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Indian Pediatr 2014;51: 418
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Gaurav Gupta
Email: [email protected]
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Reviewing therapy of chronic urticaria: a simple,
modern approach (Ann Allergy Asthma Immunol. 2014;doi:
10.1016/j.anai.2014.02.014.)
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This review examined the available treatment choices for chronic
spontaneous urticaria (CSU) and discuss a new paradigm for treating such
patients, focussing attention on the most recent evidence. Omalizumab
has been found to have considerable efficacy in phase 2 and phase 3
trials in more than 900 patients. A response rate of 65% was seen in
patients resistant to antihistamines as well as to histamine-2 blockers
and leukotriene antagonists, and 40% of patients were completely free of
hives as long as therapy was continued. In addition, serious adverse
events were not seen. Only cyclosporine and corticosteroids can match
this response rate, but the adverse effect profile (blood pressure and
renal function), in comparison, is high. The mechanism by which
omalizumab works in CSU is not clear because the response rate is
unrelated to the autoimmune profile and can occur within a few days. The
authors conclude that omalizumab has exceptional efficacy for
antihistamine-resistant CSU with an excellent safety profile.
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Can otitis media delay reading skills in children? (Int
J Pediatr Otorhinolaryngol. 2014;78:670)
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This study investigated the relation between otitis media and delayed
language acquisition and reading skills. Participants were 40 children
(age 7-10 yrs); half had a history of otitis media anytime between birth
and the age of 3 years, and half were free of the disease. These
children were tested with the Stanford Binet and Arabic Dyslexia
Assessment Test. Children with a history of otitis media scored over a
year below grade level in reading, and significantly lower than controls
on Arabic Dyslexia Assessment tests and Verbal IQ factor on the Stanford
Binet test. The study suggests that children with early onset otitis
media tend to be at greater risk for delayed reading than age-matched
controls.
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Mean platelet volume as an indicator of disease activity in
juvenile SLE (Clin Rheumatol. 2014 Feb 25. [Epub ahead of
print])
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This study assessed mean platelet volume (MPV) in children with systemic
lupus erythematosus (SLE) at the active and inactive stages. Twenty
children with SLE and 30 age- and gender-matched controls were enrolled.
Demographic data, SLE disease activity index (SLEDAI), erythrocyte
sedimentation rate (ESR), C-reactive protein (CRP), MPV, complement 3
(C3), complement 4 (C4), urine protein (Up), and urine creatinine (Ucr)
values upon reactivation and remission phases were recorded. MPV was
statistically higher in patients than in controls, and significantly
increased in active phase compared to inactive phase. A MPV level of
8.4 fL was determined as predictive cut-off value of activation of SLE
(sensitivity 75%, specificity 90%). MPV was positively correlated with
SLEDAI, ESR, CRP and Up/Ucr, and negatively correlated with C3, albumin
and hemoglobin. MPV has the potential to be used as an early indicator
of reactivation in children with SLE, and seems to be more accurate than
ESR, CRP, and C3 for this purpose.
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Does oseltamivir (Tamiflu) really work in Influenza?
(BMJ 2014;348:doi:http://dx.doi.org/10.1136/bmj.g2545)
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This updated systematic review described the potential benefits and
harms of oseltamivir by reviewing all clinical study reports of 83
randomized placebo controlled trials. In treatment trials on adults,
oseltamivir reduced the time to first alleviation of symptoms by 16.8
hours (95% CI 8.4 to 25.1 h). There was no beneficial effect in children
with asthma, but there was an effect in otherwise healthy children (mean
difference 29 hours; 95% CI 12 to 47 hours). In treatment trials, there
was no difference in admissions to hospital in adults; data were sparse
in children, and for prophylaxis. In adult treatment trials, oseltamivir
reduced investigator-mediated unverified pneumonia but the effect was
not statistically significant in the five trials that used a more
specific definition of pneumonia. The effect on unverified pneumonia in
children, and for prophylaxis was not significant. There was no
significant reduction in risk of unverified bronchitis, otitis media,
sinusitis, or any complication classified as serious or that led to
withdrawal from study. Oseltamivir increased the risk of nausea and
vomiting. In prophylaxis studies, oseltamivir increased the risk of
psychiatric adverse events during the combined ‘on-treatment’ and
‘off-treatment’ periods, and there was a dose-response effect.
Oseltamivir also increased the risk of headaches, renal events, and
nausea.
The evidence suggests that there are insufficient
grounds to support the use of oseltamivir in preventing person-to-person
spread of influenza. The trade-off between benefits and harms should be
borne in mind when making decisions to use oseltamivir for treatment,
prophylaxis, or stockpiling.
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