Immediate food hypersensitivity reactions on the first known exposure to the food

We report 8 infants with immediate hypersensitivity reactions to foods (milk, egg, or peanut), occurring at the first-known exposure. Each developed symptoms within the first hour, but these generally settled within 2 hours. Sensitisation to the food concerned was demonstrated by positive immediate allergen skin prick tests in every case. Symptoms experienced included irritability, erythematous rash, urticaria, angio-oedema, vomiting, rhinorrhoea, and cough. Five infants were being followed prospectively and 4 were clinically tolerant of the food by age 16 months. The most likely route of sensitisation was via breast milk. None of the infants experienced similar reactions while being breast fed, suggesting that the reaction was dose dependent. As 5 out of a group of 80 infants being followed prospectively developed an immediate reaction at their first known exposure to a food, this appeared to be a not uncommon presentation of food hypersensitivity in infancy.     

Risk Assessment for Osteoporosis Using Bone Mineral Density Determination: A Belgian Perspective

The availability of bone densitometry in daily clinical practice has revolutionized the capacity to detect osteoporosis, to estimate the risk of future fracture, and to select those patients who are likely to benefit most from preventive or therapeutic measures. In spite of the high availability of densitometry in Belgium and the high incidence of risk factors for osteoporosis in elderly women, osteoporosis is presumably underdiagnosed. It is likely that the limited use of widely available technology to evaluate osteoporosis results from a complex interaction of numerous factors, some of which are discussed. In spite of many unanswered questions, the main conclusion to be drawn from the Belgian experience is that a high density of densitometry facilities is no guarantee that the majority of women who are at greatest risk of fracture will actually become the focus of preventive measures or therapy.     

A special case on the use of ultrasonography for evaluation of the spinal canal and its contents in adults

In this article we present a 70-year-old man with a history of severe trauma in the upper thoracic spine. This patient presented at our emergency department with a leaking wound in the lower neck after removal of osteosynthetic material. He had undergone a laminectomy of the third thoracic vertebra in the past. As an incidental finding, while examining the region of the lower neck by transcutaneous ultrasonography, we diagnosed a post-traumatic syrinx of the spinal medulla at this level.     

Real Time-PCR HBV-DNA Analysis: Significance and First Experience in Armed Forces

Background

HBV DNA quantitation is used extensively world wide for the diagnosis and monitoring of treatment of Hepatitis B virus (HBV) infection. However, it has still to be popular in India. The aim of this study was to quantitate HBV – DNA by Real time – PCR method in Hepatitis B and in immuno-compromised patients, to compare the results with HBeAg detection and to monitor the response to therapy of chronic Hepatitis B patients to antivirals.

Methods

Ninety one serum samples of Hepatitis group of patients (all HBsAg positive), 41 samples from immuno-compromised patients (all HBsAg negative) and 49 patients of Chronic Hepatitis B group (all HBsAg positive) were the subjects of this first ever study in Armed Forces. Twenty serum samples from healthy volunteers and non-hepatitis B patients served as negative controls. The amplification detection was carried out in a Rotor-Gene 2000-sequence detector

Results

Amongst Hepatitis B group, 33% (30/91) of the samples were positive for HBV-DNA and 26% (24/91) of samples were positive for HBeAg. In the immuno-compromised group of patients 14.6% (6/11) of samples were positive for HIV-DNA and 9.7% (4/41) were positive for HBeAg. Of the Chronic Hepatitis B patients on treatment, all (100%) were positive by HBV-DNA, whereas 29/49 (59.2%) were positive by HBeAg before treatment. After treatment with antivirals, 06/49 (12.2%) were positive by both tests and 11/49 (22.5%) were positive only by HBV-DNA. 32/49 (65.3%) patients became negative serologically after therapy.

Conclusion

HBeAg status did not necessarily reflect HBV-DNA level in the serum, as 10/91 (11%) in the Hepatitis B group, 2/41 (4.9%) in the immuno compromised group and 20/49 (40.8%) patients in the Chronic Hepatitis B group were positive for HBV-DNA but negative for HBeAg. HBV-DNA was not found to be positive amongst any of the negative controls. Real time – PCR is a sensitive and reproducible assay for HBV-DNA quantitation and may be started in Armed Forces referral centers in the near future.Key Words: Real time – PCR, Chronic Hepatitis B, HBV – DNA, Antivirals     

A cross-sectional study of postmenopausal women found an association between osteoporosis and past gastric surgery or oral corticosteroids

OBJECTIVE: To determine the relationship between osteoporosis and the presence of specific and nonspecific medical conditions in postmenopausal women. To what extent is this relationship useful in detecting osteoporosis in daily general practice. STUDY DESIGN AND SETTING: Subjects were 1,684 postmenopausal women registered with 23 general practitioners. Multivariate logistic regression analysis was done with 52 disease variables and 24 biometrical and lifestyle variables, using BMD as the dependent variable. Bivariate analysis was performed to calculate their contribution to the risk of having osteoporosis. RESULTS: Having more than one disease was associated with a lower prevalence of osteoporosis. A positive association with the presence of osteoporosis was only found for the use of corticosteroids, gastric surgery, and cervical complaints. The risk for osteoporosis in the high risk category increased from 39 to 71% in women using oral corticosteroids, from 39 to 56% in women with a history of gastric surgery, and from 39 to 63% in women with cervical complaints. CONCLUSION: The clinical relevance of medical conditions for detecting osteoporosis is limited. However, all patients using oral corticosteroids and patients with a history of gastric surgery should be checked for the presence of osteoporosis. Cervical compaints in the high risk category was associated with osteoporosis.     

Falls and fractures in postmenopausal women: a review

Older people are a major risk group for falls. 35-40% of over-65s living at home fall at least once a year, and between a third and a half of these fall twice or more. The figure rises to 50% for the over-80s. Falls contribute to the occurrence of fractures. Of all the fractures linked to osteoporosis and falls, hip fractures are the most important in terms of early death, functional dependence, and costs of care. Many identifiable risk factors have been shown to contribute to hip fracture risk, including low bone density, previous fractures, clinical risk factors for falls, and low body weight. Interaction has been found between falls and osteoporosis in the occurrence of fractures. Prospective studies are needed to evaluate whether a combined bone- and fall-directed therapy can further decrease the risk for fractures in patients with low bone density and an increased fall risk.     

A SURVEY OF HOSPITAL MORBIDITY,MORTALITY AND QUALITY OF LIFE FOLLOWING CORONARY ARTERY BYPASS SURGERY IN A UK INDO-ASIAN POPULATION

To survey the in-hospital morbidity, mortality, length of stay in the intensive therapy unit (ITU) and hospital and quality of life in patients of Indo-Asian origin following coronary artery bypass (CABG) surgery, 345 consecutive patients (mean age 58 years; SD 8.9; range 32-88 years) undergoing primary, isolated CABG were studied. Non-elective CABG was undertaken in 41% of patients. The left anterior descending artery (LAD) was grafted in 89%, although in 30% of these the internal mammary artery (IMA) was not used. Following CABG, the hospital morbidity and mortality was within the expected range, although there was a trend towards higher in-hospital mortality in the Parsonnet low risk group of patients. The length of ITU and hospital stay was not prolonged. Using the SF-36 questionnaire in postoperative patients, low quality of life scores were obtained for six of the eight modalities tested including physical functioning, bodily pain and general health perception. The low quality of life scores and IMA usage in Indo-Asians needs to be addressed.     

Femoral neck trabecular microstructure in ovariectomized ewes treated with calcitonin: MRI microscopic evaluation.

Ovariectomy induces deterioration of the trabecular structure in the femoral neck of ewes, as depicted by MR microscopic imaging. This structural deterioration is prevented by salmon calcitonin treatment. INTRODUCTION: This study evaluated the trabecular (Tb) microarchitecture of an ovariectomy (OVX)-induced osteoporotic model in ewes and determined the effects of salmon calcitonin (sCT), an osteoclast inhibitor, on the Tb structure. This is the first report of OVX-induced changes in the Tb structure in the femoral neck in the ewes and effect of sCT on the microarchitecture. MATERIALS AND METHODS: Ewes (5-8 years old, n = 28) were equally allocated into sham (Sham), OVX injected with vehicle, or OVX injected with sCT at 50 or 100 IU, three injections per week. They were killed 6 months after OVX. The femoral neck was examined with an MR imager at 9.4 T in axial, coronal, and sagittal planes. An internal calibration procedure as a means of standardizing image analysis was used to adjust the segmentation threshold. Data from all three planes were averaged. RESULTS AND CONCLUSIONS: Compared with Sham, OVX induced significant changes (p < 0.0125) in the MRI-derived femoral neck Tb structure: Tb bone volume fraction (BV/TV), -18%; Tb number, -20%; Tb separation, +23%; number of free ends, +28%; number of nodes, -39%; number of Tb branches, -23%; mean length of Tb branches, -19%. Compared with OVX, treatment of sCT at 100 IU significantly improved all the Tb structural parameters to the Sham level (p < 0.0001 approximately p = 0.0281), whereas 50 IU significantly increased the Tb number and the mean length of the Tb branches. BV/TV explained 74% of the variation of compressive stress of the trabecular cylinder cores of the femoral neck. Combining all structural parameters in a multivariate regression analysis significantly improved the explanation to 84%, and adding BMD further improved the predictive ability of the model to 92%. We conclude that OVX induces deterioration of the MRI-derived Tb microstructure in the femoral neck of ewes. sCT treatment prevents OVX-induced changes. The femoral neck microarchitecture significantly correlates with its biomechanical properties. Combining microstructural parameters with BMD further improves the prediction of bone biomechanical properties. The effects of sCT on OVX ewes may help explain reduced fracture risk in postmenopausal osteoporotic women treated with sCT.