AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mostly causes confusion with our undifferentiated patients. In fact, the guidelines may potentially create unnecessary vulnerabilities in our clinical practice by minimalizing our approach to these wheezing infants. Clinical evaluations, workups, and treatments seem to be discouraged.Diagnosis under the AAP Guidelines1a. Clinicians should diagnose bronchiolitis and assess disease severity based on history and physical examination. (Evidence Quality: B; Recommendation Strength: Strong Recommendation.)1b. Clinicians should assess risk factors for severe disease, such as age under 12 weeks, a history of prematurity, underlying cardiopulmonary disease, or immunodeficiency, when making decisions about the evaluation and management of children with bronchiolitis. (Evidence Quality: B; Recommendation Strength: Moderate Recommendation.)1c. Radiographic or laboratory studies s...
This study sought to investigate the relationship between galectin-3 (Gal-3), myocardial fibrosis (MF) and outcomes in acute heart failure. Materials &methods: The single-nucleotide polymorphisms (SNPs) of LGALS3 at rs4644 and rs4652, plasma Gal-3 level, MF and major adverse events (MAEs) were obtained. Results: There was no significant difference in MAEs when categorizing patients by the LGALS3 SNPs at rs4644 and rs4652. The circulating Gal-3 was related to the degree of MF (p
Publication date: Available online 18 September 2020Source: Life SciencesAuthor(s): Nosayba Al-Azzam, Lina Elsalem
Number of cases worldwide passes 30 million; Victoria announces 21 new Covid-19 cases and seven more deaths; UK faces possible second national lockdown. Follow all the developmentsMutant virus: should we be worried that Sars-CoV-2 is changing ?UK entering second wave of virus, Johnson warns‘Shocking’: Trump under fire from ex-adviser for Covid failures5.31amBSTThe Victorian Department of Health and Human Services has put out some more information on the latest case numbers today.The 21 cases is the lowest number of new cases since 24 June.Of the 834 current active cases in Victoria:5.12amBSTThe Australian minis...
Authors: Mandlik DS, Mandlik SK Abstract Asthma is the most common, long-lasting inflammatory airway disease that affects more than 10% of the world population. It is characterized by bronchial narrowing, airway hyperresponsiveness, vasodilatation, airway edema and stimulation of sensory nerve endings that lead to recurring events of breathlessness, wheezing, chest tightness and coughing. It is the main reason for global morbidity and occurs as a result of the weakening of the immune system in response to exposure to allergens or environmental exposure. In asthma condition, it results in the activation of numerous ...
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Publication date: Available online 18 September 2020Source: Indian Heart JournalAuthor(s): Prakash Chand Negi, Arvind Kandoria, Sanjeev Asotra, Neeraj kumar Ganju, Rajeev Merwaha, Rajesh Sharma, Kunal Mahajan, Shivani Rao, a
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