How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem.

BACKGROUND: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies.

BACKGROUND: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. OBJECTIVE: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term "anaphylaxis" with "death", "study design", and "main outcomes" (incidence). RESULTS: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. CONCLUSION: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Explaining variations in the diversity of parasitoid assemblages in a biosphere reserve of Mexico: evidence from vegetation, land management and seasonality.

Insect fauna biodiversity in natural protected areas has not been thoroughly studied. Therefore, the aim of this work was to assess whether and how vegetation types, land management and seasonality influence the diversity of Ichneumonidae (Hymenoptera) in the Ría Lagartos Biosphere Reserve (Mexico). A sampling programme was conducted using Malaise traps from 2008 to 2009 in three vegetation types, each with two conservation zones (core and buffer zones). Three seasons were considered: rainy, dry and north-winds (isolated storms from November to February). A total of 336 species were identified. Rarefaction and Generalized Linear Model indicated higher species richness and abundance, respectively, in the buffer zone of the dry forest; possible explanations for this finding include the intermediate disturbance hypothesis, wherein diversity can be higher in sites where disturbance is not very frequent or very intense, and the 'enemies hypothesis', wherein structural complexity and high plant diversity favour increased predators or, in this case, parasitoids. Diversity was higher during the rainy season, which may have been due to the higher availability of resources. Vegetation and management had a positive impact on the Coc (attack cocoons and pupae) and Myc (attack concealed larvae living in the fruiting bodies of mushrooms) parasitoid guilds. Members of the Coc guild are generalist parasitoids, which may be favoured in complex vegetation with a high richness of potential hosts and non-hosts. The Myc guild requires certain environmental conditions that promote fungal growth, such as humidity, that is absent in the other vegetation types of savannah and coastal dune scrubland.

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011.

BACKGROUND AND OBJECTIVE: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. METHODS: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. RESULTS: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. CONCLUSIONS: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Effects of Botanical Insecticides on Hymenopteran Parasitoids: a Meta-analysis Approach.

Botanical insecticides (BIs) are considered a valuable alternative for plant protection in sustainable agriculture. The use of both BIs and parasitoids are presumed to be mutually compatible pest management practices. However, there is controversy on this subject, as various studies have reported lethal and sublethal effects of BIs on hymenopteran parasitoids. To shed new light on this controversy, a meta-analytic approach of the effects of BIs on adult mortality, parasitism, and parasitoid emergence under laboratory conditions was performed. We show that BIs increased mortality, decreased parasitism, and decreased parasitoid emergence. Botanical insecticides derived from Nicotiana tabacum and Caceolaria andina were particulary lethal. Most of the parasitoid groups showed susceptibility to BIs, but the families Scelionidae and Ichneumonidae were not significantly affected. The negative effects of BIs were seen regardless of the type of exposure (topical, ingestion, or residual). In conclusion, this meta-analysis showed that under laboratory conditions, exposure of hymenopteran parasitoids to BIs had significant negative effects on adult mortality, parasitism, and parasitoid emergence.

Dopaminergic function in panic disorder: comparison with major and minor depression.

Several lines of evidence suggest that dopamine might be involved in anxiety states. In this study, we assessed the growth hormone (GH) response to apomorphine (a dopaminergic agonist) 0.5 mg SC in nine drug-free inpatients meeting Research Diagnostic Criteria (RDC) for panic disorder who were age-matched and gender-matched with nine major depressive, and nine minor depressive inpatients. The three groups differed significantly in their mean GH peak response: 5.29 +/- 2.75 ng/ml in major depressives, 26.27 +/- 12.71 ng/ml in minor depressives, and 37.28 +/- 10.58 ng/ml in panics, with a significantly higher response in panic than in either minor or major depressive patients. These results support dopaminergic overactivity in panic disorder as compared with major and minor depression.

Suicidal behavior in depressive disorder: an event-related potential study.

P300 and contingent negative variation (CNV) were recorded in depressive inpatients with and without history of suicide attempt. The results showed a significant reduction of P200, P300, and CNV and a significant increase of postimperative negative variation (PINV) in patients who had attempted suicide compared to patients with a negative history. Moreover, P300 amplitude was negatively related with the Suicidal Risk and the Hopelessness but not with the Hamilton scales. These results stress the need to differentiate clinical subgroups of patients to assess the psychophysiology of depression, and indicate that patients who attempted suicide exhibit lower cortical resources and poorer cortical performance than patients without history of suicide attempt.

Reduced dopamine function in depressed patients is related to suicidal behavior but not its lethality.

Several lines of evidence suggest a role for dopamine in the control of suicidal behaviour. Previously, we suggested an involvement of D2-dopaminergic function in the biology of suicide by demonstrating a smaller growth hormone (GH) response to apomorphine, a dopaminergic agonist, in depressed patients who later died by suicide. The purpose of the present study was to assess GH response to apomorphine in major depressed in-patients with a history of highly lethal suicide attempt compared to depressed patients with a low lethal lifetime suicide attempt history and non-attempters. The study was performed in a sample of 26 male depressed in-patients with a history of suicide attempt compared to 26 male depressed non-attempters. We observed a significant difference between suicide attempters and non-attempters (for GH peak, 6.3+/-5.1 ng/ml vs 15.8+/-14.2 ng/ml, F=10.3, df=1, 50, P=0.002). Moreover, GH peak responses to apomorphine did not differ between depressed patients with a high lethal lifetime suicide attempt history and patients who made low lethal lifetime suicide attempt. In conclusion, the results of the present study support a role for dopamine in the biology of suicidal behaviour. More specifically, an impaired GH response to apomorphine could be a marker of suicide risk.

Relationship between alpha 2-adrenergic function and suicidal behavior in depressed patients.

The current main neurochemical theories of the biological correlates of suicidal behavior involve serotonergic and, to a lesser extent, dopaminergic systems. Few data are available about the possible implication of the noradrenergic function. In the present study, we assessed the growth hormone response to clonidine, a selective alpha 2-adrenergic agonist, in 15 DSM-III-R major depressive inpatients with a history of suicide attempts, compared with 15 age- and gender-matched major depressive inpatients without a history of suicidal behavior. Mean (+/- SD) growth hormone peak responses to clonidine were significantly lower in the group of suicide attempters than in the control group: 2.93 +/- 3.01 ng/ml vs. 8.28 +/- 8.15 ng/ml. Therefore, these results suggest that a blunted growth hormone response to clonidine could be a biological correlate of suicidal behavior.

The tridimensional personality questionnaire (TPQ) and depression.

The relationships between the Tridimensional Personality Questionnaire (TPQ) and depression were examined in a sample of 53 major depressive patients and 33 healthy controls. Depressed patients exhibit higher harm avoidance scores as well as lower novelty seeking sub-scale exploratory excitability (NS1) scores as compared to healthy controls. However, the other dimensions and their sub-scales do not differ between depressive patients and controls. In the depressive group, the harm avoidance dimension is related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the novelty seeking sub-scale NS1 and depression.

Review of Mexican species of Podogaster Brullé (Hymenoptera: Ichneumonidae: Anomaloninae) with description of two new species.

Two new species of Podogaster Brullé, Podogaster brunneus n. sp. and Podogaster lagartensis n. sp., are described. The material was collected with Malaise traps operated for a year in the Ría Lagartos Biosphere Reserve, a dry tropical area of Southeast Mexico. Podogaster rosteri Gauld & Bradshaw is synonymized with Podogaster mexicanus (Cresson). A key to the Mexican species is also provided.

Diurnal flight behavior of Ichneumonoidea (Insecta: Hymenoptera) related to environmental factors in a tropical dry forest.

The biology and behavior of insects are strongly influenced by environmental conditions such as temperature and precipitation. Because some of these factors present a within day variation, they may be causing variations on insect diurnal flight activity, but scant information exists on the issue. The aim of this work was to describe the patterns on diurnal variation of the abundance of Ichneumonoidea and their relation with relative humidity, temperature, light intensity, and wind speed. The study site was a tropical dry forest at Ría Lagartos Biosphere Reserve, Mexico; where correlations between environmental factors (relative humidity, temperature, light, and wind speed) and abundance of Ichneumonidae and Braconidae (Hymenoptera: Ichneumonoidea) were estimated. The best regression model for explaining abundance variation was selected using the second order Akaike Information Criterion. The optimum values of temperature, humidity, and light for flight activity of both families were also estimated. Ichneumonid and braconid abundances were significantly correlated to relative humidity, temperature, and light intensity; ichneumonid also showed significant correlations to wind speed. The second order Akaike Information Criterion suggests that in tropical dry conditions, relative humidity is more important that temperature for Ichneumonoidea diurnal activity. Ichneumonid wasps selected toward intermediate values of relative humidity, temperature and the lowest wind speeds; while Braconidae selected for low values of relative humidity. For light intensity, braconids presented a positive selection for moderately high values.

Growth hormone response to apomorphine in panic disorder: comparison with major depression and normal controls.

Several lines of evidence suggest that dopamine might be involved in anxiety states. In the present study we assessed the growth hormone (GH) response to 0.5 mg apomorphine (a dopaminergic agonist) in 10 male drug-free inpatients meeting Research Diagnostic Criteria for panic disorder who were compared with 10 male major depressive inpatients and 10 male normal controls. The three groups differed significantly in the GH peak response (mean +/- SD): 27.8 +/- 12.5 ng/ml in panics, 5.4 +/- 4.0 ng/ml in major depressives, and 25.8 +/- 11.3 ng/ml in normal controls (F(2,27) = 15.3; P = 0.00003). Although there were significant differences between panics and major depressives (P = 0.00004), and between major depressives and controls (P = 0.00004), panics did not significantly differ from controls. These results do not support the hypothesis of an overlap between panic and affective disorders, and suggest that the hypothalamo-GH-somatomedin axis could be intact in panic disorder.

Effect of previous antidepressant therapy on the growth hormone response to apomorphine.

Several lines of evidence suggest a role for dopamine in the pathophysiology of depression. In 1988, we reported a blunted response of growth hormone (GH) to apomorphine, a dopaminergic agonist, in endogenous depression. However, an antidepressant washout period is a major confounding factor in studies assessing the GH response to apomorphine. Indeed, whereas the influence of tricyclic antidepressants on the GH response to apomorphine is presently unknown, several reports have suggested that tricyclics may impair the GH response to clonidine for periods longer than 3 weeks following their discontinuation. In the present study, we hypothesized that a blunted GH response to apomorphine in depressed patients could be related to the recent administration of antidepressants. Therefore, the GH response to apomorphine (0.5 mg) was studied in 11 male DSM-III-R major depressive inpatients who had never received antidepressant therapy (group 1) compared to 11 normal controls and 11 major depressive inpatients drug free for at least 2 weeks (group 2). The three groups differed significantly in the GH peak response to apomorphine: mean (SD) 5.4 (4.0) ng/ml in group 1, 25.5 (10.7) in normal controls, and 5.5 (5.1) in group 2 (F = 15.5, df = 3, 30, p = 0.00001). While group 1 and normal controls (F = 21.8, p = 0.0002) as well as group 2 and controls (F = 5.6, p = 0.03) differed significantly, group 1 and group 2 did not (F = 0.18, p = 0.68). These results suggest that a washout period of 2 weeks could be sufficient in studies assessing the GH response to apomorphine.