Robert Finn

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided, investigators reported in the August 2007 issue of Pediatric Neurology.

Some clinicians advocate early steroid use for optic neuritis, but others say steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and colleagues from Hippokration General Hospital, Thessaloniki (Greece).

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye. The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138-9). Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk. Visual-evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye. After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor.

The investigators noted optic neuritis is a rare complication of varicella. It often accompanies complications like acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. Pathogenesis is unknown. The condition may result from direct viral invasions or from an autoimmune mechanism.

Steroid treatment is usually contraindicated since the disease typically improves rapidly and spontaneously. However, steroids do seem appropriate in bilateral optic neuritis after chickenpox, they noted.

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided, investigators reported in the August 2007 issue of Pediatric Neurology.

Some clinicians advocate early steroid use for optic neuritis, but others say steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and colleagues from Hippokration General Hospital, Thessaloniki (Greece).

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye. The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138-9). Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk. Visual-evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye. After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor.

The investigators noted optic neuritis is a rare complication of varicella. It often accompanies complications like acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. Pathogenesis is unknown. The condition may result from direct viral invasions or from an autoimmune mechanism.

Steroid treatment is usually contraindicated since the disease typically improves rapidly and spontaneously. However, steroids do seem appropriate in bilateral optic neuritis after chickenpox, they noted.

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided, investigators reported in the August 2007 issue of Pediatric Neurology.

Some clinicians advocate early steroid use for optic neuritis, but others say steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and colleagues from Hippokration General Hospital, Thessaloniki (Greece).

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye. The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138-9). Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk. Visual-evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye. After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor.

The investigators noted optic neuritis is a rare complication of varicella. It often accompanies complications like acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. Pathogenesis is unknown. The condition may result from direct viral invasions or from an autoimmune mechanism.

Steroid treatment is usually contraindicated since the disease typically improves rapidly and spontaneously. However, steroids do seem appropriate in bilateral optic neuritis after chickenpox, they noted.

Two different cholesterol-lowering drugs reduce inflammation, disease activity, and aortic stiffness, and also improve endothelial function in patients with rheumatoid arthritis.

Participants in this randomized, double-blind crossover study included 20 patients with active rheumatoid arthritis (RA), defined as a disease activity score 28 (DAS28) greater than 3.5 and a C-reactive protein (CRP) level above 6 mg/L. None of the participants had cardiovascular disease, untreated hypertension, diabetes, elevated cholesterol, or renal disease, and none was a smoker.

Following a 2-week period during which all participants received placebo, they were given either 20 mg simvastatin or 10 mg ezetimibe for 6 weeks each, separated by a 6-week washout period before receiving the other drug for 6 weeks.

At baseline, the aortic pulse-wave velocity (PWV), a marker of aortic stiffness, was significantly higher in patients with RA than in 20 age-matched, healthy controls (9.42 m/s vs. 7.69 m/s, respectively). Likewise, flow-mediated dilatation (FMD) of the brachial artery, a marker of endothelial function, was reduced at baseline in RA patients, compared with controls. Both drugs reduced PWV while increasing FMD, but in neither case did the improvements achieve statistical significance.

Both drugs reduced total cholesterol significantly, from 5.3 mmol/L at baseline to 4.7 mmol/L for ezetimibe, and from a baseline of 5.4 mmol/L to 4.1 mmol/L for simvastatin. Likewise, both drugs reduced LDL cholesterol, from a baseline value of 3.08 mmol/L to 2.53 mmol/L for ezetimibe, and from a baseline of 3.18 mmol/L to 1.95 mmol/L for simvastatin.

Improvements—albeit less statistically significant ones—were seen in two markers of inflammation on both drugs. The erythrocyte sedimentation rate (ESR) dropped from a baseline of 18.2 mm/hour to 12.9 mm/hour for ezetimibe, and from a baseline of 18.6 mm/hour to 13.8 mm/hour for simvastatin. C-reactive protein (CRP) dropped from a baseline of 14.2 mg/L to 8.8 mg/L for ezetimibe, and from a baseline of 15.3 mg/L to 10.3 mg/L for simvastatin.

The patients' disease activity score also decreased somewhat, from a DAS28 of 4.41 at baseline to 3.86 for ezetimibe, and from a baseline DAS28 of 4.65 to 3.98 for simvastatin (J. Am. Coll. Cardiol. 2007;50:852-8).

Because two cholesterol-lowering agents operating by two different mechanisms each had these effects, it appears that it was the reduction in cholesterol itself that was responsible for reducing aortic stiffness and endothelial function, wrote Kaisa M. Mäki-Petäjä and her colleagues at the University of Cambridge (England).

And because the agents also reduced ESR and CRP—both markers of inflammation—as well as the rheumatoid arthritis composite DAS28, the investigators suggested that cholesterol-reducing therapies may benefit RA patients. These agents are well tolerated, improve clinical outcome in patients at risk for heart disease, and reduce surrogates of cardiovascular risk.

The investigators acknowledged, however, that future studies will be needed to establish whether reducing arterial stiffness and improving endothelial function with drugs intended to reduce hyperlipidemia will translate into an overall improvement in cardiovascular outcome in patients with RA.

The effects of simvastatin and ezetimibe differed significantly in a number of parameters. Simvastatin was better at reducing total cholesterol, LDL cholesterol, and oxidized LDL cholesterol. But they were equally effective in all other measures, including reducing inflammatory markers and aortic PWV, and increasing FMD. They were also equally effective in improving the tender-joints count and the swollen-joints count, the authors wrote.

Throughout the study, patients remained on their RA therapy, which consisted of methotrexate in 13 patients, NSAIDs in 14, prednisolone in nine, and other disease-modifying drugs in seven. In all, 18 patients took two or more drugs concomitantly and none was off RA drugs completely.

Ms. Mäki-Petäjä disclosed that her doctoral studies are funded by GlaxoSmithKline Inc., and one of the other investigators on the study disclosed receiving funding from Pfizer. Neither company is involved in marketing simvastatin or ezetimibe, both of which are manufactured by Merck & Co.

Two different cholesterol-lowering drugs reduce inflammation, disease activity, and aortic stiffness, and also improve endothelial function in patients with rheumatoid arthritis.

Participants in this randomized, double-blind crossover study included 20 patients with active rheumatoid arthritis (RA), defined as a disease activity score 28 (DAS28) greater than 3.5 and a C-reactive protein (CRP) level above 6 mg/L. None of the participants had cardiovascular disease, untreated hypertension, diabetes, elevated cholesterol, or renal disease, and none was a smoker.

Following a 2-week period during which all participants received placebo, they were given either 20 mg simvastatin or 10 mg ezetimibe for 6 weeks each, separated by a 6-week washout period before receiving the other drug for 6 weeks.

At baseline, the aortic pulse-wave velocity (PWV), a marker of aortic stiffness, was significantly higher in patients with RA than in 20 age-matched, healthy controls (9.42 m/s vs. 7.69 m/s, respectively). Likewise, flow-mediated dilatation (FMD) of the brachial artery, a marker of endothelial function, was reduced at baseline in RA patients, compared with controls. Both drugs reduced PWV while increasing FMD, but in neither case did the improvements achieve statistical significance.

Both drugs reduced total cholesterol significantly, from 5.3 mmol/L at baseline to 4.7 mmol/L for ezetimibe, and from a baseline of 5.4 mmol/L to 4.1 mmol/L for simvastatin. Likewise, both drugs reduced LDL cholesterol, from a baseline value of 3.08 mmol/L to 2.53 mmol/L for ezetimibe, and from a baseline of 3.18 mmol/L to 1.95 mmol/L for simvastatin.

Improvements—albeit less statistically significant ones—were seen in two markers of inflammation on both drugs. The erythrocyte sedimentation rate (ESR) dropped from a baseline of 18.2 mm/hour to 12.9 mm/hour for ezetimibe, and from a baseline of 18.6 mm/hour to 13.8 mm/hour for simvastatin. C-reactive protein (CRP) dropped from a baseline of 14.2 mg/L to 8.8 mg/L for ezetimibe, and from a baseline of 15.3 mg/L to 10.3 mg/L for simvastatin.

The patients' disease activity score also decreased somewhat, from a DAS28 of 4.41 at baseline to 3.86 for ezetimibe, and from a baseline DAS28 of 4.65 to 3.98 for simvastatin (J. Am. Coll. Cardiol. 2007;50:852-8).

Because two cholesterol-lowering agents operating by two different mechanisms each had these effects, it appears that it was the reduction in cholesterol itself that was responsible for reducing aortic stiffness and endothelial function, wrote Kaisa M. Mäki-Petäjä and her colleagues at the University of Cambridge (England).

And because the agents also reduced ESR and CRP—both markers of inflammation—as well as the rheumatoid arthritis composite DAS28, the investigators suggested that cholesterol-reducing therapies may benefit RA patients. These agents are well tolerated, improve clinical outcome in patients at risk for heart disease, and reduce surrogates of cardiovascular risk.

The investigators acknowledged, however, that future studies will be needed to establish whether reducing arterial stiffness and improving endothelial function with drugs intended to reduce hyperlipidemia will translate into an overall improvement in cardiovascular outcome in patients with RA.

The effects of simvastatin and ezetimibe differed significantly in a number of parameters. Simvastatin was better at reducing total cholesterol, LDL cholesterol, and oxidized LDL cholesterol. But they were equally effective in all other measures, including reducing inflammatory markers and aortic PWV, and increasing FMD. They were also equally effective in improving the tender-joints count and the swollen-joints count, the authors wrote.

Throughout the study, patients remained on their RA therapy, which consisted of methotrexate in 13 patients, NSAIDs in 14, prednisolone in nine, and other disease-modifying drugs in seven. In all, 18 patients took two or more drugs concomitantly and none was off RA drugs completely.

Ms. Mäki-Petäjä disclosed that her doctoral studies are funded by GlaxoSmithKline Inc., and one of the other investigators on the study disclosed receiving funding from Pfizer. Neither company is involved in marketing simvastatin or ezetimibe, both of which are manufactured by Merck & Co.

Two different cholesterol-lowering drugs reduce inflammation, disease activity, and aortic stiffness, and also improve endothelial function in patients with rheumatoid arthritis.

Participants in this randomized, double-blind crossover study included 20 patients with active rheumatoid arthritis (RA), defined as a disease activity score 28 (DAS28) greater than 3.5 and a C-reactive protein (CRP) level above 6 mg/L. None of the participants had cardiovascular disease, untreated hypertension, diabetes, elevated cholesterol, or renal disease, and none was a smoker.

Following a 2-week period during which all participants received placebo, they were given either 20 mg simvastatin or 10 mg ezetimibe for 6 weeks each, separated by a 6-week washout period before receiving the other drug for 6 weeks.

At baseline, the aortic pulse-wave velocity (PWV), a marker of aortic stiffness, was significantly higher in patients with RA than in 20 age-matched, healthy controls (9.42 m/s vs. 7.69 m/s, respectively). Likewise, flow-mediated dilatation (FMD) of the brachial artery, a marker of endothelial function, was reduced at baseline in RA patients, compared with controls. Both drugs reduced PWV while increasing FMD, but in neither case did the improvements achieve statistical significance.

Both drugs reduced total cholesterol significantly, from 5.3 mmol/L at baseline to 4.7 mmol/L for ezetimibe, and from a baseline of 5.4 mmol/L to 4.1 mmol/L for simvastatin. Likewise, both drugs reduced LDL cholesterol, from a baseline value of 3.08 mmol/L to 2.53 mmol/L for ezetimibe, and from a baseline of 3.18 mmol/L to 1.95 mmol/L for simvastatin.

Improvements—albeit less statistically significant ones—were seen in two markers of inflammation on both drugs. The erythrocyte sedimentation rate (ESR) dropped from a baseline of 18.2 mm/hour to 12.9 mm/hour for ezetimibe, and from a baseline of 18.6 mm/hour to 13.8 mm/hour for simvastatin. C-reactive protein (CRP) dropped from a baseline of 14.2 mg/L to 8.8 mg/L for ezetimibe, and from a baseline of 15.3 mg/L to 10.3 mg/L for simvastatin.

The patients' disease activity score also decreased somewhat, from a DAS28 of 4.41 at baseline to 3.86 for ezetimibe, and from a baseline DAS28 of 4.65 to 3.98 for simvastatin (J. Am. Coll. Cardiol. 2007;50:852-8).

Because two cholesterol-lowering agents operating by two different mechanisms each had these effects, it appears that it was the reduction in cholesterol itself that was responsible for reducing aortic stiffness and endothelial function, wrote Kaisa M. Mäki-Petäjä and her colleagues at the University of Cambridge (England).

And because the agents also reduced ESR and CRP—both markers of inflammation—as well as the rheumatoid arthritis composite DAS28, the investigators suggested that cholesterol-reducing therapies may benefit RA patients. These agents are well tolerated, improve clinical outcome in patients at risk for heart disease, and reduce surrogates of cardiovascular risk.

The investigators acknowledged, however, that future studies will be needed to establish whether reducing arterial stiffness and improving endothelial function with drugs intended to reduce hyperlipidemia will translate into an overall improvement in cardiovascular outcome in patients with RA.

The effects of simvastatin and ezetimibe differed significantly in a number of parameters. Simvastatin was better at reducing total cholesterol, LDL cholesterol, and oxidized LDL cholesterol. But they were equally effective in all other measures, including reducing inflammatory markers and aortic PWV, and increasing FMD. They were also equally effective in improving the tender-joints count and the swollen-joints count, the authors wrote.

Throughout the study, patients remained on their RA therapy, which consisted of methotrexate in 13 patients, NSAIDs in 14, prednisolone in nine, and other disease-modifying drugs in seven. In all, 18 patients took two or more drugs concomitantly and none was off RA drugs completely.

Ms. Mäki-Petäjä disclosed that her doctoral studies are funded by GlaxoSmithKline Inc., and one of the other investigators on the study disclosed receiving funding from Pfizer. Neither company is involved in marketing simvastatin or ezetimibe, both of which are manufactured by Merck & Co.

SAN FRANCISCO — Intensive care unit patients leave the hospital more than 4 days early if they receive spontaneous awakening and breathing trials every day, Dr. E. Wesley Ely said at the International Conference of the American Thoracic Society.

The multicenter, controlled ABC (awakening, breathing, controlled) trial involved 335 patients randomized to either standard goal-directed sedation or the awakening, breathing approach.

Compared with controls, the ABC trial patients left the ICU an average of 3.8 days sooner (9.1 days vs. 12.9 days), were discharged from the hospital 4.4 days sooner (14.8 days vs. 19.2 days), and spent 3.1 more days alive and off the ventilator (14.7 days vs. 11.6 days). There was no significant difference in the percentage of patients who survived for 28 days or more (72% for the ABC patients, 65% for controls).

“You can save somewhere in the neighborhood of $5,000–$15,000 per patient via protocols like this,” said Dr. Ely of Vanderbilt University, Nashville, Tenn.

Earlier studies demonstrated daily breathing trials improved the outcomes of ventilated patients, and daily lifting of medically induced comas improved the outcomes of critical care patients. This was the first trial to put both of those protocols together.

“For years we have not optimized the removal of those sedatives, analgesics, and the ventilator. Instead, we allow the patients on average to probably get 2 or 3 days of additional unnecessary time on the ventilator, all the while being exposed to these high doses of very potent psychoactive drugs, “Dr. Ely said. “On average patients receive too long of a duration and too high of a dose of these medicines, and while it's well intentioned,… I think we're overshooting. People generally think of these drugs as not harmful, but we're actually finding that ICU delirium, which is a result of these drugs, is a very important predictor of death.”

The ABC trial protocol is easy to implement, Dr. Ely said. All it takes is the will to make the change among the providers who manage patients in the ICU.

About half the patients enrolled in the trial had sepsis or acute respiratory distress syndrome. Other common diagnoses were myocardial infarction/congestive heart failure, chronic obstructive pulmonary disease/asthma, and altered mental status. Surgical ICU patients were excluded because the investigators did not want to discontinue analgesia in patients with incisions.

Dr. Ely emphasized patients under the ABC trial protocol must be watched closely. “A very important point here is that we did not sacrifice patient comfort,” he said. If patients exhibited signs of distress such as rapid breathing or sweating, sedation and analgesia were resumed, beginning at half the previous dose.

SAN FRANCISCO — Intensive care unit patients leave the hospital more than 4 days early if they receive spontaneous awakening and breathing trials every day, Dr. E. Wesley Ely said at the International Conference of the American Thoracic Society.

The multicenter, controlled ABC (awakening, breathing, controlled) trial involved 335 patients randomized to either standard goal-directed sedation or the awakening, breathing approach.

Compared with controls, the ABC trial patients left the ICU an average of 3.8 days sooner (9.1 days vs. 12.9 days), were discharged from the hospital 4.4 days sooner (14.8 days vs. 19.2 days), and spent 3.1 more days alive and off the ventilator (14.7 days vs. 11.6 days). There was no significant difference in the percentage of patients who survived for 28 days or more (72% for the ABC patients, 65% for controls).

“You can save somewhere in the neighborhood of $5,000–$15,000 per patient via protocols like this,” said Dr. Ely of Vanderbilt University, Nashville, Tenn.

Earlier studies demonstrated daily breathing trials improved the outcomes of ventilated patients, and daily lifting of medically induced comas improved the outcomes of critical care patients. This was the first trial to put both of those protocols together.

“For years we have not optimized the removal of those sedatives, analgesics, and the ventilator. Instead, we allow the patients on average to probably get 2 or 3 days of additional unnecessary time on the ventilator, all the while being exposed to these high doses of very potent psychoactive drugs, “Dr. Ely said. “On average patients receive too long of a duration and too high of a dose of these medicines, and while it's well intentioned,… I think we're overshooting. People generally think of these drugs as not harmful, but we're actually finding that ICU delirium, which is a result of these drugs, is a very important predictor of death.”

The ABC trial protocol is easy to implement, Dr. Ely said. All it takes is the will to make the change among the providers who manage patients in the ICU.

About half the patients enrolled in the trial had sepsis or acute respiratory distress syndrome. Other common diagnoses were myocardial infarction/congestive heart failure, chronic obstructive pulmonary disease/asthma, and altered mental status. Surgical ICU patients were excluded because the investigators did not want to discontinue analgesia in patients with incisions.

Dr. Ely emphasized patients under the ABC trial protocol must be watched closely. “A very important point here is that we did not sacrifice patient comfort,” he said. If patients exhibited signs of distress such as rapid breathing or sweating, sedation and analgesia were resumed, beginning at half the previous dose.

SAN FRANCISCO — Intensive care unit patients leave the hospital more than 4 days early if they receive spontaneous awakening and breathing trials every day, Dr. E. Wesley Ely said at the International Conference of the American Thoracic Society.

The multicenter, controlled ABC (awakening, breathing, controlled) trial involved 335 patients randomized to either standard goal-directed sedation or the awakening, breathing approach.

Compared with controls, the ABC trial patients left the ICU an average of 3.8 days sooner (9.1 days vs. 12.9 days), were discharged from the hospital 4.4 days sooner (14.8 days vs. 19.2 days), and spent 3.1 more days alive and off the ventilator (14.7 days vs. 11.6 days). There was no significant difference in the percentage of patients who survived for 28 days or more (72% for the ABC patients, 65% for controls).

“You can save somewhere in the neighborhood of $5,000–$15,000 per patient via protocols like this,” said Dr. Ely of Vanderbilt University, Nashville, Tenn.

Earlier studies demonstrated daily breathing trials improved the outcomes of ventilated patients, and daily lifting of medically induced comas improved the outcomes of critical care patients. This was the first trial to put both of those protocols together.

“For years we have not optimized the removal of those sedatives, analgesics, and the ventilator. Instead, we allow the patients on average to probably get 2 or 3 days of additional unnecessary time on the ventilator, all the while being exposed to these high doses of very potent psychoactive drugs, “Dr. Ely said. “On average patients receive too long of a duration and too high of a dose of these medicines, and while it's well intentioned,… I think we're overshooting. People generally think of these drugs as not harmful, but we're actually finding that ICU delirium, which is a result of these drugs, is a very important predictor of death.”

The ABC trial protocol is easy to implement, Dr. Ely said. All it takes is the will to make the change among the providers who manage patients in the ICU.

About half the patients enrolled in the trial had sepsis or acute respiratory distress syndrome. Other common diagnoses were myocardial infarction/congestive heart failure, chronic obstructive pulmonary disease/asthma, and altered mental status. Surgical ICU patients were excluded because the investigators did not want to discontinue analgesia in patients with incisions.

Dr. Ely emphasized patients under the ABC trial protocol must be watched closely. “A very important point here is that we did not sacrifice patient comfort,” he said. If patients exhibited signs of distress such as rapid breathing or sweating, sedation and analgesia were resumed, beginning at half the previous dose.

SAN FRANCISCO — About 40% of emergency departments lack 24/7 access to pediatricians, according to the Centers for Disease Control and Prevention.

Telemedicine provides one possible means of closing this gap, and now a study comparing telemedicine consultations to telephone consultations has shown improvements in diagnostics and parent satisfaction, Madan Dharmar reported at a meeting sponsored by the National Initiative for Children's Healthcare Quality.

The prospective cohort study involved eight rural emergency departments that were designated telemedicine sites and five rural emergency departments as control sites. The sites were matched with regard to hospital volume and physician training.

Children older than 1 day and younger than 17 years were included in the study if they were triaged in the highest category at presentation to the emergency department, said Mr. Dharmar, a doctoral student in epidemiology at the University of California, Davis.

Investigators provided the telemedicine sites with either a wall-mounted or a pole-mounted telemedicine system.

Physicians requesting telemedicine or telephone consultation called a toll-free number that connected them with a UC Davis specialist in pediatric emergency care or pediatric intensive care, typically within 2–5 minutes.

The investigators looked at three outcomes: whether there were changes in medical diagnostics and therapeutic advice; whether there were improvements in the quality of care; and whether there were improvements in parent/guardian satisfaction. Of the 37 telemedicine consultations, 19 resulted in added or changed diagnostic studies, compared with 1 of 14 telephone consultations, a significant difference. There was also a nonsignificant difference in the consulting physician changing therapeutic advice (41% for telemedicine vs. 14% for telephone consultation).

“Telephone consultations have limitations with the fact that the specialist is unable to see the kid,” Mr. Dharmar said. “The specialist usually treats based on a [summary] from the referring physician at the remote site. Another important aspect is that the specialist is unable to involve parents in the care of the kid.”

Parents were significantly more satisfied with telemedicine than with telephone consultations on four different measures. They had higher levels of satisfaction with the courtesy of the emergency department nurses, the courtesy of the physicians, the knowledge and skill of the referring emergency physician, and with the explanation of what was done for their child.

Two pediatric emergency physicians' ratings of initial data gathering, integration of data and diagnosis, initial treatment plan, and plan for disposition or follow-up had no significant differences between the telemedicine and telephone consultations.

Mr. Dharmar stated that he had no financial interest with any organizations or commercial products involved in the study.

Telephone consultations have limitations with the fact that the specialist is unable to see the kid. MR. DHARMAR

SAN FRANCISCO — About 40% of emergency departments lack 24/7 access to pediatricians, according to the Centers for Disease Control and Prevention.

Telemedicine provides one possible means of closing this gap, and now a study comparing telemedicine consultations to telephone consultations has shown improvements in diagnostics and parent satisfaction, Madan Dharmar reported at a meeting sponsored by the National Initiative for Children's Healthcare Quality.

The prospective cohort study involved eight rural emergency departments that were designated telemedicine sites and five rural emergency departments as control sites. The sites were matched with regard to hospital volume and physician training.

Children older than 1 day and younger than 17 years were included in the study if they were triaged in the highest category at presentation to the emergency department, said Mr. Dharmar, a doctoral student in epidemiology at the University of California, Davis.

Investigators provided the telemedicine sites with either a wall-mounted or a pole-mounted telemedicine system.

Physicians requesting telemedicine or telephone consultation called a toll-free number that connected them with a UC Davis specialist in pediatric emergency care or pediatric intensive care, typically within 2–5 minutes.

The investigators looked at three outcomes: whether there were changes in medical diagnostics and therapeutic advice; whether there were improvements in the quality of care; and whether there were improvements in parent/guardian satisfaction. Of the 37 telemedicine consultations, 19 resulted in added or changed diagnostic studies, compared with 1 of 14 telephone consultations, a significant difference. There was also a nonsignificant difference in the consulting physician changing therapeutic advice (41% for telemedicine vs. 14% for telephone consultation).

“Telephone consultations have limitations with the fact that the specialist is unable to see the kid,” Mr. Dharmar said. “The specialist usually treats based on a [summary] from the referring physician at the remote site. Another important aspect is that the specialist is unable to involve parents in the care of the kid.”

Parents were significantly more satisfied with telemedicine than with telephone consultations on four different measures. They had higher levels of satisfaction with the courtesy of the emergency department nurses, the courtesy of the physicians, the knowledge and skill of the referring emergency physician, and with the explanation of what was done for their child.

Two pediatric emergency physicians' ratings of initial data gathering, integration of data and diagnosis, initial treatment plan, and plan for disposition or follow-up had no significant differences between the telemedicine and telephone consultations.

Mr. Dharmar stated that he had no financial interest with any organizations or commercial products involved in the study.

Telephone consultations have limitations with the fact that the specialist is unable to see the kid. MR. DHARMAR

SAN FRANCISCO — About 40% of emergency departments lack 24/7 access to pediatricians, according to the Centers for Disease Control and Prevention.

Telemedicine provides one possible means of closing this gap, and now a study comparing telemedicine consultations to telephone consultations has shown improvements in diagnostics and parent satisfaction, Madan Dharmar reported at a meeting sponsored by the National Initiative for Children's Healthcare Quality.

The prospective cohort study involved eight rural emergency departments that were designated telemedicine sites and five rural emergency departments as control sites. The sites were matched with regard to hospital volume and physician training.

Children older than 1 day and younger than 17 years were included in the study if they were triaged in the highest category at presentation to the emergency department, said Mr. Dharmar, a doctoral student in epidemiology at the University of California, Davis.

Investigators provided the telemedicine sites with either a wall-mounted or a pole-mounted telemedicine system.

Physicians requesting telemedicine or telephone consultation called a toll-free number that connected them with a UC Davis specialist in pediatric emergency care or pediatric intensive care, typically within 2–5 minutes.

The investigators looked at three outcomes: whether there were changes in medical diagnostics and therapeutic advice; whether there were improvements in the quality of care; and whether there were improvements in parent/guardian satisfaction. Of the 37 telemedicine consultations, 19 resulted in added or changed diagnostic studies, compared with 1 of 14 telephone consultations, a significant difference. There was also a nonsignificant difference in the consulting physician changing therapeutic advice (41% for telemedicine vs. 14% for telephone consultation).

“Telephone consultations have limitations with the fact that the specialist is unable to see the kid,” Mr. Dharmar said. “The specialist usually treats based on a [summary] from the referring physician at the remote site. Another important aspect is that the specialist is unable to involve parents in the care of the kid.”

Parents were significantly more satisfied with telemedicine than with telephone consultations on four different measures. They had higher levels of satisfaction with the courtesy of the emergency department nurses, the courtesy of the physicians, the knowledge and skill of the referring emergency physician, and with the explanation of what was done for their child.

Two pediatric emergency physicians' ratings of initial data gathering, integration of data and diagnosis, initial treatment plan, and plan for disposition or follow-up had no significant differences between the telemedicine and telephone consultations.

Mr. Dharmar stated that he had no financial interest with any organizations or commercial products involved in the study.

Telephone consultations have limitations with the fact that the specialist is unable to see the kid. MR. DHARMAR

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided.

Some clinicians advocate the early use of steroids for optic neuritis, but others point out that steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and his colleagues from Hippokration General Hospital, Thessaloniki, Greece.

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye.

The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138–9).

Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk.

Visual evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye.

After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor, they reported.

The investigators noted that optic neuritis is a rare complication of varicella, and that it often accompanies other complications such as acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. The pathogenesis is unknown, and the condition may result from direct viral invasions or from an autoimmune mechanism.

Dr. Stergiou and his colleagues wrote that steroid treatment is usually contraindicated because the disease typically improves rapidly and spontaneously.

Steroids do appear to be appropriate, however, in cases of bilateral optic neuritis after chickenpox.

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided.

Some clinicians advocate the early use of steroids for optic neuritis, but others point out that steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and his colleagues from Hippokration General Hospital, Thessaloniki, Greece.

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye.

The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138–9).

Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk.

Visual evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye.

After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor, they reported.

The investigators noted that optic neuritis is a rare complication of varicella, and that it often accompanies other complications such as acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. The pathogenesis is unknown, and the condition may result from direct viral invasions or from an autoimmune mechanism.

Dr. Stergiou and his colleagues wrote that steroid treatment is usually contraindicated because the disease typically improves rapidly and spontaneously.

Steroids do appear to be appropriate, however, in cases of bilateral optic neuritis after chickenpox.

A 6-year-old boy developed unilateral optic neuritis following a varicella infection, but the neuritis improved spontaneously with only symptomatic relief provided.

Some clinicians advocate the early use of steroids for optic neuritis, but others point out that steroids might exacerbate the condition if there is direct viral invasion of the optic nerve, wrote Dr. Panagiotis K. Stergiou and his colleagues from Hippokration General Hospital, Thessaloniki, Greece.

One week following a varicella eruption, the boy presented with severely decreased visual acuity and painful movement of his right eye; he was only able to count fingers for a counting test with that eye.

The pupil was dilated and sluggishly reactive to light, and he had no color vision. His left eye was normal, with 20/20 vision (Pediatr. Neurol. 2007;37:138–9).

Fundoscopic examination revealed edema of the right disk with opacification of the nerve fibers, venous engorgement, and a splinter hemorrhage at the margin of the disk.

Visual evoked potential measurements revealed abnormal responses in the right eye, while the left eye remained normal.

Clinicians prescribed only symptomatic relief with antipyretics, and the boy returned 4 weeks later with a visual acuity of 20/60 in the right eye.

After 3 months there was further improvement to 20/40, but the right optic disk remained pale, the pupil did not react to light, and the boy's color perception remained poor, they reported.

The investigators noted that optic neuritis is a rare complication of varicella, and that it often accompanies other complications such as acute transverse myelitis, encephalomyelitis, ataxia, and retinopathy. The pathogenesis is unknown, and the condition may result from direct viral invasions or from an autoimmune mechanism.

Dr. Stergiou and his colleagues wrote that steroid treatment is usually contraindicated because the disease typically improves rapidly and spontaneously.

Steroids do appear to be appropriate, however, in cases of bilateral optic neuritis after chickenpox.

Increased adiposity and weight gain are strong risk factors for the development of psoriasis in women, according to a recently published study.

As such, weight loss may be a potential target for preventing and managing psoriasis, said Dr. Arathi R. Setty of Massachusetts General Hospital, Boston, and colleagues (Arch. Intern. Med. 2007;167:1670-5).

Earlier studies have noted an association between weight and psoriasis, but this is the first prospective study to be published, with 78,626 women participating as part of the Nurses' Health Study II, an ongoing longitudinal study of registered nurses from 15 U.S. states who were aged 25–42 years in 1989. They were followed for 1,085,658 person-years, during which time 892 women were newly diagnosed with psoriasis.

After adjusting for age, alcohol consumption, and smoking status, women who were in the highest category of body mass index (greater than 35 kg/m

Even women who were overweight, but not obese, had an increased risk of developing psoriasis. Women with a BMI of 25–30 had a 48% increased risk of developing psoriasis, compared with normal-weight women. The amount of weight a woman gained after the age of 18 was also associated with a higher risk of developing psoriasis, as was higher waist circumference, hip circumference, and waist-hip ratio.

Adiposity is associated with chronic, low-grade inflammation, and the investigators hypothesized that this may explain the increased risk of psoriasis in obese women. Adipose tissue overproduces certain inflammatory cytokines, some of which have been implicated in the pathophysiology of psoriasis. Weight loss decreases cytokines levels, which may translate to a reduced risk or reduced severity of psoriasis.

Increased adiposity and weight gain are strong risk factors for the development of psoriasis in women, according to a recently published study.

As such, weight loss may be a potential target for preventing and managing psoriasis, said Dr. Arathi R. Setty of Massachusetts General Hospital, Boston, and colleagues (Arch. Intern. Med. 2007;167:1670-5).

Earlier studies have noted an association between weight and psoriasis, but this is the first prospective study to be published, with 78,626 women participating as part of the Nurses' Health Study II, an ongoing longitudinal study of registered nurses from 15 U.S. states who were aged 25–42 years in 1989. They were followed for 1,085,658 person-years, during which time 892 women were newly diagnosed with psoriasis.

After adjusting for age, alcohol consumption, and smoking status, women who were in the highest category of body mass index (greater than 35 kg/m

Even women who were overweight, but not obese, had an increased risk of developing psoriasis. Women with a BMI of 25–30 had a 48% increased risk of developing psoriasis, compared with normal-weight women. The amount of weight a woman gained after the age of 18 was also associated with a higher risk of developing psoriasis, as was higher waist circumference, hip circumference, and waist-hip ratio.

Adiposity is associated with chronic, low-grade inflammation, and the investigators hypothesized that this may explain the increased risk of psoriasis in obese women. Adipose tissue overproduces certain inflammatory cytokines, some of which have been implicated in the pathophysiology of psoriasis. Weight loss decreases cytokines levels, which may translate to a reduced risk or reduced severity of psoriasis.

Increased adiposity and weight gain are strong risk factors for the development of psoriasis in women, according to a recently published study.

As such, weight loss may be a potential target for preventing and managing psoriasis, said Dr. Arathi R. Setty of Massachusetts General Hospital, Boston, and colleagues (Arch. Intern. Med. 2007;167:1670-5).

Earlier studies have noted an association between weight and psoriasis, but this is the first prospective study to be published, with 78,626 women participating as part of the Nurses' Health Study II, an ongoing longitudinal study of registered nurses from 15 U.S. states who were aged 25–42 years in 1989. They were followed for 1,085,658 person-years, during which time 892 women were newly diagnosed with psoriasis.

After adjusting for age, alcohol consumption, and smoking status, women who were in the highest category of body mass index (greater than 35 kg/m

Even women who were overweight, but not obese, had an increased risk of developing psoriasis. Women with a BMI of 25–30 had a 48% increased risk of developing psoriasis, compared with normal-weight women. The amount of weight a woman gained after the age of 18 was also associated with a higher risk of developing psoriasis, as was higher waist circumference, hip circumference, and waist-hip ratio.

Adiposity is associated with chronic, low-grade inflammation, and the investigators hypothesized that this may explain the increased risk of psoriasis in obese women. Adipose tissue overproduces certain inflammatory cytokines, some of which have been implicated in the pathophysiology of psoriasis. Weight loss decreases cytokines levels, which may translate to a reduced risk or reduced severity of psoriasis.

SAN DIEGO – Results from a large randomized trial indicate that greater degrees of breast-feeding exclusivity do not lead to lower levels of allergic sensitization, Dr. Bruce D. Mazer reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In fact, the study provides some indication that breast-feeding may actually increase sensitization to several common allergens, according to Dr. Mazer of McGill University, Montreal, and his coinvestigators. “There are a lot of good reasons to breast-feed, but prevention of allergic sensitization is not one of them,” Dr. Mazer said in an interview.

The study involved a secondary analysis of the Promotion of Breast-Feeding Intervention Trial (PROBIT) in which 17,046 healthy newborns and their mothers seen at 31 maternity hospitals in the Republic of Belarus were randomized (hospital by hospital) to receive either standard instruction on infant nutrition or enrollment in a program modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health-care worker assistance with initiating and maintaining lactation and breast-feeding.

Among the original findings of that study were that infants of women randomized to the program were far more likely to receive their nutrition exclusively by breast-feeding at follow-up at 3 months and 6 months of age than were infants of women receiving standard instruction.

When these children reached the age of 6.5 years, 13,889 mother-child pairs were identified and approached for further study, which included skin-prick testing and an assessment of allergic symptoms and diagnoses based on the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. More than 99% of the mother-child pairs completed the questionnaire, and 11,145 of the children (80%) underwent skin-prick testing.

There were no significant differences between children who had been assigned to the program and those in the control group in their answers to any of the ISAAC questions. In addition, after adjustment for which maternity hospital they had been seen in, there were no significant differences in the percentages of children who tested positive to any of five common allergens.

The investigators noted that six of the maternity hospitals had unusually high rates of positive skin-prick tests. When data from those suspect sites were eliminated from the analysis, the investigators found that children in the program were significantly more likely to have positive skin-prick tests to dust mites, cats, birch pollen, and Alternaria, but not to mixed northern grasses.

“Our results underline the importance of seeking other explanations for the recent epidemic of allergy and asthma, and of investigating other potential etiologic factors to develop and test new preventive interventions,” the investigators concluded.

SAN DIEGO – Results from a large randomized trial indicate that greater degrees of breast-feeding exclusivity do not lead to lower levels of allergic sensitization, Dr. Bruce D. Mazer reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In fact, the study provides some indication that breast-feeding may actually increase sensitization to several common allergens, according to Dr. Mazer of McGill University, Montreal, and his coinvestigators. “There are a lot of good reasons to breast-feed, but prevention of allergic sensitization is not one of them,” Dr. Mazer said in an interview.

The study involved a secondary analysis of the Promotion of Breast-Feeding Intervention Trial (PROBIT) in which 17,046 healthy newborns and their mothers seen at 31 maternity hospitals in the Republic of Belarus were randomized (hospital by hospital) to receive either standard instruction on infant nutrition or enrollment in a program modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health-care worker assistance with initiating and maintaining lactation and breast-feeding.

Among the original findings of that study were that infants of women randomized to the program were far more likely to receive their nutrition exclusively by breast-feeding at follow-up at 3 months and 6 months of age than were infants of women receiving standard instruction.

When these children reached the age of 6.5 years, 13,889 mother-child pairs were identified and approached for further study, which included skin-prick testing and an assessment of allergic symptoms and diagnoses based on the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. More than 99% of the mother-child pairs completed the questionnaire, and 11,145 of the children (80%) underwent skin-prick testing.

There were no significant differences between children who had been assigned to the program and those in the control group in their answers to any of the ISAAC questions. In addition, after adjustment for which maternity hospital they had been seen in, there were no significant differences in the percentages of children who tested positive to any of five common allergens.

The investigators noted that six of the maternity hospitals had unusually high rates of positive skin-prick tests. When data from those suspect sites were eliminated from the analysis, the investigators found that children in the program were significantly more likely to have positive skin-prick tests to dust mites, cats, birch pollen, and Alternaria, but not to mixed northern grasses.

“Our results underline the importance of seeking other explanations for the recent epidemic of allergy and asthma, and of investigating other potential etiologic factors to develop and test new preventive interventions,” the investigators concluded.

SAN DIEGO – Results from a large randomized trial indicate that greater degrees of breast-feeding exclusivity do not lead to lower levels of allergic sensitization, Dr. Bruce D. Mazer reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In fact, the study provides some indication that breast-feeding may actually increase sensitization to several common allergens, according to Dr. Mazer of McGill University, Montreal, and his coinvestigators. “There are a lot of good reasons to breast-feed, but prevention of allergic sensitization is not one of them,” Dr. Mazer said in an interview.

The study involved a secondary analysis of the Promotion of Breast-Feeding Intervention Trial (PROBIT) in which 17,046 healthy newborns and their mothers seen at 31 maternity hospitals in the Republic of Belarus were randomized (hospital by hospital) to receive either standard instruction on infant nutrition or enrollment in a program modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health-care worker assistance with initiating and maintaining lactation and breast-feeding.

Among the original findings of that study were that infants of women randomized to the program were far more likely to receive their nutrition exclusively by breast-feeding at follow-up at 3 months and 6 months of age than were infants of women receiving standard instruction.

When these children reached the age of 6.5 years, 13,889 mother-child pairs were identified and approached for further study, which included skin-prick testing and an assessment of allergic symptoms and diagnoses based on the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. More than 99% of the mother-child pairs completed the questionnaire, and 11,145 of the children (80%) underwent skin-prick testing.

There were no significant differences between children who had been assigned to the program and those in the control group in their answers to any of the ISAAC questions. In addition, after adjustment for which maternity hospital they had been seen in, there were no significant differences in the percentages of children who tested positive to any of five common allergens.

The investigators noted that six of the maternity hospitals had unusually high rates of positive skin-prick tests. When data from those suspect sites were eliminated from the analysis, the investigators found that children in the program were significantly more likely to have positive skin-prick tests to dust mites, cats, birch pollen, and Alternaria, but not to mixed northern grasses.

“Our results underline the importance of seeking other explanations for the recent epidemic of allergy and asthma, and of investigating other potential etiologic factors to develop and test new preventive interventions,” the investigators concluded.

LOS ANGELES — High body mass index is associated with a lower risk of lung cancer among smokers, Jian-Min Yuan, Ph.D., reported in a poster presentation at the annual meeting of the American Association for Cancer Research.

The study involved a prospective, population-based cohort of 63,257 middle-aged and older Chinese men and women who were enrolled in the Singapore Chinese Health Study between 1993 and 1998.

Smokers with a body mass index (BMI) of at least 28 kg/m

The inverse association between BMI and lung cancer risk was strongest in current smokers, much weaker in lifelong nonsmokers, and absent in former smokers. The association was stronger in men than in women. The investigators hypothesized that smoking may increase the metabolic rate that leads to high cellular production of reactive oxygen species in lean smokers.

LOS ANGELES — High body mass index is associated with a lower risk of lung cancer among smokers, Jian-Min Yuan, Ph.D., reported in a poster presentation at the annual meeting of the American Association for Cancer Research.

The study involved a prospective, population-based cohort of 63,257 middle-aged and older Chinese men and women who were enrolled in the Singapore Chinese Health Study between 1993 and 1998.

Smokers with a body mass index (BMI) of at least 28 kg/m

The inverse association between BMI and lung cancer risk was strongest in current smokers, much weaker in lifelong nonsmokers, and absent in former smokers. The association was stronger in men than in women. The investigators hypothesized that smoking may increase the metabolic rate that leads to high cellular production of reactive oxygen species in lean smokers.

LOS ANGELES — High body mass index is associated with a lower risk of lung cancer among smokers, Jian-Min Yuan, Ph.D., reported in a poster presentation at the annual meeting of the American Association for Cancer Research.

The study involved a prospective, population-based cohort of 63,257 middle-aged and older Chinese men and women who were enrolled in the Singapore Chinese Health Study between 1993 and 1998.

Smokers with a body mass index (BMI) of at least 28 kg/m

The inverse association between BMI and lung cancer risk was strongest in current smokers, much weaker in lifelong nonsmokers, and absent in former smokers. The association was stronger in men than in women. The investigators hypothesized that smoking may increase the metabolic rate that leads to high cellular production of reactive oxygen species in lean smokers.

SAN FRANCISCO — Omalizumab, when added to asthma treatments, reduced the number of rescue bursts of corticosteroids in patients allergic to cat dander, Marc Massanari, Pharm.D., said in a poster presentation at the International Conference of the American Thoracic Society.

The omalizumab patients needed 25% fewer steroid puffs than those on placebo and had a 100% increase in forced expiratory volume in 1 second (FEV₁), compared with a 33% increase in placebo patients, both statistically significant differences.

The results came from a pooled population of 2,236 patients enrolled in five placebo-controlled clinical trials of omalizumab. Dr. Massanari and his colleagues, all of whom are employed by Novartis Pharmaceuticals Corp., East Hanover, N.J., focused on the 1,589 patients with moderate to severe and persistent IgE-mediated asthma and who showed sensitivity to cat dander. Of those, 811 received omalizumab and 778 received placebo administered subcutaneously every 2 or 4 weeks.

The omalizumab patients also had significant decreases in rescue beta-agonist puffs and showed significant improvements in all domains of the Asthma Quality of Life Questionnaire. Novartis and Genentech Inc. supported the study

SAN FRANCISCO — Omalizumab, when added to asthma treatments, reduced the number of rescue bursts of corticosteroids in patients allergic to cat dander, Marc Massanari, Pharm.D., said in a poster presentation at the International Conference of the American Thoracic Society.

The omalizumab patients needed 25% fewer steroid puffs than those on placebo and had a 100% increase in forced expiratory volume in 1 second (FEV₁), compared with a 33% increase in placebo patients, both statistically significant differences.

The results came from a pooled population of 2,236 patients enrolled in five placebo-controlled clinical trials of omalizumab. Dr. Massanari and his colleagues, all of whom are employed by Novartis Pharmaceuticals Corp., East Hanover, N.J., focused on the 1,589 patients with moderate to severe and persistent IgE-mediated asthma and who showed sensitivity to cat dander. Of those, 811 received omalizumab and 778 received placebo administered subcutaneously every 2 or 4 weeks.

The omalizumab patients also had significant decreases in rescue beta-agonist puffs and showed significant improvements in all domains of the Asthma Quality of Life Questionnaire. Novartis and Genentech Inc. supported the study

SAN FRANCISCO — Omalizumab, when added to asthma treatments, reduced the number of rescue bursts of corticosteroids in patients allergic to cat dander, Marc Massanari, Pharm.D., said in a poster presentation at the International Conference of the American Thoracic Society.

The omalizumab patients needed 25% fewer steroid puffs than those on placebo and had a 100% increase in forced expiratory volume in 1 second (FEV₁), compared with a 33% increase in placebo patients, both statistically significant differences.

The results came from a pooled population of 2,236 patients enrolled in five placebo-controlled clinical trials of omalizumab. Dr. Massanari and his colleagues, all of whom are employed by Novartis Pharmaceuticals Corp., East Hanover, N.J., focused on the 1,589 patients with moderate to severe and persistent IgE-mediated asthma and who showed sensitivity to cat dander. Of those, 811 received omalizumab and 778 received placebo administered subcutaneously every 2 or 4 weeks.

The omalizumab patients also had significant decreases in rescue beta-agonist puffs and showed significant improvements in all domains of the Asthma Quality of Life Questionnaire. Novartis and Genentech Inc. supported the study

SAN FRANCISCO — Pregnant women with obstructive sleep apnea have a 2.3-fold increased risk of gestational diabetes and a 4.2-fold increased risk of pregnancy-induced hypertension, compared with women without the sleep disorder, according to a poster presentation at the International Conference of the American Thoracic Society.

Previous data have suggested that obstructive sleep apnea (OSA) may induce systemic hypertension and diabetes mellitus in the general population, but the connection was much less clear in pregnant women, Dr. Michael S. Nolledo of the Robert Wood Johnson Medical School, Princeton, N.J., said in a press briefing.

Physicians dealing with women with gestational diabetes or pregnancy-induced hypertension (PIH) should inquire about sleep-disordered breathing, especially because it is easy to treat OSA with continuous positive airway pressure (CPAP), he said.

But he acknowledged that his study contains no direct evidence that treating sleep apnea will improve PIH or gestational diabetes.

The study relied on data from the 2003 National Inpatient Sample, sponsored by the Agency for Healthcare Research and Quality. The database includes all inpatient records from a sample of about 20% of U.S. community short-stay hospitals and provides weights to calculate national estimates.

Using this database, the investigators calculated that there were 3,979,840 deliveries in the United States in 2003, of which 167,227 were complicated by gestational diabetes and 300,902 were complicated by PIH. The overall rate of sleep apnea for these women was 1.14/10,000—but that rate was 4.01/10,000 among women with gestational diabetes and 5.52/10,000 among women with PIH.

When controlled for age and race, women with sleep apnea were 3.5 times more likely to develop gestational diabetes; when controlled for obesity, the odds ratio was still 2.3. Similarly, the odds ratio for PIH in women with sleep apnea was 6.6 when controlling for age and race, and 4.2 after also controlling for obesity.

In an interview, Dr. Nolledo acknowledged that the overall rate of OSA recorded in the database—just over 1/10,000, or 0.01%–-is much lower than the 2%–4% rate of OSA estimated for the general population.

He attributed this in part to the fact that physicians don't inquire about sleep-disordered breathing. Another explanation could be that physicians may be more inclined to ask about sleep-disordered breathing when faced with patients with gestational diabetes or PIH, he said, and that alone can account for the apparent increases in risk.

SAN FRANCISCO — Pregnant women with obstructive sleep apnea have a 2.3-fold increased risk of gestational diabetes and a 4.2-fold increased risk of pregnancy-induced hypertension, compared with women without the sleep disorder, according to a poster presentation at the International Conference of the American Thoracic Society.

Previous data have suggested that obstructive sleep apnea (OSA) may induce systemic hypertension and diabetes mellitus in the general population, but the connection was much less clear in pregnant women, Dr. Michael S. Nolledo of the Robert Wood Johnson Medical School, Princeton, N.J., said in a press briefing.

Physicians dealing with women with gestational diabetes or pregnancy-induced hypertension (PIH) should inquire about sleep-disordered breathing, especially because it is easy to treat OSA with continuous positive airway pressure (CPAP), he said.

But he acknowledged that his study contains no direct evidence that treating sleep apnea will improve PIH or gestational diabetes.

The study relied on data from the 2003 National Inpatient Sample, sponsored by the Agency for Healthcare Research and Quality. The database includes all inpatient records from a sample of about 20% of U.S. community short-stay hospitals and provides weights to calculate national estimates.

Using this database, the investigators calculated that there were 3,979,840 deliveries in the United States in 2003, of which 167,227 were complicated by gestational diabetes and 300,902 were complicated by PIH. The overall rate of sleep apnea for these women was 1.14/10,000—but that rate was 4.01/10,000 among women with gestational diabetes and 5.52/10,000 among women with PIH.

When controlled for age and race, women with sleep apnea were 3.5 times more likely to develop gestational diabetes; when controlled for obesity, the odds ratio was still 2.3. Similarly, the odds ratio for PIH in women with sleep apnea was 6.6 when controlling for age and race, and 4.2 after also controlling for obesity.

In an interview, Dr. Nolledo acknowledged that the overall rate of OSA recorded in the database—just over 1/10,000, or 0.01%–-is much lower than the 2%–4% rate of OSA estimated for the general population.

He attributed this in part to the fact that physicians don't inquire about sleep-disordered breathing. Another explanation could be that physicians may be more inclined to ask about sleep-disordered breathing when faced with patients with gestational diabetes or PIH, he said, and that alone can account for the apparent increases in risk.

SAN FRANCISCO — Pregnant women with obstructive sleep apnea have a 2.3-fold increased risk of gestational diabetes and a 4.2-fold increased risk of pregnancy-induced hypertension, compared with women without the sleep disorder, according to a poster presentation at the International Conference of the American Thoracic Society.

Previous data have suggested that obstructive sleep apnea (OSA) may induce systemic hypertension and diabetes mellitus in the general population, but the connection was much less clear in pregnant women, Dr. Michael S. Nolledo of the Robert Wood Johnson Medical School, Princeton, N.J., said in a press briefing.

Physicians dealing with women with gestational diabetes or pregnancy-induced hypertension (PIH) should inquire about sleep-disordered breathing, especially because it is easy to treat OSA with continuous positive airway pressure (CPAP), he said.

But he acknowledged that his study contains no direct evidence that treating sleep apnea will improve PIH or gestational diabetes.

The study relied on data from the 2003 National Inpatient Sample, sponsored by the Agency for Healthcare Research and Quality. The database includes all inpatient records from a sample of about 20% of U.S. community short-stay hospitals and provides weights to calculate national estimates.

Using this database, the investigators calculated that there were 3,979,840 deliveries in the United States in 2003, of which 167,227 were complicated by gestational diabetes and 300,902 were complicated by PIH. The overall rate of sleep apnea for these women was 1.14/10,000—but that rate was 4.01/10,000 among women with gestational diabetes and 5.52/10,000 among women with PIH.

When controlled for age and race, women with sleep apnea were 3.5 times more likely to develop gestational diabetes; when controlled for obesity, the odds ratio was still 2.3. Similarly, the odds ratio for PIH in women with sleep apnea was 6.6 when controlling for age and race, and 4.2 after also controlling for obesity.

In an interview, Dr. Nolledo acknowledged that the overall rate of OSA recorded in the database—just over 1/10,000, or 0.01%–-is much lower than the 2%–4% rate of OSA estimated for the general population.

He attributed this in part to the fact that physicians don't inquire about sleep-disordered breathing. Another explanation could be that physicians may be more inclined to ask about sleep-disordered breathing when faced with patients with gestational diabetes or PIH, he said, and that alone can account for the apparent increases in risk.