BACKGROUND:
Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).
METHODS:
Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.
RESULTS:
The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.
CONCLUSION:
This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

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International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis.

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

/pdf/a-systematic-review-on-the-influence-of-fear-of-falling-on-1ud0z2s6ap.pdf

A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?

In 2006, PAIN published a systematic review of the measurement properties of self-report pain intensity measures in children and adolescents (Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. PAIN 2006;125:143-57). Key developments in pediatric pain necessitate an update of this work, most notably growing use of the 11-point numeric rating scale (NRS-11). Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain. Methodological quality and sufficiency of measurement properties for reliability, validity, responsiveness, and interpretability was assessed by at least 2 investigators using COnsensus based Standards for the selection of health Measurement INstruments (COSMIN). Searches identified 60 unique self-report measures, of which 8 (reported in 80 papers) met inclusion criteria. Well-established measures included the NRS-11, Color Analogue Scale (CAS), Faces Pain Scale-Revised (FPS-R; and original FPS), Pieces of Hurt, Oucher-Photographic and Numeric scales, Visual Analogue Scale, and Wong-Baker FACES Pain Rating Scale (FACES). Quality of studies ranged from poor to excellent and generally reported sufficient criterion and construct validity, and responsiveness, with variable reliability. Content and cross-cultural validity were minimally assessed. Based on available evidence, the NRS-11, FPS-R, and CAS were strongly recommended for self-report of acute pain. Only weak recommendations could be made for self-report measures for postoperative and chronic pain. No measures were recommended for children younger than 6 years, identifying a need for further measurement refinement in this age range. Clinical practice and future research implications are discussed.

Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.

Importance Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). Objective To measure the association between depression, ...

/pdf/association-among-facial-paralysis-depression-and-quality-of-4r40s7e486.pdf

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

https://pure.rug.nl/ws/files/17596084/Title_and_contents_.pdf

Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes

Now-a-days there is significant discussion about patient-reported outcomes (PRO) in medical world. The following article covers almost all the areas of PRO including-their importance, important concepts for understanding of PRO, significance, ideal properties, types, development and evaluation of PRO instruments. It is useful for physicians, pharmacists and patients for the assessment and improvement of the therapy.

Patient-reported outcomes: A new era in clinical research

Although multiple bee stings are of rare incidence, they can cause many harmful reactions in humans. Massive inoculation of bee venom is reported to cause skin necrosis, shock hypertension, bleeding, hemolysis, thrombocytopenia, pancreatitis, (adult) respiratory distress syndrome, rhabdomyolysis, and acute renal failure (ARF).[1–12] Generally, three major reactions occur after bee inoculation as 1) local swelling and irritation, 2) generalized anaphylactic responses, and 3) serum sickness like symptoms, which include hemolysis, disseminated intravascular coagulation, rhabdomyolysis, and ARF.[13,14] In India, existences of honey combs are general in rural as well as urban areas but there are sparse data available in the literature on bee sting toxicity. To the best of our knowledge, there are no epidemiological studies reported until now on multiple bee sting-induced ARF and/or rhabdomyolysis in the Indian population. Hence, we performed a retrospective study for multiple bee sting-induced ARF and/or rhabdomyolysis.

The cases under International Classification of Diseases 2010 (Code T63.4) i.e., “venom of other arthropods” were screened retrospectively from January 2009 to December 2011 after Institutional Ethics Committee (IEC) approval. A total 32 cases were found. The inclusion criteria were the adult cases diagnosed to have multiple bee sting-induced rhabdomyolysis, ARF and/or other complication. Nine cases were selected in the study [Table 1, Figure ​Figure11 and ​and2],2], out of which six were diagnosed with acute kidney injury (AKI) and rhabdomyolysis, two with AKI only, and one with rhabdomyolysis only. The following type of information was collected from the patient records: Age, sex, complaints on admission, diagnosis, medical, medication, social and family history, days between bee stings and hospital admission, number of hemodialysis given, length of stay in the hospital; laboratory results like serum urea, serum creatinine, aspartate (AST), and alanine (ALT) aminotransferases, alkaline phosphatase (ALP), creatine kinase (CK), lactate dehydrogenase (LDH), total leukocyte count (TLC), hemoglobin (Hb), presence of myoglobin in urine, and other relevant data as per the case were obtained. All the patients had no significant abnormalities in serum potassium and sodium. The distribution of the AKI cases as per the risk, injury, failure, loss, end-stage (RIFLE) criteria was 1-‘Risk’, 6-‘Failure’, 1-‘Loss’.



Table 1

Details of the patients





Figure 1

Serum urea levels of the patients





Figure 2

Serum creatinine of the patients



The unique points in each case are discussed below. In all the cases, for anaphylaxis standard treatment was given.

Acute Renal Failure and/or Rhabdomyolysis due to Multiple Bee Stings: A Retrospective Study

Breast cancer is a leading problem in developing world and India can be considered as one of the major contributors for incidence of breast cancer. In this article authors have reviewed quality of life studies on Indian breast cancer population. There are many factors which may hear common but cannot be neglected in case of Indian population. Policies and future directions to be implemented for breast cancer are also discussed.

Patient-reported quality of life outcomes in Indian breast cancer patients: importance, review of the researches, determinants and future directions

Pharm D: A new concept in India.

Atorvastatin-induced acute pancreatitis (AP) is one of the rare adverse effects available in the literature. We report a case of 53-year-old patient developed AP after treatment with atorvastatin monotherapy which resolved after drug withdrawal. Extensive workup on AP failed to reveal any other etiology for it. To our knowledge, this is one of the rare case reports of AP caused due to atorvastatin monotherapy and it further strengthens the fact that statins may cause AP. There is need of continued reporting of such a rare adverse effect of atorvastatin for increasing awareness and to manage and avoid the same.

Prasanna R Deshpande

Papers

Patient-reported outcomes: A new era in clinical research

Acute Renal Failure and/or Rhabdomyolysis due to Multiple Bee Stings: A Retrospective Study

Patient-reported quality of life outcomes in Indian breast cancer patients: importance, review of the researches, determinants and future directions

Pharm D: A new concept in India.

Atorvastatin-induced acute pancreatitis