Background: The effect of prophylactic nasal corticosteroids on wheezing episodes associated with colds was investigated in a 12 week parallel group, double blind, randomised controlled trial in preschool children. Methods: Data were collected from 50 children aged 12-54 months with a history of at least three episodes of wheeze associated with colds over the previous winter, but few or no interval symptoms; 24 were given one dose of fluticasone aqueous nasal spray (50 µg) into each nostril twice daily and 26 received an indistinguishable placebo spray. Episodes of lower respiratory illness occurring within 2 days of the onset of a cold were identified from daily symptom diaries. The main outcome was nocturnal symptom score during the first 7 days of an episode. Results: The groups were well balanced on entry except that the treatment group had a history of more prolonged episodes. During the trial there was no significant difference in the number of episodes in the treatment and control groups (27 and 37, respectively), in the severity of nocturnal symptoms (mean score 1.33 and 1.22, respectively, confidence interval of difference -0.24 to +0.47) or in daytime symptoms, activity or total scores during episodes. Compliance was estimated to be over 50% in 43 of the children. Conclusions: Nasal corticosteroid treatment does not prevent acute wheezy episodes associated with upper respiratory infections (common colds) in preschool children.
Aims/IntroductionThe hemoglobin glycation index (HGI) represent the disparity between actual glycated hemoglobin measurements and predicted HbA1c. It serves as a proxy for the degree of non‐enzymatic glycation of hemoglobin, which has been found to be positively correlated with diabetic comorbidities. In this study, we investigated the relationship between HGI and non‐alcoholic fatty liver disease (NAFLD), along with other relevant biological markers in patients with diabetes.Materials and MethodsThis cross‐sectional study consisted of 3,191 adults diagnosed with type 2 diabetes mellitus. We calculated the predicted glycated hemoglobin levels based on fasting blood glucose levels. Multivariate binary logistic regression analysis was conducted to examine the correlation between the HGI and NAFLD. Hepatic steatosis was diagnosed using ultrasonography.ResultsAmong all participants, 1,784 (55.91%) were diagnosed with NAFLD. Participants with confirmed NAFLD showed elevated body mass index, diastolic blood pressure, liver enzyme, total cholesterol, triglyceride, low‐density lipoprotein and uric acid levels compared with those without NAFLD. In the unadjusted model, participants in the last tertile of HGI were 1.40‐fold more likely to develop NAFLD than those in the first tertile (95% confidence interval 1.18–1.66; P < 0.001). In the fully adjusted model, those in the last tertile of HGI had a 39% increased risk of liver steatosis compared with confidence interval in the first tertile of HGI (95% confidence interval 1.12–1.74; P < 0.001).ConclusionsA higher HGI suggests an elevated risk of developing NAFLD in patients with type 2 diabetes.
SubjectiveSleep-disordered breathing (SDB) is highly prevalent in polio survivors. Obstructive sleep apnea (OSA) is the most frequent type. Full polysomnography (PSG) is recommended for OSA diagnosis in patients with comorbidities by current practice guidelines, but it is not always accessible. The purpose of this study was to evaluate whether type 3 portable monitor (PM) or type 4 PM might be a viable alternative to PSG for the diagnosis of OSA in postpolio subjects.MethodsA total of 48 community-living polio survivors (39 men and 9 women) with an average age of 54.4 ± 5.3 years referred for the evaluation of OSA and who volunteered to participate were recruited. First, they completed the Epworth Sleepiness Scale (ESS) questionnaire and underwent pulmonary function testing and blood gas tests the day before PSG night. Then, they underwent an overnight in-laboratory PSG with a type 3 PM and type 4 PM recording simultaneously.ResultsThe AHI from PSG, respiratory event index (REI) from type 3 PM, and ODI3 from type 4 PM was 30.27 ± 22.51/h vs. 25.18 ± 19.11/h vs. 18.28 ± 15.13/h, respectively (P < 0.001). For AHI ≥ 5/h, the sensitivity and specificity of REI were 95.45 and 50%, respectively. For AHI ≥ 15/h, the sensitivity and specificity of REI were 87.88% and 93.33%, respectively. The Bland–Altman analysis of REI on PM vs. AHI on PSG showed a mean difference of −5.09 (95% confidence interval [CI]: −7.10, −3.08; P < 0.001) with limits of agreement ranging from −18.67 to 8.49 events/h. ROC curve analysis for patients with REI ≥ 15/h showed an area under the curve (AUC) of 0.97. For AHI ≥ 5/h, the sensitivity and specificity of ODI3 from type 4 PM were 86.36 and 75%, respectively. For patients with AHI ≥ 15/h, the sensitivity was 66.67%, and the specificity was 100%.ConclusionType 3 PM and Type 4 PM could be alternative ways to screen OSA for polio survivors, especially for moderate to severe OSA.
Introduction To determine the presence of respiratory impairment in community-living subjects with a history of poliomyelitis. Methods In a study conducted from July 2013-January 2014, we used a national database to recruit individuals (212 males, 86 females) from north and south provinces in China with a known prior poliomyelitis infection >25 years previously. 298 subjects (96.8%) completed overnight oximetry to collect the number/hr of drops in oxygen saturation >4% (ODI4) and Epworth Sleepiness Scale (ESS); many completed a metabolic and lipid panel, arterial blood gas analysis, chest x-ray (CXR), spirometry and maximal voluntary ventilation (MVV). Some completed risk profiling for OSA. Results Age was 47.8 ± 6.7 years (M±SD) and, when known, the age of infection was 2.3 ± 1.8 yrs. As defined by ODI4 ≥ 5/hr, the frequency of sleep-disordered breathing (SDB) was 37.2%; 9% (n = 27) had an ODI4 ≥15/hr. Those with vs. those without SDB differed by male gender (81% vs 65%, p = 0.004) and BMI (25.9 vs 23.0kg/m2, p < 0.001). ESS was within the normal range, but was higher in those with 6.8 ± 5.0 vs. without 5.2 ± 4.0 (p < 0.01) SDB. Spirometry and MVV revealed no differences among groups. Scoliosis on the CXR was present 26.1% of those with and 14.4% of those without SDB. ODI4 correlated weakly with body mass index (r = 0.40). Glucose levels or hyperglycemia were not different. A triglyceride level > 1.7 mmol/L was present in 47.2% of those with and 21.3% of those without SDB (p < 0.001). Conclusion Mild (28%) and to a smaller extent moderate-severe (9%) SDB is present many years after surviving poliomyelitis in infancy. In most, sleepiness is low but scoliosis is often present, and associations to hyperlipidemia and obesity are not reflected in fasting glucose levels. Support no
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