Non-immediate-reading skin tests and prolonged challenges in non-immediate hypersensitivity to beta-lactams in children.

BACKGROUND: A minority of children reporting non-immediate reactions to beta-lactams (BLs) are allergic. Allergy workup usually includes late-reading (48-72 hours) skin tests (ST) and short (1-3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper-late-reading (≥6-7 days) ST and of prolonged DPT for the diagnosis of non-immediate hypersensitivity to BLs is yet to be determined. OBJECTIVES: To establish the diagnostic values of late-reading ST and hyper-late-reading ST and of prolonged DPT in children reporting non-immediate reactions to BLs. METHODS: Prospective assessment of children reporting non-immediate reactions to BLs with late- and additional hyper-late-reading intradermal (ID) and patch tests, and if negative, with prolonged DPT. RESULTS: Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non-immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6-7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT. CONCLUSION: Additional hyper-late-reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non-severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non-immediate hypersensitivity to BLs.

Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests.

Studies based on skin and challenge tests have shown that 12-60% of children with suspected betalactam hypersensitivity were allergic to betalactams. Responses in skin and challenge tests were studied in 1865 children with suspected betalactam allergy (i) to confirm or rule out the suspected diagnosis; (ii) to evaluate diagnostic value of immediate and non-immediate responses in skin and challenge tests; (iii) to determine frequency of betalactam allergy in those children, and (iv) to determine potential risk factors for betalactam allergy. The work-up was completed in 1431 children, of whom 227 (15.9%) were diagnosed allergic to betalactams. Betalactam hypersensitivity was diagnosed in 50 of the 162 (30.9%) children reporting immediate reactions and in 177 of the 1087 (16.7%) children reporting non-immediate reactions (p<0.001). The likelihood of betalactam hypersensitivity was also significantly higher in children reporting anaphylaxis, serum sickness-like reactions, and (potentially) severe skin reactions such as acute generalized exanthematic pustulosis, Stevens-Johnson syndrome, and drug reaction with systemic symptoms than in other children (p<0.001). Skin tests diagnosed 86% of immediate and 31.6% of non-immediate sensitizations. Cross-reactivity and/or cosensitization among betalactams was diagnosed in 76% and 14.7% of the children with immediate and non-immediate hypersensitivity, respectively. The number of children diagnosed allergic to betalactams decreased with time between the reaction and the work-up, probably because the majority of children with severe and worrying reactions were referred for allergological work-up more promptly than the other children. Sex, age, and atopy were not risk factors for betalactam hypersensitivity. In conclusion, we confirm in numerous children that (i) only a few children with suspected betalactam hypersensitivity are allergic to betalactams; (ii) the likelihood of betalactam allergy increases with earliness and/or severity of the reactions; (iii) although non-immediate-reading skin tests (intradermal and patch tests) may diagnose non-immediate sensitizations in children with non-immediate reactions to betalactams (maculopapular rashes and potentially severe skin reactions especially), the diagnostic value of non-immediate-reading skin tests is far lower than the diagnostic value of immediate-reading skin tests, most non-immediate sensitizations to betalactams being diagnosed by means of challenge tests; (iv) cross-reactivity and/or cosensitizations among betalactams are much more frequent in children reporting immediate and/or anaphylactic reactions than in the other children; (v) age, sex and personal atopy are not significant risk factors for betalactam hypersensitivity; and (vi) the number of children with diagnosed allergy to betalactams (of the immediate-type hypersensitivity especially) decreases with time between the reaction and allergological work-up. Finally, based on our experience, we also propose a practical diagnostic approach in children with suspected betalactam hypersensitivity.

Caesarean section on request: are there loco-regional factors influencing maternal choice? An Italian experience.

We aimed to evaluate regional differences in women's motivations and in obstetricians' attitudes re 'caesarean section on request' between obstetricians practicing in Southern and Northern Italy. An anonymous questionnaire was sent to 70 randomly selected specialists practicing in the Veneto region and Sicily. Demographic characteristics, percentage of caesarean section, increase of caesarean section on demand, maternal motivations and the role played by anxiety, relatives and instrumental examinations were analysed. Moreover, obstetricians' opinion and their behaviour in fulfilling, or not, the maternal request were evaluated. Among the emotional reasons, fear of pain was more frequently reported in Sicily (p = 0.045), and previous negative experiences and gestational anxiety in the Veneto region (p = 0.009; p = 0.001). As regards instrumental examinations influencing maternal request, a significant difference was found for ultrasonography (28% in Sicily vs 60% in Veneto, p = 0.002). The husband's role was more frequently reported in the Veneto region (p = 0.006). Obstetricians of both regions noticed a rising rate of caesarean section on maternal request. The reasons for this upward trend are complex, vary from one region to another and are influenced by local socio-cultural and healthcare background.

Arthroscopic laser surgery in temporomandibular functional joint disorders.

AIM: The authors present the 1-year results of combined use of arthroscopic lysis and lavage procedure, capsular stretch and holmium:yttrium-aluminium-garnet (Ho:YAG) laser techniques for the treatment of chronic closed lock of the temporomandibular joint. METHODS: Twelve joints were treated in 10 patients (9 females and 1 male) affected by anterior disk displacement without reduction not responsive to conservative treatment. All the patients were studied with preoperative magnetic resonance immaging (MRI). Surgical procedures included lysis and lavage, capsular stretch and Ho:YAG laser techniques with anterior release, posterior scarification and debridment of cartilage surface. The individual outcome was evaluated with the clinical examination, a visual analogue scale (VAS) for pain and a questionnaire concerning mandibular functional impairment. Patients were followed-up for 1 year. RESULTS: One-year results show that 9 patients (success rate 90%) achieved improvement of mandibular function and reduction of pain. The clinical recordings at the 1-year follow-up indicated good outcomes. Nine patients could masticate a regular diet at 1-year follow-up. CONCLUSIONS: These findings seem to justify the use of Ho:YAG laser techniques together with the lysis and lavage procedure and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. These arthroscopic procedures represent the first choice and an effective approach in the surgical treatment of this condition.

Polineuropatía desmielinizante inflamatoria crónica como forma de presentación de lupus eritematoso sistémico / Chronic inflammatory demyelinating polyneuropathy such as presentation of systemic lupus erythematosus

Se describe el caso de una mujer de 35 años que presenta polineuropatía desmielinizante inflamatoria crónica como compromiso neurológico en su diagnóstico inicial de lupus eritematoso sistémico (LES). Si bien el compromiso neurológico es de una prevalencia variable en lupus, la asociación que se describe no es frecuente y tiene importantes connotaciones en el tratamiento.

We described a 35 years old female, who developed Chronic inflammatory demyelinating polyneuropathy as neurologic commitment during the early diagnosis in Systemic Lupus Erithematosus (SLE). While the neuropsychiatric commitment has a variable prevalence in SLE, the association that we describe is infrequent and it has important concerns during its treatment.

Polineuropatía desmielinizante inflamatoria crónica como forma de presentación de lupus eritematoso sistémico / Chronic inflammatory demyelinating polyneuropathy as a form of presentation of systemic lupus erythematosus

Se describe el caso de una mujer de 35 años que presenta polineuropatía desmielinizante inflamatoria crónica como compromiso neurológico en su diagnóstico inicial de lupus eritematoso sistémico (LES). Si bien el compromiso neurológico es de una prevalencia variable en lupus, la asociación que se describe no es frecuente y tiene importantes connotaciones en el tratamiento.

We described a 35 years old female, who developed Chronic inflammatory demyelinating polyneuropathy as neurologic commitment during the early diagnosis in Systemic Lupus Erithematosus (SLE). While the neuropsychiatric commitment has a variable prevalence in SLE, the association that we describe is infrequent and it has important concerns during its treatment.

[Radical hysterectomy. Operative complications]. / Isterectomia radicale. Complicanze operatorie.

The Authors carried out a retrospective examination of data relating to 241 patients undergoing radical hysterectomy with pelvic lymphadenectomy between 1970 and 1991. The basic aim of the study was to identify and quantify complications correlated to radical hysterectomy using the Wertheim-Meigs method. Surgery was performed in 223 cases due to cervical cancer, in 13 cases due to endometrial cancer, in 3 cases due to vaginal cancer and in 2 due to ovarian cancer with secondary extension to the uterus. Complications were subdivided into intraoperative and postoperative. Intraoperative complications involved the urinary tract in 4.5% and other apparatus (intestinal and nervous lesions, hemorrhage due to vascular damage) in 8.7% of cases. Postoperative complications were classified as follows: 35.2% involving the urinary tract (fistula 20.3% and vesical dysfunction 14.9%) and 8% involving other organs or systems (infections, neuropathy, pelvic lymphocele, pathologies of intestinal canalization, etc.). Lastly, the Authors examined the individual complications of radical hysterectomy, focusing attention in particular on vesicourethral dyskinesia, in the light of the physiopathological mechanisms reported in the literature. The mean rate of complications in the series examined here was substantially comparable to that reported by other Authors.

[Determination of cesium in human placenta 3 years after Chernobyl]. / Determinazione del cesio in placente umane tre anni dopo Chernobyl.

Three years after the nuclear reactor accident in Chernobyl, 80 human placentae were tested to determine concentrations of cesium 134 and cesium 137 radionuclides. The activities of radionuclides were measured using a low-back ground gamma-ray spectrometry system. Human placentae were obtained from normal and at term pregnancies in women who lived in rural areas of northern-Italy and north-west of Yugoslavia and who in particular used locally grown vegetables and meats. According to the data of other Authors, the low cesium isotopes 134 and 137 levels detected (inferior to 2 Bq/kg) in human placentae suggest that, in the observed geographic areas, the fetal risk following the reactor accident in Chernobyl was negligible.

[Drug adverse effects in the elderly hospitalized with acute pathologies]. / Effetti collaterali da farmaci in anziani ospedalizzati per patologie acute.

OBJECTIVES: Data of Literature suggest that age is not an independent risk factor for adverse drug reactions (ADR), while there is evidence of a positive correlation between ADR and the number of drug taken. To investigate if that is true, we have examined the occurrence of ADR in elderly patients admitted to our Geriatric Department in the first nine months of 1999 for acute illness. MATERIALS AND METHODS: We have evaluated the occurrence of ADR in 510 patients more than 65 years of age (80 +/- 7.35 years). The adverse drug effect was worth considering when symptomatical or caused a change in the management of the patient (suspension or change of therapy, prolongation of staying in hospital). We used the algorithm of Naranjo (19) to estimate the probability that a drug caused an ADR. RESULTS AND CONCLUSIONS: In our study the frequency of ADR was 12.5%. Furosemide was responsible for 50% and digoxin for 8% of ADR. Among the patients taking furosemide, 12.5% had an ADR (generally low potassium). The frequency of ADR was correlated neither with the age of the subjects nor with the number of drug taken. It can be possible that the main cause of ADR is the type of drugs assumed by elderly.

[Blood component transfusion in full-term and premature new born infants]. / Transfusão de hemocomponentes em recém-nascidos de termo e prematuros.

BACKGROUND: Blood transfusion requirements for preterm infants are greater than for newborn ones. We compare blood transfusion requirements for newborn and premature infants and their pathology: clinical or surgical; hemorrhagic accidents and survival. METHODS: 48 newborns classified in 2 groups: 26 newborn and 22 preterm infants received 251 units of blood components: 177 units of red cell concentrates, 36 of platelet concentrates, 30 of fresh frozen plasma and 8 of total blood in a 186 days period. We analyzed total requirements of components in each group and daily, under a live-infant/day rate until 120 days. RESULTS: The all-components median requirements were 7.31 units for premature and 3.46 for newborn infants. Daily requirements analyzes reveal that requirements were greater before 60th day of life (d.l.) on clinical patients and after 86th d.l. may be caused by surgical acts. Hemorrhagic accidents happen on premature with less than 60,000 platelets/mm3. The survival wave by number of transfusions, until 186 d.l., show an inversely proportional trend between the number of transfusions done and the hope of life. CONCLUSIONS: Blood requirements for preterm infants are greater than for term ones. Those requirements are related to their pathology. Prophylatic platelet transfusions may reduce hemorrhagic accidents then red blood cell transfusions in preterm infants group. The number of transfusions over 10 is a surrogate marker of bad prognosis for both groups up to 120 d.l.

Estudo das plantas medicinais, utilizadas pelos pacientes atendidos no programa "Estratégia saúde da família" em Maringá/PR/Brasil / Study of the use of medicinal plants by population served by the family health strategy in Maringá, Paraná, Brazil

RESUMO Estima-se que 80% da população mundial dependam das plantas medicinais no processo da atenção primária em saúde, e grande parte destes tem nas plantas a única fonte de medicamentos. O presente estudo teve como objetivo verificar a utilização de plantas medicinais pela comunidade, pertencente à equipe 10 da Estratégia Saúde da Família (ESF) da Unidade Básica de Saúde (UBS) Pinheiros, em Maringá, Paraná, Brasil. Os dados foram coletados no período de março de 2012 a maio de 2012. A equipe de pesquisadores aplicou 95 questionários intercalando os domicílios. Observou-se que 24,2% utilizam plantas medicinais com frequência, 40% utilizam esporadicamente e 35,8% não utilizam. Entre as pessoas que utilizam, observou-se que a forma mais citada foi o uso era pela indicação de amigos ou pelos ancestrais As plantas medicinais mais citadas foram: hortelã (Mentha sp.), boldo (Plectranthus barbatus), camomila (Matricaria recutita), erva cidreira (Melissa officinalis) e guaco (Mikania glomerata). Quando perguntados se o uso de plantas medicinais somente fazem bem à saúde, 68,5% dos participantes afirmaram que plantas medicinais não causam nenhum mal à saúde. A partir destes resultados, observou-se que a utilização de plantas medicinais é bem aceita pela população e que ainda existe uma lacuna grande a ser preenchida pelos profissionais da saúde no que diz respeito à orientação sobre o uso correto desse tipo de terapia.

ABSTRACT It is estimated that 80% of the population depends on herbal medicine regarding primary health care and most of these people use plants as their only source of drugs. The current study aimed to know the profile of the community served by the staff 10 of the Family Health Strategy (FHS) of Basic Unity of Health (BUH) Pinheiros, in Maringá, Paraná State, in regard to the use of medicinal plants. The data was collected between March of 2012 and May of the same year. Ninety-five questionnaires were applied. 24.2% of people employ medicinal plants frequently, 40% use it occasionally and 35.8% do not appeal to them at all. Most of them learnt about medicinal plants with family and friends. The most mentioned medicinal plants by population were the following: Mentha sp., Plectranthus barbatus, Matricaria recutita, Melissa officinalis and Mikania glomerata. 68.5% of the participants believe that medicinal plants do not cause any harm to health. From these results, we can notice that medicinal plants are widely accepted and there is a big gap to be filled by health professional in terms of proper orientation about the use of this kind of therapy.

Contribuição ao estudo farmacognóstico da Piper ovatum Vahl / Contribution to the pharmacognostic study of Piper ovatum Vahl

RESUMO: O presente estudo descreve as características morfo-anatômicas dos órgãos vegetativos e do pó da Piper ovatum Vahl de modo que os dados obtidos possam ser utilizados como referência em análises de controle de qualidade de amostras de fármacos, a fim de verificar sua autenticidade. As raízes, caules, pecíolos e folhas foram fixadas, seccionadas à mão livre e coradas, as secções transversais e paradérmicas foram analisadas por microscopia óptica e a superfície do limbo foi observada, também, por microscopia eletrônica de varredura (MEV). Os órgãos vegetativos da P. ovatum apresentam morfologia e anatomia similar às outras espécies de Piper. No entanto, não foram observadas inclusões celulares nas folhas de P. ovatum. Análises por MEV mostraram a presença de tricomas glandulares constituídos de pedúnculo unicelular e porção secretora globóide igualmente unicelular recoberto por cutícula, na epiderme abaxial das folhas. Também foi observada a presença de uma cutícula espessa e que origina crostas no limite entre uma célula e outra, em ambas as superfícies foliares. No mesófilo foi observada a presença de idioblastos oleíferos característica marcante de outras espécies de Piperaceae. Além disso, na microscopia do pó foram observados hipoderme e idioblastos oleíferos em fragmentos do limbo, fragmentos de fibras esclerenquimáticas do caule, além de células esclerosas isoladas ou em grupos no pecíolo. O perfil cromatográfico do extrato hidroetanólico das folhas de P. ovatum foi obtido por cromatografia líquida de alta eficiência (CLAE). Nas análises por CLAE foram identificados como substâncias majoritárias do extrato as amidas piperovatina e piperlonguminina nos tempos de retenção de 10,25 e 10,81 min., respectivamente.

ABSTRACT: The present study describes the morphological and anatomical characteristics of vegetative organs and powder of the Piper ovatum Vahl, in order to use the obtained data as reference in the quality control tests of pharmaceutical samples, investigating their authenticity. The roots, stems, petioles and leaves were fixed, freehand sectioned and stained according to usual microtechniques. The transverse and paradermal sections were analyzed by optical microscopy and the leaf surface was also observed by scanning electron microscopy (SEM). The vegetative organs of the P. ovatum show morphology and anatomy similar to other species of Piper. However, cellular inclusions were not observed in the P. ovatum leaves. The SEM analysis showed the presence of glandular trichomes consisting of a unicellular stalk and globular secretory portion covered by cuticle on the abaxial surface of the leaves. The SEM also had shown one thick cuticle forming crusts in the limit of the epidermal cells, on both leaf surfaces. In the mesophyll, we observed oil idioblasts, which are typical features of other species of Piperaceae. Moreover, in the powder of the P. ovatum we observed hypodermis and oil idioblasts in leaf fragments, fragments of sclerenchyma fibers from the stem and isolated sclereids or in petiole groups. The chromatographic profile of the hydroethanolic extract of the P. ovatum leaves was obtained by high performance liquid chromatography (HPLC). In this analysis, we identified the amides piperovatine and piperlonguminine in the retention times of 10.25 and 10.81 min., respectively, as majority compounds present in the extract.

Autonomic changes during pregnancy: assessment by spectral heart rate variability analysis.

The aim of this study was to investigate cardiovascular autonomic balance in normal pregnancy through spectral analysis of heart rate variability. For this purpose, electrocardiograms were recorded in 8 nonpregnant women and in 32 pregnant women at 10-39 weeks of gestation. Low-/high-frequency peak (LF/HF) ratio was used as an indirect index of sympathovagal balance. In left lateral recumbency, the LF/HF ratio was lower in pregnant women than in control subjects at all gestational ages. The LF/HF ratio was not affected by turning from left lateral to supine recumbency in control subjects, whereas it significantly increased in pregnant women (eg, from a mean +/- SD of 1.05 +/- 0.81 to 2.18 +/- 1.69 after the 33rd week of gestation). Handgrip at low intensity remarkably increased the LF/HF ratio both in control subjects (from 2.21 +/- 2.76 to 2.73 +/- 1.91) and in pregnant women (from 1.28 +/- 1.17 to 2.24 +/- 0.95 at 34-39 weeks of gestation). The results suggest that a rearrangement of autonomic tone takes place in normal pregnancy, which could be interpreted either as a shift of autonomic balance toward a relative vagal predominance or as the consequence of attenuation of baroreflexes.

A new laparoscopic procedure for the correction of vaginal vault prolapse.

PURPOSE: We verified the feasibility and results of a new laparoscopic technique for repairing vaginal vault prolapse. MATERIALS AND METHODS: Laparoscopic repair of vaginal vault prolapse was done in 12 women 46 to 82 years old. Stage 1 consisted of culdoplasty similar to that of Moschowitz. Stage 2 included a transverse incision of the peritoneum covering the vaginal vault to expose the vaginal fascia. Two sutures were then fixed to the vaginal corners, passed through the subperitoneal connective tissue and attached to the fascia of the abdominal muscles with multiple stitches. RESULTS: No intraoperative or postoperative complications occurred and anatomical repair was complete in all women. Followup ranged from 9 to 28 months. Sexual function was recovered in all cases. CONCLUSIONS: If these results are confirmed in larger series with a longer followup, our laparoscopic approach would be considered a valid alternative to current surgical techniques.

[Use of blood and blood components and derivatives in newborn infants] / Uso de sangue, hemocomponentes e hemoderivados no recém-nascido.

OBJECTIVE: To describe the current rationale for the transfusion of blood, blood components, and plasma derivatives in term and preterm infants. SOURCES: Selection of relevant medical articles published within the last ten years. SUMMARY OF THE FINDINGS: Peculiar characteristics and special care concerning exchange transfusion, transfusion of red blood cells, platelets, granulocytes, and fresh frozen plasma were described. The recommendations for the use of hematopoietic growth factors, and plasma derivatives such as fibronectin, immunoglobulins, and albumin were also evaluated. CONCLUSIONS: The authors comment on the recommendations and contraindication of blood transfusions, and warn against the limitations and hazards involved.

Early primary immune response against erythrocytes: a case report.

BACKGROUND: Primary immune response against red blood cell (RBC) antigens often takes weeks or months to be detected. In previous reports, for children receiving multiple units of blood components, ranging from five to 81 units, the elapsed time between the first RBC transfusion and antibody detection ranged from 18 to 78 days. Cytomegalovirus (CMV) is sometimes associated with immunohaematologic findings and may modulate immune response. CASE REPORT: A 24-week-old male infant with interstitial pneumonia and hepatitis because of CMV developed an RBC auto antibody and two RBC alloantibodies: anti-Jka, detected in tube 11 days after a single RBC transfusion, and anti-K, detected only in papain gel test 18 days later. CONCLUSION: As anti-Jka is not a naturally occurring antibody, this is the most rapid primary immune response against an RBC antigen after a single RBC transfusion ever described, in the youngest child ever described.

Effect of Maytenus aquifolium extract on the pharmacokinetic and antiinflammatory effectiveness of piroxicam in rats.

This study explored the interference by Maytenus aquifolium leaves hydroalcoholic (MALHE) extract, administered orally, on the pharmacokinetic and antiinflammatory activity of piroxicam in rats. The results showed no significant difference in piroxicam bioavailability with simultaneous application of MALHE. MALHE also had no effect on the inhibitory effect of piroxicam on inflammatory processes induced by carrageenan and complete Freund adjuvant.

Antiulcer effectiveness of Maytenus aquifolium spray dried extract.

The antiulcer activity of Maytenus aquifolium spray dried extract was studied in rats. Ulcers were induced by means of three experimental models: acidified-ethanol, indomethacin and acute stress. The extract was found to have significant antiulcer activity against all the models studied. These results show that preparation of the extract by means of the spray dried technique does not alter the biological activity of Maytenus aquifolium.