Specific IgE against staphylococcal enterotoxin [superantigens] in allergic rhinitis: an independent risk factor for severe bronchial asthma

The study aimed to investigate whether IgE to Staphylococcus aureus enterotoxins might be relevant to disease severity in adult asthmatic patients. Specific IgE antibody concentrations in serum against enterotoxins, grass pollen [GP], and house dust mite [HDM] allergens and total IgE levels were measured in 69 adult control subjects, 152 patients with non-severe asthma, and 166 patients with severe asthma. Severe asthma was defined as inadequately controlled disease despite high-dose inhaled corticosteroids plus at least 2 other controller therapies, including oral steroids. Statistical analysis demonstrated Enterotoxin IgE positivity which was significantly greater in patients with severe asthma [59.67%] than in healthy control subjects [13% P< .001]. Twenty-one percent of patients with severe asthma showing positive enterotoxin IgE were considered non atopic. Also statistical analyses demonstrated significantly increased risks for enterotoxin IgE-positive subjects to have severe asthma [95%] versus enterotoxin IgE-negative subjects. The presence of GP or house dust IgE antibodies was not associated with either significantly increased risk for asthma or severity. Oral steroid use and hospitalizations were significantly increased in patients with positive enterotoxin IgE and non-atopic asthma. GP IgE was associated with a higher FEV1 percent predicted value and enterotoxin IgE was associated with a lower FEV1 percent predicted value. Staphylococcal enterotoxin IgE antibodies, but not IgE against inhalant allergens, are risk factors for asthma severity. We hypothesize that the presence of enterotoxin IgE in serum indicates the involvement of Staphylococcal superantigens in the pathophysiology of patients with severe bronchial asthma

Expression of epidermal growth factor receptor [EGFR], p53 and Ki-67 in major salivary glands tumors: a clinicopathologic and immunohistochemical study

The parotid gland is the most common site for the uncommon salivary glands tumors. However the immunohistochemical characteristics of the salivary gland tumors, regarding expression of proliferating cell antigens and oncogenes, in relation to their clinical behavior have not been fully clarified. These may provide predictive quantitative measures for the prognosis of salivary neoplasms and may assess in their management. The aim of this study was to detect the immunohistochemical expression of epidermal growth factor receptor [EGFr], ki-67 proliferating cell antigen and p53 concoprotein in major salivary glands tumors and also to study the relation between these markers expression and the clinicopathological parameters of these tumors focusing on prognostic factors and tumor differentiation. Thus twelve patients with primary tumors of their major salivary glands were included in this study. They were seven men and five women and ranged in age between 32 to 67 years [mean age=51.7 years]. All patients were treated surgically by complete excision of their masses after preoperative investigations including computed tomographic [CT] scan and fine-needle aspiration biopsy [FNAB] and followed up clinically postoperatively for a period ranging from 11 to 48 months [average =33 months]. The tumor size ranged between 15 and 55 mm [average = 31.2 mm]. The clinicopathologic features and the immunohistochemical expression of EGFr, p53 and ki-67 detected with monoclonal antibodies in these cases were analyzed. The results revealed that 6 cases [50%] showed grade-1 of differentiation while the other 3 cases [75%] were grade-II. None of these cases had cellular pleomorphism, vascular or neural invasion, recurrence, lymph modes or distant metastasis. [5 cut of 6 cases. 83.3%] and in all ALs and MECs with no significant differential expression in the various salivary gland tumors. However, p53 and ki-67 expressions were negative in almost all benign cases [PAs and Als] and positive in all MECs but with no significant difference between grade-1 and grade-II cases. Also, no significant association was found between any of these cell markers and the evaluated clinicopathologic parameters of these tumors regarding tumor location, size, aggressiveness, recurrences, lymh nodes or distant metastasis. In conclusions, there was a high prevalence of EGFr expression in primary salivary glands tumors [either benign or malignant with no significant difference]. However, p53 seems to be involved in the pathogenesis of MECs but not in Pas or Als. Also, the highly significant difference in expression of p53 and ki-67 biomarkers between the benign and the low-grade malignant tumors of the major salivary glands can help to distinguish between them, although they may have similarities in their clinicopatholoogic features

Ciliary dyskinesia in severe chronic rhinosinuitis patients and using a modified fess approach for management

Defective ciliary ultrastructure and impaired mucociliary clearance play an important role in the development of severe or refractory chronic respiratory tract disease which is still a challenging problem. The aim of this study was to define the role of ciliary dyskinesia in severe chronic rhinosinusitis. Also, the validity of a modified functional endoscopic sinus surgery [FESS] for treating such patients is evaluated in this study. Fifteen patients [8 males and 7 females with a mean age = 17.2 years] with severe chronic rhinosinusitis [i.e., refractory to medical treatment] with suspected ciliary dyskinesia [i.e., with prolonged saccharin test more than 45 minutes] were included in this study. All patients had a preoperative computerized tomographic [CT] sean documentation of their severe multiple sinus disease. They were treated with a modified FESS under general anaesthesia during which nasal biopsies from the middle turbinate were taken for evaluation by transmission electron microscopy [TEM] to detect ultrastuctural abnormalities. Also, two nasal biopsies from normal volunteers were taken as controls. The patients were followed up postoperatively for a period of 9 to 18 months [average 12 months] both clinically [by nasal endoscope] and radiologically [by coronal CT scan] with special emphasis on patency of middle meatal antrostomy [MMA]. Transmission electron microscopic [TEM] study of nasal epithelium of control subjects revealed normal ciliated pseudostratified columnar epithelium. While in the study group, ciliated cells were detected in 11 [73%] biopsies with 4[27%] cases having no cilia. However, foci of normal ciliated epithelium were found in only 7 [47%] biopsies and often in epithelial invaginations. Six patients [40%] in the study group had shown rimary Ciliary dyskinesia [PCD]. Nine [60%] of study group patients showed Secondary Ciliary dyskinesia [SCD] with variable ultratructural defects affecting minor population of cilia in the specimen [5 secimens or 33%], or with squamous metaplsia or denuded surface with complete loss of cilia [4 specimens or 27%]. All biopsies showed variable loss of differentiated epithelial cells ranging from denuded epithelim to basal cell hyperplasia often associated with squamous metaplasia secondary to chronic sinonasal disease. This study demonstrated that patients with severe or refractory chronic rhinosinusitis exhibit a prominent loss of differentiated epithelial cells, as well as ciliary defects, most of which are likely to be secondary to the chronic disease process. The modified FESS used in this study was highly effective in treating patients with severe or refractory chronic rhinosinusitis with ciliary dyskinesias [either primary or secondary] with patent MMA and relief of their severe manifestations as it improves the gravitational drainage and aireation of the paranasal sinuses besides respecting the mucociliaray clearance concepts