tag:blogger.com,1999:blog-21311327453419115062024-03-12T15:03:36.401-07:00Houston Pediatric SpecialistsThis blog informs the public about information key to pediatric specialists in the Houston and East Texas area. Dr. Rotenberg serves as the editor. Independent MD/PhD pediatric specialists are invited to participate. These physician specialists welcome patients who require attention. This blog will be relevant if you want to learn more about an illness affecting a child, teen or young adult.Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.comBlogger320125tag:blogger.com,1999:blog-2131132745341911506.post-32356145400219336082017-04-17T11:15:00.000-07:002017-04-17T11:15:05.931-07:00STUDY FINDS PREVALENCE OF INSOMNIA IN PATIENTS WITH ASTHMA<div style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px;">
<b><i><span style="font-size: large;">Declining lung function may occur routinely due to sleep physiology, making already marginal asthma worse. Dr. Susarla</span></i></b></div>
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A recent study found a high prevalence of clinical insomnia in individuals with asthma. In addition, the study also determined the effects of insomnia on the well-being, asthma control, and asthma-related health care utilization of patients. Researchers concluded that insomnia is highly prevalent in individuals with asthma, and those with insomnia experience adverse health effects and are at risk for not having well-controlled asthma.</div>
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A team of researchers, lead by Faith S. Luyster at the University of Pittsburg, studied the prevalence of insomnia in patients with asthmas to determine its association with asthmas and the health of the patient by using the Insomnia Severity Index, Asthma Control Test, Asthma Quality of Life Questionnaire, and Hospital Anxiety and Depression Scale. The study collected data from 714 participants confirmed with asthma and enrolled in the Severe Asthmas Research Program III.</div>
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Researchers identified insomnia in 263 participants (37%). Insomnia in patients increased their risk for not having well-controlled asthma by 2.4-fold and their risk for asthma-related health care utilization by 1.5-fold in the past year compared to patients without insomnia. Patients with insomnia also showed higher levels of anxiety and depression, as well as poor quality of life.</div>
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While patients with asthma commonly report sleep difficulties, the relationship between asthma and insomnia is unknown. The researchers concluded, “Insomnia is highly prevalent in asthma and is associated with adverse outcomes. Further studies are needed to gain a better understanding of the interaction between insomnia and asthma control.”</div>
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<a href="http://www.consultant360.com/exclusives/study-finds-prevalence-insomnia-patients-asthma">See linked article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-53092113855294255062017-04-13T04:03:00.000-07:002017-04-17T10:42:14.596-07:00OMEGA-3 FATTY ACIDS REDUCE INFLAMMATION IN PATIENTS WITH ASTHMA<div class="separator" style="clear: both; text-align: center;">
<i><b><span style="font-size: large;">Natural asthma therapies? Inflammation is the cause for most asthma sufferers. Dr. Susarla</span></b></i></div>
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A recent study found that high quality omega-3 fatty acids (17-HDHA) may decrease the inflammatory immune system response related to allergic asthma, and might be an effective alternative to corticosteroids for patients with mild asthma.</div>
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“While corticosteroids can be effective at suppressing chronic inflammation, systemic or [oral corticosteroids] also have deleterious side effects, including weight gain, osteoporosis, and growth retardation in children,” the researchers wrote.</div>
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Specialized proresolving mediators, such as omega-3 fatty acids, have been shown in animal models to reduce inflammation in chronic inflammatory diseases.</div>
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To investigate their effects in patients with asthma, researchers collected blood samples from 17 patients with asthma taking inhaled corticosteroids, with β2-agonists as needed; 3 of the 17 participants were taking high dosages of oral corticosteroids. Blood samples from healthy donors were also collected.</div>
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Researchers isolated peripheral blood B cells and treated them with either 17-HDHA or resolvin D1 (RvD1) using cells from at least 3 participants to test that effects of omega-3 fatty acids on immunoglobulin E (IgE) production in B cells. In one experiment, researchers tested the effects of corticosteroids on the ability of 17-HDHA to reduce inflammation.</div>
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Their findings showed that 17-HDHA and RvD1 reduced the level of IgE antibodies in blood samples, indicating a reduction in the antibodies that cause allergic reactions and asthma symptoms.</div>
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However, the results were not found in samples from participants on high doses of oral corticosteroids as researchers discovered that the steroids blocked the beneficial effects of omega-3 fatty acids in participants with severe asthma. </div>
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“Our results suggest that [specialized proresolving mediators] are important potential therapeutics for most patients with allergic asthma. Further, our results highlight that immunosuppressive therapies like [oral corticosteroids] also suppress endogenous resolution pathways and suggest one method by which [oral corticosteroids] may actually exacerbate allergic diseases,” the researchers concluded.</div>
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<a href="http://www.consultant360.com/exclusives/study-omega-3-fatty-acids-reduce-inflammation-patients-asthma">Article linked here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-1159589942375096462017-04-10T04:36:00.000-07:002017-04-10T04:36:11.024-07:00Most Kids Who Died of Flu Weren’t Vaccinated, Study Finds<div style="box-sizing: inherit; color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem; margin-bottom: 1.125em; padding-bottom: 0px; padding-top: 0px; word-wrap: break-word;">
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<b><i>Notwithstanding the seasons where flu efficacy is poor, this is still a good default argument for treating at-risk kids. Dr. Susarla</i></b></div>
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Most children who have died of flu in recent years were not vaccinated against the virus, Centers for Disease Control and Prevention researchers reported Monday. </div>
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<span style="color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem;">They found that at least three-quarters of kids who</span><span style="color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem;"> </span><a href="http://www.nbcnews.com/id/51290370/ns/health-cold_and_flu/t/flu-kills-children-most-not-vaccinated-cdc-says/#.WOJm5m8rJ6s" style="box-sizing: inherit; color: #4372b8; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem; text-decoration: none;">died from influenza</a><span style="color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem;"> </span><span style="color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.01rem;">between 2010 and 2014 had not been vaccinated in the months before they got sick.</span></div>
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<span style="background-color: white; color: #232323; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: 0.1599999964237213px;">And while kids with asthma, developmental disorders and other conditions are at especially high risk, fully half the kids who died were considered healthy before they became infected, the researchers found.</span></div>
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Article linked <a href="http://www.nbcnews.com/health/health-news/most-kids-who-died-flu-weren-t-vaccinated-study-finds-n742046">here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-38986212447552336232017-04-09T07:28:00.000-07:002017-04-13T19:17:40.956-07:00 'Last Supper' Portions have Super Sized Over TimeNot neurology but interesting anyway. - JR<br />
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<u><b><span style="font-size: large;">Portion Sizes in 'Last Supper' Paintings Grew Over Time </span></b></u><br />
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By Andrea Thompson | March 22, 2010<br />
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<a href="https://upload.wikimedia.org/wikipedia/en/6/60/BouveretLastSupper.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="192" src="https://upload.wikimedia.org/wikipedia/en/6/60/BouveretLastSupper.jpg" width="320" /></a>Nutrition experts have analyzed the food depicted in some of the best-known paintings of the biblical Last Supper and found that the portion and plate sizes depicted in them increased substantially from older paintings to those painted more recently.<br />
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The findings suggest the trend of bigger plates and portions that has been noticed recently and linked to obesity may have been in the works for much longer, the researchers suggest.<br />
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"I think people assume that increased serving sizes, or 'portion distribution' is a recent phenomenon," said Brian Wansink, director of the Cornell Food and Brand Lab. "But this research indicates that it's a general trend for at least the last millennium."<br />
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"As the most famously depicted dinner of all time, the Last Supper is ideally suited for review," Craig Wansink said.<br />
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From the 52 paintings, which date between 1000 and 2000 A.D., the sizes of loaves of bread, main dishes and plates were calculated with the aid of a computer program that could scan the items and rotate them in a way that allowed them to be measured. To account for different proportions in paintings, the sizes of the food were compared to the sizes of the human heads in the paintings.<br />
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http://www.livescience.com/8130-portion-sizes-supper-paintings-grew-time.html<br />
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<a href="http://www.nature.com/ijo/journal/v34/n5/full/ijo201037a.html" target="_blank">Full article</a><br />
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altima cena ;Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-52792137880215439542017-03-29T07:47:00.000-07:002017-03-29T07:47:03.851-07:00Pediatric Sleep Apnea Linked to Brain Changes<div style="color: #111111; font-family: knowledge-reg, helvetica, arial, sans-serif; font-size: 1.7em; font-weight: 400; line-height: 24px; margin: 0px 0px 20px 80px; padding: 0px;">
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<span class="articleLocatio</span>n" style="transform: translate3d(0px, 0px, 0px);"><i>Medical community slowly learning more about the consequences of sleep apnea in children. Dr. Susarla</i></span></div>
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<span class="articleLocatio</span>n" style="transform: translate3d(0px, 0px, 0px);">In children with a common condition that causes them to periodically stop breathing during sleep, areas of the brain involved with thinking and problem-solving appear to be smaller than in children who sleep normally, a study finds.</span></div>
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Researchers can't say the brain changes actually cause problems for children at home or school, but they do say the condition, known as obstructive sleep apnea (OSA), has been tied to behavior and cognitive problems.</div>
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"It really does seem that there is a change in the brain or that the brain is affected," said study author Paul Macey, who is director of technology and innovation at the University of California, Los Angeles School of Nursing.</div>
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Macey and colleagues write in Scientific Reports that up to 5 percent of all children are affected by OSA. The condition causes the child's airway to become blocked, which ultimately causes the brain to go without oxygen for short periods of time and may wake the child up.</div>
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<a href="http://In children with a common condition that causes them to periodically stop breathing during sleep, areas of the brain involved with thinking and problem-solving appear to be smaller than in children who sleep normally, a study finds. Researchers can't say the brain changes actually cause problems for children at home or school, but they do say the condition, known as obstructive sleep apnea (OSA), has been tied to behavior and cognitive problems. "It really does seem that there is a change in the brain or that the brain is affected," said study author Paul Macey, who is director of technology and innovation at the University of California, Los Angeles School of Nursing. Macey and colleagues write in Scientific Reports that up to 5 percent of all children are affected by OSA. The condition causes the child's airway to become blocked, which ultimately causes the brain to go without oxygen for short periods of time and may wake the child up.">Article linked here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-44018598764729701382015-06-29T05:28:00.002-07:002015-06-29T05:28:19.417-07:00Losing Weight May Ease Asthma in Obese People<div style="border: 0px; font-family: Verdana, Arial, Helvetica; font-size: 13px; line-height: 17px; margin-bottom: 20px; padding: 0px; vertical-align: baseline;">
<i><b>There is also a correlation of obesity and asthma in children as well. The link is unclear, but may be due to mechanical and physiologic factors affecting the lung and a contribution to inflammation in the body. Dr. Susarla</b></i></div>
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Losing weight may help reduce asthma severity in obese adults, a new Canadian study finds.</div>
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"We were pleased to see significant improvement in asthma symptoms, as well as quality of life for these individuals. This study further supports the need to manage [chronic disorders] to improve patient lives," said study author Dr. Smita Pakhale, from The Ottawa Hospital and the University of Ottawa.</div>
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People who are obese are about 1.5 times more likely to have asthma than those who aren't obese. A 3-unit increase in body mass index -- BMI, an estimate of body fat based on weight and height -- is associated with a 35 percent increase in the risk of asthma, the researchers said in a news release from the American College of Chest Physicians.</div>
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A BMI of 18.5 to 24.9 is considered normal weight. A BMI of 25 to 29.9 is overweight, while 30 and over is considered obese.</div>
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The study found that when obese people with asthma lost weight, they showed improvement in asthma severity, asthma control and quality of life.</div>
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The study appears in the June issue of the journal <i style="border: 0px; font-family: inherit; font-size: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Chest</i>.</div>
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<a href="http://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/losing-weight-may-ease-asthma-symptoms-in-obese-people-700238.html">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-5439949199889437952015-06-22T08:27:00.000-07:002015-06-27T17:13:51.795-07:00Sleep or die -- growing body of research warns of heart attacks, strokes<div class="el__leafmedia el__leafmedia--sourced-paragraph el__leafmedia--" style="box-sizing: border-box; color: #262626; font-family: CNN, 'Helvetica Neue', Helvetica, Arial, Utkal, sans-serif; font-size: 16px; line-height: 24px;">
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Updated recommendations from the American Academy of Sleep Medicine regarding <u><b>appropriate sleep time</b></u> should be reviewed carefully. Too little sleep is consistently associated with increased medical risk. Dr. Susarla<br />
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We have all experienced the aftermath of a bad night's sleep: grogginess, irritability, difficulty carrying out even the simplest of tasks. A growing amount of research suggests that not getting enough shut-eye could also have insidious effects on heart disease, obesity and other conditions.</div>
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The American Academy of Sleep Medicine, the largest physician-based organization for sleep medicine, recently put out their first recommendations for what is <a href="http://www.aasmnet.org/articles.aspx?id=5596" style="-webkit-transition: color 0.2s; box-sizing: border-box; color: #006598; text-decoration: none; transition: color 0.2s;" target="_blank">the right amount of sleep</a>. It advises that adults get at least seven hours every night based on research on the link between inadequate sleep and a number of poor health outcomes. </div>
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Although most of us already know that we should get at least seven hours of sleep, a study last month suggested that Americans are <a href="http://www.ncbi.nlm.nih.gov/pubmed/25669182" style="-webkit-transition: color 0.2s; box-sizing: border-box; color: #006598; text-decoration: none; transition: color 0.2s;" target="_blank">creeping down to that cutoff</a>. The average amount of sleep that they reported getting a night has dropped from 7.4 hours in 1985 to 7.29 hours in 1990 to 7.18 in 2004 and 2012. </div>
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The Centers for Disease Control and Prevention, which requested and helped support the development of the current recommendations, has called not getting enough sleep a<a href="http://www.cnn.com/2015/02/18/health/great-sleep-recession/" style="-webkit-transition: color 0.2s; box-sizing: border-box; color: #006598; text-decoration: none; transition: color 0.2s;"> public health epidemic</a>.</div>
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<a href="http://www.cnn.com/2015/06/19/health/sleep-or-die/index.html">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-78942451451332269992015-06-19T05:39:00.001-07:002015-06-19T05:39:42.902-07:00Emergency room use for asthma highly prevalent in children<div style="color: #333333; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 14px; line-height: 22.652000427246094px; margin-bottom: 11.326px;">
<i><b>Although poor asthma control is multifactorial, there is no doubt that timely access to outpatient specialty asthma care can prevent exacerbations that result in frequent emergency room visits. Dr. Susarla</b></i></div>
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Children in California increasingly are flocking to emergency rooms for treatment of asthma, despite millions of dollars spent on programs to control the disease.</div>
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Statewide, the rates of ER visits for asthma symptoms rose by about 18 percent for California children ages 5 to 17 and by 6 percent for children under 5 between 2005 and 2012, according to a Kaiser Health News analysis of the latest available rates by county.</div>
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In Los Angeles County, ER visit rates rose by 17 percent for children 5 and older and by 8 percent for children under 5. </div>
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In some parts of the state, especially the Central Valley, the increases were far higher. The rate of emergency room visits for children 5 and older more than doubled in rural Madera County and nearly doubled in Merced. </div>
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All told, more than 72,000 California children under 18 visited the ER for asthma in 2012, nearly 21,000 of them from Los Angeles County.</div>
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“There’s clearly more work to be done if this many kids are going to the emergency department,” said Anne Kelsey Lamb, director of the Regional Asthma Management and Prevention program of the Oakland-based Public Health Institute. “We know a lot about what works. We absolutely should be able to reduce the rates we’re seeing.”</div>
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At the national level, asthma-related emergency room visit rates have declined in recent years, according to federal health data through 2010, the latest available.</div>
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Although ER visits declined in some counties, including Alameda, San Mateo and Marin, the overall rise in California has frustrated public health experts who have spent millions of dollars and countless hours to improve and expand asthma prevention programs around the state. The state and federal governments alone spend $1.54 million annually on such projects in California, including grants to schools to improve indoor air quality and training community health workers.</div>
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The reasons for the increase in ER visits are complex, experts say. They include parents not properly administering medications, poverty and inadequate insurance coverage, persistently high levels of indoor and outdoor pollution in some regions and the limited reach of programs that seek to manage symptoms or prevent them.</div>
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<a href="http://www.dailynews.com/health/20150607/more-children-rushing-to-ers-for-asthma-despite-programs-to-curb-disease">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-59406266264453427302015-06-06T23:44:00.000-07:002015-06-10T04:20:30.672-07:00What antifungal inhibits molds? its natural....<div class="bib-identity" style="background-color: white; font-family: Arial, sans-serif; font-size: 13.3333330154419px; line-height: 17.3333320617676px; margin: 0px 0px 1em;">
<em>What inhibits indoor molds? Tea tree oil. JR</em></div>
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<em>Int. J. Environ. Res. Public Health</em> <b>2015</b>, <em>12</em>(6), 6319-6332; doi:<a href="http://dx.doi.org/10.3390/ijerph120606319" style="border-bottom-width: 0px; color: #934e4e; text-decoration: none;">10.3390/ijerph120606319</a></div>
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Article</div>
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An Evaluation of Antifungal Agents for the Treatment of Fungal Contamination in Indoor Air Environments</h1>
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<span class="inlineblock" style="display: inline-block;"><a href="http://www.mdpi.com/search?authors=Senthaamarai%20Rogawansamy" itemprop="author" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;">Senthaamarai Rogawansamy</a><sup> 1,†</sup></span><br />
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<a class="toEncode" href="mailto:Sentha.Rogawansamy@unisa.edu.au" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;"><sup><span class="fa fa-envelope-o" style="-webkit-font-smoothing: antialiased; display: inline-block; font-family: FontAwesome; font-size: inherit; font-stretch: normal; font-weight: normal; line-height: 1; text-rendering: auto;"></span></sup></a>,</span> <span class="inlineblock" style="display: inline-block;"><a href="http://www.mdpi.com/search?authors=Sharyn%20Gaskin" itemprop="author" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;">Sharyn Gaskin</a><sup> 1,†,</sup>* <a class="toEncode" href="mailto:sharyn.gaskin@adelaide.edu.au" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;"><sup><span class="fa fa-envelope-o" style="-webkit-font-smoothing: antialiased; display: inline-block; font-family: FontAwesome; font-size: inherit; font-stretch: normal; font-weight: normal; line-height: 1; text-rendering: auto;"></span></sup></a>,</span> <span class="inlineblock" style="display: inline-block;"><a href="http://www.mdpi.com/search?authors=Michael%20Taylor" itemprop="author" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;">Michael Taylor</a><sup> 1,2</sup></span><br />
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<a class="toEncode" href="mailto:michael.taylor@flinders.edu.au" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;"><sup><span class="fa fa-envelope-o" style="-webkit-font-smoothing: antialiased; display: inline-block; font-family: FontAwesome; font-size: inherit; font-stretch: normal; font-weight: normal; line-height: 1; text-rendering: auto;"></span></sup></a> and</span> <span class="inlineblock" style="display: inline-block;"><a href="http://www.mdpi.com/search?authors=Dino%20Pisaniello" itemprop="author" style="border-bottom-width: 0px; color: black; display: inline; text-decoration: none;">Dino Pisaniello</a><sup> 1</sup><div style="display: inline; margin-left: 5px;">
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Received: 20 April 2015 / Revised: 22 May 2015 / Accepted: 27 May 2015 / Published: 2 June 2015</div>
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Diameter of growth inhibition zones of Aspergillus fumigatus and Penicillium chrysogenum after treatment using various antifungal agents. Mean ± SD (N = 40).
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Difference in growth inhibition zones of Aspergillus fumigatus and Penicillium chrysogenum 7 and 14 days after initial treatment with tea tree oil. Mean ± SD (N = 24).
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Abstract</h1>
Fungal contamination in indoor environments has been associated with adverse health effects for the inhabitants. Remediation of fungal contamination requires removal of the fungi present and modifying the indoor environment to become less favourable to growth. This may include treatment of indoor environments with an antifungal agent to prevent future growth. However there are limited published data or advice on chemical agents suitable for indoor fungal remediation. The aim of this study was to assess the relative efficacies of five commercially available cleaning agents with published or anecdotal use for indoor fungal remediation. The five agents included two common multi-purpose industrial disinfectants (Cavicide<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span> and Virkon<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span>), 70% ethanol, vinegar (4.0%-4.2% acetic acid), and a plant-derived compound (tea tree (<i>Melaleuca alternifolia</i>) oil) tested in both a liquid and vapour form. Tea tree oil has recently generated interest for its antimicrobial efficacy in clinical settings, but has not been widely employed for fungal remediation. Each antifungal agent was assessed for fungal growth inhibition using a disc diffusion method against a representative species from two common fungal genera, (<i>Aspergillus fumigatus</i> and <i>Penicillium chrysogenum</i>), which were isolated from air samples and are commonly found in indoor air. Tea tree oil demonstrated the greatest inhibitory effect on the growth of both fungi, applied in either a liquid or vapour form. Cavicide<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span> and Virkon<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span> demonstrated similar, although less, growth inhibition of both genera. Vinegar (4.0%–4.2% acetic acid) was found to only inhibit the growth of <i>P. chrysogenum</i>, while 70% ethanol was found to have no inhibitory effect on the growth of either fungi. There was a notable inhibition in sporulation, distinct from growth inhibition after exposure to tea tree oil, Virkon<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span>, Cavicide<span style="bottom: 0.33em; font-size: smaller; position: relative; vertical-align: baseline;">®</span> and vinegar. Results demonstrate that common cleaning and antifungal agents differ in their capacity to inhibit the growth of fungal genera found in the indoor air environment. The results indicate that tea tree oil was the most effective antifungal agent tested, and may have industrial application for the remediation of fungal contamination in residential and occupational buildings.</div>
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Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-43648558612108338032015-02-15T16:06:00.001-08:002015-02-15T21:03:45.820-08:00What lives in the New York Subway System? Let's map the DNA!<a href="https://blogger.googleusercontent.com/img/proxy/AVvXsEgGynBPpvn6PrhE-DAhOUMDBbLNdrvhED4EwKF9CWtY2t_qK_TA9uo0yB5O-qff_VlCdyy3wmDa4uSzp_2oJ4kggGqp9Kvc1DSfR_Y068Wq0Hkok8Tmj4IDSswvjQaBBflg3HFL8Jt248H95yHELiOzw3qWOT9eESnQaVH1ljyfqvPVvxTl_Ap1HySYyZj_=" imageanchor="1" style="clear: left; display: inline !important; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" src="http://si.wsj.net/public/resources/images/BN-GV054_0205pa_P_20150205132657.jpg" height="133" title="swabbing dna" width="200" /></a><br />
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Very very interesting...<br />
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<span style="font-size: small;">Anthrax and bubonic plague? I am not surprised.</span></h1>
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<span style="font-size: small;">But, undiscovered life? Maybe "</span><i><span style="font-size: small;">Men in Black" Fiction-ish. </span></i></h1>
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<span style="font-size: small;"> </span><span style="font-size: small;">My favorite quotes:</span><span style="font-size: 40px;"> </span></h1>
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<i><span style="background-color: white; font-size: small;">1) We have no idea what some of these microbes are. Undiscovered Species? " <span style="font-family: 'Chronicle SSm', serif; line-height: 28px;">The New York subway study quickly hit the current limits of science. Most microbes have never been isolated or studied. Only a few thousand creatures of any sort have ever had their entire set of genes analyzed, so identifications of DNA sequences through online computer comparisons can be inaccurate."</span></span></i></h1>
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<i><b style="background-color: white;"><span style="font-size: small;"><span style="font-family: 'Chronicle SSm', serif; line-height: 28px;">2) Let's share lunch....</span></span><span style="color: #333333; font-family: 'Chronicle SSm', serif; line-height: 28px;">The scientists detected DNA from bacteria associated with the production of mozzarella cheese at 151 stations. DNA from chickpeas, a key ingredient in hummus and falafel, was detected on many subway platforms and benches.</span></b></i><br />
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Big Data and Bacteria: Mapping the New York Subway’s DNA</h1>
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Scientists in 18-Month Project Gather DNA Throughout Transit System to Identify Germs, Study Urban Microbiology</span></h2>
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<div class="author mobile-scrim hasMenu" data-scrim="{"type":"author","header":"Robert Lee Hotz","subhead":"The Wall Street Journal","list":[{"type":"link","icon":"bio","url":"http://topics.wsj.com/person/A/biography/7597","text":"Biography"},{"type":"link","icon":"email","url":"mailto:Lee.Hotz@wsj.com","text":"Lee.Hotz@wsj.com"},{"type":"link","icon":"twitter","url":"http://twitter.com/LeHotz","text":"@LeHotz"}]}" itemprop="author" itemscope="" itemtype="http://schema.org/Person" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; color: #666666; display: inline-block; font-family: 'Whitney SSm', sans-serif; font-size: 14px; font-weight: inherit; line-height: 2.2rem; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline;">
<span class="name" itemprop="name" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; color: #0080c3; font-size: 1.4rem; font-weight: 600; margin: 0px; outline: 0px; padding: 0px; text-transform: uppercase; vertical-align: baseline;">ROBERT LEE HOTZ</span></div>
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<time class="timestamp" style="background: 0px 0px; border: 0px; color: #666666; display: block; font-family: 'Whitney SSm', sans-serif; font-size: 13px; line-height: 2.2rem; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Feb. 5, 2015 8:07 a.m. ET</time><br />
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Aboard a No. 6 local train in Manhattan, Weill Cornell researcher Christopher Mason patiently rubbed a nylon swab back and forth along a metal handrail, collecting DNA in an effort to identify the bacteria in the New York City subway.<br />
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In 18 months of scouring the entire system, he has found germs that can cause bubonic plague uptown, meningitis in midtown, stomach trouble in the financial district and antibiotic-resistant infections throughout the boroughs.<br />
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Frequently, he and his team also found bacteria that keep the city livable, by sopping up hazardous chemicals or digesting toxic waste. They could even track the trail of bacteria created by the city’s taste for pizza—identifying microbes associated with cheese and sausage at scores of subway stops.</div>
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The big-data project, the first genetic profile of a metropolitan transit system, is in many ways “a mirror of the people themselves who ride the subway,” said Dr. Mason, a geneticist at the Weill Cornell Medical College.<br />
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It is also a revealing glimpse into the future of public health.<br />
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Across the country, researchers are combining microbiology, genomics and population genetics on a massive scale to identify the micro-organisms in the buildings and confined spaces of entire cities.</div>
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<a href="http://www.wsj.com/articles/big-data-and-bacteria-mapping-the-new-york-subways-dna-1423159629" target="_blank">Article Here</a></div>
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<b><i>There is a well observed and documented phenomenon of increased asthma risk particularly in ex-premies delivered before 30 weeks gestational age. Parents may be alarmed by the "asthma" label, but that this study suggests that normal child growth and development may help resolve this form of early onset asthma. Dr. Susarla</i></b></div>
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<span style="line-height: 1.4375rem;">Parents of premature babies worry about many things, including an increased risk of asthma. But a large Danish study has found that asthma, common in premature babies, disappears as the children grow older. By the time they are adults, their risk of asthma is no greater than that of babies born full term.</span></div>
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Researchers combed birth and health data on 1.8 million people born from 1980 to 2009, checking for gestational age and neonatal respiratory problems.</div>
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The study, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117253" style="color: #326891;" target="_blank" title="The article.">published in PLOS One</a>, found that 27 percent of infants born earlier than 27 weeks required asthma medication during childhood, compared with 18 percent of those born at 28-31 weeks, 13 percent at 32-36 weeks, and 9 percent at full term.</div>
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But after controlling for socioeconomic status, maternal asthma, multiple birth and other factors, they found that by adolescence, the association had weakened, and by adulthood 2.4 percent of the former preemies required medication compared with 2.1 percent of those born full term, a clinically insignificant difference.</div>
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“There are more and more preemies,” said the lead author, Dr. Anne Louise Damgaard, a researcher at the University of Copenhagen, “and we don’t really know what happens to them as they get older. But up to age 31, their lungs are pretty healthy. It’s possible that the differences may become more evident as they age.”</div>
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<a href="http://well.blogs.nytimes.com/2015/02/06/premature-babies-with-asthma-outgrow-it/?ref=health&_r=0">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-25708655290381265172015-02-06T10:12:00.000-08:002015-02-06T10:12:57.722-08:00Sleep Apnea in Down Syndrome Especially Dangerous at Higher Altitudes<div class="contentHeaderContainer" style="background-color: #eeeeee; background-image: -webkit-linear-gradient(left, white, rgb(238, 238, 238)); background-repeat: repeat-x; border: 0px; font-family: Helvetica, Arial, Verdana, sans-serif; font-stretch: inherit; margin: 0px; padding: 10px 10px 0px; vertical-align: baseline; zoom: 1;">
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<span style="line-height: 20.7999992370605px;"><i><span style="font-size: large;">Children with Down Syndrome at increased risk for heart and lung problems and various forms of developmental delay. This study confirms that sleep apnea in these children may be one reason for increased hospitalization risk. The study identified higher altitude one particular risk factor for this, likely due to lower oxygen tension at higher elevations. Dr. Susarla</span></i></span></h1>
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<h1 class="aTitle" style="border-image-outset: initial; border-image-repeat: initial; border-image-slice: initial; border-image-source: initial; border-image-width: initial; border: 0px; color: #0889bb; font-family: inherit; font-size: 2.2rem; font-stretch: inherit; font-variant: inherit; line-height: 1.3; margin: 0px 0px 5px; padding: 0px; vertical-align: baseline;">
<span id="scm6MainContent_lblArticleTitle" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Greater Risk of Hospitalization in Children with Down Syndrome and Obstructive Sleep Apnea at Higher Elevation</span></h1>
<div class="authorSection sans" id="scm6MainContent_dvAuthorSection" style="border-image-outset: initial; border-image-repeat: initial; border-image-slice: initial; border-image-source: initial; border-image-width: initial; border: 0px; color: #333333; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span class="authorNames" id="scm6MainContent_lblAuthors" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Kristin M. Jensen, MD, MSc; Carter J. Sevick, MS; Laura Seewald; Ann C. Halbower, MD; Matthew M. Davis, MD, MAPP; Edward RB. McCabe, MD, PhD; Allison Kempe, MD, MPH; Steven Abman, MD</span></div>
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<a class="jumpLinkAnchor" href="https://www.blogger.com/null" id="scm6MainContent_rptSections_aJumplinkAnchor_0" name="Abstract" style="border: 0px; color: #0889bb; cursor: pointer; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></a><div class="sectionTop first" id="scm6MainContent_rptSections_divSectionTop_0" style="background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-bottom-width: 0px; border-left-width: 0px; border-right-width: 0px; border-top-style: none; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 15px; padding: 0px; position: relative; vertical-align: baseline;">
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<span id="scm6MainContent_rptSections_lblSectionTitle_0" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Abstract</span></h2>
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<span class="Abstract 72162638 0 1" id="scm6MainContent_rptSections_lblSection_0" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-size: 1em; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 1.5; margin-bottom: 10px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-family: inherit; font-size: 14px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Background:</strong> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Children with Down syndrome (DS) are at high risk for obstructive sleep apnea (OSA). Increasing elevation is known to exacerbate underlying respiratory disorders and worsen sleep quality in non-DS persons, but whether altitude modulates the severity of OSA in DS is uncertain. In this study, we evaluate the impact of elevation (≤1500m vs. > 1500m) on the proportion of hospitalizations involving OSA in children with and without DS.</span></div>
<div style="border: 0px; font-size: 1em; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 1.5; margin-bottom: 10px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-family: inherit; font-size: 14px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Methods:</strong> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Merging the 2009 Kids’ Inpatient Database with zip-code linked elevation data, we analyzed differences in the proportion of pediatric hospitalizations (ages 2-20 years) involving OSA, pneumonia, and congenital heart disease (CHD), with and without DS. We used multivariable logistic regression to evaluate the association of elevation with hospitalizations involving OSA and DS, adjusting for key comorbidities.</span></div>
<div style="border: 0px; font-size: 1em; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 1.5; margin-bottom: 10px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-family: inherit; font-size: 14px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Results:</strong> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Proportionately more DS encounters involved OSA, CHD, and pneumonia within each elevation category than non-DS encounters. However, the risk difference for hospitalizations involving OSA and DS increased disproportionately at higher elevations (DS: 16.2% (95% CI 9.2%-23.2%); non-DS: 0.1% (95% CI -0.4%-0.7%)). Multivariable estimates of relative risk indicate increased risk of hospitalization involving OSA at higher elevations for persons with DS and in children age 2-4 years or with ≥2 chronic conditions.</span></div>
<div style="border: 0px; font-size: 1em; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 1.5; margin-bottom: 10px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-family: inherit; font-size: 14px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Conclusion:</strong> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">At elevations >1500m, children with DS and OSA have a disproportionately higher risk of hospitalizations than children with OSA without DS. This finding has not been described previously. With further validation, this finding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.</span></div>
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<span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><a href="http://journal.publications.chestnet.org/article.aspx?articleID=2108995">Read abstract here.</a></span></div>
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Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-24435771559872972502015-01-23T09:50:00.001-08:002015-01-24T11:41:10.125-08:00Urine toxic metal tests & autism. Read more about provoked testing for autism.<br />
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<a href="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcTwDmG9frFAbVvpv34AkgJwcNrcv_1rxkLQB_7oqu5hGdCBxDa5aw" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" class="rg_i" data-src="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcTwDmG9frFAbVvpv34AkgJwcNrcv_1rxkLQB_7oqu5hGdCBxDa5aw" data-sz="f" height="309" jsaction="load:str.tbn" name="OMuhe2dpK4XUXM:" src="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcTwDmG9frFAbVvpv34AkgJwcNrcv_1rxkLQB_7oqu5hGdCBxDa5aw" style="height: 179px; margin-top: 0px; width: 185px;" width="320" /></a>How the "Urine Toxic Metals" Test<br />Is Used to Defraud Patients</h2>
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<i>
Urine toxic metal tests and autism. Read more about provoked testing. </i></h2>
<h3 style="font-size: 16px; text-align: center;">
Stephen Barrett, M.D.</h3>
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<tr><td valign="top">Many patients are falsely told that their body has dangerously high levels of lead, mercury, or other heavy metals and should be "detoxified" to reduce these levels. This article explains how a urine test is used to defraud patients.<br />
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The report pictured to the right is a "urine toxic metals" test ...the patient who gave it to me was told by his doctor that his mercury and lead levels were high and should be reduced with EDTA chelation therapy.<br />
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The report classifies the man's lead and mercury levels as "elevated because they are twice as high as the upper limit of their "reference ranges." <b>However, this classification is misleading because:</b><br />
<ul>
<li><b>The report states that the specimen was obtained after patient was given a "provoking agent," but the reference range is based on non-provoked tests.</b></li>
<li><b>The levels, whether provoked or not, are not high enough to conclude that the patient has a problem that requires attention.</b></li>
<li><b>Even if a problem exists, chelation may not be the best course of action.</b></li>
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<h4>
<u>Why Provoked Testing Is a Scam</u></h4>
Mercury is found in the earth's crust and is ubiquitous in the environment. Because of this, it is common to find small amounts in people's urine. The body reaches a steady state in which tiny amounts are absorbed and excreted. Large-scale population studies have shown that the general population has urine-mercury levels below 10 micrograms/liter, with most people between zero and 5 [1]. Similarly, many people circulate trivial amounts of lead.<br />
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Urine lead and mercury levels can be artificially raised by administering a scavenger (chelating agent) such as DMPS or DMSA, which attaches to lead and mercury molecules in the blood and forces them to be excreted. In other words, some molecules that would normally recirculate within the body are bound and exit through the kidneys. As a result, their urine levels are artificially and temporarily raised. How much the levels are raised depends on how the test is administered. The standard way to measure urinary mercury and lead levels is by collecting a non-provoked urine sample over a 24-hour period. Because most of the extra excretion takes place within a few hours after the chelating agent is administered, using a shorter collection period will yield a higher concentration.<br />
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When testing is performed, the levels are expressed as micrograms of lead or mercury per grams of creatinine (µg/g) and compared to the laboratory's "reference range." Well-designed experiments have demonstrated how provocation artificially raises urinary output.<br />
<ul>
<li>One experiment involved ten healthy people whose urine was examined before and after receiving a 1-hour infusion of calcium disodium EDTA. The infusion increased the excretion of lead about 6 times over the baseline level [2].</li>
<li>Another experiment tested workers who had industrial exposure to mercury. The researchers reported that provocation with DMSA raised the 24-hour average urine mercury level from 4.3 µg/g before chelation to 7.8 µg/g after chelation [3].</li>
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Both of these studies used a 24-hour urine collection period. Because most of the extra excretion occurs toward the beginning of the test, it is safe to assume that the provoked levels would have been much higher if a 6-hour collection period had been used.<br />
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Practitioners who use the urine toxic metals test typically tell patients that provocation is needed to discover "hidden body stores" of mercury or lead, which they also refer to as "body burden" or "mercury efflux disorder." However, the above experiment proved that provocation raises urine levels as much in exposed workers as in unexposed control subjects and that rise is temporary, should be expected, and is not evidence of "hidden stores." The scientific community does not recognize "mercury efflux disorder" as a diagnosis or even as a theoretical possibility.<br />
The "hidden stores" notion was further debunked by a study that compared non-provoked and DMSA-provoked urine specimens from 15 children with autism and 4 normally developing children who ranged from 3 to 7 years old. After a baseline specimen from each child was collected, the DMSA was given in three doses over a 16-hour period, and the specimens were collected for 24 hours and tested for lead, mercury, arsenic, and cadmium. The testing was performed by the Mayo Clinic's laboratory, which used reference ranges of 80 ug/liter as the upper limit of normal and over 400 µg/liter for the lower limit of the potentially toxic range for lead and 10 µg/liter as the upper limit of normal and over 50 µg/liter for the lower limit of the potentially toxic range for mercury. All of the normal children and 12 of the autistic children excreted no detectable amount of any of the tested materials. In one child, DMSA provocation raised the urine lead level from undetectable to 6 µg/liter, which the researchers said was far too low to be of concern. In another child, the mercury level rose from undetectable to 23 µg/liter, but after fish was removed from that child's diet for more than a month, it fell to 5. The study showed that when laboratory measurements are accurate and proper reference standards are used, neither autistic nor normal children are likely to have problematic levels of lead or mercury, even when provoked testing is used, but fish-eaters might consume enough mercury to enable provocation to produce an inflated value. The authors concluded that the proportion of autistic participants in this study whose DMSA-provoked excretion results demonstrated an excess chelatable body burden of Arsenic, Cadmium, Lead or mercury was zero [4].<br />
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Neither Mayo Clinic, nor any other legitimate national laboratory, has reference ranges for “provoked” specimens. Further, the references ranges for normal urine heavy metal levels used by Mayo Clinic and the largest national reference lab, Quest Diagnostics, are the same.<br />
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<b><a href="http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/urine_toxic.html" target="_blank">Full article here</a></b></div>
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Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-63600508859881428462014-12-25T18:41:00.003-08:002014-12-25T18:43:47.839-08:00Enriched environments could heal brain injuries - An argument against brain rest?<div id="BlogTitle" style="font-family: Verdana, Arial, Tahoma; margin-bottom: 5px;">
<i>Hmm...perhaps "brain rest" is not a good idea. - JR</i></div>
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Enriched environments could heal brain injuries</div>
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One of the greatest risks in contact sports such as boxing and football is a violent blow to the head, which can cause mild to severe traumatic brain injury leading to debilitating and even fatal consequences. And despite great strides made in recent years in the area of brain science, there still aren’t any effective medical or cognitive treatments for patients with this type of injury.<br />
But a new Israeli study points to an “enriched environment” — specially enhanced surroundings — as a promising path for the rehabilitation of mild traumatic brain injury (mTBI) patients.<br />
The research <a href="http://www.sciencedirect.com/science/article/pii/S0166432814003635" target="_blank">study</a> using a model of mTBI in mice, published in <em>Behavioural Brain Research</em>...<br />
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The scientists put one group of the mice into standard cages, while they moved a second group to larger cages outfitted with additional stimuli, running wheels, food and water.<br />
Using the Novel Object Recognition task, in which mice exhibit different levels of curiosity about new objects placed in their cages and run different mazes to establish navigation abilities, the researchers looked at differences in the mice’s level of functioning in each of the environments.<br />
Results of their behavioral and cognitive evaluation showed that the mice exposed to the enriched environment showed a marked improvement in recovery from brain injuries.<br />
<br />
<strong>Hidden effects of brain injury</strong><br />
Pick emphasized that the consequences of traumatic brain injury can remain hidden for years after the trauma, but they eventually will surface. These can include various degrees of amnesia, difficulty concentrating, depression, apathy, anxiety and even a prominent personality change.<br />
“A house may survive an earthquake, but up close you will see cracks in the walls. This is what may happen following traumatic brain injury,” said Pick.<br />
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“An MRI might determine that the brain looks normal, but fast forward two years and the patient, who was married and successful, is suddenly unemployed, divorced, and miserable — without any awareness or understanding that new and lasting cognitive and emotional difficulties emerged due to a car accident two years earlier.”<br />
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When a patient comes to the emergency room following a blow to the head, doctors generally use the Glasgow Coma Scale to assess the extent of brain trauma, he explained.<br />
“In the majority of cases, doctors determine minimal damage according to the symptoms that appear over a very short period of monitoring — just 30 minutes. In 85 percent of cases, this is accurate, but in 15% of cases, a cascade of serious damage has just begun, and we don’t really know why. But this is what we are trying to figure out.”<br />
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If the phenomenon they saw in mice translates to humans, the Israeli study may encourage the use of some kind of enriched environment to minimize this long-term damage.<br />
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“We have shown that just six weeks in an enriched environment can help animals recover from cognitive dysfunctions after traumatic brain injury,” Pick said.<br />
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“Possible clinical implications indicate the importance of adapting elements of enriched environments to humans, such as prolonged and intensive physical activity, possibly combined with intensive cognitive stimulation. Through proper exercise, stimuli and diet, we can improve a patient’s condition. No one is promising a cure, but now we have evidence that this can help.”<br />
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<a href="http://www.israel21c.org/headlines/enriched-environments-could-heal-brain-injuries/" target="_blank">LINK HERE</a></div>
Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-54351495057701822822014-09-12T10:24:00.003-07:002014-12-13T15:21:01.132-08:00<hgroup style="background: rgb(255, 255, 255); border: 0px; box-sizing: border-box; color: #333333; float: left; font-family: arial; font-size: 12px; line-height: 20px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; width: 530px;"><h1 style="background: transparent; border: 0px; box-sizing: border-box; color: #003f85; font-family: 'Droid Serif'; font-size: 26px; line-height: normal; margin: 20px 0px 10px; outline: 0px; padding: 0px; vertical-align: baseline;">
Biologic Eases Subset of Severe Asthma</h1>
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For severe eosinophilic asthma, the novel monoclonal antibody mepolizumab cut exacerbations whether given as an injection or infusion and reduced steroid use in patients dependent on them, two trials showed.</div>
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The drug, which targets interleukin-5 (IL-5) to inhibit eosinophilic inflammation,<a href="http://www.nejm.org/" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">cut exacerbations by 47% with intravenous dosing and by 53% with subcutaneous dosing</a> when compared with placebo (0.93 and 0.81 versus 1.75 per year, both<em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> P</em><0.001), Hector G. Ortega, MD, ScD, of GlaxoSmithKline, found in the MENSA trial.</div>
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Mepolizumab injections more than doubled the likelihood of glucocorticoid dose strata reduction compared with placebo, with a median 50% dose reduction from baseline versus none with placebo (<em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">P</em>=0.007), <a href="http://www.uva.nl/en/news-events/news/uva-news/content/professor-appointments/2007/05/dr-ehd-bel.html" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">Elisabeth H. Bel, MD, PhD</a>, of the University of Amsterdam, and colleagues found in a second study, dubbed SIRIUS. Investigators in both trials said that safety issues with the drug were no different from placebo.</div>
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Both trials were reported online in the <em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">New England Journal of Medicine</em> in conjunction with presentation at the <a href="http://www.erscongress.org/" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">European Respiratory Society meeting</a> in Munich.</div>
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Three prior trials had already shown that anti-IL-5 drugs helped in asthma cases targeted by sputum eosinophil levels, <a href="http://fhs.mcmaster.ca/medicine/respirology/faculty_member_nair.htm" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">Parameswaran Nair, MD, PhD</a>, of McMaster University in Hamilton, Ontario, noted in an accompanying editorial.</div>
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The two new trials provided some clinical observations with "important practical applications," though, he wrote.</div>
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"First, the subcutaneous administration of a lower dose of the drug (100 mg) than was previously reported was shown to be efficacious," he noted.</div>
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"Second, characterization of the eosinophilic phenotype on the basis of a blood eosinophil count of more than 300 cells per microliter despite concurrent treatment with high doses of glucocorticoids was sufficient to select patients who were likely to have a response to this therapy.</div>
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"Both these observations make it potentially simple and easy for practitioners to identify patients who are likely to benefit and administer the drug to them."</div>
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Some previous studies that had tried to identify candidates for treatment based on clinical characteristics alone had failed.</div>
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Sputum eosinophil counts have been used since, but their greater sensitivity to change than blood eosinophil levels comes at a cost in convenience.</div>
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"Although persistent blood eosinophilia may be sufficient to identify patients who are likely to have a response to this treatment, whether this biomarker is sufficient or is as effective as airway eosinophilia in monitoring the response to treatment remains to be seen," Nair pointed out.</div>
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<a href="http://www.medpagetoday.com/MeetingCoverage/ERS/47546?xid=nl_mpt_ATS_confreporter_2014-09-12&utm_source=ats-confreporter&utm_medium=email&utm_content=mpt&utm_campaign=09|12|2014&userid=656319&eun=g5766138d6r&email=doctorsusarla@gmail.com&mu_id=5766138">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-62039627927940457422014-09-12T10:22:00.004-07:002014-12-13T15:21:01.136-08:00<div style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; color: #333333; font-family: 'Droid Serif'; font-size: 14px; line-height: 20px; margin-bottom: 10px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline; visibility: visible;">
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Singulair Doesn't Ease Wheeze in Most Kids</h1>
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Intermittent montelukast (Singulair) didn't alleviate wheezing in children, except possibly for those with a specific genetic mutation, a trial showed.</div>
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Giving the leukotriene receptor blocker at the onset of wheezing <a href="http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2814%2970186-9/abstract" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">didn't cut down on unscheduled medical visits</a> for those episodes compared with placebo (mean 2.0 versus 2.3 over 12 months, incidence rate ratio 0.88, <em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">P</em>=0.06), <a href="http://blizard.qmul.ac.uk/paediatrics-staff/198-grigg-jonathan.html" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">Jonathan Grigg, MD</a>, of the Queen Mary University of London, and colleagues found.</div>
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However, the subgroup of children with the 5/5 ALOX5 promoter genotype associated with montelukast response in adults did have a 20% relative reduction in unscheduled wheeze-related medical visits with the drug (2.0 versus 2.4 over 12 months, <em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">P</em>=0.01).</div>
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No effect was seen with other genotypes (<em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">P</em>=0.79), the researchers reported at the <a href="http://www.erscongress.org/" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #003f85; outline: none 0px; text-decoration: none;" target="_blank">European Respiratory Society meeting</a> in Munich and simultaneously online in the <em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Lancet Respiratory Medicine</em>.</div>
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"These data do not support the routine use of intermittent montelukast for wheeze in children aged 10 months to 5 years," the group concluded. "Further data from stratified trials are needed before treatment is targeted to a responsive subgroup."</div>
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Their Wheeze And Intermittent Treatment (WAIT) trial included 1,358 children in the age range of 10 months to 5 years, who were seen at 21 primary care sites and 41 secondary care sites in England and Scotland. They had two or more wheeze episodes (at least one recent).</div>
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After stratification by genotype, the kids were randomized to montelukast or placebo given by parents at each wheeze episode over a 12-month period.</div>
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Overall, montelukast increased the time to first hospital admission (<em style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">P</em>=0.04) but without changing the rate of emergency department visits.</div>
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Also, montelukast-treated kids received fewer courses of rescue oral corticosteroids, but without reducing the proportion of children getting at least one course of those rescue meds.</div>
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And, "in the context of present U.K. prescribing practice, the clinical significance of a change in this indirect marker of wheeze severity is unclear," the researchers cautioned.</div>
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The number and duration of wheeze episodes didn't differ between treatment groups.</div>
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The only serious adverse event -- a skin reaction -- occurred in the placebo group.</div>
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Meta-analysis of the findings of those of three prior trials of montelukast in young children, yielded results similar to those of the trial by Grigg and colleagues, supporting no overall benefit from intermittent dosing.</div>
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<a href="http://www.medpagetoday.com/MeetingCoverage/ERS/47585?xid=nl_mpt_ATS_confreporter_2014-09-12&utm_source=ats-confreporter&utm_medium=email&utm_content=mpt&utm_campaign=09|12|2014&userid=656319&eun=g5766138d6r&email=doctorsusarla@gmail.com&mu_id=5766138">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-80095660906353194012014-09-09T03:52:00.002-07:002014-09-09T03:52:13.284-07:00Enterovirus Triggering Respiratory Problems in Children<h1 style="color: #2a2a2a; line-height: 52px; margin: 0px 0px 0.45em;">
<span style="font-family: inherit; font-size: large;"><i>Enterovirus is one of many viruses capable of triggering airway problems in children similar to asthma. As such, children with asthma are especially high risk for exacerbations. A child with poorly controlled asthma would be especially high risk. At this time, there does not appear to be an easy way to test for the virus. Dr Susarla</i></span></h1>
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What is Enterovirus 68, the mysterious illness that may be sickening hundreds of children?</h1>
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<span style="line-height: 1.8em;">Health officials in at least 10 states have reported </span><a href="http://www.washingtonpost.com/news/morning-mix/wp/2014/09/08/uncommon-but-severe-virus-hospitalizes-hundreds-of-kids-in-midwest-and-south/?tid=hp_mm&hpid=z3" style="border-bottom-color: rgb(212, 212, 212); border-bottom-style: solid; border-bottom-width: 1px; color: #2e6d9d; line-height: 1.8em; text-decoration: none; zoom: 1;" target="_blank">hundreds of cases of a respiratory illness</a><span style="line-height: 1.8em;"> </span><span style="line-height: 1.8em;">that has sent scores of children to emergency rooms and, in some cases, even to</span><span style="line-height: 1.8em;"> </span><a href="http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/HA82914.pdf" style="border-bottom-color: rgb(212, 212, 212); border-bottom-style: solid; border-bottom-width: 1px; color: #2e6d9d; line-height: 1.8em; text-decoration: none; zoom: 1;" target="_blank">intensive care units</a><span style="line-height: 1.8em;">.</span></div>
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The culprit is believed to be Enterovirus 68 (also known as EVD-68 or Eentrovirus D68), a fairly rare viral infection that can cause symptoms such as coughing, wheezing and low blood oxygen levels (also known as hypoxemia). In some cases, however, the symptoms can be severe — particularly for children who already suffer from asthma or other respiratory problems.</div>
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Jennifer Cornejo of Colorado <a href="http://www.thedenverchannel.com/news/local-news/denver-metro-hospitals-on-alert-for-mystery-respiratory-illness-striking-children09052014" style="border-bottom-color: rgb(212, 212, 212); border-bottom-style: solid; border-bottom-width: 1px; color: #2e6d9d; text-decoration: none; zoom: 1;" target="_blank">told Denver's ABC affiliate</a> that her 13-year-old son, William, had cold symptoms that developed overnight into a life-threatening illness. "He was in really bad shape," she told the station. "He came really close to death. He was unconscious at our house and white as a ghost with blue lips — he just passed out."</div>
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Here is how William Cornejo described it: "My head started hurting. And after that my lungs started closing up. It felt different."</div>
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Until recently, Enterovirus 68 was only thought to cause sporadic infections, but there have been reports of <a href="http://www.medscape.com/viewarticle/751032_5%C2%A0" style="border-bottom-color: rgb(212, 212, 212); border-bottom-style: solid; border-bottom-width: 1px; color: #2e6d9d; text-decoration: none; zoom: 1;" target="_blank">more widespread outbreaks</a> in Georgia, Pennsylvania and Arizona between 2008 and 2010.</div>
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Only Missouri and Illinois have confirmed cases of EV-D68, but cases with similar symptoms have been reported in Colorado, Georgia, Iowa, Kansas, Kentucky, North Carolina, Ohio and Oklahoma as well.</div>
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Because of how rare Enterovirus 68 is, scientists are still learning about it. But here is what you should know now:</div>
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<strong>Why is it called Enterovirus 68?</strong></div>
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Enterovirus is the name used to describe a group of more than 100 of the most common viruses that affect humans and other mammals. Most people might interact with an enterovirus by way of the common cold, which can be caused by enteroviruses as well as rhinoviruses.</div>
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<a href="http://www.washingtonpost.com/news/to-your-health/wp/2014/09/08/what-is-enterovirus-68-the-mysterious-illness-that-is-sickening-hundreds-of-children/">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-87174213881242618112014-07-17T07:05:00.000-07:002014-07-17T07:06:19.582-07:00Scientific review finds asthma drugs suppress child growth<br />
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<span style="font-size: small;"><span style="line-height: 17px;"><i>This is a well known potential side effect of inhaled corticosteroids, the most commonly prescribed asthma controller medication. As indicated in this article, the effect seems "small and non-cumulative". Moreover, this effect is not seen in all children. It is critical to re-evaluate asthma periodically to be sure medication is still needed, and to reduce dosing when appropriate. Dr. Susarla</i></span></span></h1>
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Scientific review finds asthma drugs suppress child growth</h1>
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<span id="articleText" style="background-color: white; font-family: arial, helvetica, sans;"><span class="focusParagraph">(Reuters) - Corticosteroid drugs given via inhalers to children with asthma may suppress their growth, according to two systematic reviews of scientific studies on the issue.</span></span></div>
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Health experts who conducted the review and published it in The Cochrane Library journal found that children's growth slowed in the first year of treatment, although the effects were minimized by using lower doses.</div>
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Steroid-containing inhalers are prescribed as first-line treatments for adults and children with persistent asthma.</div>
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They are the most effective asthma control drugs and have been shown to reduce asthma deaths, hospital visits and improve quality of life by cutting the number and severity of attacks.</div>
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Yet their potential effect on children's growth is a source of worry for parents and doctors - a factor which prompted the Cochrane reviewers to analyze the evidence more closely.</div>
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"The evidence... suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment," said Linjie Zhang at the Federal University of Rio Grande in Brazil, who led the review. "But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma."</div>
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According to data from the World Health Organization (WHO), some 235 million people worldwide suffer from asthma, a chronic disease which inflames and narrows the air passages of the lungs. The disease is common among children.</div>
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The first of the two systematic reviews focused on 25 trials involving 8,471 children up to 18 years old with mild to moderate persistent asthma. These trials tested almost all the available inhaled corticosteroids and showed they suppressed growth rates when compared to placebos or non-steroidal drugs.</div>
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Fourteen of the trials reported growth over a year and found the average growth rate, which was around 6 to 9 centimeters (2.4 to 3.5 inches)per year in control groups, was about 0.5 cm (0.2 inch) less in the groups of children being treated with inhaled steroids for asthma.</div>
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In the second review, researchers looked at data from 22 trials in which children were treated with low or medium doses of inhaled corticosteroids.</div>
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Only three trials followed 728 children for a year or more and the reviewers said they showed that using lower doses of inhaled corticosteroids, by about one puff per day, improved growth by around a quarter of a centimeter (0.1 inch) at one year.</div>
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Francine Ducharme of the University of Montreal in Canada, who worked on both reviews, said the findings were important and should prompt more frequent and detailed tracking of childhood asthma patients' growth.</div>
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"Only 14 percent of the trials we looked at monitored growth in a systematic way for over a year," she said. "This is a matter of major concern given the importance of this topic."</div>
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She said her team would recommend the minimal effective dose be used in children with asthma until further data becomes available. "Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing (them) in children," she said.</div>
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Experts not directly involved in the reviews cautioned, however, that the growth effects were minimal and should not prompt asthma patients to stop taking their medication.</div>
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"These studies confirm what many have suspected, that inhaled steroids can suppress growth in children," said Jon Ayres, a professor of environmental and respiratory medicine at Britain's Birmingham University.</div>
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"However, the effect seems... small and non-cumulative and many may consider this a risk worth taking compared to the alternative, which is poorly controlled and therefore potentially life threatening asthma." </div>
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<a href="http://www.reuters.com/article/2014/07/16/us-health-asthma-drug-idUSKBN0FL2VR20140716">Read article here</a></div>
</span>Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-82967033865612275092014-06-05T07:23:00.004-07:002014-06-05T07:23:42.911-07:00Scuba, flying trauma, ear infections ... What is a ruptured eardrum? How do you treat a ruptured ear drum?<div class="tgroup2col" style="background-color: white; float: left; width: 647px;">
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<span style="font-size: small;"><i><br /></i><i><br /></i><span style="font-family: Lucida Grande, Geneva, Arial, Helvetica, sans-serif;"><i><span style="font-weight: normal; line-height: 1.2;">Scuba, flying trauma, ear </span><span style="font-weight: normal; line-height: 24px;">infections</span><span style="font-weight: normal; line-height: 1.2;"> ...</span></i></span></span><span style="font-family: Lucida Grande, Geneva, Arial, Helvetica, sans-serif;"><span style="font-weight: normal; line-height: 1.2;"><i><span style="font-size: small;">What is a ruptured eardrum</span><span style="color: #0082c8; font-size: 1.6em;">?</span></i></span></span></h2>
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Ruptured eardrum</h1>
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A ruptured eardrum is an opening or hole in the eardrum. The eardrum is a thin piece of tissue that separates the outer and middle ear. Damage to the eardrum may harm hearing.</div>
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<h2 class="subheading" style="background-image: url(http://www.nlm.nih.gov/medlineplus/images/ency_section_head_bg.png); background-position: 0% 0%; background-repeat: no-repeat no-repeat; color: #0082c8; font-size: 1em; height: 25px; line-height: 1.2; margin: 10px 0px 0.5em; padding-left: 1px; padding-top: 2px;">
Causes</h2>
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Ear infections may cause a ruptured eardrum. This occurs more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open (rupture).</div>
<div style="margin-bottom: 1em;">
Damage to the eardrum can also occur from:</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/001061.htm" style="color: #990066; outline: none;">A very loud noise close to the ear</a>, such as a gunshot</li>
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/001064.htm" style="color: #990066; outline: none;">A rapid change in ear pressure</a>, which may occur when flying, scuba diving, or driving in the mountains</li>
<li>Foreign objects in the ear</li>
<li>Injury to the ear (such as a powerful slap or explosion)</li>
<li>Inserting cotton-tipped swabs or small objects into the ear to clean them</li>
</ul>
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Symptoms</h2>
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Ear pain may suddenly decrease right after your eardrum ruptures.</div>
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After the rupture, you may have:</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/003042.htm" style="color: #990066; outline: none;">Drainage from the ear</a> (drainage may be clear, pus, or bloody)</li>
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/003043.htm" style="color: #990066; outline: none;">Ear noise/buzzing</a></li>
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm" style="color: #990066; outline: none;">Earache or ear discomfort</a></li>
<li><a href="http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm" style="color: #990066; outline: none;">Hearing loss</a> in the involved ear (hearing loss may not be total)</li>
<li>Weakness of the face, or dizziness (in more severe cases)</li>
</ul>
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Exams and Tests</h2>
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The doctor will look in your ear with an instrument called an otoscope. If the eardrum is ruptured, the doctor will see an opening in it. The bones of the middle ear may also be visible.</div>
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Pus draining from the ear may make it harder for the doctor to see the eardrum.</div>
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<a href="http://www.nlm.nih.gov/medlineplus/ency/article/003341.htm" style="color: #990066; outline: none;">Audiology</a> testing can measure how much hearing has been lost.</div>
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Treatment</h2>
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You can take steps at home to treat ear pain.</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li>Put warm compresses on the ear to help relieve discomfort.</li>
<li>Use medicines such as ibuprofen or acetaminophen to ease pain.</li>
</ul>
<div style="margin-bottom: 1em;">
Keep the ear clean and dry while it is healing.</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li>Place cotton balls in the ear while showering or shampooing to prevent water from entering the ear.</li>
<li>Avoid swimming or putting your head underneath the water.</li>
</ul>
<div style="margin-bottom: 1em;">
Your health care provider may prescribe antibiotics (oral or ear drops) to prevent or treat an infection.</div>
<div style="margin-bottom: 1em;">
Sometimes the health care provider may place a patch over the eardrum to speed healing. Surgical repair of the eardrum (<a href="http://www.nlm.nih.gov/medlineplus/ency/article/003014.htm" style="color: #990066; outline: none;">tympanoplasty</a>) may be needed if the eardrum does not heal on its own.</div>
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Outlook (Prognosis)</h2>
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The opening in the eardrum usually heals by itself within 2 months. Any hearing loss is most often short-term.</div>
<div style="margin-bottom: 1em;">
Rarely, other problems may occur, such as:</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li>Long-term hearing loss</li>
<li>Spread of infection to the bone behind the ear (mastoiditis)</li>
<li>Long-term <a href="http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm" style="color: #990066; outline: none;">vertigo</a> and dizziness</li>
</ul>
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When to Contact a Medical Professional</h2>
<div style="margin-bottom: 1em;">
If your pain and symptoms improve after your eardrum ruptures, you may wait until the next day to see your health care provider.</div>
<div style="margin-bottom: 1em;">
Call your health care provider right away after your eardrum ruptures if you:</div>
<ul style="list-style-image: initial; list-style-position: outside;">
<li>Are very dizzy</li>
<li>Have a fever, general ill feeling, or hearing loss</li>
<li>Have very bad pain or a loud ringing in your ear</li>
<li>Have an object in your ear that does not come out</li>
<li>Have any symptoms that last longer than 2 months after treatment</li>
</ul>
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Prevention</h2>
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Do not insert objects into the ear canal, even to clean it. Objects stuck in the ear should only be removed by a health care provider. Have ear infections treated promptly.</div>
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Alternative Names</h2>
<div style="margin-bottom: 1em;">
Tympanic membrane perforation; Eardrum - ruptured or perforated; Perforated eardrum</div>
<h2 class="subheading" style="background-image: url(http://www.nlm.nih.gov/medlineplus/images/ency_section_head_bg.png); background-position: 0% 0%; background-repeat: no-repeat no-repeat; color: #0082c8; font-size: 1em; height: 25px; line-height: 1.2; margin: 10px 0px 0.5em; padding-left: 1px; padding-top: 2px;">
References</h2>
<div style="margin-bottom: 1em;">
Buttaravoli P, Leffler SM. Perforated tympanic membrane (ruptured eardrum). In: Buttaravoli P, Leffler SM, eds. <em>Minor Emergencies</em>. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 37.</div>
<div style="margin-bottom: 1em;">
Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. <em>Nelson Textbook of Pediatrics</em>. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 632.</div>
<h2 class="subheading" style="background-image: url(http://www.nlm.nih.gov/medlineplus/images/ency_section_head_bg.png); background-position: 0% 0%; background-repeat: no-repeat no-repeat; color: #0082c8; font-size: 1em; height: 25px; line-height: 1.2; margin: 10px 0px 0.5em; padding-left: 1px; padding-top: 2px;">
Update Date: 5/21/2013</h2>
<div style="margin-bottom: 1em;">
Updated by: Ashutosh Kacker, MD, BS, Associate Professor of Otolaryngology, Weill Cornell Medical College, and Associate Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.</div>
</div>
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Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-86394125153748961122014-05-25T22:24:00.002-07:002014-05-25T22:24:27.358-07:00Congratulations to Dr. Rotenberg, Pediatric Neurologist, and Dr. Susarla, Pediatric Pulmonologist, named as Houston Top Docs for 2014<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrBS3OglwcTKK1uNgbJBh1zf3NGKFesut9Iv9twTSgUEcQSDeRR0WzrBhDLJxCmAZwBpRTDyvVgt80qvgtPmQ3OqhlBekfkrUJtEkoo4km3ccxyAxIjVl0YORrMblyvTXfRLYiiASsATqE/s1600/2014+top+docs+magazine.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrBS3OglwcTKK1uNgbJBh1zf3NGKFesut9Iv9twTSgUEcQSDeRR0WzrBhDLJxCmAZwBpRTDyvVgt80qvgtPmQ3OqhlBekfkrUJtEkoo4km3ccxyAxIjVl0YORrMblyvTXfRLYiiASsATqE/s1600/2014+top+docs+magazine.jpg" height="316" width="320" /></a></div>
<b><u>Congratulations to Houston Specialists nominated for recognition by their colleagues!</u></b><br />
<br />
Dr. Rotenberg, Pediatric Neurologist, Sleep Specialist, Epileptologist &<br />
<br />
Dr. Susarla, Pediatric Pulmonologist, Sleep Specialist<br />
<br />
named as Houston Top Docs for 2014<br />
<br />
Read the article <a href="http://digital.mcmillencomm.com/htexas/issues/006%20-%20H%20Texas%20-%20Spring%202014/index.html" target="_blank">here</a>Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-51869292017526830232014-04-21T02:47:00.000-07:002015-05-17T16:22:19.562-07:00What does access to adequate botox treatment do for children with CP? Reduces the need for surgery from 40 to 15%!<i>I do not understand why I see kids in clinic who have leg or arm spasticity and the families are content to get treatment every year or every 6 months...or worse...not at all!?! -</i> JR<br />
<br />
<br />
<div class="cit" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.8465em; line-height: 1.45em;">
<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="J Pediatr Orthop B." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/15931031#" role="menuitem" style="border-bottom-width: 0px; color: #660066;" title="Journal of pediatric orthopedics. Part B.">J Pediatr Orthop B.</a></span> 2005 Jul;14(4):269-73.</div>
<h1 style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 1.231em; line-height: 1.125em; margin: 0.375em 0px;">
Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity.</h1>
<div class="auths" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.923em;">
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=H%C3%A4gglund%20G%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Hägglund G</a><span style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">1</span>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Andersson%20S%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Andersson S</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=D%C3%BCppe%20H%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Düppe H</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Lauge-Pedersen%20H%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Lauge-Pedersen H</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Nordmark%20E%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Nordmark E</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Westbom%20L%5BAuthor%5D&cauthor=true&cauthor_uid=15931031" style="border-bottom-width: 0px; color: #660066;">Westbom L</a>.</div>
<div class="afflist" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 12.727272033691406px; line-height: 16.363454818725586px; zoom: 1;">
<h3 style="color: #724128; font-size: 1.0769em; line-height: 1.2857; margin: 0.5em 0em; zoom: 1;">
<a aria-disabled="false" aria-expanded="false" class="jig-ncbitoggler ui-widget ui-ncbitoggler" href="http://www.ncbi.nlm.nih.gov/pubmed/15931031#" role="button" style="border-bottom-width: 0px; color: #660066; display: block; font-family: arial, sans-serif !important; outline: none; padding-left: 16px; position: relative; text-decoration: none !important;" title="Open/close author information list"><span class="ui-ncbitoggler-master-text">Author information</span><span class="ui-icon ui-icon-triangle-1-e" style="background-attachment: scroll; background-color: transparent; background-image: url(http://static.pubmed.gov/portal/portal3rc.fcgi/3982719/img/3974597); background-position: 0px -21px; background-repeat: no-repeat no-repeat; border-bottom-left-radius: 3px; border-bottom-right-radius: 3px; border: none; display: inline; height: 16px; left: 0px; margin: 0px; overflow: hidden; padding: 0px; position: absolute; right: 0px; text-indent: -99999px; top: 0px; width: 16px;"></span></a></h3>
<div aria-live="assertive" class="ui-helper-reset" style="border: 0px; line-height: 1.3; list-style: none; margin: 0px; outline: 0px; padding: 0px;">
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<div class="err" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 12.727272033691406px; line-height: 16.363454818725586px; margin: 1.1em auto 0px;">
<h3 style="font-size: 1.0769em; line-height: 1.2857; margin: 0.5em 0px 0px !important;">
Erratum in</h3>
<ul style="list-style-type: none; margin: 0px 0px 0.5em; padding: 0px;">
<li style="display: block;">J Pediatr Orthop B. 2005 Sep;14(5):388. Pedertsen, Henrik Lauge [corrected to Lauge-Pedersen, Henrik].</li>
</ul>
</div>
<div class="abstr" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 12.727272033691406px; line-height: 16.363454818725586px; margin: 1em auto auto;">
<h3 style="color: #985735; display: inline; font-size: 1.0769em; line-height: 1.2857; margin: 0px;">
Abstract</h3>
<div class="">
<div style="margin-bottom: 0.5em;">
During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CP register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P = 0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated.</div>
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<dt style="display: inline; margin-bottom: 0px; margin-left: 0px !important; margin-right: 0px; margin-top: 0px; padding: 0px; white-space: nowrap;">PMID:</dt>
<dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;">15931031</dd> <dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;">[PubMed - indexed for MEDLINE]</dd></dl>
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Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-62717822591293557802014-04-21T02:16:00.000-07:002014-04-21T02:16:46.478-07:00Cut through the fog: An evidence-based review of treatments for children with cerebral palsy<br />
<div style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;">
<br /></div>
<br />
<i>As a parent, I am also subject to all kinds of claims of efficacy for treatment. </i><br />
<i><br /></i>
<i>How can you cut through the fog?</i><br />
<i><br /></i>
<a 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" 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" style="height: 175px; margin-top: 0px; width: 125px;" width="229" /></a><i>As a member of the Academy of CP and Developmental medicine, I suggest this very readable article for parents of children with CP to educate themselves on best practices.</i><br />
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<i>- Dr. Rotenberg</i><br />
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<b>New Clinical and Research Trends in Lower Extremity </b><b>Management for Ambulatory Children with Cerebral Palsy</b><br />
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Synopsis<br />
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Cerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life.<br />
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"...<span style="background-color: white; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16.363636016845703px; line-height: 25.454544067382813px;"> </span><span style="background-color: white; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16.363636016845703px; line-height: 25.454544067382813px;">it is the intensity of walking practice, rather than the use of a device, that produces the positive functional outcomes</span>"<br />
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<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2979300/pdf/nihms249633.pdf" target="_blank">Full article here</a></div>
Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-68834258339531150882014-04-09T05:21:00.001-07:002014-04-09T05:21:09.307-07:00Does Childhood Asthma Lead to COPD?<h1 style="background-color: white; box-sizing: border-box; clear: both; font-family: Georgia, 'Times New Roman', Times, serif; letter-spacing: -1px; line-height: 1.2; margin: 0px; padding: 0px;">
<i><span style="font-size: large;">Early childhood asthma, particularly when severe, seems to impart risk of COPD - an adult condition associated with abnormal lung function that declines over time faster than the general population. Can controlling asthma early prevent this? Dr. Susarla</span></i></h1>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmqg0LvRitmmj6TB8TPvSgy86BsBEXxXdhuzQ3gmqaOX1vAhkQ5RSacdYMpt7et9imnnBH6k3WqiON24gFtdv5ZlVr8u4xdBoE6eqvHgfxVbmYCGtqfhXHIu_dKaIf-iPMT7Tu4KHxPOs/s1600/Screen+Shot+2014-04-09+at+7.19.17+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmqg0LvRitmmj6TB8TPvSgy86BsBEXxXdhuzQ3gmqaOX1vAhkQ5RSacdYMpt7et9imnnBH6k3WqiON24gFtdv5ZlVr8u4xdBoE6eqvHgfxVbmYCGtqfhXHIu_dKaIf-iPMT7Tu4KHxPOs/s1600/Screen+Shot+2014-04-09+at+7.19.17+AM.png" /></a></div>
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The association between childhood asthma and adult chronic obstructive pulmonary disease.</h1>
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INTRODUCTION:</h4>
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There is epidemiological evidence to suggest that events in childhood influence lung growth and constitute a significant risk for adult COPD. The aim of the study is to evaluate for an association between childhood asthma and adult COPD.</div>
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METHODS:</h4>
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This longitudinal, prospective study of 6-7-year-old children with asthma has been regularly reviewed every 7 years to the current analysis at 50 years of age. Participants completed respiratory questionnaires and lung function spirometry with postbronchodilator response. At the age of 50, subjects were classified to the following subgroups: non-asthmatics, asthma remission, current asthma and COPD which was defined by FEV<sub style="box-sizing: border-box;">1</sub> to FVC ratio postbronchodilator of less than 0.7.</div>
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RESULTS:</h4>
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Of the remaining survivors, 346 participated in the current study (participation rate of 76%) of whom 197 completed both questionnaire and lung function testing. As compared with children without symptoms of wheeze to the age of 7, (non-asthmatics) children with severe asthma had an adjusted 32 times higher risk for developing COPD (95% CI 3.4 to 269). In this cohort, 43% of the COPD group had never smoked. There was no evidence of a difference in the rate of decline in FEV<sub style="box-sizing: border-box;">1</sub> (mL/year, 95th CI) between the COPD group (17, 10 to 23) and the other groups: non-asthmatics (16, 12 to 21), asthma remission (20, 16 to 24) and current asthma (19, 13 to 25).</div>
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CONCLUSIONS:</h4>
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Children with severe asthma are at increased risk of developing COPD.</div>
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<a href="http://thorax.bmj.com/content/early/2014/03/31/thoraxjnl-2013-204815">Article linked here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-91421851814279888872014-04-02T03:46:00.001-07:002014-04-02T03:46:23.085-07:00Roche drug cuts asthma attacks, improves lung function -study<h1 style="background-color: white; font-family: georgia, 'times new roman', serif; line-height: 1.1; margin: 0px 0px 10px;">
<span style="font-size: large;"><i>"Biological therapies" are the new frontier in asthma treatment, especially for patients with more severe disease. These antibody based medications provide a more targeted strategy in asthma treatment compared to conventional asthma medications. Dr. Susarla</i></span></h1>
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<h1 style="background-color: white; font-family: georgia, 'times new roman', serif; font-size: 35px; font-weight: normal; line-height: 1.1; margin: 0px 0px 10px;">
Roche drug cuts asthma attacks, improves lung function -study</h1>
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(Reuters) - An experimental drug reduced asthma attacks in patients with severe uncontrolled asthma by 60 percent and helped improve lung function in certain patients, indicating that the drug could offer the first personalized approach to treatment, according to data from a clinical trial released on Tuesday.</div>
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The biotech drug lebrikizumab, which was developed by Roche Holding's Genentech unit, was tested at three doses in patients whose asthma was not sufficiently controlled even with high-dose, inhaled corticosteroids and a second asthma-controlling therapy.</div>
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In the 463-patient Phase IIb study, lebrikizumab reduced asthma attacks by a statistically significant 60 percent more than a placebo in patients found to have a high level of the protein periostin, according to pooled data from the three doses tested - 37.5 milligrams, 125 mg and 250 mg. That compared with a 5 percent reduction versus placebo over 28 to 52 weeks of treatment in those with low levels of periostin.</div>
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"If this drug gets approved we would have for the first time a personalized approach other than just blanket therapy for everyone with uncontrolled disease," Dr Nicola Hanania, one of the study's lead investigators, said in a telephone interview.</div>
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Lebrikizumab works by blocking interleukin-13, or IL-13, which contributes to airway inflammation and mucous production. Periostin is believed to be a biomarker for IL-13 activity and a likely predictor of how well the Roche drug will work.</div>
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Roche is also developing a blood test for periostin in order to identify the patients most likely to benefit from lebrikizumab, which is injected once every four weeks.</div>
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Hanania, who is director of the Asthma Clinical Research Center at Baylor College of Medicine in Houston, called the data from the study "very exciting."</div>
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In those with severe asthma receiving existing treatments, "we still see patients who still have symptoms, who still have exacerbations, hospital admissions, and this is the type of patient this study was targeting," he said.</div>
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Curiously, the greatest level of asthma attack reduction, at 81 percent, was seen with the lowest dose of lebrikizumab, something that Hanania called surprising. Hanania, who presented the data at the American Academy of Allergy, Asthma and Immunology (AAAAI) meeting in San Diego, noted, "Higher is not always the better."</div>
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Fifteen percent of the estimated 25 million Americans with asthma suffer from severe asthma, according to the National Institutes of Health. About half of severe asthmatics are believed to have high periostin levels.</div>
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Among patients with high level periostin, the drug improved lung function by 9.1 percent after 12 weeks, compared with an improvement of just 2.6 percent in the low periostin group.</div>
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Lung function was tested by change in FEV1, a measure of the maximum amount of air that can be forcibly exhaled in one second. The greatest improvement in FEV1, of 10.7 percent, was seen with the 125 mg dose of lebrikizumab.</div>
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"Statistically it's significant, and I believe it is clinically significant because it goes hand in hand with reduction in exacerbations," Hanania said of the lung function improvement seen in the high periostin group.</div>
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The incidence of serious adverse side effects was low and similar in the lebrikizumab and placebo arms of the study, researchers said.</div>
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"The safety profile was very reassuring. Nothing really stood out as major side effect or major serious adverse effect," Hanania said.</div>
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If the results are replicated in large, ongoing Phase III trials that will include more than 2,000 patients, Roche said it expects to seek approval for the drug in 2016.</div>
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"As a clinician, this is important because there is a great need for additional therapy for those with poorly controlled asthma," Hanania said. "It's a light at the end of the tunnel."</div>
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<a href="http://www.reuters.com/article/2014/03/04/roche-asthma-idUSN9N0AR02I20140304">Read article here.</a></div>
Dr. Susarlahttp://www.blogger.com/profile/00977203919127416942noreply@blogger.com0tag:blogger.com,1999:blog-2131132745341911506.post-7174406195357909412014-03-31T04:02:00.001-07:002014-03-31T04:02:14.670-07:00Diuretic may treat autism, study in rodents suggests<header><h1 class="node-title" datatype="" property="rnews:name schema:name" style="margin: 6px 0px 10px;">
<span style="font-size: x-small;"><span style="color: #212939; font-family: Lato, Helvetica, Arial, Verdana, sans-serif;"><span style="line-height: 55px;"><i>While this is a rat model, it offers some biologic evidence for an earlier treatment trial in humans. Interestingly, there are many papers about using diuretics in seizures in infants. JR</i></span></span></span></h1>
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Diuretic may treat autism, study in rodents suggests</h1>
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Drug that affects brain chloride levels staves off symptoms in mice and rats</div>
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<span class="views-label views-label-title">BY</span> <span class="field-content"><a href="https://www.sciencenews.org/author/laura-sanders" style="color: #c64308; font-weight: 700; text-decoration: none;">LAURA SANDERS</a></span> </div>
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2:00PM, FEBRUARY 6, 2014</div>
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Curbing chloride in nerve cells could combat symptoms of autism, a study of rats and mice suggests. The results may explain why a small group of children with autism seemed to improve after taking the common diuretic bumetanide in an earlier study.<br />
The new details of how bumetanide works, <a href="http://www.sciencemag.org/lookup/doi/10.1126/science.1247190" style="color: #c64308; text-decoration: none;" target="_blank">published</a> in the Feb. 7 <em>Science</em>, provide important clues about how autism spectrum disorders arise in a developing brain, says Susan Connors, an autism specialist at Massachusetts General Hospital for Children in Boston ....<br />
<a href="https://www.sciencenews.org/article/diuretic-may-treat-autism-study-rodents-suggests" target="_blank">article here</a><br />
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Here is the abstract of the human study....</div>
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<span class="rdf-meta" content="Diuretic may treat autism, study in rodents suggests" property="rnews:name schema:name" style="font-family: Lato, Helvetica, Arial, Verdana, sans-serif; font-size: 13px; line-height: 22px;"></span><span style="font-family: Lato, Helvetica, Arial, Verdana, sans-serif; font-size: 13px; line-height: 22px;"></span></div>
Transl Psychiatry. Dec 2012; 2(12): e202.<br />
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PMCID: PMC3565189<br />
A randomised controlled trial of bumetanide in the treatment of autism in children<br />
E Lemonnier,1,2,* C Degrez,1 M Phelep,1 R Tyzio,3 F Josse,1 M Grandgeorge,1,2 N Hadjikhani,4,5 and Y Ben-Ari3,*<br />
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Abstract<br />
Gamma aminobutyric acid (GABA)-mediated synapses and the oscillations they orchestrate are altered in autism. GABA-acting benzodiazepines exert in some patients with autism paradoxical effects, raising the possibility that like in epilepsies, GABA excites neurons because of elevated intracellular concentrations of chloride. Following a successful pilot study,1 we have now performed a double-blind clinical trial using the diuretic, chloride-importer antagonist bumetanide that reduces intracellular chloride reinforcing GABAergic inhibition. Sixty children with autism or Asperger syndrome (3–11 years old) received for 3 months placebo or bumetanide (1 mg daily), followed by 1-month wash out. Determination of the severity of autism was made with video films at day 0 (D0) and D90 by blind, independent evaluators. Bumetanide reduced significantly the Childhood Autism Rating Scale (CARS) (D90−D0; P<0 .004="" a="" above="" accuracy="" activation="" adjikhani="" agent="" al.="" an="" and="" are="" areas="" autism.="" autism="" best="" better="" brain="" bumetanide="" cases="" chronic="" clinical="" companion="" determine="" diagnostic="" effects="" emotional="" et="" facial="" for="" global="" hypokalaemia="" ilcoxon="" impressions="" improved="" in="" increased="" involved="" is="" k="" l="" labelling="" larger="" mean="" mild="" mm="" most="" n="9)" novel="" observation="" occasional="" p-value="0.017)." p="" perception="" placebo="" population="" potassium.="" promising="" removed="" restricted="" s.d.="" s="" schedule="" severe="" side="" significantly="" social="" student="" study="" submitted="" suited="" supplemental="" t-test:="" test:="" that="" the="" therapeutic="" therefore="" this="" to="" treat="" treated="" treatment.="" treatment="" trials="" values="" vs="" warranted="" was="" were="" when="" with=""><br />
Keywords: autism, bumetanide, clinical trial, diuretics, GABA</0>Dr joshhttp://www.blogger.com/profile/05212400752434603954noreply@blogger.com0