Larisa V. Buyantseva

Evolution of lower respiratory symptoms in New York police officers after 9/11: a prospective longitudinal study.

Objective: We studied the evolution of lower respiratory symptoms at 1 month (initial) and 19 months (follow-up) after the collapse of the World Trade Center on September 11, 2001 (9/11). Methods: A total of 1588 New York police officers completed initial self-administered questionnaires. The level of 9/11 exposure and pre-9/11 health was available in 1373. Of those, 471 (426 with no pre-9/11 chronic respiratory disease) completed a follow-up telephone survey. Results: Prevalence of cough was 43.5% at both initial and follow-up assessments, but increased were the prevalence of phlegm (14.4% to 30.7%, P < 0.001), shortness of breath (18.9% to 43.6%, P < 0.001), and wheeze (13.1% to 25.9%, P < 0.001). Rates of delayed-onset (present on follow-up assessment only) cough, phlegm, shortness of breath, and wheeze were 21%, 21.9%, 31.7%, and 17.3%, respectively. Conclusions: Most of the lower respiratory symptoms increased between 1 month and 19 months after 9/11.

Reduction in diisocyanate and non-diisocyanate sensitizer-induced occupational asthma in Ontario.

Objective: To investigate relative frequency and features of diisocyanate (ISO) and non-diisocyanate (N-ISO) allowed occupational asthma (OA) claims in Ontario, Canada, during a 5-year period (1998 to 2002). Methods: Records were abstracted from the Ontario Workplace Safety and Insurance Board using methodology similar to our previous investigation that had identified 30 ISO and 30 N-ISO claims/yr during 1980 to 1993. Results: There were 99 OA claims: 37 ISO (7.4 claims/yr) and 62 N-ISO (12.4 claims/yr). The ISO group had more males (86% vs 69%, p = 0.01), but there were no other significant differences. The commonest professions were spray painters (41%) and production workers (38%) in the ISO group and production workers (49%) and health care workers (8%) in the N-ISO group. Conclusions: ISO and N-ISO claims declined from the previous period, especially for ISO, perhaps because of effective surveillance programs.

Risk factors associated with 30-day asthma readmissions.

Abstract Objectives: Assess factors that increase the odds of 30-day asthma readmissions to hospitals. Methods: Retrospective chart review between 1/1/2002 to 12/31/2012 of pediatric and adult patients with the primary diagnosis of asthma readmitted within 30 days after the index admission was performed. Patients were identified from billing database for asthma ICD 9 code (493.9). Inclusion criteria were: physician confirmed asthma diagnosis, one or more asthma admissions and accessible medical records. Results: A total of 95 patients with multiple asthma readmissions were included in the final analysis. Thirty-seven patients (39%) were readmitted for asthma within 30 days and 58 patients (61%) had readmission in a 30–365-day period. Demographic characteristics were not significantly different between groups. Bivariate analysis showed that factors associated with higher likelihood of readmissions were a higher frequency of previous admissions, ED visits, inpatient hospitalizations, ICU stays, intubations, chest X-rays, history of chronic sinusitis, gastroesophageal reflux disease, anxiety, and the use of tiotropium or a long-acting beta-agonist (LABA). Multivariable analysis confirmed that prior hospital admissions and a history of GERD are the strongest predictive factors for early asthma readmissions, yet a history of environmental allergies might be a protective factor (p = 0.053). Conclusions: Non-allergic asthma patients with multiple prior admissions, ED visits and inpatient hospitalizations, on multiple medications with history of GERD, sinusitis, and anxiety are more likely to be readmitted within 30 days irrespective of other factors. Patients with these characteristics should be assessed for interventions in an effort to reduce early readmissions.

Alternatives for Measuring Endogenous Adrenocortical Activity in Asthmatics Treated with Inhaled Corticosteroids

We compared a 12-hour, hourly integrated plasma cortisol profile in asthmatics treated with a corticosteroids with a variety of modified methods based on less frequent blood sampling. Excellent agreement with the reference was observed for sampling at 10 p.m. and 8 a.m. (correlation coefficient of 0.97; 95% confidence interval 0.97, 0.98); at 9 p.m. and 7 a.m. (r = 0.95; 0.94, 0.96); at 11 p.m. and 7 a.m. (r = 0.94; 0.93, 0.95); every 2 hours (r = 0.96; 0.96, 0.97); and every 3 hours (r = 0.91, 0.91, 0.93). The two-sample alternatives (10 p.m/8 a.m. and 9 p.m/7 a.m.) are accurate, as well as more convenient, economical, and practical.

A 73-year-old woman with persistent diarrhea and onychomycosis.

We present a case of a 73-year-old woman who presented with chronic watery diarrhea, weight loss, and frequent sinus and nail fungal infections. Her previous workup with a gastroenterologist failed to reveal any causative agent for her symptoms. She considered herself healthy until a thymic tumor was discovered and removed years ago. Subsequently, she developed multiple sinus infections refractory to treatment. Relevant immunology laboratory tests were conducted, which led to the diagnosis. This case illustrated the need for a detailed history and thorough immunologic assessment, and the requirement to maintain a broad differential diagnosis.