Beyond Hygiene: Commensal Microbiota and Allergic Diseases

Complex communities of microorganisms, termed commensal microbiota, inhabit mucosal surfaces and profoundly influence host physiology as well as occurrence of allergic diseases. Perturbing factors such as the mode of delivery, dietary fibers and antibiotics can influence allergic diseases by altering commensal microbiota in affected tissues as well as in intestine. Here, we review current findings on the relationship between commensal microbiota and allergic diseases, and discuss the underlying mechanisms that contribute to the regulation of allergic responses by commensal microbiota.

Can a six-minute walk distance predict right ventricular dysfunction in patients with diffuse parenchymal lung disease and pulmonary hypertension?

Objectives: Pulmonary hypertension [PH] is commonly observed in patients with diffuse parenchymal lung disease [DPLD]. The purpose of this study was to explore the influence of the 6-minute walk test [6MWT] as a simple, non-invasive tool to assess right ventricular [RV] function in patients with DPLD and to identify the need for an echocardiogram [ECHO] to screen for PH

Methods: We retrospectively reviewed 48 patients with PH secondary to DPLD, who were evaluated in the PH clinic at the Mayo Clinic in Jacksonville, Florida, from January 1999 to December 2014

Results: Fifty-two percent of patients had RV dysfunction. They had a significantly greater right heart pressure by ECHO and mean pulmonary arterial pressure [MPAP] from right heart catheterization [RHC] than those with normal RV function. A reduced 6-minute walk distance [6MWD] did not predict RV dysfunction [OR 0.995; 95% CI 0.980-1.001, p = 0.138]. In addition, worsening restrictive physiology, heart rate at one-minute recovery and desaturation were not different between patients with and without RV dysfunction. However, there were inverse correlations between 6MWD and MPAP from RHC [r = -0.41, p = 0.010], 6MWD and RV systolic pressure [r = -0.51, p < 0.001], and 6MWD and MPAP measured by ECHO [r = -0.46, p =0.013]. We also found no significant correlation between 6MWD and pulmonary function test parameters

Conclusions: Our single-center cohort of patients with PH secondary to DPLD, PH was found to have an impact on 6MWD. In contrast to our expectations, 6MWD was not useful to predict RV dysfunction. Interestingly, a severe reduction in the 6MWD was related to PH and not to pulmonary function; therefore, it may be used to justify an ECHO to identify patients with a worse prognosis

The Impact of Alcohol on HIV Prevention and Treatment for South Africans in Primary Healthcare

Background: Antiretroviral treatment (ART) has substantially reduced morbidity and mortality for HIV patients. In South Africa; with the largest ART programme globally; attention is needed not only on the further expansion of ART coverage; but also on factors which undermine its effectiveness; such as alcohol use. Objective: South African primary health sector; it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV. Method: This study comprised a narrative review of relevant literature. Results: Alcohol acts through both behavioural and physiological pathways to impact on the acquisition; further transmission and then progression of HIV disease. Besides links to risky sex; alcohol undermines the immune system; raising susceptibility to contracting and then countering HIV and other infections. There are important drug interactions between alcohol and ART; or therapies for opportunistic infections and other co-morbidities. Moreover; alcohol undermines adherence to the medication which is essential for effective ART. Conclusion: Primary healthcare clinic attendees need evidence-based information on the detrimental effects of alcohol consumption on HIV infection; which ensue throughout the clinical course of HIV. This spans the role of alcohol consumption as a risk factor for HIV infection; HIV replication in infected individuals; a person's response to HIV infection and HIV treatment. Primary healthcare workers; especially nurses and HIV counsellors; require training in order to screen for and provide appropriate interventions for HIV-positive patients; those on treatment and treatment-naive patients; who will benefit from reduced alcohol consumption or the cessation thereof

Chronic consumption of distilled sugarcane spirit induces anxiolytic-like effects in mice

OBJECTIVE: Chronic ethanol consumption is a major public health problem throughout the world. We investigated the anxiolytic-like effects and the possible ever injury induced by the chronic consumption of ethanol or sugarcane spirit in mice. METHOD: Adult mice were exposed to a two-bottle free-choice paradigm for 6 weeks. The mice in Group A (n = 16) had access to sugarcane spirit + distilled water, the mice in Group B (n = 15) had access to ethanol + distilled water, and the mice in Group C (control, n = 14) had access to distilled water + distilled water. The ethanol content in the beverages offered to Groups A and B was 2 percent for the first week, 5 percent for the second week and 10 percent for the remaining four weeks. At the end of the experimental period, the mice were evaluated using the elevated-plus maze and the hole-board test to assess their anxiety-related behaviors. We also determined the serum aspartate aminotransferase and alanine aminotransferase levels. RESULTS: In the elevated-plus maze, the time spent in the open arms was increased in the mice exposed to chronic ethanol (32 + 8 vs. 7 + 2 s, n = 9) or sugarcane spirit (36 + 9 vs. 7 + 2 s, n = 9) compared to the controls. In the hole-board test, the mice exposed to ethanol or sugarcane spirit displayed increases in their head-dipping frequency (16 + 1 for the control group, 27 + 2 for the ethanol group, and 31 + 3 for the sugarcane-spirit group; n = 9 for each group). In addition, the mice exposed to sugarcane spirit displayed an increase in the aspartate aminotransferase / alanine aminotransferase ratio compared to the ethanol group (1.29 + 0.17 for the control group and 2.67 + 0.17 for the sugarcane spirit group; n = 8 for each group). CONCLUSION: The chronic consumption of sugarcane-spirit produces liver injury and anxiolytic-like effects and the possible liver injury in mice.

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Análisis preliminar y datos normativos del Cuestionario de Ansiedad Estado-Rasgo en adolescentes y adultos de la ciudad de Santiago de Chile / Preliminary analysis and normative Data of the State-Trait Anxiety Inventory (STAI) in adolescent and adults of Santiago, Chile

El estudio reporta los análisis preliminares y datos normativos, para una muestra de población general del Cuestionario de Ansiedad Estado Rasgo (Spielberger, Gorsuch & Lushene, 1970). Los datos fueron obtenidos de una muestra total de 1488 personas entre 13 y 60 años de edad. La consistencia interna obtenida fue .92, para STAI-S y .87 para STAI-R. Del análisis factorial confirmatorio se obtienen dos factores para cada escala. Finalmente, se realizan análisis de comparación de medias para la obtención de datos normativos, para la muestra total diferenciada por sexo y para la muestra de adolescentes y adultos.

The present study reports the preliminary analyses and normative data of the State-Trate anxiety inventory (Spielberger, Gorusch & Lushene, 1970), for a Chilean, general population sample. Data were obtained from a total sample of 1488 people, between 13 and 60 years old. A high internal consistency for STAI-S .92 and for STAI-T .87 is reported. Two factors were obtained from the confirmatory factorial analysis. Finally, analyses of the means were carried out, obtaining normative data for the total sample, differentiated by sex, and for the adolescents and adults sample.

An evaluation of the intensive care unit resources and utilization in Trinidad / Una evaluación de los recursos y la utilización de las unidades de cuidados intensivos en trinidad

OBJECTIVES: To evaluate resources and utilization of Intensive Care Units in Trinidad and Tobago. DESIGN AND METHODS: This was a prospective observational study to evaluate Intensive Care Units (ICU) of three public and two private hospitals in Trinidad with respect to their infrastructure, process of care and patient outcome. Structure of ICUs was assessed by interviews and personal observations. A Cost Block Model was used to determine the expenditure for ICUs. The process of ICU was assessed by Therapeutic Intervention Scoring System (TISS-28). For outcome evaluation, two prognostic scoring systems namely Simplified Acute Physiology Score (SAPS II) and Paediatric Index of Mortality-2 (PIM-2) were used RESULTS: The total number of ICU beds was 27. The overall bed occupancy was 66.2%. One hundred and eighteen patients consecutively admitted to ICU during a two-month period were enrolled for process and outcome evaluation. The overall median age of patients was 44 years [Interquartile range (IQR) 25, 59]. The mean cost per patient in the public hospitals was TT $64,746 compared to $77,000 in a private hospital. The average total daily TISS per patient was 27.01 +/- 5.4 (SD). The median length of stay was five days (IQR 2, 9). The overall predicted mortality was 32.9%, the observed mortality was 29.7% and thus the standardized mortality ratio (SMR) was 0.9. CONCLUSIONS: The overall bed availability in ICUs with respect to Trinidad and Tobago's population and case-mix is low compared to developed countries, although the process of ICU care is comparable. Outcome of patients was good in terms of risk-adjusted mortality. The study highlights the need to further increase bed-strength and optimize the resource utilization of ICUs in Trinidad and Tobago.

OBJETIVOS: Evaluar los recursos y su utilización en las Unidades de Cuidados Intensivos en Trinidad y Tobago. DISEÑO Y MÉTODOS: Se trata de un estudio prospectivo observacional con el propósito de evaluar las Unidades de Cuidados Intensivos de tres hospitales públicos y dos privados en Trinidad, con respecto a su infraestructura, proceso de cuidado y respuesta clínica (resultado) del paciente. La estructura de las UCIs fue evaluada mediante entrevistas y observaciones personales. Un modelo de bloques del costo fue usado a fin de determinar los gastos en relación con las UCIs. El proceso de la UCI fue evaluado mediante el Sistema de Puntuación de Intervención Terapéutica (TISS-28). Para la evalua-ción del resultado clínico, se utilizaron dos sistemas de puntuación pronóstica, a saber, la puntuación simplificada de fisiología aguda (SAPS II) y el Índice Pediátrico de Mortalidad (PIM2). RESULTADOS: El número total de camas de UCI fue 27. La ocupación general de las camas fue de 66.2%. Los ciento dieciocho pacientes ingresados consecutivamente en la UCI durante un período de dos meses, fueron incorporados a la evaluación del proceso y los resultados. La edad mediana general de todos los pacientes fue de 44 años y el rango intercuartil (IQR) 25,59. El costo medio por paciente en los hospitales públicos fue TT $64 746 en comparación con $ 77 000 en un hospital privado. Según el TISS, el total promedio diario por paciente fue 27.01 ± 5.4 (SD). El tiempo mediano de estadía fue de 5 días (IQR 2, 9). La mortalidad general anticipada fue de 32.9%, la mortalidad observada fue de 29.7%, y por consiguiente la razón de mortalidad estandarizada (SMR) fue 0.9. CONCLUSIONES: La disponibilidad total de camas en las UCIs con respecto a la población y la casuística de Trinidad y Tobago, es baja en comparación con los países en desarrollo, aunque el proceso de cuidado de las UCIs es comparable. El resultado clínico de los pacientes fue bueno en términos de la...

A computer program for single-injection tracer clearance from one, two, or many blood samples

A computer program based on a Bayesian statistical model has been developed for calculating tracer clearance from any number of plasma samples drawn at arbitrary time intervals. Bayesian prior parameters were calculated from clinical data for Tc99m-MAG3, Tc99m-EC, I131-OIH, Tc99m-DTPA, and Yb169-DTPA and then used to calculate clearance from prospective data. Clearance estimates using only one or two plasma samples were found to closely approximate the results of using multiple samples. When only one or a few samples are available, the program supplements the observed data by a Bayesian prior probability distribution (based on prior clinical measurements) to achieve agreement with multisample clearance. When many points are available, the observed data overwhelm the prior probability, and results approach those of conventional curve fitting but with less sensitivity to bad data points and less risk of fitting failure.

Tuberculosis along the United States-Mexico border, 1993-2001

OBJECTIVES: Tuberculosis (TB) is a leading public health problem and a recognized priority for the federal Governments of both Mexico and the United States of America. The objectives of this research, primarily for the four states in the United States that are along the border with Mexico, were to: (1) describe the epidemiological situation of TB, (2) identify TB risk factors, and (3) discuss tuberculosis program strategies. METHODS: We analyzed tuberculosis case reports collected from 1993 through 2001 by the tuberculosis surveillance system of the United States. We used those data to compare TB cases mainly among three groups: (1) Mexican-born persons in the four United States border states (Arizona, California, New Mexico, and Texas), (2) persons in those four border states who had been born in the United States, and (3) Mexican-born persons in the 46 other states of the United States, which do not border Mexico. RESULTS: For the period from 1993 through 2001, of the 16 223 TB cases reported for Mexican-born persons in the United States, 12 450 of them (76.7 percent) were reported by Arizona, California, New Mexico, and Texas. In those four border states overall in 2001, tuberculosis case rates for Mexican-born persons were 5.0 times as high as the rates for persons born in the United States; those four states have 23 counties that directly border on Mexico, and the ratio in those counties was 5.8. HIV seropositivity, drug and alcohol use, unemployment, and incarceration were significantly less likely to be reported in Mexican-born TB patients from the four border states and the nonborder states than in patients born in the United States from the four border states (P < 0.001). Multivariate analysis revealed that among pulmonary tuberculosis patients who were 18-64 years of age and residing in the four border states, the Mexican-born patients were 3.6 times as likely as the United States-born patients were to have resistance to at least isoniazid and rifampin (i.e., to have multidrug-resistant TB) and twice as likely to have isoniazid resistance. Mexican-born TB patients from the four border states and the nonborder states were significantly more likely to have moved or to be lost to follow-up than were the TB patients born in the United States from the four border states (P < 0.001). CONCLUSIONS: Increased...

Avaliação do InstantScreen na rotina, um ensaio ultra rápido para detecção de anticorpos anti-HIV-1/2 / Evaluation of InstantScreen under routine, an ultra rapid HIV-1/2 assay for the detection of HIV antibodies

Objetivo: Avaliar o InstantScreen Rapid HIV-1/2(GAIFAR GmbH, Alemanha), em condições de rotina em Caxias do Sul, RS, Brasil. Métodos: 781 amostras de soro coletadas de doadores de sangue, de pacientes com síndrome da imunodeficiência adquirida (SIDA), de gestantes e de crianças (<12 meses de idade) atendidas em instituições de saúde locais. Os testes foram realizados entre o dia 1 de abril até 20 de dezembro de 2001. O soro foi pesquisado para a presença de anticorpos anti HIV pelo InstantScreen assim como por testes de referência (Genscreen HIV 1/2 Vrsion 2, sanofi Pasteur; ICE HIV 1.0.2, Murex Diagnostics e Abbott Axsym HIV-1/HIV-2, Abbott Diagnostics. Resultados: 780 amostras testadas obtiveram os seguintes dados de desempenho: sensibilidade (IC = 95%) 160/160 = 100% (98-100%), especificidade (IC = 95%) 620/620 = 100% (99-100%). conclusão: O teste se mostrou de alta confiabilidade. As membranas do teste podem ser removidas, servindo de opção para a documentação permanente. Devido à facilidade de execução, o teste é adequado para ser utilizado nas mais variadas condições de trabalho.

Antigen Nonspecific Death of Immature Thymocytes by Corticosteroids and TNF

BACKGROUND: In the thymus, developing thymocytes continually interact with thymic epithelial cell components. Self MHC restriction of mature T cells are imposed in the thymus through interaction of immature double positive thymocytes and thymic cortical epithelial cells. The site of negative selection, however, is a matter of debate. Through systemic injection of anti-TCR antibody or antigenic peptides, investigators suggested that most of the negative selection occurs in the thymic cortex. But the requirements for negative selection, i.e cellular counterparts and costimulatory molecules are more available in the medulla or cortico-medullary junction rather than in the thymic cortex. METHODS: The direct and indirect pathways of thymocyte death after systemic anti-TCR antibody injection were separated through several experimental systems. B6 mice were either adrenalectomized or sham-adrenalectomized to evaluate the role of endogenous glucocorticoids from adrenal gland. Role of TNF were evaluated through using TNF receptor double knockout mice. RESULTS: We found that without indirectly acting mediators such as TNF-alpha or corticosteroid, double positive thymocyte death were minimal by systemic injection of anti-TCR antibody in TNF receptor double knockout neonatal mice. Also by analyzing neonatal wild-type mice with adoptively transferred mature T cells, only peripheral activation of mature T cells could induce extensive double positive thymocyte death. CONCLUSION: Thus, systemically injected anti-TCR antibody mediated thymocyte death are mostly induced through indirect pathway.

Evaluating the Necessity of Routine Monitoring of Netilmicin Serum Concentrations in Korean Pediatric Patients with Normal Renal Function / 감염

BACKGROUND: When pediatric patients with normal renal function were given the recommended keep-up amount of aminoglicocide for the use, they showed a better clinical symptom not indicating the poisonous without checking serum concentrations. We studied this subject against the patients who used Netimilcin in order to know if the blood creatinine significantly increases in a clinic and if it reaches the maximum and minimum concentrations without adjusting the amount and the symptom of infection and the result get better. METHODS: We picked the maximum concentration of drugstuffs 30 minutes after injection and its minimum just prior to the next injection within 24~32 hours with a vein injection of 2 mg/kg/dose Netilmicin with the 8 hours difference against 16 patients at the age between 3 months and 14 years. We measured the blood creatinine at the beginning of the treatment and at the closing, and we decided the medicine serum concentration with TDX system and we counted the result of Pharmaco-kinetic parameter with Simkin PC clinical Database system. To check the patients' result of better clinical conditions, leukocyte values and the temperature were measured 72 hours after the treatment. The analysis of statistics was performed with the use of paired t-test. RESULTS: The average age of 16 patients shows 3.5+/-3.2, average weight 15.2+/-8.5 kg, the leukocyte value first 14.9+/-6.6X10X10X10/mm3, and 72 hours after the treatment it shows 6.6+/-1.9X10X10X10/mm3, average temperature fell from 37.7+/-1 celsius into 36.3+/-0.4 celsius. The average drug amount taken in case of patients showed 2.06+/-0.4, the average treatment period was 7.6+/-2.3 days, the maximum serum concentration shows 5.5+/-1.1 mg/mL, the minimum concentration shows 0.5+/-0.3 mg/mL. The average blood creatinine was first 0.52+/-0.19 mg/mL, and at closing 0.46+/-0.11 mg/dL (P=0.209). The minimum concentration didn't show more than 2 mcg/mL, the blood creatinine didn't increase showing 0.5 mg/mL(P=0.201). CONCLUSION: At the result of checking the medicine concentration of Netilmicin in pediatric patients in our clinic, there is no detecting the betterment of the clinical symptom owing to the decrease of the values of leukocyte. There was no necessity to adjust the amount of medicine from the beginning to the end as there was no sign of change of blood creatinine. In view of this result, we can understand that we don't need the regular examination of the medicine concentration about the aminoglicocide from Korean pediatric patients with normal renal function.

Influência da biometria na crise da atenção à saúde: dicotomia entre a doença do médico e a doença do doente / Influence of biometry on crisis of the health care: dichotomy between physician'disease and the patient'disease

Este artigo analisa as influências do saber biomédico na crise da atenção à saúde, através do estabelecimento de correlações entre as características principais do paradigma clínico-epidemiológico da biomedicina e os dilemas, dissensos e fracassos da atividade médica cotidiana. Discute os aspectos teóricos, limitações do estilo de pensamento e pressupostos filosóficos do saber biomédico contemporâneo que fomentam, enquanto características inerentes a esse saber, a crise por que passa a medicina e a atenção à saúde contemporâneas nos serviços públicos brasileiros

Resultados preliminares de um programa de detecçäo precoce para o hipotireoidismo congênito / Congenital hypothyroidism screening program: preliminary results

Objetivo: Os autores têm por objetivo relatar os primeiros resultados do programa de detecçäo precoce de hipotireoidismo congênito (HC), realizado no período de julho de 1993 a dezembro de 1994 no estado de Santa Catarina. Métodos: Foram estudados todos os lactentes triados para HC pelo Laboratório Central de Saúde do Estado de Santa Catarina (LACEN), no período de julho de 1993 a dezembro de 1994. Foi coletada uma amostra de sangue em papel filtro para dosagem de TSH por imunofluorometria, em triplicata. na persistência de valores de TSH acima dos de corte, após a reconvocaçäo, os pacientes foram encaminhados para avaliaçäo especializada....