Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ribavirin was approved in early 1986 for treatment of illness associated with respiratory syncytial virus (RSV) infection in hospitalized children; however, the value of its use remains controversial. This investigation was undertaken to describe ribavirin utilization and to evaluate the effectiveness of ribavirin in reducing the period of hospitalization. All children with laboratory-confirmed RSV infection, hospitalized over seven epidemic periods at a single institution, were identified. Characteristics from the medical records of the 768 children and their course of hospitalization were evaluated as determinants of treatment with ribavirin. Very young age as well as diagnoses of congenital heart disease, certain pulmonary conditions, and failure to thrive were all significantly related to increased likelihood of treatment. Children requiring intensive care were likely to be treated; however, the most critically ill children, those who required mechanical ventilation, were not treated. Although these results were in keeping with treatment guidelines for the use of ribavirin, actual utilization declined significantly over the course of the evaluation. The effect of ribavirin treatment on the duration of hospitalization among children with community-acquired infection was evaluated in a multivariate model, which controlled for the effects of underlying conditions, measures of illness severity, and epidemic year. This analysis failed to demonstrate a benefit for ribavirin in reducing length of stay; in fact, ribavirin treatment was significantly associated with prolonged hospitalization. It was not likely that the explanation for ribavirin's association with prolonged hospitalization was that the most seriously ill children were treated; however, it was not possible to determine whether this association was due to an adverse effect of treatment or resulted from a perceived need to complete the course of therapy.
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PMID:Ribavirin utilization and clinical effectiveness in children hospitalized with respiratory syncytial virus infection. 878 Jun 3

Respiratory syncytial virus (RSV) is a recognised cause of lower respiratory tract infection in infants and young children. It causes severe respiratory disease in preterm infants with or without chronic lung disease. This study, conducted at Waterford Regional Hospital, evaluates the incidence of RSV infection in hospitalised children, its seasonal variation, and effectiveness of its prevention. Thirty eight percent of admitted children with bronchiolitis were RSV positive in the year 1999 November to March is the peak season for this infection. A highly selected group of 7 preterm children with or without chronic lung disease received Palivizumab prophylaxis. Not one of them acquired RSV infection. The high cost of Palivizumab was the main factor for its restricted use. Palivizumab was found to be effective in preventing RSV infection in our study. Since we had a small number of patients, further studies are needed for its economic and judicious use. Respiratory syncytial virus (RSV) is virulent easily transmissible and the most common cause of lower respiratory tract disease in children of less than 2 years of age. Up to 98% of children attending day care will be infected in single RSV season. Between 0.5% and 3.2% of children with RSV infection require Hospitalisation. Approximately 90,000 hospital admissions and 4500 deaths per year were reported in United States. In Ireland 2807 patients were admitted with Bronchiolitis in 1998. Major risk factors for hospitalisation due to RSV are Prematurity, chronic lung disease, congenital heart disease, compromised immunity and age younger then 6 weeks in otherwise healthy children. No effective treatment of RSV positive bronchiolitis beside supportive care in the form of adequate nutrition and oxygen therapy is available. Antiviral therapies such as Ribavirin has not been proved to be effective in RSV infection. Bronchodilators show variable results. Corticosteroids were not found effective. There is no effective vaccine available as yet. There is no proven method for active immunity. Various immunoglobulins are available for acquiring passive immunity against RSV infection. PREVENT study group in Jan. 1997 showed intravenous immunoglobulin (RSV- IGIV) use in reducing 41% to 63% hospitalisation in RSV patients. But RSV-IGIV was not licensed outside the United States because of risk of transmission of blood borne products, difficulty in administration ie. intravenous access, large fluid volume (15 ml/kg), high protein load (750 mg/kg), shortage of supply and need to postpone live vaccine (eg. MMR, varicella). monoclonal antibody Palivizumab was developed for prophylaxis against RSV infection. Clinical safety and efficacy of Palivizumab were demonstrated in IMpact trial published in Sept. 1998. Reduction in hospitalisation up to 55% was noted in this study. It was a pivotal randomised, double blind, placebo controlled phase 3 study conducted in 139 centres throughout Canada, United States and United Kingdom. We looked at our experience in patients admitted with bronchiolitis in Waterford Regional Hospital. We described the outcome of carefully selected Seven children of high risk group for Palivizumab prophylaxis. Its clinical Implications and cost effectiveness was evaluated in this study.
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PMID:Prophylaxis in RSV infection (Palivizumab)--is it worthwhile? 1120 17

Respiratory syncytial virus (RSV) bronchiolitis in early life is a risk factor for later development of asthma and atopy. Ribavirin is the only effective drug currently available against acute RSV bronchiolitis. However, the long-term effects of ribavirin remain unclear. We investigated a cohort of children hospitalized with RSV bronchiolitis from when they were under 2 yr old until they reached a mean age of 6.2 yr. In total, we enrolled 175 children in this study. Both the group treated with ribavirin and the group not treated with ribavirin included high-risk young children with congenital heart disease or chronic lung disease. Their respective age-matched controls, that we labeled groups A and B, both without ribavirin treatment, consisted of previously healthy subjects. Wheezing was either verified by physicians or estimated by a questionnaire. Allergen sensitization was judged by serum allergen-specific IgE levels. The cumulative incidence of physician-diagnosed asthma or recurrent wheezing in the ribavirin group (15%) was significantly lower than its incidence in the non-ribavirin-treated group (34%, p = 0.049), and in the control A group (43%, p = 0.005). Allergen sensitization was also least frequent in the ribavirin group. Ribavirin therapy was an independent factor in reducing the risk of developing asthma, asthma/recurrent wheezing, and sensitization to D. pteronyssinus/D. farinae. The long-term value of ribavirin for acute RSV bronchiolitis and its underlying mechanisms deserves further research.
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PMID:Ribavirin for respiratory syncytial virus bronchiolitis reduced the risk of asthma and allergen sensitization. 1825 4

Several population-based birth cohort studies documented that 30% of children suffer from wheezing during respiratory infections before their third birthday. Infants are prone to wheeze because of anatomic factors related to the lung and chest wall in addition to immunologic and molecular influences in comparison to older children. Viral infections lead to immunologic derangements that cause wheezing both in immunocompetent and immunodeficient infants. Anatomic causes of wheeze may be extrinsic or intrinsic to the airway. Not every wheeze is indicative of asthma but prediction of asthma in persistent wheezers is possible. Testing for allergy in these infants is worthwhile and can be of significant value in avoidable allergens. Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable and a trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Ribavirin administered by aerosol, hyper-immune respiratory syncytial virus immunoglobulin (RSV IVIG), and intramuscular monoclonal antibody to an RSV protein have been used for RSV bronchiolitis in infants with congenital heart disease or chronic lung disease.
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PMID:Wheezing in infancy. 2328 43

The paramyxoviruses are a heterogeneous group of viruses causing a variety of clinical diseases in humans, animals, and birds. This chapter examines in more detail the structure and properties of the important human viruses in this group, namely measles, respiratory syncytial virus (RSV), mumps and parainfluenza viruses I-V. They are all enveloped, negative-stranded, riboviruses of helical symmetry. It is suggested that susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is contraindicated. Mumps vaccine can be of particular value to children approaching puberty and for adolescents and adults, especially males who have not had mumps in childhood. Ribavirin therapy may be particularly beneficial for children at risk for severe and often fatal RSV infection, such as infants with congenital heart disease. Attenuated measles vaccines have been developed empirically by selection of host range mutants, and are widely and successfully used throughout the world. Using the vaccine, some countries may soon eliminate measles as an endogenous virus but continued problems are anticipated, particularly in adults with viruses re-introduced by visitors from abroad. Basic studies on new antivirals are continuing (particularly with oligopeptides) but antiviral compounds are unlikely to have extended use in the clinic, except perhaps in tropical areas where the disease may be life threatening. However, a vaccination programme in these areas is preferable, and is an urgent need.
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PMID:Chapter 8 Paramyxoviruses. 3233 40