RESUMEN
BACKGROUND: Influenza infection is responsible for thousands of hospitalizations and deaths in the United States each year. Until recently, management options were limited to vaccination or use of the antiviral agents amantadine and rimantadine. Two antiviral drugs, zanamivir and oseltamivir, have recently been approved by the US Food and Drug Administration for the treatment of influenza A and influenza B. OBJECTIVE: This article reviews the published data on the pharmacology and clinical utility of zanamivir and oseltamivir in the treatment and prevention of influenza A and influenza B illness. METHODS: To identify relevant literature, a search of MEDLINE, International Pharmaceutical Abstracts, and the Iowa Drug Information Service was conducted for the period from 1969 to 2000. The search terms used were influenza, neuraminidase, zanamivir, oseltamivir; amantadine, and rimantadine. The reference lists of the articles so obtained were used to identify additional publications. RESULTS: Zanamivir and oseltamivir inactivate viral neuraminidase, an enzyme responsible for cleaving sialic acid residues on newly formed virions as they bud off from the host cell. This inhibition results in aggregation of virions on the surface of the host cell, which limits the extent of infection and speeds recovery from illness. Clinical studies have shown that neuraminidase inhibitors can decrease the median duration of influenza-related symptoms by approximately 1 day if initiated within 48 hours of the onset of symptoms of influenza. CONCLUSIONS: Evidence supports the use of zanamivir and oseltamivir in the treatment of influenza; however, additional studies are needed to clarify their utility and tolerability in pediatric and high-risk patients, as well as their utility in the prevention of influenza.
Asunto(s)
Acetamidas/uso terapéutico , Antivirales/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Gripe Humana/tratamiento farmacológico , Neuraminidasa/antagonistas & inhibidores , Ácidos Siálicos/uso terapéutico , Acetamidas/efectos adversos , Animales , Guanidinas , Humanos , Gripe Humana/prevención & control , Oseltamivir , Piranos , Ácidos Siálicos/efectos adversos , ZanamivirRESUMEN
Because admission to a regional child and adolescent psychiatric unit is often fraught with difficulties children with psychiatric disorders were admitted to a general children's ward. Over the four years (1980-4) 24 patients accounted for 31 admissions. Of these, five had feeding disorders (anorexia, bulimia), seven neuroses, three psychoses, four elimination disorders, and five other diagnoses. All the children were later discharged to their homes, most having appreciably improved. Because of the proximity of the hospital to the child's natural environment work with the families and schools was not interrupted by the admission. The results of this approach are encouraging and could have implications for future planning of services for this category of patients.
Asunto(s)
Hospitales de Distrito , Hospitales Generales , Hospitales Públicos , Trastornos Mentales/terapia , Adolescente , Factores de Edad , Niño , Preescolar , Inglaterra , Femenino , Hospitalización , Humanos , Masculino , Psicoterapia , Factores SexualesRESUMEN
A review of 950 patients who had waited for more than one year for orthopaedic treatment at a large District General Hospital was undertaken. Searches of medical records eliminated 193 patients who had already had operations, but, whose names had not been removed from the list. Of the remaining 757 patients, 48% indicated their wish to remain on the list. This proportion was lowest for: the under 45 year old age group (43%), the over 75s (36%), patients awaiting less complex procedures (35%) and those with waiting times longer than five years (31%).
Asunto(s)
Citas y Horarios , Departamentos de Hospitales/estadística & datos numéricos , Ortopedia , Listas de Espera , Recolección de Datos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Reino UnidoRESUMEN
Forty-seven migrainous children were examined medically, neurologically and psychiatrically and compared with matched controls from a dental clinic. One in six children suffered from more than one type of migraine. There was a wide variation in age of onset and the frequency and duration of attacks varied considerably. An "emotional upset" was the most frequently reported (86%) precipitating factor. Most children responded to simple therapeutic measures and detailed instructions about the timely use of medication. A significantly higher proportion of migrainous children than their controls showed signs of a neurotic disorder (mainly anxiety or depression) and had had a higher prevalence of neurotic disorder in the previous year. This increased prevalence was found to be associated with a disturbed parental relationship and certain factors related to their mothers (age, "malaise" score). A prospective study of an epidemiological sample based on systematic observation rather than recollections and opinions is likely to yield more conclusive results.