Importance of the integrated evaluation of the child with asthma

When evaluating the effects of the practical application of a therapeutic strategy, the results of the controlled and random clinical tests with the above mentioned treatment, as they are important, do not constitute the only factor to be considered. Especially as frequently the clinical tests only take into account the efficiency of the treatment, without considering other essential aspects such as safety, performance and cost. The combination of these factors results in the PRACTICAL efficiency of the treatment, that often differs considerably from the results obtained in clinical tests. Therefore, the clinical tests do not precisely reflect the conditions that exist when a treatment is applied in real life and thus, the evaluation of the practical efficiency of the said treatment is essential if you want to know what the real repercussion that the treatment has on a specific problem, such as asthma, represents. And this is important as, in spite of the notable advances over the last few years in the treatment of this illness, the objectives that the GINA propose in order to consider the control of asthma as sufficient, are a long way from being achieved, as the results of the AIRE study that was carried out in 7 European countries illustrate. On the other hand, the valuation of the efficiency of a treatment is a problem that is worth discussing. As, due to operational and precision reasons, of then the clinical tests consider one or a few variables as objectively as possible (for example, the lung function) when valuing the efficiency of a treatment. However, on many occasions it is possible to appreciate notable discrepancies between these objective variables and the patient's symptoms, the subjective appreciation of how the asthma is affecting them, etc. Therefore, it is necessary to take into account the fact that an integral valuation of the repercusion that asthma has on the patients, their families and their environment, and how a specific treatment changes the situation on these levels, and obligues us to consider in an integral manner, a series of medical (clinical, functional and biological), humanistic (quality of life, patients satisfaction) and economic variables.     

Suppression of ongoing experimental allergic encephalomyelitis in DA rats by novel peptide drug,structural part of human myelin basic protein 46–62

Previously, we demonstrated that autoantibodies (AAb) in multiple sclerosis (MS) reveal site-specific binding and cleavage toward myelin basic protein (MBP) epitope library. We have found several fragments of MBP immunodominant in terms of AAb binding. Here, we applied these peptides to DA rats with induced protracted relapsing experimental allergic encephalomyelitis (EAE) most closely related to MS. DA rats with EAE induced by syngenic spinal cord homogenate in complete Freund's adjuvant were treated by nasal route with human MBP 46–62, 81–102, 124–139, 147–170, and Copaxone®. MBP 124–139 and 147–170 displayed only mild therapeutic effects but MBP 46–62 significantly reduced EAE, reflected by lower clinical scores and shorter EAE duration compared to controls.     

MR Denoising Increases Radiomic Biomarker Precision and Reproducibility in Oncologic Imaging

Journal of Digital Imaging - Several noise sources, such as the Johnson–Nyquist noise, affect MR images disturbing the visualization of structures and affecting the subsequent extraction of...     

Crohn''s Disease of the Colon

Retroperitoneal lumbocrural abscess occurred in 12 patients of 231 with Crohn's colitis or ileocolitis. Although all patients with this complication fell within the group of 175 ileocolitis patients, at least four originated in fistulous tracts of the colon. Eleven of the 12 abscesses developed spontaneously as the first major complication of the disease. The prominent clinical features included pain radiating down the thigh, hip joint flexion, difficulty in walking, hydronephrosis and hydroureter. Internal and external fistulas were significantly more common in the abscess group of 12 patients than in the 219 patients without retroperitoneal abscess. Radiological evidence of granulomatous disease was found in all patients; fistulous tract formation was characteristic and the development of extraperitoneal gas bubbles, in four patients, pathognomonic of abscess with gast-forming organisms. In the presence of established retroperitoneal abscess, the surgical sequence suggested is drainage synchronous with, or followed by diversion and ultimately definitive resection. Resection with anastomosis should not be carried out in the presence of an acute inflammatory process with frank abscess or free pus communicating with the peritoneal cavity. The spontaneous development of retroperitoneal abscess is a serious development in the natural history of Crohn's (ileo) colitis. It frequently heralds the first of a series of operative procedures to deal with the abscess. It sequels are enterocutaneous fistulas and further extension of the disease process.     

Combined Cerebral and Renal Near-Infrared Spectroscopy After Congenital Heart Surgery

The maintenance of an adequate oxygen supply to tissues after congenital heart surgery is essential for good outcomes. The objective of this study was to assess the usefulness of near-infrared spectroscopy (NIRS) for estimating central venous oxygen saturation (ScvO₂) using both cerebral and renal measurements, explore its relation with cardiac output measurements and check its ability to detect low cardiac output. A prospective observational pilot study was conducted in patients weighing <10 kg undergoing cardiopulmonary bypass surgery. Spectroscopy probes were placed on the forehead and renal area, and serial cardiac output measurements were obtained by femoral transpulmonary thermodilution over the first 24 h after surgery. In the 15 patients studied, ScvO₂ was correlated with cerebral (r = 0.58), renal (r = 0.60) and combined (r = 0.71) measurements. Likewise, the systolic index was correlated with the NIRS signals: cerebral (r = 0.60), renal (r = 0.50) and combined (r = 0.66). Statistically significant differences were found in the NIRS measures registered in the 29 low cardiac output events detected by thermodilution: cerebral: 62 % (59–65) versus 69 % (63–76); renal: 83 % (70–89) versus 89 % (83–95); and combined 64 % (60–69) versus 72 % (67–76). In our series, combined cerebral and renal monitoring was correlated with central venous oxygen saturation and cardiac output; low cardiac output detection associated a different spectroscopy pattern.