Clinical and Immunologic Changes due to Subcutaneous Immunotherapy With Cat and Dog Extracts Using an Ultrarush Up-Dosing Phase: A Real-Life Study.

OBJECTIVES: We aimed to evaluate the efficacy of and immunologic changes caused by subcutaneous immunotherapy (SCIT) in patients with allergy to cat and dog. METHODS: The study population comprised patients with rhinitis and/or asthma and allergy to cat or dog from a previous safety study. All patients had specific IgE to cat and/or dog. The SCIT maintenance dose was administered using an infusion pump over a single 4-hour session, followed by monthly administration over 6 months. Data were gathered on clinical outcomes, pulmonary function, FeNO, rhinitis and asthma symptoms, quality of life (QOL), and scores for the Asthma Control Test and symptom visual analog scale were recorded at baseline and then at 1, 3, and 6 months. Specific IgE and IgG antibody responses to cat and dog allergens were determined. RESULTS: The study population comprised 61 patients with a mean age of 35.6 (9.7) years, of whom 40 underwent SCIT for at allergy. A significant improvement was observed in rhinitis and asthma symptoms and in QOL, use of medication, visual analog scale score, and Asthma Control Test score at 1 month; these improvements persisted at month 6. The clinical improvement with cat extract was significantly more marked than with dog extract. Nearly half of the patients (49.09%) had an increase of >0.9 in the ESPRINT-15 QOL in allergic rhinitis questionnaire, and 58.18% had an increase of >0.5 in the Asthma Quality of Life Questionnaire score at month 6. Both differences represent the minimal clinical important difference. A significant increase was observed in specific IgG and IgE to different allergens at 3 and/or 6 months. CONCLUSION: Ultrarush SCIT with cat and dog extracts has substantial clinical value for many patients.

Clinical and Immunologic Changes due to Subcutaneous Immunotherapy With Cat and Dog Extracts Using an Ultrarush Up-Dosing Phase: A Real-Life Study

Objective: We aimed to evaluate the efficacy of and immunologic changes caused by subcutaneous immunotherapy (SCIT) in patients with allergy to cat and dog.Methods: The study population comprised patients with rhinitis and/or asthma and allergy to cat or dog from a previous safety study. All patients had specific IgE to cat and/or dog. The SCIT maintenance dose was administered using an infusion pump over a single 4-hour session, followed by monthly administration over 6 months. Data were gathered on clinical outcomes, pulmonary function, FeNO, rhinitis and asthma symptoms, quality of life (QOL), and scores for the Asthma Control Test and symptom visual analog scale were recorded at baseline and then at 1, 3, and 6 months. Specific IgE and IgG antibody responses to cat and dog allergens were determined.Results: The study population comprised 61 patients with a mean age of 35.6 (9.7) years, of whom 40 underwent SCIT for at allergy. A significant improvement was observed in rhinitis and asthma symptoms and in QOL, use of medication, visual analog scale score, and Asthma Control Test score at 1 month; these improvements persisted at month 6. The clinical improvement with cat extract was significantly more marked than with dog extract. Nearly half of the patients (49.09%) had an increase of >0.9 in the ESPRINT-15 QOL in allergic rhinitis questionnaire, and 58.18% had an increase of >0.5 in the Asthma Quality of Life Questionnaire score at month 6. Both differences represent the minimal clinical important difference. A significant increase was observed in specific IgG and IgE to different allergens at 3 and/or 6 months.Conclusions: Ultrarush SCIT with cat and dog extracts has substantial clinical value for many patients (AU)

Objetivo: Nuestro objetivo fue evaluar la eficacia y los cambios inmunológicos causados por la inmunoterapia subcutánea (SCIT) enpacientes con alergia a perro y gato.Métodos: Se incluyeron pacientes que presentaban rinitis y/o asma con alergia al gato o al perro de un estudio de seguridad previo. Todostenían IgE específica para gato y/o perro. Usando una bomba de infusión (IP), la dosis de mantenimiento de SCIT se administró duranteuna sesión de 4 horas, seguida de la administración mensual durante 6 meses. Se recopilaron datos de función pulmonar, FeNO, síntomasde rinitis y asma, calidad de vida (QoL), control del asma (ACT) y escala analógica visual de síntomas (VAS) al inicio y a los 1, 3 y 6 meses.Se determinaron las respuestas específicas de anticuerpos IgE e IgG a diferentes alérgenos de perro y gato.Resultados: Se incluyeron 61 pacientes con una edad media de 35,6 ± 9,7 años, 40 de los cuales se sometieron a SCIT de gato. Seobservó una mejora significativa en los síntomas de rinitis y asma, calidad de vida, el uso de medicamentos, VAS y ACT en el primer mes.Estas mejorías se mantuvieron en el mes 6. La mejoría clínica con el extracto de gato fue significativamente mayor que con el de perro.Se observó un aumento de >0,9 en ESPRINT-15 en el 49,09% de los pacientes, y el 58,18% mostró un aumento de >0,5 en AQLQ enel mes 6, ambas diferencias indican la mínima diferencia importante. Se observó un aumento significativo en IgG e IgE específicas adiferentes alérgenos a los 3 y/o 6 meses.Conclusiones: La SCIT ultrarápida con extractos de perro y gato induce una mejoría clínica relevante rápida y mantenida en muchos pacientes (AU)

Subcutaneous Immunotherapy With High-Dose Cat and Dog Extracts: A Real-life Study.

BACKGROUND AND OBJECTIVE: Background: Data on the efficacy of immunotherapy administered to patients with cat or dog allergy are scarce. Objective: We aimed to evaluate the safety and efficacy of subcutaneous immunotherapy (SCIT) in patients with allergy to cat and dog dander. METHODS: Consecutive patients with rhinitis and/or asthma related to sensitization to cat or dog dander were included in a pragmatic, real-life, prospective, observational study. All patients had specific IgE to cat, dog, or both. SCIT was administered using an infusion pump over 3 sessions as part of a rush protocol, followed by monthly administration over 12 months. We recorded adverse events, clinical outcomes, pulmonary function, FeNO, symptoms of rhinitis and asthma, quality of life (QoL), Asthma Control Test (ACT) score, and visual analog scale (VAS) score at baseline, 6 months, and 12 months. RESULTS: The study population comprised 66 patients (38 females, 46 allergic to cat and 20 to dog), with ages ranging from 9 to 59 years. During the up-dosing phase, in which the infusion pump was used, 8.1% of doses elicited a systemic reaction and 5.4% caused a local reaction, while 9.3% of doses administered during the maintenance phase (ie, without an infusion pump) induced a systemic reaction. No local reactions were recorded. A significant improvement in FEV1, symptoms of rhinitis and asthma, QoL, use of medication, VAS score, and ACT score was observed at 6 months and continued at 12 months. Clinical improvement with cat extract was significantly better than with dog extract. CONCLUSIONS: High-dose SCIT has substantial clinical value in many cat- and dog-allergic patients.

Safety of an ultrarush (4 Hours) subcutaneous immunotherapy schedule with cat and dog extracts using an infusion pump

No disponible

Peptoanaerobacter stomatis Primes Human Neutrophils and Induces Granule Exocytosis.

Peptoanaerobacter stomatis is a newly appreciated taxon associated with periodontal diseases; however, little is known about the organism's pathogenic potential or its interaction with the host immune response. Neutrophils are the most abundant innate immune cell present in the gingival tissue and function to constrain the oral microbial challenge. However, some periodontal pathogens have developed strategies to evade phagocytosis and killing by neutrophils. Therefore, to begin to understand the role of P. stomatis in periodontitis, we studied its interactions with human neutrophils. Our data showed that after 30 min of incubation, neutrophils failed to engulf P. stomatis efficiently; however, when P. stomatis was internalized, it was promptly eradicated. P. stomatis challenge induced a robust intracellular respiratory burst; however, this response did not contribute to bacterial killing. Minimal superoxide release was observed by direct bacterial challenge; however, P. stomatis significantly increased N-formyl-methionyl-leucyl phenylalanine (fMLF)-stimulated superoxide release to an extent similar to that of cells primed with tumor necrosis factor alpha (TNF-α). When neutrophils were challenged with P. stomatis, 52% of the bacterium-containing phagosomes were enriched for the specific granule marker lactoferrin and 82% with the azurophil granule marker elastase. P. stomatis challenge stimulated exocytosis of the four neutrophil granule subtypes. Moreover, P. stomatis susceptibility to extracellular killing could be attributed to the exocytosis of antimicrobial components present in neutrophil granules. Priming neutrophils for an enhanced respiratory burst together with promoting granule content release could contribute to the chronic inflammation and tissue destruction that characterize periodontal diseases.

Vivencias cotidianas en espacios clínicos del estudiante de enfermería / Nursing students' daily experiences in clinical spaces / Vivências cotidianas em espaços clínicos do estudante de enfermagem

Objetivo: Comprender las vivencias cotidianas en espacios clínicos del estudiante de enfermería. Métodos: Es un estudio cualitativo con método fenomenológico, se recolectó la información a través de 8 entrevistas a profundidad, a estudiantes de 4.o año de la Licenciatura en Enfermería de la Escuela Superior de Enfermería Culiacán, México. Tras obtener el consentimiento se les informó individualmente del estudio y su desarrollo, respetando la confidencialidad y la veracidad de los datos. El análisis de discurso permitió señalar conceptos significativos y asignar códigos para generar categorías. La validación de los resultados fueron credibilidad, confirmabilidad y transferibilidad. Resultados: Se trata de resultados preliminares, se presenta el análisis de la primera categoría, 1) Significados del espacio clínico, con 3 subcategorías: 1.1 satisfacción en espacios clínicos, 1.2 aprendizajes en espacios clínicos, y 1.3 figura simbólica en espacios clínicos. Conclusiones: Los estudiantes manifestaron satisfacción y agrado porque van motivados a aprender y realizan actividades novedosas en los espacios clínicos. Además la enfermera del servicio simboliza el apoyo y enseñanza en los escenarios clínicos. Sin embargo, al referirse a los cuidados que realizan, estos aprendizajes están enfocados, como se ha señalado, a espacios planificados, fragmentados, basados en técnicas y procedimientos, como toma de signos vitales, tendido de cama y administración de medicamentos.

Objective: To comprehend the daily experiences of nursing students in their clinical spaces. Method: This is a qualitative study using a phenomenological method. Data were collected through 8 in-depth interviews to senior students enrolled in the Nursing Baccalaureate at the Nursing Superior School, Culiacan, Mexico. After gathering their corresponding informed consents, students were individually updated on the study development, always respecting the data confidentiality and veracity. The discourse analysis allowed to identify significant concepts, and assign them codes to form categories. The validation of the results included credibility, confirmability, and transferability. Results: Preliminary results refer to the analysis of the first category, 1) meanings of the clinical space, with its three sub-categories: 1.1: satisfaction in the clinical spaces, 1.2: learning in the clinical spaces, and 1.3: symbolical figure in the clinical spaces. Conclusions: Students expressed satisfaction and comfort because they go motivated to learn, and they perform novel activities in the clinical spaces. Also, the service nurse is a symbol of support and teaching within the clinical spaces. Nevertheless, while addressing their care duties, students stated that this learning is focused on planned and fragmented spaces and based on techniques and procedures such as vital signs readings, making beds, and medication dispensing.

Objetivo: Compreender as vivencias cotidianas em espaços clínicos do estudante de enfermagem. Métodos: É um estudo qualitativo com método fenomenológico, coletou-se a informação a través de 8 entrevistas a profundidade, a estudantes de 4° ano da Licenciatura em enfermagem da Escola Superior de Enfermagem Culiacán, México. Depois de obter o consentimento foram informados individualmente do estúdio e seu desenvolvimento, respeitando a confidencialidade e a veracidade 2 dados. A análise de discurso permitiu assinalar conceitos significativos, atribuir códigos para gerar categorias. A validação dos resultados foram credibilidade, confirmabilidade e transferibilidade. Resultados: Trata-se de resultados preliminares, apresenta-se a análise da primeira categoria, 1) Significados do espaço clínico, com três subcategorias: 1.1 satisfação em espaços clínicos, 1.2 aprendizagens em espaços clínicos, 1.3 figura simbólica em espaços clínicos. Conclusões: Os estudantes manifestaram satisfação e agrado porque estão motivados a aprender e realizam atividades inovadoras nos espaços clínicos. Além disso, a enfermeira de serviço simboliza o apoio e o ensino nos cenários clínicos. Porém, ao se referir aos cuidados que realizam, estes aprendizados estão focalizados, como se tem assinalado, aos espaços planificados, fragmentados, baseados em técnicas e procedimentos, como a toma de sinais vitais, o estendido de cama, a administração de medicamentos.

Clinical relevance of molecular diagnosis in pet allergy.

We describe the pattern of sensitisation to pet IgE components and its association with clinical symptoms. Hundred and fifty nine consecutive patients with rhinitis/asthma sensitised to dog, cat, and horse were recruited. Specific IgE to whole extracts and to pet recombinant allergens were performed. Only 5% of patients were monosensitised to animal allergens. Specific IgE to Can f 1 was significantly associated with persistent rhinitis, Can f 2 with asthma diagnosis, Can f 3 with moderate/severe rhinitis (M/S-R) and asthma diagnosis (AD), and Can f 5 with persistent and M/S-R. Positive IgE to Fel d 2 was significantly associated with M/S-R and AD, Equ c 1 with M/S-R and Equ c 3 with persistent rhinitis, AD and severe asthma. Sensitisation to ≥2 molecules or to pet albumins was associated with more severe respiratory symptoms. Molecular diagnosis in patients with pet allergy may also help clinicians to predict clinical symptoms and their severity.

Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response.

PURPOSE: Further examination of clinical outcomes and inflammatory response of bacteremic pneumococcal community-acquired pneumonia (CAP) is of great interest to enhance the care of patients with pneumococcal CAP. METHODS: This is a secondary analysis of the Community Acquired Pneumonia Organization (CAPO) to compare the time to clinical stability (TCS), length of hospital stay (LOS), and in-hospital mortality of hospitalized pneumococcal CAP patients with and without bacteremia. To measure the effect of bacteremia in pneumococcal CAP patients on outcomes, we modeled all-cause in-hospital mortality using a Poisson regression model, and TCS and LOS using Cox proportional hazards models. Adjusted multivariate regression models were also used to predict the probability of occurrence of each of the study outcomes. To investigate the inflammatory response, we measured the plasma levels of pro- and anti-inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1rα, IL-6, IL-8, IL-10], inflammatory biomarkers [C-reactive protein (CRP), pro-calcitonin (PCT), and B-type natriuretic peptide (BNP)], and peripheral blood neutrophil responses in 10 patients, 4 bacteremic and 6 non-bacteremic pneumococcal CAP, upon admission and every other day during the first 6 days of hospitalization. Functional data were presented as median and standard error of the median (SEM); due to small number of samples no statistical comparisons were performed between groups. RESULTS: From 833 pneumococcal CAP patients, 394 patients (47 %) were bacteremic. Bacteremic pneumococcal CAP were less likely to reach TCS with an adjusted hazard ratio (AHR) of 0.82 (95 % CI 0.69-0.97; p = 0.02) and had higher in-hospital mortality with an AHR of 1.63 (95 % CI 1.06-2.50, p = 0.026). Bacteremic pneumococcal CAP patients had a longer LOS than non-bacteremic pneumococcal CAP (p < 0.003). Higher plasma levels of CRP, PCT, and BNP were found in bacteremic than in non-bacteremic patients. The bacteremic group had consistently higher plasma levels of both pro- and anti-inflammatory cytokines. The blood neutrophil functional responses were similar in both groups of patients. CONCLUSIONS: Bacteremic pneumococcal CAP patients were significantly associated with higher in-hospital mortality, lower TCS, and longer LOS. HIV-infected patients showed a greater mortality which was not statistically significant. Bacteremic pneumococcal CAP patients had higher levels of biomarkers and systemic cytokines.

Cytokines and neutrophils responses in influenza pneumonia.

This case report shows a striking correlation of remarkable brief high levels of pro- and anti-inflammatory cytokines coupled with increased neutrophil activation, followed by a sharp decrease in cytokine levels and increased neutrophil apoptosis associated with the favorable clinical outcomes of a patient with severe influenza infection. The host response examined in our case is not complete, given it did not assess the full spectrum of host response. The brief neutrophil and cytokine response seen in our case in the absence of antiviral therapy and in the presence of methotrexate immunosuppressive therapy rise the question as to whether the latter optimally modulated the macrophage function, resulting in a favorable outcome of severe influenza viral infection.

Síndrome de hipergammaglobulinemia IgE con infecciones recurrentes: patogénesis, diagnóstico y aproximación terapéutica / Hyper-IgE recurrent infection syndrome: pathogenesis, diagnosis and therapeutic management

El síndrome de la hipergammaglobulinemia IgE con infecciones recurrentes es una inmunodeficiencia primaria poco frecuente, que se caracteriza por niveles elevados de IgE, dermatitis eccematoide, infecciones recurrentes de piel y pulmón por Staphylococcus aureus, y formación de abscesos con escasos signos inflamatorios. También produce alteraciones dentarias, esqueléticas y del tejido conjuntivo. La forma clásica (tipo 1) está causada por mutaciones dominantes del gen de la proteína transductora de señal y activadora de la transcripción 3. Se ha descrito una forma incompleta (tipo 2) solo con las manifestaciones de la inmunodeficiencia, pero sin manifestaciones mesenquimales. Esta forma incompleta se debe a la mutación recesiva del gen de la tirosin-cinasa 2. Ambas mutaciones condicionan un déficit en la generación de células Th17 a partir de células T CD4+. Estos avances en el conocimiento genético e inmunológico del síndrome de hipergammaglobulinemia IgE han permitido la mejor comprensión de los fenómenos clínicos de la enfermedad(AU)

Hyper-IgE recurrent infection syndrome is an uncommon primary immunodeficiency characterized by high serum levels of total IgE, eczema-like dermatitis, recurrent skin abscesses and staphylococci pneumonias, which can produce abscesses with mild inflammatory signs. It also causes dental, musculoskeletal and connective tissue abnormalities. The classical (type 1) variation is caused by autosomal-dominant mutations in signal transducer and activator of transcription 3. An incomplete form (type 2) has been described with only the immunological manifestations, but without the mesenchymal manifestations, has been described. This incomplete form is caused by recessive mutations in the tyrosine kinase 2 gene. Both kinds of mutations produce deficient formation of Th17-cells. These advances in the genetic and immunologic knowledge of hyper-IgE recurrent infection syndrome have allowed a better clinical comprehension of the clinical phenomena of the disease(AU)

[Hyper-IgE recurrent infection syndrome: pathogenesis, diagnosis and therapeutic management]. / Síndrome de hipergammaglobulinemia IgE con infecciones recurrentes: patogénesis, diagnóstico y aproximación terapéutica.

Hyper-IgE recurrent infection syndrome is an uncommon primary immunodeficiency characterized by high serum levels of total IgE, eczema-like dermatitis, recurrent skin abscesses and staphylococci pneumonias, which can produce abscesses with mild inflammatory signs. It also causes dental, musculoskeletal and connective tissue abnormalities. The classical (type 1) variation is caused by autosomal-dominant mutations in signal transducer and activator of transcription 3. An incomplete form (type 2) has been described with only the immunological manifestations, but without the mesenchymal manifestations, has been described. This incomplete form is caused by recessive mutations in the tyrosine kinase 2 gene. Both kinds of mutations produce deficient formation of Th17-cells. These advances in the genetic and immunologic knowledge of hyper-IgE recurrent infection syndrome have allowed a better clinical comprehension of the clinical phenomena of the disease.

Akt inhibition upregulates FasL, downregulates c-FLIPs and induces caspase-8-dependent cell death in Jurkat T lymphocytes.

In T lymphocytes, the role of Akt in regulating Fas/Fas ligand (FasL)-mediated apoptotic signaling and death is not clearly understood. In this study, we observed that inhibition of Akt causes enhanced expression of FasL mRNA and protein and increased death-inducing signaling complex (DISC) formation with Fas-associated death domain (FADD) and procaspase-8 recruitment. Also, caspase-8 was activated at the DISC with accompanying decrease in c-FLIPs expression. FasL neutralizing antibody significantly decreased apoptotic death in the Akt-inhibited T cells. Additionally, Akt inhibition-induced Fas signaling was observed to link to the mitochondrial pathway via Bid cleavage. Further, inhibition of caspase-8 activity effectively blocked the loss of mitochondrial membrane potential and DNA fragmentation, suggesting that DISC formation and subsequent caspase-8 activation are critical initiating events in Akt inhibition-induced apoptotic death in T lymphocytes. These data demonstrate yet another important survival function governed by Akt kinase in T lymphocytes, which involves the regulation of FasL expression and consequent apoptotic signaling.

[Rotavirus infection in children seen at a greater Buenos Aires hospital]. / Infección por rotavirus en niños asistidos en un hospital del Gran Buenos Aires.

In order to diagnose rotavirus infection, stool samples from 134 children assisted at the Hospital B. Houssay, Vte. López, Pcia. de Buenos Aires, Argentina, have been analysed employing the Rotazyme II Diagnostic Kit (Abbot Lab.). The percentage of positive samples reached 38.8% detecting 30 and 22 positive samples in 1994 (n(o) = 84) and 1995 (n(o) = 50), respectively. The frequency of the agent peaked during the cold season of the year. The age group between 6 and 23 months was the most affected, whereas the lowest percentage of viral identification was detected in children under 6 months. No differences were detected due to the gender of children. Viral RNA analysis pointed out 7 different electropherotypes, all of them showing long electropherotype patterns.

Infección por rotavirus en niños asistidos en un hospital del Gran Buenos Aires / Rotavirus infection in children seen at a greater Buenos Aires hospital

In order to diagnose rotavirus infection, stool samples from 134 children assisted at the Hospital B. Houssay, Vte. López, Pcia. de Buenos Aires, Argentina, have been analysed employing the Rotazyme II Diagnostic Kit (Abbot Lab.). The percentage of positive samples reached 38.8 detecting 30 and 22 positive samples in 1994 (n(o) = 84) and 1995 (n(o) = 50), respectively. The frequency of the agent peaked during the cold season of the year. The age group between 6 and 23 months was the most affected, whereas the lowest percentage of viral identification was detected in children under 6 months. No differences were detected due to the gender of children. Viral RNA analysis pointed out 7 different electropherotypes, all of them showing long electropherotype patterns.

Infección por rotavirus en niños asistidos en un hospital del Gran Buenos Aires / Rotavirus infection in children seen at a greater Buenos Aires hospital

In order to diagnose rotavirus infection, stool samples from 134 children assisted at the Hospital B. Houssay, Vte. López, Pcia. de Buenos Aires, Argentina, have been analysed employing the Rotazyme II Diagnostic Kit (Abbot Lab.). The percentage of positive samples reached 38.8 detecting 30 and 22 positive samples in 1994 (n(o) = 84) and 1995 (n(o) = 50), respectively. The frequency of the agent peaked during the cold season of the year. The age group between 6 and 23 months was the most affected, whereas the lowest percentage of viral identification was detected in children under 6 months. No differences were detected due to the gender of children. Viral RNA analysis pointed out 7 different electropherotypes, all of them showing long electropherotype patterns.(AU)

Infección por rotavirus en niños asistidos en un hospital del Gran Buenos Aires. / [Rotavirus infection in children seen at a greater Buenos Aires hospital]

In order to diagnose rotavirus infection, stool samples from 134 children assisted at the Hospital B. Houssay, Vte. López, Pcia. de Buenos Aires, Argentina, have been analysed employing the Rotazyme II Diagnostic Kit (Abbot Lab.). The percentage of positive samples reached 38.8

detecting 30 and 22 positive samples in 1994 (n(o) = 84) and 1995 (n(o) = 50), respectively. The frequency of the agent peaked during the cold season of the year. The age group between 6 and 23 months was the most affected, whereas the lowest percentage of viral identification was detected in children under 6 months. No differences were detected due to the gender of children. Viral RNA analysis pointed out 7 different electropherotypes, all of them showing long electropherotype patterns.