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Robert J Boyle

Publications and source records attributed to Robert J Boyle.

9 recordsLinked to original sources
PubMed2006

Probiotic use in clinical practice: what are the risks?

Probiotics have been advocated for the prevention and treatment of a wide range of diseases, and there is strong evidence for their efficacy in some clinical scenarios. Probiotics are now widely used in many countries by consumers and in clinical practice. Given the increasingly widespread use of probiotics, a thorough understanding of their risks and benefits is imperative. In this article we review the safety of probiotics and discuss areas of uncertainty regarding their use. Although probiotics have an excellent overall safety record, they should be used with caution in certain patient groups-particularly neonates born prematurely or with immune deficiency. Because of the paucity of information regarding the mechanisms through which probiotics act, appropriate administrative regimens, and probiotic interactions, further investigation is needed in these areas. Finally, note that the properties of different probiotic species vary and can be strain-specific. Therefore, the effects of one probiotic strain should not be generalized to others without confirmation in separate studies. Careful consideration should be given to these issues before patients are advised to use probiotic supplements in clinical practice.

Adult↗
PubMed2005

The development of food allergy after liver transplantation.

The acquisition of new food allergy after orthotopic liver transplantation is now a well described phenomenon, mainly reported in children. The etiology of this phenomenon is at present unclear, but has been ascribed by some to tacrolimus treatment. Here we report a case of liver transplant acquired food allergy (LTAFA) in a child who received a split liver graft. The case is remarkable for the absence of new food allergy in the adult recipient of the same graft. This suggests that host-specific factors play an important role in the development of food allergy after liver transplantation, and emphasizes the predisposition that children have toward this phenomenon. Possible mechanisms underlying the development of food allergy after liver transplantation are discussed. In conclusion, tacrolimus treatment alone cannot account for LTAFA. Host factors such as the maturity of immune regulatory mechanisms are likely to play a critical role in the development of new food allergy after a liver transplant.

Adult↗
PubMed2005

Hereditary angio-oedema in children: a management guideline.

Hereditary angio-oedema is an uncommon condition, which usually first presents in childhood. In the absence of appropriate treatment hereditary angio-oedema has a high mortality. There are a number of reports of successful short- and long-term treatment with individual agents in those who suffer from hereditary angio-oedema. However, there is little guidance in the literature for the overall management of children and adolescents with this condition. Here we review the treatment options available for children and adolescents with hereditary angio-oedema, and propose a simple management guideline for such patients.

Adolescent↗
PubMed2004

Longterm follow-up in chondrodysplasia punctata, tibia-metacarpal type, demonstrating natural history.

We report the longterm clinical and radiological progression in three unrelated patients with the tibia-metacarpal form of chondrodysplasia punctata (CDP-TM). The patients were followed for 37, 25, and 32 years, respectively. At follow-up intellectual function was normal, and physical function was well preserved. There was also marked resolution of several significant early radiographic features. The patients attained adult heights of 152, 138, and 148 cm. Two patients had chronic serous otitis media requiring tympanostomy tubes during childhood. One patient suffered persisting back pain related to spinal stenosis and required lumbar laminectomy at the age of 26 years. One patient had hip dysplasia requiring orthopedic surgical intervention. All patients had recurrent patella dislocation. Sterol and very long chain fatty acid profiles, FISH analysis for SHOX gene deletions, blood lymphocyte karyotype, and phytanic acid levels were normal in those tested, and no mutations in arylsulfatase D and E genes were detected. These data suggest that the longterm clinical and functional prognosis in this condition appears to be better than that expected based on initial clinical and radiological findings.

Adolescent↗
PubMed2003

An ethical approach to giving couples information about their fetus.

The amount of information available to couples about the health of their fetus is increasing. An important question in prenatal diagnosis is what information should be given to couples, and how best to present it. It has been argued elsewhere that, in the absence of economic constraints on testing, there is no place for limiting the information available to couples about their fetus. However, not every couple wants all available information, and it is not always clear what couples do want to know. Providing unwanted information about the health of a fetus may be harmful in a number of ways. Herein, the potential harms of being given unwanted information about one's fetus are illustrated by using case studies drawn from clinical practice, and a new approach to prenatal diagnosis is suggested. If the harms of being given unwanted information about one's fetus are to be avoided, then couples need an opportunity to limit the data gathered about their fetus at prenatal diagnosis.

Chromosome Aberrations↗
PubMed2003

Prenatal diagnosis for "minor" genetic abnormalities is ethical.

Is it justified to detect minor genetic aberrations before birth and terminate pregnancies based upon such information? We present the case of a woman who wanted Prenatal Diagnosis (PND) to detect whether her female fetus was a Haemophilia mutation carrier. Such carriers are usually healthy. She wished to eradicate the Haemophilia mutation from her family to avoid future generations being affected and to protect her children from having to go through PND themselves. We explore existing guidelines, public attitudes and possible objections to providing PND for minor abnormalities. We argue that in a society where couples have considerable autonomy relating to decisions about the fetus at least until viability, the routine restriction of PND for minor genetic abnormalities would be an unjust infringement of individual liberty.

Abortion, Eugenic↗
PubMed2002

Clinical implications of inducible beta-lactamase activity in Gram-negative bacteremia in children.

BACKGROUND: Organisms of the spp., indole-positive spp., spp. and (ESCaPPM) group are a common cause of hospital-acquired bacteremia and share the potential to develop beta-lactam resistance during therapy. The emergence of such resistance may have adverse consequences, but the frequency with which this occurs has not been studied in children. It has been suggested that such organisms should be treated with combination antimicrobials or carbapenems, but the optimal regimen is uncertain. AIM To determine the frequency with which beta-lactam resistance develops during ESCaPPM sepsis in children and the optimal treatment of such sepsis. METHODS: A review of the case notes and microbiologic records of all cases of ESCaPPM bacteremia and meningitis managed at a tertiary children's hospital during a 6-year period. RESULTS: Fifty-eight cases were identified, and in three (5%) cases beta-lactam resistance emerged during treatment, with adverse clinical consequences in two cases. Clinical and microbiologic outcome was similar in those treated with carbapenems and in those treated with a beta-lactam and aminoglycoside combination. Cefotaxime resistance was found in 57, 30, 24 and 7% of children who had received carbapenems, cephalosporins, penicillins or no/other antimicrobials in the month before ESCaPPM sepsis, respectively. CONCLUSIONS: The emergence of beta-lactam resistance during treatment of ESCaPPM sepsis is uncommon in our hospital but can have adverse consequences. Where isolates are reported as susceptible to both classes of drugs, an extended spectrum penicillin in combination with an aminoglycoside may be preferable first line treatment of ESCaPPM sepsis to a carbapenem or quinolone.

Adolescent↗