Impact of ongoing treatment with inhaled corticosteroids during specific inhalation challenges for diagnosing occupational asthma.

BACKGROUND: Specific inhalation challenge tests (SIC) are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72h prior to SIC. OBJECTIVE: To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in FEV1, change in methacholine PC20 as well as sputum eosinophil counts after exposure to the suspected agent. METHODS: We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects. RESULTS: Six-hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS treated subjects (39. 6%) compared to steroid-naïve subjects (27.5%, p<0.001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC20 or percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects. CONCLUSION: An ongoing ICS treatment during a SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.

Maintaining Cognitive Performance at the Expense of Gait Speed for Asymptomatic Concussed Athletes: A Novel Dual-Task and Post-Exercise Assessment.

Our goal was to evaluate persisting deficits in gait and executive functioning in asymptomatic athletes with a history of concussion using a novel approach combining a dual-task paradigm and post-exercise exertion. Thirty-eight athletes aged 17 to 25 years old participated in the study, including 18 with a history of concussion. The dual-task paradigm required walking continuously at a predetermined self-paced target speed of 6.5 km/h while executing a complex switch task. Athletes completed two conditions, each on separate days: (1) dual task alone and (2) dual task following 20 min of running on a non-motorized treadmill. The statistical analyses revealed a significant reduction in gait speed exclusively for athletes with a history of concussion and only following the post-exercise condition (p = 0.008). These findings suggest that although asymptomatic concussed athletes maintain a cognitive performance comparable to non-concussed athletes, this appears to be achieved at the expense of gait speed. Our results underscore the importance of incorporating gait assessments and post-exercise exertion into concussion evaluation protocols in both research and clinical settings.

Irritant-Induced Asthma.

Irritant-induced asthma (IIA) is a phenotype of asthma caused by the inhalation of irritant agents. Definite, probable, or possible IIA have been described, depending on the concentration of the inhaled irritants and the onset of respiratory symptoms respective to the time of exposure. Definite IIA represents approximately 4% to 14% of all cases of new-onset work-related asthma. Agents responsible for IIA can be encountered as fumes, gases, aerosols, or dusts. The most frequent are chlorine, nitrogen oxides, sulfur dioxide, ammonia, acetic acid, solvents, and cleaning materials. Although the diagnosis of definite IIA is based on a suggestive clinical history along with evidence of reversible airflow limitation and/or nonspecific bronchial hyperresponsiveness, possible IIA cannot be diagnosed with certainty because the relationship between exposure and the onset of symptoms is difficult to establish. This article reviews the epidemiology, pathophysiology, diagnostic approach, and management of IIA.

Psychometric properties of a color-shape version of the switch task.

The current study aims to examine the psychometric properties of a color-shape version of the switch task. In Study 1, 128 participants completed a battery of standardized measures of executive functions (EFs) as well as the switch task to determine the construct validity of three traditionally computed costs (global, switch, and mixing) and primary variables (accuracy [ACC], reaction time [RT], and inverse efficiency score [IES] of the heterogeneous condition). In Study 2, 48 participants completed the task twice, seven days apart, to evaluate its short-term test-retest reliability. Results do not support the construct validity and the test-retest reliability of switch and mixing costs. The overall higher psychometric properties of the global costs (RT and IES), and primary variables (Hetero RT and IES) suggest that they may be useful measures for clinicians to assess EFs. The latter variables show evidence of convergent validity with standardized measures of EFs and good test-rest reliability (ICC ≥ .68).

Pre-exchange training - Developing ethical and cultural competencies in medical students.

Background: The International Federation of Medical Students' Associations (IFMSA) organizes over 15,000 international medical exchanges per year in over 100 countries. In the past, there was no standardized Pre-Departure Training (PDT) for participants. A PDT is important to protect patient safety and prepare students for their exchange.Objective: To determine whether a two-hour case-based Pre-Departure Training can increase self-reported level of comfort on competencies in basic medical ethics, cultural competence, research ethics, and recognizing the limits of one's level of skill in medical students.Methods: In 2017, the PDT was implemented in nine countries for medical students prior to their IFMSA exchange. Participants self-evaluated their competencies in an online questionnaire before and after the PDT.Results: 234 students from 32 countries completed the pre-PDT evaluation and 104 completed both evaluations. Participants demonstrated statistically significant improvements in self-reported competencies in 16 out of 18 items including voicing lack of skill to a supervisor (p < 0.001) and recognizing personal cultural biases (p < 0.001).Conclusions: A case-based PDT can improve participants' self-reported comfort in treating patients from different cultural backgrounds and help maintain high ethical standards abroad. The PDT was implemented at large within IFMSA in 2018.