Effects of a self-management educational program for the control of childhood asthma

The objective of the present study was to evaluate the effects of a self-management educational program on 29 children between 6 and 14 years old and their parents implemented in an office setting in Venezuela. Children were randomly assigned to experimental and control group. Children's asthma knowledge, self-management abilities, index morbidity, parents' asthma knowledge and management abilities were measured. The program consisted of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and an informative brochure for the parents. Results of t tests indicate that the experimental group experienced a statistical significant effects on children's asthma knowledge (P < 0.001) and practice of self-management abilities (P < 0.000) and in parents' knowledge (P < 0.008) compared to the control group. The educational Self-management program had a significant impact on the Morbidity Index of the study group at post-test (P < 0.05). Younger children benefited more from the program compared to older ones (P < 0.09). Children's age is highlighted as a critical variable in designing asthma educational programs. Results suggest the effectiveness on these programs independently of the cultural context.

Renal transplantation with limit donors: to what should the good results obtained be attributed?

BACKGROUND

With the aim of offsetting the reduction in donors of kidneys for transplantation, we extended the acceptance criteria, considering donors over 60 years old.

METHODS

The results obtained in 84 transplants carried out with this type of donor (group A) was compared with those of a control group of 125 transplants carried out with kidneys from donors under 60 years old (group B). The protocol for selection of donors was appropriate creatinine clearance, minimum proteinuria, and normal renal scan. The histological study was not included because it was not considered appropriate to assess the extent of the possible glomerulosclerosis, as this has a focal, segmented distribution. There were no significant differences between the recipients except for age (57.8 years old in group A vs. 39.2 years in group B).

RESULTS

After the transplantation, there were significant differences in the duration of hospitalization (26.8 days vs. 21.8 days, P<0.009), annual plasma creatinemia (177, 225, 233, 235, and 205 micromol/L vs. 136, 150, 121, 111, and 133 micromol/L, P<0.0002/0.0004), graft survival (87%, 85%, 81%, 81%, and 81% vs. 89%, 88%, 86%, 86%, and 85%, P<0.03), and patient survival (92%, 89%, 85%, 85%, and 85% vs. 99%, 99%, 97%, 96%, and 95%, P<0.0004). Death of the patient was the only significantly more frequent cause of graft loss among group A patients (7 vs. 1 death, P<0.004). No kidney was "never working" and none were lost because of chronic rejection.

CONCLUSIONS

It was concluded that elderly donors should be considered as suitable for transplantation irrespective of their chronological age, provided that they fulfill the acceptance criteria. The quality of life achieved was comparable in both groups. Despite the lower renal function in group A, this remained constant during the follow-up period.

Successful transplantation of organs retrieved from a donor with enterococcal endocarditis

We report on a patient with an extensive cerebral infarction secondary to enterococcal endocarditis that, in spite of adequate antibiotic treatment, evolved to brain death. The patient was evaluated as a potential organ donor; renal and liver function were normal and both liver and kidneys appeared normal on ultrasonographic examination. When negativity of serial blood and urine cultures was ascertained, liver and kidneys were retrieved for transplantation. The organs were transplanted into three recipients with good results after 14 months of follow-up. All of the recipients received antibiotic prophylaxis against Enterococcus faecalis. None of them has presented infectious complications to date. This case emphasizes that patients with enterococcal endocarditis may be potential organ donors provided both donor and recipients are adequately treated. This is especially important when organs are urgently needed.

beta-Carotene partially prevents the damage induced by 1,4-dimethylaminoazobenzene in mice

Hepatocarcinogenesis (HC) induced by various carcinogens such as 1,4-dimethylaminoazobenzene (DAB) is a multistep and complex process. The anticancer efficacy of beta-carotene (beta C) was evaluated by estimating some biochemical parameters during the initiation stage of HC. beta C dietary supplementation partially prevented the rise in delta-aminolevulinate synthetase activity. P 450 levels were dramatically enhanced in all groups studied. beta C administration did not overcome catalase inactivation due to DAB treatment; however, superoxide dismutase activity levels showed to be less decreased in the DAB + beta C animals in comparison to the DAB group. The great enhancement provoked by DAB of glutathione S-transferase, a proposed marker of HC, was partially reversed by beta C. In conclusion, heme pathway regulation, drug metabolism, and natural oxidative defence systems, strikingly modified in DAB fed animals, were partially controlled by provitamin A. The potential use of beta C in preventing carcinogenesis is suggested.

Kinetics of W3/25 anti-rat CD4 monoclonal antibody. Studies on optimal doses and time-related effects

Although anti-CD4 monoclonal antibodies (MoAb) have been proven successful in preventing or treating adjuvant arthritis, little is known about the duration of the effects of these MoAb and their pharmacokinetics. In this work, we report the effects of a mouse anti-rat CD4 MoAb, named W3/25, on peripheral blood lymphocytes from female Wistar rats. Animals received a single dose of W3/25, from 1 to 3 mg, and blood was sampled at different time points from 0 h to 15 days after MoAb administration. After erythrocyte lysis, samples were stained by indirect immunofluorescence and analyzed by flow cytometry. Pharmacokinetic data were studied by assessing plasma levels of mouse IgG1 by ELISA-sandwich. W3/25 produced the down-regulation of surface CD4 molecule as early as 20 min after its administration at doses of 2 and 3 mg. The same effect was seen 30 min after a dose of 1 mg. The recovery of lymphocytes with normal expression of CD4 also depended of the dose administered. Thus, CD4+ lymphocytes were recovered at 48, 72 and 96 h in rats treated with 1, 2 or 3 mg of W3/25, respectively. Plasma levels of free antibody were detectable from 20 min to 72 h, 60 min to 48 h and 60 min to 24 h after administration of 3, 2 and 1 mg, respectively, of W3/25. The mouse IgG1 MoAb used in this study followed a two-compartment model and its behavior was linear.

Hepatic enzymatic metabolism alterations and oxidative stress during the onset of carcinogenesis: protective role of alpha-tocopherol

Oxidants play a role in several stages of carcinogenesis. A high antioxidant capacity is expected to protect 'initiated' cells from excessive oxidant toxicity. The aim of this study was to determine the chemopreventive effect of a-tocopherol (alpha-T) on the hepatocarcinogenesis induced with p-dimethylaminoazobenzene (DAB) in mice. The dietary administration of alpha-T completely reversed the induction of delta-aminolevulinate synthetase and glutathione-S-transferase (the tumoral marker enzyme). alpha-T greatly enhanced P 450 levels, which were even higher in animals exposed to DAB. Indirect evidence for the involvement of oxygen radicals in the DAB model of hepatocarcinogenesis was provided by increased levels of thiobarbituric acid reactive species, which were detected in animals with severe liver damage and were assessed by histological analysis. alpha-T reduced the degree of hepatic injury, although this vitamin produced only slight changes in the oxidative parameters evaluated. The use of alpha-T as a potential chemopreventive agent, particularly during the initiation stage of carcinogenesis provoked by DAB, is worthy of further study.

Non-operative management of traumatic pancreatic pseudocysts associated with pancreatic duct laceration in children

Objective. To assess the successful non-operative management in traumatic pancreatic pseudocysts (TPP) associated with duct laceration in children. Surgical therapy (cystogastrostomy or distal pancreatectomy with splenic salvage) has been classically considered the treatment of choice for those pseudocysts. Materials and methods. This report presents the clinical and imaging findings in two children with TPP and pancreatic duct disruption observed either on endoscopic retrograde cholangiopancreatography or injection via catheter drainage. Results. Both children responded to long-term cyst drainage. Conclusion. Although the experience is limited, the authors suggest that pancreatic injury associated with duct laceration can respond to non-operative management.

Altered heme pathway regulation and drug metabolizing enzyme system in a mouse model of hepatocarcinogenesis: effect of veronal

1. Male CF 1 mice were fed p-dimethylaminoazobenzene (DAB) for 35 days and received 5,5-diethylbarbituric acid, before or after DAB treatment, with the purpose of investigating whether the onset of the preinitiation stage of carcinogenesis alters the natural regulatory mechanism of the heme pathway. 2. Changes detected in drug metabolizing enzymes are likely to be the consequence of a primary deregulation mechanism of heme metabolism, shown by an increase in delta-aminolevulinic acid synthetase activity and a decrease in microsomal heme oxygenase, which would finally lead to a great enhancement of cytochrome P450 levels. 3. The alterations found here would give rise to a pattern distinctive to that usually observed in the so-called resistant hepatocyte.

Successful transplantation of organs retrieved from donors with bacterial meningitis

BACKGROUND

The shortage of organs for transplantation is the most important factor limiting the number of transplants performed. Consequently, in recent years, criteria for considering a patient as a potential organ donor have been broadened.

METHODS

From 1995 through 1996, we have retrieved organs from five donors who were brain dead because of bacterial meningitis. The causative microorganisms were Neisseria meningitidis in one patient, Streptococcus pneumoniae in three patients, and Escherichia coli in one patient. Fifteen organs were retrieved and transplanted into 16 recipients. All the donors and recipients received adequate antibiotic therapy.

RESULTS

None of the recipients developed infectious complications caused by the meningeal pathogens. After a follow-up ranging from 4 to 30 months, 12 patients are alive with functioning grafts. The cause of death was noninfectious in the four patients who died.

CONCLUSIONS

Our study demonstrates that patients with brain death caused by bacterial meningitis due to meningococci, pneumococci, or E coli may be suitable organ donors. Transplantation of organs from such donors does not increase the risk of infection transmission to the recipient, provided that both donor and recipient had received adequate antibiotic therapy.

Mite-contaminated foods as a cause of anaphylaxis

BACKGROUND

Although insect and arthropod contamination of certain foods has been recognized for many years, allergic manifestations caused by ingestion of mite allergens have only rarely been reported.

OBJECTIVE

The purpose of this study is to present clinical observations in patients who experienced acute anaphylaxis after eating mite-contaminated foods.

METHODS

Thirty atopic subjects who were first seen with systemic anaphylaxis precipitated by the ingestion of wheat-containing foods underwent skin prick tests with inhalant and food extracts, as well as with uncontaminated and mite-contaminated wheat flour. Flour samples were examined microscopically for identification and counting of mites. Der p 1 and Der f 1 levels were quantitated by using immunochemical methods.

RESULTS

The most common symptoms were breathlessness, angioedema, wheezing, and rhinorrhea, which started between 10 and 240 minutes after eating. Abundant mites were present in the flour obtained from 28 patients; Suidasia spp. mites were found in grated bread from the other two patients. Positive prick test responses to Dermatophagoides farinae-and mite-contaminated flour and negative skin test responses to wheat extract, other food extracts, and uncontaminated wheat flour were found in all patients. Skin test responses were positive in volunteers with mite allergy even after heating the mite-contaminated flour at 100 degrees C. Screening of 35 unselected flour samples demonstrated the presence of mites in 13 of them (37.1%).

CONCLUSIONS

Systemic anaphylaxis can occur after the ingestion of heated or unheated mite-contaminated foods. This problem may be more prevalent in tropical and subtropical countries than previously recognized.

Heme biosynthesis pathway regulation in a model of hepatocarcinogenesis pre-initiation

1. Heme regulation before the appearance of hyperplastic nodules was investigated in mice models of hepatocarcinogenesis. 2. With this aim 5-aminolaevulinate synthetase (ALA-S), microsomal heme-oxygenase (MHO), mitochondrial and cytoplasmic rhodanese activities were examined throughout a period of 35 days in animals exposed to dietary p-dimethylaminoazobenzene (DAB). 3. ALA-S activity was significantly diminished (50%) on day 14, then showing a sharply rising profile from day 28 onwards, and reaching 350% on day 35. 4. A similar profile was observed for mitochondrial rhodanese activity. 5. Changes in MHO and cytoplasmic rhodanese activities were almost the opposite to those observed for ALA-S. 6. The distinctive alteration in mitochondrial and cytoplasmic rhodanese would suggest that it plays a subtle role in ALA-S regulation during carcinogenesis initiation through a mechanism that appears to involve subcellular localization controls perhaps by means of the breakage of cystine trisulphide postulated to act as an ALA-S activator. 7. Taking into account the present results, we suggest a probable mechanism for the onset of hepatocarcinogenesis that includes a primary activating liver status, provoking biochemical aberration leading to the stage of initiation of hepatocarcinogenesis involving the whole organ.

T-cell depletion and in vitro thymosin inducibility in asthmatic children

Thirty asthmatic children were compared with an equal number of age-matched healthy children. The mean peripheral blood T-lymphocyte level without foetal calf serum was lower in the asthmatic group (mean 970/mm3, as against 1740/mm3; P less than 0.0001), but this difference was abolished by adding foetal calf serum or thymosin, thus explaining how quite severe T-cell deficiency can be missed by widely used methods. The degree of eosinophilia and the degree of elevation of the plasma IgE level in the asthmatic patients were positively correlated. Positive correlations were also shown between the degree of severity of the asthma, the degree of eosinophilia and the degree of elevation of the plasma IgE level, but not the degree of depression of the T-cell numbers. If this T-cell deficiency reflects an inadequate suppression of IgE responses, a clinical trial of thymosin appears to be warranted.