ABSTRACT
People with developmental disabilities are becoming an important part of the general practice population. Although they have a similar range of medical conditions to the general population, there are some important differences in prevalence, risk factors, presentation and management of particular conditions. We use gastro-oesophageal reflux to illustrate how developmental disability may affect the presentation, assessment and management of a common condition.
Subject(s)
Gastroesophageal Reflux/complications , Intellectual Disability/complications , Physician's Role , Adult , Diagnosis, Differential , Family Practice , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Male , Pain Measurement , Sick RoleABSTRACT
BACKGROUND: Following otitis media, 10% to 50% of children develop residual middle ear effusion with concurrent hearing loss and potential cognitive, behavioral, and language impairment. Prophylactic antibiotics and tympanostomy tubes are currently recommended treatments for chronic middle ear effusion. OBJECTIVE: In a double-blind, placebo-controlled, randomized study of chronic middle ear effusion, we assessed the effectiveness of topical intranasal beclomethasone as an adjunct to prophylactic antibiotic therapy. METHODS: Sixty-one children, aged 3 to 11 years with persistent middle ear effusion greater than 3 months, were randomized into three treatment groups: (1) prophylactic antibiotics; (2) prophylactic antibiotics plus intranasal beclomethasone (336 micrograms/day); and (3) prophylactic antibiotics plus intranasal placebo. Patients were evaluated with aeroallergen skin tests at entry; and tympanogram, otoscopic examination, and symptom questionnaire at 0, 4, 8, and 12 weeks. RESULTS: While middle ear pressures, otoscopic examinations, and symptom scores were improved for each treatment group over 12 weeks of therapy, the beclomethasone plus antibiotics group improved all three measures more rapidly than the antibiotics-alone and placebo nasal spray plus antibiotics groups over the first 8 weeks. Only the beclomethasone group significantly improved left (P = .004) and right (P = .01) middle ear pressures over 12 weeks. Resolution of chronic middle ear effusions was more frequent in the beclomethasone group (P < or = .05 at 4 and 8 weeks). No difference in response to nasal steroids was observed between atopic and nonatopic subjects. CONCLUSIONS: We conclude that intranasal beclomethasone may be a useful adjunct to prophylactic antibiotic treatment of chronic middle ear effusion.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Beclomethasone/therapeutic use , Otitis Media with Effusion/drug therapy , Acoustic Impedance Tests , Acute Disease , Administration, Intranasal , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Beclomethasone/administration & dosage , Child , Child, Preschool , Chronic Disease , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Otitis Media/complications , Otitis Media/drug therapy , Otitis Media with Effusion/complications , Otoscopes , Patient Compliance , Severity of Illness Index , Sinusitis/complications , Sinusitis/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Imported fire ants (IFA) are a common cause of insect venom hypersensitivity in the southeastern United States. The purpose of this study was to determine the sting attack rate and development of specific IgE in an unsensitized population. METHODS: Study participants consisted of 137 medical students with limited exposure to IFA-endemic areas who were temporarily training in San Antonio, Tex. Subjects were surveyed for prior IFA exposure with a questionnaire, and IFA-specific IgE was evaluated with RAST and intradermal skin testing. Evaluations were performed on arrival and reported at departure from the endemic area 3 weeks later. RESULTS: One hundred seven subjects completed the study. Field stings were reported in 55 subjects, resulting in a sting attack rate of 51%. In these 55 subjects 53 (96%) reported a pustule or a small local reaction at the sting site, one (2%) reported an isolated large local reaction, and none reported a systemic reaction. At the 3-week follow-up skin test and RAST conversions occurred in seven subjects (13%) and in one subject (1.8%), respectively. CONCLUSIONS: Even brief exposures to IFA-endemic areas result in significant sting rates and concurrent rapid development of IFA-specific IgE in 16% of stung subjects.
Subject(s)
Ants , Bites and Stings/complications , Environmental Exposure , Hypersensitivity/etiology , Adult , Animals , Humans , Hypersensitivity/diagnosis , Incidence , Radioallergosorbent Test , Skin Tests , Southeastern United StatesABSTRACT
It is shown that the reflection from a phase-conjugate mirror does not exhibit a Doppler shift in frequency. The physical basis for this phenomenon is discussed, and it has been verified experimentally by using four-wave mixing with photorefractive Bi(12)SiO(20) (BSO) in a phase-conjugate Michelson interferometer. The same measurement is also used to determine the response time of the nonlinear material to moving spatial holograms. This response time is 7.3 msec in BSO.