Duodenal Microbiota in Stunted Undernourished Children with Enteropathy

BACKGROUND

Environmental enteric dysfunction (EED) is an enigmatic disorder of the small intestine that is postulated to play a role in childhood undernutrition, a pressing global health problem. Defining the incidence of this disorder, its pathophysiological features, and its contribution to impaired linear and ponderal growth has been hampered by the difficulty in directly sampling the small intestinal mucosa and microbial community (microbiota).

METHODS

In this study, among 110 young children (mean age, 18 months) with linear growth stunting who were living in an urban slum in Dhaka, Bangladesh, and had not benefited from a nutritional intervention, we performed endoscopy in 80 children who had biopsy-confirmed EED and available plasma and duodenal samples. We quantified the levels of 4077 plasma proteins and 2619 proteins in duodenal biopsy samples obtained from these children. The levels of bacterial strains in microbiota recovered from duodenal aspirate from each child were determined with the use of culture-independent methods. In addition, we obtained 21 plasma samples and 27 fecal samples from age-matched healthy children living in the same area. Young germ-free mice that had been fed a Bangladeshi diet were colonized with bacterial strains cultured from the duodenal aspirates.

RESULTS

Of the bacterial strains that were obtained from the children, the absolute levels of a shared group of 14 taxa (which are not typically classified as enteropathogens) were negatively correlated with linear growth (length-for-age z score, r = -0.49; P = 0.003) and positively correlated with duodenal proteins involved in immunoinflammatory responses. The representation of these 14 duodenal taxa in fecal microbiota was significantly different from that in samples obtained from healthy children (P<0.001 by permutational multivariate analysis of variance). Enteropathy of the small intestine developed in gnotobiotic mice that had been colonized with cultured duodenal strains obtained from children with EED.

CONCLUSIONS

These results provide support for a causal relationship between growth stunting and components of the small intestinal microbiota and enteropathy and offer a rationale for developing therapies that target these microbial contributions to EED. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02812615.).

The environment and antiphospholipid syndrome

The etiology of autoimmune diseases is multifactorial. The degree to which genetic and environmental factors influence susceptibility to autoimmune diseases is poorly defined. It is believed that versatile clinical presentations of autoimmune diseases stem from various combinations of the genetic and environmental factors. One of the newly diagnosed autoimmune diseases is the antiphospholipid syndrome (APS). APS is characterized by vascular thrombosis, and/or pregnancy morbidity associated with anticardiolipin (aCL), anti-β2-glycoprotein-I (anti-β2GPI) and lupus anticoagulant (LAC).

Environmental and infectious factors in eosinophilic esophagitis

Identifying possible environmental or infectious etiologic factors for eosinophilic esophagitis (EoE) may offer insight into opportunities for disease prevention and treatment. We reviewed the current literature to assess environmental and infectious factors evaluated in EoE. Few studies have been conducted, however a consistent inverse association between EoE and H. pylori has been described. Several studies suggest a weak association between season and EoE diagnosis, but the evidence is inconclusive. EoE has also been associated with early life factors, including Cesarean delivery and antibiotic use. Larger studies are needed to evaluate these associations more thoroughly. Several papers have speculated the potential for anti-secretory agents to contribute to EoE. This has not been formerly evaluated. In summary, there is significant opportunity in the future to advance our understanding of possible environmental etiologic factors for EoE.

Environmental risk factor assessment: a multilevel analysis of childhood asthma in China

BACKGROUND

Rapid changes in socioeconomic environment and their diverse patterns in China raise a question: how socio-environmental factors affect childhood asthma in China. We performed a multilevel analysis based on a 2005 national survey to understand the association between environmental factors and asthma, and to provide insights on developing prevention strategies.

METHODS

A multi-center, cross-sectional survey was conducted in 2018 school-aged children chosen from eight Chinese cities. Children of 6-13 years old were chosen randomly from schools of 39 centers in 8 cities. The multilevel analysis was made to assess both individual-level and city-level risk factors. The effect of gross domestic product (GDP) was further investigated by analysis of the factors.

RESULTS

Analysis of city-level environmental factors showed that GDP [adjusted odds ratio (OR)=1.88], particulate matter with aerodynamic diameter ≤10 μm (PM10) (adjusted OR=1.37), and average humidity (adjusted OR=1.33) were strong risk factors. Further analysis of the factors decomposed GDP into two major factors, the first represented by urban construction, energy consumption, nitrogen dioxide concentration, and the second represented by health-system coverage. This suggested that the negative effects of GDP outweighed its positive effects on asthma.

CONCLUSIONS

The prevalence of childhood asthma varies significantly in the eight Chinese cities. Socioenvironmental factors such as GDP, PM10 and average humidity are strong risk factors controlling individual attributes, suggesting that balance is needed between public health and economic development in China.

[The inflammatory response as a manifestation of the influence of environmental chemical factors]

The paper shows that a chronic slowly developing inflammation manifesting itself as adipokine imbalance and lipid metabolism abnormalities in the body under the influence of unfavorable environmental factors.

[Scientific and methodological rationale for the pathomorphism of Lamblia infection in children during chemical contamination of the biosphere]

The paper analyzes the clinical and laboratory features of Lamblia infection in children living under long-term low-dose chemical load. The scientific search methodology comprised the meticulous examination of the patients randomized by the presence or absence of protozoonosis and the statistical processing and expert analysis of the results. The comprehensive approach could define the main signs of the pathomorphism of lambliosis in the areas with high anthropogenic loads and identify immunological disorders, intoxication, and hepatobiliary dysfunctions. The impact of environmentally induced chemical contamination of the biosphere on the natural history of protozoonosis should be borne in mind when evaluating the biological hazard and risk of environmental biological factors on the population health and when scheduling and implementing hygienic and sanitary-and-epidemiological measures to prevent lambliosis in the high anthropogenic load areas.

[Efficiency of ACE inhibitors, beta adrenoblocker and antihypoxant in the phase of stationary rehabilitation of patients with myocardial infarction working in environmentally unfriendly conditions]

The aim of this work was to study effect of fosinopril combined with propranolol or cytomack on ecoendotoxicosis, size of myocardial infarction (MI), left ventricular (LV) systolic function, and clinical picture of stationary phase MI in patients working in environmentally unfriendly conditions. 42 patients aged 30-70 yr presenting with MI and initial Q-wave were randomized into 2 groups of 21 subjects each. In group 1, they were given fosinopril with propranolol, in group 2 fosinopril with cytomack. Mean age of group 1 and 2 patients was 57.8 +/- 2.1 and 56.9 +/- 23 yr respectively. All the patients were hospitalized within 6 hr after onset of the disease and received heparin. They underwent PETG and echoCG, also studied were endotoxicosis (PSD), central hemodynamics, left ventricular systolic functions (ESV, EDV, EF), size of MI (total ST, AST, total Rh), and clynical symptoms. It was shown that patients working in environmentally unfriendly conditions were characterized by high degree of PSD. In group 1 they exhibited reduction of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF. Decreased systolic and diastolic AP did not lead to clinically significant hypotension. Patients of group 2 showed stabilization of AP, decrease of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF that prevented the development of cardiac insufficiency in the phase of stationary rehabilitation of MI. Characteristics of groups 1 and 2 were not significantly different. The clinical course of IM in patients given fosinopril with cytomack was more favourable than in those treated with fosinopril and propranolol. Two patients of group 1 suffered cardiac insufficiency.

[Mercury pollution of the habitable area of the Amur Region and the endemia of tuberculosis]

Analysis of the 1991-2006 statistical data of the Amur Region has indicated that the prevalence of tuberculosis does not depend on the level of ambient air pollution, the total amount of mercury-containing pesticides introduced into the plough-lands, and the environmental emission of metallic mercury at gold mining. The established set and the level and ratio of major mineral and trace elements in the blood of healthy individuals are suggestive of their adaptation to the specific geochemical environment. The excess and deficiency of major mineral and trace elements in the blood of patients with pulmonary tuberculosis result from the occurring pathomorphological, pathophysiological, metabolic, and other disorders that hamper the excretion of toxicants.

Food allergies and eosinophilic gastrointestinal illness

Eosinophilic gastrointestinal disorders are characterized by eosinophilic infiltration and inflammation of the gastrointestinal tract in the absence of previously identified causes of eosinophilia, such as parasitic infections, malignancy, collagen vascular diseases, drug sensitivities, and inflammatory bowel disease. These disorders include eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis. This article focuses mainly on eosinophilic esophagitis and eosinophilic gastroenteritis.

Environmental illness in athletes

This article examines environmental illness in athletes. Causes, symptoms, and treatment of heat-related illness, cold-related illness, and altitude-related illness are discussed.

Cough: occupational and environmental considerations: ACCP evidence-based clinical practice guidelines

OBJECTIVES

This section of the guideline aims to review the role of occupational and environmental factors in causing and contributing to cough. It also aims to indicate when such causes should be considered in a clinical setting, and a general approach to assessment and management.

METHODS

A review was performed of published data between 1985 and 2004 using PubMed. The search terms used included "air pollution," "sick building syndrome," "occupational asthma," "occupational lung disease," "hypersensitivity pneumonitis" (HP), "cigarette smoke," and "asthma." Selected articles were chosen when meeting the objectives, but the extent of articles available and the limited space for this section does not permit a fully comprehensive review of all of these areas, for which the reader is referred to other sections of this clinical practice guideline, the published literature, textbooks of occupational lung disease, or more specific review articles.

RESULTS/CONCLUSIONS

Almost any patient presenting with cough may have an occupational or environmental cause of or contribution to their cough. The importance of this is that recognition and intervention may result in full or partial improvement of the cough, may limit the need for medication/symptomatic treatment, and may improve the long-term prognosis. Nonoccupational environmental contributing factors for upper and lower airway causes of cough include indoor irritant and allergenic agents such as cigarette smoke, cooking fumes, animals, dust mites, fungi, and cockroaches. Causes of HP indoors include birds and fungal antigens. Outdoor pollutants and allergens also contribute to upper and lower airway causes of cough. Occupational exposures can cause hypersensitivity responses leading to rhinitis and upper airway cough syndrome, previously referred to as postnasal drip syndrome, as well as asthma, HP, chronic beryllium disease, and hard metal disease, as well as irritant or toxic responses. The diagnosis is only reached by initially considering possible occupational and environmental factors, and by obtaining an appropriate medical history to determine relevant exposures, followed by objective investigations. This may require referral to a center of expertise.

Psychiatric morbidity and toxic burden in patients with environmental illness: a controlled study

OBJECTIVE

Patients with environmental illness experience a large number of psychological symptoms. The nature of these symptoms and their pathogenesis (toxicogenic versus psychogenic) is controversial. The objective was to (1) characterize the nature of the psychological symptoms according to well-established diagnostic criteria, and (2) to investigate the association between toxicological factors and psychological symptoms.

METHODS

Toxic burden, somatic morbidity, and psychiatric morbidity were assessed in 309 outpatients with environmental illness and 59 semiconductor industry workers matched for age and gender. Psychiatric disorders were assessed by a structured psychiatric interview (SCID), and distress was assessed by the Symptom-Checklist-90-Revised (SCL-90-R). Routine and specific laboratory tests in blood and urine samples were used to assess chemical exposures.

RESULTS

Overall psychiatric morbidity was significantly higher in patients than in controls according to SCID (75% versus 24%). Somatoform, mood, and anxiety disorders were significantly more frequent in patients with environmental illness. They also revealed marked stress on the SCL-90-R somatization subscale and scored significantly higher than controls on most of the other subscales. Industry workers from the control group tended to have higher urine metal concentrations than environmental illness patients and similar concentrations of solvents in blood.

CONCLUSION

Our data extend previous findings of high psychiatric morbidity in patients with environmental illness. They do not support the notion of a direct causal link between chemical exposure and the psychological symptoms.

[Current opinions on pathogenesis and treatment of otitis media with effusion in children]

Otitis media with effusion (OME) is one of the most often diagnosed diseases in the pre-school children. OME is defined as the presence of effusion behind the intact tympanic memebrane without symptoms of acute infection. Pathogenesis of OME is multifactorial and represents the interactions between environmental, social, anatomical and infectious factors and an allergy. Due to the hearing impairment accompanying this disease, effective prevention and treatment are necessary. This publication presents current knowledge concerning etiopathogenesis of OME taking into consideration the role of Eustachian tube, infectious factor, allergy, immunological factors, NO and gastroesophageal reflux disease. Recommended methods of treatment depending on the clinical condition and the age of children are also presented. The initiation of appropriate therapy is crucial because of the possibility of remote complications.

Symptoms attributed to the environment – a systematic, interdisciplinary assessment

PROBLEM

To assess symptoms attributed to the environment from an interdisciplinary perspective and to evaluate the plausibility of the participants' individual theory of a causal relationship between exposure and health impairment.

METHOD

We assessed the medical, psychiatric and environmental background in every participant in an environmental medicine project and discussed the explanatory value of our findings for each reported symptom.

RESULTS

Every second participant had at least one symptom that could be plausibly explained by simultaneously occurring medical, psychological or environmental findings. In 40% of the participants the research team rated the association between an environmental exposure and the health complaints to be 'plausible'. Psychiatric disorders were frequent, but did not exclude environmentally caused symptoms.

CONCLUSION

Only an interdisciplinary structure including medical, psychiatric and environmental expertise is likely to adequately diagnose and advise persons with environmentally related symptoms.

Cockroach allergens: environmental distribution and relationship to disease

Cockroach allergy has been recognized as an important cause of asthma. Exposure to high levels of cockroach allergens in the home is a major risk factor for symptoms in sensitized individuals. Previously identified allergens from Blatella germanica and Periplaneta americana include Bla g 2 (inactive aspartic proteinase), Bla g 4 (calycin), Bla g 5 (glutathione-S-transferase), Bla g 6 (troponin), the Group 1 cross-reactive allergens Bla g 1 and Per a 1, Per a 3 (arylphorin), and Per a 7 (tropomyosin). The primary site of cockroach allergen accumulation is the kitchen. However, lower levels of allergen can be found in bedding, on the bedroom floor, and in sofa dust. Strategies for decreasing exposure to cockroach have been investigated. The results suggest that a sustained decrease in cockroach allergen levels is difficult to accomplish, even after successful extermination of cockroach populations. The use of recombinant cockroach allergens may lead to the development of new approaches to asthma treatment in the future.

Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common behavioral disorder in children. ADHD is characterized by attention deficit, impulsivity, and sometimes overactivity ("hyperactivity"). The diagnosis is empirical, with no objective confirmation available to date from laboratory measures. ADHD begins in childhood and often persists into adulthood. The exact etiology is unknown; genetics plays a role, but major etiologic contributors also include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants. Thyroid hypofunction may be a common denominator linking toxic insults with ADHD symptomatologies. Abnormalities in the frontostriatal brain circuitry and possible hypofunctioning of dopaminergic pathways are apparent in ADHD, and are consistent with the benefits obtained in some instances by the use of methylphenidate (Ritalin) and other potent psychostimulants. Mounting controversy over the widespread use of methylphenidate and possible life-threatening effects from its long-term use make it imperative that alternative modalities be implemented for ADHD management. Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine (PS) can ameliorate ADHD symptoms. When individually managed with supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and other features of a wholistic/integrative program of management, the ADHD subject can lead a normal and productive life.

[The incidence of peculiar IgE in response to inhalant allergens in relation to the age of the patient]

208 patients between the age of 1 month to 56 years, with symptoms of respiratory tract allergy were investigated. In all cases serum titre of sIgE to birch, thymoty, rye, mugwort pollen, Alternaria Alternata, dog, cat fur, Dermatophagoides pteronyssinus and farinae was determined with the use of Quidel immunoenzymatic method. We have found sIgE to Alternaria Alternata in 8 (38%), birch pollen in 5 (23.8%) dog fur in 5 (23.8%) and thymoty and rye pollen in 3 (14.3%) even among one years-old infants. In the second and third years of life allergy to dog fur, Alternaria Alternata and pollen of birch, thymoty and rye increases while the age of 4 and 5 is less significant, later (6-10 years old patients) increases again. Among teenagers pollinosis gets decreases and adults have development constant level of the disease.

Putative environmental factors in Type 1 diabetes

Various environmental triggers, e.g. certain viruses and dietary factors, are thought to initiate the autoimmune process, leading to the destruction of pancreatic beta-cells and consequent Type 1 diabetes. A genetic predisposition is another prerequisite allowing the autoimmune process to progress. Twin studies, major geographical variations in incidence rates, temporal trends in the incidence and findings in migrant studies indicate that environmental factors play a crucial role in the development of Type 1 diabetes. In the present review the major focus is on dietary factors, and among them particularly the possible role of cow's milk proteins. The cow's milk and Type 1 diabetes hypothesis was developed more than 10 years ago, and the issue is still not settled. Among viral infections, enteroviruses are today the most interesting group of viruses in this respect, as recent prospective studies indicate that these viruses may trigger and potentiate existing beta-cell autoimmunity. Among toxins, particularly N-nitroso compounds are of potential interest, as they are probably involved in the aetiology of some cases. Finally, psychosocial factors and the interaction between genetic predisposition and environmental factors are briefly discussed.

Angioedema and swellings of the orofacial region

OBJECTIVE

Patients may have various forms of angioedema and require dental treatment which can cause or contribute to the onset of an episode of angioedema. This paper seeks to highlight the causes and the management of this serious condition.

DESIGN

An outline of the different types of angioedema is given here, along with three case reports which illustrate treatment and management.

SUBJECTS AND METHODS

Three patients who presented to an Oral Medicine clinic with angioedema are presented to illustrate various types of angioedema and the different contributing factors that precipitated episodes of the condition.

MAIN OUTCOME MEASURES

The three patients were all investigated for biochemical and allergic factors which may have caused their disease.

RESULTS

Both drugs and dental materials were shown to be involved in the pathogenesis of angioedema in this short series of patients.

CONCLUSIONS

Dental treatment or the use of some materials may promote or contribute to the disorder. Referral to hospital for specialist care is indicated for certain groups of patients who require invasive dental treatment. The multi-disciplinary team approach in the investigation and management of patients with angioedema is emphasised.

A nonconventional approach to the treatment of "environmental illness"

Twenty patients with symptoms of "environmental illness" were subject to a controlled study of deep versus superficial acupuncture. The patients were evaluated by a detailed questionnaire concerning their occupational, environmental, and medical history. Blood samples were taken as well. Patients were randomized to deep or superficial acupuncture. Both groups improved significantly in key variables during and after treatment. There were no group differences. There were no changes in biological variables apart from a gradual and continuous increase in serum cortisol and a decrease in neuropeptide Y, which was somewhat more accentuated in those receiving deep acupuncture. This rise in cortisol may have contributed to decreased dermal symptoms among the participants. It is hypothesized that the positive treatment results observed are partly due to weakening of the conditioned response, linking bodily symptoms to environmental agents. To date, a number of different methods have been tried in the management of patients with environmental illness. However, only rarely have the treatments been evaluated in controlled studies.