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Biomedical subjects

Stephen J McGeady

Publications and source records attributed to Stephen J McGeady.

9 recordsLinked to original sources
PubMed2006

Lack of cross-reactivity between 5-aminosalicylic acid-based drugs: a case report and review of the literature.

BACKGROUND: 5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product. OBJECTIVE: To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third. METHODS: A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide. RESULTS: The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects. CONCLUSIONS: Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.

Adult↗
PubMed2004

Developing resources to teach and assess the core competencies: a collaborative approach.

Graduate medical education programs face new challenges as they seek to comply with the mandate from the Accreditation Council on Graduate Medical Education to demonstrate that they are teaching and assessing residents on the six core competencies. The authors describe a project designed as a collaborative venture between the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the Center for Educational Outcomes at Dartmouth College (CEdO) to provide residency programs in allergy/immunology with resources for teaching and assessing the core competencies. The goal was to create a set of learning and assessment resources that maximized the content knowledge expertise provided by the AAAAI and the learning expertise provided by CEdO. A highly interactive, iterative process was used to create a set of Web-based modules. Bilateral communication, buy-in, and active involvement in the process were seen as crucial to the development of resources and their successful implementation. Approximately 18 months after the modules were made available to training program directors, 80% of the directors surveyed were aware of and had accessed the modules. The joint creation process used in this project, designed to be generally applicable across specialties, reveals how the burden of meeting new requirements can be decreased when experts in content knowledge and experts in learning collaborate.

Accreditation↗
PubMed2004

Immunocompetence and allergy.

Developed nations are experiencing a marked increase in prevalence of the familial allergic diseases including asthma, allergic rhinitis, atopic dermatitis, and allergic gastroenteropathy, which are often called atopic diseases. No satisfactory explanation for this epidemic is known, but it has been proposed that some facets of modern life tend to bias immune responses away from the Th1 cellular immune responses that protect against many infections and toward Th2 responses that favor atopy. There are 2 hypotheses to explain why this epidemic is occurring now. Hypothesis 1 suggests that nutritional patterns have changed or that we are exposed to environmental toxicants that were not previously present. Hypothesis 2 holds that some aspects of modern lifestyles in affluent nations have minimized exposure to infectious agents or to their by-products, such as endotoxin. This feature of contemporary lifestyle, it is suggested, has favored the development of Th2 immune responses to environmental allergens and the development of the attendant atopic diseases. This latter theory has been designated the "hygiene hypothesis." Although there is evidence both for and against both hypotheses, evidence for hypothesis 2 is stronger and more convincing.

Allergens↗
PubMed2003

Antibody response in common variable immunodeficiency.

BACKGROUND: Common variable immunodeficiency (CVID) describes a heterogeneous group of immunologic disorders of unknown etiology. It is characterized by low levels of serum immunoglobulin (Ig) and impaired antibody response. OBJECTIVE: To describe antibody response and the kinetics of IgG decline in patients identified with CVID. METHODS: Clinical and immunologic observations of four patients identified with CVID were obtained by chart review. RESULTS: Antibody response to polysaccharide antigens in patients identified with CVID is lost earlier than the antibody response to protein antigens, which may be preserved even in the face of profound hypogammaglobulinemia. In three patients who were followed prospectively, the Ig loss was progressive. CONCLUSIONS: Absence of antibody response to polysaccharide antigens may be a universal finding in patients with CVID, whereas preservation of T cell-dependent protein antibody response may be seen.

Adolescent↗
PubMed2002

Lactic acidosis and status asthmaticus: how common in pediatrics?

BACKGROUND: Lactic acidosis is a well described phenomenon in adult patients with severe asthma. However, this entity is rarely reported in children with status asthmaticus. OBJECTIVE: To report our experience in a 13-year-old girl who developed lactic acidosis as a complication of status asthmaticus and to investigate the prevalence of this complication of severe asthma. We sought to determine the frequency of lactic acidosis in such patients and to review etiologies of lactic acidosis. METHODS: 1) Observations on the clinical and laboratory findings in an adolescent girl with status asthmaticus who developed lactic acidosis were recorded. 2) The medical records of 100 children and adolescents with status asthmaticus admitted to an intensive care unit were reviewed for laboratory evidence of lactic acidosis. 3) We also reviewed our own previous experience of status asthmaticus with respiratory failure. RESULTS: Among 100 patients admitted to a pediatric intensive care unit for status asthmaticus, a single case of isolated metabolic acidosis was identified. This proved to be attributable to lactic acidosis. When records of patients with severe respiratory failure were examined, no cases of metabolic acidosis were found. CONCLUSIONS: Although rare, lactic acidosis does occur in pediatric-aged patients during status asthmaticus. It is important that this complication be recognized and treated because acidosis may inhibit the effectiveness of bronchodilator therapy, produce electrolyte disturbances, and cause serious adverse effects on the patient's cardiovascular system.

Acidosis, Lactic↗
PubMedDate not supplied

A 5-month-old boy with recurrent respiratory infections, failure to thrive, and borderline elevated sweat chloride levels.

Both severe combined immunodeficiency (SCID) and cystic fibrosis (CF) may present in infancy with a history of respiratory infections and failure to thrive. Elevated sweat chloride levels on multiple sweat tests is diagnostic of CF; transient elevation of sweat chloride has been reported in patients with hypogammaglobulinemia and antibody deficiency without CF. This article presents a case report of a 5-month-old boy with recurrent respiratory infections, failure to thrive, and two borderline elevated sweat test levels. Laboratory evaluation including testing for CF as well as immune deficiency was performed in this patient. Two borderline abnormal sweat chloride tests together with isolation of Pseudomonas from the airway caused clinicians initially to suspect CF; however, mutation in gene coding for the gamma-chain of the IL-2 receptor and a negative CF genetic mutation analysis ultimately led to the final diagnosis of SCID. It is essential to make the diagnosis of SCID as early as possible because infants with SCID who do not undergo reconstitution of their immune system universally die in infancy because of infection. Early diagnosis and intervention can lead to an excellent prognosis in a previously fatal disease.

Chlorides↗