Prevalence of Drugs as Triggers of Exacerbations in Chronic Urticaria.

BACKGROUND AND OBJECTIVE: Many patients with chronic spontaneous urticaria (CSU) report various drugs as triggers of their symptoms and often avoid medication unnecessarily. Objective: To estimate the clinical impact of the drugs patients most frequently suspect of inducing CSU exacerbations. METHODS: The prevalence of self-reported drug reactions was evaluated by questioning patients about their clinical history of urticaria and drug reactions and performing challenge tests with the suspect drugs. A group of healthy persons were included as controls to evaluate the prevalence of self-reported drug reactions. RESULTS: The study population comprised 245 patients with CSU and 127 healthy individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%) and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and the control group, respectively. Positive results in the challenge tests were less common than self-reports in the CSU group (13%) and the control group (0.7%). CONCLUSIONS: Self-reporting is generally not sufficient to confirm a drug reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients who experience CSU than in those who do not. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions.

Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma.

BACKGROUND: Adherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance. OBJECTIVE: To evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population. METHODS: A cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week. RESULTS: 1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient p<0.01) and lower academic performance (failed: 20% vs. 33% p<0.01). After dividing the symptomatic group between adherents and non-adherents to the pharmacotherapy, the group of adherents had a similar school performance to the asymptomatic group and it was significantly different from the no-adherent group. CONCLUSION: Respiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children.

Prediction of the Efficacy of Antihistamines in Chronic Spontaneous Urticaria Based on Initial Suppression of the Histamine- Induced Wheal.

BACKGROUND: Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not. OBJECTIVE: To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment. METHODS: We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient's quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks. RESULTS: The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%. CONCLUSIONS: Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens.

Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study.

BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3 ml at first injection, and in single 0.5 ml doses in subsequent monthly injections. A 30 min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system. RESULTS: 575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates.

Omalizumab beyond asthma.

INTRODUCTION: Omalizumab has been demonstrated to be a successful therapy in the management of asthma through reduction of patient's symptoms and use of inhaled corticosteroids. The effect of omalizumab is achieved by immunoglobulin E (IgE) blockage and other secondary mechanisms resulting from this blockage. Because other diseases have an important IgE mediation in their physiopathology, the question arises as to if omalizumab would be useful in the treatment of other IgE-mediated diseases. OBJECTIVE: We present an overview of the experimental studies and clinical reports evaluating the use of omalizumab in diseases different to asthma including atopic dermatitis, urticaria, eosinophilic gastrointestinal disorders, idiopathic anaphylaxis, latex allergy, hymenoptera venom allergy, and other IgE diseases. METHODS: We reviewed the literature using PUBMED, EMBASE, and LILACS for publications which used omalizumab in the treatment of patients with allergic diseases or any other diseases. Complete articles published in English, Spanish or Portuguese were included. CONCLUSION: There is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases.

Influence of design, physico-chemical and environmental parameters on pharmaceuticals and fragrances removal by constructed wetlands.

The ability of several mesocosm-scale and full-scale constructed wetlands (CWs) to remove pharmaceuticals and personal care products (PPCPs) from urban wastewater was assessed. The results of three previous works were considered as a whole to find common patterns in PPCP removal. The experiment took place outdoors under winter and summer conditions. The mesocosm-scale CWs differed in some design parameters, namely the presence of plants, the vegetal species chosen (Typha angustifolia versus Phragmites australis), the flow configuration (surface flow versus subsurface flow), the primary treatment (sedimentation tank versus HUSB), the feeding regime (batch flow versus continuous saturation) and the presence of gravel bed. The full-scale CWs consisted of a combination of various subsystems (ponds, surface flow CWs and subsurface flow CWs). The studied PPCPs were ketoprofen, naproxen, ibuprofen, diclofenac, salicylic acid, carbamazepine, caffeine, methyl dihydrojasmonate, galaxolide and tonalide. The performance of the evaluated treatment systems was compound dependent and varied as a function of the CW-configuration. In addition, PPCP removal efficiencies were lower during winter. The presence of plants favoured naproxen, ibuprofen, diclofenac, salicylic acid, caffeine, methyl dihydrojasmonate, galaxolide and tonalide removal. Significant positive correlations were observed between the removal of most PPCPs and temperature or redox potential. Accordingly, microbiological pathways appear to be the most likely degradation route for the target PPCPs in the CWs studied.

[Macroamylasaemia in paediatrics]. / Macroamilasemia en pediatría.

Macroamylasaemia should be considered in any patient with high plasma amylase, no clinical signs and negative additional investigations for pancreatic or parotid diseases. It is characterised by an increase in serum amylase due to circulating high molecular mass macrocomplexes, most often formed due the binding of the amylase to an immunoglobulin. With a normal renal function, a hyperamylasaemia without an increase in urine amylase suggests the diagnosis, and is confirmed by identifying the macromolecular components. It is an uncommon entity in paediatrics. It has been described as a casual finding associated to abdominal pain and to celiac disease. We report two paediatric cases of macroamylasaemia, and a review of the tests needed for its diagnosis. The better understanding of this biochemical anomaly allows us to differentiate it from other situations associated to hyperamylasaemia, in order to avoid additional invasive explorations and unnecessary treatments.

First Report of Exserohilum rostratum Associated with Rice Seed in Venezuela.

Rice (Oryza sativa L.) is an important cereal crop in Venezuela and is planted on approximately 200,000 ha. Fungal diseases caused by the Helminthosporium complex of fungi are considered a major constraint to rice production. In 2005, a blotter method was used to identify fungi associated with rice seed. Seeds (150) of cv. INIA-017 were placed on a plate with moistened filter paper and incubated at 26 ± 2°C with a 12-h light/12-h dark cycle for 5 days until fungal sporulation. Single spores were transferred to 2% water agar (WA). Germinated spores were then transferred to potato dextrose agar (PDA), and resultant colonies were preserved until used. To induce sporulation, 4-mm-diameter discs were cut from 72-h-old cultures, transferred to WA, and incubated at 26 ± 2°C for 48 h (modified technique of Alcorn [1]). Discolored seed yielded isolates of Bipolaris oryzae (Berda de Haan) Shoemaker and Exserohilum rostratum (Drechs.) Leonard and Suggs (2). Pathogenicity tests were performed on 60-day-old rice plants of cv. Blue Bonnet 50. Four plants per pot were used for each isolate. Before inoculation, plants were placed in humidity chambers for 48 h. Spores were harvested from discs into a beaker containing 50 mL of a dilute gelatin solution (Gelatin Difco; 5 g/100 mL of sterile distilled water [SDW]). Spore suspensions were filtered through cheesecloth and adjusted to 7 × 104 spores per ml. The inoculated plants were placed in humidity chambers for 72 h. Control plants were sprayed with SDW. Inoculated plants were removed from humidity chambers and placed on a greenhouse bench. Plants inoculated with B. oryzae were symptomatic 5 days after inoculation; resultant lesions were red-brown with chlorotic borders. Lesions subsequently turned gray with reddish borders and were rhombic in shape. Plants inoculated with E. rotratum were symptomatic 7 days after inoculation with elliptical lesions that were orange-brown along venation. These lesions turned gray with reddish borders. Both fungi were reisolated from symptomatic leaf tissue. To our knowledge, this is the first report of E. rostratum from rice in Venezuela. References: (1) J. L. Alcorn. Mycotaxon. 17:1, 1983. (2) A. Sivanesam. Mycol. Pap. 158, 1987.

Evaluación funcional del adulto mayor con enfermedad cardiovascular durante la hospitalización: Scoping Review / Funtional evaluation during hospitalization of older patients with cardiovascular disease

RESUMEN INTRODUCCIÓN: Un evento cardiovascular puede reducir o alterar la capacidad funcional de las personas y, por ende, afectar el desempeño adecuado en el ámbito físico, familiar, social y laboral. La OMS ha definido la salud de los adultos mayores por su capacidad funcional y no por sus limitaciones, discapacidades o enfermedades. Por lo tanto, la calidad de vida de los adultos mayores está estrechamente relacionada con la capacidad funcional y el conjunto de condiciones que le permiten participar en su propio autocuidado, en la vida social y familiar. OBJETIVO: El objetivo de este estudio es explorar la evidencia existente en la última década acerca de las pruebas y escalas de funcionalidad usadas en población adulta mayor con enfermedad cardiovascular durante su hospitalización y que reciben tratamiento de terapia física. MÉTODOS: Se usó la metodología Scoping Review, usando los términos DeCS/MeSH: cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient, y functionality. La revisión siguió el modelo PRISMA para ordenar y sintetizar los resultados. Las bases de datos consultadas fueron: Pubmed, Scielo, Sciencedirect y Scopus, Lilacs, PeDro. RESULTADOS: 20 artículos fueron seleccionados en los cuales se identificó que las escalas de valoración funcional más utilizadas fueron: caminata de 6 minutos, escala de independencia (FIM), Percepción de salud SF -36. CONCLUCIONES: La evidencia encontrada para guiar la rehabilitación física en paciente adulto mayor muestra cambios significativos en el incremento de la capacidad funcional.

ABSTRACT: INTRODUCTION: A cardiovascular event can reduce or alter the functional capacity of people affecting the physical capacity, and the performance in family, social and work environments. The WHO has defined the health of older adults by their functional capacity and not by their limitations, disabilities or illnesses. Therefore, the quality of life of older adults is closely related to the functional capacity and the set of conditions that allow them to participate in their own self-care, in social and family life. The aim of this study was to explore the existing evidence in the last decade about the tests and scales of functionality used in older adults with cardiovascular disease receiving physical therapy during hospitalization. METHODS: The Scoping Review methodology was used. Mesh and DeCS/MeSH terms included were cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient and functionality. The review followed the PRISMA model to sort and synthesize the results. The databases consulted were: Pubmed, Scielo, Science direct and Scopus, Lilacs, PeDro. RESULTS: 20 articles were selected in which it was identified that the most used functional assessment scales were: The 6-minute walk test, the Independence scale (FIM) and the Health Perception scale (SF-36). CONCLUSION: In older patients the functional tests identified allowed to detect significant improvements in functional capacity following cardiac rehabilitation.

Activation of carcinogenic arylhydroxamic acids by human tissues.

Incubation of the carcinogenic arylhydroxamic acids N-hydroxy-N-2-fluorenylacetamide or N-hydroxy-N-4-biphenylacetamide and tRNA with 105,000 times g supernatants of homogenates of human small intestine, liver, or colon led to formation of arylamine-substituted nucleic acid adducts. These data indicated that enzymes of human tissues could activate arylhydroxamic acids by N leads to O acyl transfer. The unstable N-acetoxyarylamines formed by these enzymes reacted spontaneously with the tRNA to give covalently linked adducts with the nucleic acid.

Irradiation-induced adduct formation of RNA with carcinogenic arylamine derivatives.

Radiolysis of N2O-saturated solutions of transfer RNA (tRNA) and the arylacethydroxamic acids, N-hydroxy-N-2-acetylaminofluorene and N-hydroxy-N-4-acetylaminobiphenyl; their corresponding acetamides, 2-acetylaminofluorene and 4-acetylaminofluorene; or the O-glucuronide of N-hydroxy-N-2-acetylaminofluorene resulted in adduct formation of the nucleic acid with these carcinogenic arylamine derivatives. The yield of adducts on irradiation of the arylacethdroxamic acids with tRNA was greater than that for their corresponding acetamides or the O-glucuronide. The fluorenylacethydroxamic acid and acetamide were also more reactive than the biphenyl analogs. Adduct formation resulting from radiolysis of tRNA and the arylacethydroxamic acids or the O-glucuronide proceeded with retention of both the aromatic nucleus and the N-acetyl group. The yields of adducts were much greater for irradiated mixtures than for irradiation of either component alone followed by mixing. Evaluation of the data shows that initial modification of the tRNA or the carcinogen can lead to adduct formation. In the case of primary radical attack of the nucleic acid, it has been shown that short-lived reactive RNA intermediates are responsible for a major fraction of the observed yield of adducts in the irradiated mixtures. Comparative studies showed that irradiation under conditions that favor reaction of oxidizing radicals enhanced formation of the adducts. Oxygen was shown to protect RNA from irradiation-induced binding of the arylacethydroxamine acids due to competition of O2 with the carcinogen for the reactive RNA intermediates.

Comparative adduct formation of 4-aminobiphenyl and 2-aminofluorene derivatives with macromolecules of isolated liver parenchymal cells.

Isolated parenchymal cells of rat liver have been used in a study of the metabolic activation of derivatives of the carcinogens 4-aminobiphenyl and 2-aminofluorene. The formation of adducts of these compounds with cellular RNA and protein has been taken as evidence of their transformation to metabolites that are capable of spontaneous reaction with tissue macromolecules. The hydroxamic acid N-hydroxy-N-4-acetylaminobiphenyl was bound to RNA to a greater extent than were the amino-, hydroxylamino-, nitroso-, nitro-, acetylamino-, or azoxybiphenyl derivatives. RNA adducts of the hydroxamic acid retained little of the acetyl group. The structural requirements for binding and the nature of the bound derivatives are consistent with the activation of N-hydroxy-N-4-acetylaminobiphenyl by N leads to O acyltransfer. Approximately equal quantities of 4-nitrosobiphenyl and the hydroxamic acid were bound to protein, but far less of the nitroso derivative was incorporated into RNA. Adduct formation of N-hydroxy-N-2-acetylaminofluorene with RNA occurred with retention of the acetyl group and was dependent on the concentration of sulfate in the media. Consequently, reaction of the fluorenyl derivative with RNA probably resulted from conjugation of the hydroxamic acid with sulfate.

Glutathione and cysteine in HIV-infected hemophiliacs.

A cross-sectional study was designed to determine whether plasma concentrations of glutathione and cysteine in HIV-infected hemophiliacs vary according to the progression of the disease and to compare them with those obtained in HIV negative hemophiliacs. Cysteine, total glutathione and glutathione disulphide were measured in plasma of HIV-infected hemophiliacs at different stages of HIV infection and in plasma of HIV-negative hemophiliacs. CD4 and CD8 T-cell counts, leukocyte and lymphocyte counts, beta 2-microglobulin and p24 antigen values were recorded for HIV positive hemophiliacs at the time of the study. The hemophiliac HIV-positive group showed a decrease in total glutathione levels (-18%) and an increase of glutathione disulphide (8.18 vs. 14.90%) compared to the HIV-negative group. The cysteine levels found in HIV-positive hemophiliacs were not different from those found in the HIV-negative group. There were no differences with statistical significance in total glutathione, glutathione disulphide and cysteine among HIV-infected hemophiliacs according to the different clinical stage of the disease (AIDS vs. non-AIDS). The interest of evaluating plasma concentrations of glutathione and cysteine in HIV-infected patients is limited from the point of view of considering them as markers of progression of the disease. Interest in a therapeutic strategy designed to replenish or normalize glutathione plasma levels is also limited.

Synthesis and antimicrobial activity of N-substituted N'-cyano-S-(triorganostannyl)isothioureas.

Six N-substituted N'-cyano-S-(trimethylstannyl)isothioureas were synthesized by the reaction of (trimethylstannyl)cyanamide with various organic isothiocyanates. The IR spectrum of each compound was obtained over the 4000-30-cm(-1) range, and some bands were assigned. The six new compounds and five previously synthesized N-substituted N'-cyano-S-(triphenylstannyl)isothioureas were tested for and were found to exhibit antifungal activity. N-Phenyl-N'-cyano-S-(triphenylstannyl)isothiourea was also investigated for antibacterial activity and was observed to be especially inhibitory toward Gram-positive species. The antimicrobial activity of two compounds was compared to that of the oxygen analogs of these compounds.

Impact of laparoscopy on the management of an unusual case of nonpalpable testis in an adult patient.

BACKGROUND: In the past decade, cryptorchidism has generally been treated in the first 36 months of life using an inguinal approach, in the case of palpable testis, or using laparoscopy, in the case of nonpalpable testis. Nevertheless, before this period some children were managed incorrectly. This case report shows how laparoscopy and the collaboration between pediatric surgeons and urologists may lead to optimal results. CASE REPORT: A 19-year-old male was referred to our unit following routine medical examination for enrollment in the military service with a diagnosis of right cryptorchidism. The clinical history showed the anamnesis of right cryptorchidism diagnosed at birth as a right nonpalpable testis, confirmed at 2 years of age with clinical examination and computer tomography. The patient came to our attention to again undergo a clinical examination, ultrasonography, computed tomography, and magnetic resonance imaging. We found a left, well-positioned testis of 20 ml in volume and an empty right scrotum; all the instrumental examinations were negative. The patient was thus scheduled for a diagnostic laparoscopy. A pediatric surgeon with extensive experience in this pathology performed the procedure. The 10-mm 30 degrees optics introduced through the umbilicus showed a closed right inguinal ring, with no evidence of either vas deferens or inner spermatic vessels at the level of the inguinal region or pelvis. Two more trocars were introduced and a testis of 15 ml in volume was found under the ascending colon 10 cm away from the cecum. An orchiectomy was performed via laparoscopy. CONCLUSION: This case clearly shows that some males with nonpalpable testis may have been treated incorrectly in the prelaparoscopic era and may now have an intraabdominal testis. In addition, our experience shows that intraabdominal testis may sometime be in an unusual location, and a laparoscopic surgeon with experience in this pathology is fundamental to finding the testis. In the case of adults with nonpalpable testis, when echography, computed tomography, and magnetic resonance imaging are not useful, the only effective diagnostic procedure is laparoscopy.