Skin testing with raw egg does not predict tolerance to baked egg in egg-allergic children

BACKGROUND

Most children with egg allergy tolerate egg in baked foods, such as cake, but tolerance cannot be predicted with conventional allergy testing. We hypothesized that the skin prick test (SPT) wheal to unprocessed raw egg might predict tolerance of baked egg at formal oral food challenge (OFC).

METHODS

We conducted a retrospective chart review to assess the utility of SPT wheal to egg extract (EE), raw egg (RE), and the ratio of EE:RE in predicting outcome of baked-egg OFC in children presenting to our tertiary referral centers with a physician diagnosis of egg allergy and following complete egg avoidance in their diet, between 2009 and 2013. OFC were performed following a standardized protocol using baked egg in cake, to a total dose equivalent to 3g egg protein.

RESULTS

Data were analyzed from 186 completed challenges: OFC was positive in 64 (34%) children and negative in 122 (66%). Six children experienced anaphylaxis at OFC. Children tolerant to baked egg were more likely to have a lower SPT to egg extract/raw egg and EE:RE (median 0.56) than their allergic counterparts (0.70, p < 0.05). However, ROC curve analysis demonstrated poor predictivity of challenge outcome, with AUC for SPT to egg extract, raw egg and EE:ER equal to 0.71, 0.63 and 0.60, respectively.

CONCLUSION

EE:RE was not helpful in predicting outcome of baked-egg OFC. Indeed, SPT to egg extract was slightly better at predicting outcome than either SPT to raw egg or EE:RE. Unfortunately, tolerance to baked egg can only be predicted from previous history or through controlled exposure.

Determination of volatile organic compounds and associated health risk assessment in residential homes and hostels within an academic institute, New Delhi

The purpose of this study was to investigate the concentrations of volatile organic compounds (VOCs) in different indoor microenvironments of residential homes and hostels in an academic institute, in New Delhi, during March-May 2011. Eleven VOCs (aromatic and halogenated) were assessed. Sampling and analytical procedure were based on National Institute for Occupational Safety and Health (NIOSH) standard method. The lifetime cancer and non-cancer risk were calculated for targeted VOCs using US Environmental Protection Agency guidelines. The mean concentrations of ∑ VOCs (sum of monitored VOCs) and individual VOC were found to be higher indoors as compared to outdoors at both types of premises. Indoor to outdoor (I/O) ratios of the targeted VOCs exceeded 1.0, suggesting the significant presence of indoor sources. Strong correlations between I/O concentrations of VOCs in the current study suggest the presence of common sources. Factor analysis (FA) was used for source evaluation separately at two premise types. The estimated lifetime cancer risks in the current study for all occupants at both premises exceeded 10(-6) .

Multifocal central nervous system demyelination and Lhermitte's phenomenon secondary to combination chemotherapy for chronic lymphocytic leukaemia

The CRF regime (cyclophosphamide, rituximab and fludarabine) is used for the treatment of chronic lymphocytic leukaemia. We report a case of diffuse CNS demyelination following treatment with CRF, presenting with Lhermitte's phenomenon, and imaging and neurophysiological evidence of demyelination. Fludarabine is the most likely causative agent, although CNS demyelination has not been previously described in low dose therapy.

Effect of feeding tannin degrading bacterial culture (Streptococcus gallolyticus strain TDGB 406) on nutrient utilization, urinary purine derivatives and growth performance of goats fed on Quercus semicarpifolia leaves

To study the effect of supplementation of tannin degrading bacterial culture (Streptococcus gallolyticus strain TDGB 406) on growth performance, nutrient utilization and urinary purine derivatives of goats fed on oak (Quercus semicarpifolia) leaves. For growth study, eighteen billy goats (4 month old, average body weight 9.50 ± 1.50 kg) were distributed into three groups of six animals each. The animals of group 1 served as control while animals of groups 2 (T1) and 3 (T2) were given (@ 5 ml/kg live weight) autoclaved and live culture of isolate TDGB 406 (10(6) cells/ml) respectively. The animals were fed measured quantity of dry oak leaves as the main roughage source and ad libitum maize hay along with fixed quantity of concentrate mixture. The feeding of live culture of isolate TDGB 406 (probiotic) did not affect dry matter intake and digestibility of nutrients except that of dry matter and crude protein, which was higher in T2 group as compared to control. All the animals were in positive nitrogen balance. There was no significant effect of feeding isolate TDGB 406 on urinary purine derivatives (microbial protein production) in goats. The body weight gain and average live weight gain was significantly higher (p = 0.071) in T2 group as compared to control. Feed conversion efficiency was also better in the goats fed on live culture of TDGB 406 (T2). The feeding of tannin degrading bacterial isolate TDGB 406 as probiotic resulted in improved growth performance and feed conversion ratio in goats fed on oak leaves as one of the main roughage source.

Dual diagnosis vs. triple diagnosis in HIV: a comparative study to evaluate the differences in psychopathology and suicidal risk in HIV positive male subjects

INTRODUCTION

The problem of triple diagnosis of HIV, substance abuse and psychiatric disorders is a complex one with difficult solutions. HIV disease progression is affected by substance use as well as psychiatric illness burden due to both direct as well as indirect factors. Continuing substance abuse with poor drug adherence coexists with psychiatric disorders leading to increased morbidity and mortality.

METHOD

A total of 100 HIV positive subjects comprising of two groups each having 50 subjects with and without substance abuse were assessed using detailed history, mental state examination, WHO schedule for clinical assessment in neuropsychiatry (SCAN 2.0) and Beck's Scale for Suicidal Ideation (BSS). Statistical analysis used Chi-Square test, Fischer's exact test, Student's t-test, Pearson's correlation coefficient, univariate and multiple regression analysis, univariate and multiple logistic regression analysis. p-Value<0.05 was considered to denote statistical significance.

RESULTS

Subjects with substance use disorder had higher rates of psychiatric morbidity (52% vs. 24%, 95% CI=0.5200, p<0.05). The rate of antiretroviral therapy default was almost double in subjects with substance abuse, as compared to subjects without substance use. Suicidal risk was significantly increased (p<0.05) in subjects with co-morbid medical disorders but substance abuse did not increase the risk.

CONCLUSION

Substance abuse inflicts a much greater burden on HIV positive individuals as compared to subjects without substance use. Concomitant substance abuse resulted in significantly increased duration of illness and psychiatric morbidity.

Study of Mutations in β-Thalassemia Trait among Blood Donors in Eastern Uttar Pradesh

BACKGROUND

Knowledge on distribution of different mutations of thalassaemia, which are prevalent in a particular area, is a prerequisite for prenatal diagnosis.

OBJECTIVES

Studying mutations in β - thalassaemia trait among blood donors in eastern Uttar Pradesh, India.

MATERIAL AND METHODS

One thousand non - remunerated voluntary blood donors who were between 18 - 40 years of age, were included in the study. Both replacement and voluntary healthy blood donors were included. 4ml of venous blood was collected and it was stored at 4°C. Complete Blood Count (CBC), Haemoglobinopathy Screening and Molecular Analysis by ARMS - PCR (Amplification Refractory Mutation System - PCR) were done. Screening for β thalassaemia was done in a blood bank by using D - 10, Bio Rad, which was based on High Performance Liquid Chromatography (HPLC).

RESULTS

Twenty Eight subjects with β- thalassaemia trait were found among 1000 voluntary blood donors. IVS 1-5 (G-C) mutation was most common type (50%), followed by FS 8/9 (+G) 25% which was the second most common type. In our study, a rare mutation of CD 16 (-C) was also found. Out of 14 subjects who had IVS 1-5 (G-C) mutation (most common), six were from Varanasi (6/261) and five of them were Sindhis. It was seen that FS 41/42 (TCTT) mutation was distributed among all groups of populations which had higher prevalences of β-thalassaemia trait.

CONCLUSION

A comprehensive knowledge on beta thalassaemia mutations is necessary for determining a prenatal diagnosis. The occurrence of mutations may vary according to geographic region. Therefore, this study dealt with current problem of unknown mutations, in order to avoid complications.

Disseminated Tuberculosis Causing Pancytopaenia in an Indian Boy

Tuberculosis still remains a major public health problem, particularly in developing countries. We report 11 year old Indian boy who presented with low grade fever, weight loss, hepatomegaly, ascites and petechial spots for past 6 weeks associated with pancytopaenia. Subsequently, bone marrow biopsy from the iliac crest revealed an epithelioid cell granuloma with hypercellularity. This is a rare presentation where disseminated tuberculosis presented as pancytopaenia. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7577 J Nepal Paediatr Soc. 2013;33(1):52-54

Electrically driven nanopillars for THz quantum cascade lasers

In this work we present a rapid and parallel process for the fabrication of large scale arrays of electrically driven nanopillars for THz quantum cascade active media. We demonstrate electrical injection of pillars of 200 nm diameter and 2 µm height, over a surface of 1 mm(2). THz electroluminescence from the nanopillars is reported. This result is a promising step toward the realization of zero-dimensional structure for terahertz quantum cascade lasers.

Cost-effectiveness of systemic therapies for metastatic pancreatic cancer

PURPOSE

Gemcitabine and capecitabine (gem-cap), gemcitabine and erlotinib (gem-e), and folfirinox (5-fluorouracil-leucovorin-irinotecan-oxaliplatin) are new treatment options for metastatic pancreatic cancer, but they are also more expensive and potentially more toxic than gemcitabine alone (gem). We conducted a cost-effectiveness analysis of these treatment options compared with gem.

METHODS

A Markov model was constructed to examine costs and outcomes of gem-cap, gem-e, folfirinox, and gem in patients with metastatic pancreatic cancer from the perspective of a government health care plan. Ontario health economic and costing data (2010 Canadian dollars) were used. Efficacy data for the treatments were obtained from the published literature. Resource utilization data were derived from a chart review of consecutive metastatic patients treated for pancreatic cancer at Princess Margaret Hospital, Toronto, Ontario, 2008-2009, and supplemented with data from the literature. Utilities were obtained by surveying medical oncologists across Canada using the EQ-5D. Incremental cost-effectiveness ratios (icers) were calculated.

RESULTS

The icers for gem-cap, gem-e, and folfirinox compared with gem were, respectively, CA$84,299, CA$153,631, and CA$133,184 per quality-adjusted life year (qaly). The model was driven mostly by drug acquisition costs. Given a willingness-to-pay (wtp) threshold greater than CA$130,000/qaly, folfirinox was most cost-effective treatment. When the wtp threshold was less than CA$80,000/qaly, gem alone was most cost-effective. The gem-e option was dominated by the other treatments.

CONCLUSIONS

The most cost-effective treatment for metastatic pancreatic cancer depends on the societal wtp threshold. If the societal wtp threshold were to be relatively high or if drug costs were to be substantially reduced, folfirinox might be cost-effective.

Multi-phonon assisted upconversion emission and power dependence studies in LaF3:Er3+ phosphor

LaF3:Er3+ phosphor is synthesized through chemical precipitation method and its upconversion (UC) emission studies have carried out using 532-nm excitation. Phosphor has shown two-photon absorption UV bands at the 325 nm, 342 nm, 383 nm, 403 nm and 411 nm wavelengths. At relatively higher excitation powers multi-phonon assisted energy migration from 2H11/2 (4S3/2) level to the upper 4F3/2, 4F5/2 and 4F7/2 levels has observed and this energy migration opened new channel of emission at 440 nm, 453 nm and 488 nm due to the 4F3/2→4I15/2, 4F5/2→4I15/2 and 4F7/2→4I15/2 transitions, respectively. Temperature dependent UC measurement is also done and observed emission pattern is correlated with the power dependence studies. Upconversion bands at 411 and 488 nm wavelengths have shown reversal in intensity as either excitation power or sample temperature is increased and hence these two bands are found to act as optical switch. Planck blackbody like continuum emission has also observed at higher excitation powers.