To estimate adult asthma prevalence in the world's most rapidly growing mega-city, we applied epidemiologic surveillance tools, as a cooperating center of the European Community Respiratory Health Survey, to a randomly selected sample of Mumbai (Bombay) residents in 1992 through 1995. From a metropolitan population of over 10 million, we took a one-in-ten random sample from electoral rolls in a socially diverse residential district, and examined asthma symptoms in adults age 20 to 44 yr. In Phase I, we interviewed 2,313 adults about symptoms, asthma diagnosis, and medications in the previous 12 mo. In Phase II, family and smoking history, socioeconomic data, housing characteristics, serum IgE, allergy skin tests, spirometry, and methacholine challenge tests were obtained in a subset of 20% of those who had completed Phase I. House dust mite was the most common positive skin test (18% prevalence) and the only one of the nine applied that was significantly associated with asthma symptoms and physician-diagnosed asthma. Asthma prevalence was 3.5% by physician diagnosis, and 17% using a very broad definition including those with asymptomatic bronchial hyperreactivity. Asthma prevalence was strongly associated with positive house dust mite skin test, family history of asthma, and total IgE.
It is a common clinical practice to initiate enteral hyperalimentation using low flow rates or diluted formula. These adjustments are made in an effort to minimize patient intolerance. Using complex and elemental enteral formulas, we investigated whether various flow rates or osmolalities effected clinical intolerance or carbohydrate malabsorption in 20 healthy volunteers. Our infusion rates ranged between 50 and 150 kcal/hr and the osmolalities ranged between 325 and 690 mOsm/Kg of water. Even at the maximal flow rate and osmolality, our results show that both types of enteral formulas were well tolerated as assessed by the frequency of abdominal pain, bloating, passage of rectal gas and stooling. No carbohydrate malabsorption was detected as measured by breath hydrogen. In well nourished subjects, our findings do not support the common clinical practice of initiating alimentation with low flow rates or diluted formula.
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