Prevalence of allergic diseases in children in Beirut: comparison to worldwide data.

OBJECTIVE: To report on the prevalence of allergic rhinitis and atopic eczema in school children in Beirut, Lebanon, and compare the prevalence rates of allergic diseases in Beirut to the rest of the world. SUBJECTS AND METHODS: A random sample of school children aged 13-14 years completed the ISAAC written and video questionnaires. Data was entered using a special program prepared by ISAAC and analyzed using SPSS version 6.0. RESULTS: The prevalence rates of allergic rhinitis and rhinoconjunctivitis were 25.5% and 15.9% respectively. Atopic eczema was more common among males, with a total prevalence rate of 11%. CONCLUSION: The prevalence rates of allergic diseases in childhood was along the 50th percentile worldwide. The prevalence rates of uncontrolled asthma was very high while that of allergic rhinitis was low as compared to the rest of the world.

Prevalence of asthma and asthma symptoms in children in urban Lebanon.

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Topical hypothermia: ineffective and deleterious as adjunct to cardioplegia for myocardial protection.

BACKGROUND: Topical hypothermia, an early method developed for myocardial protection by virtue of its reduction of cardiac metabolic rate, is not without sequelae such as phrenic nerve paralysis and pulmonary complications. METHODS: The hospital records of 505 nonrandomized consecutive patients undergoing coronary artery bypass grafting between 1991 and 1995 at the University of South Alabama were reviewed to evaluate the effectiveness of topical hypothermia and its relationship to pulmonary complications. Group A included 191 patients between 1991 and 1992 who received systemic hypothermia and topical hypothermia with iced slush in addition to cold blood cardioplegia. Group B included 314 patients between 1993 and 1995 who received systemic hypothermia and intermittent cold blood cardioplegia without iced slush. RESULTS: Myocardial temperature mapping did not reveal any difference between the two groups. Postoperative cardiac morbidity, manifested as intraaortic balloon use, low cardiac output, inotrope use, and perioperative myocardial infarction, was decreased in group B, but the difference failed to achieve statistical significance. Mortality (group A, 3.14%; group B, 3.82%) and rates of significant morbidity such as sternal infection, stroke, reoperation for bleeding, renal failure, and prolonged ventilation were comparable between the two groups. However, there was a statistically significant difference in the incidence of diaphragmatic paralysis between group A and group B. Group A had a 25% incidence of diaphragmatic paralysis on the first postoperative day, 18% on the 15th postoperative day, and 8% at 6 months, as opposed to group B, which had incidences of 2% on the first postoperative day, 1% on the 15th postoperative day, and 1% at 6 months (p < 0.001). Also, there was a significant difference in incidence of pleural effusions (60% versus 25%) and rate of thoracentesis (25% versus 8%) between groups A and B (p < 0.0001). CONCLUSIONS: We conclude that topical hypothermia did not offer any additional cardioprotective benefit above systemic hypothermia and cold blood cardioplegia alone in coronary bypass patients, but significantly increased the incidence of diaphragmatic paralysis and associated pulmonary complications.

Management and outcome of splenic injury: the results of a five-year statewide population-based study.

Although splenectomy was the preferred method of treating the injured spleen in the past, the methods of splenorrhaphy and nonoperative management have appeared to gain in popularity. The purpose of this study was to determine whether the management of splenic injuries has changed over the course of time and if there has been any differences in the morbidity and mortality associated with different methods of treatment. We retrospectively examined the discharge records from 2627 patients with splenic injuries from the North Carolina Discharge Database. There were 2258 adults and 369 pediatric patients for evaluation. The rate of nonoperative therapy increased from 33.9 per cent to 46.3 per cent over the 5 years of the study, whereas the rate of splenectomy decreased from 52.9 per cent to 43.4 per cent over the same time period. Splenorrhaphy was used in approximately 10 per cent of the injuries over the course of the entire study period. Adults treated nonoperatively required late operation 6.0 per cent (49/811) of the time. The pediatric late operation rate for nonoperative management was 0.4 per cent(1/231). Reoperation after splenorrhaphy was 2.9 per cent (7/240) for adult patients and 4.3 per cent (2/47) for pediatric patients. The majority of adults (57.2%) with an Injury Severity Score (ISS) < or = 15 were able to be cared for via nonoperative methods, whereas the majority of adults (66.4%) with an ISS > 15 required splenectomy. The majority of pediatric patients were able to be cared for in a nonoperative fashion in both the ISS < or = 15 (83.4%) and ISS > 15 (45.5%).

Dehydroepiandrosterone fails to improve immunoglobulin synthesis and lymphocyte mitogenic response after burn injury.

Dehydroepiandrosterone has been proposed as a means of restoring immune function after injury. In this study we examined the effect of dehydroepiandrosterone on the impaired immunoglobulin M synthesis and depressed lymphocyte mitogenic responses observed after burn injury. We divided BALB/c mice (n = 28) into four equal groups that received either a 25% total body surface area dorsal steam burn or a sham procedure. One hour later we injected mice subcutaneously either with 100 micrograms dehydroepiandrosterone or vehicle alone. Five days later we isolated splenocytes for assessment of immune function. We stimulated splenocytes with lipopolysaccharide and 5 days later measured immunoglobulin M synthesis specific for peptidoglycan polysaccharide, a ubiquitous bacterial antigen. We stimulated additional cultures with lipopolysaccharide or concanavalin A to measure B- or T-lymphocyte mitogenic response. Burn injury impaired peptidoglycan polysaccharide-specific immunoglobulin M synthesis compared with sham (p < 0.05), and this impairment was not restored by the administration of dehydroepiandrosterone (p < 0.05). Furthermore dehydroepiandrosterone did not correct the burn-induced impairments of B- and T-cell mitogenic responses (p < 0.05). Our study demonstrates that in this model the administration of dehydroepiandrosterone in vivo does not correct the impairments of humoral or cellular immunity induced by burn injury.

Effect of dietary fish oil on plasma thromboxane B2 and 6-keto-prostaglandin F1 alpha levels in septic rats.

Increased mortality from sepsis is associated with high levels of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1 alpha (PGF1 alpha). Linoleic acid, an n-6 essential fatty acid, is the usual precursor of TXB2 and PGF1 alpha, while fish oil is rich in n-3 essential fatty acid, the precursor of less active moieties. Rats were fed chow, an essential fatty acid-deficient diet, or an essential fatty acid-deficient diet supplemented with linoleic acid or fish oil for 2 weeks. The animals then underwent a sham operation or cecal ligation and puncture to induce sepsis. Six hours later, blood was obtained for analysis. The chow and linoleic acid diets produced significant (twofold to fivefold) increases in levels of both TXB2 and PGF1 alpha after sepsis. The essential fatty acid-deficient diet and fish oil diet protected against increases in levels of TXB2 or PGF1 alpha during sepsis. Dietary restriction of linoleic acid or fish oil supplementation may play an important role in altering the inflammatory mediator response to sepsis.

Endothelial cells can synthesize leukotriene B4.

Leukotriene B4 (LTB4) from vascular endothelium may play a key role in the genesis of atherosclerotic lesions. However, the ability of this tissue to synthesize LTB4 is controversial. To resolve this issue arachidonic acid metabolism was characterized in cultures of confluent monolayers of a rabbit aortic endothelial cell line by use of both high-pressure liquid chromatography and radioimmunoassay. Cells were grown to confluence in Dulbecco's modified Eagle's medium/Ham's F12 with 5% fetal bovine serum. Lipoxygenase activity was studied by placing the cells in Hank's balanced salt solution with 2 mumol/L indomethacin. After 30 minutes preincubation with indomethacin cells were exposed to either arachidonic acid (10 mumol/L) or arachidonic acid labeled with radioactive carbon (14C) (1 microCi; SA 58 mCi/mmol) and then stimulated with 9.5 mumol/L calcium ionophore A23187 for 55 minutes. Studies of the cyclooxygenase activity were performed without preincubating with indomethacin. Samples were prepared for high-pressure liquid chromatography by evaporation to dryness under a vacuum and resuspending in 2 ml of 1:1 methanol/water. Tritium-labeled standards were added before loading the 14C-labeled samples on the column. Radiolabeled arachidonic acid metabolites were separated by high-pressure liquid chromatography and detected by means of a dual channel flow-through radiodetector that monitors both 14C and 3H. Based on coelution with authentic standards three lipoxygenase metabolites of arachidonic acid have been identified: LTB4, 12- and 5-hydroxyeicosatetraneoic acid. Leukotriene B4 was further characterized by ultraviolet spectral analysis and inhibition studies with use of nordihydroguaiaretic acid. Quantitation was facilitated by commercially available radioimmunoassay kits. An average of 600 pg LTB4/10(6) cells was measured from separate experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Endothelial cell thromboxane production and its inhibition by a calcium-channel blocker.

Vascular endothelium has been established as a major source of prostacyclin production. Whether endothelial cells are also capable of synthesizing thromboxane A2 remains controversial. Suppression of such endothelial thromboxane synthesis would be beneficial for short-term patency of vascular grafts. This study examined the production of thromboxane A2 by endothelial cells and its modulation by the calcium-channel blocker nifedipine in vitro. The results indicate that (1) endothelial cells spontaneously secrete thromboxane A2, (2) this production can be enhanced severalfold in the presence of arachidonic acid, and (3) the calcium-channel blocker nifedipine significantly inhibits thromboxane production without demonstrable toxicity to the endothelial cells.

On the transformation of coliform types, proper and irregular forms.

Physiological changes have been induced in strains of E. coli I and its irregular forms, using a basal synthetic medium and addition of sodium pyruvate, or glucose, or yeast extract, or peptone. Changes in biochemical patterns, using the IMViC reactions plus growth at 44.5 degrees C, were induced, thus brining transformations between the regular types and irregular forms. Ultra-violet irradiation of E. coli I for 90 seconds may turn it into a methyl-red negative strain, while education of E. coli III for producing acid and gas at 44.5 degrees C was possible. Thus, E. coli I could be transformed to give the same reactions as the untyped form 1 of Geldreich (1966) through U.V. irradiation, while E. coli III may give the biochemical reactions of E. coli I via heat-resistance and training in MacConkey broth. The relationship between regular and irregular coliforms was also verified by phage typing. The results obtained were discussed both qualitatively, using "lytic activity", and quantitatively in terms of "efficiency of plating", especially with sewage-derived phages and irregular coliforms.

67Ga scintigraphy in lymphomas with special reference to cardiac apical mass.

The cardiac apical mass of Hodgkin's disease, an infrequent presentation of lymphomas, can be selectively labeled with 67Ga-citrate. Three cases are presented illustrating the value of 67Ga scintigraphy in the differential diagnosis of pericardial masses, as well as its role in the management and assessment of therapy.

Generation rates of faecal streptococci in various vehicles.

Potassium tellurite media gave the highest detrimental effects on the generation number of all tested faecal streptococci species. This applies to all investigated vehicles. However, drastic tellurite effects became more conspicuous with certain vehicles than with others. This is particularly true with acid and alkaline foods and water, especially with strains like Streptococcus bovis, Str. faecium, and Str. durans. Again, tellurite becomes more influencial with regard to old cells rather than young cells in the logarithmic phase. On the other hand, the use of thallous acetate as a concentration agent secured better results than either the tellurite or azide almost with all tested vehicles. Yet, sodium azide may be regarded as holding an intermediate position between tellurite and thallous acetate in terms of vehicles, Streptococcus species, and age of pollution. A lower number of generation resulted with all tested faecal streptococci species, using liquid media bearing more than one concentrating agent. This applied to water and milk examination.