Efficacy of sublingual immunotherapy tablets in dust mite and pollen allergy.

The latest evidence on the mechanisms, efficacy, and safety of sublingual immunotherapy (SLIT) was reviewed. Interleukin (IL) 35 and IL-35-producing regulatory T cells were assessed as new biomarkers for SLIT responsiveness. A detailed analysis of clinical studies, including timothy grass pollen, 5-grass pollen, ragweed, and house-dust mite SLIT tablets, was provided, including a comparative analysis of efficacy and safety of SLIT versus subcutaneous immunotherapy.

A systematic review of asthma case definitions in 67 birth cohort studies.

BACKGROUND: Birth cohort studies are a valuable source of information about potential risk factors for childhood asthma. To better understand similarities and variations in findings between birth cohort studies, the methodologies used to measure asthma require consideration. OBJECTIVE: To review and appraise the definitions of "asthma" used in birth cohort studies. METHODS: A literature search, conducted in December 2017 in the MEDLINE database and birth cohort repositories, identified 1721 citations published since 1990. Information extracted included: study name, year of publication, sample size, sample age, prevalence of asthma (%), study region, source of information about asthma, measured outcome, and asthma case definition. A meta-analysis evaluated whether asthma prevalence in cohorts from Europe and North America varied by the studies' definition of asthma and by their data sources. RESULTS: The final review included 67 birth cohorts, of which 48 (72%) were from Europe, 14 (21%) from North America, 3 (5%) from Oceania, 1 (1%) from Asia and 1 (1%) from South America. We identified three measured outcomes: "asthma ever", "current asthma", and "asthma" without further specification. Definitions of "asthma ever" were primarily based upon an affirmative parental response to the question whether the child had ever been diagnosed with asthma by a physician. The most frequently used definition of "current asthma" was "asthma ever" and either asthma symptoms or asthma medications in the last 12 months. This definition of "current asthma" was used in 16 cohorts. There was no statistically significant difference in the pooled asthma prevalence in European and North American cohorts that used questionnaire alone versus other data sources to classify asthma. CONCLUSION: There is substantial heterogeneity in childhood asthma definitions in birth cohort studies. Standardisation of asthma case definitions will improve the comparability and utility of future cohort studies and enable meta-analyses.

Association of the CD14 C159T and the Toll-like receptor 4 Asp299Gly polymorphisms with various phenotypes of asthma in adults from Crimea.

Background: This study assessed gene polymorphisms of the CD14 receptor (C-159T) and Toll-like receptor 4 (Asp299Gly) in a patient population in Crimea, Ukraine, stratified by clinical (early versus late onset; frequent versus occasional relapses; fixed versus reversible obstruction) and immunologic (atopic versus nonatopic; eosinophilic; neutrophilic or paucigranulocytic inflammation) subtype. Methods: Two polymorphisms, CD14 C-159T and TLR4 Asp299Gly, were assessed in 331 patients with asthma. The control group included 285 volunteers who were nonatopic. The single nucleotide polymorphisms were studied by using polymerase chain reaction with electrophoretic detection. Results: There were increased odds of asthma development in patients with the Asp299Gly TLR4 mutation compared with the general population underdominant odds ratio (OR) 1.52 [95% confidence interval (CI), 1.00-2.32] and overdominant (OR 1.55 [95% CI, 1.01-2.38]) models after adjustment for gender and age. In addition, mutations in this gene decreased the odds of nonatopic asthma in underdominant (OR 0.26 [95% CI, 0.07-0.93]; p = 0.027), overdominant (OR 0.27 [95% CI, 0.07-0.96]; p = 0.033), and log-additive models (OR 0.26 [95% CI, 0.07-0.93]; p = 0.026) compared with the atopic subgroup after adjustment for gender, age, number of exacerbations, and type of airway inflammation. Allele frequencies for CD14 and TLR4 polymorphisms did not show statistical differences between the patients with asthma and the control subjects. Conclusion: CD14 C-159T polymorphisms were not associated with asthma in the adult population in Crimea. TLR4 Asp299Gly polymorphisms were associated with asthma and with decreased odds of nonatopic asthma compared with atopic asthma in the adult population in Crimea.

Healthcare-associated infections in intensive care units.

OBJECTIVE: Introduction: Healthcare-associated infections (HAIs) remain a major public health problem and patient safety threat worldwide. Scant information is available on the occurrence HAI and antimicrobial susceptibility of responsible pathogens in Ukrainian intencive care units (ICUs). The aim: To evaluate the prevalence of HAIs and antimicrobial resistance of the responsible pathogens. PATIENTS AND METHODS: Materials and methods: The study included 642 patients and 262 samples isolated from patients with microbiologically proven HAI. The identification and antimicrobial susceptibility of the cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute. RESULTS: Results: Among 642 patients, 148 HAIs were observed (23.1%). Death during hospitalization was reported in 20.1% HAI cases. Pneumonia (47.3%), blood stream infection (21.6%), and urinary tract infection (14.9) together accounted for 83.8% of all HAIs reported. Most cases of these infections were device-associated. Considering all HAI types together, Klebsiella pneumoniae were most commonly reported, accounting for 21.8% of all organisms, followed by Acinetobacter baumanni (14.3%), Pseudomonas aeruginosa (12.4%) and Escherichia coli (9.4%). 59.8% and 6.6% of Staphylococcus aureus were oxacillin and teicoplanin resistant, respectively. Third-generation cephalosporins resistance was found in 53.8% of K.pneumoniae and 32.1% of E.coli isolates; and carbapenem resistance in 78.6% of A. baumanni and 29.3% of K. pneumoniae isolates. CONCLUSION: Conclusions: Infection control priorities in intensive care units should include preventing nosocomial pneumonia, blood stream infection, urinary tract infection and of deviceassociated infections.

Efficacy of Probiotic Therapy on Atopic Dermatitis in Adults Depends on the C-159T Polymorphism of the CD14 Receptor Gene - A Pilot Study.

BACKGROUND: The C-159T polymorphism of the CD14 receptor gene can be associated with the development of atopic dermatitis. Probiotics can modulate chronic inflammation through activation of the CD14 receptor. So, the efficacy of probiotic therapy can be dependent on this genetic polymorphism. AIM: The purpose of the study was to investigate the efficacy of adding probiotic (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, BB-12) to standard treatment (ointment of fluticasone propionate 0.005% and emollient) of atopic dermatitis in adults during 28 days, depending on the stratification of patients on CC or TT genotypes of the CD14 receptor gene. MATERIAL AND METHODS: The study included 37 adult patients with AD. There were identified 19 patients with exogenous (IgE-dependent) and 18 with endogenous (IgE-dependent) AD. To evaluate the efficacy of the probiotics all patients were divided into three groups for both exogenous and endogenous AD. The first group was selected from patients with CC genotype (C-159T) who received standard therapy (ointment of fluticasone propionate 0.005% - 2 times a day, emollients - 2 times a day) and probiotic (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, BB-12 - 1 capsule 2 times per day) The second group included patients with CC genotype, who received only standard therapy. The third group was presented by patients with TT genotype (C-159T) who received standard therapy and probiotic. The SCORAD and DLQI parameters were evaluated on Day 0, 14 and 28. The level of IL-4, IL-5, IL-10, TGF-ß cytokines was determined on Day 0 and Day 28. RESULTS: The results of our study found that the addition of probiotics (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, BB-12) to standard treatment (ointment of fluticasone propionate 0.005%, emollient) significantly increased the effectiveness of treatment of atopic dermatitis in adults with exogenous form and CC genotype (C-159T), confirmed by clinical (a significant decrease of SCORAD and DLQI indices) and immunological criteria (a significant decrease of IL-4 and an increase of TGF-ß). CONCLUSION: Simultaneous determination of the exogenous or endogenous form, identification of the C-159T genotypes, evaluation of the serum level of IL-4 and TGF-ß can serve as an algorithm for the personalised treatment of patients with atopic dermatitis.

Prevalence of health care-associated infections and antimicrobial resistance of the responsible pathogens in Ukraine: Results of a multicenter study (2014-2016).

BACKGROUND: The aim of this study was to obtain the first national estimates of the current prevalence and incidence and death of health care-associated infections (HAIs) of all types in acute care hospitals in Ukraine. METHODS: Prospective surveillance was conducted from January 2014 to December 2016 in 17 hospitals. Surveillance case definitions were derived from the Centers for Disease Control and Prevention's National Healthcare Safety Network HAI case definitions. The identification and antimicrobial susceptibility of cultures were determined using a automated microbiology analyzer. Some antimicrobial susceptibility tests used Kirby-Bauer antibiotic testing. RESULTS: Of 97,340 patients, 10,986 (11.3%) HAIs were observed. The most frequently reported HAI types were surgical site infections (60%), respiratory tract infections (pneumonia and lower respiratory tract, 18.4%), bloodstream infections (10.2%), and urinary tract infections (9.5%). Death during hospitalization was reported in 9.7% of HAI cases. The most common organism reported was Escherichia coli, accounting for 21.8% of all organisms, followed by Staphylococcus aureus (18.4%), Enterococcus spp (15.7%), and Pseudomonas aeruginosa (12.4%). Antimicrobial resistance among the isolates associated with HAIs showed that 42.1% and 3.6% of coagulase-negative Staphylococcus spp isolates were ß-lactam (oxacillin)- and glycopeptide (teicoplanin)-resistant, respectively. Meticillin resistance was reported in 39.2% of S aureus isolates. CONCLUSIONS: HAIs and increasing antimicrobial resistance present a significant burden to the Ukraine hospital system. Infection control priorities in hospitals should include preventing surgical site infections, respiratory tract infections (which also include PNEU and LRTI), bloodstream infections, and urinary tract infections, as well preventing infections due to antimicrobial-resistant pathogens.