Placebo Controlled Trial of Systemic Corticosteroids in Acute Childhood Asthma

ABSTRACT. In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p < 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p < 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p < 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.     

Explaining trends in the privatization of health services in South Africa

This paper analyses the two major factors that have affectedthe trend towards privatization in the health sector in SouthAfrica. The first is the shift in government policy in favourof greater private sector participation in hearth care. Thesecond is the increase in medical aid scheme membership. The shift in government policy towards privatization shouldbe seen in the context of a shift away from welfarism to monetaristmacro-economic policies, witnessed in several advanced industrializedcountries. The change in SA's health policy should also be seenin the light of the post-1977 reform strategies of the Apartheidstate. However, the most important factor in the policy shiftsis the state's inability or unwillingness to fund hearth servicesadequately. Yet for privatization to succeed there has to be an increasein demand for private health care, i.e., an increase in thenumber of people able and willing to afford private health care.In SA the market amongst whites for private care is more orless saturated. Thus the second major factor promoting the growthof private medicine in SA is the increase in the number of blackscovered by medical aid schemes (i.e. health insurance). Thereasons for this trend are outlined. Finally, the implicationsof this analysis for policy interventions are discussed.     

An anti-EnaTS detected in the serum of an MiI homozygote

The serum of EH reacted with all red cells (RBCs) except her own, ficin- or trypsin-treated red cells, and En(a-) red cells. This reactivity defined an anti-EnaTS specificity. The red cells of the proposita typed as M-N+S-S+, Vw+Mur-Hil-Hut-Anek-Lane-, Wr(a-b+), EnaKT+. Red cells of five relatives were Vw+ and positive with her serum. Titration studies suggest that EH is genetically an MiI homozygote and that her Vw+ relatives are MiI heterozygotes. There is no history of consanguinity. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting studies have agreed with the serologic observations. A variant sialoglycoprotein of faster mobility than normal glycoprotein A, but no normal glycoprotein A, was detected on her red cells. Treatment with N-glycanase did not alter the mobility, which indicated that there was no N-glycosylation of residue 26. These findings are in agreement with the reported properties of the Mi.I-specific glycoprotein A. The relatives' Vw+ red cells showed the variant sialoglycoprotein and normal glycoprotein A. EH appears to be the first reported MiI homozygote.     

The necessary and the unnecessary transfusion: a critical review of reported appropriateness rates and criteria for red cell transfusions

BACKGROUND: The purpose of this study was to evaluate the criteria for assessing the appropriateness of red cell transfusions. The data were obtained by a computer search of all English-language literature from 1966 to October 1992. STUDY DESIGN AND METHODS: Nine studies were selected, which dated from 1986 to 1989 and employed explicit criteria evaluating the appropriateness of red cell transfusion in adults. The following data were abstracted from all studies: study design, timing, location, criteria for evaluating appropriateness, and rate of appropriate or inappropriate transfusions. RESULTS: Five studies evaluated transfusion appropriateness. Appropriateness rates ranged from 88 to 99 percent in three studies, and inappropriateness rates ranged from 0.3 to 57.3 percent in two studies. Four studies evaluated transfusion inappropriateness and reported inappropriateness rates of 18 to 55 percent. Substantial variation was found in the criteria for an appropriate or an inappropriate transfusion. Appropriateness rates did not depend upon characteristics of the study design, location, or timing of data collection. Restrictiveness in the criteria used to determine appropriateness and the use of additional implicit evaluation after an initial explicit review affected appropriateness rates. CONCLUSION: In the 1980s, high rates of inappropriate transfusion and low rates of appropriate transfusion were still reported. Appropriateness rates varied widely, in part because of marked variation in the criteria for an appropriate transfusion. Newly derived standards for an appropriate red cell transfusion, published in 1992, appear to provide a simple and objective means of evaluating the appropriateness of a transfusion. Appropriateness rates resulting from the application of these new standards have not yet been determined.     

Electronmicroscopic examination of white cell reduction by four white cell-reduction filters

The mechanisms of white cell (WBC) reduction in 16-hour-old CPDA-1 red cell (RBC) concentrates by filtration on a column filter and on three different flatbed filters were studied by electron microscopy, with special emphasis on cell-to-cell interaction, cell damage, and interaction of blood cells with the material. Generally, lymphocytes were removed by mechanical sieving and monocytes by adherence and mechanical sieving. Granulocyte depletion occurred by mechanical sieving, direct adhesion to the fibers, and indirect adhesion to activated and spread platelets. In the column filter, most granulocytes were captured by adhesion. In the coarse layers of two of the flatbed filters, indirect adhesion was most prominent, whereas direct adhesion was most prominent in the other flatbed filter. For the most part, granulocytes were captured by direct adhesion in the fine layers, but in one flatbed filter, capture apparently occurred by mechanical sieving. The results of this study suggest that the efficiency and the mechanism of WBC reduction depend on the physicochemical characteristics of the non-woven materials in the filters as well as the cellular composition of the RBC concentrates.     

The clinical efficacy and safety of the FVIII/VWF concentrate,BIOSTATE®, in children with von Willebrand disorder: a multi‐centre retrospective review

Summary. Factor replacement with BIOSTATE^®, a factor VIII (FVIII)/von Willebrand factor concentrate, forms the mainstay of treatment for children with von Willebrand disorder (VWD) in Australia and New Zealand. However, published data on the clinical efficacy and safety of BIOSTATE in the VWD paediatric population are limited. We retrospectively assessed the efficacy and safety of BIOSTATE in 43 children with VWD who received treatment for surgery, non‐surgical bleeds or continuous prophylaxis at eight paediatric haemophilia centres in Australia and New Zealand. Data were collected on patient demographics, disease history, treatment history, dosage, administration, adverse reactions, concomitant medications and excessive bleeding events. BIOSTATE provided excellent/good haemostatic efficacy in 90% of surgical procedures (n = 42) with a mean daily FVIII dose of 47 IU FVIII:C kg^?1 and a median treatment duration of 3 days. Excellent/good haemostatic efficacy was achieved in 94% of non‐surgical bleeding events (n = 72) with a mean FVIII dose of 45 IU FVIII:C kg^?1 day^?1 and a median treatment duration of 1 day. There were no bleeding events attributable to lack of efficacy. One case of nausea, possibly related to BIOSTATE administration, was reported. These results suggest that BIOSTATE is safe and effective for the treatment and prophylaxis of bleeding in children with VWD.