A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis

Objectives: The antiinflammatory effect of macrolide antibiotics has been well-established, as has their role in the treatment of certain disorders of chronic airway inflammation. Several studies have suggested that long-term, low-dose macrolides may be efficacious in the treatment of chronic rhinosinusitis; however, these studies have lacked a control group. To date, this effect has not been tested in a randomized, placebo-controlled study. Method: The authors conducted a double-blind, randomized, placebo-controlled clinical trial on 64 patients with chronic rhinosinusitis. Subjects received either 150 mg roxithromycin daily for 3 months or placebo. Outcome measures included the Sinonasal Outcome Test-20 (SNOT-20), measurements of peak nasal inspiratory flow, saccharine transit time, olfactory function, nasal endoscopic scoring, and nasal lavage assays for interleukin-8, fucose, and a2-macroglobulin. Results. There were statistically significant improvements in SNOT-20 score, nasal endoscopy, saccharine transit time, and IL-8 levels in lavage fluid (P < .05) in the macrolide group. A correlation was noted between improved outcome measures and low IgE levels. No significant improvements were noted for olfactory function, peak nasal inspiratory flow, or lavage levels for fucose and a2-macroglobulin. No improvement in any outcome was noted in the placebo-treated patients. Conclusion: These findings suggest that macrolides may have a beneficial role in the treatment of chronic rhinosinusitis, particularly in patients with low levels of IgE, and supports the in vitro evidence of their antiinflammatory activity. Additional studies are required to assess their place in clinical practice.

A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents.

Abnormal visual habituation in pediatric photosensitive epilepsy

Objective - To investigate visual habituation – a measure of visual cortical excitability – in photosensitive patients in pediatric age and compare the findings with a matched sample with idiopathic generalized epilepsies without photosensitivity and with normally developing children. Methods - We presented a full-field black-and-white checkerboard pattern, at 3 reversal/s with 100% contrast binocularly for 600 consecutive trials and measured the N75–P100 and P100–N145 pattern-reversal visual evoked potential inter-peak amplitudes and N75, P100, N145 latencies for the six blocks of 100 responses. As a measure of habituation we used the slope of the linear regression line of the N75–P100 and P100–N145 peak-to-peak amplitudes. The slope of the linear regression line of the N75–P100 and P100–N145 latencies was also analyzed. Results - Statistical analysis revealed significant differences between the three groups in the slope index of N75–P100 PR-VEP amplitude, with increased or constant amplitude in the PS group compare to the IGE and ND across the six blocks. Conclusions - Our results support the notion that photosensitivity is associated with altered control of excitatory and inhibitory cortical processes. The causal relationship between habituation deficit and photo-paroxysmal response needs to be further investigated with longitudinal studies. Significance This study supports the hypothesis that suppression of PR-VEP is a sensitive intermediate phenotype, which discriminates patients with photosensitivity from those with generalized epilepsies in pediatric age.

A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents. © 2011 British Contact Lens Association.

AllerTOP - a server for in silico prediction of allergens

Background: Allergy is a form of hypersensitivity to normally innocuous substances, such as dust, pollen, foods or drugs. Allergens are small antigens that commonly provoke an IgE antibody response. There are two types of bioinformatics-based allergen prediction. The first approach follows FAO/WHO Codex alimentarius guidelines and searches for sequence similarity. The second approach is based on identifying conserved allergenicity-related linear motifs. Both approaches assume that allergenicity is a linearly coded property. In the present study, we applied ACC pre-processing to sets of known allergens, developing alignment-independent models for allergen recognition based on the main chemical properties of amino acid sequences.Results: A set of 684 food, 1,156 inhalant and 555 toxin allergens was collected from several databases. A set of non-allergens from the same species were selected to mirror the allergen set. The amino acids in the protein sequences were described by three z-descriptors (z1, z2 and z3) and by auto- and cross-covariance (ACC) transformation were converted into uniform vectors. Each protein was presented as a vector of 45 variables. Five machine learning methods for classification were applied in the study to derive models for allergen prediction. The methods were: discriminant analysis by partial least squares (DA-PLS), logistic regression (LR), decision tree (DT), naïve Bayes (NB) and k nearest neighbours (kNN). The best performing model was derived by kNN at k = 3. It was optimized, cross-validated and implemented in a server named AllerTOP, freely accessible at http://www.pharmfac.net/allertop. AllerTOP also predicts the most probable route of exposure. In comparison to other servers for allergen prediction, AllerTOP outperforms them with 94% sensitivity.Conclusions: AllerTOP is the first alignment-free server for in silico prediction of allergens based on the main physicochemical properties of proteins. Significantly, as well allergenicity AllerTOP is able to predict the route of allergen exposure: food, inhalant or toxin. © 2013 Dimitrov et al.; licensee BioMed Central Ltd.

'Their tummys don't really suit that food':children and young teenagers understanding of food allergy

Background: Food allergy (FA) is aunique chronic condition as sufferers aregenerally well unless they accidentally ingest an allergen, whereupon symptoms can be life threatening. A good under-standing of the condition is essential forsuccessful self-management, however little is known about children and young teenagers' understanding. This study aimed toexplore understanding of FA in childrenwith and without FA and whether under-standing changes as children get older.Method: Participants aged 6–14 years (53with FA; 89 without), recruited from loc evidence of a prospective associationbetween maternal, perinatal or infant VDIand subsequent IgE-mediated FA schools and allergy clinics took part insemi-structured interviews; data were analysed using thematic analysis.Results: Three themes were identified fromthe data across the different age groups andallergy statuses: food allergy as a sickness, food allergy as an illness and food allergy asintolerance to food. Children aged 6–8 years described FA as a sickness; you were not allowed the food because it makes youpoorly. Children aged 9–11 years also talked about FA as something that makesyou poorly, but many also described it as anillness and understood that symptoms were caused by food. Children aged 12–14 yearsdescribed it as an intolerance or that FA was your body's response to a particularfood. These age-related differences wereseen in children with and without FA. Conclusion: Although sophistication ofknowledge of FA increases with age, it is still a little understood condition by chil-dren and young teenagers. Clear, age-re-lated information about food allergy andhow it should be managed is needed forthose with and without allergy, to avoidmisunderstanding, and aid awareness andbetter self-management of the condition

Anafilaxia en urgencias: incidencia, diagnóstico y manejo clínico

La anafilaxia fue descrita en 1902, sin embargo, sigue sin existir una definición de anafilaxia universalmente aceptada. La más utilizada, en la actualidad, es la publicada en el documento de consenso del simposio sobre la definición y el manejo de la anafilaxia del año 2005, que la describe como “una reacción alérgica de inicio rápido que puede producir la muerte”. Actualmente, la anafilaxia se clasifica en inmunológica (IgE dependiente o independiente) y no inmunológica (por ejemplo, la originada por algunos contrastes iodados). Sus síntomas están causados por una liberación masiva de mediadores, principalmente de mastocitos y basófilos, que pueden tener como diana cualquier órgano. Los datos epidemiológicos acerca de la anafilaxia son escasos. La prevalencia se estima entre el 0,05% y el 2%, aunque su incidencia parece estar aumentando. En los últimos años, se han publicado varios estudios que han intentado establecer la incidencia de anafilaxia en los servicios de urgencias de diversos hospitales. Los datos publicados en estos estudios oscilan entre el 0,07% y el 0,4%. Esta variabilidad puede deberse a características de la población y zona geográfica, y también a limitaciones metodológicas, condicionadas principalmente por la falta de consenso en cuanto a su definición, las dificultades para la codificación de la anafilaxia mediante códigos CIE y el funcionamiento de los servicios de urgencias. Además, la mayor parte de estos estudios se centran en pacientes adultos, y en menos ocasiones analizan las características de los pacientes en edad pediátrica...

Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia.

METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE).

RESULTS: -Vital status at 24 months was known for 2960 (88.5%) patients. Two thirds were female. Although patients were young (median age 28 years, interquartile range 18 to 40), the two year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.80-3.11), CHF (HR 2.16, 95% CI 1.70-2.72), New York Heart Association functional class III/IV (HR 1.67, 95% CI 1.32-2.10), atrial fibrillation (AF) (HR 1.40, 95% CI 1.10-1.78) and older age (HR 1.02, 95% CI 1.01-1.02 per year increase) at enrolment. Post-primary education (HR 0.67, 95% CI 0.54-0.85) and female sex (HR 0.65, 95%CI 0.52-0.80) were associated with lower risk of death. 204 (6.9%) had new CHF (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or TIA (8.45/1000 patient-years), 19 (0.6%) had ARF (3.49/1000 patient-years), and 20 (0.7%) had IE (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/TIA or systemic embolism. Patients from low and lower-middle income countries had significantly higher age- and sex-adjusted mortality compared to patients from upper-middle income countries. Valve surgery was significantly more common in upper-middle income than in lower-middle- or low-income countries.

CONCLUSIONS: -Patients with clinical RHD have high mortality and morbidity despite being young; those from low and lower-middle income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and treatment of clinical RHD are required to improve outcomes.

Pruebas inmunológicas en la hiperreactividad bronquial

Se define y describe la hiperreactividad bronquial y se citan a continuación algunos fenómenos fisiopatológicos básicos. Se menciona los hechos más importantes que motivaron la investigación acerca de la utilidad en el diagnóstico de hiperreactividad bronquial mediante la determinación de IgE sérica. Eosinófilos en sangre periférica y frotis nasal. Se analizan 100 niños de 2 a 12 años de edad que consultaron en el Dpto. de Pediatría del Hospital Vicente Corral Moscoso de la ciudad de Cuenca- Ecuador, en 1989-1990, divididos en tres grupos. El tipo clínico de hiperreactividad bronquial, el segundo con patología infecciosa respiratoria a repetición y el tercero conformado por 25 niños sanos (grupo testigo). Se encuentra que la hiperreactivad bronquial es multifactorial, probablemente determinada por factores genéticos, infecciosos, inmunológicos, endocrinos, etc. Los resultados muestran diferencias estadísticas importantes entre los diferentes grupos de estudio, a favor del grupo A, en el cual se detectó aumento de la IgE, aumento de eosinófilos en sangre periférica y secresión nasal. Se hace necesario conocer la población del alto riesgo y una vez identificado el paciente se deben indicar las medidas rpofilácticas que serán: restricciones dietéticas, emjoramiento de factores ambientales y del hogar, uso adecuado de medicamentos profilácticos y manejo psicológico adecuado

Desenvolvimento sustentável: algumas linhas de ação para a Amazônia

As sociedades enfrentam problemas cuja complexidade aumenta na razão direta do crescimento da população e dos impactos causados por uma demanda exponencial de recursos, energia, água e espaço físico na Terra. Embora seja desejável que cada cidadão contemporâneo participe ativamente na resolução dos problemas e na tomada de decisões coletivas, muitos se sentem incapazes de, ao menos, entender a magnitude das questões e correspondentes implicações em um mundo definitivamente imerso na ciência e na tecnologia. Assim, a concepção de tempo – especialmente a de tempo geológico – é crucial para fazer emergir a educação em ciência como instrumento capaz de permitir que todos, jovens e adultos, compreendam o mundo onde vivem. As taxas de derrubada de florestas tropicais na grande bacia hidrográfica amazônica aceleraram-se desde a metade do século XX, com alguns intervalos de redução. Os elementos revelam ser inadiável fortalecer e reintroduzir as Ciências da Terra na Educação, especialmente no Brasil. O conhecimento pode contribuir efetivamente para formar cidadãos conscientes e críticos, capazes de tomar decisões equilibradas e ponderadas sobre atividades humanas que envolvam ocupação e uso do ambiente, materiais naturais e fontes de energia. Neste artigo procuramos refletir sobre a importância do conhecimento geocientífico para formar cidadãos capazes de contribuir nos dias de hoje para plena adoção do conceito de desenvolvimento sustentável. Os dois elementos são fundamentais para que seja possível formular novas interseções e introduzir inovações no contexto da região Amazónica.

A Very Big Hand Is a Very Big Problem: Soft-Tissue Infection, Venous Thrombosis, or Just an Insect Sting?

A 67-year-old woman developed severe edema of her right hand and forearm, for which she was treated with antibiotics, without benefit. The echography excluded a venous thrombosis. Subsequently, she referred a wasp sting before the development of the edema. Specific Hymenoptera venom immunoglobulin E (IgE) was found to be positive for paper wasp and yellow jacket. A large local reaction (LLR) was diagnosed due to the hymenoptera sting. Self-injectable epinephrine was prescribed for possible, though unlikely, systemic reactions following hymenoptera stings.

Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen.

Background: Mycobacterium tuberculosis and human immunodeficiency virus (HIV) are known to cause abnormal thyroid function. There is little information on whether HIV infection aggravates alteration of thyroid function in patients with MDRTB. Objectives: This study was carried out to determine if HIV co-infection alters serum levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in patients with MDR-TB patients and to find out the frequency of subclinical thyroid dysfunction before the commencement of MDR-TB therapy. Methods: This observational and cross-sectional study involved all the newly admitted patients in MDR-TB Referral Centre, University College Hospital, Ibadan, Nigeria between July 2010 and December 2014. Serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were determined using ELISA. Results: Enrolled were 115 patients with MDR-TB, out of which 22 (19.13%) had MDR-TB/HIV co-infection. Sick euthyroid syndrome (SES), subclinical hypothyroidism and subclinical hyperthyroidism were observed in 5 (4.35%), 9 (7.83%) and 2 (1.74%) patients respectively. The median level of TSH was insignificantly higher while the median levels of T3 and T4 were insignificantly lower in patients with MDR-TB/HIV co-infection compared with patients with MDRT-TB only. Conclusion: It could be concluded from this study that patients with MDR-TB/HIV co-infection have a similar thyroid function as patients having MDR-TB without HIV infection before commencement of MDR-TB drug regimen. Also, there is a possibility of subclinical thyroid dysfunction in patients with MDR-TB/HIV co-infection even, before the commencement of MDR-TB therapy.

Sensibilización y alergia alimentaria mediada por Inmunoglobulina E específica y su afectación a la calidad de vida en un grupo de adolescentes de 13 a 15 años de edad en el Cantón Santa Isabel: Un estudio trasnversal.

Antecedentes: Este estudio reporta la prevalencia de SA, AA y su afectación en la calidad de vida en un grupo de adolescentes de Santa Isabel-Ecuador. Métodos: Un estudio de corte transversal se llevó a cabo en 462 adolescentes de los colegios de Santa Isabel entre Julio de 2014 y Febrero de 2016. La recolección de datos incluyó la aplicación de test cutáneos utilizando un total de 19 alérgenos alimentarios y un cuestionario de auto reporte de síntomas a todos los participantes. Los adolescentes con test cutáneo positivo a uno o varios alimentos y con síntomas tras la ingesta de los mismos se les aplicó un cuestionario de calidad de vida y se cuantificó la Inmunoglobulina E (IgE) sérica específica para corroborar el diagnóstico de AA. Resultados: La prevalencia de SA fue del 7,14% y de AA 4,33%. En ambos casos el camarón y el maní fueron los principales alérgenos. La cuantificación de IgE específica, corroboró la presencia de AA en 2.4% de los participantes. La presencia de AA no afecta la calidad de vida de adolescentes en promedio 0,05/6, DE±0,94 Conclusiones: Este estudio contribuye con la prevalencia de SA y AA cuya importancia radica en la metodología utilizada, lo que servirá de base teórica para estudios posteriores. La SA y AA son prevalentes en los adolescentes del cantón de Santa Isabel, siendo el maní y camarón los alérgenos de mayor importancia asociados a reacciones anafilácticas. A pesar de los riesgos, los adolescentes no refleja afectación en su calidad de vida.

Discovering the effects of omega-3 and omega-6 fatty acids on allergy using a hek-blue cell line

In recent times, allergy has become a financial, physical andpsychological burden to the society as a whole. Allergic reactions can result in life-threatening situations causing morbidity and high economic cost. Therefore, more effective reagents are needed for allergy treatment. Literature suggests that a causal relationship exists between the intake of Omega-3/6 fatty acids such as DHA, EPA, DPA and AA and atopic individuals suffering from allergies. In an allergic cascade, cytokines IL-4 and IL-13 bind to IL-4 receptor (IL-4R), which activates the STAT6 phosphorylation pathway leading to gene activation of allergen-specific IgE production by B cells. The overall aim of this study is to characterise Omega-3/6 fatty acids and their effects on IgE production.

Discovering the effects of omega-6 fatty acids on allergy using a HEK-Blue cell line

In recent times, allergy has become a financial, physical and psychological burden to the society as a whole. Allergic reactions can result in life-threatening situations causing morbidity and high economic cost. Therefore, more effective reagents are needed for allergy treatment. Omega-6 fatty acids have gained attention in allergic studies mainly due to their inflammatory properties. Literature suggests that a causal relationship exists between the intake of omega-6 fatty acids such as DPA and AA and atopic individuals suffering from allergies. In an allergic cascade, cytokines IL-4 and IL-13 bind to IL-4 receptor (IL-4R), which activates the STAT6 phosphorylation pathway leading to gene activation of allergen-specific IgE production by B cells. Consequently, IgE production leads to clinical symptoms of allergy. The overall aim of this study is to characterise DPA and AA and their effects on IgE production.