Recurrent wheezing … is it only asthma?

We report the case of an 18-year-old female patient observed in our allergy clinic with a diagnosis of uncontrolled asthma. The unexpected behaviour of the disease led us to consider other diagnoses and we finally diagnosed Churg-Strauss syndrome, a rare multisystem disorder requiring a different clinical approach.

Influence of Catechol-O-Methyltransferase (COMT) Genotypes on the Prognosis of Canine Mammary Tumors

Catechol-O-methyltransferase (COMT) is an important enzyme involved in inactivation of catechol estrogens, which are metabolites with carcinogenic properties. Some investigations in human breast cancer associate a genetic polymorphism in the COMT gene (COMT val158met) with an increased risk and poor clinical progression of the disease. In dogs, there are 2 recognized single nucleotide polymorphisms in the COMT gene (COMTG216A and COMTG482A); however, their influence on the outcome of mammary neoplasms has never been investigated. The purpose of this study is to investigate the influence of COMT in the clinical progression of canine mammary tumors, namely in recurrence, metastasis and survival by testing 2 SNPs (G216A and G482A), and 2 genotypes of the COMT gene. A case series was conducted analyzing genomic DNA samples by polymerase chain reaction-restriction fragment length polymorphism from 80 bitches with mammary tumors. Animals were submitted to an active follow-up study for a period of 24 months after surgery. We observed that bitches carrying both genetic variations simultaneously are more likely to develop recurrence of mammary lesions. Our results demonstrate a possible role for COMT genotypes in the outcome of mammary neoplasms in the dog. Identifying a genetic factor predictive of recurrence may be useful in selecting the most effective surgical approach for canine mammary neoplasms.

Unawareness of weight and height--the effect on self-reported prevalence of overweight in a population-based study

OBJECTIVE

Self-reported height and weight are commonly used to estimate body mass index. The present study aims to identify the characteristics of participants who reported not to know their height or weight and to evaluate the consequence of these missing data on the estimates of the prevalence of body mass index categories.

DESIGN AND PARTICIPANTS

We evaluated 1492 adults, aged 18-92 years, who were selected using random digit dialing. During a general interview, participants were asked to report their current height and weight and actual anthropometrical measurements were obtained as part of a subsequent physical examination. We classified as unaware subjects who reported not to know their height or weight.

RESULTS

In this sample, 185 (12.4%) subjects reported not to know their height or weight (19.6% of females and 6.3% of males, p < 0.001). Women unaware of their weight or height were older, less educated, overweight or obese, never smoker and more frequently reported no regular physical exercise practice. In men, only ex-smokers were significantly less aware of their weight or height. In women, the prevalence of obesity using measured data was 25.3%, decreasing to 22.2% when considering only participants aware of their weight and height. Using self-reported data the obesity prevalence, in females, was 15.0%.

CONCLUSION

A large proportion of adults, mainly women and older persons, reported not to know their weight and height and the exclusion of those participants results in differential errors depending on the actual values. The exclusion of participants unaware of their weight or height is an additional source of bias that decreases the sensitivity in detecting obesity and underestimates the real problem, namely in the older population.

Implementation of a systematic approach to diabetes in primary care in Bahia, Brazil improves metabolic outcomes: PRODIBA-Programa de Interiorização da Assistência ao Diabetes na Bahia (Project for Dissemination of Diabetes Care in the State of Bahia)

BACKGROUND

Staged Diabetes Management (SDM) improves glycaemic control and reduces diabetes-related complications in primary care.

METHODS

An 18-month randomized controlled cohort study was conducted in two municipalities in the state of Bahia, Brazil, involving 100 patients with Type 2 diabetes in each municipality. In one municipality, healthcare professionals were trained to use SDM customized protocols for clinical decisions and, in the other municipality, no protocols for diabetes care were implemented. We hypothesized that, in the municipality with SDM trained professionals, patients would have better outcomes, including a fall in glycated haemoglobin (HbA(1c)).

RESULTS

Improvements in some metabolic parameters were observed in the SDM group, including a 22% decrease in mean random glucose, a significant 15% decrease in mean HbA(1c), a 6% decrease in systolic blood pressure and an 11% decrease in diastolic blood pressure. There were no differences in body mass index and lipid profile.

CONCLUSIONS

SDM customized algorithms are effective, practical and easy to use in primary healthcare teams with very limited resources.

Development of a tool for the assessment of calcium and vitamin D intakes in clinical settings

The study aim was to develop a tool (software and ruler) to assess the dietary calcium and vitamin D intakes in Portugal, and evaluate the usefulness of non-dietary variables as intake predictors. Our findings indicated that is possible to estimate both using three and six food items, respectively, and non-dietary predictors.

INTRODUCTION

The study aim was to develop a tool to assess the dietary calcium and vitamin D intakes in Portugal, and evaluate the usefulness of non-dietary variables as predictors.

METHODS

Trained interviewers collected information of 2,414 adults of Porto, Portugal, using a structured questionnaire and a validated semi-quantitative food frequency questionnaire (FFQ). Food items with the highest contribution to the total intake and non-dietary predictors (gender, age and body mass index (BMI)) were selected for the tool. Different statistical approaches were used to predict the intake. A Bland-Altman plot compared the predictions from the tool and the full FFQ.

RESULTS

The items selected to predict intake were milk (38%), cheese (12%), yogurt (10%) and gender for calcium and oily fish (39%), canned fish (9%), white fish (7%), eggs (5%), red meat (5%), age and BMI for vitamin D. The Bland-Altman plot showed that the mean differences were 0.0 (limits of agreement = [-220.67; 220.77]) mg/day and 0.0 (limits of agreement = [-1.03; 1.05]) microg/day, respectively for calcium and vitamin D.

CONCLUSION

The equations estimated by the best statistical model to predict the calcium and vitamin D intake allowed for the design of a software and a circular ruler useful in clinical settings.

Association of ERBB2 gene status with histopathological parameters and disease-specific survival in gastric carcinoma patients

The clinical significance of ERBB2 amplification/overexpression in gastric cancer remains unclear. In this study, we evaluated the ERBB2 status in 463 gastric carcinomas using immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH), and compared the findings with histopathological characteristics and with disease-specific survival. ERBB2 overexpression (2+ and 3+) and amplification (ratio ERBB2/CEP17⩾2) were found in 43 (9.3%) and 38 (8.2%) gastric carcinomas, respectively. Perfect IHC/FISH correlation was found for the 19 cases scored as 0 (all negative by FISH), and also for the 25 cases scored as 3+ (all positive by FISH). One out of six carcinomas scored as 1+ and 12 out of 18 carcinomas scored as 2+ were positive by FISH. ERBB2 amplification was associated with gastric carcinomas of intestinal type (P=0.007) and with an expansive growth pattern (P=0.021). ERBB2 amplification was detected in both histological components of two mixed carcinomas, indicating a common clonal origin. A statistically significant association was found between ERBB2 amplification and worse survival in patients with expansive gastric carcinomas (P=0.011). We conclude that ERBB2 status may have clinical significance in subsets of gastric cancer patients, and that further studies are warranted to evaluate whether patients whose gastric carcinomas present ERBB2 amplification/overexpression may benefit from therapy targeting this surface receptor.

DNA cytometry and kinetics of rat urothelial lesions during chemical carcinogenesis

The aims of this study were to evaluate the DNA content of chemically-induced rat urothelial lesions and their relationship to the proliferation index and histological patterns. Sixty female Fisher 344 rats were divided randomly into six groups, four groups were exposed to N-butyl-N-(4-hydroxybutyl) nitrosamine for a period of 10 and 20 weeks, and two groups of ten rats were used as control animals. Paraffin sections were Feulgen stained and analyzed using DNA image cytometry analysis; histograms were classified as either diploid or aneuploid. Ki-67 immunoreactivity was determined by means of the streptavidin-biotin-complex immunoperoxidase method. All normal urothelium from the control groups were found to have diploid DNA content. The same histogram pattern was found in the simple hyperplasia group. As regards the other histological lesions, the frequency of the aneuploidy varied depending on the lesion type: 20% of aneuploidy were nodular hyperplasia, 32% of aneuploidy were dysplasias, 25% of aneuploidy were papilloma, 44% of aneuploidy were papillary neoplasm of low malignant potential, 22% of aneuploidy were low-grade papillary carcinoma, 100% of aneuploidy were high-grade papillary carcinoma and 100% of the aneuploidy were invasive carcinoma. Our results revealed the existence of a statistically significant relationship between DNA ploidy and histological pattern lesions (r=0.3, p<0.023). The Ki-67 proliferation index was significantly higher in aneuploid lesions than in diploid (r=0.56, p=0.01). There was also a statistically significant difference in the Ki-67 proliferation index in relation to the histopathological pattern (r=0.751, p<0.01). DNA content was associated with the Ki-67 proliferation index and histopathological grade. DNA content and prolife-ration index have critical roles to play during urothelial carcinogenesis.

Physical training does not increase allergic inflammation in asthmatic children

The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma. Subjects with persistent allergic asthma (aged 12.7+/-3.4 yrs; n = 34) were randomly allocated into training and control groups. Exercise consisted of twice-weekly 50-min sessions for 12 weeks. Inflammation was assessed by levels of exhaled nitric oxide, blood eosinophils, eosinophil cationic protein, C-reactive protein, and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined. The Paediatric Asthma Quality of Life Questionnaire and Paediatric Asthma Caregiver's Quality of Life Questionnaire were used to evaluate activity restrictions, symptoms and emotional stress. The efficacy of the training was assessed by accelerometry. Following the programme, the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities. No differences in changes were seen between groups for asthma outcomes. However, total IgE decreased more in the exercise group, as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma, and may have decreased both total and allergen-specific immunoglobulin E levels. It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise.