Association between blood aluminum and beta-2 receptor gene methylation with childhood asthma control.

Previous studies have shown that environmental exposure to heavy metals has been related to epigenetic changes, such as DNA methylation in receptors involved in pathogenesis of asthma. One of these receptors is beta-2 adrenergic receptor (ADRB2). We conducted this study to examine the association between blood aluminum concentration, blood ADRB2 5' untranslated region (5'-UTR) methylation level, and childhood asthma control level. Our results showed a significant positive association between high blood aluminum concentration (odds ratio, 16, 95% confidence interval (CI) [3.57 to 71.76], p < 0.001) and high blood ADRB2 5'-UTR methylation level (odds ratio, 4.75, 95% CI [1.39 to 16.2], p = 0.013), and risk of uncontrolled asthma. Multivariable logistic regression revealed that higher blood aluminum concentration was independently associated with increased risk of uncontrolled bronchial asthma (odds ratio, 9.10, 95% CI [2.38 to 34.85], p = 0.0013], after controlling for age, sex, and blood ADRB2 5'-UTR methylation level. In addition, blood ADRB2 5'-UTR methylation level significantly correlated with whole blood aluminum concentration in asthmatic children (r = 0.480, p < 0.001). We concluded that increasing blood aluminum concentration is an important independent correlate of risk for uncontrolled bronchial asthma as well as increased blood aluminum concentration caused ADRB2 5'-UTR hyper-methylation with increasing risk of uncontrolled bronchial asthma.

Tonsillectomy and adenotonsillectomy in Sudanese patients.

OBJECTIVES: To highlight the indications for and complications of tonsillectomy or adenotonsillectomy operations in Sudanese patients and to find out whether any correlation can be deduced between routinely requested pre-operative investigations and the complications which may arise. DESIGN: A prospective study. SETTING: Khartoum ENT Teaching Hospital, Khartoum, Sudan. SUBJECTS: One hundred and twenty patients, 55% females and 45% males, age range 3 to 50 years. Pre-operative investigations consisted of a complete blood count and bleeding and clotting times., ASO titres and urinalysis. INTERVENTIONS: Consisted of tonsillectomy or adenotonsillectomy performed on in-patients by one of the authors under general anaesthesia. MAIN OUTCOME MEASURES: High erythrocyte sedimentation rate (ESR) or ASO titres should not deter an indicated tonsillectomy operation which can still be carried out if meticulous haemostasis is observed. RESULTS: Three or more episodes of exudative tonsillitis per year and upper airway obstruction were the commonest indications for tonsillectomy or adenotonsillectomy accounting for 72.5% and 16.7% of the operations. Intra-operative bleeding occurred in 63 (52.5%) of the patients. Low figures of reactionary and secondary haemorrhages were seen. CONCLUSION: It is concluded that as bleeding, both intra- and post-operative is the main complication of tonsillectomy, its incidence can be reduced to minimal levels by careful selection of patients, in whom the operation is carried out under general anaesthesia with gentle handling of tissues and detention of the patients post-operatively for two to three days. We also found out that coagulation tests need not be routinely requested and reserved for patients with a history of bleeding tendencies.