um problema de saúde pública nos países desenvolvidos, onde tem ressurgido na última década devido a alterações no estilo de vida e hábitos alimentares.2-4 Países como Canadá e Estados Unidos da América (EUA) têm reportado na última década inúmeros casos clínicos e elaborado revisões casuísticas que revelam um aumento importante dos casos de raquitismo carencial.3-5 Dos fatores de risco identificados destacam-se, pela sua prevalência, exposiç...
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