A study of a Self-Care Rehabilitation Program in pediatric asthma

The Self-Care Rehabilitation in Pediatric Asthma (SCRPA) project was designed to ascertain the level to which children with asthma are able to acquire the asthma knowledge and skills presented in a self-management training program conducted by the American Lung Association of Utah and the effect of such training on the asthma experience. The preschool SCRPA Curriculum (ages 2-5) consisted of six 1-hour classes scheduled twice a week for 3 weeks. The first and last classes were for one or both parents only, and the middle four sessions were for the child and parent(s). The school-age SCRPA curriculum (ages 6-14) consisted of eight 90-minute classes for both child and parent(s) scheduled twice a week for 4 weeks. Private physicians referred 21 preschool children and 38 school-age children into the program. The school-age children were randomly assigned to a study or control group, and the preschool children served as their own controls. A comparison of asthma episodes during the 3 months before and after training showed a statistically significant decrease in the number of episodes but no change in severity in the preschool, school study, and school control groups. The decrease in episodes for the control groups suggest that the family record keeping required of all subjects may have a beneficial effect, a phenomenon worth further investigation. Also, the school-age group, in pre- and posttesting, demonstrated that the SCRPA curriculum increased knowledge and skills in the study group, changes not found in the control group.

The effect of temperature and mode of agitation on the resuspension of platelets during preparation of platelet concentrates

A problem arose in a blood bank in which about 10 percent of platelet concentrates (PC) observed at day 1 had a large number of macroscopic aggregates. The aggregates were clumps of platelets that did not go into suspension during preparation of PC. These units were set aside for observation. A maximum of 25 percent were stored on a circular rotator; the remainder were stored on either an elliptical rotator or horizontal shaker. By the end of storage, 6 percent of the units still had a large number of clumps. This percentage was reduced to 2.4 percent, when all clumped units were stored on a circular rotator. The number of clumped units observed at day 1 and at the end of storage were reduced dramatically when the temperature of the laboratory (18-19 degrees C), centrifuge (20 degrees C) and storage environmental chamber (22 degrees C) were increased to 24 degrees C. The units with clumps at day 5 were reduced from 225 (out of 8316) to 25 (out of 7137).

Quantitative gastroesophageal reflux and pulmonary function in asthmatic children and normal adults receiving placebo, theophylline, and metaproterenol sulfate therapy

There is evidence that theophylline therapy inhibits lower esophageal sphincter pressure and enhances gastroesophageal reflux in normal adults and adult asthmatics. No studies have used intraesophageal pH monitoring to assess the effect of bronchodilators over prolonged periods. With the use of the latter procedure, we studied 10 randomly selected chronic asthmatic children (mean age 10.6 yr) and 10 normal adult subjects; all subjects were without clinical symptoms of GER. In this single-blind study, all subjects were evaluated for GER during three separate 24-hr periods while they were receiving oral doses of placebo, theophylline, and metaproterenol sulfate therapy. No significant increase of GER was found in asthmatic subjects or normal subjects on either drug. No adverse correlation of GER and pulmonary function was noted in either group. Asthmatic subjects and normal subjects had asymptomatic or "silent" physiologic GER during sleep and in the 2-hr postprandial period. This study confirms that in chronic asthmatic children standard oral bronchodilator therapy does not adversely affect "silent" GER or pulmonary functions.

Chronic vitamin A intoxication. A multisystem disease that could reach epidemic proportions

Two patients seen in a six-month period had a diffuse, multisystem disorder characterized by edema of the extremities and face, rash, bone pain and tenderness, symptoms of increased intracranial pressure, and hypercalcemia. Both had been receiving extraordinarily high doses of vitamin A for some time. Serum vitamin A concentrations were markedly elevated, and serum vitamin D concentrations were normal. The history of excessive vitamin administration was only elicited following the detection of hypercalcemia. This is a potential complication of the administration of unregulated food supplements, stressing the need for complete dietary histories in the evaluation of multisystem disorders, with or without hypercalcemia.

The lipoidal derivatives of steroids as biosynthetic intermediates

The lipoidal derivatives of [3H]pregnenolone, prepared biosynthetically, were converted, by incubation with a mitochondrial-microsomal fraction from adrenal cortical tissue, into lipoidal derivatives of 17-hydroxy-pregnenolone and of dehydroisoandrosterone, thus proving that these pregnenolone derivatives can serve as substrates for 17-hydroxylase and for the lyase enzyme that converts a C21-17-hydroxy-20-ketol into a C19-17-ketosteroid. Three synthetically prepared esters of pregnenolone, the oleate, the linoleate, and the arachidonate, were also hydroxylated at C-17 by a similar adrenal preparation. With the synthetic substrates, however, the corresponding esters of dehydroisoandrosterone were not formed.

Locus of control and personality functioning of learning disabled children

Evaluated the personality functioning of 51 learning disabled children, who ranged in age from 7 through 11. Significant externality was noted for both males and females. Older children were significantly more external than their younger counterparts. Males were significantly more unintelligent, assertive, impulsive, independent, shrewd and anxiously insecure. Females tended to be unintelligent, submissive, dependent, serious and inhibited. Analyses of sex differences indicated that males were significantly more assertive, impulsive and independent than females.

Study of coinciding foci of malaria and leptospirosis in the Peruvian Amazon area

A hyperendemic malaria focus, found in 1973 in a secluded valley in South-eastern Peru, was restudied in 1975. Tests for antibodies to Plasmodium and Leptospira were performed on blood serum and blood slides collected at three locations on the Rio Ene and confluent streams and at two locations in the neighbouring highlands. The hyperendemic focus of P. vivax-P. malariae found at Mission Cutivirini in 1973 was confirmed in this study. Another hyperendemic focus of predominantly P. vivax was found at the village of Saoreni. Lesser amounts of malaria were found at other locations. Serology indicated past or present contact with Leptospira of from 50 to 75% of individuals at all locations. The two hyperendemic malaria foci therefore were embedded in a much larger hyperendemic focus of leptospirosis. The value of the indirect immunofluorescence test for malarial antibodies as a sero-epidemiological tool was emphasized by this study.

Desquamative interstitial pneumonia following long-term nitrofurantoin therapy

Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales, roentgenographically by diffuse interstitial infiltrate and physiologically by a restrictive lung defect. Pathologically, light microscopy revealed desquamative interstitial pneumonia. In one patient electron microscopy was characteristic of desquamative interstitial pneumonia. Immunofluorescent studies of one biopsy specimen showed specific fluorescence of interstitial cells with immunoglobulin E and third component of complement. In in vitro studies, nitrofurantoin therapy failed to induce lymphoblast transformation or histamine release. Treatment consisted of discontinuing the administration of nitro=furantoin and adding corticosteroids. Both patients felt better and showed clinical improvement. Our findings suggest that in some cases desquamative interstitial pneumonia may be drug related.