Relationships between indoor allergens, sensitization, and allergic asthma and rhinitis symptoms

INTRODUCTION: There is a strong and consistent association between immediate hypersensitivity, asthma and exposure to allergens. However, the role that the inhaled allergen plays and the timing of events related to sensitization are still controversial. BACKGROUND: Information obtained by studies of the follow-up of cohorts underlines the fact that there is no continuum between specific IgE responses and the development of childhood asthma. Allergic rhinitis and asthma result from a complex and multifactorial interaction between genetic factors, exposure to allergens, and many biological or chemical co-factors. However, when the child is exposed to an allergen, sensitization to the allergen is a risk factor for childhood asthma and severity of the disease. CONCLUSIONS AND VIEWPOINTS: Despite numerous epidemiological studies, the association and links between atopy, allergens, environment, sensitization and allergic rhinitis and/or asthma remain difficult to evaluate and poorly understood. Complementary studies are also necessary for the standardization of therapeutic strategies.     

Need for improved antimicrobial and infection control stewardship in Vietnamese intensive care units

Objective Survey of antibiotic consumption, microbial resistance and hygiene precautions in the intensive care units of three hospitals in northern Vietnam. Methods Observational study. Data were collected from the microbiological laboratories. Antibiotic consumption was determined based on quantities of drugs delivered from the pharmacy. A protocol to observe the application of hygiene precautions was developed and used. Bacteria were typed and tested for drug susceptibility using the disc‐diffusion method. Results The mean antibiotic consumption was 811 defined daily doses per 1000 occupied bed days. The most commonly used antibiotics were third‐generation cephalosporins, followed by carbapenems, amoxicillin and ampicillin. Eighty per cent of bacterial isolates were Gram‐negative. The most common pathogens found in blood cultures were Escherichia coli and Klebsiella spp., Pseudomonas spp., Acinetobacter spp., Staphylococcus aureus and Enterococcus faecalis. Acinetobacter and Pseudomonas spp. were the two most frequently isolated bacteria from the respiratory tract and all other sources together. Seventy per cent of Acinetobacter species showed reduced susceptibility to imipenem, 80% to ciprofloxacin and 89% to ceftazidime. Forty‐four per cent of Pseudomonas spp. showed reduced susceptibility to imipenem, 49% to ciprofloxacin and 49% to ceftazidime. Escherichia coli was fully susceptible to imipenem, but 57% of samples were resistant to both ciprofloxacin and cefotaxime. Hygiene precautions were poor, and fewer than 50% of patient contacts incorporated appropriate hand hygiene. Conclusion Low antibiotic consumption, poor hygiene precautions and the high level of antibiotic resistance indicate that there is room for improvement regarding antibiotic use and infection control.     

Dyslipidémies de la femme après 50 ans : le rôle de l’âge et de la ménopause

A high prevalence of cardiovascular risk factors is reported in postmenopausal women. The objective of this review was to determine whether the effect of the menopause on lipid profile remained after adjusting for age in middle age women. The results of 10 cross sectional studies and nine longitudinal studies added evidence of a worsening effect of the menopause on total cholesterol, LDL cholesterol and triglyceride plasmatic levels. This effect remained after adjustment for age. Menopausal estrogenic deficiency could be an explanation for those results, even if the hormonal replacement therapy effect on the lipid profile remains unclear.     

Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial

Objectives There has been increased attention to access to water, sanitation and hygiene (WASH) at schools in developing countries, but a dearth of empirical studies on the impact. We conducted a cluster‐randomized trial of school‐based WASH on pupil absence in Nyanza Province, Kenya, from 2007 to 2008. Methods Public primary schools nested in three geographical strata were randomly assigned and allocated to one of three study arms [water treatment and hygiene promotion (WT & HP), additional sanitation improvement, or control] to assess the effects on pupil absence at 2‐year follow‐up. Results We found no overall effect of the intervention on absence. However, among schools in two of the geographical areas not affected by post‐election violence, those that received WT and HP showed a 58% reduction in the odds of absence for girls (OR 0.42, CI 0.21–0.85). In the same strata, sanitation improvement in combination with WT and HP resulted in a comparable drop in absence, although results were marginally significant (OR 0.47, 0.21–1.05). Boys were not impacted by the intervention. Conclusion School WASH improvements can improve school attendance for girls, and mechanisms for gendered impacts should be explored. Incomplete intervention compliance highlights the challenges of achieving consistent results across all settings.     

Clinical exercise testing and the Fick equation: strategic thinking for optimizing diagnosis

This article examines the expected exercise-induced changes in the components of the oxygen transport system as described by the Fick equation with a view to enable a critical analysis of a standard incremental exercise test to identify normal and abnormal patterns of responses and generate hypotheses as to potential physiological and/or pathophysiological causes. The text reviews basic physiological principals and provides useful reminders of standard equations that serve to integrate circulatory, respiratory and skeletal muscle functions. More specifically, the article provides a conceptual and quantitative framework linking the exercise-induced increase in whole body oxygen uptake to central circulatory and peripheral circulatory factors with the view to establish the normalcy of response. Thus, the article reviews the exercise response to cardiac output determinants and provides qualitative and quantitative perspective bases for making assumptions on the peripheral circulatory factors and oxygen use. Finally, the article demonstrates the usefulness of exercise testing as an effective integrative physiological approach to develop clinical reasoning or verify pathophysiological outcomes.     

Evaluation of serum zonulin level in prediabetic patients

BackgroundThis study aimed to investigate the relationship between lipopolysaccharide (LPS) and zonulin levels and also to show the effect of acute hyperglycemic stress induced by oral glucose tolerance testing (OGTT) on zonulin levels in pre-diabetic patients.MethodsFour groups were constituted according to the criteria of the American Diabetes Association (ADA), based on OGTT results: control group (n:40); prediabetic group (n:56), divided into two subgroups: impaired fasting glucose group (IFG) (n:36), and impaired glucose tolerance (IGT) + IFG group (n:20) and type-2 diabetes mellitus (T2DM) group (n:45).ResultsZonulin and LPS did not significantly differ between the prediabetes and control groups, but were significantly higher in the T2DM group compared to both the prediabetic and the control group (P < 0.001). After OGTT, zonulin and LPS were significantly higher in the prediabetes group compared to the control group (P < 0.01 and P < 0.05, respectively), and significantly lower in the IFG and IFG + IGT groups compared to the T2DM group (P < 0.001, P < 0.001 and P < 0.001, P < 0.001, respectively). A positive correlation was detected between fasting zonulin and 2-hour zonulin (r = 0.727, P < 0.001) and between fasting LPS (r = 0.555, P < 0.001) and 2-hour LPS (r = 0.567, P < 0.001) in the prediabetic group. Increased zonulin and LPS levels and the positive correlation between these levels during the prediabetic period although non significant suggests onset of intestinal permeability.ConclusionsDuring acute hyperglycemia in prediabetic patients, up-regulation of zonulin and LPS may affect intestinal function. The intestines may play a key role in up-regulation of glucose and the pathogenesis of diabetes.     

Fourier transform spectral analysis of cutaneous blood flux in systemic sclerosis

OBJECTIVES: Endothelial dysfunction is an early event and a critical step in the pathogenesis of systemic sclerosis. Accurate and sensitive tests are needed to correctly assess the degree of microvascular endothelial dysfunction. Spectral analysis of skin blood flow contains a characteristic low frequency reported to be associated with endothelial function in healthy subjects. We hypothesized that the relative amplitude of the oscillation recorded for this low frequency spectrum (0.008 to 0.021 Hz) would be less pronounced in patients with systemic sclerosis than in healthy subjects and in patients with primary Raynaud's phenomenon. PATIENTS AND METHOD: Twenty-one patients with systemic sclerosis, twenty patients with primary Raynaud phenomenon and eleven healthy subjects were enrolled. Skin perfusion was recorded at rest for 30 minutes using laser Doppler flowmetry on the pad of the left third left. Fourier transform spectral analysis was applied to obtain the mean amplitude of the cutaneous blood perfusion signal of the total spectrum from 0.008 to 1.6 Hz and the mean amplitude of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations. RESULTS: The relative amplitudes of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations were not statistically different in the three groups, particularly for frequency spectrum from 0.008 Hz to 0.021 Hz. CONCLUSION: Fourier transform spectral analysis of baseline cutaneous blood flow does not provide significant information. Further studies are required, perhaps using wavelet spectral analysis or stimulated conditions.     

Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden

Background

Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.

Lipoprotein(a): Pathophysiology,measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

Central Illustration. Pathophysiological pathways providing a causal link between high plasma concentrations of lipoprotein(a) (Lp(a)) and atherosclerotic vascular disease and aortic valve stenosis (AVS). Clinical outcomes are related to accelerated atherosclerosis complicated by atherothrombosis (myocardial infarction, stroke), peripheral artery disease (PAD) or aortic valve replacement (AVR) caused by valve calcification and aortic stenosis. Apo(a): apolipoprotein(a); LDL: low-density lipoprotein; OxPL: oxidized phospholipids; NSFA: Nouvelle Société Francophone d’Athérosclérose; SP: serine-protease domain; V: plasminogen kringle V (reproduced with permission).