Repeated dose inhaled budesonide versus placebo in the treatment of croup

OBJECTIVE: To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL-1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup. METHOD: Eighty-two children hospitalised with croup received either 2 mg 4 mL-1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge. RESULTS: Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02). CONCLUSION: Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.     

Determinants of Medical System Delay in the Diagnosis of Colorectal Cancer Within the Veteran Affairs Health System

Background and Aims  

The goals of this study are to evaluate determinants of the time in the medical system until a colorectal cancer diagnosis and to explore characteristics associated with stage at diagnosis.     

Initiation and Discontinuation of Hormone Therapy for Menopausal Symptoms: Results From a Community Sample

Factors related to initiation and discontinuation of hormonal therapy (HT) for treatment of menopausal symptoms were examined in a community sample of 533 peri/postmenopausal women aged 45–54 by telephone three times. Over 40 variables including: sociodemographic characteristics, clinical reasons to start HT use, HT contraindications, HT attitudes/knowledge, and health behaviors were examined in logistic regression models comparing women who discontinued HT to women who continued using HT over 9 months (discontinuers) and women who initiated HT versus women who never used HT over 9 months (initiators). Increased understanding of HT, confidence, mental health symptoms, perception that menopause is natural, and having gynecological surgery were related to decreased likelihood of HT discontinuation. Increased understanding about risks of HT, vasomotor symptoms, mood symptoms, and having gynecological surgery were related to increased likelihood of HT Initiation. These findings highlight the importance of physicians discussing HT with their patients, particularly because of recent clinical trial developments.     

Grade-specific prostate cancer associations of IGF1 (CA)19 repeats and IGFBP3-202A/C in blacks and whites

Carrying the cytosine-adenosine (CA)19 repeat polymorphism in insulin-like growth factor-1 (IGF1) is associated with lower serum proteins and decreased prostate cancer risk. Carrying the -202A/C genotype in insulin-like growth factor binding protein-3 (IGFBP3) also has been associated with lower serum levels of the binding protein. However, the association between this variant and prostate cancer is inconsistent. To test the hypothesis that inconsistencies are partly due to cancer grade-specific differences in strength and direction of associations, we reanalyzed data from our previous Durham Veterans Administration Hospital study of blacks and whites comprising 47 cases (19 African Americans) with Gleason sum > or = 7, 50 cases (30 African Americans) with Gleason sum < 7 and 93 controls (49 African Americans). Compared to controls, the association between carrying the IGFBP3 C allele and prostate cancer risk was in OR(Low-Gleason) = 4.0; 95% CI: 1.4-12.3 compared to OR(High-Gleason) = 1.0; 95% CI: 0.4-2.2. Association patterns were similar in African Americans (OR(Low-Gleason) = 3.6; 95% CI: 1.0-13.2 vs. OR(High-Gleason) = 1.4; 95% CI: 0.4-2.3) and whites (OR(Low-Gleason) = 5.6; 95% CI: 0.6-49.0 vs. OR(High-Gleason) = 0.6; 95% CI: 0.2-2.2). The inverse association between carrying the IGF1 (CA)19 repeat variant did not vary by grade or ethnicity. If confirmed in larger studies, these findings support the hypothesis that the association between IGFBP3 C allele and prostate cancer is grade specific in both ethnic groups.     

Spinal anaesthesia

Spinal anaesthesia involves the injection of local anaesthetic solution into the intrathecal space. It is a widely practiced anaesthetic technique that can provide surgical anaesthesia for procedures below the umbilicus. Due to the proximity of the central nervous system, safe practice is of paramount importance and requires a good understanding of relevant anatomy, physiology and pharmacology. Complications are rare but need to be recognized and managed rapidly and appropriately.