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Omalizumab: a second look in severe persistent asthma: new adverse effects.

Omalizumab: a second look in severe persistent asthma: new adverse effects.

Prescrire Int. 2011 Apr;20(115):90-2

Authors:

When severe asthma persists despite high-dose inhaled corticosteroid therapy, it is better to switch to oral corticosteroid therapy than to add another asthma drug. In 2007, we concluded that omalizumab had a negative risk-benefit balance in this setting. In mid-2010, we found no new data on the efficacy of omalizumab. At best, omalizumab prevents 1 emergency room visit approximately every 2.5 years. Post-marketing follow-up data confirm the infectious adverse effects and hypersensitivity reactions associated with omalizumab, and show that anaphylactic reactions can occur several days after an injection. A possible increase in the risk of cancer has not yet been ruled out. New adverse effects associated with omalizumab have emerged, including serious cardiac effects and severe thrombocytopenia. In practice, despite longer followup, the efficacy of omalizumab remains uncertain, while new, sometimes serious adverse effects have emerged. It is better to adjust standard treatments to the individual's situation than to risk using omalizumab.

PMID: 21648207 [PubMed - indexed for MEDLINE]

Short courses of antibiotics for children and adults with bronchiectasis.

Authors: Wurzel D, Marchant JM, Yerkovich ST, Upham JW, Masters IB, Chang AB Bronchiectasis is an important cause of respiratory morbidity in both developing and developed countries. Antibiotics are considered standard therapy in the treatment of this condition but it is unknown whether short courses (four weeks or less) are efficacious. PMID: 21678381 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Antibiotics for bronchiolitis in children.

Authors: Spurling GK, Doust J, Del Mar CB, Eriksson L Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting babies. It is often caused by respiratory syncytial virus (RSV). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure. Nevertheless, they are used at rates of 34% to 99% in uncomplicated cases. PMID: 21678346 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Pleural controversy: Close needle pleural biopsy or thoracoscopy—Which first?

ABSTRACTThe most efficient and cost‐effective approach to the diagnosis of pleural exudates remains controversial. Important considerations include the respective diagnostic yields of thoracocentesis, closed pleural biopsy and thoracoscopy; the incremental gain in diagnostic yield when sequentially combining these investigations; and the role of various image modalities. The diagnostic yield of thoracocentesis is in the order of 60% for malignancy and >90% for tuberculosis. A second aspiration may increase the yield for malignancy, but a third is generally superfluous. Many authorities consider thoracoscopy the investigation of choice in exudative pleural effusions where a thoracocentesis was nondiagnostic and particularly when malignancy is suspected. It allows for the direct inspect...

Respiratory disorders in the Middle East: A review

ABSTRACTThe spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East. We shed light on the diverse conditions commonly encountered in the region, from the centuries‐old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare. We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, for example, climate factors in the desert region, cultural habits, for example, water‐pipe smoking and disorders unique to the region, such as Behçet's disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social ...

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