Hypersensitivity to Non-Steroidal Anti-Inflammatory Drugs on a pediatric Portuguese cohort.

Summary: Background. Non-steroidal anti-inflammatory drugs (NSAID)/analgesics (paracetamol) are among the most common causes of drug hypersensitivity reactions in children, with a reported prevalence of around 0.3% in the pediatric population. Paracetamol and ibuprofen are the most commonly reported culprits in the pediatric population. Our objective was to describe the allergy workup to NSAID/paracetamol of a pediatric population monitored in an allergy outpatient clinic. Methods. Retrospective observational study by consulting the medical records of patients evaluated in a pediatric outpatient clinic with history of NSAID/paracetamol, between January 2016 to August 2022. Results. A total of 43 patients have been evaluated for NSAID/paracetamol suspected allergy: 53.5% females, mean age of 9.8 ± 5.1 years, 47.7% atopic. The drugs reported as culprits were: ibuprofen (75.6%), paracetamol (17.8%), metamizole (4.4%) and naproxen (2.2%) and clinical manifestations were mainly urticaria/angioedema and maculopapular exanthema. Skin tests were performed in 7 patients: paracetamol (n = 5) and metamizole (n = 2), which were all negative. Fourty-six drug provocation tests were performed: 28 with the culprit drug and 18 with an alternative one; only 2 were positive (ibuprofen - culprit NSAID group): one immediate periorbital angioedema and one delayed lip edema with oropharyngeal tightness. Conclusions. The investigation of allergy to NSAID/paracetamol in children remains a challenge. In our population, ibuprofen was the most common NSAID reported. There were only 2 (4.3%) mild reactions on DPT. We could allow the use of the culprit NSAID/analgesic in 11 patients and an alternative one in 9 patients. This study highlights the importance of DPT in children for a correct diagnosis of NSAID hypersensitivity and selection of an alternative drug.

Use of electronic health records by child primary healthcare providers in Europe.

BACKGROUND: There is limited data on the use and functionality level of electronic health records (EHRs) supporting primary child health care in Europe. Our objective was to determine European primary child healthcare providers' use of EHRs, and functionality level of the systems used. METHODS: European primary care paediatricians, paediatric subspecialists and family doctors were invited by European Academy of Paediatrics Research in Ambulatory Setting Network (EAPRASnet) country coordinators to complete a web-based survey on the use of EHRs and the systems' functionalities. Binomial logistic analysis has been used to evaluate the effect of specialty and type of practice on the use of EHRs. RESULTS: The survey was completed by 679 child primary healthcare providers (response rate 53%). Five hundred and fifty four responses coming from 10 predominant countries were taken for further analysis. EHR use by respondents varied widely between countries, all electronic type use ranging between 7% and 97%. There was no significant difference in EHR use between group practice and solo practitioners, or between family doctors and primary care paediatricians. History and physical examination can be properly recorded by respondents in most countries. However, growth chart plotting capacity in some countries ranges between 22% and 50%. Vaccination recording capacity varies between 50% and 100%, and data exchange capacity with immunization databases is mostly limited, ranging between 0% and 54%. CONCLUSIONS: There is marked heterogeneity in the use and functionalities of EHRs used among child primary child healthcare providers in Europe. More importantly, lack of critical paediatric supportive functionalities like growth tracking and vaccination status has been documented in some countries. There is a need to explore the reasons for these findings, and to develop a cross European paediatric EHR standards.

First molecular description of autochthonous urban cases of canine visceral leishmaniasis in the city of Belém, Pará, Brazil.

Leishmaniasis is an anthropozoonosis transmitted by vectors, with dogs being the main domestic reservoirs. Brazil is one of the countries most affected by this disease, and it has been described in humans and dogs in every region in the country. In the northern region leishmaniasis cases in humans have been described in more than 100 municipalities in the State, including the capital, Belém. This study involves two cases of canine visceral leishmaniasis in which the animals developed clinical signs compatible with the disease in urban areas in Belém, the Pará state capital. The diagnosis was confirmed via polymerase chain reaction (PCR) to detect SSUr-rDNA and kDNA of Leishmania sp. and Leishmania infantum, respectively. In one of the cases the animal died and in the other the animal underwent treatment with medicines prescribed for dogs. Through this treatment, parasitemia in the second animal has been kept under control and is being monitored through molecular tests. Previously, no canine cases had been notified from urban neighborhoods in the city of Belém, but only on the island of Cotijuba, at a distance of 29 kilometers from the city. Cases of canine and human leishmaniasis have been recorded close to the capital, Belém, which has areas of conserved vegetation and where the presence of disease vectors has been described. Thus, as has been done in several other Brazilian cities, this study uses clinical and laboratory findings to confirm the presence of autochthonous cases of canine visceral leishmaniasis in the city of Belém.

Qualitative and quantitative analysis of human herpesviruses in chronic and acute B cell lymphocytic leukemia and in multiple myeloma.

Real-time quantitative polymerase chain reaction (qPCR) was used to quantify viral loads of human herpesviruses (HHVs) at diagnosis in 61 samples of malignant B cells: 21 chronic lymphocytic leukemia (B-CLL), 29 acute lymphoblastic leukemia (B-ALL) and 11 multiple myeloma (MM); control samples were blasts from 16 acute myeloid leukemia (AML) and 24 blood or bone marrow samples from healthy donors. The majority of samples from healthy donors and patients (B-ALL, B-CLL or AML, but not MM) was positive for EBV and contained <100 ebv copies/100 ng dna. ebv loads were occasionally high (>500 copies/100 ng DNA) in B-ALL (2/16) and in B-CLL (2/21) samples. The fractions of samples positive for HHV-8 and HHV-6A, less than 10% for MM patients, were high for adults with B-ALL (18.8% HHV-8+, 43.8% HHV-6A+) or B-CLL (28.6% HHV-8+, 52.4% HHV-6A+). B-ALL, B-CLL and MM samples were rarely positive for HHV-6B and HHV-7. Lastly, 75% of B-ALL samples were positive for CMV, and CMV loads were significantly higher in B-ALL samples than in MM, B-CLL or AML samples. We also used PCR with consensus-degenerate hybrid oligonucleotide primers (CODEHOP) to look for novel HHVs in B cell samples: no sequence indicative of a new HHV was detected. Altogether, the data indicate that the presence of multiple HHVs, including EBV and CMV at high loads, is not rare in B-ALL and B-CLL cell samples. Future prospective studies should determine whether patients with high EBV/CMV loads at diagnosis in tumor samples face a higher risk of delayed hematological recovery, virus-related complications or relapse.

Ubiquitin genes in Tetrahymena pyriformis and their expression during heat shock.

The genome of Tetrahymena pyriformis was shown to contain a ubiquitin multigene family consisting of at least four polyubiquitin genes. Three genomic clones with different ubiquitin-coding sequences, were isolated and partially characterized. The complete nucleotide sequence of one of these clones (pTU2) was determined and showed two open reading frames (ORFs) at opposite ends of the cloned DNA insert. A comparison of the predicted amino acid (aa) sequence of T. pyriformis ubiquitin-coding unit with those from other organisms indicated a high degree of homology. However, Tetrahymena ubiquitin contained two aa substitutions at positions 16 (Asp) and 19 (Ala). Interestingly, the first pTU2 ORF showed two extra triplets coding for Ser and Gln, upstream from TGA. This feature is different from all the polyubiquitin genes thus far sequenced. Regions flanking the 3' and 5' ubiquitin-coding sequences presented several conserved motifs. The 5' flanking sequence of the second ORF of pTU2 contained one heat-shock element. We therefore studied the expression of the ubiquitin genes under stress conditions. The results showed that they are heat-inducible and that a new specific 1.6-kb mRNA appeared. These results suggest that the regulation of ubiquitin genes is important in T. pyriformis under thermal stress conditions.

Cloning and characterization of two ubiquitin::79-amino-acid extension protein-encoding fusion genes from Lupinus albus.

Two different ubiquitin::79-amino-acid (aa) extension protein-encoding fusion genes were isolated from a Lupinus albus nuclear DNA library and sequenced. Both genes have 465-nucleotide open reading frames encoding a single ubiquitin (Ub) monomer fused in frame to a 79-aa extension (Ext) protein. The deduced aa sequences of the encoded Ub are identical to the aa sequences of Ub from other plants. The encoded Ext proteins are putative ribosomal proteins, highly basic, differing by 2 aa from each other, and have a high degree of similarity to Ext proteins from other plants.

The macronuclear polyubiquitin gene of the ciliate Tetrahymena pyriformis.

The presence of ubiquitin in ciliates was first demonstrated in Tetrahymena pyriformis. One clone--pTU2--presents two incomplete open reading frames and the putative polyubiquitin genes have been shown to be highly similar to those of other organisms. To further analyze the organization of this multigene family, several fragments of macronuclear DNA were cloned. We report here the isolation and characterization of one genomic clone (pTU20) that encodes a polyubiquitin gene (TU20) with five tandem repeats and presenting only one extra triplet CAA (Gln) upstream from the TGA. The promoter region of TU20 also presents a consensus heat shock element. The specific detection of RNA species with a synthetic oligonucleotide probe reveals that it corresponds to the 1.8 kb mRNA species whose expression is increased by temperature stress.

Molecular cloning and expression of a Tetrahymena pyriformis ubiquitin fusion gene coding for a 53-amino-acid extension protein.

The genome of Tetrahymena pyriformis has been shown to contain a ubiquitin multigene family consisting of several polyubiquitin genes and at least one ubiquitin fusion gene. We report here the isolation and characterization of one genomic clone (pTU11), that encodes a ubiquitin extension protein. A comparison of the predicted amino acid sequence of the ubiquitin extension protein gene of T. pyriformis with those from other organisms indicated a high degree of homology. However, the Tetrahymena ubiquitin extension protein contains 53 and not 52 amino acids. This feature is different from all ubiquitin 52-amino-acid extension protein genes thus far sequenced. Furthermore, we found an array of four cysteine residues similar to those found in nucleic acid binding proteins. Also, the C-terminal sequence possesses a conserved motif which may represent a nuclear translocation signal. The ubiquitin 53-amino-acid extension protein gene encodes the smallest class of ubiquitin mRNAs in T. pyriformis.