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Archive for the ‘CHILDREN’ Category

Acute bronchiolitis

Andrew Bush, professor of paediatric respirology. BMJ  2007;335:1037-1041 (17 November).

Acute bronchiolitis is a clinical diagnosis. It “is a seasonal viral illness, characterised by fever, nasal discharge and dry, wheezy cough. On examination, there are fine inspiratory crackles and/or high-pitched expiratory wheeze.

Summary points:

• Bronchiolitis caused by respiratory syncytial virus is an important and seasonal cause of respiratory morbidity in the first year of life
No effective preventive or therapeutic strategies exist, and supportive management is offered
Unnecessary investigations and ineffective treatment must be avoided
Many infants have medium to long term post-bronchiolitic symptoms, which should not be confused with true asthma and which do not respond to any current treatments

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BMJ  2007;335:663-666 (29 September).

Managing anovulatory infertility and polycystic ovary syndrome

BY: Adam H Balen, professor of reproductive medicine and surgery, Anthony J Rutherford, consultant in reproductive medicine and surgery.

Summary points

  • Polycystic ovary syndrome is the most common endocrine problem affecting women and the most common cause of anovulatory infertility
  • Oral clomifene citrate remains the first line treatment to induce ovulation
  • Gonadotrophin treatment needs careful monitoring to reduce risk of multiple pregnancy
  • Despite early promise, the role of metformin and insulin lowering agents is unclear in the management of anovulatory polycystic ovary syndrome

Anovulation is the cause of infertility in about a third of couples attending infertility clinics, and polycystic ovary syndrome accounts for 90% of such cases.

The definition of polycystic ovary syndrome recognises obesity as an association and not a diagnostic criterion. Only 40-50% of women with the syndrome are overweight.

Obesity has a profound effect on both natural and assisted conception—it influences the chance of becoming pregnant and the likelihood of a healthy pregnancy. Obesity is associated with increased rates of congenital anomalies (neural tube defects and cardiac defects), miscarriage, gestational diabetes, hypertension, problems during delivery, stillbirth, and maternal mortality.

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BMJ 2007;335:618 (22 September).

Doping in sport—a warning from history.

East German athletes who were doped to win gold medals in 1976 Olympics now struggle with chronic health problems.

Sport is tough, mean, and uncompromising.

The German Democratic Republic looked coldly at what was required and did it. Potential medal winners were selected at an early age for sports school, trained, and prepared systematically.

Athletes were given oral anabolic steroids until the time of competition but were injected with testosterone during competition as it was then undetectable.

It is the involuntary and systematic abuse of underage athletes that hits hardest. These athletes, recruited from as young as 10 years old, did not know what medication they were taking and were discouraged from asking.

The sports doctors had signed a confidentiality agreement, monitored by the East German secret police, the Stasi. They made no protest, and 70 of them were later convicted of illegal doping.

We were left wondering where those doctors are now and how they feel about their role.

Perhaps it is a little unfair to judge history by current standards. But doping remains a part of sport.

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BMJ 2007;335:607 (22 September).

BMJ updates

Second generation antidepressants should remain an option for children and adolescents with depression or anxiety.

Are second generation antidepressants associated with suicidal ideation or suicide attempts in children and adolescents with depression or anxiety?

Answer Yes, but the risk is small and statistically non-significant. In general, the benefits of these agents outweigh the risks.

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