Exercise-induced bronchoconstriction in rhinitis children without asthma.

Background: Exercise-induced bronchoconstric-tion (EIB) is a condition that leads to limited participation in sports. Prevalence of EIB ranges from 5-20% in general population to 40 - 90% in asthmatic patients. But the prevalence among rhinitis children with EIB remains debatable. We aimed to determine the prevalence of EIB in non-asthmatic children with rhinitis. Methods: A cross-sectional study was performed on 53 rhinitis patients without known asthma who attended the Pediatric Allergy Clinic between March 2009 and February 2010.They all underwent physical examination, skin prick test, pulmonary function tests and an exercise challenge test (ECT) on a treadmill. A positive ECT was defined as a decrease in FEV1 > 10% after exercise. baseline pulmonary function and the decline in FEV1 after exercise. Results: The patients’ mean age was 12.3±2.6 years. Most of them (60.4%) had moderate to severe persistent rhinitis. Eleven out of 53 patients (20.7%) had EIB. The peak time for occurrence of EIB was 10 minutes after exercise. Most of the EIB episodes observed were of mild degree. Patients who had persistent symptoms and a short duration of rhinitis treatment prior to the ECT day had more positive ECT results (72.7% vs. 28.6%, p 0.013, 0.2 years vs.1.9 years, p 0.012, respectively). The history (Hx) was not a reliable means of identifying children who had EIB (ECT+/Hx+ 54.6%, ECT-/Hx+ 54.8%). There was no significant relationship between Conclusion: The prevalence of EIB in rhinitis children without asthma is 20.7%. History, physical examination and pulmonary function are insufficient to diagnose EIB.

Intranasal corticosteroid.

Rapidly metabolized intranasal corticosteroid (INS), with high topical potency and low systemic bioactivity, was introduced for perennial rhinitis in 1974 and found to be as effective as corticosteroids administered systemically. These second-generation INSs include beclomethasone dipropionate (BDP), budesonide (BUD), flunisolide (FLU), fluticasone propionate (FP), triamcinolone acetonide (TAA), mometasone furoate (MF), and fluticasone furoate (FF). Although these INSs represent improvements relative to earlier topical corticosteroids, they do vary from one to the other in potency and systemic bioactivity. For example, MF is equal in potency to FP and is considered to be the most potent INS to date and has almost undetectable systemic availability. FF, the most recently introduced INS, is a novel, enhanced-affinity glucocorticoid with potent anti-inflammatory activity administered in a unique side-actuated device. Among the therapeutic indications for INS are seasonal and perennial allergic rhinitis, nonallergic rhinitis, acute and chronic rhinosinusitis, rhinitis medicamentosa, and nasal polyposis.

Risk factors for strongyloidiasis hyperinfection and clinical outcomes.

Strongyloidiasis, caused by Strongyloides stercoralis, consists of various clinical syndromes. Strongyloidiasis hyperinfection leads to morbidity and mortality particularly in immunocompromized patients. This study aimed to determine the risk factors for strongyloidiasis hyperinfection and clinical outcomes. The medical records for hospitalized patients infected with S. stercoralis at Ramathibodi Hospital during 1994-2005 were retrospectively reviewed. Risk factors for strongyloidiasis hyperinfection were determined. There were 123 episodes of strongyloidiasis in 111 patients. The mean age was 46.8 +/- 17.8 years; 61% were males. Of 123 episodes, 37 (30.1%) had strongyloidiasis hyperinfection; the others had chronic strongyloidiasis. All the patients with strongyloidiasis hyperinfection and 88.3% of those with chronic strongyloidiasis were immunocompromized (p = 0.032); 89.2% of the former and 55.8% of the latter had received corticosteroids (p < 0.001). There were no significant differences in the type of immunocompromized host and the corticosteroid dosage between the two groups (p > 0.05). The hyperinfection group had a lower mean serum protein (p = 0.026) and albumin (p = 0.027) but a higher frequency of sepsis (p = 0.029), asthma-like symptoms (p = 0.025), adult respiratory distress syndrome (p = 0.026), and a longer duration of treatment (p=0.004). By logistic regression, corticosteroids use was a risk factor for hyperinfection (OR = 6.5, 95% CI = 2.1-20.0, p = 0.001). Most of the patients were treated with albendazole or thiabendazole, with a cure rate of 76.9%, whereas other recent cases treated with ivermectin had an average cure rate of 83.3%. The overall mortality rate was 8.1%.

Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: a case report of intractable strongyloidiasis.

We describe a patient with an overlapping syndrome disseminated strongyloidiasis and gram-negative sepsis. She was previously treated with albendazole 400 mg/day 14 days before admission without success. This admission, she was treated with a combination of oral ivermectin (injectable solution form), with a dosage of 200-400 microg/kg/day, and albendazole for 14 days. Strongyloides larvae disappeared from the stool by day 4 and from the sputum by day 10. No side effects were encountered during hospitalization or at the 1-month follow-up visit.