Paradoxical use of corticosteroids in steroid-phobic patients Brief report

Background: Childhood-onset eczema is a common condition associated with pruritus, sleep disturbance and disrupted quality of life. The mainstay of treatment is usage of emollients and topical corticosteroid (CS). Nevertheless, many steroid-phobic parents are very skeptical about western medicine that may contain CS. Furthermore, complementary and alternative medicine (CAM) is popular among Chinese patients in Asia and many citizens idolize CAM and believe that traditional Chinese medicine and herbs are without any side effects. Pressed by public's quest for efficacious and safe treatment, and lucrative profits, CAM practitioners may take the risks of prescribing steroids and "western medicine" in the name of traditional Chinese herbal medicine. Methods: We report a series of illustrative cases of uninformed systemic and topical corticosteroid usage for eczema by steroid-phobic parents to alert the public of this risk. The drugs were detected by high-performance liquid chromatography with diodearray detection, liquid chromatography-tandem mass spectrometry, gas chromatography mass spectrometry, or liquid chromatography ion trap time-of-flight mass spectrometry. Results: Five cases of uninformed corticosteroid usage for moderate-to-severe eczema by steroid-phobic parents were reported. Conclusions: The physician caring for children with skin disease should also be aware that even steroidphobic parents might indeed be using potent CS without awareness. The patient usually suffers chronic relapsing eczema of moderate-to-severe degree. The steroidphobic parent is usually non-compliant in following advice on usage of emollient, topical CS, and avoidance of triggers in accordance with western doctors. The CAM practitioner, when confronted by an anxious steroidophobic parent who demands efficacious topical and/or systemic treatment, may knowingly or unknowingly be forced into prescribing potent albeit illegal products containing corticosteroids in the name of traditional Chinese herbal medicine. World J Pediatr 2012;8(3):263-26

Be Careful, Mom and Doc: Hepatotoxicity Associated with Prescribed Medications in Young Infants

Accidental poisonings in young infants are relatively uncommon, and the careless caregiver is usually the culprit. We report two cases of hepatotoxicity due to prescribed medications. An infant was given 15 mL instead of 1.5 mL of paracetamol by his mother because she omitted the decimal point on the label of the drug bottle. The infant became symptomatic, and liver enzyme and clotting profile were abnormal, necessitating treatment with N-acetyl cysteine. Another infant was prescribed oral ketoconazole for thrush, resulting in elevation of liver enzymes. The serum alanine aminotransferase levels were transiently elevated but returned to normal, and both infants recovered uneventfully. This report serves to alert the doctor to avoid using decimal points in drug labeling and to avoid prescribing excessive amount of drug for trivial acute illness. Thrush in infancy is common and usually treated with oral nystatin. Other oral antifungals such as ketoconazole may be associated with liver derangement and should be avoided in infants

Be Careful, Mom and Doc: Hepatotoxicity Associated with Prescribed Medications in Young Infants

Accidental poisonings in young infants are relatively uncommon, and the careless caregiver is usually the culprit. We report two cases of hepatotoxicity due to prescribed medications. An infant was given 15 mL instead of 1.5 mL of paracetamol by his mother because she omitted the decimal point on the label of the drug bottle. The infant became symptomatic, and liver enzyme and clotting profile were abnormal, necessitating treatment with N-acetyl cysteine. Another infant was prescribed oral ketoconazole for thrush, resulting in elevation of liver enzymes. The serum alanine aminotransferase levels were transiently elevated but returned to normal, and both infants recovered uneventfully. This report serves to alert the doctor to avoid using decimal points in drug labeling and to avoid prescribing excessive amount of drug for trivial acute illness. Thrush in infancy is common and usually treated with oral nystatin. Other oral antifungals such as ketoconazole may be associated with liver derangement and should be avoided in infants.Peer Reviewe

Complications of Bezoar in Children: What Is New?

A bezoar is a mass found trapped in the gastrointestinal system. The condition may be associated with pica, especially in developmentally retarded children. Clinical manifestations are usually nonspecific. Endoscopic diagnosis and removal of the foreign materials is often indicated. Occasionally, severe complications may occur. We report two cases to illustrate the clinical features and complications in these children. In the first case, a reliable history was not obtained in the developmentally delayed girl which precluded prompt diagnosis, but the grossly dilated stomach on plain abdominal radiograph gave clues to an underlying insidious mechanical obstruction of upper gastrointestinal tract. In the second case of a normal child, the unrelenting symptoms and weight loss prompt further investigations which revealed the diagnosis. Literature on pediatric bezoar is reviewed. Oesophagoduodenoscopy is the investigation of choice for diagnostic confirmation, but surgical facilities must be available to deal with acute complications

Complications of Bezoar in Children: What Is New?

A bezoar is a mass found trapped in the gastrointestinal system. The condition may be associated with pica, especially in developmentally retarded children. Clinical manifestations are usually nonspecific. Endoscopic diagnosis and removal of the foreign materials is often indicated. Occasionally, severe complications may occur. We report two cases to illustrate the clinical features and complications in these children. In the first case, a reliable history was not obtained in the developmentally delayed girl which precluded prompt diagnosis, but the grossly dilated stomach on plain abdominal radiograph gave clues to an underlying insidious mechanical obstruction of upper gastrointestinal tract. In the second case of a normal child, the unrelenting symptoms and weight loss prompt further investigations which revealed the diagnosis. Literature on pediatric bezoar is reviewed. Oesophagoduodenoscopy is the investigation of choice for diagnostic confirmation, but surgical facilities must be available to deal with acute complications.Peer Reviewe

Fighting tobacco smoking: a difficult but not impossible battle

According to the World Health Organization (WHO), tobacco-related disease is the single largest preventable cause of death in the world today, killing around 5.4 million people a year – an average of one person every six seconds. The total number of death caused by tobacco consumption is higher than that of tuberculosis, HIV/AIDS and malaria combined. Unlike other communicable diseases, however, tobacco-related disease has a man-made consensus vector – the tobacco companies that play an active role to promote tobacco consumption, which directly heightens the disease morbidity. Any public health policy designed to curb smoking behavior has to prepare for opposite lobbying actions from tobacco companies that undermine the effects of the health measures. Another unique nature of the tobacco epidemic is that it can be cured, not by medicines or vaccines, but on the concerted actions of government and civil society. Many countries with a history of tobacco control measures indeed experienced a reduction of tobacco consumption. As most of these governments launched a range of measures simultaneously, it is hard to quantify the relative merits of different control strategies that contributed to the drop in the number of smokers. These packages of strategies can come in different forms but with some common features. Political actions with government support, funding, and protection are crucial. Without these, antismoking efforts in any part of the world are unlikely to be successful

Rabies: Epidemiology, pathogenesis, and prophylaxis

<p><strong>Article full text</strong></p><p><br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/BF02877781"><b>here</b>.</a><br> <br> <strong>Provide enhanced content for this article</strong><br> There are currently no enhanced features for this article. If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:</p><p>• Summary Slides</p><p>• Slide decks</p><p>• Videos and animations</p><p>• Audio abstracts</p><p> </p><p>• Audio slides</p> <p> </p> <p> </p

Fighting Tobacco Smoking - a Difficult but Not Impossible Battle

According to the World Health Organization (WHO), tobacco-related disease is the single largest preventable cause of death in the world today, killing around 5.4 million people a year – an average of one person every six seconds. The total number of death caused by tobacco consumption is higher than that of tuberculosis, HIV/AIDS and malaria combined. Unlike other communicable diseases, however, tobacco-related disease has a man-made consensus vector – the tobacco companies that play an active role to promote tobacco consumption, which directly heightens the disease morbidity. Any public health policy designed to curb smoking behavior has to prepare for opposite lobbying actions from tobacco companies that undermine the effects of the health measures. Another unique nature of the tobacco epidemic is that it can be cured, not by medicines or vaccines, but on the concerted actions of government and civil society. Many countries with a history of tobacco control measures indeed experienced a reduction of tobacco consumption. As most of these governments launched a range of measures simultaneously, it is hard to quantify the relative merits of different control strategies that contributed to the drop in the number of smokers. These packages of strategies can come in different forms but with some common features. Political actions with government support, funding, and protection are crucial. Without these, antismoking efforts in any part of the world are unlikely to be successful