Treatment of congenital extrahepatic portosystemic shunts in dogs : a systematic review and meta‐analysis

Background Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence-based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs. Objectives To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques. Animals Not used. Methods A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta-analysis was performed. Results Forty-eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant. Conclusions and Clinical Importance The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential

Association between secondhand smoking in the home and respiratory morbidity in preschool children

Abstract OBJECTIVE Identifying the prevalence of secondhand smoking in the home and its association with morbidity and hospitalization from respiratory causes in preschool children. METHOD This is a cross-sectional study conducted in five early childhood education centers at a public university in São Paulo. Sample size calculation was performed and the participants were randomly determined. Data were collected through questionnaires completed by family members or caregivers of 215 children. Chi-square and Student's t-test were used for the statistical analysis, using a 0.05 significance level. RESULTS The prevalence of secondhand smoke in the household was 15.3%. Bivariate analysis revealed that secondhand smoke in the household was associated with the occurrence of rapid breathing, subdiaphragmatic retractions in the past three months, and treated ear infections/otitis. CONCLUSION A low prevalence of secondhand smoking in the home was found. Secondhand smoke was associated with a higher prevalence of respiratory symptoms and morbidity

Self-care for common colds: A European multicenter survey on the role of subjective discomfort and knowledge about the self-limited course - The COCO study

<div><p>Introduction</p><p>Common colds are the most frequently encountered disease worldwide and the most frequent reason for self-care. According to the cross-sectional European Common Colds study (COCO), patients use as many as 12 items on average for self-care. Little is known about the influence of discomfort and knowledge on self-care for common colds.</p><p>Main objective</p><p>To understand the influence of patients’ discomfort during a cold and their knowledge about the self-limited disease course on the use of self-care measures.</p><p>Materials and methods</p><p>This COCO analysis included 2,204 patients from 22 European primary care sites in 12 countries. Each site surveyed 120 consecutive adults with a 27-item questionnaire asking about patients’ self-care, subjective discomfort during a cold (discomfort: yes/no), and knowledge about the self-limited course (yes/no). Country-specific medians of the number of self-care items served as a cut-off to define high and low self-care use. Four groups were stratified based on discomfort (yes/no) and knowledge (yes/no).</p><p>Results</p><p>Participants’ mean age was 46.5 years, 61.7% were female; 36.3% lacked knowledge; 70.6% reported discomfort. The group <i>has discomfort/no knowledge</i> exhibited the highest mean item use (13.3), followed by <i>has discomfort/has knowledge</i> (11.9), <i>no discomfort/no knowledge</i> (11.1), and <i>no discomfort/has knowledge</i> (8.8). High use was associated with discomfort (OR 1.8; CI 1.5–2.2), female gender (OR 1.7; 1.4–2.0), chronic pain/arthritis (OR 1.6; 1.2–2.1), more years of education (OR 1.3; 1.1–1.6), age <48 years (OR 1.3; 1.0–1.5), and lack of knowledge (OR 1.2; 1.0–1.4).</p><p>Discussion</p><p>Counseling on common colds should address patients’ discomfort and soothing measures in addition to providing information on the natural disease course.</p></div