Systematic Review on the Efficacy of Fexofenadine in Seasonal Allergic Rhinitis: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Clinical Trials

Rationale: Evidence-based medicine represents the effort to highlight the best intervention for patients, clinicians, and policy makers, each from their respective viewpoint, to solve a particular health condition. According to a recently diffused grading system of evidence and recommendations for medical interventions, efficacy and safety represent 2 of the most important features to consider, and data from meta-analyses of randomized controlled clinical trials (RCTs) is the strongest supporting demonstration. Fexofenadine has been used for its efficacy and safety in the treatment of allergic rhinitis (AR) for many years although no meta-analyses supporting its use currently exist. The aim of this study is to assess for the first time the efficacy and safety of fexofenadine in the treatment of AR by means of a meta-analytic analysis of existing RCTs. Since specific evidence should be provided to address recommendations in a pediatric population, the quality of the estimates of this subgroup analysis is assessed. Methods: All double-blind, placebo-controlled randomized trials assessing the efficacy of fexofenadine in AR were searched for in OVID, Medline, and Embase databases up to December 2007. Outcomes were extracted from original articles; when this information was not available, the authors of each trial were contacted. Some graphics were digitalized. The RevMan 5 program was used to perform the analysis. GradePro 3.2.2 was used to assess the quality of the evidence for a pediatric population. Results: Of 2,152 identified articles, 20 were potentially relevant trials. Eight studies satisfied the inclusion criteria and were included in the meta-analysis. The main reasons for exclusion were: unnatural exposure, strong study limitations, an atypical outcome measurement, a design for other outcomes, and not being a placebo-controlled, single-blind study. Seven trials investigated a mixed population of adults and children, 1 trial investigated only children, and 1 trial only adults. In 1,833 patients receiving fexofenadine (1,699 placebo), a significant reduction of the daily reflective total symptom scores (TSS) (SMD –0.42; 95% CI –0.49 to –0.35, p < 0.00001) was found. Positive results were also found for morning instantaneous TSS and individual nasal symptom scores (sneezing, rhinorrhea, itching, and congestion). The safety analysis did not show a significant difference in reported adverse events (AE) between the active and placebo treatment groups (OR = 1.03; 95% CI 0.87–1.22, p = 0.75). A very low heterogeneity between the studies was detected, so a fixed-effects model was used. The mean quality level of the included trials was medium. Specific information for a pediatric population may be assumed with a moderate quality of evidence from only 1 study and with a low quality of evidence, mainly due to indirectness, from the others. Conclusions: This study has 5 major strengths: it represents the first attempt to evaluate the efficacy and safety of fexofenadine in the treatment of AR by means of a meta-analysis of RCTs; there was consistency between positive results in terms of efficacy in TSS and in individual symptoms; a large population was studied; there was an irrelevant interstudy heterogeneity, and the AE frequency was similar in both groups. All of these values encourage the recommendation of fexofenadine for AR. Further research focused on the benefits and disadvantages for a pediatric population is needed

Information Access, Document Delivery and Resource Sharing in Earth-Science Libraries: the Italian Project NILDE

The National Research Council (CNR) Bologna Research Area Library is a multidisciplinary scientific library serving a community of about 1.500 local and remote users among researchers staff, PhD, undergraduate students and visiting scientists. The Library became operative in 1997, progressively integrating the existing resources of the Institutes belonging to the Research Area thus reducing costs whilst increasing the quantity and quality of advanced library services, such as: access to over 6.000 online journals, access to specialised bibliographical databases, document delivery, etc... Library online collections cover, among the Earth Sciences, the fields of Geology, Ocenography, Climatology, Atmospheric and Environmental Sciences. Among library services, the Document Delivery Service allows rapid supply of scientific documents, books, theses and other documents not owned by the Library through Inter-Library loan and exchange or purchase. This service is for internal users. On the other side, the Library offers rapid and comprehensive document supply and interlibrary loan to other Italian libraries from its extensive collection. Document Delivery (DD) plays an important role in Italian research and university libraries. The main Internet resources for Document Delivery and Resource Sharing are the Archivio Collettivo Nazionale dei Periodici (ACNP, the collective serials Italian catalogue), the Sistema Bibliotecario Nazionale Catalogue (SBN) and the MetaOpac Azalai Italiano (MAI). In 1999 the Library started a project aiming at the development of an Internet-based Document Delivery Service, in order to: - exploit the new Internet technologies; - promote cooperation among CNR and Italian university libraries; - reduce service costs; - achieve short turnaround times and higher user satisfaction. The resulting system, NILDE (Network Inter-Library Document Exchange), is a web based software for libraries and end-users, that allows libraries to manage the entire work-flow of document delivery activities. The main advantages for libraries are the provision of synthetic and analytical statistics, provision of performance indicators such as ?fill-rate? and ?turn-around time?, and support for secure electronic delivery via Internet by means of a file-uploading/web-server. The main advantages for end-users are the possibility to forward a document delivery request to their library from any OpenURL-compliant bibliographical database (e.g. Web of Science, Scopus, Scifinder, PubMed, CSA Illumina and SFX platforms) and to check the status of their requests. NILDE is presently used by more than 500 Italian libraries and counts about 3.000 registered end-users. It has allowed to build up a large library network, based on cooperation, resource sharing and a degree of standard quality of service and fair behaviours. Technical-scientific and bio-medical libraries represent the core of the NILDE network, performing more than 80% of the total number of document exchanges. The most recent progress and implementation of the NILDE project and software will be presented. We will also focus on the important contribution made by earth-science libraries to the NILDE network and how it will be possible to increase it, by actively involving even more libraries and complying with the user-needs of earth-scientists

Olfactory Dysfunction in Patients with Chronic Rhinosinusitis

Objectives. To measure the prevalence of and identify the clinical characteristics associated with olfactory decline in patients with chronic rhinosinusitis. Methods and Materials. There is analytical, prospective, and observational study in adult patients with a diagnosis of chronic rhinosinusitis. The olfactory test used was the Connecticut Chemosensory Clinical Research Center (CCCRC). Results. They are 33 patients total. Within the group of patients aged 18 to 39, 9% had normosmia, 73% hyposmia, and 18% anosmia (P<0.001). Between 40 and 64 years old, there was no patient with normosmia, 63% hyposmia, and 37% anosmia (P<0.001). Of patients older than 65 years old, 33% showed mild hyposmia, 34% severe hyposmia, and 33% anosmia (P<0.001). 52% were females, and 48% were males. Conclusion. Nasal polyposis, asthma, septal deviation, turbinate hypertrophy, tobacco, and allergic rhinitis are predicting factors of olfactory dysfunction. Antecedents of previous endoscopic surgeries, age, and gender would not be associated with olfactory loss

Barriers to Asthma Treatment in the United States: Results From the Global Asthma Physician and Patient Survey

BACKGROUND: The Global Asthma Physician and Patient (GAPP) survey evaluated the perceptions of both physicians and patients on the management of asthma. Here we present the results from the United States (US) subpopulation of the GAPP survey. METHODS: The GAPP Survey was a large, global study (physicians, n = 1733; patients, n = 1726; interviews, n = 3459). In the US, 208 adults (aged ≥ 18 years) with asthma and 224 physicians were recruited. Respondents were questioned using self-administered online interviews with close-ended questionnaires. RESULTS: Physician and patient responses were found to differ in regard to perception of time spent on asthma education, awareness of disease symptoms and their severity, asthma medication side effects, and adherence to treatment and the consequence of nonadherence. Comparison of the US findings with the global GAPP survey results suggest the US physician-patient partnership compared reasonably well with the other countries in the survey. Both patients and physicians cited a need for new asthma medication. CONCLUSIONS: Similar to the global GAPP survey, the US-specific findings indicate that in general there is a lack of asthma control, poor adherence to therapy, and room for improvement in patient-physician communication and partnership in treating asthma

A internet da indústria das coisas: oportunidades e ganhos potenciais

The Industrial Internet of Things, IIoT is an in-process innovation based on the application of the Internet of Things in industry, which will increase the efficiency of machines, reduce costs, adjust production processes, monitor fleets, gains in scale , product improvement and market opening This article aims to point out the types of innovation resulting from the industrial internet IIoT of things, as well as to support the concept of IIoT and to point out the gains from IIoT and understand its application, with emphasis on Brazil. To carry out the study, a bibliographic review was made, based on the following authors: Oliveira et al. (2016), Waka (2015), Keller (2016), Romano (2017), Rocha (2017), Trindade (2013) and Fortino et al (2017) We conclude that it is the industrial internet of things, an innovation in process, is a fundamental tool not only for creating and sustaining competitive advantage for industries, but above all for nations that claim to be competitive in the 21st century. Keywords: Industrial Automation. Internet of Things. Industrial Internet of Things.A Internet Industrial das Coisas, a IIoT é uma inovação em processo a partir da aplicação da internet das coisas na indústria, aonde permitirá aumentar a eficiência das máquinas, reduzir os custos, ajustar os processos de produção, monitorizar frotas, ganhos em escala, melhoria de produtos e abertura de mercados Este artigo tem como objetivo apontar os tipos de inovação decorrentes da internet industrial IIoT das coisas, como também fundamentar o conceito de IIoT e apontar os ganhos advindos da IIoT e compreender sua aplicação, com destaque para o Brasil. Para realizar o estudo foi feito uma revisão bibliográfica, com base nos seguintes autores: Oliveira et al. (2016), Waka (2015), Keller (2016), Romano (2017), Rocha (2017), Trindade (2013) e Fortino et al (2017). Conclui-se que é a internet industrial das coisas, uma inovação em processo, é uma ferramenta fundamental não somente para criação e sustentação de vantagem competitiva para as indústrias, mas sobretudo para as nações que se pretendem competitivas no século XXI. Palavras-chave: Automação Industrial. Internet das Coisas. Internet Industrial das Coisas

Calouro cidadão: um projeto que tornou possível a cultura do trote não violento nos cursos de graduação da Unifal-MG - Campus Poços de Caldas

Haircuts and games feared to be potentially dangerous have been replaced by solidarity and integration actions during the arrival of new students (newcomers) to the university environment, since the first class entering the technological bachelor degree courses at the Universidade Federal de Alfenas/MG – campus Poços de Caldas, in 2009. This institutional posture aims to restrain the violent and embarrassing culture of the reception of the newcomers in engineering by the veterans. In this sense, the Extension Project Calouro Cidadão aims to encourage students to participate in social and educational actions that, in a pleasant and constructive way, provide moments of integration and welcome among the newcomers and veterans, besides humanizing the trot at the university, through activities of a social, philanthropic and educational nature, aiming at a positive change of attitudes between students. The project has its actions concentrated in the first week of class of each period of the year. Some examples of actions are informative lectures about the functioning of the University, food and clothes collection, going to Lar São Vicente de Paulo, going to APAE, going to the hemocenter, and others. This project is based on the indissociability of teaching, research and extension and, in view of the acceptance and interest of the students in continuing the work and the fact that there have never been reports of violent hazing inside or even outside the campus, it is possible to see that the context of non-violent hazing is taking root in the culture of the campus.El corte de pelo y los juegos temidos por ser potencialmente peligrosos han sido reemplazados por acciones de solidaridad e integración durante la llegada de nuevos estudiantes (estudiantes de primer año) al entorno universitario desde la primera clase del campus de Poços de Caldas - MG. Esta postura institucional tiene como objetivo frenar la cultura violenta y vergonzosa de los veteranos que reciben estudiantes de primer año. En este sentido, Calouro Cidadão tiene como objetivo alentar a los estudiantes a participar en acciones de carácter social y educativo que, de manera placentera y constructiva, brinden momentos de integración y un sentimiento de bienvenida entre los nuevos y los viejos. Se puede ver que en este proyecto la inseparabilidad de la enseñanza, la investigación y la extensión se hace presente y el contexto de las novatadas no violentas arraigadas en la cultura del campus.Cortes de cabelo e brincadeiras temidas por serem potencialmente perigosas têm sido substituídos por ações solidárias e de integração durante a chegada dos novos alunos (calouros) ao ambiente universitário, desde a primeira turma ingressante em cursos de bacharelado tecnológicos da Universidade Federal de Alfenas/MG – Campus Poços de Caldas, no ano de 2009. Essa postura institucional objetiva coibir a cultura violenta e constrangedora da recepção dos calouros de engenharia pelos veteranos. Nesse sentido, o Projeto de Extensão Calouro Cidadão visa incentivar os discentes a participarem de ações de caráter social e educativo que, de forma prazerosa e construtiva, proporcionam momentos de integração e boas-vindas entre os discentes, além de humanizar o trote na universidade, por meio de atividades de cunho social, filantrópico e educativo, visando uma mudança positiva de atitudes entre calouros e veteranos. O projeto tem suas ações concentradas na primeira semana de aula de cada período do ano. Alguns exemplos de ações são palestras informativas sobre o funcionamento da Universidade, mutirão de arrecadação de alimentos e roupas, ida ao Lar São Vicente de Paulo, ida à APAE, ida ao hemocentro, dentre outras. Este projeto está pautado na indissociabilidade do ensino, pesquisa e extensão e, tendo em vista a aceitação e o interesse dos alunos em dar continuidade ao trabalho e de nunca terem ocorrido denúncias de trote violento dentro ou mesmo fora do campus, é possível perceber que o contexto de trote não violento está se enraizando na cultura do campus

Fexofenadine is Efficacious and Safe in Children (Aged 6-11 Years) with Seasonal Allergic Rhinitis

Background: This is the first prospective, randomized, doubleblind, placebo-controlled study showing statistical improvement of an H1-antihistamine in children with seasonal allergic rhinitis in all symptoms throughout the entire treatment period. Objective: This randomized, placebo-controlled, parallelgroup,double-blind study was performed to assess the efficacy and safety of fexofenadine in children with seasonal allergic rhinitis. Methods: This study was conducted at 148 centers in 15 countries. Nine hundred thirty-five children (aged 6-11 years) were randomized and treated with either fexofenadine HCl 30 mg (n = 464) or placebo (n = 471) tablets twice a day for 14 days. Individual symptoms (sneezing; rhinorrhea; itchy nose, mouth, throat, and/or ears; itchy, watery, and/or red eyes; and nasal congestion) were assessed at baseline and then daily at 7:00 AM and 7:00 PM (±1 hour) during the double-blind treatment period. Each total symptom score was the sum of all symptoms, excluding nasal congestion. The primary efficacy variable was the change from baseline in the average of the daily 12-hour evening reflective total symptom scores throughout the double-blind treatment. Safety was evaluated from adverse-event reporting, vital signs, physical examinations, and clinical laboratory data at screening and study end point

The effect of ketotifen on inflammatory markers in allergic conjunctivitis: an open, uncontrolled study

BACKGROUND: The efficacy and safety of ketotifen eye drop treatment in allergic conjunctivitis (AC) management is perfectly known by several studies, but the mechanism of action at the biochemical levels is poorly understood so we decided to perform an open, uncontrolled study in order to investigate the effect of the topical administration of ketotifen fumarate 0.05% on biochemical markers of inflammation on conjunctival cells in patients with AC. METHODS: Nineteen patients with symptoms and signs of AC (itching, discharge, burning, redness, increase in the watery discharge, swelling and follicles) and with a history of allergy were prescribed with two daily instillation of one drop of eyewash ketotifen fumarate 0,05% in both eyes during thirty days. They were studied by measuring clinical and immunologic parameters. RESULTS: Ketotifen fumarate treatment significantly reduced the total symptoms and signs score for each patient as well as each symptoms and signs at all time points compared with day 0 (p < 0.0001 and p < 0.016, respectively). Although the percentage of HLA-DR+ epithelial cells diminished only in 58% of patients, the numbers of CD29+ and eotaxin+ epithelial cells dropped significantly in 68% and 73 % of them (p < 0.0062 and <0.0082, respectively) as a consequence of the treatment. In 9 out of 19 patients a simultaneous decrease in the percentage of epithelial cells positive for CD29 and eotaxin was observed. CONCLUSION: Ketotifen besides the well-known effect in reducing signs and symptoms of AC significantly diminished production of eotaxin and expression of CD29 by epithelial cells in patients with seasonal AC

100 Years of Immunotherapy: The Monaco Charter

Aims of the Monaco Charter: (1) to present the current evidence on the efficacy and safety of allergen-specific immunotherapy (SIT) and to address the reasons for its underuse in clinical practice; (2) to develop strategies to increase the awareness about the benefits and the hazards of SIT in allergic patients, lay public and healthcare professionals not trained in allergy, and (3) to make SIT accessible and affordable to eligible patient