Supine posture changes lung volumes and increases ventilation heterogeneity in cystic fibrosis

INTRODUCTION: Lung Clearance Index (LCI) is recognised as an early marker of cystic fibrosis (CF) lung disease. The effect of posture on LCI however is important when considering longitudinal measurements from infancy and when comparing LCI to imaging studies. METHODS: 35 children with CF and 28 healthy controls (HC) were assessed. Multiple breath washout (MBW) was performed both sitting and supine in triplicate and analysed for LCI, Scond, Sacin, and lung volumes. These values were also corrected for the Fowler dead-space to create 'alveolar' indices. RESULTS: From sitting to supine there was a significant increase in LCI and a significant decrease in FRC for both CF and HC (p<0.01). LCI, when adjusted to estimate 'alveolar' LCI (LCIalv), increased the magnitude of change with posture for both LCIalv and FRCalv in both groups, with a greater effect of change in lung volume in HC compared with children with CF. The % change in LCIalv for all subjects correlated significantly with lung volume % changes, most notably tidal volume/functional residual capacity (Vtalv/FRCalv (r = 0.54,p<0.001)). CONCLUSION: There is a significant increase in LCI from sitting to supine, which we believe to be in part due to changes in lung volume and also increasing ventilation heterogeneity related to posture. This may have implications in longitudinal measurements from infancy to older childhood and for studies comparing supine imaging methods to LCI

Update on current views and advances on RSV infection (Review).

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood

Timespaces in the city and everyday life: comparative study in Athens and in Mexico city.

This thesis deals with the everyday life from the point of view of the subjects that live that everyday. It studies the lived and the practiced everyday in Athens and in Mexico City following the theoretical approaches developed by H. Lefebvre and D. Massey. It focuses on timespaces of meeting/conversing (semi-public spaces of “free time”/leisure) which are called “spaces (timespaces) of pleasure”. It is based mainly on interviews of 40 individuals who are employed, are 25-45 years old, without pressing family obligations and who visit specific places of pleasure in their everyday. The research brings to the surface the interrelation and the fluidity of the timespaces of the specific subjects and describes some common categories, like timespaces of work, timespaces of pleasure (to go “out”), trajectories in the city and also their representations about the category of “free time”. It seems that the lived timespaces and the interconnected practices are related to the alternating of timespaces of relaxation and intensity; they express the everyday as a continuum and they often go beyond the discrete limits of counted times and material spaces or other abstract representations. The development of a relation with the city is investigated through the use of public and semi-public places. The thesis proposes the concept of the lived representation of the “public familiar” in order to define the specific places of pleasure. In other words, as far as the conceptualization of the subjects is concerned, the public familiar tries to describe a lived timespace with a scientific discourse. The thesis highlights the importance of the lived timespaces in the construction of the everyday in the city and their possible deviation from the abstract representations about time and space. The lived produces practices and so influences the construction of the city itself. At the same time, the lived, especially of timespaces of relaxation, can create representations which, through their “contradictions”, express the creativity of the everyday and the limitations of our (scientific) categorizations.Η παρούσα διδακτορική διατριβή αφορά την προσέγγιση της καθημερινότητας στην Αθήνα και στην πόλη του Μεξικού από την οπτική των κοινωνικών υποκειμένων. Μελετά καθημερινά βιώματα και πρακτικές, ακολουθώντας τις θεωρητικές αναλύσεις των H. Lefebvre και D. Massey για το χώρο. Εστιάζει σε χρονοχώρους συνάντησης-συζήτησης (ημιδημόσιους χώρους “ελεύθερου” χρόνου), οι οποίοι ονομάζονται “χώροι (χρονοχώροι) απόλαυσης”. Βασίζεται κυρίως σε πρωτογενή έρευνα πεδίου στην Αθήνα και στην πόλη του Μεξικού, και συγκεκριμένα σε ημιδομημένες συνεντεύξεις 40 ατόμων ηλικίας περίπου 25-45 ετών, τα οποία εργάζονται, δεν έχουν οικογενειακές υποχρεώσεις και συνηθίζουν να επισκέπτονται συγκεκριμένους χώρους απόλαυσης στην καθημερινότητά τους. Η έρευνα αναδεικνύει τον αλληλοσυσχετισμό και τη ρευστότητα των χρονοχώρων των συγκεκριμένων υποκειμένων και εξετάζει κάποιες κοινές κατηγορίες, όπως χρονοχώροι εργασίας, χρονοχώροι απόλαυσης (το “έξω”) και διαδρομές στην πόλη, καθώς και τις αναπαραστάσεις σε σχέση με την κατηγορία του “ελεύθερου” χρόνου. Οι βιωμένοι χρονοχώροι και οι αντίστοιχες πρακτικές φαίνεται ότι αφορούν εναλλαγές χρονοχώρων χαλάρωσης και έντασης και εκφράζουν μια καθημερινότητα ως συνεχές, ενώ συχνά ξεφεύγουν από τα διακριτά όρια μετρήσιμων χρόνων και υλικών χώρων ή άλλων αφηρημένων αναπαραστάσεων. Η ανάπτυξη μιας σχέσης με την πόλη μελετάται μέσω της χρήσης δημόσιων και ημιδημόσιων χώρων και προτείνεται η έννοια της βιωματικής αναπαράστασης του “δημόσιου οικείου” για να ορίσει τους συγκεκριμένους χρονοχώρους απόλαυσης που εξετάζει η έρευνα. Ως προς τη σημασιολόγηση, δηλαδή, των υποκειμένων, προτείνεται το “δημόσιο οικείο” σε μια προσπάθεια να περιγραφεί με επιστημονικούς όρους ένα βίωμα. Η διατριβή αναδεικνύει τη σημασία των βιωμάτων στη συγκρότηση της καθημερινότητας στην πόλη και την πιθανή απόκλισή τους από αφηρημένες κυρίαρχες αναπαραστάσεις για το χρόνο και το χώρο. Τα βιώματα παράγουν πρακτικές και, άρα, επηρεάζουν την κατασκευή της ίδιας της πόλης. Επίσης, τα βιώματα, κυρίως χρονοχώρων χαλάρωσης, μπορούν να δημιουργήσουν βιωματικές αναπαραστάσεις οι οποίες, μέσα από τις “αντιφάσεις” τους, εκφράζουν τη δημιουργικότητα της καθημερινότητας, αλλά και τους περιορισμούς των δικών μας (επιστημονικών) κατηγοριοποιήσεων

The validity of clinical criteria in the differentiation of infantile acute bronchiolitis syndrome

Introduction: the purpose of this study was to evaluate the validity of the clinical criteria in the differentiation of infantile acute bronchiolitis syndrome, over a follow up period of 6-8 years. The clinical criteria were the following: number of bronchiolitic episodes/year, personal and family history of atopy, the response to bronchodilation, the total serum IgE levels and skin prick testingMaterials and methods: fifty four infants out of 116 (46.5 %), who were hospitalized with wheezing associated respiratory illness. In infancy were followed up for 6-8 years. Thirty out of 54 infants responded to nebulized b2 agonists (salbutamol) therapy (Group A) and the rest did not (Group B).Results: in group A 90% of the children continued to have wheezing episodes , 76.6% collateral signs of atopy, 86.6%r responded to bronchodilating medications and 70% had higher levels of serum IgE than the expected for age values. In group B the above findings were respectfully: 37.5%, 29.1%, 25% and 20%. More children in group A (26.6%) versus 8.3% in group B had positive prick tests to aeroallergens (p<0.05).Conclusions: our findings indicate that the above mentioned clinical criteria are accurate, simple and easily applied for the early diagnosis of the reversible airways obstruction

The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup

Aim. The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup. Methods. Children six months to five years of age, presenting to the Emergency Department (ED) with a croup score of at least 2 participated in the study. All children were assigned in a randomised double-blind fashion to receive either nebulized L-epinephrine (LE), a single intramuscular injection of dexamethasone (D) 0.6 mg/kg, or inhaled beclomethasone dipropionate (BD) 200 mg, via aerochamber. Croup score (CS), heart rate (HR), blood pressure, respiratory rate (RR) and oxygen saturation were recorded at study entry and at 15, 30, 60, 90 and 120 minutes after treatment. Results. Sixty-four patients were enrolled into the study. Significant improvement of the croup score was noticed at the end of observation time in all groups. The LE group showed significant improvements of CS, HR and RR in comparison to the Other two groups. Inhaled BD was as effective as intramuscular D in the treatment of mild to moderate croup in the ED. Conclusion. The use of inhaled beclomethasone in the outpatient management of croup was associated with a significant reduction in the severity of illness within 24 h after treatment