Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Saturday, October 27, 2012

Hand Hygiene Cannot Stop Asthma, Study Shows

Although viruses are one of the main triggers of asthma exacerbations, aggressive hand hygiene did not appear to be enough to stop 'attacks'.  Dr. Susarla

School 'hand hygiene' plan shows no asthma benefit

An arsenal of hand sanitizers, hygiene education and good old-fashioned soap failed to prevent asthma attacks among school children in one Alabama county.

For children with asthma, the common cold is the top trigger of symptom attacks. So in theory, cleaner hands at school could mean fewer colds being passed around - and fewer asthma attacks.

But in a new clinical trial, researchers found that kids at schools with a "hand hygiene" plan, including alcohol-based hand sanitizers, suffered asthma attacks just often as their peers at other schools.

The findings are not, however, the final word, according to Lynn B. Gerald, a professor of health promotion sciences at the University of Arizona in Tucson who led the study.
That's because the trial hit an obstacle when the H1N1 "swine" flu epidemic broke out right at the study's outset: All of the schools in the trial became a lot more vigilant about clean hands, Gerald said.

Schools that weren't part of the hand-hygiene program started putting hand sanitizer on the list of school supplies given to parents.

"Hand sanitizer became ubiquitous in schools," Gerald said.

So, she told Reuters Health, it's hard to draw conclusions about whether hand sanitizers, added to old-fashioned hand washing, might prevent some asthma attacks.

The sanitizers and soap used in the trial were provided to schools for free by Akron, Ohio-based GOJO, which makes the Purell brand hand sanitizers.

GOJO "believes there is great benefit in establishing the effectiveness of hand hygiene interventions under real-world conditions and supports scientific studies that take that approach," the company told Reuters Health.

"We agree with the conclusion that the results of this study were highly confounded by increased overall hand hygiene practices, even in the usual-care schools, as a result of the H1N1 pandemic," they said in an emailed statement.

The findings appear in the Journal of Allergy and Clinical Immunology.

When Should I See An Asthma Specialist To Treat My Asthma, And Do I Need A Pulmonologist?

When Should I See An Asthma Specialist To Treat My Asthma, 

And Do I Need A Pulmonologist? 

Stephen Wasserman, M.D., Professor of Medicine, UC San Diego School of Medicine

Answer: Essentially all patients with asthma should at some point in their medical course see an asthma specialist. An asthma specialist may be someone specially trained in the subspecialty of pulmonary medicine or somebody specially trained in allergy and immunology. But also, many pediatricians and many general internist and many family physicians are well-versed in the management of asthma.
But at some point, particularly if the asthma is proving troublesome, an asthma specialist would be a beneficial person to evaluate the asthma, to look at the treatment plan that's been set forward and to decide if there are modifications.
In addition, when asthma is not responding as expected, it's important to see someone who can differentiate between asthma and things that mimic asthma. The old adage that physician use is, "Not everything that wheezes is asthma." And occasionally, asthma can be misdiagnosised and that is generally best approached by someone who is well-versed in the understanding of asthma.


Our new office mural - Wow!

Thanks to the Montanegro's

Thursday, October 25, 2012

Can Vitamin D Help Asthma?

This research study is one to follow, since it still is not clear if supplementing with vitamin D can help children with poorly controlled asthma if levels are low.  Dr Susarla

New Study Aims To Determine Relation Between Vitamins & Asthma

Previous studies show that lung function is worse in asthmatic children with a vitamin D deficiency, even when treated with inhaled steroids.
But the way these studies have been designed, only a link can be established — not cause and effect.
That’s why doctors at Allegheny General Hospital are taking part in a multi-center, randomized, placebo-controlled clinical trial in adults.

“This is actually your true best test to find a cause and effect relationship,” Dr, Deborah Gentile, an allergist at AGH, said.
Obesity, living in the city, and being African-American are common risk factors for both vitamin D deficiency and asthma.
So is it the vitamin D or some other factor that makes asthma harder to control? That’s what this clinical trial is designed to figure out.
Right now, they’re still screening for 12 participants to be randomly assigned to take 5,000 units of vitamin D daily or placebo.
To participate you must be 18 or older and have asthma and take controller medications, such as an inhaled steroid and still have symptoms several times a week.
You will not be eligible if you’ve smoked within the last year or if you already take high-dose vitamin D.
Aimee Fogarty is being screened today.
“My main things in the fall are ragweed, and dust mites are a killer for me. In the spring, it’s more grass,” she said.
Her inhaled steroids aren’t cutting it.
“They normally do, but right now, I’m having a little bit of a difficult time, and had to double the dose,” Fogarty said. “The taking of the steroids, I just don’t like it. It’s bothering me that I have to take a steroid to breathe better.”
People eligible for the study get a blood test for a vitamin D level, and breathing tests. Then, they are randomly assigned to a treatment group.
“Some will get placebo. Some will get vitamin D,” Dr. Gentile said.
For six months, lung function and symptoms will be closely watched.
“On the one hand, we may find it works, and it very inexpensively improves the outcomes in our patients. On the other hand, if it’s negative and we find out it doesn’t help, we know that it doesn’t help,” Dr. Gentile said.
“My whole family has it,” Fogarty said. “And if this can help people in any way, I’d like to be a part of it.”
Read article here.

Tuesday, October 23, 2012

Asthma attack led to teen's death

The rule is asthma-related deaths are avoidable, which makes stories like this shocking.  Even mild asthma requires routine evaluation.  Dr. Susarla

Asthma attack led to teen's death

Family and friends remember JheVontae Davis

CHESAPEAKE, Va. (WAVY) - Family members of a Chesapeake teen who died after football practice say the teen complained of chest pain before he collapsed earlier this week.
According to family members, 14-year-old JheVontae Davis, who played JV football at Oscar Smith High School, complained of a cough and chest pain before he collapsed at practice. Davis was diagnosed with severe asthma when he was a baby. 
"Early on, it was more intense, and he had to frequent the hospital multiple times," said Jamal Vaughn, Davis' cousin. "But as he grew older, the asthma became more controllable, to the point where he was able to just have his inhaler."

Davis used a breathing machine to sleep at night, but the asthma never crippled his competitive nature or his love for sports, especially football.

At Friday's varsity football game, Oscar Smith's team took a knee and prayed over Davis' jersey. The announcer called for a moment of silence and, in the fence, students used cups to draw a heart around the number Davis wore when he played.

"The moment of silence and the player that wore his jersey, it was just like, man, it was a very touching moment for myself, because he touched so many hearts," said Vaughn, who was a father figure in Davis' life.
He remembers Davis' plans to go to college. He says the teen had so much living left to do.

"We had our whole life planned out and what we wanted to do," said Zyuanya Laguerre, Davis' younger cousin. "I never thought that was the last time I was going to say goodbye to my cousin." 

Cognitive rest for concussion management lacks data

Good debate on concussion treatment data! I suspect that the ER docs and pediatric neurologists are talking about different clinical scenarios. Who would argue with avoiding vigorous athletics or contact injury just after leaving the ER?

But, let's consider a sample of typical school recommendations following a concussion:

Treatment/ Rehabilitation    

"XX ISD athletes who sustain a head injury will be instructed to rest, both 
physically and cognitively.  This means that the athlete will be restricted from athletic 
participation, and should be restricted from recreational exercise, video games/television 
viewing, computer usage, including text messaging"

This can go on for months in some students.

Some school recommend that students avoid spicy foods.


Where is the pediatric data?

- JR

Cognitive rest for concussion management lacks data

  • Infectious Diseases in Children, October 2012
    Joshua Rotenberg, MD; Marc P DiFazio, MD, FAAN; Michael W Kirkwood, PhD
Raising awareness among pediatricians about how to best manage concussions in children and adolescents is important and more information is beginning to appear in various media. However, reports that encourage “cognitive rest” as the cornerstone of concussion treatment are not yet validated.
Unfortunately, although sports-related concussion is common in childhood, there is a paucity of empirical literature to support rest — cognitive or otherwise — as a management approach. Adding to the confusion, media reports implicate concussion in debilitating neurologic conditions and long-term neurodegenerative conditions; although to date, the evidence here remains speculative based on single case studies or survey data rather than controlled studies.

‘Second-impact syndrome’

There are reasons to briefly interrupt a child’s participation in contact sports after concussion. Patients may be at greater risk for injury, in general, if balance is affected and it allows time for adequate assessment of the injury. However, management during the past decade has emphasized removal from sports participation to lessen the risk for so-called “second-impact syndrome.”
Marc P. DiFazio
Marc P. DiFazio
This condition reportedly puts the individual at risk for fatal brain edema after a second concussion while still symptomatic from the first. However, critical analysis of the purported syndrome emphasizes the nebulous nature of this condition and even questions its existence. Catastrophic outcomes from sports-related concussion are much more likely to stem from acute intracranial bleeding after single concussions than diffuse edema or back-to-back concussions. Regardless of the exact pathology, death from sports-related head trauma in youth, although tragic in every case, is also several times less likely than death from sports-related cardiovascular events — and even less likely than death from lightning strikes.
Although physical exercise itself has never been implicated in worsening recovery from concussion, complete physical rest is commonly recommended. Additionally, many practitioners now recommend “cognitive rest” to supposedly hasten recovery. Cognitive rest remains ill-defined and usually entails a removal from school and cognitively stressful activities. A return of symptoms (pain, dizziness) upon reintroduction of activity, physical or otherwise, is considered causative of more injury, and further rest is prescribed. Patients are often told to rest until asymptomatic, often resulting in weeks missed from school, sports or extracurricular activities.
Michael W. Kirkwood
Michael W. Kirkwood
Currently, there is no evidence that the brain can be “put to rest” by refraining from such activity, and the increase in symptoms that may be associated with cognitive stress does not imply a worsening of the underlying concussive injury. That is, head pain and other nonspecific symptoms have not been shown to be definitive markers of ongoing cerebral injury. Although cognitive rest certainly sounds logical, brain activity is continuous and is generally uncontrolled by conscious means, and even during sleep intense brain remodeling and activity is evident.
Additionally, there is no good evidence in humans that rest results in brain healing or improved outcomes, and some data actually suggest that activity relatively soon after injury or while symptomatic has no effect on outcomes. Clearly, a standard-of-care guide regarding rest after sports-related concussion does not yet exist.

Negative effects of cognitive rest

Joshua Rotenberg
Joshua Rotenberg
Some might wonder whether there is really a downside to recommending cognitive rest. The implicit idea in the recommendation for rest is that if this is not followed, problems can be expected. In fact, prospective controlled studies demonstrate that most athletes recover well and relatively quickly with or without rest. More generally, psychoeducation and early reassurance after injury appears to reduce the chance of persistent symptoms after mild traumatic brain injury. This appears to support the clinical impression that patient or parental anxiety after a concussion can exacerbate symptoms and delay a return to typical functioning.
Adolescent obesity leads to midlife morbidity, and correspondingly, middle-aged adults who are obese have increased cardiovascular and neurologic health risks. Additionally, involvement in youth sports has long demonstrated physical and psychological benefits.

Individual approach to assessment

Given the lack of evidence supporting rest or even a symptom-free waiting period subsequent to a concussion, we approach our children and adolescents in a positive and reassuring fashion, avoiding rigid adherence to any particular management strategy. We recommend a return to exercise in a staged fashion, with an allowance for a self-determined escalation in activity, as tolerated. Regarding cognitive stress, we encourage a child’s return to school, albeit with temporary accommodations for headache and any cognitive difficulties that may occur. Frequent breaks and forgiveness for time and work missed are strongly recommended to avoid placing more stress on the student.
Children who experience concussion with recalcitrant symptoms or a previous history of neuropsychiatric difficulties are offered early psychological or medical intervention targeting anxiety, depression, fatigue, sleep difficulties or attentional challenges. Children are seen frequently and are encouraged and reassured that most who experience a mild traumatic brain injury have complete resolution within several weeks. We employ a number of indicators to craft an individual approach to assessment, including physical examination, symptom report, balance assessment, neurocognitive screenings, neuropsychological evaluation and screening for previous neuropsychiatric challenges. This approach is typically welcomed by parents, who are often relieved and reassured by the individualized care.
We hope that professional discourse among pediatric specialists will result in a data-driven approach to management of this common neurologic problem. Allowing anecdotes, popular beliefs or the media to dictate how we address this very frequent and long-standing sports-related complication is imprudent. Recommendations to avoid sports participation or exercise are potentially dangerous — given that more than 20% of children are obese — and as such are at greater risk for neurologic and cardiovascular complications during the lifespan, according to a 2012 study by Dattilo and colleagues.
Pediatricians should encourage exercise and sports participation while offering prudent counseling regarding concussion and brain protection throughout the life span.

  • Marc P. DiFazio, MD, FAAN, is the Medical Director of the Regional Outpatient Center and Assistant Professor of Neurology at Children’s National Medical Center in Washington, D.C. He is also Assistant Professor at the Uniformed Services University of the Health Sciences in Bethesda, Md. DiFazio can be reached at: marcdifazio@gmail.com.
    Michael W. Kirkwood, PhD, is from the Department of Physical Medicine & Rehabilitation at University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colo. Kirkwood can be reached at: Michael.Kirkwood@childrenscolorado.org.
    Joshua Rotenberg, MD, is Board Certified in Child and Adolescent Neurology and works with the Texas Medical & Sleep Specialists in Houston. Rotenberg can be reached at: pedzzz@gmail.com.
  • Disclosure: DiFazio, Kirkwood and Rotenberg report no relevant financial disclosures.

  • We thank Dr. DiFazio and colleagues for their editorial about cognitive rest as a treatment following concussion. Approximately 75% to 80% of traumatic brain injuries are mild and there is robust evidence that these seemingly minor injuries result in poor neurocognitive outcomes in an important proportion of pediatric patients.
    We agree with Dr. DiFazio’s group that there is equivocal evidence supporting, and significant controversy surrounding, ‘second-impact syndrome,’ and that this potential risk of death is extremely rare. However, we do not identify fatality risks due to second-impact syndrome as the driving force behind the recommendation for cognitive and physical rest following concussion. Instead, our focus is on the far more common morbidity and short-term disability following concussion due to metabolic mismatch and associated symptoms in the acute phase immediately following the injury.
    In this early phase, activities that place demands on brain metabolism (ie, physical exercise, learning or recreational activities such as school, video games and texting) divert metabolic resources away from the healing process. Research on pediatric concussion has demonstrated increased energy demand with decreased cerebral blood flow immediately following these injuries. Due to the time course of this physiologic process, treatment in the acute phase differs from management in the chronic stages of concussion. Patients with acute injury are more likely to seek emergency medicine and general pediatric care prior to referral to a subspecialist for more persisting symptoms from concussion. It is during the early initial acute phase post-injury when cognitive rest may be helpful in light of our current understanding of the pathophysiology of concussion.
    While we agree that the evidence surrounding the effectiveness of this treatment is still emerging, there are data supporting cognitive and physical rest immediately following concussion. Animal studies of exercise following traumatic brain injury demonstrate worse outcomes with early exercise, and better outcomes with later exercise. Other research on children with concussion shows increased symptoms and poorer cognitive testing performance with cognitive and physical disability in the early phase following injury, and improved performance with reduced symptoms following cognitive rest.
    Rather than being prescriptive about the absolute duration and of cognitive rest, we emphasize that it is variable, personalized to each specific child and directed by the elicitation of symptoms. We follow a gradual approach to “return to learn” with subsequent “return to play,” whereby patients and their families can continue a self-paced approach to recovery. Patients can progress to the next step in their recovery if symptoms resolve, and revert to a prior step if symptoms are elicited. Our steps, modeled after the Zurich Return to Play guidelines, include a graded re-entry into cognitive activity.
    Rest can vary from a day to a week or more, and is highly individualized. However, after the acute phase a few weeks following injury, cognitive rest has not been demonstrated to be helpful, and may actually be counterproductive. Rather, patients in this stage benefit from active rehabilitation including directed vestibular therapy as well as a graded aerobic therapy program. Of note, as our recommendation for cognitive rest is not synonymous with bed rest, includes a graded return to cognitive activity and is not meant to last indefinitely, we do not think a reasonable period of rest following injury would at all contribute to the emerging obesity epidemic as the authors suggest. Our aim in sports medicine is to return patients back to full participation in sports and other activities as safely and expeditiously as possible given our current understanding of pediatric and adolescent concussion.
    We believe prescribing a combination of appropriate initial rest with a progressive increase in activity in the acute phase, followed by active rehabilitation would in fact minimize the duration of symptomatology, while facilitating a timely return to both cognitive and physical activity.
    We agree with the authors that there is a great amount of needed research on this topic, including identifying the optimal time of rest and risk factors for poor outcomes. We fully support ongoing biomolecular and animal research focused on pathophysiology, biomechanical study of injury mechanisms, epidemiologic analysis of existing patient data, and clinical trials of various treatments in order to further the field of mild traumatic brain injury management. We would encourage that, while further data emerges, recommendations should focus on a “moderate” standpoint, whereby neither strict cognitive and physical rest for a pre-determined time, nor immediate resumption of physical or cognitive activities are recommended following injury. Instead, providers should first ‘do no harm’, and allow, during the acute phase of injury, the brains of acutely concussed children to rest for a reasonable duration that is primarily driven by individual symptomatology, with appropriate rehabilitation for children with chronic, prolonged symptoms.
    Kristy B. Arbogast, PhD
    Matthew F. Grady, MD
    Christina L. Master, MD
    Roni L. Robinson, RN, MSN, CRNP
    Douglas J. Wiebe, PhD
    Douglas J. Wiebe, PhD
    Mark R. Zonfrillo, MD, MSCE,
    • Kristy B. Arbogast, PhD, is from the Center for Injury Research and Prevention and the Division of Emergency Medicine at the Children’s Hospital of Philadelphia. Arbogast can be reached at arbogast@email.chop.edu.

      Matthew F. Grady, MD, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Grady can be reached at gradym@email.chop.edu.

      Christina L. Master, MD, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Master can be reached at masterc@email.chop.edu.

      Roni L. Robinson, RN, MSN, CRNP, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Robinson can be reached at robinsonr@email.chop.edu.

      Douglas J. Wiebe, PhD, is from the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine, University of Pennsylvania. Wiebe can be reached at dwiebe@exchange.upenn.edu.

      Mark R. Zonfrillo, MD, MSCE, is from the Center for Injury Research and Prevention and the Division of Emergency Medicine at the Children’s Hospital of Philadelphia. Zonfrillo can be reached at zonfrillo@email.chop.edu.

Full article here

Sunday, October 14, 2012

Infants Exposed to Specific Molds Have Higher Asthma Risk

The potential of household mold to cause respiratory disease has sometimes been sensationalized.  However, there is definitely an association with asthma.  This new research suggests that having household mold exposure in infancy may increase risk for asthma later in life.  Dr. Sarat Susarla

Infants Exposed to Specific Molds Have Higher Asthma Risk

ScienceDaily (Aug. 2, 2012) — In the United States, one in 10 children suffers from asthma but the potential environmental factors contributing to the disease are not well known. Cincinnati-based researchers now report new evidence that exposure to three types of mold during infancy may have a direct link to asthma development during childhood.
These forms of mold -- Aspergillus ochraceus, Aspergillus unguis andPenicillium variabile -- are typically found growing in water-damaged homes, putting a spotlight on the importance of mold remediation for public health.
Lead author Tiina Reponen, PhD, and colleagues report these findings in the August 2012 issue of theJournal of Allergy and Clinical Immunology, the official scientific publication of the American Academy of Allergy, Asthma and Immunology.
In a long-term population study of nearly 300 infants,, researchers from the University of Cincinnati (UC), U.S. Environmental Protection Agency (EPA) and Cincinnati Children's Hospital Medical Center assessed allergy development and the respiratory health of children annually for the first four years of life then again at age 7 -- an early age for objective diagnosis of asthma in children. The team also monitored home allergens and mold. All infants enrolled in the study were born to at least one parent with allergies.
They found that 25 percent of children whose parents had allergies were asthmatic by age 7. Among the multiple indoor contaminants assessed, only mold exposure during infancy emerged as a risk factor for asthma at age 7.
"Previous scientific studies have linked mold to worsening asthma symptoms, but the relevant mold species and their concentrations were unknown, making it difficult for public health officials to develop tools to effectively address the underlying source of the problem," explains Reponen, who is a professor in the UC College of Medicine's environmental health department.
The UC-based team used the environmental relative moldiness index (ERMI), a DNA-based mold level analysis tool, to determine that exposure to Aspergillus ochraceus, Aspergillus unguis and Penicillium variabile was linked to asthma development in the high-risk study population. The ERMI tool was developed by the EPA to combine analysis results of 36 different types of mold into one index that describes a home's cumulative mold burden.
"This is strong evidence that indoor mold contributed to asthma development and this stresses the urgent need for remediating water damage in homes, particularly in lower income, urban areas where this is a common issue," says Reponen. "Therapeutics for asthma may be more efficient if targeted toward specific mold species."
Children included in this study were part of the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a long-term population-based study of more than 700 children from the Greater Cincinnati area. CCAAPS looked at the effects of environmental particles on childhood respiratory health and allergy development. Participants were identified during infancy as at high risk to develop allergies based on family medical history

Thursday, October 11, 2012

How Childhood Virus Leads to Adult Asthma

RSV (respiratory syncitial virus) early in life seems to uncover the potential of developing asthma later in life.  It is still unclear why.  Some researchers have uncovered the role of immune system alterations that may explain this increased risk.  Dr. Susarla

How childhood virus leads to adult asthma

U. PITTSBURGH (US) — The normal immunity babies receive from breast milk is disabled by a common childhood virus, raising the risk of developing allergic asthma later in life.
Early in life, regulatory T cells, or Treg, play an important role in the establishment of immune tolerance, which can prevent the immune system from triggering an allergic reaction to antigens such as pollen and dust, write senior authors Anuradha Ray and Prabir Ray, both professors of medicine and immunology at the University of Pittsburgh School of Medicine.
“We know that recurrent infections by respiratory syncytial virus (RSV) that require hospitalization in early life increase the risk for asthma in adult life,” notes Anuradha Ray. “But, until now, it hasn’t been clear why this happens.”

“So we went from ‘bedside to bench’ to better understand the immunological impact of early, repeated RSV infection and to see if it affects Tregs,” explains lead author, Nandini Krishnamoorthy, postdoctoral associate, Division of Pulmonary, Allergy, and Critical Care Medicine.Allergens and biologic molecules that suppress the immune system are transferred from mothers to infants via breast milk, which induces protective regulatory Tregs in the infants help block the development of allergic diseases later in life, such as asthma.
As reported online in the journal Nature Medicine, the research team first fed newborn mice with breast milk from their mothers, who in turn had been exposed to the egg-white protein ovalbumin every other day for 10 days, to see if the babies would become tolerant to the protein.
The newborn mice were weaned after 21 days, and then some of them were infected with RSV several times for the next three weeks to mimic human infection. In the sixth week, the young mice were challenged with ovalbumin.
Mice that had not been infected with RSV did not have an immune response to the ovalbumin, to which they had been exposed through their mothers’ milk, indicating they had developed tolerance for it. Those that had been repeatedly infected with RSV, however, had increased immune cell infiltration in their airways and increased mucus production when challenged with the egg protein.
In another experiment, Treg cells were isolated from either the RSV-infected or uninfected mice and transferred into ovalbumin-exposed animals, which were then challenged with the protein. The cells from the uninfected mice, but not those from the infected ones, potently prevented airway inflammation and other markers of allergic reaction.
RSV also promoted the production of regulatory proteins called cytokines that foster inflammation, as well as triggered other changes in the cellular microenvironment altering the function of Treg cells.
“So without the suppressive function of the Tregs, the mice developed inflammatory immune responses to the ovalbumin allergen and developed asthma-like symptoms,” says Prabir Ray, who initiated the study.
“If the memory Tregs are crippled early in life, an important protective mechanism against allergens is lost, which increases susceptibility to asthma.”
“These studies suggest a link between early RSV viral infection and the development of adult allergy via direct effects of the virus infection on the very important regulatory T cell,” says Mark T. Gladwin, chief of the Division of Pulmonary, Allergy and Critical Care Medicine.
“From a clinical standpoint, efforts to control RSV infection or to enhance activation of regulatory T cells with breastfeeding and other strategies appear to be a promising approach to reducing our current asthma and allergy epidemic.”
Researchers from Emory University, Vanderbilt University, and Children’s Healthcare of Atlanta contributed to the study, which was funded by the National Institutes of Health.

RSV Hides in the Lungs AFTER Infection - Can Cause Asthma

Common Respiratory Syncytial Virus May Hide In The Lungs, Lead To Asthma, Researchers Report

Dr. Asuncion Mejias has shown that RSV may hide in the lungs even after other symptoms abate, ultimately resurfacing to cause recurrent wheezing and chronic airway disease. (Credit: Image courtesy of UT Southwestern Medical Center)
ScienceDaily (Oct. 22, 2008) — Conventional wisdom has been that respiratory syncytial virus (RSV) – a common virus that causes infection in the lungs – comes and goes in children without any long lasting impact.
A study conducted in mice by UT Southwestern Medical Center researchers, however, suggests that RSV may hide in the lungs even after other symptoms abate, ultimately resurfacing to cause recurrent wheezing and chronic airway disease.
"This research suggests that there's a potential new mechanism for asthma related to viral infections in children that could be associated with RSV," said Dr. Asuncion Mejias, assistant professor of pediatrics at UT Southwestern and senior author of a study available online and in the Nov. 15 issue of the Journal of Infectious Diseases. "These findings could aid in the development of preventive and therapeutic interventions for children with recurrent wheezing due to a virus such as RSV."
RSV is the leading cause of viral respiratory infections and hospitalizations in infants and children worldwide. Half of all babies develop an RSV infection within the first year of life and practically all have had at least one RSV infection by age 3, said Dr. Octavio Ramilo, professor of pediatrics at UT Southwestern and study co-author. About 3 percent to 10 percent of infants with RSV infections develop severe bronchitis and require hospitalization.
Most children recover within a week, but RSV can cause repeated infections throughout life. There is currently no vaccine available.
Dr. Ramilo said the team's findings contradict the current thinking that ribonucleic acid viruses like RSV are easily destroyed. "Whether RSV persists in children remains to be seen, but the fact that the virus persists in mice is amazingly powerful," he said.
The most striking finding, Dr. Mejias said, is that the amount of virus detected in the lungs of the mice directly correlates with the severity of airway hyperreactivity. Airway hyperreactivity, or episodes of bronchospasms in humans, is the main characteristic of asthma.

Friday, October 5, 2012

Teens who use mobiles after 'lights out' may struggle with sleep, depression

Bright mobile phone screens can disrupt sleep which in turn may contribute to mood disorders such as depression.  Dr. Susarla

Teens who use mobiles after 'lights out' may struggle with sleep, depression

Published in the October issue of the Journal of Pediatric Psychology , researchers found a link between teens who used mobile phones after they went to bed and poor mental health and suicidal thoughts compared to those who did not use their phones at this time of night. The researchers controlled for other factors, including alcohol and drug usage. In the study, researchers investigated nearly 18,000 children in junior high and high schools in Japan, with subjects answering questions about their mental health, in addition to sleep and mobile phone habits. The study follows prior research that finds poor sleep is associated with mental problems in teens. For example, a study published last year in the Journal of Psychiatric Research found teens who had difficulty sleeping were at an increased risk for suicidal thoughts. Additionally, Rensselaer Polytechnic Institute's Lighting Research Center in the US found that looking at the backlit screen of certain electronic devices can suppress melatonin, a hormone produced during sleep, and cause sleeplessness. This study was published recently in the journal Applied Ergonomics.

Pioneering Doctor's Early Insights on SIDS

Though SIDS is a true condition and is the highest cause of infant mortality, this doctor discovered that many early cases of "crib deaths" were not in fact due to a mysterious disease, but were due to infanticide.  Infant apnea monitors surfaced around this time.  Dr. Susarla

Pathologist, pioneering researcher on SIDS, and mother of 11 children

The photograph shows Dr. Marie Valdés-Dapena performing an autopsy. She is nine months pregnant. She is watching a clock - timing her contractions, determined to complete the job before delivering her own baby.
In that picture, vividly recalled by her daughter Cris, are hints of an extraordinary life to come: a pioneer in the study of sudden infant death syndrome; a leading pediatric pathologist who was among the first to recognize what is now known as child abuse; and a working mother of 11 children in an era when few women worked and far fewer were doctors.
Dr. Valdés-Dapena, 91, who was best known to the public as a pathologist in the biggest maternal infanticide case in recorded history - Marie Noe's murder of eight babies in Kensington - died Sunday at the Rose Tree Place retirement community near Media. She had struggled with advanced dementia for many years, her family said.
"She was warm as toast and never, ever, ever too busy to devote what seemed like all the time in the world to the lowliest, us residents," said Sarah Long, who arrived at St. Christopher's Hospital for Children as a resident in 1970 and who has been chief of infectious diseases for 35 years. "Her owlish glasses would fall down her nose as she was doing an autopsy. She would push them back with a great big smile and tell you something she had just noticed."
In 1944, when Dr. Valdés-Dapena graduated from Temple University School of Medicine, "pathology was the top of the medical profession," said M. Daria Haust, professor emerita at the University of Western Ontario; pathologists found the diseases.
St. Christopher's, at the time Temple's teaching hospital for pediatrics, was an international leader in pathology. But hardly anything was known about postmortems on infants.
Moonlighting at the Philadelphia Medical Examiner's Office, Dr. Valdés-Dapena encountered "crib deaths": babies who went to sleep healthy and were dead in the morning, with no clues to be found during autopsies. She had investigators visit homes, and put pins on a big map to find patterns.
It was one of the earliest scientific examinations of what later became known as sudden infant death syndrome. In the 1960s and '70s, Dr. Valdés-Dapena was a leading researcher and the chief debunker of various SIDS theories, from viruses to milk allergies. Many such deaths are still unexplained, but after recommendations in the 1990s that babies be placed on their backs to sleep, mortality plummeted.

Monday, October 1, 2012

Virus Patterns Where Kids Live May Affect Asthma Risk

Not all asthma triggers are allergic.  A major one is respiratory viruses which begin to surge in fall and persist until spring.  Dr. Susarla

Virus Patterns Where Kids Live May Affect Asthma Risk

Certain respiratory infections more common in urban than suburban infants, study finds

WEDNESDAY, Sept. 26 (HealthDay News) -- Infants in urban areas have different patterns of viral respiratory illness than those in the suburbs, which may explain why inner-city children are more likely to develop asthma, a new study suggests.
The findings may lead to new ways to treat childhood asthma, according to Dr. James Gern of the University of Wisconsin, Madison, and colleagues.
Previous studies have linked viral respiratory illnesses to the development of asthma in children and have shown that children with human rhinovirus infections are more likely to develop asthma by age 6 than those with respiratory syncytial virus infections.
In this study, researchers analyzed nasal secretions from 500 infants living in inner-city areas of Boston, Baltimore, New York City and St. Louis, and 285 infants from suburban Madison, Wis. The samples were taken while the children were healthy, and also when they had respiratory illnesses.
Inner-city infants had lower rates of human rhinovirus and respiratory syncytial virus than suburban infants, but were more likely to test positive for adenovirus infections -- 4.8 percent of urban babies tested positive for adenovirus only versus 0.7 percent of suburban babies.
Adenovirus can cause persistent infections and the researchers suggested that adenovirus infections early in life could alter the development of the lungs or airways. The investigators plan to follow the inner-city kids for at least 10 years to determine whether adenovirus infections are associated with increased rates of asthma and lower levels of lung function.