ribbed short sleeve top Blue Pringle Of Scotland Wide Range Of Cheap Online Wide Range Of For Sale Discount Authentic Online Cheap Nicekicks Very Cheap Online 9zHSoqigj

ribbed short sleeve top - Blue Pringle Of Scotland Wide Range Of Cheap Online Wide Range Of For Sale Discount Authentic Online Cheap Nicekicks Very Cheap Online 9zHSoqigj
ribbed short sleeve top - Blue Pringle Of Scotland

Recently, we published a prospective study on the reproductive competence, educational achievements, and social adjustment of former CPP women in early and middle adulthood as compared to women with normal puberty ( 10 ). In the present study, we expanded our research to assess their present health status using data-mining techniques utilizing the computerized database of the Clalit Health Services (CHS), the largest health management organization in Israel, with a nationwide distribution that includes 53% of the Israeli population.

Our primary end-point was to assess the current BMI and general health status and metabolic outcome of former CPP women between the third and fifth decades of life as compared to women with normal puberty. Our secondary end-point was to determine whether pubertal suppressive therapy significantly affected the long-term medical outcome, by comparison of treated to untreated CPP women.

Patients and Methods

Among the medical files of the 186 girls who had sought medical attention due to idiopathic progressive CPP at the Institution for Pediatric Endocrinology at Schneider Children's Medical Center of Israel between the years 1984 and 2005, we identified 142 women (100 GnRHa treated and 42 untreated) who had fulfilled the criteria for diagnosis, treatment, and follow-up of CPP and who are currently insured by the CHS. These comprised the study cohort. Diagnosis of progressive CPP required that all of the following criteria be met: appearance of secondary pubertal signs (breast Tanner stage 2 with or without sexual hair) ( 11 ) before the chronological age (CA) of 8 years, accelerated growth rate, advancement of bone age more than 1 year above CA, and GnRH-stimulated peak LH above 5 IU/L ( 1 ). In accordance with our departmental policy at that time, pubertal-suppressive therapy was offered to all girls diagnosed as having progressive CPP after an observation period of up to 6 months to rule out nonsustained or slowly progressive forms of CPP. Among the initial 186 patients identified, therapy was accepted, with parental consent, by 135 girls and refused by 51. Therapy consisted of a depot preparation of GnRHa (Decapeptyl; Ferring Pharmaceuticals Ltd) administered by im injection every 4 weeks at a calculated dose of 1.5–3.0 μg/kg release per day to a maximal dose of 3.75 mg. Treatment was discontinued in most cases at an age when normal puberty could be expected (at CA 11–11.5 y and bone age 12–12.5 y). All girls, treated and untreated, were regularly followed up to the completion of puberty and attainment of final height. Excluded from the study were girls born prematurely or small for gestational age; girls with chronic disease, bone dysplasia, organic brain disease, congenital adrenal hyperplasia, or other endocrinological abnormalities; girls who had undergone radiation therapy and/or chemotherapy; and girls who had been treated for less than 2 years or who were noncompliant.

Published: April 9, 2018

Neutropenia is a condition associated with a low white blood cell count. These types of white blood cells, called neutrophils, are made in the bone marrow and fight off infections. If there is a decrease in neutrophil production, an accelerated usage of neutrophils, or an increased destruction of neutrophils, the risk of infection increases, particularly those caused by bacteria or fungi.

Adults that have less than 1,500 neutrophils per microliter of blood are considered neutropenic, but some people can have lower-than-average neutrophil counts but not have an increased risk of infection. Neutrophil counts less than 1,000 per microliter – and in severe cases, less than 500 per liter – are always considered to be neutropenia and are at the highest risk of infection.

What causes neutropenia?

Cancer chemotherapy is the most common cause of neutropenia. Other cancer treatments, including radiation therapy , stem cell or bone marrow transplants , or steroids (which usually actually raise the neutrophil count, but still increase the risk of infection), can also lower neutrophil count. Sometimes, while destroying cancer cells, these treatments can also affect normal, healthy cells like neutrophils, resulting in immunosuppression: compromised immune system functioning.

Additionally, neutropenia can result from specific diseases, such as leukemia or bone marrow disorders, among others, or from certain infections, such as hepatitis A, B, and C, or Lyme disease.

How do doctors diagnose neutropenia?

Doctors use a blood sample to diagnose neutropenia. They look to the absolute neutrophil count (ANC), the number of neutrophils in a certain amount of blood, to monitor the patient’s immune system before, during, and after treatment.

What are symptoms of neutropenia?

Neutropenia alone has no specific symptoms, but it is typically diagnosed in the context of a fever or an infection. Often, a persistent infection is also what leads doctors to test blood cells counts to identify blood cell cancers like leukemia. When a patient is neutropenic, severe infections can develop rapidly and become overwhelming in the space of minutes to hours. Fortunately, because doctors expect potential changes in immune responses during various cancer treatments, they pay close attention to fluctuations in blood counts to prevent such occurrences.

How is neutropenia treated?

The treatment of neutropenia itself depends on its cause and severity. Drugs that may cause neutropenia can be stopped whenever possible and exposures to infections or suspected toxins can be avoided. If an underlying disease has caused the neutropenia, treatment of the disease will then impact treating the neutropenia.


Article Information



Format Available

Full text: HTML | PDF

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley Sons, Ltd.

Request Permissions

  • Article first published online:

Editorial Group


Additional references

ARIA 2008
Barham 2015
Berjis 2011
  • Berjis N , Sonbolastan SM , Okhovat SH , Narimani AA , Razmjui J . Normal saline versus hypertonic 3% saline: its efficacy in non-acute rhinosinusitis . Iranian Journal of Otorhinolaryngology 2011 ; 23 : 23 - 8 .
Bonnomet 2016
BSACI 2008
Chong 2016
Chusakul 2013
Egger 1997
Elkins 2011
Georgitis 1994
Handbook 2011
  • Higgins JPT , Green S (editors) . Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 . Available from www.cochrane-handbook.org .
Hermelingmeier 2012
Katelaris 2012
Khianey 2012
Kim 2008
King 2015
Mims 2014
Pynnonen 2007
  • Pynnonen MA , Mukerji SS , Kim HM , Adams ME , Terrell JE . Nasal saline for chronic sinonasal symptoms: a randomized controlled trial . Archives of Otolaryngology--Head Neck Surgery 2007 ; 133 ( 11 ): 1115 - 20 .
Rabago 2005
  • Rabago D , Pasic T , Zgierska A , Mundt M , Barrett B , Maberry R . The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms . Otolaryngology - Head and Neck Surgery 2005 ; 133 : 3 - 8 .
RevMan 2014 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration . Review Manager (RevMan) . Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 .
Schoenwetter 2004
Wormald 2004
  • Wormald PJ , Cain T , Oates L , Hawke L , Wong I . A comparative study of three methods of nasal irrigation . Laryngoscope 2004 ; 14 : 2224–7 .

Version History

Citing Literature

  • Number of times cited : 0