The relationship between asthma severity, family functioning and the health-related quality of life of children with asthma

This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma.

Management of needlestick injuries in general dental practice

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing concern to healthcare workers. Successful prophylaxis requires careful planning in advance. Whilst all practices should have a policy for sharps injuries, prevention of needlestick injuries remains the best policy.

Efficacy of once-daily tobramycin monotherapy for acute pulmonary exacerbations of cystic fibrosis: a preliminary study

Our objective was to compare the efficacy, safety, and microbiology of once-daily intravenous (IV) tobramycin with conventional 8-hourly tobramycin/ceftazidime IV therapy for acute Pseudomonas aeruginosa (PA) pulmonary exacerbations in cystic fibrosis (CF). CF patients with PA-induced pulmonary exacerbations were allocated to receive either once-daily tobramycin (Mono) or conventional therapy with tobramycin/ceftazidime given 8-hourly (Conv). The two longitudinal groups received therapy in a double-blind, randomized manner over a period of 2 years. Tobramycin doses were adjusted to achieve a daily area under the time-concentration curve of 100 mg x hr/L in both groups. Results were assessed for both short-term changes (efficacy and safety after 10 days of IV antibiotics during acute exacerbations) and long-term changes (efficacy, safety, and sputum microbiology between study entry and exit). Pulmonary function tests (PFTs) on admission were similar in both groups. After 10 days of IV antibiotics, absolute mean improvements in percent of predicted PFTs were 12.8, 12.1, and 13.7 for forced expiratory volume in 1 sec (FEV(1)), forced vital capacity (FVC), and forced expired flow between 25--75% of FVC (FEF(25--75%)) in the Conv group (n = 51 admissions) compared to 10.6, 9.9, and 10.6 in the Mono group (n = 47)(P<0.05 for all). Sixteen percent in the Conv group and 15% of patients in the Mono group did not respond to therapy by day 10. Long-term PFT patterns were similar for the Conv and Mono groups. The time between admissions did not differ. The Mono group showed a significant increase in tobramycin minimum inhibitory concentrations (MICs) against PA from study entry to study exit (P = 0.02, n = 27 strains); this failed to reach significance in the Conv group (P = 0.08, n = 25). There was no significant increase in the number of isolates, with MIC> or =8 mg/L in both groups. No short- or long-term changes in audiology or serum creatinine were found in either group. After 10 days of IV therapy, the urinary enzyme N-acetyl-beta-d-glucosaminidase/creatinine ratios increased in both groups (P0.05). This increase was greater in the Conv compared to the Mono group (P < 0.05). We conclude that this pilot study indicates once-daily tobramycin therapy to be as effective and safe as conventional 8-hourly tobramycin/ceftazidime therapy. Combination antibacterial therapy appears to offer no clinical advantage over once-daily tobramycin monotherapy. Tobramycin once-daily monotherapy is a potential alternative to conventional IV antibacterial therapy which deserves further investigation, including the impact on susceptibility of PA to tobramycin.

The relationship between the quality of life of children with asthma and family functioning

The quality of life of 84 children with asthma, aged 7-12 years, and their family functioning was assessed using standard questionnaires. A significant relationship was found between children's reports of their quality of life and several key dimensions of family functioning. The results suggest that independent of their frequency, the extent to which asthma symptoms upset and bother children varies depending on the level of the functioning of the children's families. Treatment approaches designed to improve family functioning may reduce the extent to which children are bothered by their asthma symptoms and thus improve their quality of life.

Absent hematuria and expensive computerized tomography: case characteristics of emergency urolithiasis

PURPOSE

We validated the descriptive characteristics of emergency cases presenting with urolithiasis, determined the incidence of normal urinalysis in such cases and compared the expense of diagnostic computerized tomography (CT) and excretory urography (IVP).

MATERIALS AND METHODS

We retrospectively reviewed the charts of all consecutive patient visits to a community emergency department for 48 months. Explicit protocols for case selection, data abstraction and monitoring were used to maximize accuracy. Entry criteria were urolithiasis diagnosed by IVP, CT or stone passage, and urinalysis. Data analysis included descriptive statistics and the calculation of confidence intervals.

RESULTS

From 159,083 emergency visits during this period 397 met study entry criteria. Absent hematuria was noted in 9% (95% confidence interval 7% to 12%) of patients with proved urolithiasis. There was no correlation of the degree of obstruction with absent hematuria. Most patients presenting with painful urolithiasis were male (73%), in the fifth decade of life (mean age 47 years), had stones in the mid ureter (32%) or at the ureterovesicular junction (44%) and received opiates for pain control (91%). Of the patients 48% presented between 5 p.m. and 7 a.m. when the radiology department was available only for emergency imaging. The diagnosis was made by CT in half of the patients, who were charged $1,409. The maximal insurance reimbursement was $673. The diagnosis was made by IVP in half of the patients, who were charged $445. The maximal insurance reimbursement was $141.

CONCLUSIONS

Hematuria is not universally present in patients with painful urolithiasis and does not correspond to the degree of obstruction. Despite previous reports to the contrary, CT is significantly more expensive for patients than IVP.

Apparently unstable normal FMR1 alleles in nine developmentally delayed patients: implications for molecular diagnosis of the fragile X syndrome

The Fragile X syndrome is a common form of X-linked mental retardation, affecting approximately 1 in 4,000 males. Since the discovery of the FMR1 gene responsible for the syndrome, molecular, rather than cytogenetic, diagnosis of Fragile X syndrome has become the gold standard. Numerous molecular diagnostic centers worldwide use PCR and Southern blotting to characterize the size of the CGG repeats within the gene, expansion of which has been shown to be associated with the vast majority of cases of Fragile X syndrome. Instability of this repeat through successive generations has been demonstrated in many patients and has been associated with numerous factors, including repeat length and molecular structure of the repeat. Nine males with normal-size alleles that exhibit repeat length instability by the presence of a second normal length distinct band by repeated PCR analysis from peripheral lymphocytes are reported. Many hypotheses addressing the reason for this apparent instability were tested without elucidating the underlying molecular causes, including cytogenetic analysis, sequence analysis of the repeat locus, and analysis of flanking dinucleotide repeat loci. All patients exhibited a normal complement of sex chromosomes by cytogenetic and molecular analysis. These results from the widely used PCR analysis illustrate an interesting molecular phenomenon and raise many questions relating to the factors and mechanisms involved in trinucleotide instability as well as having implications for the diagnostic testing of the Fragile X syndrome.