Epidemiological Data on Anaphylaxis in French Emergency Departments

BACKGROUND

Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis.

METHODS

Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis.

RESULTS

Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine.

CONCLUSION

Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.

Do bulbar-onset amyotrophic lateral sclerosis patients have an earlier respiratory involvement than spinal-onset amyotrophic lateral sclerosis patients?

AIM

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving limbs and bulbar muscles. The major cause of death in these patients is respiratory insufficiency. However, bulbar-onset ALS patients have a shorter survival than those with spinal-onset. It is not established if this difference is related to an earlier respiratory dysfunction in bulbar-onset patients. The aim of the present study was to determine if bulbar-onset patients have an earlier respiratory impairment as compared with the spinal-onset ones.

METHODS

From the population of ALS patients followed in our centre, we studied 82 patients (45 spinal-onset and 37 bulbar-onset, group 1 and 2 respectively), all evaluated between 6-18 months after disease onset. We investigated forced vital capacity, maximal inspiratory (PI max) and expiratory (PE max) pressures, mouth occlusion pressure at 100 ms after inspiration, arterial blood gases, percutaneous nocturnal oxymetry, phrenic nerve conduction, needle electromyography (EMG) of the right diaphragm and right internal intercostals muscles and functional ALS scale (ALS-FRS).

RESULTS

No statistical difference was found for gender and disease duration between both groups, but bulbar-onset patients were older. PI max and PE max were statistically lower (P<0.001 and P<0.006, respectively) in group 2. However, no correlation was found between bulbar ALS-FRS subscore and PI max or PE max.

CONCLUSIONS

Our results support that PI max and PE max are sensitive measurements of respiratory dysfunction in bulbar patients. Probably, this finding cannot be solely explained by the oro-facial weakness of bulbar-patients. We speculate that respiratory accessory muscles weakness can contribute for this observation.

Impact of mouthrinses on morning bad breath in healthy subjects

BACKGROUND

During sleep, a proliferation of oral bacteria is responsible for the release of offending gases in morning breath even in healthy people. Thus, the aim of this study was to evaluate the bad breath-inhibiting effect of four commercially available mouthrinses (0.03% triclosan, 0.12% chlorhexidine gluconate, 0.05% cetylpyridinium chloride and essential oils) on morning breath when compared with a positive and a negative control.

METHOD

A six-step double-blind, crossover, randomised study was conducted in 12 dental students with healthy periodontium, who refrained from mechanical plaque control during a 4-day period. The subjects were instructed to rinse twice daily with the assigned product during each period. Fifteen-day washout intervals were used. Before professional plaque and tongue coating removal (baseline), the morning breath was scored through volatile sulphur compounds (VSCs) level measured by a sulphide monitor. After 4 days, VSCs and plaque index (PI) were recorded.

RESULTS

Even in the absence of mechanical plaque control, there was a decrease in VSC level with the use of all mouthrinses, with the exception of an increase with the use of the negative control. The VSC formation was inhibited in descending order, by positive control (0.2% chlorhexidine), 0.12% chlorhexidine, triclosan and essential oils and cetylpyridinium chloride. Plaque formation was inhibited by chlorhexidine mouthrinses and essential oils.

CONCLUSIONS

These findings suggest that mouthrinses can reduce morning bad breath, and that such a reduction is not attributable only to the reduction of supragingival plaque formation.

[Treatment of neonatal hyperbilirubinemia]

OBJECTIVE: To review the recent medical literature on the treatment of neonatal jaundice, focusing on practical aspects that are relevant to pediatricians and neonatologists. SOURCES: An extensive review of the related literature was performed, also including the authors clinical experience in this field of investigation. SUMMARY OF THE FINDINGS: Jaundice is very common among infants during the first days of life. Several factors such as maternal and neonatal history have to be considered before implementing treatment. Significant advances have been made in the past few years concerning the treatment of jaundiced newborn infants. This review focuses on three forms of treatment of neonatal hyperbilirubinemia: phototherapy, exchange transfusion and the use of drugs to reduce serum bilirubin concentration. CONCLUSIONS: Nowadays, the in-depth knowledge about the mechanism of action of phototherapy, the development of intensified phototherapy units and the use of drugs to reduce bilirubin formation, have contributed to significantly decrease the need for exchange transfusion.

Evaluation of anti-Schistosoma mansoni IgG antibodies in patients with chronic schistosomiasis mansoni before and after specific treatment

The circumoval precipitin test (COPT), enzyme-linked immunosorbent assay (ELISA) and the immunoblotting anti-adult worm antigen (AWA) and soluble egg antigen (SEA) tests were applied to 17 chronically schistosome-infected patients for the detection of anti-Schistosoma mansoni antibodies before and on four occasions after oxamniquine administration over a period of six months. Compared to a control group, schistosomiasis patients showed high levels of IgG antibodies in AWA and SEA-ELISA. A decrease in IgG levels was observed six months after treatment, although negative reactions were not obtained. Significant decreases in IgG1, IgG3 and, mainly, IgG4, but not anti-SEA IgG2 levels were observed six months after treatment, again without negativity. Analysis of anti-AWA IgG antibodies by immunoblotting before treatment showed a 31 kDa strand in 14 patients (82%) which disappeared in three cases up to six months after treatment; furthermore, anti-SEA IgG antibodies showed the same band in nine patients (53%) before treatment, which disappeared in only four cases up to six months after treatment.

[Revealing the nurses participation in the Brazilian Nurses Association-Cascavel region]

The objective of the present research is to identify the reasons for the scarce participation of nursing professionals in the Brazilian Association of Nursing (ABEn) and other professional associations. The data was collected from nurses in the city of Cascavel-Paraná and was analysed according to qualitative and quantitative methods. Results show that a small number of professionals take part in the events promoted by ABEn-Cascavel and that there is little interest in joining any professional association. 36.6%, of nurses interviewed showed interest in becoming members of ABEn. Thus, for these professionals ABEn should define strategies of inclusion. The data collected in this research, regarding the reasons for the participation of nurses in the association, has provided ABEN-Cascavel with information that can support its performance in the city, as well as help on the planning of new activities and policies such as the promotion of events and changes on the price of the tuition, which was pointed out as one of the main reasons for the scarce participation of nurses in the association.

Zymosan phagocytosis by mouse peritoneal macrophages is increased by apoHDL- and not by intact HDL-covered particles

The uptake of lipids and lipoprotein particles by macrophages undergoes phagocytic activation and the formation of foam cells are key events in atherosclerosis. In this study we determined how intact high density lipoproteins (HDL) and apolipoproteins-HDL (removal of the lipid component from HDL, i.e., apoHDL) influence the phagocytosis of zymosan by mouse peritoneal macrophages. Zymosan particles preincubated together with lipoproteins or alone (control) were incubated with the macrophages. Phagocytosis activity was reported as the percent of macrophages that internalized three or more zymosan particles. HDL co-incubated with zymosan did not influence the over-all uptake of zymosan particles compared to apoHDL, which greatly enhanced the ability of the particle to be phagocytized (P<0.001). Part of this effect might be related to a greater binding of apoHDL to the particles compared to that of HDL (P<0.05). We conclude that this can be a useful method to study the ability of lipoproteins, including modified lipoproteins obtained from subjects with genetic forms of hyperlipidemia, to opsonize particles such as red blood cells and thus to investigate the processes that control the formation of foam cells and the mechanisms of atherogenesis.

Lipoproteins modify the macrophage uptake of triacylglycerol emulsion and of zymosan particles by similar mechanisms

The uptake of lipids and formation of foam cells are key events in atherosclerosis and in eruptive xanthomata formation in primary hyperchylomicronemia. Here we have compared the influence of low density lipoprotein (LDL), oxidized LDL (oxLDL), high density lipoprotein (HDL), and delipidated HDL (apoHDL) on the uptake by macrophages of zymosan (an insoluble fraction of yeast cell walls) and of triglyceride-rich emulsion (EM) particles that resemble chylomicrons, but, like zymosan, are equally devoid of protein components. Zymosan internalization is known to occur through unspecific phagocytosis, whereas natural chylomicrons are taken up by several specific lipoprotein receptors. We found that phagocytosis is not promoted as much by oxLDL as by normal LDL. HDL-coated zymosan was found to be inert and apoHDL slightly enhanced phagocytosis. LDL and apoHDL promoted the uptake of EM while oxLDL and HDL significantly inhibited the uptake. Therefore, the data support that HDL, and not apoHDL, particles inhibit EM uptake. We concluded that by using lipoprotein-coated zymosan particles, we could demonstrate different biological effects of LDL, oxLDL, HDL, and apoHDL on macrophage phagocytosis and that this method could be useful to delineate components of the various lipoproteins important for the propagation or inhibition of the formation of foam cells.

Intensified phototherapy using daylight fluorescent lamps

Jaundice is a common reason for therapeutic intervention in newborn infants and phototherapy is effective treatment if enough light energy is delivered to a skin surface area of sufficient size. Narrow spectrum blue light is superior to white light, but in developing countries fluorescent blue lamps often have to be imported and are much more expensive than white lamps. We developed a phototherapy unit in which seven daylight fluorescent tubes are placed immediately under the floor of a transparent plexiglass crib. The efficacy of this unit, delivering approximately 19 microW/cm2/nm, was compared with that of two conventional phototherapy units using overhead lamps placed 35 cm above the infants. One unit used daylight fluorescent tubes and delivered approximately 4 microW/cm2/nm, the other unit used special blue fluorescent tubes and delivered approximately 22 microW/cm2/nm. Fifty-one infants were included in the analyses, all of them breastfed on demand. Serum bilirubin levels were determined spectrophotometrically at 0, 12 and 24 h. The decrement in serum bilirubin concentrations was significantly greater in infants undergoing phototherapy with the new device or with special blue lamps compared to conventional overhead daylight lamps (p < 0.001 both at 12 and at 24 h). We conclude that highly efficient phototherapy may be delivered with daylight fluorescent lamps placed in very close proximity to the patient. Thus, lack of access to expensive imported special blue lamps does not preclude delivery of effective phototherapy in developing countries.

[Expectations of nursing students from their initial hospital training experiences]

The first experience in hospital training may create tensions and anxieties. These feelings interfere negatively in the teaching-learning process. The aim of this paper was to investigate the expectations of Nursing Fundamentals II students regarding their initial hospital training. Second-year students of the Nursing Course offered by Universidade Estadual de Maringá (state of Paraná, Brazil) were chosen as subjects of this investigation. The students revealed a state of anxiety when confronting technical procedures, relationship with patients and evolution. By reflecting on these aspects instructor the may increase the teaching-learning efficiency and humanize the professional training.

[Distribution of single-dose drugs. Reflection on nursing practice]

The nurse, as a member of the staff, is supposed to take responsibility on the administration of medicines as one of the important duties among all the activities he/she has to perform. The implementation of the distribution system of only-dose medicine is directly bound to nurses' activities. Therefore, this study has as its main purpose to detect nurses' reflections about the system and their impact on nursing practice. The authors questioned the way the nurse and his/her staff are inserted in this context of changes, in a way of really assuring benefits for the patients, following and evaluating the whole process, considering that such change affects directly part of these activities.

Lipoprotein desialylation simultaneously enhances the cell cholesterol uptake and impairs the reverse cholesterol transport system: in vitro evidences utilizing neuraminidase-treated lipoproteins and mouse peritoneal macrophages

Desialylation of low density lipoprotein (LDL) brings about accumulation of cholesterol in cultured cells. The influence of the neuraminidase-treated lipoprotein (LP) on the reverse cholesterol transport system was investigated in vitro utilizing very low density lipoprotein (VLDL), LDL, total high density lipoprotein (HDL) and its subfractions, HDL2 and HDL3, isolated from healthy donor plasma and mouse peritoneal macrophages. It was found that LP desialylation significantly: (1) decreased the capacity of total HDL and of HDL2, but not of HDL3, to efflux cellular cholesterol; (2) lowered the cholesterol esterification rate by lecithin:cholesterol acyltransferase (LCAT) without modifying the intrinsic LCAT activity of HDL; (3) increased the cholesteryl ester transfer from HDL to apo B-containing LP mediated by cholesteryl ester transfer protein (CETP); (4) enhanced the uptake by macrophages of cholesterol from HDL and LDL, although the amount of cholesterol taken up by the cells was much greater from the desialylated LDL than from desialylated HDL. Taken together, these in vitro evidences indicate that, in addition to enhancing the cell cholesterol LP uptake, desialylation may contribute to the premature development of atherosclerosis by impairing the reverse cholesterol transport system.

The age-related rise of plasma cholesterol in humans is not caused by a cell removal defect of LDL particles: 'in vitro' studies in peripheral mononuclear blood cells

In healthy subjects with a normal body mass index, total plasma cholesterol, low-density lipoprotein (LDL) cholesterol, and apoB lipoprotein levels are higher in older individuals (n = 34) than in younger subjects (n = 43). The two groups studied ranged in age from 60 to 93 years and from 17 to 30 years, respectively. The cholesterol synthesis rates of peripheral mononuclear blood cells from 14C-acetate, total and unesterified cholesterol concentrations in freshly isolated cells, and the rates of uptake of pooled donor LDL, labeled with 125I- or 14C-cholesteryl oleoyl ether, by cells derepressed in a lipoprotein-free medium were similar in both experimental groups. Thus, the rise of LDL cholesterol with age would seem to be likely secondary to the higher rate of very-low-density lipoprotein production, as shown by other investigators.

Phototherapy units in Brazil: are they effective?

The irradiance delivered by a phototherapy unit is an important contributing factor to its efficacy. However, measurement of irradiance during phototherapy requires the use of a photometer which is rarely available in the nurseries of developing countries. We assessed the irradiance of phototherapy units both in the laboratory and in all public hospitals of the City of Rio de Janeiro and found that: a) there is no consensus among companies manufacturing phototherapy units as to the number of fluorescent lights to be used in an equipment since this number varied from 4 to 8, b) over 1/3 of the phototherapy units analysed had 1 or more burnt out lamps, c) the mean irradiance delivered by phototherapy units was 2.36 +/- 0.75 muw/cm2/nm (0.6 to 4.4 muw/cm2/nm) which is considerably lower than the dose currently recommended for clinical efficacy. These results may be relevant to other developing countries where phototherapy meters are seldomly available and irradiance is not routinely measured.

Fecal bilirubin excretion and serum bilirubin concentrations in breast-fed and bottle-fed infants

To assess the rate of excretion of bilirubin in the stools and its effects on serum bilirubin concentrations, we studied 24 breast-fed and 13 bottle-fed infants during the first 3 days after birth. Bottle-fed infants passed significantly more stool (3-day totals, 82 vs 58 gm, P less than 0.001), excreted more bilirubin (3-day totals, 23.8 vs 15.7 mg, P less than 0.05), and had lower serum bilirubin values (day 3, 6.8 vs 9.5 mg/dl, P less than 0.02). Among the breast-fed infants, greater stool output was associated with greater fecal bilirubin excretion (r = 0.56, P less than 0.05) and lower serum bilirubin concentrations (r = 0.66, P less than 0.001). Our data suggest that hyperbilirubinemia in breast-fed infants may be related to a delay in bilirubin clearance resulting from low stool output.

Biological characterization of various forms of elongation factor 1 from rabbit reticulocytes

Two forms of elongation factor 1 (EF-1) have been tested for a variety of biological functions. One form, EF-1H, is a high-molecular-weight aggregate (Mr greater than 500,000) containing four distinct polypeptides (alpha, beta, gamma, delta). The other form, EF-1 alpha, consists of a single polypeptide which is the same as the alpha subunit of EF-1H. Both EF-1 alpha and EF-1H function catalytically in binding Phe-tRNA to ribosomes, and in poly(U)-directed polyphenylalanine synthesis. The activity of EF-1 alpha is enhanced in polyphenylalanine synthesis by a complementary component, EF-1 beta delta. It is also shown that EF-1 beta delta can facilitate an exchange of EF-1 alpha-bound GDP for GTP. The EF-1 alpha dissociation constants for GDP and GTP were 0.47 and 0.55 microM respectively, while the EF-1H dissociation constants for GDP and GTP were 2.0 and 1.6 microM, respectively. Thus, while EF-1 alpha and EF-1H had approximately the same affinities for GDP and GTP, the EF-1 alpha dissociation constants were about fourfold lower than the EF-1H dissociation constants. Attempts to isolate complexes of EF-1 alpha or EF-1H with GTP and Phe-tRNA or with GTP, Phe-tRNA, and ribosomes were unsuccessful using either Millipore filters, gel filtration, or sucrose density gradients. The results presented in this report, along with studies from other laboratories, strengthen the hypothesis that the general mechanism of the elongation cycle is similar in eucaryotes and procaryotes.

Purification of various forms of elongation factor 1 from rabbit reticulocytes

Previous studies have indicated that the high-molecular-weight form of elongation factor 1 (EF-1H) contained four subunits (alpha, beta, gamma, and delta). Using the conventional methods of gel-filtration and ion-exchange chromatography, various forms of elongation factor 1 (EF-1 alpha, EF-1 beta delta, EF-1 beta gamma delta) have been purified from rabbit reticulocyte lysate. The procedure described allows one to purify these factors from a single batch of lysate in sufficient amounts for physical and biochemical studies. EF-1 alpha is a single polypeptide of Mr 52,000, and has an isoelectric point of 9.1. EF-1 beta delta and EF-1 beta gamma delta are composed of two and three nonidentical polypeptides, respectively, as judged by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. Both proteins can form stable aggregates in native conditions that can reach more than 2,000,000 Da. The isoelectric point for each polypeptide was determined; 5.8 for EF-1 beta, 5.5 for EF-1 gamma, and 4.8 for EF-1 delta. The activity of both proteins was compared on a molecular basis by their ability to stimulate EF-1 alpha in the poly(U)-directed synthesis of polyphenylalanine. On the basis of this assay EF-1 beta gamma delta is slightly more active than EF-1 beta delta. The similarity of the amino acid composition of EF-1 gamma and EF-1 delta and the molar ratio of alpha: beta: gamma: delta in EF-1H of approximately 1:1:0.5:0.5 have led to the conclusion that EF-1 delta is probably a breakdown product of EF-1 gamma, and that the native form of EF-1H probably contains only the alpha, beta, and gamma subunits.

Effect of frequent breast-feeding on early milk production and infant weight gain

To investigate the effects of frequency and duration of breast-feeding on infants' milk intake and weight gain, two groups of mother-infant pairs were studied during the first month after delivery. Mothers in the control group (n = 24) nursed their infants on a 3- to 4-hour schedule. Those in the experimental group (n = 20) were encouraged to nurse frequently. During the first 14 postpartum days, all mothers recorded the length and time of each breast-feeding. On the 15th and on the 35th postpartum day, milk intake per feeding for 24 hours and infant weight gain from birth were measured. During the first 2 weeks after delivery, mothers in the experimental group nursed more frequently (9.9 v 7.3 feedings per 24 hours; P less than .0001). On day 15, their infants took more milk (725 v 502 mL/24 h; P less than .0002), and had gained more weight from birth (561 v 347 g; P less than .02). On day 35, although mothers in the experimental group were still nursing more frequently (9.8 v 6.8 feedings per 24 hours; P less than .01), milk intake and weight gain from birth were not significantly different.

Frequency of breast-feeding and serum bilirubin concentration

Recent studies suggest that the three- to four-hour feeding regimens followed in many maternity units for breast-feeding mothers may not be physiological and that human infants should be fed more frequently. To determine the effects of frequency and length of brest-feeding in the first days after birth, we studied 55 mothers and their infants. Infants who nursed on average more than eight times per 24 hours in the first three days of life had significantly lower serum bilirubin levels (65. v 9.3 mg/fL, P less than .01) than those who fed less than eight times per 24 hours. The results of this investigation suggest that present breast-feeding policies that reduce or limit the number of feedings may interfere with the normal processes that eliminate bilirubin from the newborn infant.