Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis

Objectives: We aimed to assess the association between long-term use of inhaled corticosteroids (ICS) and bone adverse effects in patients with asthma. Design: Systematic review and meta-analysis of fracture risk and changes in bone mineral density with long-term ICS use in asthma. Methods: We initially searched MEDLINE and EMBASE in July 2013, and performed an updated PubMed search in December 2014. We selected randomised controlled trials (RCTs) and controlled observational studies of any ICS (duration at least 12 months) compared to non-ICS use in patients with asthma. We conducted meta-analysis of ORs for fractures, and mean differences in bone mineral density. Heterogeneity was assessed using the I2 statistic. Results: We included 18 studies (7 RCTs and 11 observational studies) in the systematic review. Meta-analysis of observational studies did not demonstrate any significant association between ICS and fractures in children (pooled OR 1.02, 95% CI 0.94 to 1.10, two studies), or adults (pooled OR 1.09, 95% CI 0.45 to 2.62, four studies). Three RCTs and three observational studies in children reported on bone mineral density at the lumbar spine, and our meta-analysis did not show significant reductions with ICS use. Three RCTs and four observational studies in adults reported on ICS use and bone mineral density at the lumbar spine and femur, with no significant reductions found in the meta-analysis compared to control. Conclusions ICS use for ≥12 months in adults or children with asthma was not significantly associated with harmful effects on fractures or bone mineral density

Impact of inhaled corticosteroids on growth in children with asthma: systematic review and meta-analysis

Background: Long-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth. Methods: We initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic. Results: We found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65). Conclusion: Use of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users

Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.</p

Funktions- og værktøjer til understøttelse af netbaseret kollaborativ læring

F&oslash;rste gang publiceret i UNEV nr. 2: E-l&aelig;ringsplatforme - muligheder og potentialer, januar - marts 2004, red. Tom Nyvand og Michael Pedersen. ISSN 1603-5518.Netbaseret kollaborativ l&aelig;ring er forl&oslash;b, der didaktisk tager udgangspunkt i de studerende f&aelig;lles videnskonstruktion. Netbaserede kollaborative l&aelig;ringsforl&oslash;b egner sig til proces- og projektorienterede l&aelig;ringsforl&oslash;b p&aring; universitetsniveau. IKT anvendes b&aring;de underst&oslash;ttende og kvalificerende i disse processer. I artiklen tages afs&aelig;t i fire centrale handlingstyper for den kollaborative gruppe, og der peges i oversigtsform p&aring; hvilke funktioner, v&aelig;rkt&oslash;jer og E-l&aelig;ringssystemer, der i s&aelig;rlig grad synes at kunne underst&oslash;tte CSCL (Computer Supported Collaborative Learning). Artiklen kommer ikke ind p&aring; administrative funktioner i forbindelse med valg af E-l&aelig;ringssystem

Sveriges Forskningskomité for Landbrugsbygninger udsender sin første Beretning.

Sveriges Forskningskomité for Landbrugsbygninger udsender sin første Beretning

Varme, Ventilation og Fugtighedsmaalinger i norrlandske Landbrugsbygninger.

Varme, Ventilation og Fugtighedsmaalinger i norrlandske Landbrugsbygninger