Allergic diseases in India – Prevalence,risk factors and current challenges

Epidemiological studies have shown a rise in the prevalence of allergic diseases in India during the last two decades. However, recent evidence from the Global Asthma Network study has observed a decrease in allergic rhinitis, asthma and atopic dermatitis in children. Still, with a population over 1.3 billion, there is a huge burden of allergic rhinitis, asthma and atopic dermatitis, and this is compounded by an unmet demand for trained allergy specialists and poor health service framework. There is wide variation in the prevalence of allergic diseases between different geographical locations in India, and the reasons are unclear at present. This may at least in part be attributable to considerable heterogeneity in aero-biology, weather, air pollution levels, cultural and religious factors, diet, socioeconomic strata and literacy. At present, factors enhancing risks and those protecting from development of atopy and allergic diseases have not been well delineated, although there is some evidence for the influence of genetic factors alongside cultural and environmental variables such as diet, exposure to tobacco smoke and air pollution and residence in urban areas. This narrative review provides an overview of data from India regarding epidemiology, risk factors and genetics and highlights gaps in evidence as well as areas for future research.     

Die Bekämpfung der Malaria in Puntacroce

Ohne Zusammenfassung     

Carotid artery stenting – current status of the procedure

Surgical carotid endarterectomy (CEA) was long considered the standard approach for the treatment of atherosclerotic carotid artery disease. This was based on results of several randomized trials demonstrating its effectiveness over the best medical therapy. In the past two decades, patients identified high-risk for surgery were offered carotid artery stenting (CAS) as a less invasive option. Despite its initial limitations, CAS has evolved into an elaborate method currently considered to be equivalent and in selected patients even preferable to CEA. However, outcomes of both procedures are highly operator dependent and a simple stratifying method to prioritize CAS, CEA or medical therapy only has not yet been proposed. In addition, recently published randomized trials highlighted the importance of proper patient selection and rigorous training contributing to low absolute rates of (procedural) adverse events. This review discusses the history and evidence for carotid revascularization and briefly presents technical aspects and innovations in CAS.     

Is hyponatremia mistreated? – Challenging the current paradigm

Background

Hyponatremia is a common but often mistreated clinical situation in the ICU. This often requires the physician to identify the underlying problem, adrenal insufficiency. However, by the textbook, the current treatment always involves sodium chloride supplementation to hyponatremic patients, either intravenous or oral intake. We hypothesize that the mechanism behind most hyponatremia is most likely to be the sodium and water redistribution from the serum to the cells or the interstitial spaces due to the insufficient cortical steroid, not the sodium deficiency. As we have no reason to believe the patients have lost that much sodium which caused hyponatremia. Therefore, giving this type of hyponatremic patients (adrenal insufficient) sodium chloride is always ineffective and sometimes catastrophic.

Methods

We discuss the possible mechanism for hyponatremia in critically ill/post surgery patients who are mostly likely to be adrenal insufficient rather than absolute sodium deficiency. In combination with many other common but unexplainable symptoms such as nausea, vomiting, obstinate diarrhea, hypotension and coma in the ICU, it is highly likely that hyponatremia is a condition which reflects the patients’ adrenal function. The evidence supporting our hypothesis is that, (1) the serum sodium level does not always respond well to sodium supplementation therapy; (2) those aforementioned symptoms alleviated simultaneously with the serum sodium level returned to normal after the hydrocortisone or prednisone was administered without any oral/intravenous sodium supplementation; (3) patient with an elevated serum/urine cortisol level suffers from aforementioned unexplainable symptoms does not warrant him being adrenal sufficient. If the patient also has hyponatremia, the diagnosis can be considered as “relative adrenal insufficiency” and the patient would respond well to hydrocortisone or prednisone therapy.

Conclusions

We hypothesize that hyponatremia without significant loss of sodium can be used as an indicator to monitor the patients’ adrenal function regardless of the serum/urine cortisol level. Furthermore, we propose a novel approach toward hyponatremia treatment in critically ill patients would be hydrocortisone or prednisone therapy depending on the circumstances.     

Endocardial Lead Extraction in the Polish Registry – clinical practice versus current Heart Rhythm Society consensus

Introduction

Over the last 10 years, there has been an increasing number of patients with pacemaker (PM) and cardioverter-defibrillator (ICD). This study is a retrospective analysis of indications for endocardial pacemaker and ICD lead extractions between 2003 and 2009 based on the experience of three Polish Referral Lead Extraction Centers.

Material and methods

Since 2003, the authors have consecutively retrospectively collected all cases and entered the information in the database. All patients which had indication for lead extraction according to Heart Rhythm Society Guidelines were included to final analyze. Between 2003 and 2005, the data were analyzed together. Since 2006, data have been collected and analyzed annually.

Results

In each year, a significant increase in lead extraction was observed. The main indications for LE were infections in 52.4% of patients. Nonfunctioning lead extraction constituted the second group of indications for LE in 29.7% of patients. During the registry period, the percentage of class I indications decreased from 80% in 2006 to only 47% in 2009. On the other hand, increasingly more leads were removed because of class 2, especially class 2b. In 2009, 40% of leads were extracted due to class 2b.

Conclusions

Polish Registry of Endocardial Lead Extraction 2003-2009, shows an increasing frequency of lead extraction. The main indication for LE is infection: systemic and pocket. An increase in class 2, especially 2b, LE indication in every center during the study period was found.     

Treatment of pemphigus vulgaris: part 1 – current therapies

ABSTRACT

Introduction: While biologic agents that can be used for treating pemphigus vulgaris (PV) are increasing, themajority of the world’s PV patients can afford only corticosteroids (CS) and some immunosuppressive agents (ISA).

Areas covered: The spectrum of side effects encountered when PV patients receive high-dose, long-term CS and ISA are presented based on total dose and duration of therapy. The steroid-sparing effect of individual ISA as documented in published studies and their clinical outcomes, in terms of duration of remissions, frequency of relapses and time to relapse, are presented, so that comparisons are possible. Thus, rational choices can be made for the individual patient.

Expert opinion: In 2019, the majority of PV patients globally will continue to be treated with CS and ISA. This review will help clinicians and patients become aware of when to anticipate which side effects and if possible, to prevent or avoid them. It provides guidelines to maximize the clinical benefits of ISA in inducing and maintaining remission and minimizing side effects by monitoring them.     

Neonatal intensive care and premature birth – maternal perceptions and coping

Summary Premature birth and neonatal intensive care are distressing events for mothers requiring active coping. 42 consecutive mothers of infants treated on a NICU were interviewed prospectively during the first week postpartally, after 4–6 weeks and after 5–6 months with a semistructured interview. The mothers had a high rate of previous psychosocial stressors, medical complications and past perinatal losses. The groups with infants under (VLBW) and over 1,500 g were compared. In the first postpartal week, the VLBW mothers showed a significantly higher degree of distress, fears concerning death and handicaps of the child and negative or ambivalent feelings at first contact than mothers with newborns over 1,500 g. In the next weeks, most mothers were able to cope well with social and professional support and the differences between the two groups were no longer significant. Still, fears concerning their child continued at high rates and disturbing memories occurred often, so that at least subgroups do require more intense help during the early stages of adaptation postpartally. One of the subgroups at risk are the VLBW mothers.     

Die Bekämpfung der Malaria in der Maremma Toscana

Ohne ZusammenfassungHierzu Taf. II u. III.     

Acupuncture for allergic disease therapy – the current state of evidence

This review summarizes current evidence for acupuncture treatment of allergies. Several randomized controlled trials have demonstrated a specific effect of acupuncture for allergic rhinitis; while a few studies have shown positive effects for atopic dermatitis, asthma and itch. Specifically for allergic rhinitis and asthma, acupuncture may be cost-effective in terms of money spent per quality-of-life gained. Acupuncture plays an increasingly important role as an evidence-based therapy for allergy relief and can be recommended as adjunct therapy for allergic rhinitis. Future randomized controlled trials need to further explore acupuncture efficacy for the treatment of itch, atopic dermatitis and asthma. More experimental research is also needed to investigate mechanisms of action underlying acupuncture for allergy relief.     

Towards Developing a Malaria Vaccine Based on CD4 T Cell Mediated Immunity in Blood Stage of Malaria Infection

Twenty-one years after malaria antigens were first cloned avaccine still appears to be a long way off. There havebeen periods of great excitement and in model systemssubunit vaccine homologues can induce robust protection.However, significant challenges e…     

Is Ischemia Involved in the Pathogenesis of Murine Cerebral Malaria?

Sequestration of parasitized erythrocytes in the central nervous system microcirculation and increased cerebrospinal fluid lactate are prominent features of cerebral malaria (CM), suggesting that sequestration causes mechanical obstruction and ischemia. To examine the potential role of ischemia in the pathogenesis of CM, Plasmodium berghei ANKA (PbA) infection in CBA mice was compared to infection with P. berghei K173 (PbK) which does not cause CM (the non-CM model, NCM). Cerebral metabolite pools were measured by (1)H nuclear magnetic resonance spectroscopy during PbA and PbK infections. Lactate and alanine concentrations increased significantly at the terminal stage of CM, but not in NCM mice at any stage. These changes did not correlate with parasitemia. Brain NAD/NADH ratio was unchanged in CM and NCM mice at any time studied, but the total NAD pool size decreased significantly in the CM mice on day 7 after inoculation. Brain levels of glutamine and several essential amino acids were increased significantly in CM mice. There was a significant linear correlation between the time elapsed after infection and small, progressive decreases in the cell density/cell viability markers glycerophosphocholine and N-acetylaspartate in CM, indicative of gradual loss of cell viability. The metabolite changes followed a different pattern, with a sudden significant alteration in the levels of lactate, alanine, and glutamine at the time of terminal CM. In NCM, there were significant decreases with time of glutamate, the osmolyte myo-inositol, and glycerophosphocholine. These results are consistent with an ischemic change in the metabolic pattern of the brain in CM mice, whereas in NCM mice the changes were more consistent with hypoxia without vascular obstruction. Mild obstructive ischemia is a likely cause of the metabolic changes during CM, but a role for immune cell effector molecules cannot be ruled out.     

Acute viral hepatitis – Should the current screening strategy be modified?

BackgroundThe epidemiology of viral hepatitis has changed. Since the introduction of safe and effective vaccines for hepatitis A and B in 1980s, the incidence of acute infections caused by these viruses has been declining in the UK. At the same time, hepatitis E virus (HEV) has been recognised as an increasingly important cause of acute hepatitis, but testing is not widely available.ObjectivesThe aim of this study was to establish the viral causes of acute hepatitis, and use that data to modify the current diagnostic algorithm.Study designA Cognos search was performed to collate subjects tested for HAV, HBV, HCV, HEV, EBV and CMV between June 2010 and December 2012. Information included virological result and their ALT level if done within 5 days from virological testing.ResultsFrom 3462 subjects with suspected acute viral hepatitis, only 25% had biochemical evidence of acute hepatitis (n = 854; ALT > 100 IU/l). The frequency of detection of acute HEV infection (25/409) was over 31-times higher than that of HAV (6/3462), and 7-times higher than that of HBV (24/3462). Most cases of acute HAV, HEV, EBV and CMV infections presented with abnormal ALT levels. Most EBV infections were associated with lymphadenopathy (23/34); in comparison most of CMV infections were not associated with lymphadenopathy (18/22).ConclusionsHEV screening should be included in the initial testing panel for acute hepatitis and screening at least for HAV and HEV might be limited to those with abnormal ALT levels.     

Malaria in Vietnam: what is the awareness of risk for travel in 2000?

Increasing numbers of people are travelling to Vietnam. From december 1st 1998 to april 31 1999, we surveyed by questionnaire 191 travellers who consulted at health centres attached to French diplomatic representations (Hanoi, Ho-Chi-Minh Ville) in order to evaluate their prophylaxis practices with regard to malaria; 59% of these travellers were taking no preventive measures whatsoever, while the rest were following an often ill-adapted treatment.