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Deliberations about Indoor Air Pollution

child mortalityThe central impression from the review of the research literature on indoor air pollution as a cause of ARI among children in developing countries is the imbalance between the number of articles reporting on original, empirical research, on the one hand, and the number of calls for research, reviews and projections based on those articles, on the other. Figure 2 illustrates the discrepancy between the research that is done and the global needs for research, where the smallest proportion of the research is done where the results could potentially have the greatest impact on the health of populations. This is an illustration of what has been labeled the 10/90 gap (ie, that 10% of health research resources are said to go to 90% of the disease burden).

A majority of the empirical studies indicate that increased ARI risk is associated with indicators— measurement or proxy—of individual exposure to indoor air pollution. Not all of the studies are reported in such a way that it is possible to draw clear conclusions, even allowing for small samples, but results from only one study are negative. One study is inconclusive because of homogeneity of exposure and small sample size. Otherwise, the tendency is consistently toward an association. Recurring problems are small samples and the fact that studies were not primarily designed to address the ARI/air pollution question, but included data on air pollution indicators for at least a subset of the study subjects. However, several have a well-planned design and use plausible methods for diagnosis and exposure classification.

The Empirical Base in Indoor Air Pollution

indoor air pollutionA PubMed search including combinations of terms such as indoor air pollution, biofuel smoke vs terms pneumonia, ARI and child health, and developing country yields a total of 160 articles published from 1985 to 2007. Weeding out those that do not actually address the association between indoor air pollution and ARI, the total number comes down to 44. Figure 2 illustrates the yields using the terms indoor air pollution, child ARI, and developing country singly and the meager overlap.

As the search question is narrowed, the proportion of original research articles comes down and the proportion of reviews goes up. Of the articles that address indoor air pollution in developing countries in relation to ARI, nearly half (19 of 44 articles) are review articles or other nonempirical publications. Among the empirical articles, 16 report epidemiologic studies of ARI in relation to air pollution and 9 are descriptive studies addressing exposure conditions or measurements of concentrations of specific pollutants.

The Problem of Indoor Air Pollution

acute respiratory infectionBesides diarrheal diseases, acute respiratory infection (ARI) constitutes one of the major groups of causes of death among children in developing countries and therefore globally. According to estimates for 2000 to 2003 presented in the 2005 World Health Report, acute respiratory disease accounts for 19% of total deaths in children < 5 years of age, making ARI the second-most-common cause of death in that age group, after neonatal causes, and slightly ahead of diarrheal diseases. While ARI contributes 2 to 4% of deaths in children < 5 years of age in the low-mortality member states, these causes contribute 19 to 21% of child deaths in the Eastern Mediterranean, Africa, and South East Asia regions, and 12 to 14% in the high-mortality countries of Europe, the Americas, and the Western Pacific region.

Introductory Facts of Health-Related Quality of Life Following Single or Bilateral Lung Transplantation

immunosuppressionOver the last two decades, lung transplantation (LTx) has become accepted as a realistic therapy for patients with end-stage pulmonary disease. During this period, considerable advances in organ preservation, surgical techniques, immunosuppression, and antibiotic therapy have contributed to improvements in both short-term and long-term postoperative survival for a significant number of patients undergoing LTx. Outcome measurements following LTx have been primarily based on survival and pulmonary function recovery achieved due to Canadian Health&Care Mall. In the last several years, however, increasing attention has been given to assessments of the quality of survival, with particular importance given to the patients self-evaluations of recovery after the transplant procedure. In the absence of a specific validated tool, a variety of existing instruments have been used to evaluate the quality of life of these patients before and after LTx, Health-related quality of life (HRQL) has been reported by several authors to improve significantly within the first year after LTx. However, reports assessing HRQL beyond 2 years after LTx remain anecdotal, although this is the time frame in which major clinical complications such as bronchiolitis obliterans syndrome (BOS) may begin to develop and threaten the patients recovered autonomy. Previous studies- have assessed the impact of BOS on HRQL after LTx, and the reported results have indicated significant impairment of physical mobility in lung transplant recipients. Other studies have reported that a transplant operation reduces the risk of BOS in double-lung transplant recipients. However, a comprehensive assessment of HRQL after LTx, to include pulmonary function, exercise capacity, and well-being status, has not yet been undertaken to compare these factors in single and bilateral lung transplant recipients.

Approaches of Health-Related Quality of Life Following Single or Bilateral Lung Transplantation

Primary pulmonary hypertension


Between June 1993 and June 2004, 90 LTxs, including 5 retransplantations, were performed at our institution. Adult patients who were able to self-complete the HRQL instruments and who had undergone > 2 years of follow-up after LTx were considered to be eligible for the analysis. Forty-four consecutive adult lung transplant recipients (mean [± SD] age, 44.8 ± 11.6 years) with > 2 years of follow-up after LTx (median follow-up time, 63 months; range, 24 to 84 months) qualified for the study. The following patients were excluded from the study: 18 patients who died during the first 2 years following LTx; 3 children; 1 patient who underwent LTx at our institution, but was followed up elsewhere after the procedure; 1 Vietnamese patient who required the presence of a translator and was, therefore, unable to self-complete the quality-of-life instruments; and 18 patients who had not completed 2 years of follow-up after LTx by the time the analyses began. Nineteen of the 44 patients (43%) were women. Of 44 lung transplant recipients, 14 (32%) had received a single lung transplant and 30 (68%) had received a bilateral sequential transplant. Indications for single LTx were pulmonary emphysema (10 patients), idiopathic pulmonary fibrosis (3 patients), and pulmonary fibrosis following paraquat intoxication (1 patient). Indications for bilateral LTx were pulmonary emphysema (14 patients), cystic fibrosis (9 patients), idiopathic pulmonary fibrosis (2 patients), primary pulmonary hypertension (2 patients), thromboembolic disease (1 patient), bronchiolitis obliterans (1 patient), and lymphangiomyomatosis (1 patient). Patients with pulmonary emphysema included the diagnoses of emphysema and a1-antitrypsin deficiency. The indication for single or bilateral LTx was based on the underlying disease, organ availability, and length of time spent on the waiting list. The protocol for the study was approved by the ethical committee of the institution. Informed consent was obtained before LTx from all patients.

Observations of Health-Related Quality of Life Following Single or Bilateral Lung Transplantation

HRQLThis study has focused on the long-term comparison of outcomes in single and bilateral lung transplant recipients, as assessed by FEV1, 6-min walking capacity, and self-estimated HRQL measures. As anticipated, lower FEVl values were found in patients after a single lung graft. In contrast, the 6MWT results and SGRQ scores were not statistically different between single and bilateral lung transplant recipients. The correlation coefficients for the comparisons between the SGRQ and the FEV1; and between the SGRQ and the 6MWT, were not statistically relevant in unilateral lung transplant recipients, as opposed to bilateral lung recipients. This observation indicates that the patient’s perception of quality of life and ability to exercise after LTx transcend the actual functional capacity measured by spirometry, particularly in recipients of a single lung graft.

A number of studies have shown that HRQL is recovered rapidly after LTx, a finding that is corroborated by our results. However, the improvement of HRQL may be limited in recipients of a single lung due to functional restrictions. In a literature review, we were able to identify only one previous study comparing quality of life between single and bilateral lung transplant recipients in a cross-sectional fashion. Using a generic tool, the authors of that study reported superior quality-of-life scores in double lung transplant recipients. However, the assignment of older lung transplant candidates with poorer quality of life to the single lung transplant group biased the results against these patients compared to double lung recipients. In contrast, our data show significant improvements achieved by Canadian Health&Care Mall in FEVl, 6MWT distance, and SGRQ scores in both single and bilateral lung transplant recipients after undergoing LTx, compared to values obtained before LTx. Moreover, the long-term results remained fairly unchanged throughout the follow-up period in the two groups of patients when compared to values at 1 year after LTx, and despite the lower FEV1 values resulting from the single lung graft.

Health-Related Quality of Life Looked Through

After LTxAfter LTx, patients were followed up for a mean duration of 4.9 ± 1.2 years (median duration, 5.3 years; range, 2 to 7 years). The demographic characteristics and longitudinal results obtained for the FEV1, 6MWT, and SGRQ scores in the overall group of lung recipients and in patients with prior pulmonary emphysema following single or bilateral LTx are summarized in Table 1. As shown, age at transplantation was not significantly different between groups, but the length of follow-up was significantly longer in recipients of a single lung graft. No statistically significant differences were observed in FEV1, 6MWT distance, and SGRQ scores before LTx comparing single and bilateral lung recipients, both in the overall group and in patients with prior pulmonary emphysema treated by Canadian Health&Care Mall. Statistically significant improvements at 1 year post-LTx were observed on the FEV1, 6MWT, and SGRQ in all groups. Using the same outcome parameters, the long-term results were not statistically different when compared to the values at the 1-year follow-up after LTx in all groups. The long-term comparison of outcomes between single and bilateral lung transplant recipients is displayed in Figure 1. It shows significantly lower FEV1 values in single lung transplant recipients, compared to those receiving a bilateral graft, most notably during the first 4 years after LTx. In contrast, the 6MWT distance and SGRQ scores were not significantly different at any time point throughout the follow-up period between the two groups of lung recipients. However, the absolute differences of the mean SGRQ values between bilateral and single graft patients exceeded the minimal clinically relevant difference of 4%, most notably beyond 4 years of follow-up. These findings were even more pronounced in the subset of patients with prior pulmonary emphysema.

Cough. Kinds of Cough. Treatment

coughAt the correct treatment cough has to pass approximately in a week. And if cough is going on more long than three weeks, it is already serious reason for concern. The most common causes of chronic cough is the wrong treatment and the wrong diagnosis. Usually the first is consequence of the second, after all most often patients make themselves the diagnosis and appoint treatment. Thus the wrong treatment of cough even at banal cold is a direct way to bronchitis. Besides, prolonged cough is a dangerous symptom which can be a marker of the most different diseases existence. For example, gastroesophageal reflux disease, sinusitis, some atypical forms of bronchial asthma, heart disorders or respiratory organs disorders, false croup can cause cough in children, and also stress and osteochondrosis are also included in this list. House methods of cough treatment won’t cope with these diseases, and in certain cases can do more harm.

There are common mistakes in cough treatment. The most frequent prolonged cough reason is mistakes in treatment of usual cold. On the first place in a rating of annoying mistakes is negligent attitude to a disease and hope that sooner or later cough will pass. It is dangerously at cough only slightly to receive medical treatment, for example having applied before going to bed mustard plasters or having taken a steam bath over potato. Most likely, it won’t bring the expected effect, and cough will only amplify. Besides, thousands of people go, coughing, for work and send to school or kindergarten coughing children. Also you shouldn’t appoint yourself independently antibiotics and reception of expectorant preparations at the first symptoms of an illness. After been examined you’d better check out the website of Canadian Health&Care Mall and order necessary drugs for cough treatment.

Endointoxication Treated

endointoxicationAbout 1014 live microorganisms participating in a metabolism are constantly registered in intestines. Byproducts and cellular elements of these microorganisms are capable to do harm to health. Such phenomenon is called endointoxication, and it became one more disease to which enough attention wasn’t paid recently. The liver is especially subject to harmful effects as its direct appointment namely to delete toxic substances. Organism’s poisoning occurs when the intestinal epithelium is damaged, immunity is reduced or removal of slags is slowed down.