What Is Anaphylaxis? Pediatric Residents’ Perception and Treatment of Anaphylactic Reactions

2020 ◽  
Vol 60 (1) ◽  
pp. 25-31
Author(s):  
Ronald M. Ferdman
Keyword(s):  
Allergic Reaction ◽  
Clinical Outcomes ◽  
Diagnosis And Treatment ◽  
Organ Involvement ◽  
Allergy Clinic ◽  
Pediatric Residents ◽  
Criteria For Diagnosis ◽  
Definition Of ◽  
Single Organ

To assess knowledge regarding symptoms and treatment of anaphylaxis, a vignette of a child having an allergic reaction to a peanut was presented to residents in an allergy clinic. Twelve sets of clinical outcomes ranging from severe multi-organ to mild single organ involvement were described, and residents were asked if each symptom set met criteria for diagnosis of anaphylaxis, whether epinephrine should be administered acutely and prescribed at follow-up, and whether peanuts should be avoided in the future. Of cases that met the definition of anaphylaxis 28.8% were incorrectly diagnosed, in 13.6% of cases they would allow peanuts to be eaten again, and in 23.9% of cases they would not prescribe epinephrine at follow-up. In 26.1% of cases meeting criteria for acute anaphylaxis residents would not administer epinephrine. Deficits regarding the diagnosis and treatment of anaphylaxis by residents were identified, and increased educational efforts are needed.

Consensus on the change of criteria for cure of acromegaly during the last decade

2011 ◽  
Vol 152 (18) ◽  
pp. 703-708 ◽  
Author(s):  
Gábor László Kovács ◽  
Judit Dénes ◽  
Erika Hubina ◽  
László Kovács ◽  
Sándor Czirják ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Disease Control ◽  
Short Communication ◽  
Consensus Statement ◽  
Diagnosis And Treatment ◽  
Clinical Aspects ◽  
Insulin Like Growth Factor ◽  
Criteria For Diagnosis ◽  
Definition Of

The Acromegaly Consensus Group redefined the consensus criteria for cure of acromegaly. 74 neurosurgeons and experienced endocrinologists summarized the latest results on diagnosis and treatment of acromegaly. In this consensus statement the reliable growth hormone and insulin-like growth factor-1 assays were established. Definition of disease control was discussed based on the available publications and evidence. This short communication summarizes the clinical aspects of consensus criteria for diagnosis and cure of acromegaly based on the original article. Orv. Hetil., 2011, 152, 703–708.

scholarly journals Intermittent gross hematuria after lithotripsy: ureteral stent or residual stone?

2020 ◽  
Author(s):  
Linjie Peng ◽  
Junjun Wen ◽  
Wen Zhong
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Potassium Level ◽  
Potassium Citrate ◽  
Ureteral Stent ◽  
Gross Hematuria ◽  
Stone Fragment ◽  
Independent Risk Factors ◽  
Definition Of

AbstractPurposeTo explore the role of stone fragment and ureteric stent in process of intermittent gross hematuria (IGH), discuss the definition of ureteral stent related symptoms (USS) in a setting of lithotripsy and clinical outcomes of IGH.MethodsBetween January 2018 and July 2019, patients with completed one month follow up after lithotripsy were collected. Based on whether occurrence of IGH, demographics, stent information and clinical outcomes were mainly analyzed.ResultsA total of 258 consecutive patients were eventually analyzed, among which 97 patients (37.6%) suffered from IGH. Compared to patients without symptom of IGH, preoperative potassium level (3.89±0.43mmol/L vs. 4.02±0.42mmol/L, p=0.01), initial stone free rate (SFR, 50.52% vs. 68.32%, p=0.007) and potassium citrate application (11.34% vs. 4.55%, p=0.04) were found statistically different in univariate analysis. In multivariate logistic analysis, preoperative potassium level (OR: 0.39, CI: 0.19-0.76, p=0.007), potassium citrate (OR: 2.96, CI: 1.07-8.73, p=0.04), initial SFR (OR: 0.42, CI: 0.24-0.74, p<0.001), and hospital stay (OR: 0.94, CI: 0.89-0.99, p=0.045) were independent risk factors, rather than stent size and stent position. Hemoglobin change, stone area reduction and SFR in one-month follow-up were similar between groups, but more outpatient consultations were found in hematuria group (20 vs. 3, p<0.001), among which 2 patients were readmitted for severe ongoing hematuria.ConclusionsStone fragment, rather the size or length of ureteral stent, is the independent risk factors of IGH. Definition of USS is not suitable for IGH after lithotripsy, and a comprehensive inform and enough rest would reduce the unnecessary medical consultations.

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Conservative Treatment of Vestibular Schwannomas: A Follow-Up Study on Clinical Outcomes

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
M. Sadadcharam ◽  
R. Wormald ◽  
M. Javadpour ◽  
D. Rawluk ◽  
R. McConn-Walsh
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Vestibular Schwannomas ◽  
Follow Up Study

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Biomarkers of Acromegaly and Growth Hormone Action

2020 ◽  
Vol 27 (12) ◽  
pp. 1231-1245
Author(s):  
Filippo Maffezzoni ◽  
Teresa Porcelli ◽  
Andrea Delbarba ◽  
Letizia Pezzaioli ◽  
Carlo Cappelli ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Biological Markers ◽  
Clinical Care ◽  
Hormone Deficiency ◽  
Surrogate Outcomes ◽  
Current State ◽  
Growth Hormone Action ◽  
Igf I ◽  
Definition Of

: Biological markers (biomarkers) play a key role in drug development, regulatory approval and clinical care of patients and are linked to clinical and surrogate outcomes. : Both acromegaly and Growth Hormone Deficiency (GHD) are pathological conditions related to important comorbidities that, in addition to having stringent diagnostic criteria, require valid markers for the definition of treatment, treatment monitoring and follow-up. GH and insulin-like growth factor-I (IGF-I) are the main biomarkers of GH action in children and adults while, in acromegaly, both GH and IGF-I are established biomarkers of disease activity. : However, although GH and IGF-I are widely validated biomarkers of GHD and acromegaly, their role is not completely exhaustive or suitable for clinical classification and follow-up. Therefore, new biological markers for acromegaly and GH replacement therapy are strongly needed. : The aim of this paper is to review and summarize the current state in the field pointing out new potential biomarkers for acromegaly and GH use/abuse.

Characteristics of Asian Mosquito Saliva Allergens for Specific Diagnoses and Effective Therapies

2020 ◽  
Vol 21 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Soung-Hoo Jeon
Keyword(s):  
Allergic Reaction ◽  
East Asia ◽  
East Asian ◽  
Diagnosis And Treatment ◽  
Recombinant Allergens ◽  
Systemic Reactions ◽  
The Future ◽  
Mosquito Saliva ◽  
The Difference ◽  
Future Direction

An allergic reaction to mosquitoes can result in severe or abnormal local or systemic reactions such as anaphylaxis, angioedema, and general urticarial or wheezing. The aim of this review is to provide information on mosquito saliva allergens that can support the production of highly specific recombinant saliva allergens. In particular, candidate allergens of mosquitoes that are well suited to the ecology of mosquitoes that occur mainly in East Asia will be identified and introduced. By doing so, the diagnosis and treatment of patients with severe sensitivity to mosquito allergy will be improved by predicting the characteristics of East Asian mosquito allergy, presenting the future direction of production of recombinant allergens, and understanding the difference between East and West.

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