British medical bulletin
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British medical bulletin · Jan 2002
ReviewRecent advances in the rapid diagnosis of respiratory tract infection.
Molecular techniques have enabled major advances in the speed and sensitivity of the laboratory diagnosis of respiratory infections. Although the polymerase chain reaction is the most commonly used, there are several other methods available, which have applicability across the range of microbial pathogens.
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Upper respiratory tract infections are common and important. Although rarely fatal, they are a source of significant morbidity and carry a considerable economic burden. Numerous therapies for the common cold have no effect on symptoms or outcome. ⋯ Respiratory viruses play a major role in the aetiology of acute otitis media (AOM); prevention includes the use of influenza or RSV vaccination, in addition to reducing other risk factors such as early exposure to respiratory viruses in day-care settings and to environmental tobacco smoke. The use of ventilation tubes (grommets) in secretory otitis media (SOM) remains controversial with conflicting data on developmental outcome and quality of life in young children. New conjugate pneumococcal vaccines appear safe in young children and prevent 6-7% of clinically diagnosed AOM.
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Antibiotic resistance remains rare in paediatric community-acquired pneumonia in the UK, but is more common in hospital-acquired pneumonia and in patients with chronic lung diseases. It should also be considered in children arriving from countries with a high prevalence of antibiotic resistance, children with previous heavy antibiotic exposure, those who are immunosuppressed, and those who are not responding to conventional therapy. ⋯ Continued vigilance and research is required. The recently introduced pneumococcal conjugate vaccines offer great promise as they are likely to prevent cases of disease due to penicillin-resistant serotypes.
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British medical bulletin · Jan 2002
ReviewRespiratory infections following haemopoietic stem cell transplantation in children.
Disorders of the respiratory system are well recognised following the administration of chemotherapy schedules; although respiratory complications may occur following less intensive regimens, they are most frequently seen following the administration of high dose chemotherapy with or without radiotherapy which is used in preparation for haemopoietic stem cell transplantation (SCT). In this setting, respiratory complications may occur in up to 50% of patients and account for over 40% of all deaths; those patients who require admission to intensive care (ICU) requiring intubation and mechanical ventilation have a particularly poor prognosis, with less than 10% becoming long-term survivors.
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Acute stroke treatment using aspirin and/or heparin was studied in the International Stroke Trial (IST) and Chinese Acute Stroke Trial (CAST) which randomised over 40,000 patients altogether. Combining the results demonstrated that aspirin (150-300 mg) given within 48 h of the onset of stroke produced a small but significant improvement in outcome (death or dependency) 4 weeks to 6 months after stroke of about 1 patient per 100 treated. There was a significant reduction in recurrent ischaemic stroke of similar degree, which was not associated with significant increase in cerebral haemorrhage. ⋯ Low molecular weight heparins and heparinoids have not proved any more beneficial. Therefore, heparin does not appear to be a useful routine therapy in acute stroke. The use of heparin should, therefore, be limited to patients at high risk of deep vein thrombosis or early recurrence.