Enzyme replacement as an effective treatment for the common symptoms of complex carbohydrate intolerance.

Complex carbohydrates are an essential part of a healthy diet. However, many people suffer from varying degrees of carbohydrate intolerance, resulting in embarrassing gastrointestinal symptoms and avoidance of these components of a healthy diet. To facilitate awareness and discussion, we propose the phrase "complex carbohydrate intolerance" (CCI) as a broad term to encompass the range of symptoms associated with carbohydrate intolerance. While various treatments offer symptomatic relief, enzyme replacement therapy targets the cause of the problem: an enzyme deficiency. The enzyme, alpha-galactosidase, currently only found in the over-the-counter product, Beano, may be an effective preventative treatment for CCI.     

Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group

Classification criteria for Sj?gren's syndrome (SS) were developed and validated between 1989 and 1996 by the European Study Group on Classification Criteria for SS, and broadly accepted. These have been re-examined by consensus group members, who have introduced some modifications, more clearly defined the rules for classifying patients with primary or secondary SS, and provided more precise exclusion criteria.     

The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early-onset neonatal group B streptococcal disease

OBJECTIVE: Our purpose was to evaluate the effectiveness of a risk-based intrapartum antibiotic prophylaxis strategy for the prevention of early-onset neonatal group B streptococcal disease. STUDY DESIGN: Cases and controls were selected from infants born to women with one or more risk factors: preterm labor or rupture of membranes, prolonged rupture of membranes (>18 hours), fever during labor, or previous child with group B streptococcal disease. Cases were matched with controls by birth hospital and gestational age. Data abstracted from medical records were analyzed to estimate the effectiveness of intrapartum antibiotic prophylaxis. RESULTS: We analyzed data from 109 cases and 207 controls. Nineteen (17%) case versus 69 (33%) control mothers received an acceptable regimen of intrapartum antibiotic prophylaxis. In adjusted analyses, the effectiveness of intrapartum antibiotic prophylaxis was 86% (95% confidence interval, 66%-94%). When the first dose of antibiotics was given > or =2 hours before delivery, the effectiveness increased to 89% (95% confidence interval, 70%-96%); when it was given within 2 hours of delivery, the effectiveness was 71% (95% confidence interval, -8%-92%). Effectiveness was lowest in mothers with intrapartum fever (72%, 95% confidence interval, -9%-93%). On the basis of a 70% prevalence of maternal risk factors expected among cases in the absence of intrapartum antibiotic prophylaxis, we estimate that the risk-based strategy could reduce early-onset group B streptococcal disease by 60%. CONCLUSIONS: The risk-based approach to intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease. To achieve the maximum preventive effect, the first dose of antibiotics should be administered at least 2 hours before delivery.     

Treatment of tremors in complex regional pain syndrome

A 14-year-old girl presented with Complex Regional Pain Syndrome, Type I (CRPS-1) of the left ankle after a remote history of sprain. Allodynia, pain, temperature and color changes, and swelling were successfully treated with physical therapy, transcutaneous electrical nerve stimulation (TENS), gabapentin, amitriptyline, and tramadol. Five weeks later, she presented with a continuous, involuntary, intermittent coarse tremor of the left foot causing increased pain. The electromyogram showed rhythmic discharges of 3 Hz frequency lasting 20-80 milliseconds in the left tibialis, peroneus and gastrocnemius, suggestive of either basal ganglia or spinal origin. Tremor and pain were controlled with epidural bupivacaine, but the tremor reappeared after discontinuing epidural blockade. Carbidopa/levodopa 25/100 (Sinemet) was started and the tremor disappeared after two days. With continued physical therapy, pain and swelling resolved within two months and carbidopa/levodopa was discontinued after five weeks with no recurrence of the tremor. Our success in the treatment of CRPS-associated tremor in this young girl with carbidopa/levodopa suggests that this patient may have had underlying movement disorder which was unmasked by the peripheral injury.     

HsCRP levels: measurement of airway inflammation in asthmatic children.

BACKGROUND: The inflammatory marker, high-sensitivity C-reactive protein (HsCRP), is known to be related to non-allergic asthma, obesity, cardiovascular disease and smoking in adults. The aim of the present study was to determine whether HsCRP is related to respiratory symptoms and pulmonary function test findings in asthmatic children. METHODS: HsCRP was measured in 63 asthmatic children aged 2-12 years. The measurements were performed in 37 children during an episode of acute exacerbation and in 42 children during remission. RESULTS: HsCRP level (14.28 +/- 8.45 mg/L) during exacerbation was significantly higher than the mean level (1.92 +/- 3.16 mg/L) during remission (P < 0.0001), with the decrease being more prominent in children with a low body mass index percentile (P < 0.05). A reciprocal relationship was found between forced expiratory volume in 1 s and high-sensitivity C-reactive protein values (P > 0.049). CONCLUSION: Elevated HsCRP levels were significantly associated with respiratory impairment in children.     

Individual and Community Predictors of Preterm Birth and Low Birthweight Along the Rural-Urban Continuum in Central Pennsylvania

CONTEXT: Preterm birth and low birthweight remain high priority public health problems and are associated with increased risk of infant mortality as well as long-term health impairments. Although 20% of all births nationally are to rural women, relatively little attention has been paid to pregnancy outcomes in rural areas relative to more urbanized areas. PURPOSE: This study examines the relationship of individual- and community-level socioeconomic, health care, and health status-related characteristics to preterm birth and low birthweight outcomes among women living in urban and various types of rural communities. METHODS: Vital record data on singleton first births to residents of a 28-county region in central Pennsylvania in 2002 (N = 11,546) were merged with zip code-level information from the census and residence in a primary care health professional shortage area. Rural-urban commuting area codes were also appended. Multiple logistic regression analyses were performed to model risks of preterm birth and low birthweight using generalized estimating equations to account for clustering within zip code. FINDINGS: Women residing in large rural city-focused areas had lower adjusted odds of both preterm birth and low birthweight as compared to urban women, controlling for individual risk factors including maternal demographic characteristics, health conditions, and prenatal care use. In contrast, risks of these adverse birth outcomes were not significantly lower among women living in more rural areas relative to those in urban communities. CONCLUSIONS: Reduced risks of preterm birth and low birthweight risk are associated with some, but not all types of rural as compared to urban communities.