Generic Viagra

People who need a new kidney may need to look no farther than across the dining room table, according to a new study that shows that spouses are good potential sources for so-called “living-unrelated organ donation.”

Due to a worldwide shortage of organs available for transplant from people who have died, “living organ donors” have become a major source of organs for transplantation.

And while a “well-matched” donor organ from a sibling, parent or other close relative has the highest likelihood of surviving in the recipient, there is also evidence that organs from “living-unrelated donors” such as spouses yield similar survival rates to those from well-matched living-related donors.

However, transplant patients may be reluctant to consider an organ from their spouses because the organs may not be well-matched in terms of blood and tissue type. Such poor matching can cause the immune system to reject the organ.

Against this backdrop, Dr. Yu-Ji Lee and colleagues from Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea Lee reviewed the medical records of 185 people who successfully underwent living-unrelated kidney transplantation at their institution. A total of 55 out of the 185 transplant patients received kidneys from their spouses.

They report in the journal Dialysis and Transplantation that kidney transplantation from spousal donors “has comparable outcomes to those of other living-unrelated donors, and shortens the time spent on the waiting list.”

While the incidence of acute rejection of the kidney in the first year after transplantation was more frequent in people who received a kidney from a spouse, the survival rates at 1 and 5 years for spousal and other living-unrelated kidneys were both high and were not significantly different.

“Spouses are important potential donors for living-unrelated kidney transplantation,” the investigators note in their report, and “should be considered as a useful source to overcome an organ shortage.”

Spousal donors have a strong emotional bond with their recipients, Lee and colleagues point out, and some investigators have found that spousal donor transplantation improved family relationships. There is also evidence, they say, that such a strong emotional bond may be related to the high survival rate of kidneys from spouses.

To ease the anxiety of a child undergoing surgery, it helps if parents and children are well-prepared, advises the American Society of Anesthesiologists.

“Undergoing surgery can be a source of stress for a person of any age, but when the patient is a child, a whole new layer of sensitivity is added,” ASA President Dr. Roger A. Moore said in a news release from the society. “The anesthesiologist, surgeon and entire care team do their best to make a child’s visit to the hospital as pleasant as possible, but parents also have a key role to play in the process. To this end, we urge parents to begin preparing their child as soon as a decision is made to perform surgery.”

The ASA offers these tips:
Be informed. Learn what you and your child should expect during and after surgery. Ask the doctor to walk you through the operation, then seek details about when and where you can be present, the anesthesia, recovery time, pain, scars and other pertinent details.
Inform your child in an age-appropriate manner. Older children may be able to handle more detailed information than younger ones. Your doctor should be able to offer advice on relaying surgery specifics.
Be positive. In general, always offer reassurance. Children like knowing that the medical staff contains experts looking out for their well-being. Emphasize that short-term discomfort will be outweighed by longer-term health and happiness.
Set realistic expectations. Remind your child that no one immediately bounces back from surgery, and it may be a gradual healing process with some discomfort along the way.
Seek support. Have family and friends provide encouragement in person or through calls, cards or e-mails.
Distract your child. Plan activities for the day before or of surgery to keep your child’s mind free of worry. A new toy can help occupy the time.
Work with your medical team. Being open and honest will help them make the right decisions for your child. Be aware of cues they offer to help keep your child calm.
Care for yourself. Stay calm because children often pick up on their parent’s attitude and demeanor. Ask for or accept help from others with meals and child care to keep your daily life moving smoothly forward.
Stay alert even after surgery. Follow your doctor’s post-op instructions closely. Be on the lookout for post-surgical complications, even well after the operation.

A single dose of a corticosteroid, given along with antibiotics, can relieve severe sore throat pain faster and more effectively than antibiotics alone, a new study suggests.

“In people with severe sore throat, a single dose of an oral steroid is effective in relieving pain in 24 and 48 hours,” said researcher Dr. Carl Heneghan, the deputy director of the Centre for Evidence-Based Medicine at the University of Oxford in the U.K.

This treatment is not advised for a mild sore throat, which will go away by itself, Heneghan stressed.

“If you turn up at your emergency department and you have really bad tonsillitis and you are in a lot of pain, an additional treatment is to take a single dose of a corticosteroid,” he explained.

The report is published in the Aug. 7 online edition of BMJ.

Corticosteroids relieve pain by reducing inflammation and are commonly prescribed for conditions such as asthma and croup. Their use as a pain reliever for sore throat could help reduce the need for antibiotics, which can be overused and help create resistant bacteria, the U.K. researchers say.

For the study, Heneghan’s group analyzed eight trials comparing the effectiveness of corticosteroids to placebo in adults or children with severe sore throats. In total, the studies included 743 patients, 369 of whom were children.

The researchers found that patients given corticosteroids plus antibiotics were three times more likely to report having no pain 24 hours after treatment compared with patients given antibiotics and a placebo.

After two days this effect was less apparent, which suggests that a single dose of corticosteroids is all that is needed, according to the researchers. In addition, corticosteroids also reduced the time it took to relieve pain by about six hours.

Heneghan’s team noted that significant pain relief was only observed in adult patients and not in children receiving corticosteroids.

In addition, other painkillers made no difference in the results, the researchers found.

“What we don’t know is: do corticosteroids replace antibiotics?” Heneghan stated. “That’s another piece of research we would like to do,” he said.

Dr. Julie Wei, an assistant professor of otolaryngology at the University of Kansas Medical Center, agreed that steroids work well in relieving severe sore throat pain, but she cautioned that they are not a substitute for antibiotics, which treat the infection, not the pain.

“The use of steroid should never be for the purpose of replacing antibiotics,” Wei said. “Based on the current information, that is not the conclusion people should have.”

Single-dose steroid use is already a common practice, Wei said. “For example, all my pediatric patients undergoing tonsillectomy and adenoidectomy get a single dose intravenously at the time of surgery, because steroids are the most potent anti-nausea, anti-vomiting medication we have,” she said.

Single-dose steroids also help improve eating and drinking, and feeling good, Wei said. “Also, people in the emergency room or children admitted for throat abscess usually get a single dose of steroids if they are having severe pain or difficulty opening their mouth due to inflammation. We ENTs already recommend that commonly,” she added.

“The bottom line is, it is already commonly used in anesthesia, ER setting, etc., but does not replace antibiotics,” Wei said.

Hispanic whites seeking emergency treatment for gastrointestinal (GI) illnesses wait twice as long to see a doctor compared to non-Hispanic whites, new research shows.

The most likely explanation for this “striking” disparity is that Hispanic patients may have difficulty communicating to hospital staff, and require help from translators, Dr. Bechien Wu of Brigham and Women’s Hospital in Boston, who was involved in the study, told Reuters Health. Based on what he’s seen at his hospital, Wu added, “patients who rely upon those services are really apt to have more delay in their assessment.”

It’s crucial for patients with severe belly pain to see a doctor quickly, Wu said, because this pain may signal a life-threatening condition like stomach hemorrhage or a ruptured appendix.

Wu and his team looked at whether ER crowding influenced how quickly patients with stomach problems were seen by a physician by using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1997 to 2006.

Their analysis included 1.6 million ER visits for acute inflammation of the pancreas, 2.2 million for appendicitis, 1.2 million for gall bladder inflammation, and 3.9 million for upper gastrointestinal tract hemorrhage.

Patients experienced a delay in seeing a physician 24% of the time, the researchers found. Delays were more common for non-Hispanic whites in each of the four diagnostic categories; for example, non-Hispanic whites with appendicitis waited 43.5 minutes to see a doctor, on average, compared to 91.2 minutes for Hispanic whites, while the waiting time for gastrointestinal hemorrhage was 46 minutes for non-Hispanic whites and 73.7 for Hispanic whites.

The NHAMCS data didn’t include information on what languages people spoke, Wu and his team point out, but “a major delay in physician assessment and ultimately treatment can occur while waiting for a language interpreter in a busy emergency ward,” they point out in a report in the American Journal of Gastroenterology.

The findings are particularly concerning, Wu noted, given that Hispanics are by far the fastest-growing segment of the US population.

The findings could also signal more widespread problems with health care access. “If there’s a particular segment of the population that’s having to wait longer across the board this could be just the tip of the iceberg in terms of their interaction with the overall health care system.”

Employing bilingual “patient navigators” — health care workers who guide patients through the system — is one way to tackle the problem, Wu said. “Most emergency departments already have interpreter services. I think it’s a question of how we can better utilize those interpreter services.”

And making things work better at the front end of the system could be an important way to improve health care quality, he added. “The point of first contact is so critical for getting our patients into the system and managed appropriately.”