What are the possibilities of preventing dementia?

Population ageing makes issue of dementia prevention very important. Measures used in prevention of other diseases are also effective in prevention of dementia. Incidence of vascular dementia is decreased by effective treatment of hypertension, diabetes and anticoagulatory treatment in patients with atrial fibrillation. Nonsteroidal antiinflammatory drugs and statins reduce incidence of Alzheimer's disease.     

Why is the concept of spondyloarthropathies important?

The concept of spondyloarthropathy was recognized first by clinicians based on the aggregation of several diseases occurring either sequentially in the same patient or simultaneously in a family. This concept was thereafter confirmed by the higher prevalence of the HLA-B27 antigen, not only in the group of patients suffering from an axial involvement of ankylosing spondylitis but also in other diseases belonging to the concept of spondyloarthropathy, i.e. psoriatic arthritis, reactive arthritis, inflammatory-bowel-disease-related arthritis and/or other clinical manifestations such as acute anterior uveitis. Recognition of the concept of the spondyloarthropathy is of great importance not only for research purposes but also in daily practice because such recognition has at least a threefold effect: (a) it permits earlier diagnosis, (b) it facilitates patients' education and monitoring, and (c) it has prognostic implications     

Children outgrowing asthma: What are the odds,what are the facts?

It's every parent's hope, but can children who have asthma really outgrow it by the time they become adults?     

What are the anticoagulation options for intermittent hemodialysis?

Prevention of clotting in the extracorporeal circuit was one of the major hurdles that had to be overcome to enable the expansion of routine outpatient hemodialysis to free-standing satellite centers and the home. Unfractionated heparin, the anticoagulant of choice for many years, is now being replaced by low-molecular-weight heparins (LMWHs) in an expanding number of countries. This trend is attributable to the ease and convenience of the administration of LMWHs coupled with their reliability and predictability of dosing. However, the choice of which LMWH to use depends on the duration and frequency of the dialysis sessions. For patients who are allergic to heparin or have heparin-induced thrombocytopenia, alternative anticoagulants--the direct thrombin inhibitors and heparinoids--are now available. These agents either have short half-lives (and therefore need to be delivered by infusions), or prolonged half-lives, which allows simple bolus administration, but increases the risk of drug accumulation, overdosage and hemorrhage. In patients at risk of bleeding, regional anticoagulants enable anticoagulation to be limited to the extracorporeal circuit. Prostanoids and nafamostat mesilate are expensive regional anticoagulants, and citrate infusions add complexity to the procedure. A citrate-based dialyzate has now been introduced that might enable heparin-free dialysis or reduce systemic anticoagulant requirements.     

What are the mechanisms of regional musculoskeletal pain?

Pain is a subjective experience that is unique to the individual. Although pain is usually associated with tissue injury or inflammation, it is strongly influenced by changes within the nervous system as well as by psychological and social factors. This review focuses on those 'nociceptive' mechanisms which contribute to pain and demonstates how an appreciation of underlying molecular and cellular mechanisms can lead to improved diagnosis and treatment.     

Acute-on-Chronic Liver Failure: What are the Implications?

Acute-on-chronic liver failure (ACLF) is a clinical entity that is well recognized by those who care for patients with cirrhosis, however in spite of this widespread recognition, there remains little consensus with regard to definition and clinical features. While many similarities exist between ACLF and decompensated cirrhosis, there are also key differences, the implications of which are far reaching for both clinicians and patients alike. Among these differences are the possibility of a reversible component, the presence of a defined insult, prognosis, and outcomes associated with ACLF (see Fig. 1). However, for ACLF to have meaningful clinical implications, it first must be defined. If ACLF can be clearly defined and more easily recognized, then clinicians may be better able to prevent, treat, prognosticate, and counsel such patients.     

What are the factors affecting fertility in 2008?

The number of infertile couples to be cared for in infertility centres is estimated to be between 1 to 6 %. This figure has been rising over the past years. During the 24th annual meeting of the ESHRE (European society of Human Reproduction) in Barcelona, changes in the population of infertile couples have been analysed. The major trend is an increase in women's age but also in men's age when desiring their first child. This mean rise has reached more than two years for women's age, over the past 10 years. The negative influence of the woman's age on fertility, especially after 35 years, is clearly established. However, new data in men suggest that an age higher than 35 years could be linked to an increased rate of miscarriages. The concept of preconceptionnal care in order to detect comorbidities, especially smoking, overweight and diabetes has been emphasized. Furthermore, the influence of current lifestyles on fertility, a potential role of endocrine disrupters, represent new concerns, which are in line with a policy of preventive care of infertility. Lastly, patients undergoing treatment with gonadotoxic drugs represent a 'new" population in fertility clinics. Techniques of testicular and ovarian preservation, especially frozen oocytes, must be disseminated and improved in order to prevent infertility in those patients.     

What are the costs of childhood-onset rheumatic disease?

Juvenile rheumatic diseases have important impacts on health, i.e. on patients' body functions and structures, activities, and social participation. The identification and treatment of these disorders is costly. Treatment involves periods of hospitalization, the use of physicians and other professional services, drugs and other treatments. Frequent outpatient visits are needed, as may be surgery. This all imposes a large financial burden on health-care systems and on families of children who suffer from rheumatic illnesses. Costs borne by families are both out-of-pocket as well as related to time spent in providing care, which may involve loss of income. Of course, the burdens are not only monetary, and they sometimes continue for life. The measurement of the different types of cost is essential to get a full picture of the burden of childhood-onset rheumatic illnesses. This chapter presents data on the costs of these illnesses, and introduces methodologies and their limitations for cost evaluation within paediatric rheumatology.