Acetaminophen and the risk of asthma: the epidemiologic and pathophysiologic evidence

The prevalence of asthma has increased worldwide. The reasons for this rise remain unclear. Various studies have reported an association between acetaminophen, a widely used analgesic, and diagnosed asthma. In a prospective cohort study, the rate of newly diagnosed asthma was 63% higher among frequent acetaminophen users than nonusers in multivariate analyses. Studies of patients with asthma suggest that acetaminophen challenge can precipitate a decline in FEV(1) > 15% among sensitive individuals. Plausible mechanisms to explain this association include depletion of pulmonary glutathione and oxidative stress. This article reviews the existing literature and evaluates the epidemiologic and pathophysiologic evidence underlying a possible link between acetaminophen and asthma.     

Noradrenaline versus terlipressin in the management of type 1 hepatorenal syndrome: A randomized controlled study

Background

Hepatorenal syndrome (HRS) occurs in decompensated liver disease and carries high mortality. Vasoconstrictors are the drug of choice. Terlipressin is widely used and is expensive. In this study, we compared noradrenaline and terlipressin in the management of type 1 HRS.

Methods

Sixty consecutive patients with type 1 HRS were managed with noradrenaline (Group A, n?=?30) or terlipressin (Group B, n?=?30) with albumin in a randomized controlled trial at a tertiary center.

Results

Reversal of type 1 HRS was achieved in 16 (53%) patients in group A and 17 (57%) in group B. There was statistically insignificant difference between the two groups in decreasing serum creatinine and increasing urine output (p?>?0.05). On univariate analysis, Child-Turcotte-Pugh (CTP) score, serum sodium, serum urea, serum albumin, prothrombin time, International normalized ratio (INR), serum alanine aminotransferase (ALT), ascitic fluid protein, and history of bleeding were associated with response to treatment (noradrenaline/terlipressin). However, on multivariate analysis, only baseline CTP score, serum urea, serum albumin, and prothrombin time were independent predictors of response. All patients who responded were discharged alive with no mortality within 30 days.

Conclusions

There is no difference in outcome of patients with type 1 HRS treated with noradrenaline or terlipressin. Thus, noradrenaline, which is cheaper, can be used instead of terlipressin (Clinical Trials Registry-India [CTRI] No. CTRI/2011/09/002032).

     

The clinical significance of complete class switching defect in Ataxia telangiectasia patients

Background: Ataxia telangiectasia (AT) is a primary immunodeficiency associated with recurrent infections. We aimed to investigate clinical and immunological classification in AT patients who suffer from a different spectrum of humoral immune defects.

Methods: AT patients were categorized according to the ability of class switching and patients with hyper IgM (HIgM) profile were defined as class switching defect (CSD).

Results: Serum immunoglobulin profile in 66 AT patients showed normal immunoglobulin level (22.8%), IgA deficiency (37.9%) and hypogammaglobulinemia (18.1%) in the majority of patients, while 21.2% had HIgM profile revealing CSD. CSD does not affect the frequency of infections, however, the frequency of lymphoproliferation (p < 0.001), and autoimmunity (p = 0.004) were significantly higher in this group. Neurologic symptoms in CSD patients are mild or appear after recurrent infections, therefore these patients were usually misdiagnosed as HIgM syndrome.

Conclusions: Although most of AT patients have reduced IgA levels or normal immunoglobulin levels, but a fraction of these patients may show CSD ensuing HIgM-profile. CSD poses affected individuals at higher risk of non-infectious complications.     

Haematopoietic stem cell transplantation in Nigerian sickle cell anaemia children patients

Background:

Sickle cell anaemia (SCA) remains associated with high risks of morbidity and early death. Children with SCA are at high risk for ischaemic stroke and transient ischaemic attacks, secondary to intracranial arteriopathy involving carotid and cerebral arteries. Allogeneic haematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCA. We report our experience with transplantation in a group of patients with the Black African variant of SCA.

Patients and Methods:

This study included 31 consecutive SCA patients who underwent bone marrow transplantation from human leukocyte antigen (HLA)-identical sibling donors between 2010 and 2014 following a myeloablative-conditioning regimen.

Results:

The median patient age was 10 years (range 2–17 years). Before transplantation, 14 patients had recurrent, painful, vaso-occlusive crisis; ten patients had recurrent painful crisis in association with acute chest syndrome; three patients experienced ischaemic stroke and recurrent vaso-occlusive crisis; two patients experienced ischaemic stroke; one patient exhibited leukocytosis; and one patient exhibited priapism. Of the 31 patients, 28 survived without sickle cell disease, with Lansky/Karnofsky scores of 100. All surviving patients remained free of any SCA-related events after transplantation.

Conclusion:

The protocols used for the preparation to the transplant in thalassaemia are very effective also in the other severe haemoglobinopathy as in the sickle cell anaemia with 90% disease free survival. Today, if a SCA patient has a HLA identical family member, the cellular gene therapy through the transplantation of the allogeneic haemopoietic cell should be performed. Tomorrow, hopefully, the autologous genetically corrected stem cell will break down the wall of the immunological incompatibility.     

AGS and NIA bench-to bedside conference summary: Cancer and cardiovascular disease

This report summarizes the presentations, discussions, and recommendations of the most recent American Geriatrics Society and National Institute on Aging research conference, “Cancer and Cardiovascular Disease,” on October 18–19, 2021. The purpose of this virtual meeting was to address the interface between cancer and heart disease, which are the two leading causes of death among older Americans. Age-related physiologic changes are implicated in the pathogenesis of both conditions. Emerging data suggest that cancer-related cardiovascular disease (CVD) involves disrupted cell signaling and cellular senescence. The risk factors for CVD are also risk factors for cancer and an increased likelihood of cancer death, and people who have both cancer and CVD do more poorly than those who have only cancer or only CVD. Issues addressed in this bench-to-bedside conference include mechanisms of cancer and CVD co-development in older adults, cardiotoxic effects of cancer therapy, and management of comorbid cancer and CVD. Presenters discussed approaches to ensure equitable access to clinical trials and health care for diverse populations of adults with CVD and cancer, mechanisms of cancer therapy cardiotoxicity, and management of comorbid CVD and cancer, including the role of patient values and preferences in treatment decisions. Workshop participants identified many research gaps and questions that could lead to an enhanced understanding of comorbid CVD and cancer and to better and more equitable management strategies.     

Nano branched-chain amino acids enhance the effect of uphill (concentric) and downhill (eccentric) treadmill exercise on muscle gene expression of Akt and mTOR on aged rats

Sport Sciences for Health - This study was aimed to consider the effects of uphill (concentric, CON) and downhill (eccentric, ECC) treadmill exercise with Nano-BCAA supplementation on muscle...     

An Investigation into the Accumulation of Air Borne Trace Metals in the Lungs of Common Myna Acridotheres tristis and Bank Myna Acridotheres ginginianus Captured from Urban and Semi Urban Areas of Lahore and Pattoki,Pakistan

Bulletin of Environmental Contamination and Toxicology - With increasing urbanization and industrialization, clean air is becoming a scarce resource. During the present investigation,...     

In situ synthesis and electronic transport of the carbon-coated Ag@C/MWCNT nanocomposite

A nanocomposite of Ag@C nanocapsules dispersed in a multi-walled carbon nanotube (MWCNT) matrix was fabricated in situ by a facile arc-discharge plasma approach, using bulk Ag as the raw target and methane gas as the carbon source. It was found that the Ag@C nanocapsules were ∼10 nm in mean diameter, and the MWCNTs had 17–32 graphite layers in the wall with a thickness of 7–10 nm, while a small quantity of spherical carbon cages (giant fullerenes) were also involved with approximately 20–30 layers of the graphite shell. Typical dielectric behavior was dominant in the electronic transport of Ag@C/MWCNT nanocomposites; however, this was greatly modified by metallic Ag cores with respect to pure MWCNTs. A temperature-dependent resistance and I–V relationship provided evidence of a transition from Mott–David variable range hopping [ln ρ(T) ∼ T^−1/4] to Shklovskii–Efros variable range hopping [ln ρ(T) ∼ T^−1/2] at 5.4 K. A Coulomb gap, Δ_C ≈ 0.05 meV, was obtained for the Ag@C/MWCNT nanocomposite system.

An electric transition from ln ρ(T) ∼ T^−1/4 to ln ρ(T) ∼ T^−1/2 hopping conduction happened at 5.4 K in situ synthesis of Ag@C/MWCNTs nanocomposite.     

Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection

BackgroundFever as a common presenting complaint in pediatric patients can be due to various causes. Differentiating bacterial infection from other causes is important because the prompt use of antibiotics is critical in bacterial infection. Traditional markers of infection such as BT and WBC count may be unspecific and culture may be late or absent. CRP and Procalcitonin (PCT) have been considered to evaluate the evolution of infections and sepsis in patients presenting with SIRS. Neopterin has also been proposed to aid in the diagnosis of bacterial infection. In this study, we compared the value of the serum PCT, neopterin level, and WBC count for predicting bacterial infection and outcome in children with fever.Methods158 pediatric (2-120-month-old) patients suspected to have acute bacterial infection, based on clinical judgment in which other causes of SIRS were ruled out were included in the study. WBC count with differential was determined and PCT and neopterin levels were measured.ResultsPCT level was higher in bacterial infection and patients who were complicated or expired.ConclusionRapid PCT test is superior to neopterin and WBC count for anticipating bacterial infection, especially in ED where prompt decision making is critical. Abbreviations: BT, body temperature; WBC, white blood cell; PCT, procalcitonin; CRP, C-reactive protein; SIRS, systemic inflammatory response syndrome; ED, emergency department.