Pycnogenol® as an Adjunct in the Management of Childhood Asthma

A randomized, placebo‐controlled, double‐blind study involving 60 subjects, aged 6–18 years old, was conducted over a period of 3 months to determine the effect of Pycnogenol® (a proprietary mixture of water‐soluble bioflavonoids extracted from French maritime pine) on mild‐to‐moderate asthma. After baseline evaluation, subjects were randomized into two groups to receive either Pycnogenol® or placebo. Subjects were instructed to record their peak expiratory flow with an Assess® Peak Flow Meter each evening. At the same time, symptoms, daily use of rescue inhalers (albuterol), and any changes in oral medications were also recorded. Urine samples were obtained from the subjects at the end of the run‐in period, and at 1‐, 2‐, and 3‐month visits. Urinary leukotriene C₄/D₄/E₄ was measured by an enzyme immunoassay. Compared with subjects taking placebo, the group who took Pycnogenol® had significantly more improvement in pulmonary functions and asthma symptoms. The Pycnogenol® group was able to reduce or discontinue their use of rescue inhalers more often than the placebo group. There was also a significant reduction of urinary leukotrienes in the Pycnogenol® group. The results of this study demonstrate the efficacy of Pycnogenol® as an adjunct in the management of mild‐to‐moderate childhood asthma.     

Anniversary Note: Asthma in Childhood, 1938–1988 From Zero to “Modernity” in 50 Years

The Rickets is a new disease, both as to name and thing…

John Graunt, 1620–1674 (quoted by D.J. Boorstin in The Discoverers: New York, Random House, 1983, p 668)     

Chronic Childhood Idiopathic Myelofibrosis in Down’s Syndrome: A Case Report

Idiopathic myelofibrosis a disease of elderly is rarely seen in children. A case of chronic idiopathic myelofibrosis in an 8 year old boy with Down’s syndrome is reported here, who presented with progressive pallor and hepatosplenomegaly. Peripheral blood examination revealed pancytopenia, macrocytic anemia and tear drop cells. No blasts were found. Bone marrow aspirate yielded a dry tap and trephine biopsy showed marrow fibrosis with osteosclerosis. Focally megakaryocytes were increased in number with atypical morphology. No blasts were seen. Review of literature revealed 47 reported cases of childhood idiopathic myelofibrosis. Six cases were associated with Down’s syndrome and only 3 of them had features of chronic idiopathic myelofibrosis without evidence of acute megakaryoblastic leukaemia.     

A Look at the Past History of Hepatitis E in Haiti: Should it be a Warning Sign during the Current Crisis?

Nobody can forget the devastating 7.0magnitude earthquake that struck poverty-stricken Haiti, Port-au-Prince recently on 12 January 2010. At least 75,000 people were killed and hundreds of thousands became homeless; authorities are worried about sanitation and outbreaks of disease in the region. The camps are full of people and there are not even the most basic facilities for any others. Humanity obliges us to help them in any possible way. I reviewed the literature about the hepatitis E virus infection in Haiti and I would like to draw the scientists' attention to this important topic in this time of crisis.     

Asthma Exacerbations in North American Adults: Who Are the “Frequent Fliers” in the Emergency Department?

OBJECTIVE: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. DESIGN: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. RESULTS: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. CONCLUSIONS: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.     

The Natural History of Fatal Childhood Asthma—A Case from the Isle of Wight Birth Cohort

Subjects with severe and unstable asthma are at high risk of fatal asthma attack. We describe a case of fatal childhood asthma in an 11-year old girl whose asthma was apparently stable with supranormal lung function and identify additional characteristics that should be considered as increasing the risk for fatal asthma. This opportunity was provided by this girl's participation in the Isle of Wight Whole Population Birth Cohort Study. Prospectively collected data identified her as an early-onset persistent wheezer with significant allergic comorbidity. She was highly atopic with multiple allergen sensitization and a total IgE exceeding 5000 Ku/L (normal range: 0–180 ku/l) at 10 years. Additionally at that age, whilst possessing normal lung function (FEV₁ 2.15 Litres; 110% predicted), she was found to have marked bronchial hyper-responsiveness (PC₂₀ Methacholine 1.71 mg/ml). At the age of 11 years, despite apparent clinical stability and use of regular controller asthma therapy, she suffered a fatal acute asthma attack that may have been related to acute allergen exposure. This report provides further insight into factors associated with fatal childhood asthma. We propose that highly atopic children with early onset persistent asthma are at a higher risk of fatal asthma even if their asthma is apparently stable and lung function is normal. Marked bronchial hyper-responsiveness provides a clue and should be assessed if there is concern.     

Asthma Incidence: Data from the National Health Interview Survey, 1980–1996

Objective. To obtain historical estimates of US asthma incidence from 17 years of health survey data. Methods. The 1980 through 1996 National Health Interview Survey contained a question asking about the time of asthma onset in persons with asthma. Annual past year incidence estimates were calculated from self-reports of asthma status. Results. Incidence increased from 2.5 per 1,000 (SE 0.37) in 1980 to 6.0 per 1,000 (SE 0.75) in 1996. Incidence increased faster in children than in adults and increased in females but not in males during this time. Conclusion. These findings suggest that increasing asthma incidence contributed to the increasing prevalence during this time.     

Are you busy for the next 5 years? Recruitment in the Childhood Asthma Prevention Study (CAPS)

OBJECTIVE: The process of recruitment into randomized controlled trials is not often reported. In the present paper, the methods used for recruitment into the Childhood Asthma Prevention Study are reported and the reasons why eligible subjects chose not to participate or withdrew from the trial are examined. METHODOLOGY: Recruitment was conducted at the antenatal clinics of six hospitals in Sydney (NSW, Australia). Pregnant women with a family history of asthma who consented to participate were randomized into one of four groups and were asked to follow a set of interventions. The study will continue until the infants are 5 years old. RESULTS: Of 7171 women screened, 2095 (29.2%) were eligible, of whom only 616 (29.4% of eligible women) were recruited. The main reasons for not taking part in the study were a lack of interest, ineligibility (on further questioning), inability to be contacted and 'too busy'. During the first 21/2 years of the trial, 10% of participants withdrew. The most common reasons for withdrawal from the study were loss of contact, family moving interstate or overseas and medical reasons. In families that withdrew from the trial or who were eligible but did not participate, the parents were significantly younger, mothers were less educated and fathers were less likely to be in full-time employment. CONCLUSIONS: By collecting demographic data on people who withdrew from the study and chose not to participate, we gained a better understanding of why our recruitment rate was low. The preferential recruitment of some sectors of the community has important implications for the ways in which future studies will be planned.     

Oxygen dynamics in the aftermath of the Great Oxidation of Earth’s atmosphere

The oxygen content of Earth’s atmosphere has varied greatly through time, progressing from exceptionally low levels before about 2.3 billion years ago, to much higher levels afterward. In the absence of better information, we usually view the progress in Earth’s oxygenation as a series of steps followed by periods of relative stasis. In contrast to this view, and as reported here, a dynamic evolution of Earth’s oxygenation is recorded in ancient sediments from the Republic of Gabon from between about 2,150 and 2,080 million years ago. The oldest sediments in this sequence were deposited in well-oxygenated deep waters whereas the youngest were deposited in euxinic waters, which were globally extensive. These fluctuations in oxygenation were likely driven by the comings and goings of the Lomagundi carbon isotope excursion, the longest–lived positive δ¹³C excursion in Earth history, generating a huge oxygen source to the atmosphere. As the Lomagundi event waned, the oxygen source became a net oxygen sink as Lomagundi organic matter became oxidized, driving oxygen to low levels; this state may have persisted for 200 million years.Multiple lines of geochemical evidence (1–4) point to a substantial increase in the oxygen content of the atmosphere some 2,300–2,400 million years ago (Ma) in what is known as the “Great Oxidation Event” (GOE) (4). This rise in oxygen occurred during an episode of major glaciation, known as the Huronian glaciation, but the cause of oxygen increase remains elusive. Some have argued that the GOE occurred as a direct result of cyanobacterial evolution (5) whereas others have assumed that cyanobacteria evolved well before the GOE and have looked for causes involving changes in the redox balance of the Earth surface (6–9). In any event, beginning after the GOE, and sometime between 2,300 and 2,230 Ma, there was a large positive excursion in the ¹³C of marine inorganic carbon that was apparently global in nature (10–13). This event is known as the Lomagundi carbon isotope excursion, with δ¹³C values reaching upwards of 12 per mil. The event lasted well over 100 million years, with a termination estimated at between about 2,110 Ma and 2,080 Ma and no later than 2,060 Ma (10, 14). This excursion represents the largest positive carbon-isotope excursion in Earth history.In standard thinking, a large positive carbon-isotope excursion is driven by the enhanced burial of organic carbon into sediments (15, 16). An event as sustained and dramatic as the Lomagundi excursion would seemingly require an unusual driving mechanism, and it has been suggested that the GOE itself may have been the cause through enhanced oxidative weathering on land accompanying the increase in oxygen. This oxidative weathering liberated more phosphorus to the oceans and stimulated primary production and organic carbon burial (17, 18). Organic carbon burial is a source of oxygen to the atmosphere, and it also has been suggested that the Lomagundi excursion may have driven atmospheric oxygen to higher levels than attained during the GOE itself (17, 19). The deposition of massive calcium sulfate deposits during the Lomagundi Event (20–22), indicating elevated seawater sulfate concentrations, would be consistent with this increase in oxygen. Also, the concentrations of uranium in shales deposited in anoxic marine waters during the Lomagundi excursion show enrichment compared with shales deposited both before and after the excursion (23). This observation would indicate higher marine U concentrations, consistent with globally expanded oxic conditions in marine waters. However, when ratioed to total organic carbon (TOC), the biggest U enrichments are found within the Huronian glaciation, during the initiation of the GOE, whereas the enrichments during the Lomagundi excursion are much smaller and quite comparable to those found before the GOE (23) when atmospheric oxygen was much lower in concentration (1, 3). Therefore, there remain some uncertainties in interpreting the U signal.There also have been some suggestions that oxygen fell again to lower levels as the Lomagundi event waned (17, 24, 25). Of particular interest here is an increase in the isotopic composition in δ³⁴S of carbonate associated sulfate (CAS) through the Lomagundi event, which could be taken to indicate an expansion of euxinic conditions (24) as might be expected with falling oxygen levels. However, although consistent with lower levels of ocean oxygenation, this isotope data is not direct evidence, and the CAS results are apparently restricted to sediments deposited during the Lomagundi event (as evidenced by elevated δ¹³C values) and not afterward. Overall, although there are compelling reasons to believe that the Lomagundi excursion, and its aftermath, represented a dynamic period in the history of Earth oxygenation, there is little direct evidence for the state of atmospheric and ocean oxygenation both during and beyond the event. This time window is also represented by the Francevillian Group of Gabon. Here, we explore the nature of marine water-column chemistry during the deposition of these rocks, providing a unique window into the evolution of ocean and atmospheric chemistry during what appears as an exceptionally dynamic period of oxygen evolution in Earth history.