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1
Content available remote The lateralizing and localizing value of peri-ictal cough in epileptic seizures
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Introduction. Coughing may be observed as an epiphenomenon during or after epileptic seizures. Aim. In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon. Material and Methods. Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients. Results. Six out of these seven patients were multidrug resistant temporal lobe epilepsy patients, all were right handed. They were all examined for possible epilepsy surgery and four underwent surgery with complete seizure freedom. We do not have certain evidence for lateralization in one patient with hot water epilepsy though déjà vu as an initial symptom in this patient implies a temporal lobe onset. The seven other patients had temporal lobe epilepsy. Among the patients who had surgery, three had left sided and one had right sided temporal lobe surgery with consequent seizure freedom. Conclusion. Referring to the argument in the literature, with our small patient sample, we might conclude that cough has significant value in localizing seizures to the temporal lobe but overall these limited data do not suggest a lateralizing value.
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Cough is the most common symptom of the upper and lower airway diseases. In its nature, cough is a defence re-flex mechanism of the respiratory tract that is used to clear the upper and lower airways. Chronic cough, defined as cough lasting for more than 8 weeks, is reported in 3–40% of the general population and has an important impact on patients’ quality of life, by causing anxiety, physical discomfort, social isolation and personal emabarrassment, be-ing an often medical complaint and one of the most common reasons for outpatient visits. Upper airway cough syn-drome, asthma, eosinophilic bronchitis and gastroesophageal reflux diseases account for most chronic cough after excluding somking, angiotensin-converting enzyme inhibitor use and chronic bronchitis. Many patients have more than one reason for chronic cough. Some complex diagnostic procedures, in many individuals are necessary to rec-ognized the cause/causes of chronic cough and to establish the accurate diagnosis, which implies a higher chance of effective treatment. Despite detailed diagnostic procedures, in many cases, the efficacy of chronic cough treatment is questionable and ambiguous. We observe not always satisfactory response to therapy. There are some coughs that seem refractory despite an extensive work-up. The possibility of hypersenitive cough reflex response, defining pa-tients with Cough Hypersensitivity Syndrome has been proposed to explain these cases, rather resistant to cough treatment, previously known as idioapthic cough or refractory, unexplained cough. The concept of Cough Hypersen-sitivity Syndrome helps us to understand the mechanisms underlying cough and provides better therapeutic options to treat chronic cough, like neuromodulating drugs, and speech therapy.
EN
Allergic rhinitis is a common cause of chronic cough. Topical corticosteroids are regarded as the most effective first-time treatment in allergic rhinitis. In this study we evaluated the cough sensitivity during the early and late allergic responses in guinea pigs with experimental allergic rhinitis. Another aim of the study was to follow up the effect of inhaled beclomethasone dipropionate on the cough in guinea pigs with allergic rhinitis. 31 guinea pigs were sensitized with ovalbumin (OA). Animals were intranasally challenged with OA (experiment) or saline (control) in 7-day intervals for 9 weeks. Cough was induced by inhalation of citric acid aerosols in gradually increasing concentrations for 30 s and was evaluated 1 h after the 8th nasal challenge (NCH) and 17 h after the 9th NCH. Cough was significantly increased only during an early allergic response, 1 h after repeated NCH [18 (14-23) vs. 8 (3-10); P<0.001]. Five experimental animals were inhaling aerosol of beclomethasone dipropionate seven days between the 8th and the 9th NCH and cough was evaluated 1 h after the 9th NCH. Inhaled corticosteroids significantly inhibited the enhanced allergic rhinitis related cough [4 (1-9) vs.19 (9-37) vs. 6 (3-9); P<0.05].
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In the present study we investigated the effects of nasal histamine on the intensity of coughing and the effects of intensified nasal breathing following nasal histamine on cough sensitivity (CS) in 14 subjects with seasonal allergic rhinitis. The study consisted of two parts performed one week apart. First, baseline CS to capsaicin was determined, followed by intranasal histamine challenge (4mg/ml, 0.1 ml) and the count of the number of coughs to inhaled capsaicin on the background of most intensive nasal symptoms (sneezing, itching, rhinorrhea, and nasal blockage) evoked by histamine. In the second part, CS was determined after intranasal histamine followed by 10 min of intensified nasal breathing through the nose or mouth in a randomized order at 2-day intervals. The number of coughs induced after intranasal histamine was significantly higher, compared with intranasal saline, [9 (7-12) vs. 4.5 (4-6), P<0.001]. CS also was significantly increased after nasal histamine, but nasal intensified breathing failed to cause any changes in CS. We conclude that stimulation of nasal mucosa with histamine enhanced the cough response in subjects with allergic rhinitis.
EN
In the present study we investigated the possibility of central convergence of neural pathways coming from distant anatomical regions in modulating the cough response. We addressed this issue by inducing cough from the tracheo-bronchial region on the background of capsaicin-stimulated and mesocain-blocked nasal mucosa in 14 anesthetized guinea pigs. The control group consisted of 6 guinea pigs in which the active agents, capsaicin and mesocain, were substituted for by inert physiological saline. All animals were tracheostomized, and the larynx was disconnected from the proximal part of the trachea with preserved innervations, and all were subjected to the same protocol. Cough, induced by mechanical irritation of the tracheo-bronchial mucosa, was elicited three times: in the control condition, after intranasal capsaicin challenge, and after another capsaicin challenge preceded by intranasal instillation of a local anesthetic, mesocain. The main finding of the study was that the number of cough efforts per bout, assessed from positive deflections on the intrapleural pressure recordings, was significantly enhanced by intranasal capsaicin challenge and this effect was reversed by intranasal pretreatment with the anesthetic mesocain [2.1 ±0.2 (control) vs. 3.5 ±0.4 (capsaicin) vs. 2.2 ±0.2 (capsaicin after mesocain) (P<0.01)], with no appreciable changes in the magnitude of cough efforts. The cough response in the control group remained unchanged. We conclude that tracheo-bronchial cough may be modified by neural sensory input to the brain coming from nasal mucosa. Therefore, cough reflex is subject to central convergence of peripheral neural pathways originating at distant anatomical locations.
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Content available remote Antileukotriene treatment and allergic rhinitis-related cough in guinea pigs
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Experimental allergic rhinitis produces enhanced cough response in awake guinea pigs. Leukotriene receptor antagonists, as anti-inflammatory agents, have been effective in treatment of asthma and allergic rhinitis to inhibit the early and late allergic response. In the present study, we evaluated the effect of montelukast (Singulair, Merck, USA) on the cough reflex in an experimental model of allergen-induced rhinitis in guinea pigs. Guinea pigs (n=16) were sensitized with intraperitoneal ovalbumin (OVA). The animals were then used to develop a model of allergic rhinitis by repeated intranasal instillation of 0.5% OVA at weekly intervals for 8 weeks. Allergic rhinitis was evaluated from the occurrence of typical clinical symptoms including sneezing, conjuctival and nasal secretion, or nasal acoustic phenomenon. Between the 6th and 8th nasal challenge (NCh) the animals (n=8) were treated daily for 14 days with oral montelukast (10mg/kg). Cough was induced by citric acid aerosol inhalation in gradually increasing concentration (0.05-1.6 M) and was evaluated before sensitization and then after the 1st, 6th, and 8th nasal challenge when rhinitic symptoms were most conspicuous. The intensity of cough was significantly increased after the first and repeated nasal OVA challenges, and reduced after the 8th NCh that was preceded with montelukast treatment [9(6-14) vs. 16.5(14-22) vs. 25.5(23-42) vs. 8.5(8-13); P=0.0003]. We conclude that antileukotriene therapy suppresses the stimulating effect of experimental allergic rhinitis on the chemically-induced cough in awake guinea pigs.
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Krztusiec to groźna choroba dróg oddechowych, której czynnikiem etiologicznym jest Bordetella pertussis. Choroba charakteryzuje się długotrwałym, napadowym kaszlem. Meczący kaszel może prowadzić do ciężkich powikłań, z których część kończy się śmiercią pacjenta. Grupą najbardziej narażoną na najpoważniejsze konsekwencje krztuśca są noworodki, a głównym rezerwuarem bakterii są dorośli. Szczepienia ochronne są najskuteczniejszą metodą walki z krztuścem. Ze względu na coraz wyższy odsetek osób uchylających się w Polsce od szczepień oraz ze względu na niewystarczającą skuteczność szczepionek acelularnych, w Polsce zaobserwowano wzrost zachorowań na krztusiec. Skuteczna immunizacja, obejmująca dawki przypominające u osób dorosłych, w tym ciężarnych, jest kluczem do walki z krztuścem.
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Pertussis is an acute infectious disease caused by Bordetella pertussis. Characteristically, the main symptom of the disease is long-lasting rapid cough. Pertussis can lead to serious complications, which can cause death. The main risk group are newborns. The reservoirs of the bacteria are mainly adults. Vaccination is the best way to fight pertussis. However, due to an increasing number of unvaccinated people in Poland and also due to insufficient effectiveness of acellular vaccines, an increase in pertussis cases in Poland has been observed. Effective vaccination, with booster vaccination in adults, including pregnant women, is a key strategy in the fight against pertussis.
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The aim of this study was to perform molecular analysis of canine adenovirus 2 (CAV-2) E1B 19K gene fragment isolated from 20 dogs of various breeds (12 males and 8 females aged 1-9 years), with clinical symptoms of upper respiratory tract infections, from the Lubelszczyzna region. Nasal swabs were taken from dogs. DNA of CAV-2 was detected using the PCR method in 16 swabs. All PCR products were sequenced, and the obtained sequences were compared with each other and with the sequence of the E1B 19K gene of the CAV-2 strain from an online database of NCBI GenBank: AC 000003. Based on analysis of the obtained sequences, three polymorphic variants of CAV-2 (No.1-3) with homology of 78 - 100% were distinguished. The nucleotide and amino acid sequences of the most frequently represented polymorphic variant, No. 1, differed from the sequences of polymorphic variant No. 2 with one substitution. The nucleotide and amino acid sequence of the E1B 19K gene of CAV-2 AC 000003 differed from the analogous sequences of representatives of variant No. 1 with 44 nucleotide and 19 amino acid substitutions. The small number of nucleotide differences in the E1B 19K CAV-2 gene among the examined own isolates, compared with AC 000003, suggest that the infections in dogs were caused by a relatively genetically stable virus which occurs in eastern Poland.
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Kaszel jest jednym z najbardziej uciążliwych i jednocześnie najbardziej powszechnych objawów w przebiegu przewlekłych chorób układu oddechowego. Dotychczasowe tradycyjne metody badań częstości i natężenia kaszlu polegają na obserwacji chorego, rejestracji audio-wideo, a następnie na zliczaniu występujących incydentów. Międzynarodowe organizacje zajmujące się chorobami układu oddechowego (European Respiratory Society, American College of Chest Physicians) zalecają stosowanie skomputeryzowanych i zautomatyzowanych metod pomiarowych, pozwalających na ambulatoryjną, obiektywną ocenę kaszlu u chorych. Zjawisko kaszlu wywołuje drgania klatki piersiowej chorego z jednoczesną emisją charakterystycznych zaburzeń akustycznych. Rejestracja i analiza powyższych sygnałów wibroakustycznych umożliwia zarówno monitorowanie częstości kaszlu, jak i ocenę jego natężenia zatem metoda ta będzie przydatna do oceny skuteczności procesu leczenia chorych. W artykule przedstawiono metodę badań oraz wyniki pilotażowych pomiarów, przeprowadzonych przy współpracy Centrum Techniki Morskiej (CTM) z Akademią Medyczną w Gdańsku oraz Collegium Medicum Uniwersytetu Mikołaja Kopernika w Bydgoszczy. Rejestrowano sygnały wibroakustyczne generowane podczas kaszlu u pacjentów z chorobą obturacyjną układu oddechowego i rakiem płuc. Do badań zastosowano system analizatora typu PULSE produkcji Bruel & Kjaer. Wykonano jednoczesną rejestrację sygnałów akustycznych i drgań, a następnie sygnały te poddano analizie.
EN
Cough is one of the most bothersome and frequent symptoms of chronic pulmonary diseases. Traditional examination methods rely on patient observation, audio-video registration and incidents counting. European Respiratory Society and American College of Chest Physicians recommend using computer based and automated measuring methods, which allow objective evaluation of patients cough. Cough phenomenon produces chest vibrations with simultaneous characteristic acoustic disturbances. Registration and analysis of those vibroacoustic signals enable cough frequency and intensity monitoring, which means that this method will be useful for evaluation of the therapy effectiveness. This paper presents the method and pilot study results that were obtained by R&D Marine Technology Centre in cooperation with the Medical University of Gdańsk and Collegium Medicum in Bydgoszcz. Cough vibroacoustic signals of patients with chronic pulmonary diseases and lun| cancer were recorded. Bruel & Kjaer Pulse analyzer has beer used during the examination. Registration and analysis of the acoustic and vibration has been performed.
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Content available remote Effects of thorax irradiation on citric acid-induced cough in guinea pigs
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Thoracic irradiation may cause an acute lymphocytic alveolitis or hypersensitivity pneumonitis. It is well known that cough reflex is sensitized by a number of inflammatory mediators. The purpose of the present study was to investigate the effect of the thoracic irradiation on the cough response in awake guinea pigs. Guinea pigs (Trik strain) were exposed to sham irradiation (n=16), a single irradiation dose of 10 Gy (n=12), and a fractionated irradiation dose (in five fractions) of 15 Gy (n=12) delivered to the thorax. Cough was induced by citric acid aerosol inhalation in gradually increasing concentrations (0.05-1.6 M) during the first week after thoracic irradiation. The cough response was expressed as a total number of coughs induced during all citric acid challenges. Irradiated animals with single dose of 10 Gy exhibited a time- dependent significant increase of citric acid-induced cough in the 6th day after irradiation compared with control animals (P=0.005), whereas cough was not altered significantly in irradiated animals with fractionated dose of 15 Gy. This study demonstrates that the increased cough response may be a determinant of the functional changes of airway nerve-endings mediating cough in the early phase after thoracic irradiation.
PL
Krztusiec, mimo wielu dekad szczepień, nadal jest aktualnym problemem w zdrowiu publicznym. Szczepionka pełnokomórkowa, wysoce skuteczna, lecz reaktogenna, jest coraz częściej zastępowana przez szczepionki acelularne o znacznie niższej skuteczności, jednak wyższym profilu bezpieczeństwa. Z tego względu trwają badania nad nowymi, bezpiecznymi szczepionkami, które zapewniałyby skuteczną i dłuższą ochronę przeciw pałeczkom Bordetella pertussis. W niniejszej pracy przedstawiono powody braku sukcesów w walce z krztuścem, a także typy nowych preparatów szczepionkowych, nad którymi trwają badania przedkliniczne i kliniczne.
EN
Pertussis, despite many decades of vaccination, is still a current problem in public health. The whole-cell vaccine, highly effective but reactogenic, is increasingly being replaced by acellular vaccines with much lower efficacy, but with a higher safety profile. For this reason, scientists search for new, safe vaccines that would provide effective and longer protection against Bordetella pertussis. This paper presents the reasons for the lack of success in the fight against whooping cough, as well as the types of new vaccines that are undergoing preclinical and clinical studies.
EN
Coughing is a physiological defence mechanism against irritants that stimulate respiratory mucosa. On the other hand, it can be the first symptom of a disease. Depending on symptoms duration we distinguish acute cough, subacute and chronic cough. Cough can be paroxysmal, characteristic to asthma and pertussis or “barking” with inspiratory dyspnea occurring in croup (laryngitis subglottica); it can be also dry or productive. A particular type of cough is a postinfectious cough resulting from damage of respiratory mucosa, increased sensitivity of cough receptor and bronchial hyperresponsiveness. There is also psychogenic cough, cough accompanying allergic diseases and provoked by some drugs. Diagnosis of chronic cough include a detailed clinical history, physical examination and additional diagnostic tests. Among infectious agents, that predispose to long‑term cough, there are viruses, particularly human respiratory syncytial virus (RSV), atypical organisms – Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, najand bacteria, especially Bordetella pertussis. Apart from infectious diseases, the analysis of causes of cough in young children include the presence of gastroesophageal reflux, allergic diseases (especially asthma), chronic sinusitis, aspiration of foreign material, congenital structural abnormalities of the respiratory system and chronic respiratory diseases, including cystic fibrosis or primary ciliary dyskineswia. A cardiac causes of cough should also be considered. Often cough characteristics and accompanying symptoms may indicate its cause. In the treatment of cough we can use casual treatment and symptomatic medications among which there are antitussives and mucoactive drugs. It is permissible to use butamirate and levodropropizine in persistent dry cough. Administration of opioid agonists and preparations containing promethazine should be avoided. Mucoactive drugs include expectorants, mucolytic, mucoregulatory and mucoregulatory medications.
PL
Kaszel jest fizjologicznym odruchem obronnym organizmu, skierowanym przeciw czynnikom drażniącym błonę śluzową dróg oddechowych. Może być także pierwszym objawem choroby. W zależności od długości utrzymywania się objawów wyróżniamy kaszel ostry, przedłużający się oraz przewlekły. Kaszel może być napadowy, charakterystyczny dla astmy czy krztuśca, lub szczekający, z typową dusznością wdechową występującą w podgłośniowym zapaleniu krtani, suchy lub wilgotny. Szczególnym jego rodzajem jest kaszel poinfekcyjny, związany z uszkodzeniem nabłonka oddechowego, nasileniem wrażliwości receptorów kaszlowych i wtórną nadreaktywnością oskrzeli. Ponadto wyróżniamy kaszel psychogenny, polekowy oraz alergiczny. Diagnostyka przewlekłego kaszlu obejmuje szczegółowy wywiad kliniczny, badanie przedmiotowe oraz dodatkowe badania diagnostyczne. Do czynników zakaźnych, które predysponują do długo utrzymującego się kaszlu, należą wirusy, szczególnie często wirus RS, drobnoustroje atypowe: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, a także bakterie, przede wszystkim pałeczka krztuśca. Oprócz schorzeń infekcyjnych w analizie przyczyn kaszlu u małych dzieci należy uwzględnić obecność refluksu żołądkowo‑przełykowego, choroby alergiczne (przede wszystkim astmę), przewlekłe zapalenie zatok obocznych nosa, aspirację ciała obcego, a także wrodzone wady i przewlekłe choroby układu oddechowego, w tym mukowiscydozę czy zaburzenia ruchomości rzęsek. Diagnostyka przewlekłego kaszlu powinna obejmować również przyczyny kardiologiczne. Niejednokrotnie charakter kaszlu i objawy towarzyszące wskazują na jego przyczynę. W leczeniu kaszlu stosujemy leki przyczynowe oraz leki działające objawowo, do których zaliczamy leki przeciwkaszlowe i sekretolityczne/mukolityczne. Spośród leków przeciwkaszlowych w uporczywym suchym kaszlu dopuszcza się stosowanie butamiratu lub lewodropropizyny. Należy unikać podawania agonistów receptorów opioidowych i preparatów zawierających prometazynę. Spośród leków sekretolitycznych zastosowanie znajdują leki wykrztuśne, mukolityczne, mukokinetyczne oraz mukoregulujące.
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W artykule przedstawiono możliwości zastosowania sztucznych sieci neuronowych oraz innych metod do analizy i rozpoznawania sygnałów elektrokardiograficznych. Dokonano przeglądu zagadnień dotyczących EKG, pozyskiwania i interpretacji sygnałów, sztucznych sieci neuronowych oraz danych literaturowych na temat zastosowania sieci neuronowych do rozpoznawania sygnałów EKG. Podjęto próbę zaimplementowania systemu rozróżniającego sygnały w oprogramowaniuMatlab.
EN
The possibilities of using artificial neural networks and other method of analysis to recognition signal ECG, were introduced in the article. The review of issues related to ECG, acquisition and interpretation of signals, artificial neural networks and literature data on the use of neural networks for the diagnosis of ECG, was performed. The attempt to implement the Matlab software distinguishing the signals, was undertaken.
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Content available remote Cough sensitivity in allergic rhinitis
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The objective of this study was to evaluate capsaicin cough sensitivity in pollen sensitive patients with allergic rhinitis at the time of grass pollen season and out of it. Cough reflex sensitivity was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2). Capsaicin aerosol in doubled concentrations (from 0.02 to 200 µmol) was inhaled by a single breath. Two groups of pollen sensitive rhinitis subjects and a group of healthy controls were studied. The C2 for the 23 pollen sensitive patients of the first group, studied out of pollen season (January-February), was 0.22 µmol/l (0.06-0.76) (geometric mean + 95% CI), which was substantially lower than the 4.29 µmol/l (2.54-7.26) in 24 healthy volunteers (P=0.0001). In another group of 15 pollen sensitive patients, C2 was 0.84 µmol/l (0.14-5.20) out of pollen season and 0.11 µmol/l (0.03-0.33) during the pollen season (May-June) (P=0.04). We conclude that pollen-sensitive subjects who suffer of seasonal allergic rhinitis have significantly greater capsaicin cough sensitivity, regardles of them being in or out of pollen season. Subclinical inflammatory changes in the lower airways are probably responsible for this effect.
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