The cystic fibrosis airway microbiome.

Purpose Of Review: Culture and molecular approaches have established that lower airway infections are polymicrobial. We consider how this new perspective in cystic fibrosis (CF) may affect treatment choices.

Recent Findings: Standard clinical microbiology of CF infection exacerbations often fails to provide indications of microbial causes that may drive the onset of exacerbation and the anticipated bacteriologic responses to the usual parenteral antibiotics prescribed as treatment.

What is nonacid reflux disease?

Proton pump inhibitors (PPIs) are the gold standard treatment for gastroesophageal reflux disease. In clinical practice, failure of PPIs occurs frequently, and may affect up to 30% of patients in a typical gastroenterology practice. Multichannel impedance monitoring combined with pH monitoring helps to detect nonacid reflux, and if symptoms correlate with these nonacid reflux episodes, nonacid reflux disease can be diagnosed.

Seasonal and perennial allergic conjunctivitis.

Seasonal and perennial allergic conjunctivitis are IgE-mediated, hypersensitivity ophthalmic conditions characterized by ocular pruritus, epiphora, and hyperemia. Proper diagnosis is usually made clinically based on history and physical examination. Diagnostic procedures are rarely necessary.

Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: benefits versus risks.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but are not without risks.

Aim: To provide evidence-based management recommendations to help clinicians determine optimal long-term NSAID therapy and the need for gastroprotective strategies based on an assessment of both gastrointestinal (GI) and cardiovascular (CV) risks.

Methods: A multidisciplinary group of 21 voting participants revised and voted on the statements and the strength of evidence (assessed according to GRADE) at a consensus meeting.

Alendronate once weekly for the prevention and treatment of bone loss in Canadian adult cystic fibrosis patients (CFOS trial).

Background: Patients with cystic fibrosis (CF) are at risk for early bone loss, and demonstrate increased risks for vertebral fractures and kyphosis. A multicenter, randomized, controlled trial was conducted to assess the efficacy, tolerability, and safety of therapy with oral alendronate (FOSAMAX; Merck; Whitehouse Station, NJ) in adults with CF and low bone mass.

Methods: Participants received placebo or alendronate, 70 mg once weekly, for 12 months.

Parenteral nutrition related hepato-biliary disease in adults.

Parenteral nutrition is a life-saving therapy in patients with intestinal failure. One of the major causes of morbidity and mortality in patients receiving long-term total parenteral nutrition (TPN) is liver disease. Early on, there is steatosis, which can evolve to steatohepatitis and eventually to cholestasis of varying severity.

Tuberous sclerosis complex: a review.

Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder characterized by the potential for hamartoma formation in almost every organ. The inheritance is autosomal dominant with almost complete penetrance but variable expressivity. The two gene loci that code for TSC are TSC1, located on chromosome 9q34, and TSC2 on 16p13.

Foundations of interdisciplinarity: a Lonergan perspective.

The postmodern enterprise, with its foundationlessness, fragmentariness, constructivism, and neopragmatism challenges interdisciplinarity. This paper discusses functional specialization and interdisciplinary method which provides a basis for interdisciplinary collaboration. In functional specialization, successive stages in the process of coming to know are distinguished.

Endoscopic "antireflux" procedures: not yet ready for prime time.

Gastroesophageal reflux disease affects a significant portion of the North American population on a weekly and daily basis. Options, especially for erosive disease, involve long-term proton pump inhibitors or surgical fundoplication. More recently, a number of endoscopic antireflux techniques have been assessed.

Internipple distance and internipple index.

Objective: To determine the internipple distance and internipple index in Chinese children.

Methods: The internipple distance and chest circumference were measured in 3,290 healthy Chinese children (1,715 males and 1,575 females) aged birth to 18 years seen at the Asian Medical Centre. The internipple distance and chest circumference were obtained at the end of expiration whenever possible, with a standard nonstretch tape measure graduated in millimeters with the arms hanging relaxed alongside the body.

Mycophenolate mofetil for the treatment of autoimmune hepatitis in patients refractory to standard therapy.

There are limited therapeutic options available for patients with autoimmune hepatitis in whom conventional treatment fails. A case series of five patients unresponsive to or unable to take azathioprine, 6-mercaptopurine or corticosteroids who were treated with mycophenolate mofetil (MMF) is reported. While on MMF, alanine aminotransferase normalized or remained normal in all patients.

Hemihypertrophy.

Hemihypertrophy refers to asymmetry of the body to a greater degree than can be attributed to normal variation. Most causes can be diagnosed from history and physical examination. Hemihypertrophy is cosmetically unsightly and the psychological impact can be quite prolonged.

Divergence of endocardial QT interval components during programmed electrical stimulation including observations during induction of sustained ventricular tachyarrhythmias.

Measurements were made in 12 normal subjects and during induction of sustained ventricular tachyarrhythmias in 31 patients with remote myocardial infarction. QT interval measurements were made semiautomatically with computer assistance and the total QT interval was divided into early (QT1) and late (QT2) components. QT intervals and QT interval dispersion between two right ventricular endocardial sites were plotted against the degree of prematurity of the last extrastimulus (S2, S3, or S4).