Deconstructing adverse reactions to Amoxicillin-Clavulanic Acid: the importance of time of onset.

BACKGROUND: Amoxicillin-clavulanic acid (AX-CL) is the most consumed betalactam antibiotic worldwide. We aimed to establish the different phenotypes of betalactam allergy in those referring a reaction with AX-CL and to investigate the differences between immediate and non-immediate onset. METHODS: Cross-sectional retrospective study performed at Hospital Clínico San Carlos (HCSC) and Hospital Regional Universitario de Málaga (HRUM) in Spain. Patients reporting reactions with AX-CL who completed the allergy workup between 2017 and 2019 were included. Data of reported reaction and allergy workup were collected. Reactions were classified as immediate and non-immediate with 1hour cut-off point. RESULTS: We included 372 patients (HCSC 208, HRUM 164). There were 90 (24.2%) immediate, 252 (67.7%) non-immediate reactions, and 30 (8.1%) with unknown latency. Allergy to betalactams was ruled-out in 266 (71.5%) and confirmed in 106 patients (28.5%). The final main diagnosis in the overall population were allergy to aminopenicillins (7.3%), to CL (7%), to penicillin (6.5%) and to betalactams (5.9%). Allergy was confirmed in 77.2% and 14.3% of immediate and non-immediate reactions respectively, with a relative risk of 5.06 (95%CI 3.64-7.02) of an allergy diagnosis in those reporting immediate reactions. Only 2/54 patients with late-positive intradermal test (IDT) to CL were diagnosed of CL allergy. CONCLUSION: Allergy diagnosis was confirmed in a minority of the whole study population, but 5 times more frequently in those reporting immediate reactions, making this classification useful in risk stratification. Late-positive IDT for CL has no diagnostic value and its late reading could be retrieved from the diagnosis work-up.

Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

Summary: Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.

Frequency of osteopenia and osteoporosis in men and women living with HIV/Aids: an observational study / Frequência de osteopenia e osteoporose em homens e mulheres vivendo com HIV/Aids: um estudo observacional

ABSTRACT: Aims: To identify the frequency in changes of bone metabolism, including below the average value for age, osteopenia, and osteoporosis, in people living with HIV/AIDS (PLWHA) and to compare the frequency of factors associated with bone mineral density (BMD) and body composition between sex. Methods: This observational study assessed 106 PLWHA (65 male) recruited from the University Hospital of Ribeirão Preto Medical School from 2013 to 2014. BMD was measured using Dual Energy X-ray Absorptiometry (DXA). Standard deviation values for Z- and T-score proposed by the International Society for Clinical Densitometry were adopted to classify participants below the average value for age, osteopenia, and osteoporosis. Qui-square and Fischer's exact tests were employed to compare males and females based on their factors associated with BMD reduction. Results: Fifty-two (49%) PLWHA presented at least one diagnosis for below the average value for age, osteopenia, and osteoporosis, being 37 (57%) and 15 (37%) male and female, respec-tively. Frequency of alcohol consumption was higher in males (n=20; 30.8%) than females (n=05; 12.2%) (p=0.028).Conclusions: A high rate of PLWHA showed changes in bone metabolism, with a higher frequency in males. The fre-quency of alcohol consumption was higher in males, and it may partially explain the possible causes of the increased rates of bone metabolism changes observed in this group. This information may help develop strategies for reducing the frequency of diagnosis for below the average value for age, osteopenia, osteoporosis improving quality of life in PLWHA. (AU)

RESUMO: Objetivos: Identificar a frequência de alterações no metabolismo ósseo, incluindo valores abaixo do estimado para idade, osteopenia e osteoporose, em pessoas vivendo com HIV/Aids (PVHA) e comparar a frequência de fatores associados à redução da densidade mineral óssea (DMO) e composição corporal entre sexos. Métodos: Estudo observacional que ava-liou 106 PVHA (65 do sexo masculino) recrutadas do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo entre os anos 2013 e 2014. A DMO foi medida utilizando a Absorciometria Radiológica de Dupla Energia (DXA). Valores de desvio padrão Z- e T- scores propostos pela Sociedade Internacional para Densitometria Clí-nica foram adotados para classificar os participantes em abaixo do valor estimado para idade, osteopenia e osteoporose. Os testes do qui-quadrado e exato de Fischer foram empregados na comparação entre os sexos baseado em seus respec-tivos fatores associados à redução da densidade mineral óssea. Resultados: Cinquenta e dois (49%) PVHA apresentaram ao menos um diagnóstico para abaixo do valor estimado para idade, osteopenia e osteoporose, sendo 37 (57%) do sexo masculino e 15 (37%) feminino. A frequência de consumo de álcool foi maior no sexo masculino (n=20; 30,8%) compara-do ao feminino (n=5; 12,2%) (p=0,028). Conclusões: Uma alta taxa de PVHA apresentaram alterações no metabolismo ósseo, com maior frequência no sexo masculino. A frequência no consumo de álcool foi maior no sexo masculino, podendo explicar parcialmente as possíveis causas para taxa aumentada de alterações no metabolismo ósseo observada nesse grupo. Essa informação pode contribuir no desenvolvimento de estratégias para redução da frequência do diagnóstico para valores abaixo do estimado para idade, osteopenia e osteoporose, melhorando a qualidade de vida em PVHA

Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts.

AIMS: The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. METHODS AND RESULTS: We included 18,983 and 6479 participants from the 'Seguimiento Universidad de Navarra' (SUN) and 'Prevención con Dieta Mediterránea' (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1-7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5-13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8-5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1-7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36-0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49-1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44-0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. CONCLUSION: Intermediate levels of caffeinated coffee consumption (1-7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.

Adaptation to Spanish and Validation of the Rhinitis Control Assessment Test questionnaire.

BACKGROUND AND OBJECTIVE: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is widely used to evaluate control of rhinitis. Objective: To develop and validate a Spanish version of the RCAT (RCATe). METHODS: After translation and cultural adaptation of the original RCAT, this multicenter, observational, prospective study evaluated the properties/attributes of the RCATe by assessing its validity, reliability, responsiveness, effect size, minimal important difference and cut point. RESULTS: The recruited sample comprised 252 allergic rhinitis (AR) patients from 27 allergy and otolaryngology departments in hospitals throughout Spain. Significant and strong correlations were found between the RCATe and the total nasal symptom score and the visual analog scale (-0.79 and -0.77, respectively; P<.0001). The RCATe revealed significant differences between patients grouped in the different categories of severity or duration of AR (P<.001). The internal consistency (Cronbach α) was good (0.84), and the test-retest reliability was moderate (0.54 evaluated by the physician and 0.49 by the patient). The responsiveness to change was high and significant for RCATe (P<.0001) and correlated linearly with the improvement in AR. The overall effect size was 1.62. The cut-off point to identify patients with adequate control of AR was >20 (area under the receiver operating characteristic curve, 0.746; sensitivity, 58.3%; specificity, 90.9%). CONCLUSION: The psychometric evaluation and validation of the RCATe indicated good reliability, validity, and responsiveness, thus suggesting that it is effective for measuring control of AR symptoms by Spanish-speaking patients.

Coffee consumption and risk of hypertension in the SUN Project.

BACKGROUND & AIMS: Evidence on coffee consumption and its association with the incidence of hypertension is still inconsistent. The aim of this study was to examine the association of regular or decaffeinated coffee consumption with the risk of developing hypertension in a middle-aged Mediterranean cohort. METHODS: The SUN Project is a prospective open cohort with more than 22,500 Spanish university graduates. For the present study, we analyzed data from 13,374 participants initially free of hypertension (mean follow-up 9.1 years). The consumption of regular and decaffeinated coffee was obtained at baseline using a previously validated semi-quantitative food frequency questionnaire. Validated, self-reported medical diagnoses of hypertension were collected biennially. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for incident hypertension according to baseline coffee consumption. We assessed the interaction with sex and baseline adherence to the Mediterranean diet. RESULTS: Among 121,397 person-years of follow-up, a total of 1757 participants developed hypertension. Overall, coffee consumption -either caffeinated or decaffeinated- was not significantly associated with the risk of hypertension. Only among women, higher consumption of regular coffee was associated with a 26% lower risk of hypertension (>=2 cups/d vs. never/seldom, 95% CI 9%-39%; p for interaction: 0.0236). Women with a low baseline adherence to the Mediterranean diet showed the strongest risk reduction (HR ≥ 2 cups/d vs. never/seldom 0.58, 95% CI (0.41-0.82) p for interaction = 0.0452). CONCLUSION: In the SUN project we found an inverse association between regular coffee consumption and the risk of hypertension in women, which was strongest among women with a suboptimal food pattern (low adherence to the Mediterranean diet).

[Clinical and functional results of the Broström-Gould technique for lateral ankle instability: evaluation with three scales]. / Resultados clínicos y funcionales de la plastía Broström-Gould para inestabilidad lateral de tobillo: evaluación con tres escalas.

BACKGROUND: The most frequent sequel to the ankle sprain is the instability of the lateral ligament complex; the results of surgical treatment have not been evaluated with multiple scales simultaneously. The objective of the study was to assess the clinical and functional results with three scales in patients with lateral instability of ankle undergoing Broström-Gould technique, using for fixation, anchors with suture to distal fibula. MATERIAL AND METHODS: The design of the study was cross-sectional and descriptive; we included patients with lateral instability of ankle and partial or complete rupture of the APA or CP ligament subject to repair with Broström-Gould technique. Magnetic resonance imaging was performed to confirm the diagnosis; clinical and functional outcomes were determined with three scales: EVA, SF-36 and AOFAS. Patients were evaluated at six months, or more, after the surgical procedure. RESULTS: We included 13 patients; quality of life (SF-36 questionnaire) showed a good result with average score of 90; 10 (77%) patients showed excellent results in function, absence of pain and alignment of the ankle (AOFAS 90-100). Also found significant improvement in pain (presurgical EVA: 6, compared with 1 in the postoperative period). CONCLUSIONS: The surgical procedure showed excellent results, in the short term with resolution of pain and ankle stability.

ANTECEDENTES: La secuela más frecuente del esguince de tobillo es la inestabilidad del complejo ligamentario lateral; los resultados del tratamiento quirúrgico no han sido evaluados con varias escalas simultáneamente. El objetivo del estudio fue evaluar los resultados clínicos y funcionales con tres escalas en pacientes con inestabilidad lateral de tobillo sometidos a plastía de Broström-Gould, utilizando para su fijación anclas con sutura al peroné distal. MATERIAL Y MÉTODOS: El diseño del estudio fue transversal y descriptivo; se incluyeron pacientes con inestabilidad lateral de tobillo y ruptura parcial o completa del ligamento PAA y/o PC, sometidos a reparación con plastía de Broström-Gould. Se realizó resonancia magnética nuclear para confirmar el diagnóstico; los resultados clínicos y funcionales se determinaron con tres escalas: EVA, SF-36 y AOFAS. Los pacientes fueron evaluados a los seis meses o más posteriores al procedimiento quirúrgico. RESULTADOS: Se incluyeron 13 pacientes; la calidad de vida (cuestionario SF-36) arrojó un resultado bueno con promedio de 90; 10 (77%) pacientes mostraron resultados excelentes en la función, ausencia de dolor y alineación del tobillo (AOFAS 90-100). Asimismo, se observó mejoría importante en el dolor (EVA prequirúrgico: 6, comparado con 1 en el período postquirúrgico). CONCLUSIONES: El procedimiento quirúrgico demostró excelentes resultados en el corto plazo con resolución del dolor y estabilidad del tobillo.

Position paper on nasal obstruction: evaluation and treatment.

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Relationship between respiratory and food allergy and evaluation of preventive measures.

Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions.

Proposed ratios and cutoffs for the assessment of lipodystrophy in HIV-seropositive individuals.

OBJECTIVES: To propose objective ratios using anthropometry and dual-energy X-ray absorptiometry (DXA) and to suggest cutoff points for them in order to classify lipodystrophy in male patients. METHODS: It is a cross-sectional study. DXA was applied and anthropometric measurements were performed in 100 men on highly active antiretroviral therapy. Receiver operating characteristic curves were used to propose cutoffs. Individuals were divided in without (lipo-) or with (lipo+) lipodystrophy and their metabolic parameters were compared. RESULTS: The following ratios were proposed: fat mass ratio by DXA (FMR), waist thigh ratio (WTR), waist calf ratio (WCR), and arm to trunk ratio (ATR). The best cutoffs observed for FMR, WTR and ATR were 1.26, 1.74 and 2.08, respectively. Using the proposed cutoff for FMR, we observed worse metabolic profile, with increased tryglicerides, fasting serum glucose and more hypercholesterolemia in the lipo+ group. WTR and ATR showed a significant correlation with FMR. CONCLUSIONS: Anthropometric ratios (WTR/ATR) and FMR can be used to aid the diagnosis of lipodystrophy in order to contribute to a more accurate and earlier diagnosis permitting intervention and even preventing metabolic disturbances.

Response of resistant and susceptible Brazilian Somalis crossbreed sheep naturally infected by Haemonchus contortus.

This study was carried out to evaluate the performance of Brazilian Somalis sheep to natural infections by gastrointestinal nematodes. During 98 days, 75 weaned sheep, initially 3-4 months old, were kept on the same pasture and evaluated. Fecal and blood samples were collected for parasitological and hematological exams. After this period, the eight most resistant and the eight most susceptible animals were selected based on their individual averages of nematode fecal egg counts and were slaughtered for worm burden determination and nematodes identification. Abomasum and abomasum lymph nodes were also recovered for gene expression analysis. The animals selected as resistant had lower fecal egg counts during experimental period and smaller worm burdens than the susceptible ones (P < 0.05). The genus Haemonchus, followed by Trischostrongylus and Oesophagostomum, were identified in composite cultures. Haemonchus contortus was the specie identified in the abomasum. Packed cell volume and total plasma protein means were higher in the resistant group (27.2% and 6.1 g/dL) than in the susceptible one (22.5% and 5.3 g/dL), respectively. Regarding cytokine gene expression, IL-4 (P < 0.05) was up-regulated in the abomasum of resistant animals and TNF-α (P < 0.03) and IFN-γ (P < 0.03) in susceptible ones. In abomasum lymph nodes, IL-4 (P < 0.04) and IL-13 (P < 0.05) were up-regulated in the resistant animals and IFN-γ in the susceptible one (P < 0.01). This work provides further evidence that, within a given animal breed, individuals have different responses when infected by gastrointestinal nematodes. Resistant animals who responded more quickly and efficiently to these infections activated a TH2-type response.

ESPRINT-15 questionnaire (Spanish version): reference values according to disease severity using both the original and the modified ARIA classifications.

OBJECTIVE: ESPRINT-15 is a specific and validated instrument to measure health-related quality of life in adults with allergic rhinitis. The aim of this study was to obtain new reference values based on disease severity using both the original and the modified versions of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. METHODS: ESPRINT-15 was administered to a representative sample of adults with allergic rhinitis in Spain. As in a previous study by our group, means and percentiles were analyzed for 16 quotas based on gender, allergic rhinitis type (intermittent vs persistent), and 4 symptom intensity groups according to the total symptom score (TSS4). The novel aspect of the present study was our application the severity criteria proposed by both the original and the modified ARIA classifications. RESULTS: Of the 2756 patients in our previous dataset, 2580 were included in the present analysis. In terms of symptom severity, women ha relatively more intense symptoms than men with both ARIA classifications. In fact, using only the modified ARIA classification, we were abl to determine that severe rhinitis is moderately more frequent in women (27% vs 23%), although the difference is not statistically significant. CONCLUSIONS: The new set of reference values enables the ESPRINT-15 questionnaire to be adapted to the current severity classification Consequently, this quality of life tool (http://www.seaic.org/inicio/esprint) can be easily used and better interpreted in daily clinical practice.

Análisis de la variación del calcio intracelular en células foliculares / Intracellular Calcium Variation Analysis of Follicular Cells

En este trabajo se presenta un método para medir la variación del calcio intracelular en células foliculares. Esta propuesta consiste en dos etapas: (i) La detección de los núcleos de las células; y (ii) el análisis de las variaciones de fluorescencia. La primera etapa se realiza a través de la transformada modificada de líneas divisoras de agua controlada por marcadores (en inglés: Modified-Watershed Transformation) controlando el proceso de etiquetado de células por el establecimiento de criterios particulares. El proceso de detección homogeniza las condiciones de luminosidad a través de un filtro morfológico y utiliza como descriptores a los bordes de las células. En la segunda etapa, se asocia la variación de la fluorescencia con los cambios de Ca2+ intracelular donde la variación se modela como una función exponencial decreciente. Luego, se presenta un nuevo proceso morfológico, denominado proceso de reconstrucción medio, que permite suavizar los datos para el proceso de modelado. Este proceso utiliza la información del sub modelado y sobre modelado de la señal, mediante las propiedades de los operadores de reconstrucción, conservando la estructura interna de la señal original. Finalmente, en un proceso experimental utilizando células de anfibios, se muestran los resultados obtenidos después de aplicar la propuesta a un grupo de células.

This paper presents a method for the measurement of the variation of intracellular calcium in follicular cells. This proposal consists in two stages: (i) The detection of the cell's nuclei, and (ii) the analysis of the fluorescence variations. The first stage is performed with the modified-watershed transformation, where the marker process is controlled by establishing own criterion. The detection process homogenizes the luminance conditions through a morphological filter and uses as descriptors the edges of the cells. In the second stage, the variations of fluorescence are associated with changes in intracellular Ca2+, which are modeled as an exponential decay function. Then, we present a new morphological process called medium reconstruction process, that smoothes the data in the process of model creation. This process uses the information of under and over model of the signal, through the properties of reconstruction operators, keeping the internal structure of the original signal. Finally, using amphibian cells in an experimental process, the results obtained are showed after applying the proposal to a group of cells.

Metabolic effects of the ingestion of different fructose sources in rats.

INTRODUCTION: Fructose is a simple carbohydrate that should be ingested in a restricted manner. However, current data suggest increased daily consumption of fructose which may lead to an increased incidence of diseases such as obesity, diabetes and co-morbidities associated with excess weight. Thus, the objective of the present study was to assess the effect of the ingestion of different fructose sources on weight gain, glycemia and serum triglyceride levels in rats. METHODS: The study was conducted on male Wistar rats divided into 5 groups according to the source and concentration of fructuse (ingested AD LIBITUM in liquid form). RESULTS: Drink intake was increased and chow consumption was reduced in all groups compared to control ( P<0.05). The animals of the groups receiving 10 and 20% fructose solutions showed increased triglyceride levels and the 20% group also showed weight gain. The exaggerate consumption of fructose promotes a reduced consumption of chow, an increase in serum triglyceride levels, and weight gain in some animals.

Discrimination between moderate and severe disease may be used in patients with either treated or untreated allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common disease with major socioeconomic burden and a significant impact on quality of life. OBJECTIVE: The aim of this study was to discriminate between moderate and severe AR patients whether receiving treatment or not, using a modified criterion of allergic rhinitis and its impact on asthma (ARIA) classification. METHODS: The modified ARIA severity classification (J Allergy Clin Immunol, 120, 2007, 359) categorizes AR as mild (no items affected), moderate (1-3 items affected), and severe (all four items affected). We applied these criteria to 1666 treated and 1058 untreated AR patients and compared their symptoms total four-symptom score (T4SS) and quality of life (ESPRINT-15), according to their clinical severity. RESULTS: Allergic rhinitis clinical status was significantly worse (P < 0.001) in treated than in untreated patients. For both treated and untreated patients, T4SS and ESPRINT-15 Quality of life scores were significantly worse (P < 0.001) in severe than in moderate patients. CONCLUSIONS: The modified ARIA severity classification is a useful clinical tool to discriminate moderate from severe AR among both treated and untreated patients.

Anthelmintic activity of Cocos nucifera L. against sheep gastrointestinal nematodes.

The development of anthelmintic resistance has made the search for alternatives to control gastrointestinal nematodes of small ruminants imperative. Among these alternatives are several medicinal plants traditionally used as anthelmintics. This work evaluated the efficacy of Cocos nucifera fruit on sheep gastrointestinal parasites. The ethyl acetate extract obtained from the liquid of green coconut husk fiber (LGCHF) was submitted to in vitro and in vivo tests. The in vitro assay was based on egg hatching (EHT) and larval development tests (LDT) with Haemonchus contortus. The concentrations tested in the EHT were 0.31, 0.62, 1.25, 2.5 and 5 mg ml(-1), while in the LDT they were 5, 10, 20, 40 and 80 mg ml(-1). The in vivo assay was a controlled test. In this experiment, 18 sheep infected with gastrointestinal nematodes were divided into three groups (n=6), with the following doses administered: G1-400 mg kg(-1) LGCHF ethyl acetate extract, G2-0.2 mg kg(-1) moxidectin (Cydectin) and G3-3% DMSO. The worm burden was analyzed. The results of the in vitro and in vivo tests were submitted to ANOVA and analyzed by the Tukey and Kruskal-Wallis tests, respectively. The extract efficacy in the EHT and LDT, at the highest concentrations tested, was 100% on egg hatching and 99.77% on larval development. The parameters evaluated in the controlled test were not statistically different, showing that despite the significant results of the in vitro tests, the LGCHF ethyl acetate extract showed no activity against sheep gastrointestinal nematodes.

Allergic Rhinitis and its Impact on Asthma update (ARIA 2008). The perspective from Spain.

Allergic rhinitis is a global health problem. Over 600 million patients suffer from this disease worldwide. ARIA (Allergic Rhinitis and its Impact on Asthma), an evidence-based document, was produced and published in 2001 using an extensive review of the available literature. The ARIA 2008 update was recently published and covers tertiary prevention of allergy, pharmacologic treatments, and immunotherapy. Nonallergic rhinitis is still a controversial area and may pose some treatment problems. Another important aspect of the ARIA update is the comorbidity of allergic rhinitis, in particular, asthma. The recommendations of the 2008 ARIA Update, as in 2001, are that patients with allergic rhinitis, particularly if persistent, should be evaluated for asthma, patients with asthma should be evaluated for rhinitis, and an effective and safe combination strategy should be used to treat diseases of the upper and lower airways. Over the last few years, severa studies performed in Spain report new data on the prevalence of allergic rhinitis sensitivity to common aeroallergens, comorbidity of allergic rhinitis and asthma, and impact on quality of life. The studies reviewed in this manuscript confirm--as do those from other developed countries--the enormous impact of the disease on society and health care in Spain.

A Kirkwood-Buff analysis of local properties of solutions.

For decades, the properties of liquid mixtures have been analyzed in terms of excess thermodynamic functions. These functions convey global or macroscopic information on the system. In this work, a complementary view, based on the local properties of the same system is suggested. These properties are richer and more informative regarding the local densities, composition and solvation effect. A few examples ranging from Lennard-Jones particles, to inert gas mixtures, to aqueous solutions are presented, stressing the local information that cannot be obtained directly from global properties.

Anthelmintic activity of Lippia sidoides essential oil on sheep gastrointestinal nematodes.

Medicinal plants have been investigated for their anthelmintic properties and shown to be effective against eggs and larvae of gastrointestinal nematodes. The aim of this study was to evaluate the efficacy of the Lippia sidoides essential oil (LsEO) on sheep gastrointestinal nematodes. Initially, 44 naturally infected sheep were divided and treated with 200 microg kg(-1) ivermectin and 230 and 283 mg kg(-1) LsEO, respectively, plus the control. Fecal samples were collected from each animal to determine epg at 7, 14 and 21 days after treatment. In another test, 21 sheep were distributed and treated with 200 microg kg(-1) ivermectin, 283 mg kg(-1) LsEO and the control, respectively. Seven days after treatment, they were euthanized and necropsied to count and identify the nematodes from the abomasum, small and large intestines. In the first test, the efficacy of 230 and 283 mg kg(-1) LsEO and ivermectin was 38%, 45.9% and 40.2%, respectively, 7 days after treatment, and 30%, 54% and 39.6%, respectively, 14 days after treatment. In the second experiment, the respective efficacy of 283 mg kg(-1) LsEO and ivermectin was 56.9% and 34.4% against Haemonchus spp., and 39.3% and 63.6% against Trichostrongylus spp.