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PubMed2005

Efficacy of sublingual allergen vaccination for respiratory allergy in children. Conclusions from one meta-analysis.

BACKGROUND: Sublingual route, that allows the safe administration of allergen vaccination at home and without injections, is a highly attractive alternative to parenteral delivery, especially among the youngest population. However, its efficacy in children has been questioned. OBJECTIVE: To evaluate the efficacy (symptom and medication scores) of sublingual allergen vaccination compared to placebo in paediatric patients. SEARCH STRATEGY: MEDLINE, EMBASE, ISI and the Cochrane Central Register of Controlled Trials were explored (completed in January/04) for potentially relevant studies. SELECTION CRITERIA: Randomized double-blind placebo-controlled clinical trials involving children < or = 14 years-old with either rhinitis or asthma of proved allergic aetiology. Data collection and analysis. Two reviewers analyzed independently the eligibility of studies for inclusion. The combined standardized mean difference (SMD) method was used to evaluate differences. Since heterogeneity was expected, probably due to the different procedures from each trial, we used the random effect model to obtain SMD. However, we also present the SMD values from the fixed effect model. The main outcomes were clinical symptom (asthma, rhinitis and conjunctivitis) and drug requirement scores. Safety, immunological and clinical changes were also reviewed. RESULTS: Seven double-blind placebo-controlled trials, enrolling 256 children (129 treatment and 127 placebo recipients), were analyzed. We observed decreases in symptom (SMD: -1.42 for asthma, -0.44 for rhinitis and -1.49 for conjunctivitis) and medication requirement (SMD: -1.01) scores. Only reductions in asthma (p=0.01) and drug dosage (p=0.06) scores reached statistical significance with the random effect model but changes in rhinitis symptoms (p=0.27) or conjunctival symptoms (p=0.19) were not statisticaly significant. Results obtained with the fixed effect model were similar in magnitude (SMD: -1.60 for asthma, SMD: -0.47 for rhinitis, SMD: -1.09 for conjunctivitis and, SMD: -0.54 for drug intake). Safety was a constant in all the studies; neither severe nor systemic reactions were observed and, oral and gastrointestinal complains were the most common adverse effects. CONCLUSION: In children, sublingual delivery of allergen vaccination constitutes a safe and effective alternative to the sublingual route to reduce allergy respiratory symptoms and drug intake. Further studies in this group of age are required to establish the optimal conditions for sublingual allergen vaccination.

Administration, Sublingual↗

PubMed1997

Subtle neuropsychological impairment and minor cognitive-motor disorder in HIV-1 infection. Neuroradiological, neurophysiological, neuroimmunological, and virological correlates.

HIV-1 infection of brain may be associated with multiple treatment targets, only the most severe of which is represented by HAD. Focusing on earlier treatment targets such as MCMD and cognitive-motor impairment in the absence of any clinical disorder (as well as neuroprotection) may prove to be of greater clinical utility in the treatment and prevention of such impairment than a focus on later-stage cognitive-motor disease, when neuronal cell death is already extensive. This may be especially important now that improvements using the protease inhibitors in triple-drug combination regimens have reduced plasma viral load to unmeasurable levels, while these drugs do not penetrate the CSF well. Currently, peripheral blood markers do not appear to be highly sensitive for central nervous system impairment, and specific CSF laboratory markers have some limited value at present-while requiring a lumbar puncture to obtain. Hence, a role for noninvasive techniques using neuroimaging exists in the clinical management of HIV-1-infected patients. To date, structural imaging techniques have proven limited in value for HIV-1-specific impairment. Several functional techniques (PET, SPECT, and MR spectroscopy) have now provided promising results for the purposes of identifying clinically significant dysfunction, relating such dysfunction to clinical neuropsychiatric symptom status, and for treatment response monitoring. Further studies are needed to examine the extent to which such imaging modalities not only parallel clinically relevant aspects of HIV-1 disease progression, but also match specific types of neuropsychologic performance deficits with potential significance for neuroanatomical localization. It is particularly important to include neurophysiological, neuroimmunological, and virological measures in studies that examine clinical neuropsychiatric status with neuroimaging techniques. In addition, the inclusion of neuropathology data, where possible, is important because demonstration of HIV-1 encephalitis cannot be equated with clinical disorder and because specific HIV-1-associated pathological changes have not yet been proven to be assessed well with neuroimaging techniques (e.g., the extent of microglial cell and macrophage activation). Also, treatment response studies are needed in conjunction with primary antiretroviral therapy regimens specifically aimed at central nervous system penetration (e.g., GW1592, GW141, and nevirapine). The results of such work will provide the data required to determine whether these promising functional neuroimaging techniques will aid in meeting the expected, imminent increase in clinical burden of this frequent complication of HIV-1 infection.

AIDS Dementia Complex↗

PubMedDate not supplied

[Artificial neural networks applied to study allergic conjunctivitis screening questionnaire].

PURPOSE: To evaluate sensibility and specificity of a screening questionnaire with multivariable analysis, compare them and elaborate an artificial neural network for future screenings. METHODS: Observational, transversal study performed at UNIFESP, with 48 patients with allergic conjunctivitis and 54 children without the disease. Their age ranged between 3 and 14 years and there was no restriction related to gender, systemic allergy or treatment. The questionnaire was applied and multivariable statistical analysis was performed. Finally, an artificial neural network was elaborated. RESULTS: Mean age was 8.4 years (7-13) and male gender was more frequent (60.7%). Mean score was 10.04 (0-18), and it was higher in the study group (p < 0.001). Allergic diagnosis was increased with the inclusion of the fifth question in 68.8%. Kappa coefficient was low (0.337; p = 0.071) and showed no agreement between diagnosis made by the questionnaire and clinical examination. Only the question number five had good sensitivity (85.4%) and specificity (85.1%). The cutoff point to separate allergic patients was 10 (sensitivity = 77.08% and specificity = 79.63%). The artificial neural network predicted allergic diagnosis in 100% using 7 of the 15 existent items. CONCLUSIONS: An efficient model was developed using seven questions, in a manner that its application might be easy to large populations.

Adolescent↗

PubMed2004

Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review.

A systematic review of the effectiveness of mass media campaigns for reducing alcohol-impaired driving (AID) and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). In eight studies that met quality criteria for inclusion in the review, the median decrease in alcohol-related crashes resulting from the campaigns was 13% (interquartile range: 6% to 14%). Economic analyses of campaign effects indicated that the societal benefits were greater than the costs. The mass media campaigns reviewed were generally carefully planned, well executed, attained adequate audience exposure, and were implemented in conjunction with other ongoing prevention activities, such as high visibility enforcement. According to Community Guide rules of evidence, there is strong evidence that, under these conditions, mass media campaigns are effective in reducing AID and alcohol-related crashes.

Accidents, Traffic↗

PubMed1998

Evaluation of a novel in vitro assay for assessing drug penetration into avascular regions of tumours.

The poor blood supply to solid tumours introduces many factors that affect the outcome of chemotherapy, one of which is the problem of drug delivery to poorly vascularized regions of tumours. Whereas poor drug penetration has been recognized as a contributing factor to the poor response of many solid tumours, the question of drug penetration through multicell layers has not been thoroughly addressed, largely because of restrictions imposed upon these studies by the requirement for either radiolabelled or naturally fluorescent compounds. The aim of this study is to describe modifications made to a recently published assay that broadens the scope for assessing drug penetration during the early stages of drug development and to characterize the ability of various drugs to penetrate multicell layers. DLD-1 human colon carcinoma cells were cultured on Transwell-COL plastic inserts placed into 24-well culture plates so that a top and bottom chamber were established, the two chambers being separated by a microporous membrane. Drugs were added to the top chamber at doses equivalent to peak plasma concentrations in vivo and the rate of appearance of drugs in the bottom chamber determined by high-performance liquid chromatography (HPLC). Both 3-amino-1,2,4-benzotriazine 1,4-dioxide (tirapazamine) and 7-[4'-(2-nitroimidazol-1-yl)-butyl]-theophylline (NITP) rapidly penetrated DLD-1 multicell layers (50.9 +/- 12.1 microm thick) with t(1/2) values of 1.36 and 2.38 h respectively, whereas the rate of penetration of 5-aziridino-3-hydroxymethyl-1-methyl-2-[1H-indole-4,7-dione] prop-beta-en-alpha-ol (EO9) and doxorubicin through multicell layers was significantly slower (t(1/2) = 4.62 and 13.1 h respectively). Inclusion of dicoumarol increases the rate of EO9 penetration, whereas reducing the oxygen tension to 5% causes a reduction in tirapazamine penetration through multicell layers, suggesting that the extent of drug metabolism is one factor that determines the rate at which drugs penetrate multicell layers. The fact that EO9 does not readily penetrate a multicell layer, in conjunction with its rapid elimination in vivo (t(1/2) < 10 min), suggests that EO9 is unlikely to penetrate more than a few microm from a blood vessel within its pharmacokinetic lifespan. These results suggest that the failure of EO9 in the clinic is due to a combination of poor drug penetration and rapid elimination in vivo.

Antibiotics, Antineoplastic↗

PubMed1987

Risk factors for wheezing during infancy. A study of 5,953 infants.

Risk factors for the development of wheezing during infancy were studied in 5,953 children. The data for the study were collected from a large prospective investigation of children born in 1959-61, who had attended a one-year follow-up examination. Wheezing was diagnosed when the symptom had been observed at least once during the first year of life, not in conjunction with pneumonia, epiglottitis or acute laryngitis. Logit analysis was used for the purpose of assessing the causal effect of environmental and other factors on the risk of wheezing among infants. The assessment of a risk factor by means of regression technique, requires certain other variables to be included in the regression model. A general rule concerning inclusion of other variables has been formulated and applied to the above data. The study demonstrated that the risk of wheezing was affected by a number of factors--particularly environmental. Poor social environment increases the risk of wheezing, as does the mother's smoking, and placement of the baby in day-care. Boys experienced wheezing more often than girls. Premature infants are more liable to develop wheezing than mature children. Remarkably, children born in the period April through September develop wheezing, but not bronchitis, more often than children born in October through March.

Birth Weight↗

PubMedDate not supplied

Diagnostic criteria for the neuropathological assessment of Alzheimer's disease: current status and major issues.

A Consensus Conference focusing on Alzheimer's disease (AD) took place in November 1996 to recommend uniform evaluation procedures and diagnostic criteria, co-sponsored by the National Institute on Aging and the Reagan Institute of the Alzheimer's Association. In conjunction with this conference, we reviewed diagnostic practices in current use, together with various neuropathological criteria proposed since 1985. Difficulties were identified in developing "gold standard" criteria for diagnosis and case classification of AD based upon the current state of knowledge. Working criteria for use within research contexts were proposed that acknowledged the realities of scientific limitations by inclusion of a broad and heterogeneous category of "uncertain" cases. (Eventually, methods will be developed for identifying these cases as preclinical AD, dementia due to multiple causes or non-AD, but this is not now possible.) Within applied contexts, the use of CERAD guidelines was supported. Finally, recommendations generated at the Consensus Conference were discussed, emphasizing the rapid pace of recent scientific advancement and the need for ongoing empirical reevaluation and modification of the Group's proposal.

Adult↗

PubMed2005

Fatal human herpesvirus type 1 infection in a white-handed gibbon (Hylobates lar).

This report documents a case of spontaneous, fatal, and likely recrudescent human herpesvirus type 1 (HHV-1) infection in a captive white-handed gibbon (Hylobates lar) confirmed by polymerase chain reaction (PCR). An approximately 44-year-old, captive, female, white-handed gibbon with a history of recurrent conjunctivitis and occasional seizures became acutely weak, disoriented, and ataxic. A postictal state was suspected by caretakers and veterinary staff, and euthanasia was ultimately elected because of lack of clinical improvement with supportive care. No significant abnormalities were detected at necropsy. Histologically, sections of cerebrum and midbrain contained minimal to mild, multifocal lymphoplasmacytic meningoencephalitis with numerous intranuclear viral inclusions within astrocytes and some neurons. The presumptive diagnosis of HHV-1-induced encephalitis was strengthened by nested PCR amplification of a segment of the herpesvirus DNA polymerase gene. Sequences from this region have been found to be unique to each herpesvirus species, thus identifying HHV-1 as the likely etiologic agent in this case. Positive HHV-1 serology from several years before the terminal episode suggested that the disease was most likely due to recrudescence of latent HHV-1 infection.

Animals↗

PubMed2004

Assembly of filamentous tau aggregates in human neuronal cells.

Intraneuronal deposition of microtubule-associated protein tau in filamentous aggregates constitutes a pathological hallmark of neurofibrillary degeneration that is characteristic of Alzheimer's disease (AD) and related disorders known collectively as tauopathies. Formation of such fibril inclusions, consisting of hyperphosphorylated tau in multiple isoforms, correlates with the severity of cognitive decline in AD. How neurofibrillary pathology evolves in tauopathy remains unclear at present, but availability of a cellular model with robust tau aggregation will permit experimental scrutiny of the mechanistic process leading to such neurodegeneration. Through the use of a serial transfection strategy in conjunction with a tau minigene construct, we succeeded in generating conditional transfectants of human neuronal lineage that overproduce wild-type human brain tau in isoforms 4R0N, 3R1N and 4R1N via TetOff and ecdysone inducible expression mechanisms. Such transgenic overexpression of tau in multiple isoforms facilitated the assembly of filamentous tau aggregates that exhibit immunoreactivities, physicochemical properties, and ultrastructural attributes reminiscent of those found in human tauopathies. The conditional tau transfectants thus provide us with a useful tool to elucidate the molecular and cellular events leading to neurofibrillary degeneration and a convenient means to test hypothetical mechanisms implicated in the etiopathogenesis of AD and related tauopathies.

Alzheimer Disease↗

PubMedDate not supplied

Epibulbar osseous choristoma: case report and review of the literature.

Epibulbar osseous choristoma is a choristomatous lesion of the conjunctiva containing bone. Originally called epibulbar osteoma, this lesion was first described by von Graefe in 1863. We discuss a case of a 4-year-old patient who presented with an epibulbar lesion consistent histopathologically with an epibulbar osseous choristoma, and report a review of the literature. The differential diagnosis of osseous choristoma should include classical limbal dermoids, epithelial inclusion cysts, prolapsed orbital fat, papillomas, dermolipomas, and complex choristomas. Although the rarest of epibulbar choristomas, 51 epibulbar osteomas have now been reported in the medical literature. Most commonly, this variety of choristoma presents as an isolated epibulbar lesion within the supratemporal quadrant but may occur in other locations on the surface of the globe and possibly in conjunction with other choristomatous tissue as much as 10% of the time. Frequently, they may involve the muscle or have dense attachments to the underlying sclera. Osseous choristomas most likely represent congenital lesions with a potential for slow growth but may occur in association with trauma. Options for management include observation or surgical excision. When surgery is contemplated, preoperative radiographic imaging may be helpful for assessing adhesion to the sclera or extraocular muscles.

Bone and Bones↗

PubMed1994

Management of heart failure. I. Pharmacologic treatment.

OBJECTIVE: This review of the pharmacologic treatment of heart failure due to left ventricular systolic dysfunction summarizes the recommendations of the expert panel for the Agency for Health Care Policy and Research Heart Failure Guideline. It provides specific advice to help guide practitioners through clinical decision making. DATA SOURCES: Data were obtained from English-language studies and referenced in MEDLINE or EMBASE between 1966 and 1993. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific treatments. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION: Only large prospective trials were used to estimate treatment efficacy. Smaller trials, case series, and case reports were reviewed for the incidence of adverse effects. DATA EXTRACTION AND SYNTHESIS: Randomized clinical trials were reviewed for inclusion and exclusion criteria, patient outcomes, adverse effects, and eight categories of study quality using a defined list of study flaws. CONCLUSION: Angiotensin-converting enzyme (ACE) inhibitors should be given to all patients unless specific contraindications exist. Diuretics should be used judiciously early in treatment to prevent excessive diuresis that could prevent titration of ACE inhibitors to target doses. Digoxin has not been shown to affect the natural history of heart failure and should be reserved for patients who remain symptomatic after treatment with ACE inhibitors and diuretics. Isosorbide dinitrate and hydralazine hydrochloride should be tried in patients who cannot tolerate ACE inhibitors or who have refractory symptoms.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2001

Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions.

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the accuracy of ultrasound (US)-guided fine-needle aspiration (FNA), with radiographic follow-up or surgical excision, in conjunction with on-site cytopathologic support in the management of nonpalpable breast lesions. MATERIALS AND METHODS: The findings of 266 consecutive mammographically or sonographically identified, nonpalpable lesions (228 patients) that underwent US-guided FNA were examined retrospectively. Clustered microcalcifications did not undergo biopsy with this method. Patients who underwent follow-up excisional biopsy or mammography with a duration of at least 24 months were included in the study. RESULTS: In all, 117 lesions met criteria for inclusion, of which 85 (73%) were diagnosed as benign at cytopathologic evaluation and underwent mammographic follow-up of at least 24 months (range, 24-67 months; mean, 36 months). Thirty-two lesions (27%) had either malignant or atypical cytopathologic findings, for which surgery was recommended. Eleven (9%) of the 32 had malignant cytopathologic findings from initial US-guided FNA, which were confirmed at surgical excision. The remaining 21 lesions (18%) were diagnosed as atypical on the basis of US-guided FNA results. Of these, 18 lesions underwent excisional biopsy: Two were diagnosed as carcinoma (not otherwise specified), and 16 were diagnosed with a variety of benign disorders. The remaining three patients with atypical lesions chose mammographic follow-up rather than surgical diagnosis, and their conditions have remained stable for more than 24 months. Of the 85 benign cases, one changed during follow-up (12 months) and underwent repeat biopsy, with malignancy noted. The sensitivity of US-guided FNA in identifying malignant lesions was 93% (13 of 14), and the specificity of a benign finding was 100% (102 of 102). The positive and negative predictive values of US-guided FNA supported by on-site cytopathologic evaluation were 100% (13 of 13) and 99% (102 of 103), respectively. CONCLUSION: Supported by appropriately trained on-site cytopathologists and in conjunction with follow-up mammography, US-guided FNA appears to be efficacious in the management of patients with abnormal radiographic findings. It is quick, relatively inexpensive, and minimally invasive, and, in the presence of competent cytopathologists, should be the modality of choice.

Biopsy, Needle↗

PubMed1975

The trochanteric approach to the hip for prosthetic replacement.

A new lateral operative approach to the hip was used for the insertion of 222 total hip prostheses for arthritis. The trochanter is cut off more deeply and more vertically than hitherto, with all of its muscle attachments, including the vastus lateralis, intact. The inclusion of the vastus lateralis stabilizes the fragment by counteracting the gluteus medius; together they generate an inward-acting muscle force on the fragment. Reattachment was by wire in 120 cases and directly to the femoral implant by bolt and graft in 102 cases. In the bolt attachment operation a new type of femoral component was used in conjunction with a variable-thickness bone graft. The method of trochanteric attachment was thought to contribute to the quality of bone repair by eliminating tensile forces and generating compressive forces. In all patients early mobilization and full weight-bearing were encouraged.

Arthritis↗

PubMed2001

Impact of abciximab and coronary stenting on outcomes and costs of percutaneous coronary interventions in a community hospital.

OBJECTIVE: To assess costs and outcomes of coronary stenting and balloon angioplasty with and without adjunctive treatment with abciximab for 3758 consecutive elective percutaneous coronary interventions at a single community center over the 2.5-year period between 1 January 1995 and 30 June 1997. RESULTS: Abciximab was more common among patients who had recently suffered myocardial infarction, patients with unstable angina, and patients with more complex coronary lesions. Use of abciximab in conjunction with balloon angioplasty or stenting and stenting alone was associated with significant reductions in incidence of major adverse cardiovascular events in hospital. Multivariate analysis indicated that use of abciximab and stenting were associated with significant independent effects on risk of an event. Hospital costs were increased for patients administered abciximab, treated with stenting, or both. Total costs and costs inclusive of those incurred in catheterization laboratory and pharmacy increased significantly with increasing complexity of lesions. Multivariate regression analysis (baseline cost US$5621) identified death (US$16098), emergency revascularization (US$13678), usage of multiple stents (US$1423 for each stent), and use of abciximab (US$1269) as independent predictors of a greater cost. One-year follow-up revealed significant differences among treatment strategies in terms of risk of need for subsequent revascularization procedures. Lack of stenting but not use of abciximab was identified as a significant predictor of need for repeat revascularization procedures. CONCLUSIONS: Our findings are in general agreement with cost analyses of use of abciximab for populations in clinical trials and suggest that improvements of early clinical outcome with abciximab treatment and stenting justify the incremental cost of treatment in a community hospital setting.

Abciximab↗

PubMed2000

Weighted vaginal cones for urinary incontinence.

BACKGROUND: Pelvic floor muscle training has long been the most common form of conservative treatment for stress urinary incontinence. Many people have trouble identifying their pelvic floor, and thus difficulty training it. One aid to help with training the pelvic floor in women is weighted vaginal cones. These are inserted into the vagina and the pelvic floor is contracted to prevent them slipping out. OBJECTIVES: To evaluate the effects of weighted vaginal cones in the treatment of female stress urinary incontinence. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (to December 1999), MEDLINE (January 1966 to November 1999), EMBASE (January 1988 to November 1999) and reference lists of relevant articles. Date of the most recent searches: December 1999. SELECTION CRITERIA: The studies had to be randomised or quasi-randomised controlled trials. One arm of the study had to be the use of weighted vaginal cones. The women studied had to have stress urinary incontinence. DATA COLLECTION AND ANALYSIS: Reports were assessed by all three reviewers to see if they complied with the inclusion/exclusion criteria. Data was abstracted by one reviewer and cross checked by the others. Included data were processed as described in the Cochrane Handbook. MAIN RESULTS: Ten studies fitted the inclusion and exclusion criteria. Four of these have only been published as abstracts. All of the studies were small and in many the quality was hard to judge. The studies tested seven comparisons. There was variation between studies in the ways cones were used and in the ways comparison treatments were given. Cones alone were compared with control, pelvic floor muscle training (PFMT), electrostimulation, PFMT plus cones, and electrostimulation plus PFMT. Cones in conjunction with PFMT were compared with PFMT alone and electrostimulation. Two of the studies recruited women with symptoms of incontinence while the others required that the women had urodynamically proven genuine stress incontinence. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high drop out rates with some of these being related to treatment with cones. Overall the dropout rate was not much different to that in the comparison treatments. Cones were better than control treatment (cure or improvement RR 0. 38; 95% CI 0.23 to 0.63), and similar to PFMT (RR 1.23; 95% CI 0.78 to 1.94) and electrostimulation (RR 1.35; 95% CI 0.82 to 2.21). Cones plus PFMT was no different to either cones alone or PFMT alone. These results held for both subjective and objective outcomes, but the confidence intervals were wide. REVIEWER'S CONCLUSIONS: This review provides limited evidence that weighted vaginal cones are beneficial in women with stress urinary incontinence. The limited data suggest that they are better than control treatments but similar to PFMT and electrostimulation. This conclusion must remain tentative until further larger high quality studies are carried out using similar relevant outcome measures. Some women treated with cones stop treatment early so cones may only be useful for those who find them acceptable.

Female↗

PubMed2006

Antibiotics versus placebo for acute bacterial conjunctivitis.

BACKGROUND: There are concerns about whether antibiotic therapy confers significant clinical benefit in the treatment of acute bacterial conjunctivitis. OBJECTIVES: The aim of this review was to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register), MEDLINE, EMBASE, SIGLE, NRR, PubMed and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials. SELECTION CRITERIA: We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic treatments. DATA COLLECTION AND ANALYSIS: One author extracted data and the accuracy was checked by a second author. MAIN RESULTS: This review includes five trials which randomised a total of 1034 participants. One further trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. Three of the trials have been conducted on a selected specialist care patient population and the two more recent trials have been conducted in a community care setting. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analyses of data on clinical and microbiological remission rates reveal that topical antibiotics are of benefit in improving early (days 2 to 5) clinical (RR 1.24, 95% CI 1.05 to 1.45) and microbiological (RR 1.77, 95% CI 1.23 to 2.54) remission rates; later (days 6 to 10) data reveal that these early advantages in clinical (RR 1.11, 95% CI 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI 1.17 to 2.09), but persist. Most cases however resolve spontaneously with clinical remission being achieved in 65% (95% CI 59 to 70) by days 2 to 5 in those receiving placebo. No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence. AUTHORS' CONCLUSIONS: Acute bacterial conjunctivitis is frequently a self-limiting condition, but the use of antibiotics is associated with significantly improved rates of clinical and microbiological remission.

Acute Disease↗

PubMed2003

Short acting beta-2 agonists for bronchiectasis.

BACKGROUND: Bronchiectasis is a condition characterized by an abnormal and irreversible dilatation of the sub segmental airways and it may be caused by a variety of disease processes. Currently medical treatment includes physiotherapy, antibiotics and occasionally mucolytics. Many people with bronchiectasis receive bronchodilator therapy, since many people with the condition show signs of airflow obstruction and bronchial hyper-responsiveness. Evidence on effectiveness of bronchodilator therapy in bronchiectasis has only recently started to be systematically studied. OBJECTIVES: The present review examined the effectiveness of short acting beta-2 agonist therapy in bronchiectasis, as this is the most frequently used treatment for airflow obstruction in people with this condition. SEARCH STRATEGY: We systematically searched four databases: CENTRAL (Issue 2, 2002); MEDLINE (1966 to September 2002); EMBASE (1980 to September 2002); and CINAHL (1982 to September 2002). We also checked bibliographies of all identified RCTs to identify potentially relevant citations. SELECTION CRITERIA: All randomised controlled trials were considered for inclusion, whether single or double blind. The control group was placebo/no treatment or other drug/physical therapy. Participants could be children or adults diagnosed with bronchiectasis by plain-film chest radiograph, bronchography or high resolution computerized tomography. Patients were excluded if they had cystic fibrosis. Any type of short acting beta-2 agonist administered by inhalation or systemic route, used in conjunction with conventional treatment was included. DATA COLLECTION AND ANALYSIS: In the absence of any relevant RCTs, we were unable to extract or analyse data. MAIN RESULTS: We identified 48 articles by the search, the majority of which could be excluded on the basis of the abstract as they were not RCTs. Six articles were retrieved and were all excluded after careful consideration because they were either not RCTs or they did not deal with the question of interest. REVIEWER'S CONCLUSIONS: We failed to identify any RCTs investigating the role of short acting beta agonists in bronchiectasis. Since short acting beta-2 agonist therapy is the most frequently used treatment for airflow obstruction in bronchiectasis, there appears to be the need to investigate the effectiveness of this therapy using an RCT.

Adrenergic beta-Agonists↗

PubMed2005

Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases.

Diagnosis of renal angiomyolipoma (AML) by fine-needle aspiration (FNA) may be difficult because cytological and radiological findings sometimes overlap with renal cell carcinoma (RCC) and liposarcoma. Five FNAs of AMLs were studied. Epithelioid and spindle stromal cells were arranged in loosely cohesive clusters and singly. The chromatin was evenly distributed and bland. Occasionally nuclear atypia was identified. Nuclei were oval to elongated, nucleoli were inconspicuous or absent, naked nuclei were present in three specimens, and intranuclear inclusions were present in two specimens. The cytoplasm was delicate and sometimes finely vacuolated. Adipose tissue was observed in two specimens. Thick-walled vessels, mitoses, and necrosis were absent. Corresponding surgical material showed typical features of AML. In FNA, bland chromatin and inconspicuous nucleoli distinguish renal AML from RCC and liposarcoma. Adipose tissue is not universally present. Cellular atypia in conjunction with overlapping radiological findings with RCC and liposarcoma are potential diagnostic pitfalls. Immunocytochemical (ICC) stains may elucidate the correct diagnosis.

Adenoma, Oxyphilic↗