Study for assessing prevalence and phenotypes of local Allergic Rhinitis

Background: Rhinitis is a global health problem that affects 20-40% of the population in developed countries and whose incidence is rising. Rising is characterized by one or more of the following symptoms: nasal congestion, rhinorrhea, sneezing and itching. It can be induced by different mechanisms and involves several etiological agents. Noninfectious rhinitis has traditionally been classified as allergic rhinitis [AR] and nonallergic rhinitis [NAR]

Objective: To evaluate the prevalence and phenotypes of local allergic rhinitis in patients with clinical manifestations of AR without evidence of systemic IgE sensitization

Methods: This cross sectional, case-control, and nonrandomized study was conducted on 120 patients with clinical manifestations suggestive of allergic rhinitis [selected from the allergy outpatient clinic at Ain Shams university hospitals and 20 healthy controls

Results: Local allergic rhinitis was diagnosed in 80% of females and 20% of males. While the patients with systemic allergic rhinitis reached 37.5% for males, and 62.5% were females. Regarding the persistence of symptoms in local allergic rhinitis it reached 88% in comparison to 67.5% in systemic allergic rhinitis. The symptoms were intermittent in 12 % of cases with local allergic rhinitis in comparison to 32.5% in systemic allergic rhinitis. The severe symptoms outweighed the mild symptoms by nearly 50%. The skin prick test reached 80% positive in cases of LAR. Those with normal levels of total IgE level, the nasal provocation test was positive in 12.5% of cases and 7.5% negative

Conclusion: Local allergic rhinitis is a prevalent entity in patient evaluated with rhinitis

Possible role of food allergy in chronic otitis media with effusion

The pathogenesis of chronic otitis media with effusion is multifactorial. Bacterial, viral infections, and eustachian tube blockage are believed to play major roles. However, the role of food allergy in its pathogenesis is the least well understood, so, the aim of this work was to detect the prevalence of food allergy in patients with chronic otitis media with effusion. 60 patients with chronic otitis media with effusion were included in this study, there were 37 males and 23 females. Their ages ranged between 6 and 14 years. All cases were subjected to clinical examination and audiological assessment [audiometry and tympanometry]. They were evaluated for the presence of food allergy by skin prick test, specific IgE testing and food elimination-challenge studies over a 12 weeks period with monitoring of their middle ear effusions. Based on these tests, there was a statistically significant linkage between food allergy and chronic otitis media, with effusion in 12/60 patients [20%], the highest frequencies occurred with milk [58%], egg white [41.5%], and wheat [16.5%]. We concluded that IgE-mediated food allergies may contribute to a proportion of cases of chronic otitis media with effusion especially if occurred in a younger age group, and if associated with nasal allergy

Primary central nervous system lymphoma [PCNSL] clinical, radiological, histopathological and immunological evalution. comparison with other CNS lymphomas

Fifteen cases of CNS lymphomas are included in the present study. 7 cases of primary central nervous system lymphoma [PCNSL] 6 cases of spinal lymphomas, and 2 cases of lymphomatous lyptomeningitis. In PCNSL patients the male to female ratio was 4-3, the initial clinical presentation tion in 4 cases [60%] was in the form of TIAS [transient ischaemic attacks], Rinds [reversible ischaemic neurologic deficits] and stroke that preceeded the clinical diagnosis of lymphoma by a mean duration of 8 months. Radiologically PCNSL was subclassified into periventricular [central] type and cortico-meningeal [peripheral] type each had a characteristic lines of spread. Staging procedures did not demonstrate the existence of extraneural dissimination in PCNSL. All cases of spinal lymphomas occurred in the dorsal regions and was associated with extensive epidural disease that involved multiple vertebral segments. Lymphomatous lyptomeningitis was presented clinically with multiple cranial nerve and quada roots affection. Staging was associated with extensive extra-neural dissimination in both spinal lymphoma and lympho matous lyptomeningitis patients. Lines of treatment and follow up of cases will also be discussed

Hepatic encephalopathy an approach using brainmapping and the quantitative pharmaco-EEG methology

In the present study 20 patients with stage II or stage III hepatic encephalopathy were examined by brainmapping and the quantitative pharmaco-EEG methodology. The spectral profile demonstrated in all patients was identical to the pharmaco-EEG profile of the Benzodiazepine [BNZ] receptor agonists [diazepam for example]. This spectral profile was instantanously normalised by injection of flumazenil [Anexate], which is a specific BNZ receptor antagonist. These findings indicate that functional increase in the GABA-ergic tone is the aetiopathogenic factor responsible for the clinical and etectrophysiological changes observed in hepatic enphalopthy and they also indicate that these functional increases in the GABA-ergic tone is mediated allosterically through pathological activation of the brain BNZ receptors probably by endogenous substances with diazepam-Like properties. The implication of these results on the management of hepatic encephalopathy will be discussed

Role of fungi in allergic bronchitis

Sputum samples from thirty asthmatic patients with recurrent infections were examined for fungi, as well as for acid fast bacilli and other pathogenic bacteria. 60 of cases were positive for fungi; either alone or associated with other bacteria. No one case showed acid fast bacilli. Eosinophilic count and serum immunoglobulin E [IgE] level were significantly high in all cases. Most of the patients, especially those infected with Candida species, showed clinical improvement after antimycotic treatment. It was concluded that hypersensitivity to fungal antigens was accused in many cases of allergic bronchitis. So the role of fungi in such cases must be taken in consideration and should be thoroughly investigated in order to choose the proper line of treatment

hyperventilation challenge test for the diagnosis of coronary vasospasm in patients with angina-like chest pain

In the evaluation of patients with agina-like chest pain but with insignificant obstructive coronary artery disease, it is important to exclude myocardial ischemia from coronary artery vasospasm. Hyperventilation, like ergonovine and acetylcholine, can also induce myocardial ischemia and its clinical expressions by provoking coronary vasospasm. A possible mechanism for hyperventilation induction of coronary vasospasm is from promotion of an intracellular influx of calcium ions, induced by the alkalotic state, which then stimulates the vascular contractile process, leading to coronary vasospasm. Fifteen patients with anginal-like chest pain [at least one attack per day] were studied. A hyperventilatory ischemic electrocardiographic changes were reported in 11 patients [73.3%] while a hyperventilatory chest pain was reported in 9 patients [60%]. All the positive responses were reported in the posthyperventilation phase or phase II and ventricular ectopics were seen in one patient [6.6%] during the hyperventilation phase, but neither infarction nor arrest have been reported. The hyperventilation test is an alternative diagnostic tool in evaluating patients with angina-like chest pain of unknown etiology and is an effective alternative diagnostic tool for the diagnosis of active coronary vasospasm, especially when spontaneous electrocardiographic evidence of myocardial ischernia, either silent or with chest pain, is not obtained