Strawberry tongue cues provider to rare condition
10 Sep : 19:29  by admin


'You don't have to remember it all, just enough to know you need to find out the rest.'
Strawberry tongue cues provider to rare condition
Strawberry tongue cues provider to rare condition

I practice in a small hospital in a rural town. Early in my career I was making rounds on a 3-year-old patient who had been admitted for fever and leukocytosis two days earlier. I had not seen her previously.

When I arrived the patient's mom was awake, but the girl was still sleeping. I began to approach the patient to examine her with the lights off, so as not to wake her, but I had an instinct to turn the lights on. When I did, the patient awoke, and I noticed she had blood shot eyes and conjunctiva without discharge. I also noticed her face was redder than what it should be, and asked if it had looked like that all along.
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Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial
09 Jul : 01:27  by admin

Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial
Dr Tohru Kobayashi MD a Corresponding AuthorEmail AddressProf Tsutomu Saji MD bTetsuya Otani MD cProf Kazuo Takeuchi MPH dTetsuya Nakamura MD e,Prof Hirokazu Arakawa MD aTaichi Kato MD fProf Toshiro Hara MD gProf Kenji Hamaoka MD hProf Shunichi Ogawa MD i,Masaru Miura MD jYuichi Nomura MD kShigeto Fuse MD lProf Fukiko Ichida MD mMitsuru Seki MD nRyuji Fukazawa MD i o,Chitose Ogawa MD pKenji Furuno MD qHirohide Tokunaga MD rShinichi Takatsuki MD bShinya Hara MD sProf Akihiro MorikawaMD aon behalf of the RAISE study group investigators
Summary
Background
Evidence indicates that corticosteroid therapy might be beneficial for the primary treatment of severe Kawasaki disease. We assessed whether addition of prednisolone to intravenous immunoglobulin with aspirin would reduce the incidence of coronary artery abnormalities in patients with severe Kawasaki disease.
Methods
We did a multicentre, prospective, randomised, open-label, blinded-endpoints trial at 74 hospitals in Japan between Sept 29, 2008, and Dec 2, 2010. Patients with severe Kawasaki disease were randomly assigned by a minimisation method to receive either intravenous immunoglobulin (2 g/kg for 24 h and aspirin 30 mg/kg per day) or intravenous immunoglobulin plus prednisolone (the same intravenous immunoglobulin regimen as the intravenous immunoglobulin group plus prednisolone 2 mg/kg per day given over 15 days after concentrations of C-reactive protein normalised). Patients and treating physicians were unmasked to group allocation. The primary endpoint was incidence of coronary artery abnormalities during the study period. Analysis was by intention to treat. This trial is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000000940.
Findings
We randomly assigned 125 patients to the intravenous immunoglobulin plus prednisolone group and 123 to the intravenous immunoglobulin group. Incidence of coronary artery abnormalities was significantly lower in the intravenous immunoglobulin plus prednisolone group than in the intravenous immunoglobulin group during the study period (four patients [3%] vs 28 patients [23%]; risk difference 0·20, 95% CI 0·12—0·28, p<0·0001). Serious adverse events were similar between both groups: two patients had high total cholesterol and one neutropenia in the intravenous immunoglobulin plus prednisolone group, and one had high total cholesterol and another non-occlusive thrombus in the intravenous immunoglobulin group.
Interpretation
Addition of prednisolone to the standard regimen of intravenous immunoglobulin improves coronary artery outcomes in patients with severe Kawasaki disease in Japan. Further study of intensified primary treatment for this disease in a mixed ethnic population is warranted.
Funding
Japanese Ministry of Health, Labour and Welfare.
 
 
 http://www.thelancet.com
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Grey's Anatomy
01 Apr : 23:57  by admin
It was like a page ripped out of her own life when Sarah Chalke guest-starred on "Grey's Anatomy." She portrayed Kasey, a mother desperate to find out what was wrong with her son. He had been falsley diagnosed, but Kasey felt certain she knew what was wrong. She just needed a doctor to listen.

The only one willing to do so was Meredith, and it was a good thing. "Parker has Kawasaki Disease," Meredith told Kasey. "You fought for your son. You didn’t give up. You saved his life today." She was right. Read more -[Click Here For More Info]-
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