A practical implementation of acoustic reflectometry for determining airway areas in routine clinical use is described. Advances over previous systems include portability, free breathing during measurements, no need to equilibrate with helium/oxygen, and real-time display of airway areas. Validation of the reflectometer with an airway model gave accuracies and reproducibilities (coefficient of variation (CV)) in the range 5-10%. With human volunteers, the within-run CV was typically 10%, and the day-to-day CV was 20%. The effect of breathing pattern on airway areas is demonstrated. In ten normal volunteers, acoustic and magnetic resonance imaging (MRI) methods of assessing pharyngeal and glottal areas were compared. The results (mean +/- SD) for the oropharynx were 1.0 +/- 0.3 cm2 acoustically and 0.9 +/- 0.5 cm2 by MRI (p = 0.77). The corresponding figures for glottal areas were 1.3 +/- 0.3 cm2 and 1.1 +/- 0.4 cm2 (p = 0.09).
The development of peripheral oedema is a major determinant of a poor prognosis in patients with chronic bronchitis and emphysema' and, when unexplained by other medical conditions, is called cor pulmonale. Chan et al found that raised alcohol consumption was associated with hypercapnic respiratory failure in bronchitis patients.2 As oedematous patients with bronchitis tend to be hypercapnic, we have studied the relation between alcohol consumption and peripheral oedema in patiets with bronchitis. Patients, methods, and resultsWe studied 73 patients (39 women and 34 men with a mean age of 68 (SEM 1) years) with severe chronic bronchitis and emphysema (forced expiratory volume in one second < 1 5 1). None of the patients had liver, renal, or ischaemic heart disease; systemic hypertension; or hypoproteinaemia. All had been clinically stable for over three weeks.Lifetime histories of alcohol consumption and smoking were taken from each patient with a reproducible structured interview technique that used key life events (for example, job changes, marriage, childbirth) to help patients remember.2 The presence or absence of dependent oedema was noted and records reviewed for previous documentation of oedema. We measured the patients' arterial blood gas tensions, forced expiratory volume, and forced vital capacity. Within the year before the interview 27 patients had had pulmonary arterial pressures measured directly and 23 had had total lung capacity (helium dilution) and gas transfer measured. Unpaired Student's t tests and X tests were used to compare data between groups. Logistic regression analysis with forward stepwise entry of variables was used to assess the relative contributions of different factors to the development of oedema.3 For this analysis, average alcohol consumption was graded into four bands: 0, 1-10, 1 1-30, and > 30 units/week. Odds ratios were also calculated for the different factors.
In Pakistan, hemorrhagic diseases, including dengue and Crimean-Congo hemorrhagic fever (CCHF), are common. Therefore, an accurate diagnosis is challenging in the early stages of sickness owing to geographic overlap and early clinical similarities between the two disorders. A 35-year-old man who had previously experienced hematemesis and high-grade fever presented to our hospital. Despite receiving supportive care for a preliminary diagnosis of dengue hemorrhagic fever, the patient's condition worsened. The results of the dengue IgM antibody test were negative. On the fourth day of admission, a qualitative polymerase chain reaction test for CCHF virus RNA was performed, and the result returned positive. All medical personnel and attendants who had contact with the patient had to receive ribavirin prophylaxis, which required significant investment in resources. Because CCHF can have long-term financial and health repercussions for contacts, including healthcare personnel in developing nations, it is essential to identify and treat it as soon as possible. It is necessary to keep track of dengue and CCHF cases more closely to develop predictors of disease diagnosis that are reasonably trustworthy, affordable, and quick. These predictors can aid in directing future choices regarding the care of similar situations. Ultimately, such an approach might result in improved cost control in environments with limited resources. Consideration should also be given to patients who receive ribavirin prophylaxis.
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