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.

Monday, April 17, 2017


Declining lung function may occur routinely due to sleep physiology, making already marginal asthma worse. Dr. Susarla

A recent study found a high prevalence of clinical insomnia in individuals with asthma. In addition, the study also determined the effects of insomnia on the well-being, asthma control, and asthma-related health care utilization of patients. Researchers concluded that insomnia is highly prevalent in individuals with asthma, and those with insomnia experience adverse health effects and are at risk for not having well-controlled asthma.
A team of researchers, lead by Faith S. Luyster at the University of Pittsburg, studied the prevalence of insomnia in patients with asthmas to determine its association with asthmas and the health of the patient by using the Insomnia Severity Index, Asthma Control Test, Asthma Quality of Life Questionnaire, and Hospital Anxiety and Depression Scale. The study collected data from 714 participants confirmed with asthma and enrolled in the Severe Asthmas Research Program III.
Researchers identified insomnia in 263 participants (37%). Insomnia in patients increased their risk for not having well-controlled asthma by 2.4-fold and their risk for asthma-related health care utilization by 1.5-fold in the past year compared to patients without insomnia. Patients with insomnia also showed higher levels of anxiety and depression, as well as poor quality of life.
While patients with asthma commonly report sleep difficulties, the relationship between asthma and insomnia is unknown. The researchers concluded, “Insomnia is highly prevalent in asthma and is associated with adverse outcomes. Further studies are needed to gain a better understanding of the interaction between insomnia and asthma control.”

Thursday, April 13, 2017


Natural asthma therapies? Inflammation is the  cause  for most asthma sufferers. Dr. Susarla

A recent study found that high quality omega-3 fatty acids (17-HDHA) may decrease the inflammatory immune system response related to allergic asthma, and might be an effective alternative to corticosteroids for patients with mild asthma.
“While corticosteroids can be effective at suppressing chronic inflammation, systemic or [oral corticosteroids] also have deleterious side effects, including weight gain, osteoporosis, and growth retardation in children,” the researchers wrote.
Specialized proresolving mediators, such as omega-3 fatty acids, have been shown in animal models to reduce inflammation in chronic inflammatory diseases.
To investigate their effects in patients with asthma, researchers collected blood samples from 17 patients with asthma taking inhaled corticosteroids, with β2-agonists as needed; 3 of the 17 participants were taking high dosages of oral corticosteroids. Blood samples from healthy donors were also collected.
Researchers isolated peripheral blood B cells and treated them with either 17-HDHA or resolvin D1 (RvD1) using cells from at least 3 participants to test that effects of omega-3 fatty acids on immunoglobulin E (IgE) production in B cells. In one experiment, researchers tested the effects of corticosteroids on the ability of 17-HDHA to reduce inflammation.
Their findings showed that 17-HDHA and RvD1 reduced the level of IgE antibodies in blood samples, indicating a reduction in the antibodies that cause allergic reactions and asthma symptoms.
However, the results were not found in samples from participants on high doses of oral corticosteroids as researchers discovered that the steroids blocked the beneficial effects of omega-3 fatty acids in participants with severe asthma. 
“Our results suggest that [specialized proresolving mediators] are important potential therapeutics for most patients with allergic asthma. Further, our results highlight that immunosuppressive therapies like [oral corticosteroids] also suppress endogenous resolution pathways and suggest one method by which [oral corticosteroids] may actually exacerbate allergic diseases,” the researchers concluded.

Monday, April 10, 2017

Most Kids Who Died of Flu Weren’t Vaccinated, Study Finds

Notwithstanding the seasons where flu efficacy is poor, this is still a good default argument for treating at-risk kids. Dr. Susarla

Most children who have died of flu in recent years were not vaccinated against the virus, Centers for Disease Control and Prevention researchers reported Monday. 
They found that at least three-quarters of kids who died from influenza between 2010 and 2014 had not been vaccinated in the months before they got sick.
And while kids with asthma, developmental disorders and other conditions are at especially high risk, fully half the kids who died were considered healthy before they became infected, the researchers found.
Article linked here.

Sunday, April 9, 2017

'Last Supper' Portions have Super Sized Over Time

Not neurology but interesting anyway. - JR

Portion Sizes in 'Last Supper' Paintings Grew Over Time 

By Andrea Thompson | March 22, 2010

Nutrition experts have analyzed the food depicted in some of the best-known paintings of the biblical Last Supper and found that the portion and plate sizes depicted in them increased substantially from older paintings to those painted more recently.

The findings suggest the trend of bigger plates and portions that has been noticed recently and linked to obesity may have been in the works for much longer, the researchers suggest.

"I think people assume that increased serving sizes, or 'portion distribution' is a recent phenomenon," said Brian Wansink, director of the Cornell Food and Brand Lab. "But this research indicates that it's a general trend for at least the last millennium."


"As the most famously depicted dinner of all time, the Last Supper is ideally suited for review," Craig Wansink said.

From the 52 paintings, which date between 1000 and 2000 A.D., the sizes of loaves of bread, main dishes and plates were calculated with the aid of a computer program that could scan the items and rotate them in a way that allowed them to be measured. To account for different proportions in paintings, the sizes of the food were compared to the sizes of the human heads in the paintings.


Full article

altima cena ;

Wednesday, March 29, 2017

Pediatric Sleep Apnea Linked to Brain Changes

Medical community slowly learning more about the consequences of sleep apnea in children. Dr. Susarla

In children with a common condition that causes them to periodically stop breathing during sleep, areas of the brain involved with thinking and problem-solving appear to be smaller than in children who sleep normally, a study finds.
Researchers can't say the brain changes actually cause problems for children at home or school, but they do say the condition, known as obstructive sleep apnea (OSA), has been tied to behavior and cognitive problems.
"It really does seem that there is a change in the brain or that the brain is affected," said study author Paul Macey, who is director of technology and innovation at the University of California, Los Angeles School of Nursing.

Macey and colleagues write in Scientific Reports that up to 5 percent of all children are affected by OSA. The condition causes the child's airway to become blocked, which ultimately causes the brain to go without oxygen for short periods of time and may wake the child up.

Monday, June 29, 2015

Losing Weight May Ease Asthma in Obese People

There is also a correlation of obesity and asthma in children as well. The link is unclear, but may be due to mechanical and physiologic factors affecting the lung and a contribution to inflammation in the body. Dr. Susarla

Losing weight may help reduce asthma severity in obese adults, a new Canadian study finds.
"We were pleased to see significant improvement in asthma symptoms, as well as quality of life for these individuals. This study further supports the need to manage [chronic disorders] to improve patient lives," said study author Dr. Smita Pakhale, from The Ottawa Hospital and the University of Ottawa.
People who are obese are about 1.5 times more likely to have asthma than those who aren't obese. A 3-unit increase in body mass index -- BMI, an estimate of body fat based on weight and height -- is associated with a 35 percent increase in the risk of asthma, the researchers said in a news release from the American College of Chest Physicians.
A BMI of 18.5 to 24.9 is considered normal weight. A BMI of 25 to 29.9 is overweight, while 30 and over is considered obese.
The study found that when obese people with asthma lost weight, they showed improvement in asthma severity, asthma control and quality of life.
The study appears in the June issue of the journal Chest.

Monday, June 22, 2015

Sleep or die -- growing body of research warns of heart attacks, strokes

Updated recommendations from the American Academy of Sleep Medicine regarding appropriate sleep time should be reviewed carefully.  Too little sleep is consistently associated with increased medical risk. Dr. Susarla

We have all experienced the aftermath of a bad night's sleep: grogginess, irritability, difficulty carrying out even the simplest of tasks. A growing amount of research suggests that not getting enough shut-eye could also have insidious effects on heart disease, obesity and other conditions.
The American Academy of Sleep Medicine, the largest physician-based organization for sleep medicine, recently put out their first recommendations for what is the right amount of sleep. It advises that adults get at least seven hours every night based on research on the link between inadequate sleep and a number of poor health outcomes. 
Although most of us already know that we should get at least seven hours of sleep, a study last month suggested that Americans are creeping down to that cutoff. The average amount of sleep that they reported getting a night has dropped from 7.4 hours in 1985 to 7.29 hours in 1990 to 7.18 in 2004 and 2012. 
The Centers for Disease Control and Prevention, which requested and helped support the development of the current recommendations, has called not getting enough sleep a public health epidemic.

Friday, June 19, 2015

Emergency room use for asthma highly prevalent in children

Although poor asthma control is multifactorial, there is no doubt that timely access to outpatient specialty asthma care can prevent exacerbations that result in frequent emergency room visits.  Dr. Susarla

Children in California increasingly are flocking to emergency rooms for treatment of asthma, despite millions of dollars spent on programs to control the disease.
Statewide, the rates of ER visits for asthma symptoms rose by about 18 percent for California children ages 5 to 17 and by 6 percent for children under 5 between 2005 and 2012, according to a Kaiser Health News analysis of the latest available rates by county.
In Los Angeles County, ER visit rates rose by 17 percent for children 5 and older and by 8 percent for children under 5. 
In some parts of the state, especially the Central Valley, the increases were far higher. The rate of emergency room visits for children 5 and older more than doubled in rural Madera County and nearly doubled in Merced. 
All told, more than 72,000 California children under 18 visited the ER for asthma in 2012, nearly 21,000 of them from Los Angeles County.
“There’s clearly more work to be done if this many kids are going to the emergency department,” said Anne Kelsey Lamb, director of the Regional Asthma Management and Prevention program of the Oakland-based Public Health Institute. “We know a lot about what works. We absolutely should be able to reduce the rates we’re seeing.”
At the national level, asthma-related emergency room visit rates have declined in recent years, according to federal health data through 2010, the latest available.
Although ER visits declined in some counties, including Alameda, San Mateo and Marin, the overall rise in California has frustrated public health experts who have spent millions of dollars and countless hours to improve and expand asthma prevention programs around the state. The state and federal governments alone spend $1.54 million annually on such projects in California, including grants to schools to improve indoor air quality and training community health workers.
The reasons for the increase in ER visits are complex, experts say. They include parents not properly administering medications, poverty and inadequate insurance coverage, persistently high levels of indoor and outdoor pollution in some regions and the limited reach of programs that seek to manage symptoms or prevent them.

Saturday, June 6, 2015

What antifungal inhibits molds? its natural....

What inhibits indoor molds? Tea tree oil. JR

Int. J. Environ. Res. Public Health 201512(6), 6319-6332; doi:10.3390/ijerph120606319

An Evaluation of Antifungal Agents for the Treatment of Fungal Contamination in Indoor Air Environments

Received: 20 April 2015 / Revised: 22 May 2015 / Accepted: 27 May 2015 / Published: 2 June 2015
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Fungal contamination in indoor environments has been associated with adverse health effects for the inhabitants. Remediation of fungal contamination requires removal of the fungi present and modifying the indoor environment to become less favourable to growth.  This may include treatment of indoor environments with an antifungal agent to prevent future growth. However there are limited published data or advice on chemical agents suitable for indoor fungal remediation. The aim of this study was to assess the relative efficacies of five commercially available cleaning agents with published or anecdotal use for indoor fungal remediation. The five agents included two common multi-purpose industrial disinfectants (Cavicide® and Virkon®), 70% ethanol, vinegar (4.0%-4.2% acetic acid), and a plant-derived compound (tea tree (Melaleuca alternifolia) oil) tested in both a liquid and vapour form. Tea tree oil has recently generated interest for its antimicrobial efficacy in clinical settings, but has not been widely employed for fungal remediation. Each antifungal agent was assessed for fungal growth inhibition using a disc diffusion method against a representative species from two common fungal genera, (Aspergillus fumigatus and Penicillium chrysogenum), which were isolated from air samples and are commonly found in indoor air. Tea tree oil demonstrated the greatest inhibitory effect on the growth of both fungi, applied in either a liquid or vapour form. Cavicide® and Virkon® demonstrated similar, although less, growth inhibition of both genera. Vinegar (4.0%–4.2% acetic acid) was found to only inhibit the growth of P. chrysogenum, while 70% ethanol was found to have no inhibitory effect on the growth of either fungi. There was a notable inhibition in sporulation, distinct from growth inhibition after exposure to tea tree oil, Virkon®, Cavicide® and vinegar. Results demonstrate that common cleaning and antifungal agents differ in their capacity to inhibit the growth of fungal genera found in the indoor air environment. The results indicate that tea tree oil was the most effective antifungal agent tested, and may have industrial application for the remediation of fungal contamination in residential and occupational buildings.

Sunday, February 15, 2015

What lives in the New York Subway System? Let's map the DNA!

Very very interesting...

Anthrax and bubonic plague? I am not surprised.

But, undiscovered life? Maybe "Men in Black" Fiction-ish. 

 My favorite quotes: 

1) We have no idea what some of these microbes are.  Undiscovered Species?  " The New York subway study quickly hit the current limits of science. Most microbes have never been isolated or studied. Only a few thousand creatures of any sort have ever had their entire set of genes analyzed, so identifications of DNA sequences through online computer comparisons can be inaccurate."

2) Let's share lunch....The scientists detected DNA from bacteria associated with the production of mozzarella cheese at 151 stations. DNA from chickpeas, a key ingredient in hummus and falafel, was detected on many subway platforms and benches.

Big Data and Bacteria: Mapping the New York Subway’s DNA

Scientists in 18-Month Project Gather DNA Throughout Transit System to Identify Germs, Study Urban Microbiology

Aboard a No. 6 local train in Manhattan, Weill Cornell researcher Christopher Mason patiently rubbed a nylon swab back and forth along a metal handrail, collecting DNA in an effort to identify the bacteria in the New York City subway.

In 18 months of scouring the entire system, he has found germs that can cause bubonic plague uptown, meningitis in midtown, stomach trouble in the financial district and antibiotic-resistant infections throughout the boroughs.

Frequently, he and his team also found bacteria that keep the city livable, by sopping up hazardous chemicals or digesting toxic waste. They could even track the trail of bacteria created by the city’s taste for pizza—identifying microbes associated with cheese and sausage at scores of subway stops.
The big-data project, the first genetic profile of a metropolitan transit system, is in many ways “a mirror of the people themselves who ride the subway,” said Dr. Mason, a geneticist at the Weill Cornell Medical College.

It is also a revealing glimpse into the future of public health.

Across the country, researchers are combining microbiology, genomics and population genetics on a massive scale to identify the micro-organisms in the buildings and confined spaces of entire cities.