Frequency of ragweed sensitization and allergy among patients with respiratory allergy.

Pollen is well known to cause seasonal allergy. Ragweed sensitization and allergy represent a worldwide challenge for allergists. Ambrosia is one of the major genera in the Asteraceae family which includes at least 51 species known as "ragweed". The current study aimed at determining frequency of ragweed sensitization and allergy among patients with respiratory allergy. The study included 220 subjects selected from patients attended the Allergy Clinic, Ain Shams University. All patients were subjected to detailed medical history, clinical examination, asthma severity grading according to the Global Initiative for Asthma (GINA) guidelines, allergic rhinitis severity grading according to the allergic rhinitis and its impact on asthma (ARIA) guidelines, pulmonary function tests for asthmatic patients, complete blood count with differential for detection of eosinophilia, serum total IgE and skin prick testing (SPT) to ragweed pollen together with common inhalants and common food allergens. Specific IgE for Ambrosia artemisiifolia was done for patients who showed positive SPT to ragweed pollen. About 34% of patients had positive SPT to ragweed, 30.5% were sensitized to ragweed and 3.2% allergic. Specific IgE for A. artemisiifolia was positive in 33.8%. There was a statistically significant association between ragweed sensitization and level of asthma control and disease duration. We concluded that ragweed sensitization is less common as the frequency of Ambrosia pollen sensitization was about one third of the studied allergic patients.

Potential impact of gut Lactobacillus acidophilus and Bifidobacterium bifidum on hepatic histopathological changes in non-cirrhotic hepatitis C virus patients with different viral load.

BACKGROUND: Composition of gut microbiota has recently been suggested as a key factor persuading the pathogenesis of numerous human diseases including hepatic cirrhosis. OBJECTIVE: To evaluate the potential impact of Lactobacillus acidophilus and Bifidobacterium bifidum microbiota on the progression of hepatic histopathological changes among patients with non-cirrhotic chronic hepatitis C (HCV) infection with different viral load. Additionally, to assess fecal composition of Lactobacillus acidophilus ATCC-4356 and Bifidobacterium bifidum ATCC-11863 microbiota genotypes MATERIAL AND METHODS: This study was carried out on 40 non-cirrhotic chronically infected HCV patients, and 10 healthy-controls. Liver biopsy and HCV genomic viral load were assessed for all patients after full clinical examination. Lactobacillus acidophilus ATCC-4356 and Bifidobacterium bifidum ATCC-11863 microbiota were assessed in all fecal samples using PCR assay, after counting total lactic acid bacteria. RESULTS: There was a significantly higher difference between the count of both total lactic acid and Lactobacillus acidophilus of healthy controls compared to patients (P-value < 0.001). Though the count of total lactic acid bacteria, and Lactobacillus acidophilus were higher in the cases with early stage of fibrosis (score ≤ 1) compared to those with score > 1, there were no statistically significant differences with both the serum level of hepatitis C viremia (P = 0.850 and 0.977 respectively) and the score of fibrosis (P = 0.246 and 0.260 respectively). Genotypic analysis for the composition of the studied microbiota revealed that diversity was higher in healthy controls compared to patients. CONCLUSIONS: The progression of hepatic fibrosis in HCV chronically infected patients seems to be plausible based on finding the altered Lactobacillus acidophilus and Bifidobacterium bifidum gut microbiota composition. Thus, modulation of these microbiota seems to be a promising target for prevention and control of HCV infection.

Prevalence of confirmed immunoglobulin E-mediated food allergy among adult Egyptian patients.

Food allergy (FA) represents an increasing social and economic health problem. Prevalence of food allergy differs from one country to another depending on genetic and environmental as well as feeding habits of each country. Estimate the prevalence of confirmed immunoglobulin E-mediated food allergy (FA) among adult Egyptian patients and identify its possible risk factors. A total of 2081 adult subjects were randomly selected from the Allergy outpatient clinic at Ain Shams university hospitals. Patients who disclosed food adverse complaints (probable food allergy group) were further subjected to a detailed questionnaire, complete blood cell count, total immunoglobulin E level, skin prick test and /or specific immunoglobulin E test for common food allergens, and oral food challenge with the culprit food. Patients were classified into confirmed food allergy and no food allergy groups depending on the results of oral food challenge test. Out of the 2081 adults, 100 subjects had self-reported food adverse complaints, and of them, 45 (45%) had confirmed diagnosis of FA. Thirty four (75.6%) confirmed FA patients were females with mean age ± SD of (38.02 ± 13.08) years, five patients (11.1%) had persistent childhood FA, 11 (24.4 %) had family history of atopy, five (11.1%) had associated atopic diseases and 24 (53.3%) were polysensitized. Female gender, young age and exercise were found to be risk factors for confirmed FA (OR: 1.766, 1.4, and 1.9 respectively). Cutaneous manifestations were the most common presentation of confirmed FA patients in the form of urticaria 40/45 (88.9%) and angioedema 18/45 (40%). The most common food allergen was milk, banana, fish, tomato, strawberry and eggs. In conclusion, IgE mediated food allergy is a noticeable health problem among adult Egyptians, particularly adult females and young age groups.

Familial history of hypertension as a predictor of increased arterial stiffness in normotensive offspring.

BACKGROUND: Increased arterial stiffness can be used as a prognostic marker of arterial hypertension. The relationship between arterial stiffness and arterial hypertension seems to be reciprocal. OBJECTIVE: Evaluation of changes of the arterial elastic prosperities in normotensive subjects, with and without parental history of hypertension. SUBJECTS AND METHODS: One hundred and ten normotensive individuals, aged 20-30 years, were divided into two groups: group-A (n = 57) and group-B (n = 53) subjects with positive and negative parental history of hypertension, respectively. Systolic, diastolic and pulse pressures were measured using mercury sphygmomanometer. The elastic properties of the ascending aorta and the common carotid arteries were assessed using M-mode echo and B-mode imaging, respectively. Stiffness index of the digital volume pulse (SIDVP) was measured in the right index finger using photoplethysmography. RESULTS: Group A subjects showed higher aortic stiffness index (p = 0.002), carotid stiffness index (p = 0.001), carotid pulse wave velocity (p â©½ 0.001) and stiffness index of digital volume pulse (p = 0.001). Group A subjects showed lower aortic distensibility (p = 0.001), aortic strain (p = 0.004), changes in aortic diameter (p = 0.022), carotid distension (p = 0.026), carotid distensibility coefficient (p â©½ 0.001) and carotid compliance coefficient (p = 0.002). CONCLUSION: The aortic and carotid stiffness parameters and SIDVP were higher in normotensive offspring of hypertensive parents. This finding could direct the attention towards the increased cardiovascular risk in this group and thus prompt earlier and tighter prevention of cardiovascular risk factors.

Ventricular tachyarrhythmia during pregnancy in women with heart disease: Data from the ROPAC, a registry from the European Society of Cardiology.

OBJECTIVES: To describe the incidence, onset, predictors and outcome of ventricular tachyarrhythmia (VTA) in pregnant women with heart disease. BACKGROUND: VTA during pregnancy will cause maternal morbidity and even mortality and will have impact on fetal outcome. Insufficient data exist on the incidence and outcome of VTA in pregnancy. METHODS AND RESULTS: From January 2007 up to October 2013, 99 hospitals in 39 countries enrolled 2966 pregnancies in women with structural heart disease. Forty-two women (1.4%) developed clinically relevant VTA during pregnancy, which occurred mainly in the third trimester (48%). NYHA class >1 before pregnancy was an independent predictor for VTA. Heart failure during pregnancy was more common in women with VTA than in women without VTA (24% vs. 12%, p=0.03) and maternal mortality was respectively 2.4% and 0.3% (p=0.15). More women with VTA delivered by Cesarean section than women without VTA (68% vs. 47%, p=0.01). Neonatal death, preterm birth (<37weeks), low birthweight (<2500g) and Apgar score <7 occurred more often in women with VTA (4.8% vs. 0.3%, p=0.01; 36% vs. 16%, p=0.001; 33% vs. 15%, p=0.001 and 25% vs. 7.3%, p=0.001, respectively). CONCLUSIONS: VTA occurred in 1.4% of pregnant women with cardiovascular disease, mainly in the third trimester, and was associated with heart failure during pregnancy. NYHA class before pregnancy was predictive. VTA during pregnancy had clear impact on fetal outcome.

B-type Natriuretic Peptide as an Index of Symptoms and Severity of Chronic Rheumatic Mitral Regurgitation.

BACKGROUND: The most common causes of severe mitral regurgitation (MR) in developing countries are rheumatic heart disease. The plasma level of B-type natriuretic peptide (BNP) is known to increase with left ventricular (LV) dysfunction. AIM OF THE WORK: To study BNP level as an index of symptoms and severity of chronic rheumatic MR. PATIENTS AND METHODS: One hundred and forty patients with rheumatic MR and LV ejection fractions (EFs) of >55% underwent assessment of symptoms, transthoracic echocardiography, and measurement of BNP. RESULTS: The level of BNP rose with increasing left atrium (LA) dimensions and volumes, LV dimensions and volumes, echocardiographic parameters of MR severity (width of the vena contracta, regurgitation jet area, effective regurgitation orifice area, and regurgitant volume), and E waves. RESULTS: BNP was significantly higher in patients with severe MR compared with moderate and mild MR (P < 0.001), and using cutoff point of 61 pg/mL mm had 97% sensitivity and 89% specificity for predicting patients with severe MR (0.99, 95% confidence interval [CI] 0.9-1). BNP was significantly higher in patients with New York Heart Association (NYHA III) compared with NYHA II, I and asymptomatic patients (P < 0.001) and using cutoff point of 53 pg/mL had 97% sensitivity and 87% specificity for predicting symptomatic patients with symptomatic MR (0.81, 95% CI 0.70-0.92). CONCLUSIONS: BNP level increase with increasing severity of rheumatic MR and are higher in symptomatic compared to asymptomatic patients, even in the presence of normal EF%.

Predictors of aortic pulse wave velocity in the elderly with severe aortic stenosis.

UNLABELLED: Predictors of aortic pulse wave velocity (AoPWV) were not previously studied in the elderly with severe aortic stenosis (AS). We aimed to compare the AoPWV in these patients with matched controls and to study the predictors of AoPWV in this population. We measured the AoPWV during cardiac catheterisation in 40 patients with severe AS and 20 matched controls. AoPWV in both groups was similar (p = 0.198) and lied within normal reference value for age in 68 % of elderly with severe AS. Central systolic blood pressure (SBP) (adjusted ß = 0.45, p = 0.001) and glomerular filtration rate (GFR) (adjusted ß = -0.29, p = 0.023) were the only independent predictors of AoPWV in AS group. Central SBP >140 mmHg was the best predictor of abnormal AoPWV (≥14.6 m/s) with 100 % sensitivity and 70 % specificity, p < 0.001. CONCLUSION: AoPWV is not increased in the elderly with severe AS compared to controls, and lies within the reference value for age in the majority of these patients. Central SBP >140 mmHg best predicts abnormal AoPWV in the elderly with severe AS.

Pregnancy in Women With a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC).

BACKGROUND: Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. METHODS AND RESULTS: Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). CONCLUSIONS: Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.

Low-grade endometrial stromal sarcoma with intravenous extension to the heart.

Endometrial stromal sarcoma (ESS) is a rare neoplasm of uterine origin. Intracardiac metastasis from this tumor is extremely infrequent. This report describes a 24-year-old woman from Yemen who had irregular vaginal bleeding shortly after spontaneous abortion. She developed left-lower-limb swelling, diagnosed by duplex scanning and magnetic resonance imaging as deep venous thrombosis in the inferior vena cava (IVC) that extended into the iliac veins on both sides, as well as the left femoral vein and right atrium. She developed acute respiratory distress, from which she recovered after transfer to the intensive care unit. Transesophageal echocardiography showed a large mass occupying the right atrium and ventricle and another mass in the right ventricular outflow tract with areas of cavitations. The tumor appeared to come from the IVC and extended through the right atrium and right ventricle into the pulmonary artery, ending in several digit-like projections. After surgical resection of the intracardiac mass, pathologic examination revealed a low-grade ESS that was confirmed by immunohistochemistry. The patient underwent panhysterectomy and IVC debridement. Pathologic examination revealed infiltrating low-grade endometrial sarcoma invading the myometrium and left adnexa, with intravenous extension into the pelvic veins and the IVC to the right side of the heart. This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.

Immunological role of nasal staphylococcus aureus carriage in patients with persistent allergic rhinitis.

Nasal carriage of staphylococcus aureus (S.aureus) exerts immunomodulatory effect in patients with atopic dermatitis and it may contribute to airway inflammation and allergic response in patients with allergic rhinitis. We Aim to investigate the frequency of nasal S.aureus carriage in patients with persistent allergic rhinitis and its possible influence on their symptoms and immune markers. We chosed 20 non smoker patients with house dust mite (HDM) allergy causing allergic rhinitis and 20 non smoker healthy subjects matched for age and sex. For all subjects rhinoscopy was done, skin prick test, nasal culture for S.aureus, nasal interleukin 4,nasal total IgE, serum total IgE and serum specific IgE(SSIgE) for HDM. Nasal S.aureus was detected in 16/20 patients (80%) and 5/20 (25%) in healthy subjects with highly significant statistical difference p<0.01. Correlation of nasal staph.aureus count and different systemic and local immune markers revealed highly significant positive correlation between nasal S.aureus count and serum total IgE (r = 0.78, p<0.01) and significant positive correlation with SSIgE (HDM) (r = 0.53, p<0.05), nasal total IgE (r = 0.39, p<0.05) and nasal IL-4 (r = 0.55, p<0.05). Nasal staph.aureus actively modulated the immune reaction in persistent allergic rhinitis patients by promoting local IgE production, so we recommend early detection and treatment of S.aureus carriage in patients.