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Indian Pediatr 2010;47: 900 |
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Amit P Shah
Email:
[email protected]
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2010 Rheumatoid Arthritis Classification Criteria –
Major Update after 1987 (Ann Rheum Dis 2010;69:1580-1588
doi:10.1136/ard.2010.138461) |
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The 1987 American College of Rheumatology (ACR) classification criteria
for rheumatoid arthritis (RA) have been criticized for their lack of
sensitivity in early disease. A joint working group from the ACR and the
European League Against Rheumatism (ELAR) developed, in three phases, a
new approach to classifying RA. The work focused on identifying, among
patients newly presenting with undifferentiated inflammatory synovitis,
factors that best discriminated between those who were and those who were
not at high risk for persistent and/or erosive disease–this being the
appropriate current paradigm underlying the disease construct ‘RA’. In the
new criteria set, classification as ‘definite RA’ is based on the
confirmed presence of synovitis in at least one joint, absence of an
alternative diagnosis better explaining the synovitis, and achievement of
a total score of 6 or greater (of a possible 10) from the individual
scores in four domains: number and site of involved joints (range 0-5),
serological abnormality (range 0–3), elevated acute-phase response (range
0-1) and symptom duration (two levels; range 0-1). This new classification
system redefines the current paradigm of RA by focusing on features at
earlier stages of disease that are associated with persistent and/or
erosive disease, rather than defining the disease by its late-stage
features.
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Newborn Behavior to Locate the Breast when Skin-to-Skin
with Mother: A Possible Method for Enabling Early Self-regulation (Acta
Pædiatrica DOI:10.1111/j.1651-2227.2010. 01983.x) |
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How an infant is sensitized to mother’s breast and gets breast feed is an
important physiological reflex to understand early establishment of breast
feeding. In this study, full-term infants were videotaped immediately
after birth. A video protocol was developed to examine infant behaviors
identified from five random videotapes. When birth crying had stopped, the
babies showed a short period of relaxation and then successively became
alert. They went through an "awakening phase", an "active phase" with
movements of limbs, rooting activity and looking at the mother’s face, a
"crawling phase" with soliciting sounds, a "familiarization phase" with
licking of the areola, and a "suckling phase" and last a "sleeping phase".
Inborn breastfeeding reflexes were depressed at birth, possibly due to a
depressed sensory system. It is hypothesized that when the infant is given
the option to peacefully go through the nine behavioral phases - birth
cry, relaxation, awakening, activity, crawling, resting, familiarization,
suckling and sleeping when skin-to-skin with its mother, it is helpful to
stimulate early breast feeding.
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Oral Immunotherapy -
Cure for Food Allergies? (Curr Opin Allergy Clin Immunol, 2010 10:
214-219) |
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The only available treatment for food allergy is strict dietary avoidance.
Food Oral Immunotherapy (OIT) is a promising therapy and was tested
recently in USA. Desensitized state, defined as the ingestion of a
substantial amount of food in the home diet that protects from severe
reactions to accidental exposures, can be achieved by approximately 50-75%
of the children treated with OIT. The rate of permanent tolerance is
unknown; the longer duration of OIT may result in permanent tolerance.
Side effects are common both during the initial dose escalation and during
home dosing. Most reactions are mild and decrease in frequency with the
longer duration of OIT. These preliminary data on OIT are encouraging.
Answers are yet to be obtained on the optimal dose, ideal duration of
oral/sublingual immunotherapy, degree of protection, efficacy for
different ages, severity and type of food allergy responsive to treatment,
and need for patient protection during home administration.
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