Salbutamol-Induced QT Interval Prolongation in a Two-Year-Old Patient.

Salbutamol-induced QT interval prolongation is a relatively rare adverse effect of beta2-agonists. We report a case of a two-year-old female patient with no known past medical history, brought by her parents to the ED 30 minutes after ingesting a total dose of 97 mg of salbutamol solution. ECG was done for the patient when she arrived and showed sinus tachycardia with prolonged QTc (509 ms) and normal QRS complex. The patient was admitted to the Pediatric Intensive Care Unit (PICU) with persistent tachycardia and tachypnea in the initial reassessment. ECG was repeated with normal QT interval after IV Mg sulfate. The patient was observed in PICU for 12 hours with serial ECG and venous blood gas (VBG). IV potassium chloride (KCL) infusion started, and serial VBG showed normal potassium and lactate. The patient was doing well in the next six hours, with normal serial ECG, labs, and vital signs. In conclusion, salbutamol-induced QT prolongation has infrequently been reported in the literature. Although inhaled salbutamol is commonly used in clinical practice, physicians have limited experience with the severe features of its toxicity. Salbutamol is known to cause minimal side effects, which may be under-recognized and progress to serious manifestations such as hypokalemia, QT prolongation, and sudden cardiac death.

Relation Between Non-Alcoholic Fatty Pancreas and Clinical and Biochemical Parameters in Women with Polycystic Ovary Syndrome: A Multi-Centric Study.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinological disease affecting women in the reproductive age. Non-alcoholic fatty pancreas disease (NAFPD) can promote many aspects of pancreatic dysfunction. The present study aimed to determine the prevalence of NAFPD and to identify its association with clinical and biochemical parameters in PCOS patients. Methods: The present study included 150 patients with PCOS and 150 age-matched healthy controls. All patients were submitted to careful history taking and thorough clinical examination. Performed laboratory investigations included fasting and postprandial blood glucose, lipid profile, liver function tests, serum prolactin and total testosterone. Fatty pancreas was diagnosed using abdominal ultrasound. Results: Among PCOS women, NAFPD was diagnosed in 57 women (38.0%) in contrast to 18 women (12.0%) in the control group (p < 0.001). Patients with NAFPD were significantly older [median (IQR): 38.0 (35.0-43.0) versus 29.0 (25.5-33.0) years, p = 0.001] with higher BMI [median (IQR): 31.5 (29.1-34.7) versus 30.4 (28.6-32.4) kg/m2, 0.042]. Moreover, they had significantly higher frequency of metabolic syndrome (84.2% versus 54.8%, p = 0.001), insulin resistance (68.4% versus 26.9%, p < 0.001) and severe NAFLD (22.8% versus 2.2%, p < 0.001). NAFPD patients had significantly lower sex hormone binding globulin (SHBG) [median (IQR): 36.0 (30.8-40.7) versus 38.1 (35.15-42.7), p = 0.002] and significantly higher free androgen index (FAI) [median (IQR): 4.08 (3.3-4.92) versus 3.47 (3.12-4.05), p < 0.001]. Conclusion: NAFPD is prevalent PCOS. It is related to metabolic syndrome, insulin resistance, dyslipidemia and hyperandrogenism.

Previous maternal oral contraception and the risk among subsequent offspring of asthma diagnosis in early childhood.

Previous maternal use of the oral contraceptive pill (OCP) has been linked with asthma in subsequent offspring and has been implicated in the increased prevalence of childhood asthma in recent decades. We conducted a matched case-control study to test the hypothesis that maternal OCP used close to conception is associated with asthma in the offspring, particularly in children with coexistent eczema. We examined maternal OCP exposure in relation to asthma in the offspring (n = 6730) compared with offspring with no asthma (n = 6730) further stratifying by eczema, age group, treatment category and gender of the offspring. Maternal use of OCP was classified as: no OCP use in the 2 years prior to conception; past OCP use within 2 years but >6 months before conception; and recent OCP use within 6 months of conception. The adjusted odds ratio (OR) for asthma in the offspring was 1.16 [95% confidence interval 1.06, 1.27] among mothers who were recent users of the OCP when compared with mothers who had not used the OCP. Past OCP use was not associated with asthma in the offspring. In the stratified analyses, we observed weak but statistically significant associations between recent maternal OCP use and asthma in the offspring among children: without a history of eczema (adjusted OR 1.22 [1.09, 1.36]), those aged < or = 3 years (adjusted OR 1.24 [1.12, 1.37]), those not on treatment for their asthma (adjusted OR 1.33 [1.12, 1.58]) and among females (adjusted OR 1.34 [1.13, 1.51]). We did not find convincing evidence for a causal relationship between maternal OCP used close to conception and asthma in the offspring. The small statistically significant associations were not among children with characteristic features of asthma such as those with eczema and may be due to bias, uncontrolled confounding or chance.

Changing trends in sex specific prevalence rates for childhood asthma, eczema, and hay fever.

Numerous surveys of school-aged children have shown increasing asthma prevalence with a less publicized but noticeable change in the male to female ratio. We sought to confirm this change in the sex ratio in four questionnaire-based surveys and investigate possible explanations. Identical questionnaire surveys were performed in 1989 (n=3,390), 1994 (n=4,047), 1999 (n=3,540) and 2004 (n=1,920) in school-children aged 9-11 years. Over these 15 years the male to female ratio (M:F) significantly narrowed for wheeze (1.34 to 0.98:1 P < 0.0002), for asthma (1.74 to 1.02:1 P < 0.0001), for eczema (1.42:1 to 0.81:1 P < 0.0001) and for hay fever (1.46 to 0.93:1 P < 0.0001). The diagnosis of asthma in children with wheeze was more commonly made in boys in 1989 relative risk RR 1.32 (1.12, 1.56), even in those with accompanying eczema and/or hay fever RR 1.20 (0.99, 1.45). By 2004 this sex bias in diagnosis was no longer present, RR 1.01 (0.91, 1.12) for wheeze and 1.02 (0.85, 1.21) for those with wheeze and eczema and/or hay fever. From 1989 to 2004 no significant difference in sex distribution changes between older and younger children occurred, making secular trends in the onset of puberty in females an unlikely contributory factor. The disappearance of the bias to diagnose asthma in symptomatic males but not in females may be partly responsible for the narrowing of the sex ratio, but other factors such as those enhancing the expression of asthma and atopy in females may also be implicated.

Mannose binding lectin gene polymorphism and preclinical carotid atherosclerosis in patients with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have increased risk of atherosclerosis and CVD that cannot be explained by traditional risk factors. Previous studies indicated that mannose binding lectin (MBL) may modify the development of atherosclerosis. This study was designed to investigate association of MBL gene polymorphism with occurrence of preclinical atherosclerosis in SLE. The study included 46 patients with SLE and 17 age and sex matched controls. MBL2 genotypes were assessed in patients and controls by the PCR-RFLP method and intima-media thickness of the common carotid artery (cclMT) was determined by means of ultrasonography. Also, serological markers were measured and the disease activity index (SLEDAI) was estimated. SLE patients had higher frequency of MBL A/B + B/B genotypes (47.8%) than controls (29.4%). ccIMT was higher in patients having A/B, B/B, A/B+B/B genotypes when compared with wild genotype (A/A). Patients with A/B+B/B genotypes showed high serum level of LDL, TG, ESRI, CRP and SLEDAI score, but low level of HDL, C3, and C4 compared to wild genotype. ccIMT of mutant SLE subgroup correlated well with SLE risk factors for atherosclerosis. In conclusion, mutant genotypes of MBL may be atherogenic as SLE patients had a higher IMT, which correlated significantly with SLE risk factors for atherosclerosis.

Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care.

AIM: To identify age- and gender-specific prevalence rates for physician-diagnosed asthma, allergic rhinitis (AR) and eczema across a whole lifespan. METHOD: Presentations of asthma, allergic rhinitis and eczema were identified in individuals aged 0 to 65 who consulted their general practitioner at least once in 1998-99 from a population sample of 266,733 in Scotland, and in 1991-95 for asthma and allergic rhinitis in 6,836,063 person years at risk in England and Wales. RESULTS: In both sexes asthma presentations peak at 4-6 years whilst eczema peaks in infancy. A second asthma peak occurs during adolescence, earlier in females, at a time when a female predominance for all three atopic diseases is established. Female predominance of eczema presentations are limited to the reproductive period of 15-49 years. CONCLUSION: The patterns of presentations for asthma, allergic rhinitis and eczema by age and gender suggest important gender-specific differences in disease predisposition and diagnosis.