Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.     

Decreased Cesarean Birth Rates and Improved Perinatal Outcome: A Seven-Year Study

ABSTRACT: This study examined the decrease in cesarean section rates in relation to perinatal mortality between 1987 and 1993 at the primary referral hospital in north Jordan. Most of the population is at high risk and of low socioeconomic status. The cesarean section rate decreased from 15.5 percent in 1987 to 8.7 percent in 1993, and has remained at this low rate. During the same period the perinatal mortality dropped from 52 to 20.9 deaths per 1000 live births. These results do not include perinatal morbidity. The successful reduction of the cesarean section rate is attributed to active management of labor, trial of labor for women with a previous cesarean birth, and vaginal breech delivery in selected women. We conclude that the rate of cesarean delivery can be safely reduced in a developing country without adverse effects on birth outcomes.     

Erythrodermic bullous pemphigoid

We report a case of erythrodermic type of bullous pemphigoid which is a rare variant of bullous pemphigoid. Our patient had a peculiar clinical presentation with bullae, erosions and extensive erythrodermic areas, and distinct direct immunofluorescent findings which included linear IgG and C3 deposits in the basement membrane and also IgG in the intercellular spaces. Very high levels of serum IgE were also detected in our patient.     

Overview on the prevalence and impact of migraine

Migraine is a highly prevalent headache disorder that has a substantial impact on the individual and society. Over the past decade, substantial advances in research have increased understanding of the pathophysiology, diagnosis, epidemiology, and treatment of the disorder. This article reviews the burden of migraine, emphasizing the population-based studies that used standardized diagnostic criteria.     

Surgery called tumoral reduction: myth or reality?]

The cytoreductive surgery (CS) or surgical debulking of tumors is supported by the following experimental concept: the maximal but incomplete resection of huge tumoral masses (debulking) induces the passage of remaining cancerous cells in proliferative cycle. So, these remaining cells become sensitive to chemotherapy, or eventually to radiotherapy. In this way, the CS appears to be a neoadjuvant treatment to the chemotherapy, this last treatment being the powerful therapeutic. In this study, we have studied successively: the theoretical basis of the CS, the experimental positive and negative arguments of this concept, and then the positive and negative clinical applications. At least, it seems that CS is more a myth than a reality, and that we should only keep the classical concepts of curative surgery or palliative surgery.