Early sustained unresponsiveness after short-course egg oral immunotherapy: a randomized controlled study in egg-allergic children.

BACKGROUND: No studies have evaluated the potential of egg oral immunotherapy (egg-OIT) to induce sustained unresponsiveness after discontinuing therapy following short-term treatments. OBJECTIVE: We assessed the efficacy of short-course egg-OIT to induce sustained unresponsiveness. METHODS: Sixty-one egg-allergic children, 5 to 17 years old, with positive double-blind placebo-controlled food challenge (DBPCFC) to dehydrated egg white (EW) were randomized to receive egg-OIT (OITG) for 3 months (maintenance dose one undercooked egg every 48 hours) or to continue egg avoidance diet (control group, CG) for 4 months. Children who completed egg-OIT avoided egg for 1 month. At 4 months, both groups underwent a DBPCFC. OITG participants who passed this challenge were instructed to add egg to their diet ad libitum. Immune markers were studied at different time points. RESULTS: Ninety-three percent (28/30) of OITG children were desensitized in a median of 32.5 days (IQR, 14 days). At 4 months, 1/31 (3%) in CG passed DBPCFC and 11/30 (37%) of OITG (95% CI, 14 to 51%; P = 0.003), all of them were consuming egg at 36 months. A decrease in EW, OVA and OVM skin test results and OVA-specific IgE (sIgE) levels was observed on OITG at 4 months (P = 0.001). EW-, OVA- and OVM-sIgE levels prior to the start of egg avoidance diet were lower in OITG children who passed DBPCFC at 4 months than in those who did not pass it. EW- and OVM-sIgE showed the best diagnostic performance in predicting DBPCFC result at 4 months. Levels above optimal EW-sIgE cut-off of 7.1 kU/L indicated 90% probability of failing DBPCFC. CONCLUSION: This is the first demonstration of sustained unresponsiveness with a three-month egg-OIT protocol. Almost all treated subjects were desensitized and 37% achieved sustained unresponsiveness. EW-sIgE levels at the end of treatment predicted sustained unresponsiveness. This protocol shows a new approach to OIT for egg-allergic children.

Renal amyloidosis in a patient with X-linked agammaglobulinemia (Bruton's disease) and bronchiectasis.

PURPOSE: We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis. CASE REPORT: A 38 year-old man was diagnosed with X-linked agammaglobulinemia (Bruton's disease) when he was 3 years old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight. METHOD AND RESULTS: Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria. Hepatitis B and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel's walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation. CONCLUSION: We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis a finding rarely reported.

Laparoscopic resection of the pancreatic tail with preservation of the spleen in a patient with a large pseudopapillary tumor of the pancreas.

Laparoscopic resections of the pancreas have gained in popularity in the last few years. Those preserving the integrity of the spleen are performed very rarely and are a challenge for every surgeon. We hereby report a case of laparoscopic resection of the pancreatic tail with preservation of the spleen and the integrity and the blood supply to the spleen in a 26 year-old patient with a large pseudopapillary tumor of the pancreas. Postoperative recovery was quick and without complications. The functional and aesthetic result was satisfactory. Laparoscopic resection of the pancreas is a safe and effective therapeutic procedure in selected patients.

Decreased serum T3 after an exercise session is independent of glucocorticoid peak.

Physical exercise increases serum glucocorticoids, which is believed to be involved in the fall of T3 after high intensity exercise. The objective was to evaluate whether a physical exercise session alters the thyroid economy and adrenal axis in humans, and the possible role of corticosteroids in thyroid function disturbance. Active but not athlete subjects were enrolled in an open field competition and cortisol, TSH, T3, and T4 were measured before and after the race. To give new insights into the mechanisms underlying the changes in thyroid economy after exercise, we used a rat model to evaluate the impact of blocking corticosterone synthesis during treadmill exercise by metyrapone administration. Cortisol levels increased 1.5-fold (from 28.2±3.8 to 42.2±2.2 µg/dl; p<0.05), while serum T3 decreased by 13% (from 115±5 to 99±5 µg/dl; p<0.05) 6 h after the race in humans. Also, in rats, glucocorticoid increased by 2-fold while T3 decreased 15% after exercise session (p<0.05). However, the complete blockage of corticosterone peak did not impair serum T3 decrease observed in rats submitted to exercise. Interestingly, the lack of corticosterone peak led not only to lower serum T3, but also to decreased serum T4, indicating that corticosterone might be fundamental for the maintenance of serum thyroid hormone levels after high intensity exercise. Although cortisol increases and T3 decreases after high intensity exercise in both humans and rats, it does not seem to be a cause-effect response since pharmacological blockage of corticosterone peak does not modulate T3 response.

Laparoscopic exploration of bile ducts in patients with calculosis. Indications, methods and first results.

INTRODUCTION: In the last few years there has been a resurgence of laparoscopic exploration of the common bile duct as an alternative to endoscopic retrograde cholangiopancreatography (ERCP), the primary method for diagnosis and treatment of biliary tract calculosis. AIM: The aim of this study was to clarify the indications and methods for performing laparoscopic bile duct exploration, based on our experience in the field and data from the literature. PATIENTS AND METHODS: We recruited 12 patients who underwent laparoscopic exploration and stone extraction from the common bile duct (CBD) in the surgical ward of Kaspela Hospital, Plovdiv over the period January 2011 to January 2012. The diagnostic and therapeutic modalities used in the study included laboratory tests, ultrasound study, CT, ERCP, digital cholangiography, clamp and balloon stone extraction, primary suture and choledochoduodenostomy. RESULTS: Stone extraction was successfully performed in 8 patients using the transcystic approach through an incision used in the cholangiography. The procedure failed in the remaining four patients and we used here 2-cm longitudinal choledochotomy. In two patients the control cholangiography following the extraction of stones demonstrated complete clearance of the biliary tree and free passage of contrast agent from bile duct to duodenum (patent ampulla of Vater). In these two patients we performed a primary closure of the choledochotomy with a single interrupted suture ("ideal choledochotomy"). In two patients from the choledochotomy group, the control cholangiography showed the presence of residual stones or fragments trapped above the sphincter of Oddi with no contrast medium in the duodenum. In these cases we completed this procedure with latero-lateral choledochoduodenostomy by Flërken. All patients had a smooth postoperative course with no recorded complications. The average hospital stay was 5 days. CONCLUSIONS: Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

Photodegradation of 2,4-D (dichlorophenoxyacetic acid) with Rh/TiO2; comparative study with other noble metals (Ru, Pt, and Au).

In this work the effect of noble metal on the photodegradation of 2,4-dichlorophenoxyacetic acid herbicide using TiO2 as support was studied. The metals and concentration were: Rh, Ru, Pt and Au and 1, 0.98, 1.89, and 1.91 wt% respectively. Rhodium was taken as reference for this experiment. The samples were characterized by X-Ray Diffraction (XRD), UV-vis absorption spectra, N2 physisorption (BET Specific Surface Area), High Annular Angle Analysis Darkfield (HAADF) and Transmission Electron Microscopy Scanning (STEM), H2 chemisorption, optical emission spectroscopy with inductive coupling plasma analysis (ICP-OES), solid fluorescence, X-ray Photoelectron Spectroscopy (XPS) and OH quantification. The presence of the anatase crystalline phase was mostly confirmed in all samples. The band gap decreased with the presence of metal (from 3.24 to 2.92 eV). The specific area was a function of the metal particle size. The metal particle diameter showed the following sequence Pt > Ru > Au > Rh. By XPS, TiO2 does not manifest changes in oxidation states, but when impregnated with metals, only Pt shows the highest abundance of any oxidized state (Pt2+). The presence of metal reveals less electron-hole recombination compared with titanium oxide. The results of photocatalytic activity showed that Pt and Rh are the two metals with the highest mineralization (99.0 and 98.3%, respectively).

Type IV reaction due to phenylephrine administered nasally with cross-reactivity with ethylephrine.

Type IV hypersensitivity eye reactions have been described after the administration of the sympathomimetic agent phenylephrine. We report the case of an atopic woman who developed nasal congestion and discharge, dysphagia, and dyspnea 1 hour after the administration of Stopcold pills and Disneumon Pernasal nasal spray for otitis. The same symptoms reappeared after the accidental administration of Rinobanedif ointment in the nasal mucosa. Skin patch tests were performed with a standard True Test panel, preservatives, Disneumon Pernasal, pseudoephedrine, eyedrops (tropicamide, cyclopentolate, and phenylephrine), and other sympathomimetic agents. The patient also underwent oral, ocular, and nasal controlled challenges with the same drugs. Finally, patch tests were performed in 11 controls with phenylephrine and ethylephrine. Our patient had a positive outcome in patch testing with nickel sulphate, fragrance mix, phenylephrine, and ethylephrine. To our knowledge, this is the first report of a type IV reaction to nasally administered phenylephrine with cross-reactivity with ethylephrine detected by patch testing.

Natural radioactivity in groundwater and estimates of committed effective dose due to water ingestion in the state of Chihuahua (Mexico).

The activity concentration of 222Rn, 226Ra and total uranium in groundwater samples collected from wells distributed throughout the state of Chihuahua has been measured. The values obtained of total uranium activity concentration in groundwater throughout the state run from <0.03 up to 1.34 Bq l-1. Generally, radium activity concentration was <0.16 Bq l-1, with some exceptions; in spring water of San Diego de Alcalá, in contrast, the value reached approximately 5.3 Bq l-1. Radon activity concentration obtained throughout the state was from 1.0 to 39.8 Bq l-1. A linear correlation between uranium and radon dissolved in groundwater of individual wells was observed near Chihuahua City. Committed effective dose estimates for reference individuals were performed, with results as high as 134 microSv for infants in Aldama city. In Aldama and Chihuahua cities the average and many individual wells showed activity concentration values of uranium exceeding the Mexican norm of drinking water quality.

Radon concentrations in ground and drinking water in the state of Chihuahua, Mexico.

This paper reports (222)Rn concentrations in ground and drinking water of nine cities of Chihuahua State, Mexico. Fifty percent of the 114 sampled wells exhibited (222)Rn concentrations exceeding 11Bq/L, the maximum contaminant level (MCL) recommended by the USEPA. Furthermore, around 48% (123 samples) of the tap-water samples taken from 255 dwellings showed radon concentrations over the MCL. There is an apparent correlation between total dissolved solids and radon concentration in ground-water. The high levels of (222)Rn found may be entirely attributed to the nature of aquifer rocks.

The relationship between faecal-associated and mucosal-associated microbiota in irritable bowel syndrome patients and healthy subjects.

BACKGROUND: The faecal-associated microbiota is commonly seen as a surrogate of the mucosal-associated microbiota. However, previous studies indicate that they are different. Furthermore, analyses of the mucosal microbiota are commonly done after standard bowel cleansing, affecting the microbial composition. AIM: To compare the mucosal-associated microbiota, obtained from unprepared colon, with faecal-associated microbiota in healthy subjects and irritable bowel syndrome (IBS) patients. METHODS: Faecal and mucosal biopsies were obtained from 33 IBS patients and 16 healthy controls. Of IBS patients, 49% belonged to the diarrhoea-predominant subgroup and 80% suffered from IBS symptoms during at least 5 years. Biopsies were collected from unprepared sigmoid colon and faecal samples a day before colonoscopy. Microbiota analyses were performed with a phylogenetic microarray and redundancy discriminant analysis. RESULTS: The composition of the mucosal- and the faecal-associated microbiota in unprepared sigmoid colon differs significantly (P = 0.002). Clinical characteristics of IBS did not correlate with this difference. Bacteroidetes dominate the mucosal-associated microbiota. Firmicutes, Actinobacteria and Proteobacteria dominate the faecal-associated microbiota. Healthy subjects had a significantly higher (P < 0.005) abundance (1.9%) of the bacterial group uncultured Clostridiales I in the mucosal-associated microbiota than IBS patients (0.3%). Bacterial diversity was higher in faecal- compared with mucosal-associated microbiota in IBS patients (P < 0.005). No differences were found in healthy subjects. CONCLUSIONS: Differences in the mucosal-associated microbiota between healthy individuals and IBS patients are minimal (one bacterial group) compared to differences in the faecal microbiota of both groups (53 bacterial groups). Microbial aberrations characterising IBS are more pronounced in the faeces than in the mucosa.

Altered faecal and mucosal microbial composition in post-infectious irritable bowel syndrome patients correlates with mucosal lymphocyte phenotypes and psychological distress.

BACKGROUND: A subset of irritable bowel syndrome (IBS) patients, denoted post-infectious IBS (PI-IBS), develop symptoms after an enteric infection. Bacterial dysbiosis and mucosal inflammation have been proposed to be involved in the pathophysiology of this entity. AIM: To characterise the mucosal and faecal microbiota in PI-IBS, general IBS and healthy controls, and to investigate associations between the microbiota and the mucosal immune system. METHODS: Mucosal biopsies and faeces were collected from 13 PI-IBS patients, 19 general IBS patients and 16 healthy controls. Global bacterial composition was determined by generating 16S rRNA amplicons that were examined by phylogenetic microarray hybridisation, principal component and redundancy analysis. We correlated previously reported lymphocyte proportions with the microbiota. RESULTS: Faecal microbiota composition of PI-IBS patients differed significantly from both general IBS patients and healthy controls (P < 0.02). Both mucosal (P < 0.01) and faecal (P = 0.05) microbial diversity were reduced in PI-IBS compared to healthy controls. In the intraepithelial lymphocytes the previously published proportion of CD8(+) CD45RA(+) was negatively correlated with mucosal microbial diversity (P < 0.005). The previously published number of lamina propria lymphocytes was negatively correlated with mucosal microbial diversity (P < 0.05). Faecal microbial diversity was significantly negatively correlated with the Hospital Anxiety and Depression scale (P < 0.05). CONCLUSIONS: We present data that distinguishes the intestinal microbiota of PI-IBS patients from that of both general IBS patients and HC. The microbial composition is significantly associated with the HADs score and alterations in lymphocyte subsets proportions.

[Evaluation of fragmented potentials in right bundle branch block without structural myocardium abnormalities. Study made by signal-averaged electrocardiogram on time and frequency domain]. / Avaliação de potenciais fragmentados em presença de bloqueio de ramo direito sem alterações estruturais miocárdicas ventriculares. Estudo pelo eletrocardiograma de alta resolução no domínio da freqüência.

PURPOSE: To evaluate if the presence of right bundle branch block (RBBB), without structural myocardial abnormalities (SMA) can generate fragmented potentials (FP) and spectral turbulence on signal-averaged electrocardiogram (SAECG). METHODS: Twelve children with atrial septal defect (ASD) and incomplete right bundle branch block (IRBBB without SMA (group I) were compared to 17 children with post-operative tetralogy of Fallot (TF) with CRBBB, all with SMA, 5 with ventricular premature beats and 2 with sustained ventricular tachycardia (group II). All had SAECG on time (TD) and frequency domain (FD) with 5 variables analysed. RESULTS: All patients of group I had normal variables, in contrast with group II which presented abnormal variables suggesting FP and ST. CONCLUSION: In ASD without SMA, the isolated IRBBB did not generate FP and ST.