Medicine and Health Sciences Commons^™

Cardiopulmonary Resuscitation With Rescue Breathing Is Superior To Hands-Only Cardiopulmonary Resuscitation For Children And Infants: Results Of A Systematic Review, Joseph W. Rossano, Richard N. Bradley

Richard N Bradley

Introduction

Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “In children and infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?”

Results

Sixty-nine records were identified and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we assessed …

Existing Research Is Inadequate For The Development Of Guidelines For The Basic Lifesupport Management Of Airway Obstruction In Adults: Results Of A Systematic Review, Richard N. Bradley, Joseph W. Rossano, Siobán Kennedy

Richard N Bradley

Introduction

There has been considerable controversy and several changes in guidelines for the basic life support (BLS) management of choking since the introduction of the Heimlich procedure in 1974.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “For adults, either conscious or unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently recommended techniques, lead to different outcomes?”

Results

We identified 475 records after duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed for eligibility; we excluded 19 of …

Preventing Ventilator Associated Pneumonia, Ashley Warner, Becky Dennis

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

The most common nosocomial (hospital acquired) infection is Ventilator Associated Pneumonia (VAP). VAP increases morbidity and mortality rates. 8-28% of critical care patients develop VAP. VAP also increases the length of a hospital stay and adds $20,000-40,000 to the cost. Insurance companies will not cover this cost. The purpose of this study is to determine the best method to reduce the occurrence of VAP.

Characteristics Of Children Attending Asthma Camp In Nevada, Priyank Shetty, Sheniz Moonie, Amy Beaulieu, Christopher M. Aquino

Nevada Journal of Public Health

The purpose of this study was to assess asthma trigger knowledge of camp attendees and the measure of agreement between physician and parent assessment of the children’s asthma severity. This study is based on cross-sectional data provided by the American Lung Association (ALA) and those children participating in summer asthma camps in Las Vegas and Reno, Nevada. Fifty-six children participated in the camp in August of 2008. The study results suggest a significant positive correlation between physician and parent assessment of asthma severity. With increasing asthma severity there was a relative increase in the number of school days missed among …

Situation Analysis Of Child Labour In Karachi, Pakistan: A Qualitative Study, Asaad Ahmed Nafees, Kausar S. Khan, Zafar Fatmi, Mubashir Aslam

Community Health Sciences

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal …

Serum 25-Hydroxyvitamin D Levels Do Not Correlate With Asthma Severity In A Case-Controlled Study Of Children And Adolescents, Jennifer Menon, Louise Maranda, Benjamin U. Nwosu

Benjamin U. Nwosu

Background: There is no consensus on the association between vitamin D and asthma.

Objective: To determine the relationship between 25-hydroxyvitamin D [25(OH)D] levels and asthma symptom severity in children and adolescents.

Methods: A retrospective, case-control study of 263 subjects of ages 2–19 years with asthma who were compared to 284 non-asthmatic controls of similar ages. Subjects were excluded if they had diseases of calcium or vitamin D metabolism or were receiving calcium or vitamin D supplementation. Serum 25(OH)D was measured in all subjects. Asthma symptom severity, usually stratified into 6 steps, was stratified into five steps [1–5] based on the …

Serial Analysis Of The Gut And Respiratory Microbiome In Cystic Fibrosis In Infancy: Interaction Between Intestinal And Respiratory Tracts And Impact Of Nutritional Exposures, J. C. Madan, D. C. Koestler, B. A. Stanton, L. Davidson, L. A. Moulton, M. L. Housman, J. H. Moore, M. F. Guill, H. G. Morrison, M. L. Sogin, T. H. Hampton, M. R. Karagas, P. E. Palumbo, J. A. Foster, P. L. Hibberd, G. A. O’Toole

Dartmouth Scholarship

Pulmonary damage caused by chronic colonization of the cystic fibrosis (CF) lung by microbial communities is the proximal cause of respiratory failure. While there has been an effort to document the microbiome of the CF lung in pediatric and adult patients, little is known regarding the developing microflora in infants. We examined the respiratory and intestinal microbiota development in infants with CF from birth to 21 months. Distinct genera dominated in the gut compared to those in the respiratory tract, yet some bacteria overlapped, demonstrating a core microbiota dominated by Veillonella and Streptococcus. Bacterial diversity increased significantly over time, …

Immune Responses In Cystic Fibrosis: Are They Intrinsically Defective?, Dmitry Ratner, Christian Mueller

Christian Mueller

Cystic fibrosis (CF), the most common lethal single-gene disorder affecting Northern Europeans and North Americans, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Cftr is a chloride channel and a regulator of other ion channels, and many aspects of the CF phenotype are directly related to ion channel abnormalities attributable to CFTR mutation. Lung disease is the most common limitation to the quantity and quality of life for patients with CF. One aspect that continues to be enigmatic is the observed alterations in innate and adaptive immune responses to certain pathogens. Altered responses to Pseudomonas …

Pharmacological Modulation Of Cgmp Levels By Phosphodiesterase 5 Inhibitors As A Therapeutic Strategy For Treatment Of Respiratory Pathology In Cystic Fibrosis., Hongwei Yu, Jens Poschet, Graham Timmons, Jennifer Taylor-Cousar, Wojciech Ornatowski, Joseph Fazio, Elizabeth Perkett, Kari Wilson, Hugo De Jonge, Vojo Deretic

Hongwei Yu

The CFTR gene encodes a chloride channel with pleiotropic effects on cell physiology and metabolism. Here, we show that increasing cGMP levels to inhibit epithelial Na(+) channel in cystic fibrosis (CF) respiratory epithelial cells corrects several aspects of the downstream pathology in CF. Cell culture models, using a range of CF cell lines and primary cells, showed that complementary pharmacological approaches to increasing intracellular cGMP, by elevating guanyl cyclase activity though reduced nitric oxide, addition of cell-permeable cGMP analogs, or inhibition of phosphodiesterase 5 corrected multiple aspects of the CF pathological cascade. These included correction of defective protein glycosylation, bacterial …

Vanadate And Triclosan Synergistically Induce Alginate Production By Pseudomonas Aeruginosa Strain Pao1, F. Damron, Michael Davis, T. Withers, Robert Ernst, Joanna Goldberg, Guangli Yu, Hongwei Yu

Hongwei Yu

Alginate overproduction by P. aeruginosa strains, also known as mucoidy, is associated with chronic lung infections in cystic fibrosis (CF). It is not clear how alginate induction occurs in the wild-type (wt) mucA strains. When grown on Pseudomonas isolation agar (PIA), P. aeruginosa strains PAO1 and PA14 are non-mucoid, producing minimal amounts of alginate. Here we report the addition of ammonium metavanadate (AMV), a phosphatase inhibitor, to PIA (PIA-AMV) induced mucoidy in both these laboratory strains and early lung colonizing non-mucoid isolates with a wt mucA. This phenotypic switch was reversible depending on the availability of vanadate salts and triclosan, …

Cross-Sectional Analysis Of Clinical And Environmental Isolates Of Pseudomonas Aeruginosa: Biofilm Formation, Virulence, And Genome Diversity, Nathan Head, Hongwei Yu

Hongwei Yu

Chronic lung infections with Pseudomonas aeruginosa biofilms are associated with refractory and fatal pneumonia in cystic fibrosis (CF). In this study, a group of genomically diverse P. aeruginosa isolates were compared with the reference strain PAO1 to assess the roles of motility, twitching, growth rate, and overproduction of a capsular polysaccharide (alginate) in biofilm formation. In an in vitro biofilm assay system, P. aeruginosa displayed strain-specific biofilm formation that was not solely dependent on these parameters. Compared with non-CF isolates, CF isolates expressed two opposing growth modes: reduced planktonic growth versus efficient biofilm formation. Planktonic cells of CF isolates showed …

Lipotoxin F Of Pseudomonas Aeruginosa Is An Algu-Dependent And Alginate-Independent Outer Membrane Protein Involved In Resistance To Oxidative Stress And Adhesion To A549 Human Lung Epithelia, F. Damron, Jennifer Napper, M. Teter, Hongwei Yu

Hongwei Yu

Chronic lung infection with P. aeruginosa and excessive neutrophil-associated inflammation are major causes of morbidity and mortality in patients with cystic fibrosis (CF). Overproduction of an exopolysaccharide known as alginate leads to the formation of mucoid biofilms that are resistant to antibiotics and host defences. Alginate overproduction or mucoidy is controlled by a stress-related ECF sigma factor AlgU/T. Mutation in the anti-sigma factor MucA is a known mechanism for conversion to mucoidy. Recently, we showed that inactivation of a kinase (KinB) in nonmucoid strain PAO1 results in overproduction of alginate. Here, we report the initial characterization of lipotoxin F (LptF, …

The Pseudomonas Aeruginosa Sensor Kinase Kinb Negatively Controls Alginate Production Through Algw-Dependent Muca Proteolysis, Hongwei Yu, F. Damron, Dongru Qiu

Hongwei Yu

Mucoidy, or overproduction of the exopolysaccharide known as alginate, in Pseudomonas aeruginosa is a poor prognosticator for lung infections in cystic fibrosis. Mutation of the anti-sigma factor MucA is a well-accepted mechanism for mucoid conversion. However, certain clinical mucoid strains of P. aeruginosa have a wild-type (wt) mucA. Here, we describe a loss-of-function mutation in kinB that causes overproduction of alginate in the wt mucA strain PAO1. KinB is the cognate histidine kinase for the transcriptional activator AlgB. Increased alginate production due to inactivation of kinB was correlated with high expression at the alginate-related promoters P(algU) and P(algD). Deletion of …

Gene Transfer In The Lung Using Recombinant Adeno-Associated Virus, Alisha Gruntman, Christian Mueller, Terence Flotte, Guangping Gao

Christian Mueller

Adeno-associated virus (AAV) is a small replication-deficient DNA virus belonging to the Parvovirinae family. It has a single-stranded ∼4.7-kb genome. Recombinant AAV (rAAV) is created by replacing the viral rep and cap genes with the transgene of interest along with promoter and polyadenylation sequences. The short viral inverted terminal repeats must remain intact for replication and packaging in production, as well as vector genome processing and persistence in the transduction process. The AAV capsid (serotype) determines the tissue tropism of the rAAV vector. In this unit we will discuss serotype selection for lung targeting along with the factors effecting efficient …

Raav9 Airway Delivery Results In Effective Knockdown Of Mutant Alpha 1-Antitrypsin In The Liver While Upregulating Wildtype Alpha 1-Antitrypsin In The Lung, Alisha Gruntman, Christian Mueller, Qiushi Tang, Lina Song, James M. Wilson, Terence R. Flotte, Maria P. Limberis

Christian Mueller

Alpha 1-Antitrypsin (AAT) deficiency is a human genetic disease resulting in the production of mutant AAT, a hepatocyte produced serine protease inhibitor that functions to prevent alveolar epithelial damage by inhibiting neutrophil elastase. Patients with AAT deficiency have increased lung disease, due to decreased proteolytic protection, as well as sporadic severe liver disease secondary to accumulation of mutant AAT, especially a common mutant form termed PiZ, within hepatocytes. We previously showed, in a PiZ mutant mouse model, simultaneous knock-down of mutant PiZ-AAT and augmentation of wild-type AAT production through intravenous delivery of a recombinant adeno-associated viral (rAAV) vector encoding both …

Microbiological Components In Mainstream And Sidestream Cigarette Smoke, Lennart Larsson, Christina Pehrson, Tenzin Dechen, Mardi Crane-Godreau

Dartmouth Scholarship

Research has shown that tobacco smoke contains substances of microbiological origin such as ergosterol (a fungal membrane lipid) and lipopolysaccharide (LPS) (in the outer membrane of Gram-negative bacteria). The aim of the present study was to compare the amounts of ergosterol and LPS in the tobacco and mainstream (MS) and sidestream (SS) smoke of some popular US cigarettes. We measured LPS 3-hydroxy fatty acids and fungal biomass biomarker ergosterol in the tobacco and smoke from cigarettes of 11 popular brands purchased in the US. University of Kentucky reference cigarettes were also included for comparison.

Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens And Patient Outcomes: An Individual Patient Data Meta-Analysis Of 9,153 Patients, Shama D. Ahuja, David Ashkin, Monika Avendano, Rita Banerjee, Melissa Bauer, Jamie N. Bayona

Dartmouth Scholarship

Dick Menzies and colleagues report findings from a collaborative, individual patient-level meta-analysis of treatment outcomes among patients with multidrug-resistant tuberculosis.

Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.

Evaluation Of Smoking Cessation Services In Ireland: Design And Pilot Of A Smoking Cessation Treatment Database, Sheila Keogan

Masters

A reduction in tobacco use is one of the stated aims of the National Health Promotion Strategy
(2000-2005) (Department of Health and Children, 2000a) as well being the core activity of
membership for all health promoting hospitals (HPH).
AIMS OF THE STUDY

1. To develop a database of smoking cessation services in Ireland.

2. Do a census of the smoking cessation services in Ireland and evaluate the range and
availability of them.
3. Develop a database for use in smoking cessation treatment services which would schedule
consultations with patients and gather all relevant demographics, treatments and their outcomes,
(cessation treatment …

Alcohol Exposure Alters Mouse Lung Inflammation In Response To Inhaled Dust., Michael L. Mccaskill, Debra J. Romberger, Jane M. Devasure, Jessica Boten, Joseph H. Sisson, Kristina L. Bailey, Jill A. Poole, Todd A. Wyatt

Journal Articles: Pulmonary & Critical Care Med

Alcohol exposure is associated with increased lung infections and decreased mucociliary clearance. Occupational workers exposed to dusts from concentrated animal feeding operations (CAFOs) are at risk for developing chronic inflammatory lung diseases. Agricultural worker co-exposure to alcohol and organic dust has been established, although little research has been conducted on the combination effects of alcohol and organic dusts on the lung. Previously, we have shown in a mouse model that exposure to hog dust extract (HDE) collected from a CAFO results in the activation of protein kinase C (PKC), elevated lavage fluid cytokines/chemokines including interleukin-6 (IL-6), and the development of …

Non-Typeable Haemophilus Influenzae Decreases Cilia Beating Via Protein Kinase Cε., Kristina L. Bailey, Tricia D. Levan, Daniel A. Yanov, Jacqueline A. Pavlik, Jane M. Devasure, Joseph H. Sisson, Todd A. Wyatt

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Haemophilus influenzae infection of the nasal epithelium has long been associated with observations of decreased nasal ciliary beat frequency (CBF) and injury to the ciliated epithelium. Previously, we have reported that several agents that slow CBF also have the effect of activating protein kinase C epsilon (PKCε) activity in bronchial epithelial cells. The subsequent auto-downregulation of PKCε or the direct inhibition of PKCε leads to the specific detachment of the ciliated cells.

METHODS: Primary cultures of ciliated bovine bronchial epithelial cells were exposed to filtered conditioned media supernatants from non-typeable H. influenzae (NTHi) cultures. CBF and motile points were …

Trends In Mortality From Septicaemia And Pneumonia With Economic Development: An Age-Period-Cohort Analysis, Irene O.L. Wong, Benjamin J. Cowling, Gabriel M. Leung, Mary Schooling

Publications and Research

Background
Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong’s unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching ‘‘first world’’ status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic …

Codon Optimization For Alpha 1-Antitrypsin Disease, Timothy Menz, Qiushi Tang, Lina Song, Christian Mueller, Terence R. Flotte

Christian Mueller

Alpha 1-antitrypsin deficiency is a genetic disorder caused by defective production of alpha 1-antitrypsin (AAT). Gene therapy approaches have been conducted in patients with AAT deficiency with successful AAT expression, but not to the therapeutic levels required to reduce the risk of emphysema. Codon optimization, a somewhat new and evolving technique, is used by many scientists to maximize protein expression in living organisms by altering translational and transcriptional efficiency as well as protein refolding. The purpose of this study was to develop single stranded and double stranded AAT gene constructs, test their protein expression in vitro, and compare with those …

Pulmonary Hyalinising Granuloma: A Rare Pulmonary Disorder, Arsalan Rahatullah, Zeeshan Waheed, Javaid A Khan, Nasir-Ud-Din

Section of Pulmonary & Critical Care

Pulmonary hyalinising granulomas are rare, noninfectious fibrosclerosing lesions of the lung which can mimic metastatic disease. It was first described in literature by Engleman et al in the year 1977. Its etiology is unknown but they may be caused by an exaggerated immune response. The patient typically presents with cough, chest pain. dyspnoea or haemoptysis in association with multiple bilateral parenchymal nodules. We report the case of a 20 years old male who presented with a 12-month history of worsening dry cough. His plain chest radiograph and subsequent CT scan revealed bilateral pulmonary nodules. A CT guided biopsy of the …

Pragmatic Research And Outcomes In Asthma And Copd, Gene L. Colice

Medicine Faculty Publications

Asthma and chronic obstructive pulmonary disease (COPD) are common diseases which cause patients and society considerable difficulties. These are costly diseases which cause substantial morbidity and death. Health care policy makers have made improving outcomes in asthma and COPD a priority. Application of guideline recommended approaches to asthma and COPD care in the real-life setting has been emphasized but outcomes have not improved. Failure to improve outcomes may not be because of inconsistent applications of guideline recommendations, but rather because there are difficulties implementing the Expert Panel Report III (EPR 3) method for categorizing asthma severity and the Global Initiative …

Water Pipe Smoking Amongst The University And College Students Of Karachi, Pakistan, Shehla Batool Jaffri, Aisha Yousuf, Waris Qidwai

Department of Family Medicine

Background:

An extensive literature search revealed that water pipe smoking is an emerging health risk and deserves the attention of health professionals. This study was therefore undertaken to determine the frequency of water pipe smoking among students in college and universities of Pakistan and to assess the practices, knowledge and attitude towards water pipe smoking among them.

Method:

A cross sectional survey was conducted in the College and Universities of Karachi, Pakistan from April 2009 to October 2009. Students were selected through non probability sampling and given self administered questionnaire after the informed consent.

Result:

A total …

Using Mathematics To Gain Insights Into Biology: An Application In Respiratory Mechanics, William Matern

Inquiry Journal 2012

No abstract provided.

Ventilator Associated Pneumonia Prevention In The Traumatically Injured Patient: Beyond The Bundle!, Cindy Umbrell Msn,Rn,Cns,Ccrn, Kenneth Miller Med, Rrt-Nps

Patient Care Services / Nursing

No abstract provided.

The Influence Of Neighborhood Characteristics On The Existence Of Asthma In Children, Elizabeth Adejuyigbe

Annual Undergraduate Conference on Health and Society

Asthma is one of the leading chronic diseases in children 17 years of age and under with nine million American children suffering from it. Previous studies to understand causal factors of disease including asthma tend to focus on the individual and sociocultural characteristics but there is little to no research using neighborhood characteristics, a factor that does influence health. Research shows that other community‐level environmental factors like collective efficacy, community structural factors, and neighborhood safety can affect a persons’ psychosocial well-being, and in turn increase morbidity. For this reason, researchers suggest that the need to understand asthma and its associated …

Functional Characterization Of A Recombinant Adeno-Associated Virus 5-Pseudotyped Cystic Fibrosis Transmembrane Conductance Regulator Vector, Jeffrey Sirninger, Christian Mueller, Sofia Braag, Qiushi Tang, Hungwen Yue, Carol Detrisac, Thomas Ferkol, William Guggino, Terence Flotte

Christian Mueller

Despite extensive experience with recombinant adeno-associated virus (rAAV) 2 vectors in the lung, gene expression has been low in the context of cystic fibrosis (CF) gene therapy, where the large size of the cystic fibrosis transmembrane conductance regulator (CFTR) coding sequence has prompted the use of compact endogenous promoter elements. We evaluated the possibility that gene expression from recombinant adeno-associated virus (rAAV) could be improved by using alternate AAV capsid serotypes that target different cell-surface receptors (i.e., rAAV5) and/or using stronger promoters. The relative activities of the cytomegalovirus (CMV) Rous sarcoma virus (RSV) promoter, the CMV enhancer/beta-actin (CB) promoter combination, …

Cystic Fibrosis Transmembrane Conductance Regulator Deficiency Exacerbates Islet Cell Dysfunction After Beta-Cell Injury, Michael Stalvey, Christian Mueller, Desmond Schatz, Clive Wasserfall, Martha Campbell-Thompson, Douglas Theriaque, Terence Flotte, Mark Atkinson

Christian Mueller

The cause of cystic fibrosis-related diabetes (CFRD) remains unknown, but cystic fibrosis transmembrane conductance regulator (CFTR) mutations contribute directly to multiple aspects of the cystic fibrosis phenotype. We hypothesized that susceptibility to islet dysfunction in cystic fibrosis is determined by the lack of functional CFTR. To address this, glycemia was assessed in CFTR null (CFTR(-/-)), C57BL/6J, and FVB/NJ mice after streptozotocin (STZ)-induced beta-cell injury. Fasting blood glucose levels were similar among age-matched non-STZ-administered animals, but they were significantly higher in CFTR(-/-) mice 4 weeks after STZ administration (288.4 +/- 97.4, 168.4 +/- 35.9, and 188.0 +/- 42.3 mg/dl for CFTR(-/-), …