RESUMO
Vertebral fracture (VF) is the most common type of osteoporotic fracture. VFs are associated with a decline in quality of life and high morbidity and mortality. The presence of a VF is a significant risk factor for developing another fracture; however, most VFs are not clinically recognized and diagnosed. Vertebral fracture assessment by dual-energy X-ray absorptiometry is a low cost, low radiation, convenient, and reliable method to identify VFs. The finding of a previously unrecognized VF may change the assessment of fracture risk, diagnostic classification, and treatment strategies. Vertebral fracture assessment or radiographic lateral spine imaging should be repeated in patients with continued high risk for fracture (e.g., historical height loss >4 cm [>1.5 inches], self-reported but undocumented vertebral fracture, or glucocorticoid therapy equivalent to ≥5 mg of prednisone or equivalent per day for greater than or equal to 3 months).
Assuntos
Absorciometria de Fóton/normas , Conferências de Consenso como Assunto , Fraturas por Osteoporose/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Humanos , RecidivaAssuntos
Desenvolvimento de Medicamentos/tendências , Pediatria/tendências , Criança , Ensaios Clínicos como Assunto , Rotulagem de Medicamentos , Guias como Assunto , Humanos , Participação do Paciente , Sulfanilamida/efeitos adversos , Talidomida/efeitos adversos , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVE: To determine the relationship between allelic variations in genes involved in fluticasone propionate (FP) metabolism and asthma control among children with asthma managed with inhaled FP. STUDY DESIGN: The relationship between variability in asthma control scores and genetic variation in drug metabolism was assessed by genotyping 9 single nucleotide polymorphisms in the CYP3A4, CYP3A5, and CYP3A7 genes. Genotype information was compared with asthma control scores (0=well controlled to 15=poorly controlled), determined using a questionnaire modified from the National Heart Lung and Blood Institute's Expert Panel 3 guidelines. RESULTS: Our study cohort comprised 734 children with asthma (mean age, 8.8±4.3 years) and was predominantly male (61%) and non-Hispanic white (53%). More than one-half of the children (56%; n=413) were receiving an inhaled glucocorticoid daily, with FP the most frequently prescribed agent (65%). Among the children receiving daily FP, single nucleotide polymorphisms in CYP3A5 and CYP3A7 were not associated with asthma control scores. In contrast, asthma control scores were significantly improved in the 20 children (7%) with the CYP3A4*22 allele (median, 3; range, 0-6) compared with the 201 children without the CYP3A4*22 allele (median, 4; range, 0-15; P=.02). The presence of CYP3A4*22 was associated with improved asthma control scores by 2.1 points (95% CI, 0.5-3.8). CONCLUSION: The presence of CYP3A4*22, which is associated with decreased hepatic CYP3A4 expression and activity, was accompanied by improved asthma control in the FP-treated children. Decreased CYP3A4 activity may improve asthma control with inhaled FP.
Assuntos
Androstadienos/farmacocinética , Asma/tratamento farmacológico , Broncodilatadores/farmacocinética , Citocromo P-450 CYP3A/genética , Administração por Inalação , Adolescente , Androstadienos/administração & dosagem , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Feminino , Fluticasona , Humanos , Masculino , Farmacogenética , Polimorfismo Genético , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
The annular pancreas remains an intriguing congenital anomaly. Many theories have sought to explain its embryological basis; however, no consensus has yet been reached regarding the exact mechanism of aberration. More recently, molecular investigations have shed light on some of these theories, confirming the origination of annular tissue from the ventral pancreatic bud. These studies highlight the role of the hedgehog signaling pathway in the development of this anomaly. Overexpression of the ventral-specific gene transmembrane 4 superfamily member 3 (tm4sf3) has also been associated with annular formation. Moreover, isolated case reports of familial annular pancreas have also been documented, suggesting a genetic basis for the development of this anomaly. Annular pancreas can initially present in childhood or adulthood with symptoms of duodenal obstruction and is diagnosed using a variety of imaging modalities. Treatment usually involves surgical correction, with bypass procedures (e.g. duodenoduodenostomy, gastrojejunostomy or duodenojejunostomy) currently favored over annular resection due to complications associated with the latter approach.
Assuntos
Pancreatopatias/genética , Adulto , Anastomose Cirúrgica , Obstrução Duodenal/etiologia , Obstrução Duodenal/genética , Feminino , Terapia Genética , Proteínas Hedgehog/genética , Proteínas Hedgehog/fisiologia , Humanos , Pâncreas/anormalidades , Pâncreas/patologia , Pancreatopatias/diagnóstico , Pancreatopatias/patologia , Gravidez , Transdução de Sinais/genética , Transdução de Sinais/fisiologiaRESUMO
A new species, Tetracha (Neotetracha) naviauxi, and a new subspecies, Tetracha (Tetracha) sobrina caicosensis, are described from the Turks and Caicos Islands. The key to Tetracha species in Naviaux (2007) is adapted to accommodate Tetracha naviauxi. Tetracha sobrina caicosensis is compared to other Caribbean subspecies of Tetracha sobrina.