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1.
Sadhana Sharma Asgar Ali Roshan Takhelmayum Mala Mahto Rathish Nair 《Journal of the National Medical Association》2017,109(2):93-97
Purpose
Currently, the curriculum of medical education is compartmentalized which makes achieving the expected outcome, a real challenge. Co-teaching, an existing concept in education, however, may be used in medical education for integrating the applied component while basic concepts are being taught. The hypothesis, “can co-teaching be an alternate for an integrated curriculum?” was explored in this study. Therefore, the present study was designed to compare the outcomes of co-teaching with the existing teaching methodology owing to the absence of integrated curriculum.Methods
Co-teaching and conventional modules of topics Diabetes mellitus (DM) and Alcohol and liver disease (AL), were prepared and validated. 100 under graduate medical students were randomly assigned to groups A and B. Group A was taught DM by Conventional teaching (CT) and AL by Integrated Co-teaching (ICT) and Group B was taught DM by ICT and AL by CT. A knowledge assessment tool of 20 multiple choice items was administered to assess the pre, post and retention knowledge scores. Change between knowledge scores was analyzed using inferential statistics.Results
Both conventional and co-teaching were significantly effective in increasing the knowledge scores (p = 0.0001) with no significant difference in learning outcomes (p = 0.59) between the two. However, co-teaching showed better knowledge retention compared to conventional teaching (p = 0.008).Conclusions
Co-teaching could be considered as a substitute for integrated curriculum as it enabled comparatively better retention of knowledge as revealed by the findings. 相似文献2.
Jesús González-Cervera Ángel Arias Olga Redondo-González María M. Cano-Mollinedo Ingrid Terreehorst Alfredo J. Lucendo 《Annals of allergy, asthma & immunology》2017,118(5):582-590.e2
Background
Eosinophilic esophagitis (EoE) has repeatedly been associated with atopic manifestations, which are reported more frequently in these patients than in the general population.Objective
To systematically assess the evidence and strength of the associations between EoE and atopy.Methods
We performed a systematic search of the MEDLINE, EMBASE, and SCOPUS databases for case-control studies comparing the frequency of atopic diatheses among patients with EoE and control subjects representing the general population without EoE. Using random-effects meta-analyses, we calculated summary estimates, including 95% confidence intervals (CIs), for bronchial asthma, atopic rhinitis, and eczema. Publication bias risks were assessed by means of funnel plot analysis and specific statistical tests.Results
Of the 2,954 references identified, data were collected from 21 studies, including a total of 53,542 patients with EoE and 54,759 controls. The criteria for defining a diagnosis of atopy in patients with EoE or controls was not structurally considered in most of the studies. Overall, allergic rhinitis was significantly more common among patients with EoE compared with control subjects (odds ratio [OR], 5.09; 95% CI, 2.91–8.90; I2 = 86.7%) as were bronchial asthma (OR, 3.01; 95% CI, 1.96–4.62; I2 = 84.5%) and eczema (OR, 2.85; 95% CI, 1.87–4.34; I2 = 57.1%). Food allergies and other atopic conditions were also assessed. No significant publication bias was found for studies dealing with allergic rhinitis and eczema in EoE.Conclusion
Despite pointing to a significant association between atopy and EoE, most of the studies provided no normalized diagnostic criteria for atopy. Further research should provide clear and standardized definitions of such conditions.3.
Background
The clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma (COPD-BA) have not been discussed thoroughly.Objective
To reveal the clinical features of patients with COPD-BA, to evaluate the risk factors of COPD-BA, and to provide suggestions for COPD individualized therapy.Methods
A retrospective observational study was performed. A total of 182 patients with COPD (90 with COPD-BA and 92 with pure COPD) were recruited in the study. Information on the following items was collected: demographics, clinical manifestations, complications, laboratory findings, other histories, and inpatient treatments during exacerbation.Results
A total of 182 patients were diagnosed with COPD, with 90 (49.45%) being classified as having COPD-BA. Patients with COPD-BA were more likely to be female (P = .004) and experienced more severe respiratory exacerbations (P = .04) despite being younger (P = .008). Those patients at onset of recurrent cough and sputum production were younger (P = .001). Significantly, a positive asthmatic family history (P = .03) was observed. Patients with COPD-BA usually had higher level of total serum IgE (although no differences were observed), had higher positive rates of the serum specific IgE (P = .004), and were more like to have an allergic history (P = .003). Allergic factor was the risk factor of COPD-BA (odds ratio, 4.477). During hospitalization, patients with COPD-BA tended to be treated with systemic corticosteroids (P = .008).Conclusion
Patients with COPD-BA were characterized by persistent airflow limitation with unique clinical features. Allergic factor was associated with the presence of asthmatic characteristics in patients with COPD. When hospitalized for exacerbation, the individualized therapy for COPD-BA might include the use of corticosteroids systemically. 相似文献4.
Daniel P. Verges Hasan Dani William A. Sterling Jeremy Weedon William Atallah Komal Mehta David Schreiber Jeffrey P. Weiss Nicholas T. Karanikolas 《Journal of the National Medical Association》2017,109(1):49-54
Purpose
Several studies suggest that a baseline prostate specific antigen (PSA) measured in young men predicts future risk of prostate cancer. Considering recent recommendations against PSA screening, high-risk populations (e.g. black men, men with a high baseline PSA) may be particularly vulnerable in the coming years. Thus, we investigated the relationship between baseline PSA and future prostate cancer in a black majority–minority urban population.Materials and methods
A retrospective analysis was performed of the prostate biopsy database (n = 994) at the Brooklyn Veterans Affairs Hospital. These men were referred to urology clinic for elevated PSA and biopsied between 2007 and 2014. Multivariate logistic regression was used to predict positive prostate biopsy from log-transformed baseline PSA, race (black, white, or other), and several other variables.Results
The majority of men identified as black (50.2%). Median age at time of baseline PSA and biopsy was 58.6 and 64.8, respectively. Median baseline PSA was similar among black men and white men (2.70 vs 2.91 for black men vs white men, p = 0.232). Even so, black men were more likely than white men to be diagnosed with prostate cancer (OR 1.62, p < 0.0001). Black men less than age 70 were at particularly greater risk than their white counterparts. Baseline PSA was not a statistically significant predictor of future prostate cancer (p = 0.101).Conclusions
Black men were more likely to be diagnosed with prostate cancer than were white men, despite comparable baseline PSA. In our pre-screened population at the urology clinic, a retrospective examination of baseline PSA did not predict future prostate cancer. 相似文献5.
Background
The reported associations of blood lipid profiles with asthma are ambiguous.Objective
To explore the association between asthma and the serum levels of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C).Methods
A systematic search was performed in the PubMed, MEDLINE, Cochrane Library, and Chinese Biomedical Literature databases. Ten studies were identified. We divided these studies into 2 subgroups according to age: children (<18 years old) and adults (≥18 years old).Results
In children, the asthma group had lower HDL-C levels (weighted mean difference, ?3.44; 95% confidence interval [CI], ?5.83 to ?1.04; P = .005) compared with the nonasthma group, whereas the serum levels of LDL-C in these 2 groups were not statistically different. In contrary, in adults, the asthma group had higher LDL-C levels (weighted mean difference, 8.95; 95% confidence interval, 3.55–14.35; P = .001) compared with the nonasthma group, whereas the HDL-C levels were not statistically different.Conclusion
There is a significant association between asthma and the serum levels of HDL-C and LDL-C. Moreover, this association differs in children and adults. 相似文献6.
Adam P. Campbell Katie M. Phillips Lloyd P. Hoehle Allen L. Feng Regan W. Bergmark David S. Caradonna Stacey T. Gray Ahmad R. Sedaghat 《Annals of allergy, asthma & immunology》2017,118(3):286-289
Background
Chronic rhinosinusitis (CRS) is associated with significant losses of patient productivity that cost billions of dollars every year. The causative factors for decreases in productivity in patients with CRS have yet to be determined.Objective
To determine which patterns of CRS symptoms drive lost productivity.Methods
Prospective, cross-sectional cohort study of 107 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test, from which sleep, nasal, otologic or facial pain, and emotional function subdomain scores were calculated using principal component analysis. Depression risk was assessed with the 2-item Patient Health Questionnaire (PHQ-2), whereas nasal obstruction was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) instrument. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months because of CRS. Associations were sought between lost productivity and CRS symptoms.Results
A total of 107 patients were recruited. Patients missed a mean (SD) of 3.1 (12.9) days of work or school because of CRS. Lost productivity was most strongly associated with the emotional function subdomain (β = 7.48; 95% confidence interval [CI], 5.71–9.25; P < .001). Reinforcing this finding, lost productivity was associated with PHQ-2 score (β = 4.72; 95% CI, 2.62–6.83; P < .001). Lost productivity was less strongly associated with the nasal symptom subdomain score (β = 2.65; 95% CI, 0.77–4.52; P = .007), and there was no association between lost productivity and NOSE score (β = 0.01; 95% CI, ?0.12 to 0.13; P = .91).Conclusion
Symptoms associated with depression are most strongly associated with missed days of work or school because of CRS. Further treatment focusing on depression-associated symptoms in patients with CRS may reduce losses in productivity. 相似文献7.
Background
Skin prick tests (SPTs) and measurements of serum specific immunoglobulin E (sIgE) antibodies are the most commonly used diagnostic tools for confirming sensitization. However, disagreement between the tests has been observed.Objective
To compare SPT and the CAP system for diagnosis of sensitization to common inhalant allergens.Methods
Subjects included 2,635 patients 10 to 90 years old who underwent analyses by SPT and CAP at the Dong-A University Hospital (Busan, Korea) from June 2011 through May 2016. The 2 test results were compared for 17 inhalant allergens.Results
Agreement between the SPT and sIgE level was 75.3%. Overall agreement was moderate (κ = 0.59), with strong agreement for house dust mites and birch (κ > 0.7) and weak agreement for Tyrophagus putrescentiae and dog (κ < 0.3). When CAP was compared with SPT as the reference, the sensitivity was 75.8% and the specificity was 75.2%. Mean wheal size by SPT showed a positive correlation with sIgE levels (r = 0.59), which decreased with age.Conclusion
There was a discrepancy between SPT and CAP for diagnosing allergic sensitization among inhalant allergens. The allergic sensitization and correlation between the tests decreased with age. Cautious interpretation of the clinical relevance of allergen sensitization based on SPT and CAP results is required, especially in older patients. 相似文献8.
Objective
Medical ultrasound examinations are performed by diverse professional cohorts: sonographers are one group. Little evidence exists regarding the teaching practices used in medical ultrasonography and their effectiveness. We report the continued development and validation of an instrument to measure sonographer skill-teaching practice perceptions (SonoSTePs).Methods
An online survey was administered to a convenience sample of sonographers who were employed in Queensland, Australia. This paper reports on the continued psychometric testing of the measurement tool.Findings
The 25-item scale demonstrated good internal reliability. Exploratory factor analysis generated four factors with acceptable internal reliability: Factor 1 (Skill execution feedback, Cronbach’s α = 0.89), Factor 2 (Cognitive overload, Cronbach’s α = 0.68), Factor 3 (Teach new skill, Cronbach’s α = 0.70), and Factor 4 (Assist learners scanning, Cronbach’s α = 0.67). The combined instrument value was 0.83. The weighted kappa of the test–retest items identified that the majority of items achieved an interrater level of agreement of ≥0.5.Conclusion
Results indicate that the SonoSTePs instrument items and factors are underpinned by theories and principles related to teaching a complex psychomotor skill. The initial data suggest that the tool is both reliable and valid. 相似文献9.
10.
Aakash A. Bavishi Leslie C. Grammer Jacqueline Pongracic Karen Rychlik Rajesh Kumar Phyllis Zee Paul A. Greenberger Anna B. Fishbein 《Annals of allergy, asthma & immunology》2017,118(1):103-107
Background
Circadian rhythms underlie many immune responses and allergic diseases. Subcutaneous immunotherapy (SCIT) can result in adverse reactions; however, it is unclear whether such reactions have a diurnal pattern.Objective
To assess whether the timing of SCIT affects the rate of adverse reactions.Methods
This study was a retrospective medical record review of adult patients (n = 289) who received SCIT at the Northwestern Medical Faculty Foundation, Chicago, Illinois, during a 10-year period (2004–2014). Injections were given in the outpatient setting. There were a total of 17,457 injections with 574 reactions. Covariates included age, sex, median income, asthma status, vial contents, number of injections, and previous immunotherapy reactions. Logistical regression was used to calculate the odds of having a reaction with time of SCIT administration as the primary determinate.Results
Immunotherapy reactions occurred more frequently after afternoon or evening (pm) injections (328/8721 = 3.8%) vs morning (am) injections (246/8736 = 2.8%), (χ2 = 12.26, P < .01). Systemic reactions, defined as World Allergy Organization grade 1 or higher, did not have diurnal variation (59/8721 = 0.67% for pm vs am 56/8736 = 0.64% for morning; χ2 = 0.08; P = .77). pm injections resulted in higher odds of reaction compared with am injection in a fully adjusted logistic regression model (odds ratio = 1.43; 95% confidence interval, 1.20–1.70; P < .01). When considering time as 4 categories, the highest odds of reaction were noted for the period from 15:01 to 17:30 (odds ratio, 1.55; 95% confidence interval, 1.21–2.00; P < .01).Conclusion
pm injections of SCIT are associated with increased cutaneous reaction rates when compared with am injections. In patients experiencing bothersome local reactions, it may be beneficial to administer SCIT in the morning. 相似文献11.
Brock H. Medsker Bronwyn K. Brew Erick Forno Henrik Olsson Cecilia Lundholm Yueh-Ying Han Edna Acosta-Pérez Glorisa J. Canino Catarina Almqvist Juan C. Celedón 《Annals of allergy, asthma & immunology》2017,118(1):55-60.e1
Background
Little is known about the joint effects of maternal asthma and maternal depression on childhood asthma.Objective
To examine whether maternal depression and maternal asthma lead to greater risk of childhood asthma than maternal asthma alone.Methods
Cross-sectional studies of children (6–14 years old) in San Juan, Puerto Rico (n = 655) and Sweden (n = 6,887) were conducted. In Puerto Rico, maternal depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire. In Sweden, maternal physician-diagnosed depression was derived from national registries, and maternal depressive symptoms were defined using an abbreviated CES-D questionnaire. Childhood asthma was defined as physician-diagnosed asthma plus current wheeze (in Puerto Rico) or plus medication use (in Sweden). Logistic regression was used for multivariable analysis.Results
Compared with Puerto Rican children whose mothers had neither asthma nor depressive symptoms, those whose mothers had asthma but no depressive symptoms had 3.2 times increased odds of asthma (95% confidence interval [CI] = 2.1–4.8) and those whose mothers had asthma and depressive symptoms had 6.5 times increased odds of asthma (95% CI = 3.3–13.0). Similar results were obtained for maternal depression and maternal asthma in the Swedish cohort (odds ratio for maternal asthma without maternal depression = 2.8, 95% CI = 2.1–3.7; odds ratio for maternal asthma and maternal depression = 4.0, 95% CI = 1.7–9.6). Although the estimated effect of maternal asthma on childhood asthma was increased when maternal depressive symptoms (Puerto Rico) or maternal depression (Sweden) was present, there were no statistically significant additive interactions.Conclusion
Maternal depression can further increase the risk of asthma in children whose mothers have a history of asthma. 相似文献12.
Suh-Young Lee Min Suk Yang Young-Hoon Choi Chang Min Park Heung-Woo Park Sang Heon Cho Hye-Ryun Kang 《Annals of allergy, asthma & immunology》2017,118(3):339-344.e1
Background
Although the severity of hypersensitivity reactions to iodinated contrast media varies, it is well correlated with the severity of recurrent reactions; however, prophylaxis protocols are not severity-stratified.Objective
To assess the outcomes of tailored prophylaxis according to the severity of hypersensitivity reactions to iodinated contrast media.Methods
Our premedication protocols were stratified based on the severity of previous reactions: (1) 4 mg of chlorpheniramine for mild reactions, (2) adding 40 mg of methylprednisolone for moderate reactions, and (3) adding multiple doses of 40 mg of methylprednisolone for severe index reactions. Cases of reexposure in patients with a history of hypersensitivity reactions were routinely monitored and mandatorily recorded.Results
Among a total of 850 patients who underwent enhanced computed tomography after severity-tailored prophylaxis, breakthrough reactions occurred in 17.1%, but most breakthrough reactions (89.0%) were mild and did not require medical treatment. Additional corticosteroid use did not reduce the breakthrough reaction rate in cases with a mild index reaction (16.8% vs 17.2%, P = .70). However, underpremedication with a single dose of corticosteroid revealed significantly higher rates of breakthrough reaction than did double doses of corticosteroid in cases with a severe index reaction (55.6% vs 17.4%, P = .02). Changing the iodinated contrast media resulted in an additional reduction of the breakthrough reaction rate overall (14.9% vs 32.1%, P = .001).Conclusion
In a total severity-based stratified prophylaxis regimens and changing iodinated contrast media can be considered in patients with a history of previous hypersensitivity reaction to iodinated contrast media to reduce the risk of breakthrough reactions. 相似文献13.
Stephanie L. Mawhirt Luz S. Fonacier Rose Calixte Mark Davis-Lorton Marcella R. Aquino 《Annals of allergy, asthma & immunology》2017,118(1):73-79
Background
The evaluation of antibiotic immediate-type hypersensitivity is intricate because of nonstandardized skin testing and challenge method variability.Objective
To determine the safety outcomes and risk factors for antibiotic challenge reactions in patients reporting a history of antibiotic immediate-type hypersensitivity.Methods
A 5-year retrospective review of patients evaluated for immediate-type antibiotic allergy was conducted. Data analyzed included patient demographics, index reaction details, and outcomes of skin testing and challenges, classified as single-step or multistep.Results
Antibiotic hypersensitivity history was identified in 211 patients: 78% to penicillins, 10% to fluoroquinolones, 7.6% to cephalosporins, and 3.8% to carbapenems. In total, 179 patients completed the challenges (median age 67 years, range 50–76 years, 56% women), and compared with nonchallenged patients, they reported nonanaphylactic (P < .001) and remote index (P = .003) reactions. Sixteen patients (8.9%) experienced challenge reactions (5 of 28 for single-step challenge, 11 of 151 for multistep challenge), and 11 of these patients had negative skin testing results before the challenge. Challenge-reactive patients were significantly younger (P = .007), more often women (P = .036), and had additional reported antibiotic allergies (P = .005). No correlation was detected between the reported index and observed challenge reaction severities (κ = ?0.05, 95% confidence interval ?0.34 to 0.24). Anaphylactic rates were similar during single-step and multistep challenges (3.6% vs 3.3%).Conclusion
In the present population, younger women with multiple reported antibiotic allergies were at greatest risk for challenge reactions. Negative skin testing results did not exclude reactions, and index severity was not predictive of challenge outcome. The multistep and full-dose methods demonstrated a comparable reaction risk for anaphylaxis. 相似文献14.
Background
Comparative studies have demonstrated that asthma education to pediatric patients decreases average hospital usage and that allergy specialists provide stronger asthma education and more improved outcomes.Objective
To evaluate the real-world benefits of allergy subspecialty involvement outside inpatient consultation and the impediments for patients in establishing allergy subspecialty care.Methods
The study population was composed mostly of minority children 0 to 18 years old seen at a large university-affiliated stand-alone children's hospital who had a hospital discharge diagnosis of asthma from 2009 to 2013. The retrospective portion of the study compared all variables pertaining to asthma, teaching, and discharge reconciliation for the following subgroups: patients recommended to allergy and immunology (AI) follow-up who adhered to the appointment (adherent), patients recommended to AI follow-up who did not adhere (nonadherent), and patients not recommended to AI follow-up (non-referred). In the phone interview portion of the study, the nonadherent patients were contacted to identify barriers to AI follow-up.Results
Of the referred sample, the adherent group had significantly fewer visits to the pediatric intensive care unit, days in the pediatric intensive care unit, and days in the hospital. Providing more specific hospital discharge instructions increased AI follow-up and hospital teaching given on the baseline admission decreased hospital visits. Phone interviews showed that nonadherent patients most commonly missed follow-up because the parents believed it unnecessary because their child showed acute improvement or from advice from their primary care physician.Conclusion
These results showed improvement in outcomes for patients who attended AI follow-up and specifically identified key barriers that could be addressed in a standardized form to prevent nonadherence in the future. 相似文献15.
L. Furuya-Kanamori A.C.A. Clements N.F. Foster C.A. Huber S. Hong T. Harris-Brown L. Yakob D.L. Paterson T.V. Riley 《Clinical microbiology and infection》2017,23(1):48.e1-48.e7
Objectives
To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period.Methods
Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models.Results
A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95% confidence interval (CI) 1.17–4.14), higher number of admissions in the previous year (RRR = 1.24; 95% CI 1.10–1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95% CI 1.23–6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95% CI 1.66–9.07) and chronic kidney failure (RRR = 5.78; 95% CI 2.29–14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated.Conclusions
Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention. 相似文献16.
Derek A. DuBay Nataliya Ivankova Ivan Herby Yu-Mei Schoenberger David T. Redden Cheryl Holt Laura Siminoff Mona Fouad Michelle Y. Martin 《Journal of the National Medical Association》2017,109(4):287-293
Background
African Americans (AA) are a third as likely as Caucasians to become registered organ donors at the Department of Motorized Vehicles (DMV). The Department of Health and Human Services has set the goal that at least 50% of adults in each state are registered donors.Aims
The purpose of this study was to explore the personal, behavioral and environmental factors associated with AA donor registration decision-making at the DMV.Methods
Guided by the Social Cognitive Theory, 13 focus groups (n = 100 participants) were conducted with AAs within 3 months of visiting a DMV and making a decision regarding whether to become or to not become a registered donor. The data were analyzed using inductive thematic and qualitative content analyses.Results
Study participants expressed a desire to learn more information while waiting in line at the DMV. Knowing a family member or friend in need of an organ transplant, and the desire to make one's own decision were two salient factors associated with the decision to become a registered organ donor. Several aspects of the DMV environment (e.g., noisy, overcrowded, lacking privacy) were cited as deterrents to becoming a registered donor.Discussion
This study highlights the personal, behavioral and environmental factors associated with AA organ donor registration decision-making at the DMV.Conclusion
The DMV is a setting where many adults make a decision about organ donation. Policies that create an environment in the DMV to support informed decision-making (e.g., privacy, informed clerks, available educational materials, etc.) are indicated. 相似文献17.
Inseon S. Choi Da-Woon Sim Seung-Hoon Kim Jin-Woo Wui 《Annals of allergy, asthma & immunology》2017,118(1):66-72.e1
Background
We previously reported that as many as one third of hospitalized patients with asthma treated with a low to medium daily dose of inhaled steroids (ICSs) for an average of 4.5 years showed adrenal insufficiency (AI).Objective
To re-examine this issue in consecutive outpatients with asthma because of possible subject selection bias.Methods
One hundred twenty-one consecutive adult patients with asthma under ICS treatment for at least 6 months underwent a rapid adrenocorticotrophic hormone stimulation test. AI was defined as a morning serum cortisol level no higher than 3 μg/dL or lower than 18 μg/dL before and after administration of 250 μg of adrenocorticotrophic hormone.Results
The mean durations of ICS use in the short-term (less than the median) and long-term (at least the median) users were 3.8 and 11.5 years, respectively. The proportion of subjects affected by AI tended to increase with the increasing cumulative dose of ICS (short-term users at a low to medium daily dose: mean cumulative dose 502 mg [15 of 34, 44.1%]; short-term users at a high dose of 941 mg [16 of 26, 61.5%]; long-term users at a low to medium dose of 1,077 mg [25 of 41, 61.0%]; long-term users at a high dose of 2,805 mg [13 of 20, 65.0%]), although not significantly. In short-term users, daily and cumulative ICS doses were significantly related to serum cortisol levels 60 minutes after taking adrenocorticotrophic hormone (r = ?0.300 and ?0.287, respectively; P < .05).Conclusion
A large number of patients with asthma might have AI even with low- to medium-dose ICS treatment when ICSs are administered over a long period. Thus, it is essential that patients with asthma under ICS treatment be checked for AI much more frequently. 相似文献18.
Ruei-Hsin Chang Tsolmon Nyamsuren Sarvesh Gyawali Szu-Chieh Fu Yi-Wen Huang Rui-Ting Hu Sien-Sing Yang 《中华民国医用超音波学会杂志》2017,25(3):161-166
Background
Histological improvement and regression of liver fibrosis after long-term use of nucleos(t)ides analogues (NUCs) have been documented. The aim of the present investigation was to evaluate the usefulness of traditional sonography to detect hepatic and splenic changes during NUC therapy in chronic hepatitis B (CHB) patients.Methods
A total of 181 CHB patients receiving NUC treatment were enrolled in this study. The study population was divided into three groups: 72 cirrhotic, 58 noncirrhotic CHB, and 51 nonreplicative hepatitis B virus carriers. All patients had blood chemistries taken and sonography at baseline and during the NUC treatment period. The changes in liver size, liver edge, spleen size, platelet count, and platelet count/spleen diameter (PC/SD) ratio were compared among the three groups of patients.Results
CHB Patients with and without cirrhosis have improved clinical features during NUC therapy with lower aspartate aminotransferase, alanine aminotransferase, international normalized ratio, hepatitis B virus DNA, and spleen size and higher platelet, liver edge, liver size, and PC/SD ratio compared with the baseline data (p < 0.05). The differences in liver edge, liver size, spleen size, and PC/SD ratio are higher in the cirrhosis group than in the noncirrhotic group (p < 0.001). A decrease in spleen size exhibited a linear relationship with treatment duration (R2 = 0.905).Conclusions
Traditional sonography is helpful to monitor changes in liver fibrosis of CHB patients under NUC therapy. 相似文献19.
Amani M. Ali Samah Selim Maggie M. Abbassi Nirmeen A. Sabry 《Annals of allergy, asthma & immunology》2017,118(5):557-563
Background
Despite the use of alfacalcidol in the management of corticosteroid-induced osteoporosis, it has never been considered an adjunct treatment for asthma management. It can target vitamin D deficiency, a possible risk factor for asthma, and, hence, improve pulmonary function of patients with asthma.Objective
To explore the effect of alfacalcidol administration on pulmonary function and study the pattern of vitamin D deficiency in adults with asthma in Egypt.Methods
Serum 25-hydroxyvitamin D was measured in 115 adults: 33 healthy subjects and 82 patients with asthma. Then, patients with asthma were randomized to receive standard asthma treatment only (n = 39) or receive it in addition to 1 μg of alfacalcidol daily for 4 months (n = 43). Randomization was stratified by the stage of asthma severity. Spirometry and measurement of 25-hydroxyvitamin were performed at baseline and end of follow-up.Results
Vitamin D deficiency was more common in patients with asthma (57.3%) than in healthy subjects (21.2%; P < .001). In patients with asthma, alfacalcidol significantly improved forced expiratory volume in the first second and forced vital capacity (P < .001 for the 2 tests). Moreover, more patients in the intervention arm showed improvement in asthma severity stage (P = .04). A nonsignificant difference was observed in improvement of forced expiratory volume in the first second between patients with vitamin D deficiency and those without deficiency in the intervention group (P > .05).Conclusion
Alfacalcidol supplementation improved the pulmonary function and severity stage of adult patients with asthma regardless of deficiency.20.
Ewa Cichocka-Jarosz Marcin Stobiecki Piotr Brzyski Iwona Rogatko Marita Nittner-Marszalska Krystyna Sztefko Ewa Czarnobilska Grzegorz Lis Anna Nowak-Węgrzyn 《Annals of allergy, asthma & immunology》2017,118(3):326-332