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PubMed2003

Caffeine as a promoter of analgesic-associated nephropathy--where is the evidence?

Individual groups of nephrologists - in their responsibility for their patients - initiated a most controversial discussion whether or not caffeine - coformulated to analgesics - might initiate or sustain analgesic overdosing. The original sources (data) of such suspicion have got lost during the debate of the last two decades. Therefore, it seemed to be appropriate to investigate the original data background and the reasons why nephrologists started to suspect caffeine as a stimulant of analgesic overdosing by employing a systematic and exhaustive review of primary nephrological publications. Their selection followed a precise selection plan, including all epidemiological studies on analgesic-associated nephropathy, the original papers of all groups having been involved in those studies, further originals from the mainly involved countries (academically, politically), and any literature thereof cited as a proof. The following results emerged from the investigation: (i) The epidemiological studies warranted no conclusion about a role of caffeine in prompting excessive analgesic use. (ii) The identified groups of nephrologists provided not substantial data to advocate the said suspicion, except for the observation of a preferential choice of phenacetin-containing combinations, especially powder preparations. (iii) Only two cited original data sources revealed drug-seeking behaviour with phenacetin-containing preparations which subsided, after phenacetin was banned from the respective markets. Conclusively, it appears that there is no substantial data to support a pivotal role of caffeine in initiating or sustaining analgesic overdosing. However, there is strong data that phenacetin, by its psychotropic properties, may have caused drug-seeking behaviour and thus led to analgesic overdosing. This conclusion is convincingly supported by thorough pharmacokinetic investigations. Note: All caffeine-related statements within the reviewed literature have been collected in tables (referred to as Table SX) which are provided in full text for check on the following website: http://www.blackwellpublishing.com/products/journals/suppmat/FCP/FCP174/FCP174sm.htm

Analgesics↗
PubMed1994

Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction.

OBJECTIVE--This review of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) provides an overview of a common but complex problem found in critically ill patients. It emphasizes definitions, common clinical patterns, metabolic responses, and pathophysiological changes. A brief discussion of treatment concepts is also included. DATA SOURCES--Data for this review were gathered from peer-reviewed journals, review articles by experts in SIRS/MODS, and selections from reference volumes written on SIRS/MODS. STUDY SELECTION--Reference selections were chosen on the basis of quality of research. Peer-reviewed journals were given primary consideration. Those review articles cited were felt to be essential to any discussion of SIRS/MODS. DATA EXTRACTION--Where possible, randomized, controlled, prospective studies were reviewed and conclusions used in this overview of SIRS/MODS. CONCLUSION--Our ability to care for critically ill patients has led to a new problem, SIRS and eventually MODS, which may become progressive organ failure and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates. Increased oxygen consumption demands highlight the physiological response. The typical metabolic responses are characterized by hyperglycemia and accelerated protein catabolism. Unrecognized perfusion deficits, an uncontrolled septic focus, a persistent source of inflammation, or injured tissue is commonly present with SIRS/MODS and should be corrected. Restoration of oxygen transport and metabolic support are also important components of treatment. The cause of SIRS/MODS is complex and not fully understood, but multiple mediators and stimulated macrophages likely are important components and areas where treatment may well be focused.

Critical Illness↗
PubMed1994

Recommendations to avoid the prone sleeping position and recent statistics for sudden infant death syndrome in the United States.

OBJECTIVE: To determine whether two recent, nonsynchronized recommendations to avoid the prone position for sleeping infants were each followed by a decline in the incidence or expected number of cases of sudden infant death syndrome (SIDS). DATA SOURCES: Data were collected from SIDS counseling programs, state vital statistics, and medical examiner records of 44 states and the city of Los Angeles, Calif. Data for a state were excluded because of either incompleteness or nonresponsiveness to request. DATA SYNTHESIS: In the 8 months following an article in the Seattle Times advising against the use of the prone position for sleeping infants, the incidence of SIDS fell by 52.0% in King County (where 32 households in every 100 receive the Seattle Times) and by 19.9% in Snohomish County (16 in 100 households). In the remaining 37 counties of Washington State (on average, < 1 in 100 households are subscribers), the incidence rose 3.4%. Examination of medical examiner records for King County and Snohomish County revealed no compensatory increase in other causes of death and no cases attributed to aspiration. In the 12 months following the initial 8 months, the number of SIDS cases in King County remained at approximately half the previous annual average (25 vs 49 cases). At the national level, the American Academy of Pediatrics' recommendation on April 15, 1992, was followed in the next 6 months by a decrease of 12.0% in the number of SIDS cases compared with the previous year. CONCLUSIONS: The results are consistent with those of intervention programs in other countries. A national campaign to inform parents of the risk of the prone position in early infancy should be given serious consideration.

Cause of Death↗
PubMed2003

Mechanisms and treatment of postoperative ileus.

OBJECTIVE: To review the pathogenesis and treatment of postoperative ileus. DATA SOURCES: Data collected for this review were identified from a MEDLINE database search of the English-language literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used. STUDY SELECTION: All relevant studies were included. Only articles that were case presentations or that mentioned postoperative ileus in passing were excluded. DATA SYNTHESIS: The pathogenesis of postoperative ileus is complex, with multiple factors contributing either simultaneously or at various times during the development of this entity. These factors include inhibitory effects of sympathetic input; release of hormones, neurotransmitters, and other mediators; an inflammatory reaction; and the effects of anesthetics and analgesics. Numerous treatments have been used to alleviate postoperative ileus without much success. CONCLUSIONS: The etiology of postoperative ileus can best be described as multifactorial. A multimodality treatment approach should include limiting the administration of agents known to contribute to postoperative ileus (narcotics), using thoracic epidurals with local anesthetics when possible, and selectively applying nasogastric decompression.

Analgesics, Opioid↗
PubMed1994

Management of heart failure. III. The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction.

OBJECTIVE: This article reviews the benefits and risks of coronary artery bypass grafting and angioplasty for patients with moderate or severe left ventricular systolic dysfunction and summarizes the recommendations of the expert panel for the Agency for Health Care Policy and Research Heart Failure Guideline. DATA SOURCES: Data were obtained from studies published in English and referenced in MEDLINE or EMBASE between 1966 and 1993. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with the terms coronary artery bypass grafting and angioplasty. STUDY SELECTION: All cohort studies and case series that provided separate outcomes data on a subgroup of patients with a left ventricular ejection fraction less than 0.40 were reviewed. DATA EXTRACTION AND SYNTHESIS: Studies were reviewed for inclusion and exclusion criteria, survival, and functional status measures using a standardized form. Cohort studies were assessed on eight aspects of study quality using a defined list of study flaws. CONCLUSION: Coronary artery bypass grafting improves 3-year survival by approximately 30% to 50% and physical functioning by approximately one New York Heart Association class in patients with moderate to severe left ventricular dysfunction and limiting angina. However, the operative mortality ranges from 5% to 30% depending on patients' ejection fractions and comorbidity. It is not clear whether patients whose predominant symptom is heart failure rather than angina benefit from bypass surgery or how much ischemia is required to justify surgical intervention. Clinical outcomes after angioplasty have not been adequately studied to determine the relative risks and benefits compared with bypass grafting.

Aged↗
PubMed2026

Exploring Professional Experiences in Caring for Vulnerable Migrants in an Italian Rural Reception Centre: A Qualitative Study Using Multidimensional Textual Analysis-Professional Experiences in Rural Migrant Care.

AIM: This study aims to explore the experiences, strengths, challenges, and potential improvements for professionals in managing the complex needs of vulnerable migrants (VM) in an Italian rural reception centre. METHODS: A qualitative study using semi-structured interviews was conducted in April 2024. Data were analysed using the Automatic Analysis of Textual Data, based on Fraire's seven-step model for Exploratory Multidimensional Data Analysis. DATA SOURCES: Data were collected from 16 professionals working in a rural reception centre in southern Italy. Interviews were conducted and analysed using AATD in April 2024. FINDINGS: The analysis identified two main dimensions of professionals' roles: balancing systemic responsibilities with personal engagement and managing immediate needs versus long-term integration goals. Professionals face significant challenges, such as resource scarcity, bureaucratic inefficiencies, and emotional fatigue, which impact their well-being and the quality of care provided to migrants. Resilience, adaptability, and multidisciplinary collaboration were identified as key strengths. CONCLUSION: The study highlights the dual nature of professionals' work in reception centres, requiring them to balance operational tasks with emotional involvement in migrant care. Targeted interventions and systemic reforms are necessary to support professionals and enhance the quality of care for vulnerable migrants, particularly in resource-constrained rural settings. IMPLICATIONS FOR PRACTICE AND/OR PATIENT CARE: This study underscores the importance of providing targeted support to professionals working in reception centres, including training in intercultural competence, stress management, and coping strategies. Policies should address systemic challenges and provide resources to enhance healthcare delivery and social integration programs. REPORTING METHOD: This study adhered to the EQUATOR guidelines for reporting qualitative research (COREQ). The findings were reported in compliance with these guidelines, ensuring methodological rigour and transparency. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the critical need for targeted support and training for professionals working in reception centres, particularly in rural settings. To improve care for vulnerable migrants, professionals should receive training in intercultural competence, stress management, and coping strategies to better navigate the complex challenges they face. Furthermore, systemic changes are necessary to alleviate the pressures on reception centres, such as streamlining bureaucratic processes and enhancing healthcare infrastructure, particularly in rural areas where resources are limited. By addressing these needs, we can improve the well-being of both the professionals and the migrants they serve, fostering more effective support systems and better care outcomes. Additionally, fostering multidisciplinary collaboration and community engagement can contribute to more comprehensive and sustainable care models. PROTOCOL REGISTRATION: The Ethics Committee of the University of Rome Tor Vergata approved this study on 07/07/2021 (protocol registration number 160.21).

Humans↗
PubMed1995

Interferon-alpha therapy for chronic myelogenous leukemia.

PURPOSE: To provide a status report on the use of interferon (IFN)-alpha in patients with chronic myelogenous leukemia (CML). DATA SOURCES: Data on IFN-alpha therapy for CML collected from published articles identified in a MEDLINE computer search. RESULTS: Previously untreated patients with low-risk factors and early-stage disease consistently had the best results in clinical trials. A dose response was seen, with patients treated with dosages of 5 million units (MU)/m2 per day showing the greatest incidence of cytogenetic remissions. In addition, randomized trials showed a survival advantage for IFN-alpha-treated patients. In studies comparing IFN-alpha therapy to chemotherapy, IFN-alpha produced significantly more major and durable cytogenetic responses than chemotherapy did. In studies combining IFN-alpha and chemotherapy, patients had significantly more cytogenetic responses, although more patient accrual and follow-up data are needed to offer conclusive statements concerning durability of response. IFN-alpha also showed activity in maintaining remissions after both chemotherapy and bone marrow transplantation. CONCLUSIONS: IFN-alpha has significant activity in patients with CML, with best results at dosages of 5 MU/m2 per day. At these dosages, in patients with early-stage, Philadelphia+ CML, hematologic response rates of 70% to 80% and cytogenetic response rates of 50% (approximately 20% of which were complete) are seen. One randomized trial shows a survival advantage with cytogenetic response in IFN-alpha-treated patients, and this advantage appears to be unrelated to the degree of that response. These questions remain under study.

Antineoplastic Agents↗
PubMed2001

Management of medically refractory ascites.

BACKGROUND: Medically refractory ascites is a clinical entity for which there exists few effective therapeutic options. Available treatment modalities include diuresis and sodium restriction, peritoneovenous shunt, liver transplant, transjugular intrahepatic portosystemic shunts and surgical shunts, and large-volume paracentesis. Herein we review the current therapeutic options for medically refractory ascites focusing on indications, benefits, and drawbacks of each specific therapy. DATA SOURCES: Data and recommendations are based on the authors' cumulative experience with complicated cirrhotic and cancer patients and on past and current literature addressing intractable ascites. CONCLUSIONS: The absence of a single, effective therapy in the management of refractory ascites speaks to the complex nature of this complication. Although most patients will respond to medical management, thoughtful application of available therapeutic options in patients who fail, as described herein, not only makes decisions regarding their care easier but also provides the best palliation in a vexing clinical scenario.

Ascites↗
PubMed1999

Economics of managed care in spinal cord injury.

OBJECTIVE: To determine and describe trends in economic variables related to the care of individuals with spinal cord injury (SCI) and significant changes in these trends coincident with major developments in medical care cost control. DATA SOURCES: Data from the National Spinal Cord Injury Statistical Center (NSCISC) database were used to review the economic trends in SCI management from 1973 to 1998 and their relation to managed care and other health care cost-containment measures. A panel of SCI health care specialists was interviewed to determine the appropriate data variables to be reviewed. The Shepherd Center Care Health Management Program, Atlanta, GA, is presented as an example of a fiscally successful managed care program for patients with SCI. DATA EXTRACTION: Data from the NSCISC database for the years studied were extracted and converted to a form suitable for analysis by means of the statistical software SAS. DATA SYNTHESIS: Statistical techniques included multiple regression analysis, logistic regression analysis, and model selection methods. CONCLUSIONS: Trends in economic variables, in the care of individuals with SCI show changes coincident with the introduction of Diagnostic Related Groups (DRGs) and managed care as models for provider reimbursement. Significant changes occurred in acute care charges, rehabilitation charges, length of stay, rehospitalization 1 year postinjury, time from injury to admission to a Model System, and discharges to a nursing home.

Cost Control↗
PubMed1998

The Health On the Net Code of Conduct for medical and health Websites.

Internet has become one of the most used communication media. This and the fact that no constraining information publishing policy exists have created an urgent need to control the quality of information circulating through this media. To this purpose, the Health On the Net Foundation has initiated the Code of Conduct (HONcode) for the health/medical domain. This initiative proposes guidelines to information providers, with the aim, on the one hand, of raising the quality of data available on the Net and, on the other hand, of helping to identify Internet sites that are maintained by qualified people and contain reliable data. The HONcode mainly includes the following ethical aspects: the author's credentials, the date of the last modification with respect to clinical documents, confidentiality of data, source data reference, funding and the advertising policy. This article presents the HONcode and its evolution since it was launched in 1996.

Advertising↗
PubMed1999

Fluorescence spectroscopy for diagnosis of squamous intraepithelial lesions of the cervix.

OBJECTIVE: To calculate receiver operating characteristic (ROC) curves for fluorescence spectroscopy in order to measure its performance in the diagnosis of squamous intraepithelial lesions (SILs) and to compare these curves with those for other diagnostic methods: colposcopy, cervicography, speculoscopy, Papanicolaou smear screening, and human papillomavirus (HPV) testing. DATA SOURCES: Data from our previous clinical study were used to calculate ROC curves for fluorescence spectroscopy. Curves for other techniques were calculated from other investigators' reports. To identify these, a MEDLINE search for articles published from 1966 to 1996 was carried out, using the search terms "colposcopy," "cervicoscopy," "cervicography," "speculoscopy," "Papanicolaou smear," "HPV testing," "fluorescence spectroscopy," and "polar probe" in conjunction with the terms "diagnosis," "positive predictive value," "negative predictive value," and "receiver operating characteristic curve." METHODS OF STUDY SELECTION: We found 270 articles, from which articles were selected if they reported results of studies involving high-disease-prevalence populations, reported findings of studies in which colposcopically directed biopsy was the criterion standard, and included sufficient data for recalculation of the reported sensitivities and specificities. TABULATION, INTEGRATION, AND RESULTS: We calculated ROC curves for fluorescence spectroscopy using Bayesian and neural net algorithms. A meta-analytic approach was used to calculate ROC curves for the other techniques. Areas under the curves were calculated. Fluorescence spectroscopy using the neural net algorithm had the highest area under the ROC curve, followed by fluorescence spectroscopy using the Bayesian algorithm, followed by colposcopy, the standard diagnostic technique. Cervicography, Papanicolaou smear screening, and HPV testing performed comparably with each other but not as well as fluorescence spectroscopy and colposcopy. CONCLUSION: Fluorescence spectroscopy performs better than colposcopy and other techniques in the diagnosis of SILs. Because it also permits real-time diagnosis and has the potential of being used by inexperienced health care personnel, this technology holds bright promise.

Carcinoma in Situ↗
PubMedDate not supplied

Emerging standardization in pharmacoeconomics.

In this study, we reviewed pharmacoeconomic guidelines from the United Kingdom, Spain, Italy, Australia, Canada, and the United States to determine areas of emerging standardization. We examined the published literature, publication guidelines of major health journals, and published and unpublished recommendations from various task forces and conferences on related topics. The review revealed several general principles for which there was consensus across guidelines. These common features included the importance of using and reporting transparent methods so that readers can easily understand what calculations are being performed on which data elements, minimizing bias, and providing justification for the methods and assumptions used. Differences were detected across guidelines on the following topics: type of pharmacoeconomic assessment, perspective, comparators and data sources, data analysis, cost analysis, future cost analysis, outcomes assessment, modeling, time horizon, discounting, disclosure, and generalizability. Evolution of economic guidelines hinges on whether the primary goal is to increase the consistency or increase the validity of economic assessments. Some balance between these two objectives is desirable.

Cost-Benefit Analysis↗
PubMed2000

Cracking the auditory genetic code: part II. Syndromic hereditary hearing impairment.

OBJECTIVE: The application of molecular genetic techniques to the study of hereditary hearing impairment has contributed significantly to our understanding of auditory physiology and disease processes. This article reviews the current state of our knowledge regarding the genes associated with syndromic hereditary hearing impairment. DATA SOURCES: Data were obtained from the Medline database and the internet. STUDY SELECTION: Articles relevant to genetics of syndromic deafness were selected. DATA EXTRACTION: Data pertaining to phenotypes, location of genes, identification of genes, and implications for hearing were extracted. CONCLUSION: Significant progress has been made in understanding the molecular pathogenesis of deafness.

Gene Expression↗
PubMed2002

[Hyperchloremic acidosis druing plasma volume replacement].

OBJECTIVES: Review of the physiological and clinical consequences of hyperchloraemic acidosis observed during plasma volume replacement using crystalloids and colloids. DATA SOURCES: Data were searched in the Medline database after 1990 using the following key words: metabolic acidosis, crystalloids, colloids, albumin, gelatin, hydroxyethyl starch. DATA EXTRACTION: Publications before 1990 were selected for their historical value. Most of articles published after 1990 and all types including case report were accepted. DATA SYNTHESIS: Large volume infusion of isotonic solution can cause hyperchloraemic acidosis. Colloid plasma substitutes using saline solvent may be responsible for the same kind of acidosis with acidaemia. The anion gap is not modified in this case because of chloride increase. Physiological mechanism may be described using the Henderson-Hasselbach equation or the strong ion difference decrease (Stewart concept). Excessive chloride infusion is a major factor in this acid-base disorder and the term hyperchloraemic acidosis should be preferred to dilutional acidosis. When perioperative acidosis occurs, careful and complete analysis of acid-base disturbance should be made. The association of a normal anion gap, normal lactatemia, hyperchloraemia and acidaemia does not need specific treatment. Acidosis corrects spontaneously and slowly following chloride normalization. But any factor that may increase acidosis should be avoided. CONCLUSION: The use of balanced solution like lactated-Ringer solution instead of isotonic saline solution for fluid resuscitation, except for specific contra-indication as intracranial hypertension, may avoid hyperchloraemic acidosis. Potential risk of this acidosis led to the conception of a new colloid using balanced crystalloids solution as the solvent (Hextend).

Acidosis↗
PubMed2002

[Effects of plasma substitutes on hemostasis].

OBJECTIVE: Data synthesis on haemostasis effects of cristalloids and colloids and clinical implications for their use for plasma volume replacement. DATA SOURCES: Data were searched in the Medline database from 1954 to 2000 using the following key-words: cristalloids, colloids, albumin, gelatin, dextran, hydroxyethyl starch, haemostasis, von Willebrand disease, haemodilution. DATA EXTRACTION: Publications from 1954 to 1990 were selected depending on the quality of their methodology. Most of articles published after 1990 and all types including case report were accepted. DATA SYNTHESIS: Cristalloids induces a moderate hypercoagulable state with 10 to 30% haemodilution. Hypocoagulation is observed above 50% haemodilution. Albumin does not impair hemostasis except with a 50% or more haemodilution where hypocoagulation is observed. Dextran dramatically impairs haemostasis and fibrinolysis. With increasing dose, a progressive decrease of all von Willebrand multimers, mostly the largest, is observed. Till 50% haemodilution, gelatin has a moderate impact on hemostasis, but platelet aggregation is moderately modified. However this moderate impairment of haemostasis may potentiate the haemostatic effect of other colloids when used in association with gelatin. More than 30% haemodilution with hydroxyethyl starch (HES) has a serious effect in vitro on platelet function and fibrinoformation. In most studies in human, less than 20 ml.kg-1 plasma volume replacement has no clinical impact, but in some evaluations postoperative bleeding is more important with HES, particularly HES 450, in comparison to other colloids. With HES 450 and HES 200 highly substituted (0.6 of degree of substitution) intravascular cumulation of large molecules leads to type I von Willebrand syndrome when doses overtake 80 ml.kg-1. Dextran and HES are prohibited in patients with impaired haemostasis due to congenital disease (haemophilia and von Willebrand disease) or acquired defect (thrombocytopenia). Caution is required in patients with renal failure or receiving antithrombotic or non-steroidal anti-inflammatory agents. Patients without a haemorrhagic diathesis must not received more than 1.5 g.kg-1.j-1 of dextran and restrictive conditions of use must be respected with HES. CONCLUSION: Except isotonic cristalloids, all colloids induce haemostastic changes particularly for haemodilution over 30%. Effects are more pronounced with HES and dextran.

Blood Coagulation↗
PubMed2003

[Hepatorenal syndrome: from physiopathology to treatment].

OBJECTIVES: Data synthesis on physiopathology and treatment of hepatorenal syndrome (HRS). DATA SOURCES: Data were searched in the Medline database from 1975 to 2002 using the following key-words: hepatorenal syndrome, ascite, cirrhosis and portal hypertension. DATA EXTRACTION: Publications from 1986 to 2002 were selected depending on the quality of their methodology and their pertinence. One publication from 1975 was kept. DATA SYNTHESIS: Hepatorenal syndrome is a common and severe complication of patients with advanced liver cirrhosis with ascites. It is a functional renal failure due to intense vasoconstriction of the renal circulation secondary to an intense splanchnic vasodilatation. Two types of HRS are differentiated mainly by the speed and the magnitude of the renal failure. Liver transplantation remains the best treatment but is rarely applicable because of the short survival after diagnosis. In the last few years, new therapy have been developed, vasoconstrictor drugs which mainly elicit their effects on the splanchnic circulation as vasopressin and principally its analogues ornipressine and terlipressine are effective in improving renal function and could act as bridge for liver transplantation. The place of the transjugular intrahepatic portosystemic shunt remain to be evaluated. CONCLUSION: Prognosis of patients with HRS remains poor but the pharmacologic treatment by terlipressine has improved the prognosis particularly in order to wait liver transplantation.

Hepatorenal Syndrome↗
PubMed2003

Management of rhinitis and asthma in pregnancy.

OBJECTIVES: To objectively critique recent available data on the proper management of allergy and asthma during pregnancy, with an emphasis on understanding the risk and benefit of medications used during pregnancy for these disorders. DATA SOURCES: Data for this article were obtained from a MEDLINE search of literature from 1975 until the present published in English. STUDY SELECTION: It was the expert opinion of the author to select and synthesize recently published articles and reviews on this broad subject. RESULTS: Asthma is estimated to affect up to 4% of pregnancies, whereas rhinitis complicates up to 20%. The cornerstones of management are environmental avoidance procedures, pharmacologic treatment, and allergen immunotherapy. Pharmaceutical treatment for allergic rhinitis should start with the first-generation antihistamines, chlorpheniramine and tripelennamine. In pregnant women, who cannot tolerate first-generation antihistamines, use of a second-generation agent, either loratadine or cetirizine, should be considered. Though data are lacking, intranasal corticosteroids appear to be safe during pregnancy. For pregnant women with persistent asthma, the use of inhaled cromolyn should be the first-line therapy, followed by inhaled budesonide if symptoms worsen. Other agents such as salmeterol, leukotriene modifiers, and newer inhaled corticosteroids may be considered in women who exhibited a good response to these agents before pregnancy. Immunotherapy is the only disease-modifying treatment for allergic rhinitis and asthma. It can be continued during pregnancy. CONCLUSIONS: Understanding the important differences in treatment for the pregnant patient is vital for all physicians caring for these patients. Proper medical management needs to take into consideration possible adverse effects of different agents used in asthma and rhinitis.

Animals↗
PubMed2001

Is diesel the cause for the increase in allergic disease?

LEARNING OBJECTIVES: The purpose of this review is to objectively critique available data regarding the role of diesel exhaust particles (DEPs) in allergic disease. Readers of this review should understand the ways in which diesel particulates can affect human airways and the extent of the scientific data which are currently available. DATA SOURCES: Data were obtained from published studies and reviews. STUDY SELECTION: The specific reviewed studies selected for this review met the following criteria: human and animal in vivo, in vitro, and pulmonary dosimetry studies, as well as epidemiologic studies to examine the role of DEPs and particulates on the airways. RESULTS: The results of the published studies show that although DEPs may play a role in the increased levels of allergic disorders through a number of immunologic mechanisms, it remains to be proven whether it is responsible for the recent rise in the prevalence of asthma and other allergic disorders. CONCLUSIONS: Further studies in humans are needed to elucidate the mechanisms by which DEPs may be responsible for the increased prevalence of allergic disorders.

Animals↗