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27 marzo, 2012

In allergic children with asthma or rhinitis, is immunotherapy useful?

Source: Evidencias en Pediatria.

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Conclusiones de los autores del estudio: en niños y adolescentes con

rinoconjuntivitis alérgica, la inmunoterapia no ha mostrado beneficio para

disminuir los síntomas o la utilización de medicación. En el asma alérgica

la inmunoterapia subcutánea parece reducir los síntomas y el uso de

medicación, pero la evidencia es limitada en cuanto a la magnitud del efecto

. Además, no está exenta de efectos secundarios. La inmunoterapia

sublingual en dosis altas produce mejoría sintomática y disminuye el uso de medicación en

niños con asma y alergia a polen de gramíneas.

Comentario de los revisores: la prevalencia de las enfermedades alérgicas está aumentando

, generando importante morbilidad. El tratamiento con inmunoterapia no ha demostrado su

eficacia, ya que produce mejorías estadísticamente significativas pero clínicamente poco

importantes y con riesgo de efectos secundarios. Por ello no debe generalizarse su uso,

reservándolo solo para casos concretos evaluados detenidamente.

Authors' conclusions: there is at present insufficient evidence that immunotherapy in any

administration form has a positive effect on symptoms or medication use in children and

adolescents with allergic rhino conjunctivitis. In allergic asthma, the subcutaneous immunotherapy

appears to reduce symptoms and use of medication but the evidence is limited concerning the

size of benefit. It is not free of side effects. High doses sublingual inmmunotherapy produce

symptomatic improvement and medication use in children with asthma and allergies to grass pollen.

Reviewers' commentary: the prevalence of allergic diseases is increasing, and its burden is

substantial. The efficacy of the treatment with allergen-specific immunotherapy has not been

demonstrated; although the improvement has statistically significance, the clinical relevance is

poor, with an increased risk of adverse reactions. Due to that, the use of immunotherapy should

no be generalised, reserving it for cases thoroughly evaluated.

25 febrero, 2012

Biological clock' is linked to heart attacks

'Biological clock' is linked to heart attacks

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

BIOLOGICAL CLOCK: The discovery opens up intriguing paths of research, in pinpointing individuals at risk of nocturnal death and devising drugs to shield them. (Photo: Mike Warot/flickr)

Scientists on Wednesday said they had uncovered the first molecular proof that the "biological clock" is linked to a type of sudden, fatal heart attack.

Ventricular arrhythmia, or abnormal heartbeat, occurs most frequently after waking in the morning — and also to a lesser degree in the evening hours — and causes a high number of deaths.

Reporting in the journal Nature, researchers in the United States said they had uncovered the first molecular link between this risk and circadian rhythm, the term by which biological processes vary according to a 24-hour period.

The finger points at levels of a protein called Klf15, they said.

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

Previous research has found Klf15 to be a circadian controller — and, startlingly, is also lacking among some patients with heart failure.

The team created mice that had been genetically engineered to either lack Klf15 or make the protein excessively.

In both cases, the rodents had a much higher risk of arrythmias compared to normal counterparts.

"It is the first example of a molecular mechanism for the circadian change in susceptibility to cardiac arrhythmias," said Xander Wehrens of Baylor College School of Medicine in Houston, Texas.

"If there was too much Klf15 or none, the mice were at risk for developing the arrhythmia."

Klf15 is only one step in a complex molecular cascade, the researchers believe.

It controls another protein, KChIP2, which affects potassium-generated electrical current that flows though heart muscle cells called cardiac myocytes.

When levels of KChIP2 fluctuate, this causes electrical instability in the myocytes.

As a result, the heart muscle's action becomes impaired and it takes longer (or conversely, less time) to empty the ventricle — the heart's pumping chamber. The heart loses the regularity of the beat and labours to pump blood efficiently.

Co-author Mukesh Jain of the Case Western Reserve University School of Medicine in Cleveland,Ohio said that further work could well uncover other circadian-related causes.

The discovery opens up intriguing paths of research, in pinpointing individuals at risk of nocturnal death and devising drugs to shield them, Jain added.

04 octubre, 2011

I just want permission to be ill': towards a sociology of medically unexplained symptoms

Image via Wikipedia

Soc Sci Med. 2006 Mar;62(5):1167-78. Epub 2005 Aug 30.

'I just want permission to be ill': towards a sociology of medically unexplained symptoms.

Nettleton S.

Source

University of York, York, UK. sjn2@york.ac.uk

Abstract

A significant proportion of symptoms are medically unexplained. People experience illness but no pathological basis for the symptoms can be discerned by the medical profession. Living without a clinical diagnosis or medical explanation has consequences for such patients. This paper reports on a small qualitative interview-based study of 18 neurology outpatients in England who live with such medically unexplained symptoms (MUS). The findings broadly concur with those identified in the related literatures on medically unexplained syndromes and unexplained pain: the difficulties of living with uncertainty; dealing with legitimacy; and a resistance to psychological explanations of their suffering. From a thematic analysis of the interview data we identify and elaborate on three related issues, which we refer to as: 'morality'; 'chaos'; and 'ambivalence'. Although this article presents empirical data its aim is primarily conceptual; it integrates the findings of the empirical analysis with the existing literature in order to try to make some sociological sense of the emergent themes by drawing on sociological and cultural analyses of risk and the body. We draw on Bauman's concept of ambivalence to suggest that the very processes associated with more precise 'problem solving' and 'classification' do, in fact, generate even more uncertainty and anxiety. On the one hand, we seek closure and certainty and yet this leaves no means of living with uncertainty. Indeed, society does not readily grant permission to be ill in the absence of disease. We conclude by suggesting that an appreciation of the experience of such embodied doubt articulated by people who live with MUS may have a more general applicability to the analysis of social life under conditions of late modernity.

PMID:: 16135395; [PubMed - indexed for MEDLINE]

14 junio, 2011

Does this child have a urinary tract infection?

Bacteriuria and pyuria demonstrated at urinary...

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JAMA. 2007 Dec 26;298(24):2895-904.

Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER.

Source

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. nader.shaikh@chp.edu

Abstract

CONTEXT:

Urinary tract infection (UTI) is a frequently occurring pediatric illness that, if left untreated, can lead to permanent renal injury. Accordingly, accurate diagnosis of UTI is important.

OBJECTIVE:

To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.

DATA SOURCES:

A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles.

STUDY SELECTION:

Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria.

DATA EXTRACTION:

Two evaluators independently reviewed, rated, and abstracted data from each article.

DATA SYNTHESIS:

In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40 degrees C (LR range, 3.2-3.3), and suprapubic tenderness (LR, 4.4; 95% confidence interval [CI], 1.6-12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI (summary LR, 2.8; 95% CI, 1.9-4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 (summary LR, 0.33; 95% CI, 0.18-0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI (for temperature >39 degrees C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2-13.0; and for temperature <39 degrees C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI.

CONCLUSIONS:

Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI.

Comment in

Ann Emerg Med. 2009 May;53(5):680-4.

PMID:: 18159059; [PubMed - indexed for MEDLINE]

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Sitios Principales

27 marzo, 2012

In allergic children with asthma or rhinitis, is immunotherapy useful?

25 febrero, 2012

Biological clock' is linked to heart attacks

'Biological clock' is linked to heart attacks

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

04 octubre, 2011

I just want permission to be ill': towards a sociology of medically unexplained symptoms

'I just want permission to be ill': towards a sociology of medically unexplained symptoms.

Source

Abstract

14 junio, 2011

Does this child have a urinary tract infection?

Source

Abstract

CONTEXT:

OBJECTIVE:

DATA SOURCES:

STUDY SELECTION:

DATA EXTRACTION:

DATA SYNTHESIS:

CONCLUSIONS:

Comment in

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27 marzo, 2012

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25 febrero, 2012

'Biological clock' is linked to heart attacks

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

Abnormal heartbeat occurs most frequently in the morning — and to a lesser degree in the evening hours — and causes a high number of deaths.

Related articles

04 octubre, 2011

'I just want permission to be ill': towards a sociology of medically unexplained symptoms.

Source

Abstract

14 junio, 2011

Source

Abstract

CONTEXT:

OBJECTIVE:

DATA SOURCES:

STUDY SELECTION:

DATA EXTRACTION:

DATA SYNTHESIS:

CONCLUSIONS:

Comment in

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