Bronchiolitis

INTRODUCTION: Bronchiolitis is the most common lower respiratory tract infection in infants, occurring in a seasonal pattern, with highest incidence in the winter in temperate climates and in the rainy season in warmer countries. Bronchiolitis is a common reason for attendance at and admission to hospital.

METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of prophylactic interventions for bronchiolitis in high-risk children? What are the effects of measures to prevent transmission of bronchiolitis in hospital? What are the effects of treatments for children with bronchiolitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS: We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bronchodilators (oral, inhaled salbutamol, inhaled adrenaline [epinephrine], hypertonic saline), chest physiotherapy, continuous positive airway pressure, corticosteroids, fluid management, heliox, montelukast, nasal decongestants, nursing interventions (cohort segregation, hand washing, gowns, masks, gloves, and goggles), oxygen, respiratory syncytial virus immunoglobulins, pooled immunoglobulins, or palivizumab (monoclonal antibody), ribavirin, or surfactants.

Modelling of saline intrusion in marine outfalls

Since their introduction in the 1950s, marine outfalls with diffusers have been prone to saline intrusion, a process in which seawater ingresses into the outfall. This can greatly reduce the dilution and subsequent dispersion of wastewater discharged, sometimes resulting in serious deterioration of coastal water quality. Although long aware of the difficulties posed by saline intrusion, engineers still lack satisfactory methods for its prediction and robust design methods for its alleviation. However, with recent developments in numerical methods and computer power, it has been suggested that commercially available computational fluid dynamics (CFD) software may be a useful aid in combating this phenomenon by improving understanding through synthesising likely behaviour. This document reviews current knowledge on saline intrusion and its implications and then outlines a model-scale investigation of the process undertaken at Queen's University Belfast, using both physical and CFD methods. Results are presented for a simple outfall configuration, incorporating several outlets. The features observed agree with general observations from full-scale marine outfalls, and quantify the intricate internal flow mechanisms associated with saline intrusion. The two-dimensional numerical model was found to represent saline intrusion, but in a qualitative manner, not yet adequate for design purposes. Specific areas requiring further development were identified. The ultimate aim is to provide a reliable, practical and cost effective means by which engineers can minimise saline intrusion through optimised outfall design.

Pepsin measured in induced sputum - a test for pulmonary aspiration in children?

Purpose The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum. Methods Children attending surgical outpatients in the Royal Belfast Hospital for Sick Children (Belfast, Northern Ireland) were recruited. After spirometry, sputum was obtained by induction with hypertonic 3% saline. Spirometry was repeated, and complications were noted. An “in-house” enzyme-linked immunosorbent assay was used to measure pepsin concentration in sputum. The lower limit of detection of pepsin was 1.19 ng/mL. Results Children (n = 21) aged 4 to 16 years were recruited. Twenty children completed the study. No adverse effects were reported. Pepsin was detected in 17 (85%) of 20 sputum samples. Conclusions The act of sputum induction appears to induce physiologic GER in a healthy childhood population. The analysis of pepsin in sputum obtained by sputum induction is therefore not useful in the investigation of reflux-related respiratory disease.

Pre- to Post-discharge Behavior in Saline Solution

The development of a plasma discharge at low voltage (200-600 V) in saline solution is characterized using fast and standard CCD camera imaging. Vapor formation, plasma formation, and vapor collapse and subsequent pressure wave propagation are observed. If, with increasing voltage, the total energy deposited is kept approximately constant, the sequence and nature of events are similar but develop faster and more reproducibly at the higher voltages. This is attributed to the slower temporal evolution of the vapor layer at lower voltages which means a greater sensitivity to hydrodynamic instabilities at the vapor-liquid interface.