Asthma and allergy development: contrasting influences of yeasts and other fungal exposures.

BACKGROUND: Infancy is a developmental stage with heightened susceptibility to environmental influences on the risk of chronic childhood disease. Few birth cohort studies have detailed measures of fungal diversity data in infants' bedrooms, limiting the potential to measure long-term associations of these complex exposures with development of asthma or allergy. OBJECTIVE: We evaluated the relation of home fungal levels in infancy to repeated measures of wheeze and development of asthma and rhinitis by age 13, and sensitization by age 12 years. METHODS: In the Epidemiology of Home Allergens and Asthma prospective birth cohort study, we recruited 408 children with family history of allergic disease or asthma. When children were aged 2-3 months, we measured culturable fungi in bedroom air and dust, and in outdoor air. Main outcomes included ascertainment of symptoms/disease onset by questionnaire from birth through age 13. We estimated hazard ratios and, for wheeze and sensitization, odds ratios for an interquartile increase in log-transformed fungal concentrations, adjusting for other outcome predictors and potential confounders. RESULTS: Elevated levels of yeasts in bedroom floor dust were associated with reduced: i) wheeze at any age; ii) fungal sensitization; and iii) asthma development by age 13 (hazard ratio (HR) = 0.86; 95% confidence interval (CI), [0.75 to 0.98]). Outdoor airborne Cladosporium and dustborne Aspergillus predicted increased rhinitis. Risk of fungal sensitization by age 12, in response to environmental Alternaria and Aspergillus, was elevated in children with a maternal history of fungal sensitization. CONCLUSIONS AND CLINICAL RELEVANCE: Despite the irritant and allergenic properties of fungi, early-life elevated dust yeast exposures or their components may be protective against allergy and asthma in children at risk for these outcomes. Ascertainment of fungal components associated with immunoprotective effects may have therapeutic relevance for asthma.

Clinical experience with using lacosamide for the treatment of epilepsy in a tertiary centre.

OBJECTIVE: Lacosamide is approved for the adjunctive treatment of partial-onset seizures in adults. Phase II/III clinical trials suggest that it is a safe, effective and well-tolerated medication. However, there is little post-marketing information available about this medication. METHODS: We report our clinical experience from a tertiary referral epilepsy centre, which has been using lacosamide for the past 18 months, with 128 patients treated during this time. RESULTS: Fifty-three patients (41%) achieved at least a 50% reduction in seizure frequency, with 14 patients (11%) achieving seizure freedom for a mean time of 35 weeks. This 50% responder rate matches, and the seizure free rate outperforms that seen in previous pooled trials. The efficacy of lacosamide did not vary with concurrent sodium channel blocking agent (SCB) use, and a statistically significant dose-dependent response was not shown, which is in contrast to previous trials. Treatment emergent adverse effects (TEAEs) were noted in 52 patients (41%), with 24 patients (19%) discontinuing the medication. TEAEs were more frequent in patients on concurrent SCBs, affecting 51% vs. 28% of patients not on other SCBs. This increased risk of TEAEs from concurrent SCB use was of statistical significance (P = 0.01). The most frequently noted TEAEs from lacosamide were dizziness, sedation and diplopia, which all appeared to be dose-related. CONCLUSION: This post-marketing analysis suggests that lacosamide in clinical practice at least mirrors, and possibly outperforms the results seen in previous phase II/III trials.

Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain.

BACKGROUND: Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly during childhood. This can be an alarming sign of an underlying disease. Gastrointestinal endoscopy (GIE) is a safe method for the diagnosis and treatment of GIB in most cases. AIM: To determine the incidence, clinical presentation, and outcomes of GIB in children in Bahrain over the last two decades. METHODS: This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex, Bahrain, between 1995 and 2022. Demographic data, clinical presentation, endoscopic findings, and clinical outcomes were recorded. GIB was classified into upper (UGIB) and lower (LGIB) GIB according to the site of bleeding. These were compared with respect to patients' sex, age, and nationality using the Fisher's exact, Pearson's χ 2, or the Mann-Whitney U tests. RESULTS: A total of 250 patients were included in this study. The median incidence was 2.6/100000 per year (interquartile range, 1.4-3.7) with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). The median age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIE alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was more frequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormal endoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatory bowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%). IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P = 0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, and esophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029, respectively). Ten (4%) patients underwent one or more therapeutic interventions. The median follow-up period was two years (0.5-3). No mortality was reported in this study. CONCLUSION: GIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due to IBD, was more common than UGIB, commonly due to gastritis.

[Evolutive particularities of appendicular plastron in children]. / Particularitati evolutive ale blocului apendicular la copil.

This paper analyses the experience of the Paediatric Surgery Department from the Emergency Hospital in Craiova regarding the clinical and therapeutical evaluation of 55 cases with appendicular plastron admitted in our department between 1997-2006. We analyse both the evolution and the complications in managing these cases, together with particular aspects of differential diagnosis related to this group of age. These 55 cases were children aged between 2 and 15 years with a 15 days average hospitalization period. Applying a standard treatment we had favorable results in 85% of cases with 15% cases underwent surgical treatment from the first admission. Comparative to a study realised in our dept. between 1975-1996, which registered 30 cases with a mortality of 6.70%, the present one revealed in the latest years an important increase of the number of appendicular plastron with a significant low mortality.

[Update in diagnosis and treatment of esophageal atresia]. / Actualitfati în diagnosticul si tratamentul atreziei de esofag.

The paper present a number of 17 cases of esophageal atresia, hospitalised and operated in a period of 4 years (2001-2004). The authors are underlining the importance of the prenatal diagnosis, preoperative and postoperative care, the chance for primary anastomosis for type III A of the disease, complications and prognosis related to the type of atresia. Esophageal atresia is a success of a complex team where the role of the neonatologist and anesthesiologist, next to the surgeon, is very important.

[The gastroschisis: clinical and therapeutic considerations]. / Laparoschizisul: consideratii clinico-terapeutice.

Gastroschisis is a severe congenital malformation of the abdominal wall, with relative low incidence. The authors are analysing different therapeutic methods, in a group of 17 cases, hospitalised and operated in Department of Pediatric Surgery, Emergency Hospital of Craiova. They are underlining the importance of the ultrasound prenatal diagnosis of the malformation, close related to different therapeutic methods applied in this period of time and also are advising secondary closure of the abdominal wall, using a synthetic material (Silo-bag) for temporary coverage of the intestine developed outside the peritoneal cavity. This method helped with the decreasing of mortality in gastroschisis but with high costs of treatment.

Combining cutaneous silent periods with quantitative sudomotor axon reflex testing in the assessment of diabetic small fiber neuropathy.

OBJECTIVE: Routine electrophysiological testing is often normal in the evaluation of painful diabetic neuropathy, as it is unable to detect dysfunction of thinly myelinated (Aδ) and unmyelinated (C) small fibers. Although cutaneous silent periods (CSP) and quantitative sudomotor axon reflex testing (QSART) respectively evaluate these fiber types in the extremities, these two tests have yet to be assessed together. METHODS: 26 patients with a clinical diagnosis of small fiber neuropathy (SFN) and 26 age-matched controls were assessed. Nine patients had Type I diabetes, nine had Type II diabetes, and eight had impaired glucose tolerance. The CSP onset latency and duration were recorded in each extremity. QSART was performed on the right side. RESULTS: 58% (15/26) of patients had abnormal sweat volumes obtained from QSART, while 50% (13/26) of patients had abnormal CSP responses. Combining these two tests increased the sensitivity of testing to 77% (20/26). Abnormalities were seen equally across all patient groups. CONCLUSIONS: Combining CSP with QSART significantly increases the sensitivity of testing when assessing patients with SFN related to diabetes, or prediabetes. SIGNIFICANCE: For clinically suspected SFN, it is preferable to test more than one small fiber type, as each possess different structural and functional properties and may be heterogeneously affected between patients.

Influence of 5alpha- and 5beta-reduced progestins on the contractility of isolated human myometrium at term.

It is very well known that progesterone induces uterine relaxation on myometrium contractile activity. However, little attention has been paid to the effect induced by its metabolites on human uterine contractility. Therefore, we set out to analyze the potential relaxing effect of some 5alpha- and 5beta-reduced progesterone derivatives on the spontaneous contractility of myometrium from pregnant women. Samples were obtained by caesarian section at 38-40 weeks of pregnancy. Spontaneous uterine contractions were recorded in vitro in the presence of progesterone, or progestins independently, at different non-cumulative microM concentrations. The progestins elicited an immediate relaxing effect that was concentration-dependent. With the exception of two 5alpha-reduced progestins (5alpha and 3beta,5alpha), the remaining progestins used in the present study were more potent than progesterone. The potency order with respect to their IC50 values was: 3alpha,5alpha (35 microM) > 5beta (81 microM) > 3beta,5beta (156 microM) > 3alpha,5beta (205 microM) > P4 (225 microM) > 5alpha (19 mM) > 3beta,5alpha (28 mM). When tissues were washed, the contractile activity was recovered. This rapid and reversible relaxing effect was not blocking by antiprogestin RU 486, suggesting that is not through receptor-mediated genomic action. The metabolites from progesterone may also determine the pattern of motility, ensuring the necessary quiescent environment to prevent abortion during gestation.

[Elements of gynecology pathology in girls before and during puberty age]. / Elemente de patologie ginecologica la fetite înainte si la vârsta pubertatii.

PURPOSE: The annexial pathology in little girls is representing a more and more frequent form of acute and chronic abdomen, especially in girls around the age of puberty with dysfunction of the menstrual cycle correlated with disturbance of growing and the occurrence of secondary sexual characters. If this kind of pathology is frequent in the period of puberty, there are cases diagnosticated at small ages. MATERIAL & METHODS: The authors are communicating a number of 25 cases with anexial pathology some of them manifesting the symptoms of the acute abdomen (most of them with torsion of the normal or pathological annexes) others having a chronic aspect. The clinical examination correlated with the imagistic investigations were the main elements for the diagnosis. RESULTS & CONCLUSIONS: The results were good, the follow-up of the patients is including social therapy with the girls and their families, for integration in the family, evaluating the chance of giving birth. The occurrence of some forms of acute abdomen was frequent on a pathologic annexes (malformated annexes), causing sometimes the excision of it, extended to the uterus. The presence of a malign tumour can be related with different malformations, also caused by exposure to some risk factors: radiation, pollution, chemical agriculture, deficitary alimentation, stress etc.).

[Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children]. / Intre dificultati si confuzii de diagnostic în abdomenul acut si cronic la copil.

The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.

[Hemorrhagic risk of different perioperative anticoagulation protocols in patients implanted with a cardiac pacemaker or defibrillator: retrospective analysis in patients implanted in a community hospital]. / Evaluation du risque hémorragique de différents protocoles d'anticoagulation péri-opératoire lors d'une primo-implantation ou un remplacement d'un stimulateur ou d'un défibrillateur cardiaque : analyse d'une cohorte de patients en centre hospitalier général.

AIMS: Perioperative management of anticoagulation in patients referred for pacemaker or cardiac defibrillator implantation isn't consensual. Our objective was to evaluate, in a large cohort, hemorrhagic complications in patients having implantation or replacement of a cardiac pacemaker or defibrillator, and to assess perioperative anticoagulation effect on hemorrhagic risk. METHODS AND RESULTS: A cohort of 461 consecutive patients having implantation or replacement of a cardiac pacemaker or defibrillator has been analyzed. Thirty patients (6,5%) had oral anticoagulants (OAC) switched to heparin/low-molecular-weight heparin, while 76 (16,5%) had their oral anticoagulation disrupted habitually for 48 hours. A total of six over 30 (20%) and two over 76 (2.6%) patients in the bridge and OAC, respectively experienced a pocket hematoma (bridge vs. OAC, p<0.05), while ten over 355 (2.8%) had a pocket hematoma in the control group (bridge vs. control p=0.006). Duration of the hospital stay was longer in the bridge group in comparison with OAC and control groups (9 vs. 7 vs. 6 days, respectively, p=0.006). CONCLUSION: Oral anticoagulation bridging with heparin or low-molecular-weight heparin is associated with a higher risk of pocket hematoma and a longer duration of hospitalization, in comparison with a strategy allowing a temporary disruption of OAC adapted to the thromboembolic risk.

Embryotoxicity following repetitive maternal exposure to scorpion venom

Although it is a frequent accident in a few countries, scorpion envenomation during pregnancy remains scarcely studied. In the present study, the effects of repetitive maternal exposure to Buthus occitanus tunetanus venom are investigated and its possible embryotoxic consequences on rats. Primigravid rats received a daily intraperitoneal dose of 1 mL/kg of saline solution or 300 µg/kg of crude scorpion venom, from the 7th to the 13th day of gestation. On the 21st day, the animals were deeply anesthetized using diethyl-ether. Then, blood was collected for chemical parameter analysis. Following euthanasia, morphometric measurements were carried out. The results showed a significant increase in maternal heart and lung absolute weights following venom treatment. However, the mean placental weight per rat was significantly diminished. Furthermore, blood urea concentration was higher in exposed rats (6.97 ± 0.62 mmol/L) than in those receiving saline solution (4.94 ± 0.90 mmol/L). Many organs of venom-treated rat fetuses (brain, liver, kidney and spleen) were smaller than those of controls. On the contrary, fetal lungs were significantly heavier in fetuses exposed to venom (3.2 ± 0.4 g) than in the others (3.0 ± 0.2 g). Subcutaneous blood clots, microphthalmia and total body and tail shortening were also observed in venom-treated fetuses. It is concluded that scorpion envenomation during pregnancy potentially causes intrauterine fetal alterations and growth impairment.(AU)