Dexamethasone therapy interferes with the development of the neutrophil oxidative burst in vitro in very low birthweight infants

Dexamethasone therapy is used in the treatment of chronic lung disease in very low birthweight (VLBW) neonates. However, several significant side effects have been observed in these patients, including an increased incidence of infection. We initiated a pilot study to examine the in vitro function of neutrophils from dexamethasone-treated VLBW infants. Following a 1-week course of dexamethasone, VLBW infants failed to demonstrate the increased oxidative burst that was observed in the age- and weight-matched untreated infants. These observations support recent evidence raising concern about effects on other organs when using dexamethasone in mechanically ventilated infants. In this example, impaired oxidative burst may be among the cellular factors contributing to the increased risk of infection during corticosteroid use in VLBW neonates in the neonatal intensive care setting.     

Second-generation antihistamines: actions and efficacy in the management of allergic disorders

Antihistamines are useful medications for the treatment of a variety of allergic disorders. Second-generation antihistamines avidly and selectively bind to peripheral histamine H1 receptors and, consequently, provide gratifying relief of histamine-mediated symptoms in a majority of atopic patients. This tight receptor specificity additionally leads to few effects on other neuronal or hormonal systems, with the result that adverse effects associated with these medications, with the exception of noticeable sedation in about 10% of cetirizine-treated patients, resemble those of placebo overall. Similarly, serious adverse drug reactions and interactions are uncommon with these medicines. Therapeutic interchange to one of the available second-generation antihistamines is a reasonable approach to limiting an institutional formulary, and adoption of such a policy has proven capable of creating substantial cost savings. Differences in overall efficacy and safety between available second-generation antihistamines, when administered in equivalent dosages, are not large. However, among the antihistamines presently available, fexofenadine may offer the best overall balance of effectiveness and safety, and this agent is an appropriate selection for initial or switch therapy for most patients with mild or moderate allergic symptoms. Cetirizine is the most potent antihistamine available and has been subjected to more clinical study than any other. This agent is appropriate for patients proven unresponsive to other antihistamines and for those with the most severe symptoms who might benefit from antihistamine treatment of the highest potency that can be dose-titrated up to maximal intensity.     

Art, science, faith and medicine: the implications of the placebo effect

The placebo effect has been shown to account for between 30 to 40 per cent of the efficacy of ‘active’ medication for a wide range of pathologies and is probably a powerful agent of cure in other therapies, for example surgery. Medicine has failed, at least explicitly, to confront the implications of this powerful effect, attending to it mainly as a nuisance variable to be controlled for in clinical trials. This paper argues that the existence and extent of the placebo effect represents a challenge to the assumptions behind much medical practice, and throws doubt on the validity of locating disease and healing within a paradigm of scientific rationality.     

MBO and performance appraisal.

Using an MBO approach, a nurse administrator tapped the resources of her staff to diagnose and resolve a performance appraisal problem. A new performance evaluation system that embodies the concepts of MBO resulted. Through this process, MBO was implemented at the unit level, where it had previously been resisted.     

Brief Report: Differences in multijoint symptomatic osteoarthritis phenotypes by race and sex: The Johnston County Osteoarthritis Project

Objective

To determine differences in the phenotypes (patterns) of multiple‐joint symptomatic osteoarthritis (OA) involvement by race and sex.

Methods

A cross‐sectional analysis of symptomatic OA phenotypes was performed in a community‐based cohort, comprising subjects for whom data were collected from 4 sites of symptomatic OA involvement (the hands, knees, hips, and lumbosacral [LS] spine) at a single visit (2003–2010). Mutually exclusive phenotypes describing all combinations of these 4 sites were compared by race and by sex, using Fisher's exact tests. For those phenotypes occurring in >40 subjects, logistic regression was performed, with adjustments for race, sex, age, and body mass index (BMI), and interactions of race and sex were assessed.

Results

The sample included 1,650 participants, of whom 36% were men and 32% were African American. The mean age of the subjects was 66 years, and the mean BMI was 31 kg/m². Overall, in this sample, 13% of subjects had symptomatic hand OA, 25% had symptomatic knee OA, 11% had symptomatic hip OA, and 28% had symptomatic LS spine OA. African Americans, as compared with Caucasians, were less likely to have involvement of symptomatic OA in the hand only, or in some combination of the hand and other sites, but were more likely to have involvement of the knee only. Men, as compared to women, were less likely to have involvement of the hand only, but were more likely to have involvement of the LS spine only.

Conclusion

There are differences in the phenotypes of multiple‐joint symptomatic OA involvement by race and by sex that may influence the definitions of multiple‐joint, or generalized, OA.

     

Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective

Recent data suggest that the risk of paediatric sport injury is high and constitutes a significant public health burden. A concern regarding long-term consequences of youth sports injury is the risk of developing osteoarthritis (OA) at a young age. Based on the available evidence, a link between youth sports injuries, particularly acute injury of the knee and ankle, and OA, is likely. Early OA development and intense participation in high-impact, high-stress elite sports at an early age also may be associated, but follow-up of elite athletes into the early adult years is needed to examine this relationship. Given that some antecedents of early adult-onset OA may be traced to child and adolescent sports injury and related surgery, and perhaps intense training regimens, it follows that efforts to prevent sports-related joint injury should begin during the childhood years. Based on the results of recent research evidence, programmes addressing prevention of youth sports injuries may provide the rewarding results of OA prevention.