May clinic has devised a scale
see:
http://www.mayoclinic.org/gi-rst/mayomodel10.html
Sunday, December 5, 2010
Vitamin E for fatty liver
N Engl J Med 2010;362:1675-85.
Pioglitazone, Vitamin E, or Placebofor Nonalcoholic Steatohepatitis
Arun J. Sanyal et al
Vitamin e 800 iu/day
higher rate of improvement in nonalcoholic steatohepatitis (43% vs. 19% in placebo, P = 0.001)
pioglitazone no extra help
http://columbiamedicine2.org/residents/bb/Dan%20Freedberg%20JC.pdf
Suugested some cryptogenic cirrhosis is fatty liver and might benefit.
Pioglitazone, Vitamin E, or Placebofor Nonalcoholic Steatohepatitis
Arun J. Sanyal et al
Vitamin e 800 iu/day
higher rate of improvement in nonalcoholic steatohepatitis (43% vs. 19% in placebo, P = 0.001)
pioglitazone no extra help
http://columbiamedicine2.org/residents/bb/Dan%20Freedberg%20JC.pdf
Suugested some cryptogenic cirrhosis is fatty liver and might benefit.
Acute OM treatment
Management of Acute Otitis Media
S. Forgie et al
Paediatr Child Health 14(7) Sept 2009 457-60
1. Watchful waiting - if child over 6 months (I would use 1 year) - watchful waiting 48-72 hours if not better then, antibiotics
2. Exceptions - toxic, high fever, severe pain, immune deficit, prior problems, Down's, aboriginal
3. Though amoxicillin suggested, B lactamase M. cartarrhalis and H. influenza not response so may need to switch - if significantly ill may start with better drugs
4. Amoxicillin 75-90 mg/kg/day divided by 2
5. Cefprozil axetil 30 mg/kg/day - /2 (Cefzil)
6. Cefuroxime 30 mg/kg /day /2 (ceftin)
7. Ceftriaxone 50 mg/kg IM or IV once (Rocephin) - or 3 days if resistent
8. Clarithromycin 15 mg/kg/day /2 (Biaxin)
Clavulin 125 0r 250/5ml - 90 mg/kg amoxicillin /2 for 10 days use clavulin - amoxicillin 25 mg/kd/day and plain amoxicillin 65 mg/kg/day
Hand out to parents:
Ear infections
Ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age, are usually not serious, and are not contagious. Most ear infections occur with a cold.
What causes an ear infection?
Viruses or bacteria (germs) cause middle ear infections. The Eustachian tube connects the middle ear with the back of the throat. Germs can travel from the back of the throat when the Eustachian tube is damaged, causing middle ear infections.
Who is at higher risk for ear infections?
Babies born prematurely.
Younger children because they have shorter Eustachian tubes.
Children who attend daycare because they tend to have more colds.
Children with allergies or exposed to cigarette smoke. Smoke can irritate the Eustachian tube, making ear infections more likely.
Children who were not breastfed. Breastmilk has antibodies that help fight infections.
Children who are bottle fed and who swallow milk while lying down. Milk can enter the Eustachian tube, which increases the risk of an ear infection.
Children with cleft palates.
Children of First Nations and Inuit descent.
How do I know if my child has an ear infection?
Older children will complain of an earache. Younger ones might not say they have an earache, but might:
have an unexplained fever,
be fussy,
have trouble sleeping,
tug or pull at their ears, and
have trouble hearing quiet sounds.
Some children have fluid draining from their ear. This fluid could contain germs. The best way to prevent the spread of these germs is to wash your hands well.
Doctors diagnose ear infections by looking at the ear drum (tympanic membrane) with a special light called an otoscope.
How is an ear infection treated?
Doctors almost always prescribe antibiotics for children under 6 months of age or for children with other serious medical problems.
For older children who don’t have too much discomfort or a high fever, your doctor will likely watch for 48 – 72 hours (2-3 days) to see if the ear infection gets better on its own.
Your doctor might suggest acetaminophen or ibuprofen to reduce your child’s pain. Only give ibuprofen if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months without first talking to your doctor.
Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children under 6 years of age without first talking to your doctor. The only exceptions are drugs used to treat fever (such as ibuprofen and acetaminophen).
Your doctor may give a prescription for antibiotics to use if your child doesn’t feel better in 2 to 3 days or she might want to re-examine your child if he is still in pain. Most children are feeling better by then.
Children usually feel better within 1 day of starting an antibiotic. Use antibiotics only as directed. Keep giving them until they are finished, even if your child feels better. Your doctor might want to see your child again to be sure the infection has cleared up completely.
When do children need tubes in their ears?
If your child has frequent ear infections, or if he has trouble hearing because of fluid in the middle ear, an ear, nose and throat surgeon might need to insert a tube through the ear drum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps any fluid to drain.
Putting tubes in requires a short operation. Children don’t usually have to stay in the hospital overnight.
When should I call the doctor?
Call your doctor if you think your child has an ear infection AND:
has other serious medical problems,
seems ill,
vomits over and over,
is younger than 6 months,
is older than 6 months and has had a fever for more than 48 hours,
has swelling behind the ear or the ear is tender,
is very sleepy,
is very irritable
has a skin rash,
isn’t hearing well or at all,
remains in a lot of pain despite at least one dose of acetaminophen or ibuprofen, or
still has an earache after 2 days of treatment with acetaminophen or ibuprofen.
How can I prevent my child from getting an ear infection?
Wash your and your child’s hands often to reduce the chance of getting a cold.
Breastfeed your baby.
Avoid bottle feeding your baby when she is lying down.
Don’t use a pacifier (soother) too often.
Don’t smoke; smoking can increase the risk of ear infections.
Have your child vaccinated with the pneumococcal vaccine (if they are at least 2 months of age, and have not already had this shot) and with the flu shot every year.
S. Forgie et al
Paediatr Child Health 14(7) Sept 2009 457-60
1. Watchful waiting - if child over 6 months (I would use 1 year) - watchful waiting 48-72 hours if not better then, antibiotics
2. Exceptions - toxic, high fever, severe pain, immune deficit, prior problems, Down's, aboriginal
3. Though amoxicillin suggested, B lactamase M. cartarrhalis and H. influenza not response so may need to switch - if significantly ill may start with better drugs
4. Amoxicillin 75-90 mg/kg/day divided by 2
5. Cefprozil axetil 30 mg/kg/day - /2 (Cefzil)
6. Cefuroxime 30 mg/kg /day /2 (ceftin)
7. Ceftriaxone 50 mg/kg IM or IV once (Rocephin) - or 3 days if resistent
8. Clarithromycin 15 mg/kg/day /2 (Biaxin)
Clavulin 125 0r 250/5ml - 90 mg/kg amoxicillin /2 for 10 days use clavulin - amoxicillin 25 mg/kd/day and plain amoxicillin 65 mg/kg/day
Hand out to parents:
Ear infections
Ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age, are usually not serious, and are not contagious. Most ear infections occur with a cold.
What causes an ear infection?
Viruses or bacteria (germs) cause middle ear infections. The Eustachian tube connects the middle ear with the back of the throat. Germs can travel from the back of the throat when the Eustachian tube is damaged, causing middle ear infections.
Who is at higher risk for ear infections?
Babies born prematurely.
Younger children because they have shorter Eustachian tubes.
Children who attend daycare because they tend to have more colds.
Children with allergies or exposed to cigarette smoke. Smoke can irritate the Eustachian tube, making ear infections more likely.
Children who were not breastfed. Breastmilk has antibodies that help fight infections.
Children who are bottle fed and who swallow milk while lying down. Milk can enter the Eustachian tube, which increases the risk of an ear infection.
Children with cleft palates.
Children of First Nations and Inuit descent.
How do I know if my child has an ear infection?
Older children will complain of an earache. Younger ones might not say they have an earache, but might:
have an unexplained fever,
be fussy,
have trouble sleeping,
tug or pull at their ears, and
have trouble hearing quiet sounds.
Some children have fluid draining from their ear. This fluid could contain germs. The best way to prevent the spread of these germs is to wash your hands well.
Doctors diagnose ear infections by looking at the ear drum (tympanic membrane) with a special light called an otoscope.
How is an ear infection treated?
Doctors almost always prescribe antibiotics for children under 6 months of age or for children with other serious medical problems.
For older children who don’t have too much discomfort or a high fever, your doctor will likely watch for 48 – 72 hours (2-3 days) to see if the ear infection gets better on its own.
Your doctor might suggest acetaminophen or ibuprofen to reduce your child’s pain. Only give ibuprofen if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months without first talking to your doctor.
Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children under 6 years of age without first talking to your doctor. The only exceptions are drugs used to treat fever (such as ibuprofen and acetaminophen).
Your doctor may give a prescription for antibiotics to use if your child doesn’t feel better in 2 to 3 days or she might want to re-examine your child if he is still in pain. Most children are feeling better by then.
Children usually feel better within 1 day of starting an antibiotic. Use antibiotics only as directed. Keep giving them until they are finished, even if your child feels better. Your doctor might want to see your child again to be sure the infection has cleared up completely.
When do children need tubes in their ears?
If your child has frequent ear infections, or if he has trouble hearing because of fluid in the middle ear, an ear, nose and throat surgeon might need to insert a tube through the ear drum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps any fluid to drain.
Putting tubes in requires a short operation. Children don’t usually have to stay in the hospital overnight.
When should I call the doctor?
Call your doctor if you think your child has an ear infection AND:
has other serious medical problems,
seems ill,
vomits over and over,
is younger than 6 months,
is older than 6 months and has had a fever for more than 48 hours,
has swelling behind the ear or the ear is tender,
is very sleepy,
is very irritable
has a skin rash,
isn’t hearing well or at all,
remains in a lot of pain despite at least one dose of acetaminophen or ibuprofen, or
still has an earache after 2 days of treatment with acetaminophen or ibuprofen.
How can I prevent my child from getting an ear infection?
Wash your and your child’s hands often to reduce the chance of getting a cold.
Breastfeed your baby.
Avoid bottle feeding your baby when she is lying down.
Don’t use a pacifier (soother) too often.
Don’t smoke; smoking can increase the risk of ear infections.
Have your child vaccinated with the pneumococcal vaccine (if they are at least 2 months of age, and have not already had this shot) and with the flu shot every year.
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