The overlapping area between Osteogenesis Imperfecta and child physical abuse: a bilbiometric analysis.

Osteogenesis Imperfecta (OI) is a hereditary connective tissue disorder. Its manifestations are fragile bones. multiple bone fractures, bone deformities with a history of minimal or no trauma. This clinical picture may be observed in Child Physical Abuse (CPA). CPA is a relevant differential diagnosis when a child presents unexplained fractures. Aim is to quantify the weight and the trends of the wrold wide literature on OI and CPA, in order to measure if and how the 2 topics overlap and are studied together. A retrospective bibliometric analysis was carried out. Through PubMed, literature was explored and 2 quoted phrases Osteogenesis Imperfecta (OI), Child Physical Abuse (CPA) (CPA) were searched in all available manuscripts. Starting from retrieved papers, a descriptive analysis and a text mining search were performed (SAS software). Search retrieved 7,140 manuscripts, distributed per interval period (1950-2006) per each DB as follows: OI 48% (1950-2006), CPA 52% (1950-2006). English is the leading language of publication: OI 70% and CPA 93%. For both the DBs the top Countries of publication are USA and UK. An overlapping area exists between OI & CPA: 70 manuscripts representing the 1% of the whole (1969-2006), written in English (84%) and published in the US and UK (45% and 29%). Further results on text mining search will follow. Results obtained show that English-written papers predominate and understanding English results fundamental to update oneself. The overlapping area is nearly absent despite the strong correlation of the two issues, it means that bibliographic search on CPA/differential diagnosis could be easily biased retrieving incomplete results, with the continuous risk of falling in a bibliographic cul-de-sac

Are elderly patients poor candidates for pegylated interferon plus ribavirin in the treatment of chronic hepatitis C?

Elderly patients with chronic hepatitis C receiving combined treatment with IFN and RBV have a higher likelihood of side effects and a significantly lower rate of virological response at the end of the treatment and 6 months afterward than younger adults

Pegylated interferon alpha-2b plus ribavirin for naive patients with HCV-related cirrhosis

BACKGROUND: Data on the efficacy of antiviral therapy in patients with HCV-related compensated cirrhosis are generally drawn from analyzing subgroups in larger trials. AIMS: (1) To analyze the safety and efficacy of combination therapy in naive patients with HCV-related cirrhosis; (2) to evaluate the factors influencing the sustained virologic response (SVR) in cirrhotic patients by comparison with a group of noncirrhotic patients; (3) to analyze the outcome of cirrhotic patients either acquiring SVR and nonresponders to the antiviral therapy during the posttreatment follow-up. METHODS: We consecutively enrolled 365 patients with biopsy-proven HCV-related chronic hepatitis meeting the inclusion criteria for pegylated interferon a-2b plus Ribavirin: 87 patients had compensated liver cirrhosis and 278 had histologic stages between 1 and 4 according to Ishak's classification. RESULTS: The 2 groups were comparable for genotype, viral load, and alanine transferase at presentation. Cirrhotic patients were significantly older and had significantly higher body mass index, serum ferritin, and gamma-glutamyl transpeptidase. The rate of side effects was similar in the 2 groups, whereas the rate of SVR was significantly lower in cirrhotic (45.9%) than in noncirrhotic patients (65.8%). Logistic regression analysis showed that genotype 1 to 4 and high viral load were independent variables correlating with nonresponse in the sample as a whole. During follow-up, hepatocellular carcinoma developed in 5/38 (13.2%) cirrhotic patients not responding or relapsing after treatment. No cases of hepatocellular carcinoma were seen among cirrhotic or noncirrhotic patients with a SVR. CONCLUSIONS: Cirrhotic patients with compensated disease have a reasonably good chance of virologic response and should be offered treatment, carefully monitoring any side-effects

Multisite trial on efficacy of constraint-induced movement therapy in children with hemiplegia: study design and methodology.

OBJECTIVE: In the past decades, several treatment approaches have been used to improve upper limb function in hemiplegic cerebral palsy. Only recently has constraint-induced movement therapy emerged as a treatment approach for children with hemiplegic cerebral palsy with the aim of reversing the behavioral suppression of movement in the affected upper limb. To date, evidence on this treatment has been very poor and limited, because all currently available trials reveal methodological limitations and a need for additional research to support the application of this treatment technique. This article presents the methodological choices, design, and main characteristics of an ongoing controlled clinical trial on the effectiveness and safety of constraint-induced movement therapy combined with an intensive rehabilitation program and compared with two comparison groups: one treated with an intensive rehabilitation program and the other with standard treatment. METHODS: Twenty-one rehabilitation sites are currently recruiting patients with hemiplegic cerebral palsy, aged between 2 and 8 yrs, who have never undergone constraint therapy. Primary outcome measures include two major domains: upper limb motor ability (Quality of Upper Extremity Skills Test) and hand function assessment evaluating both grip function and spontaneous use of the affected side (Besta scale). Secondary outcome measures concern overall function, behavior, compliance, and satisfaction with treatment program of both child and family. Patients' follow-up is of 12 mos after treatment. RESULTS: Research in children has always been neglected in comparison with adults, because of ethical reasons regarding the use of children for experimental purposes. The consequence has been the utilization of treatment and assessment tools and techniques that have not always been tested in pediatric patients or evidence is very scarce. CONCLUSION: Discussing and working on pediatric research methods represents an urgent need in rehabilitation research