Use Of Specific Treatments Research Articles

Clinical Characteristics and Outcomes of Interstitial Lung Disease Patients with Acute Respiratory Failure Admitted to the ICU

Abstract Background: Acute respiratory failure is a dreaded complication of interstitial lung disease (ILD) and is the most significant reason for mortality in most forms of ILDs. Knowledge of outcome predictors that can be assessed early after intensive care unit (ICU) admission would help guide the use of specific treatments. The present study attempts to identify the baseline characteristics of ILD patients admitted due to acute respiratory failure to ICU and to evaluate the cause of acute respiratory failure in these patients, management, and the outcomes. Materials and Methods: An observational cohort study was carried out in a tertiary care center in North India on 50 previously diagnosed patients of ILD hospitalized due to acute respiratory failure between January and December 2022. All relevant clinical, investigational, and treatment data were collected from the hospital information system. Results: The baseline mean FVC and 6-min walk distance were lower for non-survivors. The baseline mean DLCO was significantly lower among non-survivors. Comparatively, the radiology pattern of both groups showed that the usual interstitial pneumonia (UIP) pattern was associated with highest mortality. However, this difference was not statistically significant. Mortality was higher in those with lower PaO2/FiO2 ratio than among the survivors. Sputum culture positivity had a statistically significant impact on mortality. The mean hospital stay time was considerably higher in patients with idiopathic pulmonary fibrosis (IPF) and in patients with Type 2 respiratory failure. Conclusion: Baseline lung function tests, comorbidities, and exacerbating factors are invaluable in predicting the clinical outcomes. It is essential to perform all the diagnostic examinations at the earliest to ensure prompt initiation of the most appropriate therapy and lower hospital mortality. Distinguishing those patients who have a known cause for their ILD from those who do not was found to be crucial for deciding the most appropriate management.

The Concordance of Patient-Reported Symptoms, Physical Examination and Ultrasound-Detected Synovitis, in Active Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint synovitis and systemic inflammation, with joint swelling and tenderness as common clinical manifestations. Accurate assessment of disease activity is crucial for effective management and treatment planning. While ultrasound (US) has emerged as a sensitive tool for detecting synovitis, its concordance with clinical examination findings remains a subject of ongoing research. Objective: The objective of this study was to evaluate the concordance between clinical examination findings and ultrasound-detected synovitis in RA patients, with an emphasis on the diagnostic value of joint swelling and tenderness. Methods: This observational, cross-sectional study involved 40 RA patients with moderate to severe disease activity, assessed at a single center. Following ethical approval and informed consent, patients were evaluated for joint swelling, tenderness, and patient-reported symptoms. Ultrasound examinations were conducted to detect synovitis, employing gray scale (GS) and power Doppler (PD) modalities. Concordance between clinical findings and US-detected synovitis was analyzed using Cohen's kappa statistic. Disease activity was categorized using the DAS28 score, with subgroup analyses across different disease activity states. Results: Joint swelling demonstrated the highest concordance with US-detected synovitis (kappa = 0.44), while joint tenderness showed lower concordance (kappa = 0.23). Analysis across disease activity states revealed consistent concordance for joint swelling (kappa values ranging from 0.38 to 0.41), regardless of disease severity. Patient-reported symptoms and the use of specific treatments (methotrexate and biologics) were also analyzed, with 90% of patients on methotrexate and 10% on biologics. The study population was predominantly female (86%) and middle-aged (20 to 40 years: 66%). Conclusion: Our findings indicate that joint swelling is a more reliable clinical indicator of synovitis in RA patients compared to joint tenderness. This suggests that disease activity scoring systems in RA might benefit from placing greater emphasis on swelling and patient-reported symptoms. Future research should explore the integration of these parameters to enhance the accuracy and efficiency of RA management.

Heart Rate Variability Biofeedback and Psychotherapy in Polycystic Ovary Syndrome: Description of a Case Report to Shed Light on this Understudied Condition

Background: Although there is minimal information on the role of stress in PCOS, it is well-known that it may trigger the exacerbation and maintenance of the disease. Despite there being only a few studies in the literature, many researchers highlighted situations of autonomic hyperactivation characterizing PCOS. In light of these assumptions, the purpose of this study is to report on a patient who underwent psychological intervention to enhance stress management skills. Case: A 30-year-old woman was referred by the endocrinologist. From a clinical-psychological point of view, the condition of the patient was characterized by a modest psychophysiological activation. Interpersonal difficulties did not allow the patient to benefit from the social support of her loved ones, further favoring the maintenance of the excessive arousal generated by stressful life events. The patient was treated with HRV-Biofeedback integrated within cognitive-behavioral psychotherapy. Discussion: The multidimensional intervention brought benefits to the patient, teaching her better stress management strategies (i.e., reduction of psychological symptoms and improvement of hormonal tests). Keeping in mind the interplay between physiological, psychological, and interpersonal factors is fundamental in all psycho-somatic and somato-psychic disorders and is crucial to enhance the use of specific treatments to restore psychophysical well-being.

Reversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) network: Study protocol and rationale of a multicentre research collaboration.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare, but increasingly recognised cerebrovascular condition with an estimated annual age-standardised incidence of approximately three cases per million. Knowledge about risk factors and triggering conditions and information about prognosis and optimal treatment in these patients are limited. The REversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) project aims to elucidate the epidemiological and clinical characteristics of RCVS by collecting individual patient data from four countries (France, Italy, Taiwan and South Korea) in the setting of a multicentric study. All patients with a diagnosis of definite RCVS will be included. Data on the distribution of risk factors and triggering conditions, imaging data, neurological complications, functional outcome, risk of recurrent vascular events and death and finally the use of specific treatments will be collected. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and geographical region of residence. Ethical approval for the REVERCE study will be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of clinical and epidemiological characteristics of RCVS patients.

An MDS Evidence-Based Review on Treatments for Huntington's Disease.

Huntington's disease (HD) is a rare neurodegenerative disorder with protean clinical manifestations. Its management is challenging, consisting mainly of off-label treatments. The International Parkinson and Movement Disorder Society commissioned a task force to review and evaluate the evidence of available therapies for HD gene expansion carriers. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible randomized controlled trials were identified via an electronic search of the CENTRAL, MEDLINE, and EMBASE databases. All eligible trials that evaluated one or more of 33 predetermined clinical questions were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A framework was adapted to allow for efficacy and safety conclusions to be drawn from the balance between the GRADE level of evidence and the importance of the benefit/harm of the intervention. Twenty-two eligible studies involving 17 interventions were included, providing data to address 8 clinical questions. These data supported a likely effect of deutetrabenazine on motor impairment, chorea, and dystonia and of tetrabenazine on chorea. The data did not support a disease-modifying effect for premanifest and manifest HD. There was no eligible evidence to support the use of specific treatments for depression, psychosis, irritability, apathy, or suicidality. Similarly, no evidence was eligible to support the use of physiotherapy, occupational therapy, exercise, dietary, or surgical treatments. Data for therapeutic interventions in HD are limited and support only the use of VMAT2 inhibitors for specific motor symptoms. © 2021 International Parkinson and Movement Disorder Society.

Mortality and Neurologic Sequelae in Influenza-Associated Encephalopathy: Retrospective Multicenter PICU Cohort in France.

To describe and estimate the mortality rate of severe influenza-associated encephalopathy/encephalitis among children admitted to PICUs. Multicenter retrospective study. Twelve French PICUs. All children admitted for influenza-associated encephalopathy/encephalitis between 2010 and 2018 with no severe preexisting chronic neurologic disorders and no coinfection potentially responsible for the disease. None. We collected the clinical presentation; laboratory, electroencephalographic, and MRI findings; and treatments used in the PICU. The primary outcome was mortality. The secondary outcomes included sequelae at discharge and last follow-up. We included 41 patients with a median (interquartile range) age of 4.7 years (2.5-8.2 yr). The main reasons for admission were altered consciousness (59%) and status epilepticus (34%); 48% of patients had meningitis, and one third had acute necrotizing encephalopathy on MRI. Mechanical ventilation was required in 73% of patients and hemodynamic support in 24%. The use of specific treatments was variable; steroids were given to 49% of patients. Seven patients (17%) died in the PICU. Median (interquartile range) PICU stay length was 7 days (2-13 d), and total hospital length of stay was 23 days (7-33 d). On hospital discharge, 49% (n = 20) had neurologic sequelae, with 27% (n = 11) having severe disabilities defined by modified Rankin Score greater than or equal to 4. Children requiring PICU admission for influenza-associated encephalopathy/encephalitis have high mortality and morbidity rates. The management remains highly variable due to the lack of guidelines.

Development and Validation of an Interleukin-6 Nomogram to Predict Primary Non-response to Infliximab in Crohn’s Disease Patients

Background: The primary non-response (PNR) rate of infliximab (IFX) varies from 20 to 46% for the treatment of Crohn’s disease (CD). Detected PNR reduces the improper use of specific treatments. To date, there is hardly any knowledge regarding early markers of PNR. The aim of this study was to evaluate the role of Interleukin-6 (IL-6) as an early predictor of PNR of IFX for the treatment of CD. Methods: We enrolled 322 bio-naïve patients diagnosed with CD from January 2016 to May 2020. Primary response was determined at week 14. Multivariable logistic regression was used to construct prediction models. Area under the curve (AUC), calibration and decision curve analyses (DCA) were assessed in the validation cohort. GEO data were analyzed to identify potential mechanisms of IL-6 in IFX therapy for CD. Results: PNR occurred in 31.06% (100 of 322) patients who were assessable at week 14. IL-6 levels significantly decreased after IFX therapy (p < 0.001). The validation model containing IL-6 presented enhanced discrimination with an AUC of 0.908 and high calibration. Decision curve analysis (DCA) indicated that the model added extra predictive value. GEO data confirmed the IL-6 levels were increased in the PNR group and IL-6-related differentially expressed genes (DEGs) were enriched in the inflammatory response. Conclusions: We concluded that IL-6 may be used as a predictive factor to assess the risk of PNR to IFX therapy.

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo

ObjectivesTo evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization.MethodologyWe estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis.ResultsThe implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a non-significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception.ConclusionDespite significant improvement in the management of PAC, the uptake in WHO approved technology—namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.

Development and Validation of an Interleukin-6 Nomogram to Predict Primary Non-Response to Infliximab in Crohn's Disease Patients: From Bedside to Bioinformatics

Background: The primary nonresponse (PNR) rate of Infliximab (IFX) varies from 20% to 46% for the treatment of Crohn’s disease (CD). Detected PNR reduces the improper use of specific treatments. To date, there is hardly any knowledge regarding early markers of PNR. The aim of this study was to evaluate the role of Interleukin-6 (IL-6) as an early predictor of PNR of IFX for the treatment of CD. Methods: We enrolled 322 bio-naive patients diagnosed with CD from January 2016 to May 2020. Primary response was determined at week 14. Multivariable logistic regression was used to construct prediction models. The discrimination, calibration and clinical validity of the models in the validation cohort were assessed by area under the curve (AUC), calibration and decision curves analyses. GEO data were analyzed to identify potential mechanisms of IL-6 in IFX therapy for CD. Findings: PNR occurred in 31.06% (100 of 322) patients who were assessable at week 14. IL-6 levels significantly decreased after IFX therapy (P < 0.001). The validation model containing IL-6 presented enhanced discrimination with an AUC of 0.866 and high calibration. Decision curve analysis (DCA) indicated that the model added extra predictive value. GEO data confirmed the IL-6 levels were increased in the PNR group and IL-6-related differently expressed genes (DEGs) were enriched in the inflammatory response. Interpretation: We concluded that IL-6 may be used as a predictive factor to assess the risk of PNR to IFX therapy. Funding Statement: Inflammatory Bowel Disease Research Center, Renji Hospital, Shanghai Jiao Tong University. Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics Approval Statement: This study was approved by the IRB of Renji hospital, School of medicine, Shanghai Jiao Tong University (KY2019-39).

Interventions to Prevent Sperm DNA Damage Effects on Reproduction.

Excessive oxidation and antioxidant imbalance resulting from several conditions may cause sperm DNA damage, which, in turn, affect male fertility, both natural and assisted. Sperm DNA damage transferred to the embryo might also affect the health of offspring. Several conditions associated with excessive oxidative stress are modifiable by the use of specific treatments, lifestyle changes, and averting exposure to environmental/occupational toxicants. Here, we discuss the strategies to reduce sperm DNA damage with a focus on clinical and surgical interventions.

A Comprehensive Review of Wraparound Care Coordination Research, 1986–2014

Wraparound is a team-based care coordination strategy for children and youth with complex behavioral health needs and their families. Despite widespread adoption, a review of the literature pertaining to Wraparound has not previously been conducted. To address this gap, we conducted a comprehensive review, ultimately identifying 206 unique Wraparound-related publications in peer-reviewed outlets. We then coded and analyzed the publications’ methods, main foci, measures, and findings. Eighty-three publications (40%) were non-empirical, most of which focused on defining Wraparound and advocating for its use, largely based on its alignment with the System of Care philosophy. Among empirical studies (n = 123; 60%), 22 controlled studies were found, most finding positive or mixed evidence for Wraparound’s effectiveness. Other empirical studies examined implementation issues such as necessary system conditions and measurement and influence of fidelity. Major gaps include rigorous tests of Wraparound’s change mechanisms, workforce development models, peer support, and the use of specific treatments. We conclude that literature produced to date has provided useful information about Wraparound’s core components, program-level and system-level implementation supports, and applicability across systems and populations, as well as preliminary information about effectiveness and cost-effectiveness. The Wraparound research base would, however, benefit from additional studies of the model’s intervention and implementation components, as well as more rigorous effectiveness studies.

Evidence based pediatric care closer to home: A mixed methods evaluation of a clinical pathways-based emergency outreach program

Objective: While specialized pediatric care is not feasible in all Emergency Department (ED) settings, enhanced system capacity is needed to appropriately address pediatric emergency care needs. Our objective was to evaluate an innovative clinical pathway (CP) based regional ED outreach program within community EDs.Methods: This mixed-methods design includes pre/post chart audits, qualitative interviews, ED site audits, and website utilization metrics. The study was conducted in community-based hospital EDs within the region. ED nurses, physicians and administrators from eight hospitals participated in the study. The ED outreach program involved implementation of 3 CPs addressing common pediatric emergency presentations: asthma, croup and gastroenteritis. Primary outcomes from chart audits included presence of a CP-related document filed in relevant patient charts and the proportion of patients who received appropriate care as per the severity-based CP recommendations. Secondary outcomes included documented assessments of condition severity, use of specific treatments and hospital metrics.Results: ED health professionals value the outreach initiative and CPs. Site audits confirmed ED presence and knowledge of CP tools. However several adoption barriers were identified, including time, perceived threats to physician autonomy and infrequent opportunities for use. Chart audits demonstrated site-dependent, variable uptake of CP resources into ED workflows. In total, 1,274 health records were audited, with the following pre/post breakdowns: 203/211 (asthma), 131/193 (croup) and 291/245 (gastroenteritis). We could not evaluate our primary outcomes due to infrequent documentation of condition severity. Significant post-implementation improvements were demonstrated in gastroenteritis management. Median length of stay remained unchanged (asthma) or increased (croup, gastroenteritis). ED site was an important predictor of some asthma treatments and LOS for asthma (p &lt; .001), croup (p = .01) and gastroenteritis (p &lt; .001).Conclusions: CP documents were available in EDs, but may not be utilized as fully intended. Site heterogeneity may account for lack of significant change in several outcome variables.

Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study.

ObjectivesTo investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS).DesignCohort study using registry data from the Myocardial Ischaemia National Audit Project.SettingAll Clinical Commissioning Groups (CCGs) (n=211) in the English NHS.Participants357 228 patients with NSTEMI between 1 January 2003 and 30 June 2013.Main outcome measureProportion of eligible NSTEMI who received all eligible guideline-indicated treatments (optimal care) according to the date of guideline publication.ResultsThe proportion of NSTEMI who received optimal care was low (48 257/357 228; 13.5%) and varied between CCGs (median 12.8%, IQR 0.7–18.1%). The greatest geographic variation was for aldosterone antagonists (16.7%, 0.0–40.0%) and least for use of an ECG (96.7%, 92.5–98.7%). The highest rates of care were for acute aspirin (median 92.8%, IQR 88.6–97.1%), and aspirin (90.1%, 85.1–93.3%) and statins (86.4%, 82.3–91.2%) at hospital discharge. The lowest rates were for smoking cessation advice (median 11.6%, IQR 8.7–16.6%), dietary advice (32.4%, 23.9–41.7%) and the prescription of P2Y12 inhibitors (39.7%, 32.4–46.9%). After adjustment for case mix, nearly all (99.6%) of the variation was due to between-hospital differences (median 64.7%, IQR 57.4–70.0%; between-hospital variance: 1.92, 95% CI 1.51 to 2.44; interclass correlation 0.996, 95% CI 0.976 to 0.999).ConclusionsAcross the English NHS, the optimal use of guideline-indicated treatments for NSTEMI was low. Variation in the use of specific treatments for NSTEMI was mostly explained by between-hospital differences in care. Performance-based commissioning may increase the use of NSTEMI treatments and, therefore, reduce premature cardiovascular deaths.Trial registration numberNCT02436187.

Problems in long-term treatment with atypical antipsychotics: hyperprolactinemia

IntroductionSchizophrenia and other psychotic disorders are associated with high rates of morbidity and mortality, caused by the use of specific treatments as well as health factors directly related to those processes. One of the high-frequency side effects in patients treated with classic and atypical antipsychotics is hyperprolactinemia. It causes alterations in neuroendocrine sphere (amenorrhea, galactorrhea, gynecomastia…), and other mid- and long-term effects (osteoporosis, cardiovascular risk increase and increased risk of developing cancers - specifically in breasts and endometrium).ObjectivesCheck hyperprolactinemia induction by maintained treatment with atypical antipsychotics.MethodologyA naturalistic prospective study was conducted following 75 patients on maintenance treatment with a single atypical antipsychotic during 24 months. Anthropometric and laboratory data were collected, along with the presence of different endocrine-metabolic during the 2-year study alterations.ResultsChanges in prolactin levels were found in a large number of patients, with statistically significant differences between 0 (basal) and 24 months (Basal [M = 26.27; SD = 21], 2 years [M = 38.08, SD = 34.65]; t = −2.758; P = 0.013], with hyperprolactinemia increasing from 46.6% of patients at baseline to 65.5% at 2 years, mainly with paliperidone and risperidone long acting injection (statistically significant increase in both cases) (Fig. 1).ConclusionsPaliperidone and risperidone long acting injectable induce increased prolactin levels in patients in long-term antipsychotic treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Current Approaches to the Treatment of Systemic-Sclerosis-Associated Pulmonary Arterial Hypertension (SSc-PAH).

Pulmonary arterial hypertension (PAH) is a severe condition causing significant morbidity and mortality in patients with systemic sclerosis (SSc). Despite the use of specific treatments, SSc-PAH survival remains poorer than in idiopathic PAH (IPAH). Recent therapeutic advances in PAH show a lower magnitude of response in SSc-PAH and a higher risk of adverse events, as compared to IPAH. The multifaceted underlying mechanisms and the multisystem nature of SSc probably explain part of the worse outcomes in SSc-PAH compared to IPAH. This review describes the current management of SSc-PAH with an emphasis on the impact of the different organ involvements in the prognosis and treatment response. An earlier detection of PAH and a better characterization of the clinical phenotypes of SSc-PAH are warranted in clinical practice and future trials. Determinants of prognosis, surrogate markers of clinical improvement or worsening, and relevance of the common endpoints used in clinical trials should be evaluated in this specific population. A multidisciplinary approach in expert referral centers is mandatory for SSc-PAH management.

CPD article: General approach to the poisoned patient

Numerous potential toxic hazards are present in and around the home, and potential poisoning is not an uncommon presentation. Stabilisation is the priority in a critically ill animal, but in many cases animals present before the onset of signs, so a risk assessment is required to determine if decontamination is appropriate and which method (e.g. emesis, gastric lavage or activated charcoal) is best in the specific circumstances. Thereafter, further treatment is supportive, based on clinical signs, the particular risks associated with whatever substance the animal has been exposed to, and the estimated quantity involved. Management may involve laboratory monitoring, and the use of specific treatments and antidotes. If these drugs are not stocked, it is important to know where to obtain them in an emergency. A poisons information centre can provide specific advice on clinical signs and treatment recommendations if required, particularly if the substance involved is unfamiliar.

Therapeutic Approaches for New World Hantaviruses

New World Hantaviruses are characterized by a fairly non-specific viral prodrome, usually followed by a precipitous decline in cardiopulmonary function leading to circulatory collapse and multiorgan failure. Combined with a sporadic nature and unclear epidemiology, the development and use of specific treatments for Hantavirus infection are difficult. The underpinning of any therapeutic approach to Hantavirus disease is providing supportive care long enough for the elaboration of a curative immune response on the part of the patient. At this time, this is best accomplished by a combination of clinical acumen for the recognition of the chief risk factor, namely exposure to rodent excreta, combined with early referral and transfer to a clinical centre capable of providing advanced cardiopulmonary support. Several additional therapies are currently under investigation, ranging from antiviral drugs to convalescent serum. While these offer some early promise, none of these will be able to replace aggressive cardiopulmonary support in the foreseeable future.

What's new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention.

This review provides a summary of key findings from 22 systematic reviews on atopic eczema (AE) published over the 2-year period from January 2012 to 31 December 2013, focusing on prevention and treatment of AE. For an update of systematic reviews on the epidemiology, mechanisms of disease and methodological issues, see Part 1 of this update. Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life. Exposure to household pets, especially dogs, may also be protective, but exclusive breastfeeding for up to 7 months does not confer benefit. The role of vitamin D in preventing AE is currently unclear. Very few of the systematic reviews provided additional evidence for the use of specific treatments for AE. Further research is required to establish the role of desensitization, Chinese herbal medicines, homeopathy and specialist clothing. Nevertheless, there is now clear evidence that evening primrose oil and borage oil are not effective for the treatment of AE. There have been no randomized controlled trials on the use of H1 anti-histamines as monotherapy for the treatment of AE.

EPA-0589 - Toc and psychosis: when obsessions become delusions

For many years it has raised a possible association between obsessive and psychotic disorders. To enter in this topic, we present the case of a 6 year old's patient who presented tics, coprolalia, obsessive-compulsive symptoms (contamination, symmetry, accumulation) and behavioral disorders being diagnosed of Tourette's disorder. With the use of specific treatment remained stable until age 12 when obsessive thoughts changed from absurds ranges to delusional ranges causing behavioral disorganization. Furthermore, delirious humor, depersonalization and delusions were added. This led to increase the dose of antidepressants with a partial response of obsessives symptoms and persistance of psychotics symptoms; so it was Aripiprazole treatment required. Subsequently it was attempted to remove the antipsychotic drug, but it was not achieved because delirious symptoms reappeared. Finally, the patient was diagnosed of Tourette's disorder and undifferentiated schizophrenia. Thus, We might consider that exist a link between the obsessives and psychotics symptom?. We present a review of the literature in order to elucidate the association between the two entities.

Management of chronic obstructive pulmonary disease in the Middle East and North Africa: Results of the BREATHE study

Chronic obstructive pulmonary disease (COPD) is a potentially severe chronic progressive respiratory condition requiring long-term treatment and frequently involving episodic hospitalisations to manage exacerbations. The objective of this analysis was to document diagnosis, evaluation, treatment and management of COPD-related respiratory symptoms in 1,392 subjects fulfilling an epidemiological definition of COPD identified in a general population sample of 62,086 individuals aged ≥ 40 years in ten countries in the Middle East and North Africa region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. 442 subjects (31.8%) claimed to have received a diagnosis of COPD from a physician and 287 (20.6%) had undergone spirometry in the previous year. Use of specific treatments for respiratory symptoms was reported by 218 subjects (15.7%). Use of inhaled long-acting bronchodilators together with corticosteroids (53 subjects; 3.8%) and use of oxygen therapy (31 subjects; 2.3%) was very low. 852 subjects (61.2%) had consulted a physician about their respiratory condition at least once in the previous year, with a mean number of consultations of 3.4 ± 3.6. Moreover, 284 subjects (20.4%) had been hospitalised overnight for their COPD, with a mean of 2.3 ± 3.7 hospitalisations per year. Use of all healthcare resources was significantly higher (p < 0.001) in subjects with CAT scores ≥ 10 than in those with scores < 10, and greater in those with exacerbations than in those without. In conclusion, COPD in the region is under-diagnosed, inadequately evaluated and inadequately treated. Nonetheless, COPD symptoms are responsible for considerable healthcare consumption, with high levels of physician consultation and hospitalisation.