scholarly journals Food-induced anaphylaxis in children – state of art

2021 ◽  
Vol 17 (1) ◽  
pp. 8-16
Author(s):  
Łukasz Błażowski ◽  
◽  
Ryszard Kurzawa ◽  
Paweł Majak ◽  
◽  
...  
Keyword(s):  
Clinical Course ◽  
Significant Proportion ◽  
Food Challenge ◽  
Current Treatment ◽  
Food Hypersensitivity ◽  
Fatal Reaction ◽  
Medical Facilities ◽  
Treatment Plans ◽  
Definition Of ◽  
Adrenaline Administration

Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children. It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge. There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score. Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis. Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined. The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction. At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions. The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors. The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity. Delayed adrenaline administration is associated with higher incidence of severe course and death. Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors.

Is Treat-to-target in Lupus Nephritis Realistic in Clinical Practice?

2018 ◽  
Vol 15 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Chi Chiu Mok
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Safety Concern ◽  
Real Life ◽  
Current Treatment ◽  
Treat To Target ◽  
Low Disease Activity ◽  
Activity State ◽  
Definition Of ◽  
Comparative Trials

The Treat-to-Target (T2T) principle has been advocated in a number of inflammatory and non-inflammatory medical illnesses. Tight control of disease activity has been shown to improve the outcome of rheumatoid arthritis and psoriatic arthritis as compared to the conventional approach. However, whether T2T can be applied to patients with lupus nephritis is still under emerging discussion. Treatment of lupus nephritis should target at inducing and maintaining remission of the kidney inflammation so as to preserve renal function and improve survival in the longterm. However, there is no universal agreement on the definition of remission or low disease activity state of nephritis, as well as the time points for switching of therapies. Moreover, despite the availability of objective parameters for monitoring such as proteinuria and urinary sediments, differentiation between ongoing activity and damage in some patients with persistent urinary abnormalities remains difficult without a renal biopsy. A large number of serum and urinary biomarkers have been tested in lupus nephritis but none of them have been validated for routine clinical use. In real life practice, therapeutic options for lupus nephritis are limited. As patients with lupus nephritis are more prone to infective complications, tight disease control with aggressive immunosuppressive therapies may have safety concern. Not until the feasibility, efficacy, safety and cost-effectiveness of T2T in lupus nephritis is confirmed by comparative trials, this approach should not be routinely recommended with the current treatment armamentarium and monitoring regimes.

Letter to the Editor: Craniopharyngiomas in the elderly: the crucial influence of tumor topography on surgical risk assessment

2021 ◽  
Author(s):  
José M. Pascual ◽  
Ruth Prieto
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Tumor Tissue ◽  
Significant Proportion ◽  
Wide Band ◽  
The Elderly ◽  
Surgical Risk ◽  
Definition Of ◽  
Weighted Sequences ◽  
Tumor Topography

Classifying CPs within the overly vague, uninformative category “suprasellar” prevents gaining any true insight regarding the risks associated with the surgical procedure employed. Routine MRI obtained with conventional T1- and T2-weighted sequences along the midsagittal and coronal trans-infundibular planes allow an accurate and reliable preoperative definition of CP topography. CPs developing primarily within the infundibulum and/or tuberal region of the hypothalamus, as well as those wholly located within the 3V, should be distinguished preoperatively from those lesions originally expanding beneath the 3V floor (3VF), the true suprasellar tumors. Among adult patients, about 40% of CPs correspond to infundibulo-tuberal tumors expanding primarily within the 3VF, above an intact pituitary gland and stalk. This subgroup of CPs shows strong adherences to the surrounding hypothalamus, as they are embedded within a wide band of reactive gliotic tissue, usually infiltrated by microscopic finger-like solid cords of tumor tissue. In elderly patients, a significant proportion of CPs correspond to papillary tumors developing above an intact 3VF, usually showing small pedicle-like or sessile-like attachments to the infundibulum. With the current diagnostic MRI workup routinely employed for CPs, it is possible, for the majority of lesions, to preoperatively differentiate these topographical variants and predict the type of CP-hypothalamus relationship that will be found during surgery.

scholarly journals The Application of Dynamic Uncertain Causality Graph Based Diagnosis and Treatment Unification Model in the Intelligent Diagnosis and Treatment of Hepatitis B

Symmetry ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1185
Author(s):  
Nan Deng ◽  
Qin Zhang
Keyword(s):  
Hepatitis B ◽  
Response Probability ◽  
Logic Gates ◽  
Current Treatment ◽  
Subsequent Treatment ◽  
Diagnosis And Treatment ◽  
Treatment Model ◽  
Treatment Scheme ◽  
Treatment Plans ◽  
Dynamic Uncertain Causality Graph

Although hepatitis B is widespread, it is hard to cure. This paper presents a new and more accurate model for the diagnosis and treatment of hepatitis B. Based on previous research, the diagnosis and treatment modes were combined into one. By adding more influencing factors and risk factors, the overall diagnosis and treatment model will be further expanded, and a richer and more detailed overall diagnosis and treatment model will be constructed. Reverse logic gates are used in the model to improve the accuracy of the treatment planning. The new unified model is more accurate in subdividing diagnosis results, and it is more flexible and accurate in providing dynamic treatment plans. The prediction process and the static diagnosis process of the model are symmetric, and the related sub-graph is symmetric in structure. In addition, an algorithm for predicting the response probability of treatment scheme is developed, so as to predict the subsequent treatment effects of the current treatment scheme, such as the probability of drug resistance. The results show that this method is more accurate than other available systems, and it has encouraging diagnostic accuracy and effectiveness, which provides a promising help for doctors in diagnosing hepatitis B.

Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients

2021 ◽  
pp. medethics-2020-106977
Author(s):  
Christoph Becker ◽  
Alessandra Manzelli ◽  
Alexander Marti ◽  
Hasret Cam ◽  
Katharina Beck ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Medical Futility ◽  
University Hospital ◽  
Main Diagnosis ◽  
Do Not Resuscitate ◽  
Clinical Frailty Scale ◽  
Code Status ◽  
Probability Of Survival ◽  
Hospitalised Patients ◽  
Definition Of

Guidelines recommend a ‘do-not-resuscitate’ (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.

scholarly journals A Consensus Definition of Supratotal Resection for Anatomically Distinct Primary Glioblastoma: An AANS/CNS Section on Tumors Survey of Neurosurgical Oncologists

2021 ◽  
Author(s):  
Maureen Rakovec ◽  
Adham M. Khalafallah ◽  
Oren Wei ◽  
David Day ◽  
Jason P. Sheehan ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Resonance Imaging ◽  
Consensus Definition ◽  
Primary Glioblastoma ◽  
Temporal Lobes ◽  
Tumor Section ◽  
Treatment Plans ◽  
Definition Of ◽  
The Right ◽  
Supratotal Resection

Abstract Introduction: Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition. Methods Seventy-six general neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed using a crowdsourcing approach. Participants were presented with 11 definitions of SpTR and rated each definition’s appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location's eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. Results Fifty-two neurosurgeons (73.2%) agreed that resection 1-2 cm beyond contrast enhancement was an acceptable definition for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were right anterior temporal (n=58, 76.3%) and right frontal (n=55, 73.3%) glioblastomas. Conclusion Support exists within the neurosurgical oncology community to adopt the proposed consensus definition of SpTR of glioblastoma and to treat right anterior temporal and right frontal glioblastomas using SpTR. A smaller proportion of general neurosurgical oncologists than SpTR experts consider SpTR feasible in the left anterior temporal lobe.

scholarly journals Beyond General Pronouncements: A Judicial Approach to Section 27 of the Charter (forthcoming)

1995 ◽  
Vol 33 (3) ◽  
pp. 551
Author(s):  
Vern W. DaRe
Keyword(s):  
Human Rights ◽  
Current Treatment ◽  
Academic Disciplines ◽  
Liberal Theory ◽  
Canadian Society ◽  
Federal Policies ◽  
Collective Rights ◽  
Negative Role ◽  
Definition Of ◽  
Canadian Multiculturalism

The author provides a thorough synthesis and evaluation of the multicultural provision in the Charter. He begins by exploring possible definitions of multiculturalism, deriving his concept from various academic disciplines as well as federal policies. The difficulty on settling for a comprehensive definition of multiculturalism is manifest in the mixed signals within both the federal government's Multiculturalism Policy of 1971 and the subsequent legislation, the Canadian Multiculturalism Act. He then selectively surveys the judicial approaches taken to s. 27. Current treatment is sparse and any discussion of the multicultural section is largely subsumed in a general discussion of other sections of the Charter such as ss. 1 and 2. Through this survey, he demonstrates the limited, restricted reading of s. 27 accorded by the judiciary. Finally, the author considers the inherent limits of the section; he compares it to a similar provision in Quebec's human rights legislation, general liberal theory and possible conflicts between s. 27 and other precepts of Canadian society, specifically bilingualism. He concludes that s. 27 must be expanded within its negative role, protecting individual communities and individuals from the acts of others rather than being used as a tool to entrench positive or collective rights of ethnic groups.

The secondary phloem of Austrobaileya scandens

1970 ◽  
Vol 48 (2) ◽  
pp. 341-359 ◽  
Author(s):  
Lalit M. Srivastava
Keyword(s):  
Tannic Acid ◽  
Cross Sections ◽  
Significant Proportion ◽  
Sieve Tube ◽  
Secondary Phloem ◽  
Sieve Elements ◽  
Sieve Cells ◽  
Companion Cells ◽  
Parenchyma Cells ◽  
Definition Of

The origin of sieve elements and parenchyma cells in the secondary phloem of Austrobaileya was studied by use of serial cross sections stained with tannic acid – ferric chloride and lacmoid. In three important respects, Austrobaileya phloem recalls gymnospermous features: it has sieve cells rather than sieve-tube members; a significant proportion of sieve elements and companion cells arise independently of each other; and sieve areas occur between sieve elements and companion cells ontogenetically unrelated to each other. The angiospermous feature includes origin of most sieve elements and parenchyma, including companion cells, after divisions in phloic initials. In these instances companion cells show a closer ontogenetic relationship to sieve elements than do other parenchyma cells. The combination of gymnospermous and angiospermous features makes phloem of Austrobaileya unique when compared to that of all those species that have been investigated in detail. It is further suggested that the term albuminous cells is inappropriate and should be replaced by companion cells but that the ontogenetic relationship implicit in the definition of companion cells is too restrictive and should be abandoned.

Endometrial Ablation Versus Hysterectomy

2021 ◽  
pp. 218-223
Author(s):  
Christine Helou ◽  
Mandy Yunker
Keyword(s):  
Significant Proportion ◽  
Premenopausal Women ◽  
Relevant Information ◽  
Endometrial Ablation ◽  
Patient Specific ◽  
Patient Counseling ◽  
Case Scenario ◽  
Treatment Plans ◽  
Small Sample Sizes ◽  
Surgical Treatments

This article reviews study methodology, results, limitations, and utility of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB). Criticisms and limitations of the study are proposed. Relevant information from other studies or guidelines are reviewed. The key findings from this study are then applied to a clinical case scenario. The results of this study, particularly those related to reoperation, were in line with other studies. While follow-up of enrolled patients was lengthy, the study was limited by slow recruitment leading to small sample sizes. Generalizability of this study is limited by the lack of randomized with regards to surgical technique and hysterectomy route, as well as use of resectoscopic ablation techniques. Both endometrial ablation and hysterectomy were found to be effective treatments for premenopausal women with DUB. Hysterectomy was more effective at treating bleeding symptoms but was associated with more adverse events and higher rates of infection. A small but significant proportion of women initially treated with ablation subsequently underwent reoperation with either repeat ablation or hysterectomy. The information from this study when used in context with similar studies is useful in guiding patient counseling for treatment of premenopausal DUB; however, treatment plans should ultimately be individualized based on patient-specific factors to maximize the likelihood of success with initial treatment.

Identification of 11 Different HPV Subtypes in Adult Patients With Recurrent Respiratory Papillomatosis

2020 ◽  
Vol 163 (4) ◽  
pp. 785-790
Author(s):  
Rebecca C. Hoesli ◽  
Melissa L. Wingo ◽  
Brent E. Richardson ◽  
Robert W. Bastian
Keyword(s):  
Human Papillomavirus ◽  
Patient Outcomes ◽  
Clinical Course ◽  
Adult Population ◽  
Tertiary Care ◽  
Recurrent Respiratory Papillomatosis ◽  
Definition Of ◽  
Large Adult

Objective To define the human papillomavirus (HPV) subtypes seen in a large adult population with traditionally defined recurrent respiratory papillomatosis. Study Design Retrospective review. Setting Tertiary care laryngology practice. Subjects and Methods All patients had a firm diagnosis of recurrent respiratory papillomatosis defined by (1) visually obvious papillomas, (2) recurrence requiring multiple surgeries, and (3) pathology diagnosis of “papilloma.” Each patient had also undergone HPV subtyping. Age, sex, presence of malignancy, and HPV subtypes were tabulated and correlated with long-term patient outcomes. Results A total of 184 patients were identified who fulfilled the above criteria. In total, 87.0% (160) had a low risk subtype; 9.2% had an alternative subtype. These consisted of subtypes 16, 18, 31, 44, 45, 55, and 70. Four patients (2.2%) had combinations of subtypes, with 1 patient with HPV 11 and 16, 1 patient with HPV 11 and 76, 1 patient with 11 and 84, and 1 patient with 18 and 45. Finally, 3.8% of patients were HPV negative, despite fulfilling all 3 criteria listed above. Conclusion In the patient population above, almost 10% of patients had an HPV subtype other than 6 and 11. This suggests that traditionally defined recurrent respiratory papillomatosis (RRP) can be caused by HPV subtypes other than 6 and/or 11. In addition, the clinical course of persons with this definition of RRP appears to vary by subtype, and this information may offer the ability to nuance follow-up instructions, reducing in particular the burden placed upon patients who have RRP caused by subtypes 6 and 11.

scholarly journals Risks of collective investment undertakings in the context of global capital markets

2020 ◽  
Vol 74 ◽  
pp. 01025
Author(s):  
Daniela Pfeiferová ◽  
Ivana Kuchařová
Keyword(s):  
Significant Proportion ◽  
Global Scale ◽  
Interest Rate Risk ◽  
Financial Risks ◽  
Counterparty Risk ◽  
Investment Funds ◽  
Specific Investment ◽  
Equity Risk ◽  
Doing Business ◽  
Definition Of

In the context of globalization, international institutional investors have taken over a significant proportion of global investment assets. Among this group also belong to collective investment undertakings whose primary motive is regulated by collecting funds from indeterminate group of natural persons and legal persons for the purpose of doing business on a global scale. As part of their reporting obligations, these entities are required to report on the risks associated with the investment and how to eliminate them. Investment firms must use risk management methods that allow these risks to be identified at any time. The main risks associated with investments in collective investment funds include global financial risks: interest rate risk, currency risk, equity risk, credit risk, counterparty risk, liquidity risk, operational risk and political risk. This article deals with the definition of specific investment risks and the options for their elimination for collective investment entities. The main goal of the article is to recommend the elimination of these risks based on the identified risks associated with collective investment.

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