The role of allergic risk and other factors that affect the occurrence of atopic dermatitis in the first 6 months of life

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies. OBJECTIVE: To determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life. METHODS: A 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors. RESULTS: This study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects. CONCLUSION: The associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.

Learning across boundaries.

This study aims to compare the learning process and achievement of the third year students who have undergone the old style curriculum and the fourth year students had undergone the Student Centered Learning approach for the past year. These two different groups were mixed for tutorial discussions. The tutorial sessions were provided with one scenario - the subject of Oral Medicine III: the compromisedpatient. We focused on comparing the results of both groups on the process of learning and the block test. The eight mixed tutorial groups comprised of 16-20 students (half from the old style curriculum and half from the student-centered approach group) each. They were assessed by two tutors on the learning process: the time schedule, activity during discussion and relevance of questions asked. Furthermore, the study compared the results of the block test on 5 multiple choice questions (MCQs) on the compromisedpatient among 100 MCQs at the final examination. There was no significant difference between the two groups for the process of learning and the result of the block test. This study challenges the belief that new concepts or knowledge require prior knowledge; is known as learning across boundaries.