Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One thousand five hundred sixty-eight RSV infections were documented prospectively in 1,541 pediatric patients. Of these, 20 (1.3%) had acquired the RSV infection while treated by mechanical ventilation for reasons other than the actual RSV infection (group ventilated mechanically). The clinical characteristics of children who were infected with respiratory syncytial virus (RSV) infection while ventilated mechanically for other reasons are described and compared with a matched control group. Sixty percent of the group ventilated mechanically had at least one additional risk factor for a severe course of infection (prematurity 50%, chronic lung disease 20%, congenital heart disease 35%, immunodeficiency 20%). The median age at diagnosis in the group ventilated mechanically was 4.2 months. The matched pairs analysis (group ventilated mechanically vs. control group) revealed a higher proportion of patients with hypoxemia and apnoea in the group ventilated mechanically; more patients in the control group showed symptoms of airway obstruction (wheezing). At least one chest radiography was performed in 95% of the patients (n = 19) in the group ventilated mechanically versus 45% (n = 9) in the control group (P = 0.001). The frequency of pneumonia was 40% in the group ventilated mechanically and 20% in the control group. Despite existing consensus recommendations, only two patients (10%) of the group ventilated mechanically had received palivizumab previously. Significantly more patients in the group ventilated mechanically received antibiotic treatment (85% vs. 45%, P = 0.008), and attributable mortality was higher in the group ventilated mechanically (15% [n = 3] vs. 0% in the control group, P = 0.231). Children treated by long term mechanical ventilation may acquire RSV infection by transmission by droplets or caregivers and face an increased risk of a severe course of RSV infection. The low rate of immunoprophylaxis in this particular risk group should be improved.
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PMID:Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons. 1903 67

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children less than 1 year of age and causes substantial morbidity. Although there is not currently a vaccine available to prevent RSV infection, prophylaxis with the humanized monoclonal antibody palivizumab has been shown to reduce the rate of RSV hospitalization in premature infants and those infants with chronic lung disease or congenital heart disease. Because palivizumab has not been shown to have a beneficial clinical effect on established RSV disease such as reducing the rate of mechanical ventilation and mortality in children afflicted with RSV, there has been considerable debate as to the cost-benefit ratio of administering palivizumab according to international guidelines. Palivizumab has demonstrated a favorable side-effect profile in clinical trials without the development of anti-palivizumab antibodies. Future studies are needed to determine whether palivizumab, or other more potent monoclonal antibodies which are currently undergoing clinical trials, will reduce the long-term sequelae of RSV infection such as the development of wheezing and asthma.
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PMID:Palivizumab: a review of its use in the protection of high risk infants against respiratory syncytial virus (RSV). 1970 46

The anomalous origin of the left pulmonary branch known as pulmonary artery sling (PAS) is a rare form of vascular ring, a congenital heart disease in which the left pulmonary artery originates from the right pulmonary artery and runs posterior to the trachea, encircling it, and goes leftwards between the trachea and oesophagus to reach the left pulmonary hilum. The clinical outcome depends on the associated tracheal lesions and cardiac anomalies. The majority of patients (90%) have respiratory symptoms in the first year of life, due to tracheal stenosis (chronic stridor and wheezing), and with a high mortality rate if there is no surgical intervention. Other major congenital heart diseases are present in up to 50% of patients with this rare vascular ring. We present a case of this rare disease in an asymptomatic 3-year-old girl, without any associated congenital heart disease and the findings in the echocardiography and tomography that made the non-invasive diagnosis possible.
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PMID:[Asymptomatic pulmonary artery sling: Noninvasive diagnosis]. 2011 64

A review of the evidence on epidemiology, risk factors, etiology and clinical-etiological profile of acute bronchiolitis is presented. The frequency estimates are very heterogeneous; in the population under two years the frequency of admission for bronchiolitis is between 1 and 3.5%, primary care consultations between 4 and 20% and emergency visits between 1 and 2%. The frequency of admissions for respiratory infection by respiratory syncytial virus in the risk population is: in premature infants < or =32 weeks of gestation between 4.4 and 18%, in patients with bronchopulmonary dysplasia between 7.3 and 42%, and in infants with congenital heart disease between 1.6 and 9.8%. The main risk factors are: prematurity, chronic lung disease or bronchopulmonary dysplasia, congenital heart disease and age less than 3-6 months at onset of the epidemic. Other factors are: older siblings or day care attendance, male gender, exposure to smoking, breastfeeding for less than 1-2 months and variables associated with lower socioeconomic status. Respiratory syncytial virus is the dominant etiological agent, constituting just over half the cases (median 56%; interval 27% to 73%). Other viruses implicated, in descending order of frequency, are rhinovirus, adenovirus, metapneumovirus, influenza viruses, parainfluenza, enterovirus and bocavirus. In studies with genomic detection techniques, between 20 and 25% of cases the virus involved is not identified and between 9% and 27% of cases have viral co-infection. Although respiratory syncytial virus bronchiolitis shows more wheezing and retractions, longer duration of respiratory symptoms and oxygen therapy and are associated with lower use of antibiotics. This pattern is associated with the younger age of the patients and does not help us to predict the etiology. In general, the etiological identification is not useful for the management of patients. However, in young infants (<3 months) with febrile bronchiolitis in the hospital environment, conservative management may help these patients and avoid diagnostic and therapeutic procedures.
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PMID:[Consensus conference on acute bronchiolitis (II): epidemiology of acute bronchiolitis. Review of the scientific evidence]. 2015 7

We present a review of the evidence on prognosis of acute bronchiolitis, risk factors for severe forms, symptom or severity scores and risk of post-bronchiolitis asthma. Documented risk factors of long stay or PICU admission in hospitalized patients are: bronchopulmonary dysplasia and/or chronic lung disease, prematurity, congenital heart disease and age less than 3 months. Other less well documented risk factors are: tobacco exposure, history of neonatal mechanical ventilation, breastfeeding for less than 4 months, viral co-infection and other chronic diseases. There are several markers of severity: toxic appearance, tachypnea, hypoxia, atelectasis or infiltrate on chest radiograph, increased breathing effort, signs of dehydration, tachycardia and fever. Although we have some predictive models of severity, none has shown sufficient predictive validity to recommend its use in clinical practice. While there are different symptom or severity scores, none has proven to be valid or accurate enough to recommend their preferable application in clinical practice. There seems to be a consistent and strong association between admission due to bronchiolitis and recurrent episodes of wheezing in the first five years of life. However it is unclear whether this association continues in subsequent years, as there are discordant data on the association between bronchiolitis and asthma.
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PMID:[Consensus conference on acute bronchiolitis (VI): prognosis of acute bronchiolitis. Review of scientific evidence]. 2040 66

A review of the evidence on prevention of acute bronchiolitis is presented. Acute bronchiolitis prevention arises from three basic approaches: preventive treatment to reduce recurrent wheezing following an episode of acute bronchiolitis, preventive treatment to reduce the frequency and severity of RSV bronchiolitis in the population at risk (prematurity, bronchopulmonary dysplasia, congenital heart disease, etc.), and general preventive measures to reduce nosocomial infection with RSV. There is sufficient evidence on the lack of efficacy of inhaled corticosteroids, oral corticosteroids and montelukast. Intravenous RSV immunoglobulin has an unfavorable risk-benefit balance, particularly with the availability of monoclonal antibodies. Palivizumab is effective as preventive treatment of RSV infection in risk populations (high risk preterm infants and hemodynamically significant congenital heart disease), but not in the frequency and severity (ICU admission, need for mechanical ventilation and mortality) of the acute bronchiolitis. The benefits of palivizumab (less admissions) seem to be worth the adverse effects, but we do not know the cost-benefit ratio. The control and prevention measures of nosocomial transmission of RSV infection (isolation, hand washing, use of mask, gloves, cap and shoes) are based on indirect evidence.
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PMID:[Consensus conference on acute bronchiolitis (v): prevention of acute bronchiolitis. Review of scientific evidence]. 2045 17

Respiratory syncytial virus (RSV) causes seasonal epidemics (winter or wet-season) of serious lower respiratory tract infections in young infants with subsequent increased frequency of recurrent wheezing during early childhood. Palivizumab is a humanized monoclonal antibody that provides immunoprophylaxis against RSV when administered monthly over the RSV season. It significantly reduced hospitalizations in high-risk infants including preterm infants with and without bronchopulmonary dysplasia and infants with hemodynamically significant congenital heart disease. Since its license in 1998, approximately 36 methodologically different economic studies have been performed to prove cost-effectiveness of the product. The majority of cost-effectiveness analyses revealed costs of palivizumab exceeding anticipated savings from reduced RSV hospitalizations. A minority of studies performed cost-effectiveness analyses using incremental cost-effectiveness ratios as costs per quality-adjusted life-year gained. The wide variability in the results of economic studies with estimates ranging from cost savings to incremental costs of a high order of magnitude with its use is discussed, in the light of the continuing burden of RSV disease, the limited treatment modalities, and the continuing research for a vaccine.
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PMID:Palivizumab in preventing respiratory syncytial virus-related hospitalization in high-risk infants. 2052 63

Palivizumab is one of the monoclonal antibodies for RS virus(RSV), and has been widely used to preterm infants, infants with bronchopulmonary dysplasia, and infants with congenital heart disease. Palivizumab can reduce admission rate and length of hospital stay due to lower respiratory tract infection by RSV. Palivizumab can also reduce the rate of later recurrent wheezing. Motavizumab, the 2nd generation monoclonal antibody, has 18-fold greater neutralizing capacity to RSV. Clinical trials of motavizumab finished, however, motavizumab has not been granted because of skin complication. In anti RSV drugs, ribavirin administration is not recommended because the effect is unclear. Clinical trials of some new anti RSV drugs and two live attenuated intranasal vaccines are underway.
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PMID:[Anti RS virus drugs]. 2256 37

Cardiac asthma has been defined as wheezing, coughing and orthopnea due to congestive heart failure. The clinical distinction between bronchial asthma and cardiac asthma can be straight forward, except in patients with chronic lung disease coexisting with left heart disease. Pulmonary edema and pulmonary vascular congestion have been thought to be the primary causes of cardiac asthma but most patients have a poor response to diuretics. There appears to be limited effectiveness of classical asthma medications like bronchodilators or corticosteroids in treating cardiac asthma. Evidence suggests that circulating inflammatory factors and tissue growth factors also lead to airway obstruction suggesting the possibility of developing novel therapies.
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PMID:Cardiac asthma: new insights into an old disease. 2323 54

Several population-based birth cohort studies documented that 30% of children suffer from wheezing during respiratory infections before their third birthday. Infants are prone to wheeze because of anatomic factors related to the lung and chest wall in addition to immunologic and molecular influences in comparison to older children. Viral infections lead to immunologic derangements that cause wheezing both in immunocompetent and immunodeficient infants. Anatomic causes of wheeze may be extrinsic or intrinsic to the airway. Not every wheeze is indicative of asthma but prediction of asthma in persistent wheezers is possible. Testing for allergy in these infants is worthwhile and can be of significant value in avoidable allergens. Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable and a trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Ribavirin administered by aerosol, hyper-immune respiratory syncytial virus immunoglobulin (RSV IVIG), and intramuscular monoclonal antibody to an RSV protein have been used for RSV bronchiolitis in infants with congenital heart disease or chronic lung disease.
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PMID:Wheezing in infancy. 2328 43


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