The relationship between gastro-oesophageal reflux disease and asthma during childhood.

Allergol Immunopathol (Madr). 2012 Dec 18;

Authors: Ozcan C, Erkoçoğlu M, Civelek E, Demirkan H, Kırsaçlıoğlu CT, Tiryaki HT, Giniş T, Kocabaş CN

Abstract
BACKGROUND: The relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD. METHOD: Subjects who were evaluated by 24h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE. RESULTS: A total of 204 subjects (49.5% male) with a mean age of 7.8±4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p=0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p=0.001). CONCLUSION: Although, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.

PMID: 23265260 [PubMed - as supplied by publisher]

Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study.

Allergol Immunopathol (Madr). 2012 Dec 19;

Authors: Cardona R, Lopez E, Beltrán J, Sánchez J

Abstract
BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3ml at first injection, and in single 0.5ml doses in subsequent monthly injections. A 30min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system. RESULTS: 575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates.

PMID: 23265265 [PubMed - as supplied by publisher]

Community-Acquired Legionella pneumophila Pneumonia: A Single-Center Experience With 214 Hospitalized Sporadic Cases Over 15 Years.

Medicine (Baltimore). 2012 Dec 21;

Authors: Viasus D, Di Yacovo S, Garcia-Vidal C, Verdaguer R, Manresa F, Dorca J, Gudiol F, Carratalà J

Abstract
ABSTRACT: Legionella pneumophila has been increasingly recognized as a cause of community-acquired pneumonia (CAP) and an important public health problem worldwide. We conducted the present study to assess trends in epidemiology, diagnosis, clinical features, treatment, and outcomes of sporadic community-acquired L. pneumophila pneumonia requiring hospitalization at a university hospital over a 15-year period (1995-2010). Among 3934 nonimmunosuppressed hospitalized patients with CAP, 214 (5.4%) had L. pneumophila pneumonia (16 cases were categorized as travel-associated pneumonia, and 21 were part of small clusters). Since the introduction of the urinary antigen test, the diagnosis of L. pneumophila using this method remained stable over the years (p = 0.42); however, diagnosis by means of seroconversion and culture decreased (p < 0.001 and p = 0.001, respectively).The median age of patients with L. pneumophila pneumonia was 58.2 years (SD 13.8), and 76.4% were male. At least 1 comorbid condition was present in 119 (55.6%) patients with L. pneumophila pneumonia, mainly chronic heart disease, diabetes mellitus, and chronic pulmonary disease. The frequency of older patients (aged >65 yr) and comorbidities among patients with L. pneumophila pneumonia increased over the years (p = 0.06 and p = 0.02, respectively). In addition, 100 (46.9%) patients were classified into high-risk classes according to the Pneumonia Severity Index (groups IV-V). Twenty-four (11.2%) patients with L. pneumophila pneumonia received inappropriate empirical antibiotic therapy at hospital admission. Compared with patients who received appropriate empirical antibiotic, patients who received inappropriate therapy more frequently had acute onset of illness (p = 0.004), pleuritic chest pain (p = 0.03), and pleural effusion (p = 0.05). The number of patients who received macrolides decreased over the study period (p < 0.001), whereas the number of patients who received levofloxacin increased (p < 0.001). No significant difference was found in the outcomes between patients who received erythromycin and clarithromycin. However, compared with macrolide use during hospital admission, levofloxacin therapy was associated with a trend toward a shorter time to reach clinical stability (median, 3 vs. 5 d; p = 0.09) and a shorter length of hospital stay (median, 7 vs. 10 d; p < 0.001).Regarding outcomes, 38 (17.8%) patients required intensive care unit (ICU) admission, and the inhospital case-fatality rate was 6.1% (13 of 214 patients). The frequency of ICU admission (p = 0.34) and the need for mechanical ventilation (p = 0.57) remained stable over the study period, but the inhospital case-fatality rate decreased (p = 0.04). In the logistic regression analysis, independent factors associated with severe disease (ICU admission and death) were current/former smoker (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.01-8.62), macrolide use (OR, 2.40; 95% CI, 1.03-5.56), initial inappropriate therapy (OR, 2.97; 95% CI, 1.01-8.74), and high-risk Pneumonia Severity Index classes (OR, 9.1; 95% CI, 3.52-23.4).In conclusion, L. pneumophila is a relatively frequent causative pathogen among hospitalized patients with CAP and is associated with high morbidity. The annual number of L. pneumophila cases remained stable over the study period. In recent years, there have been significant changes in diagnosis and treatment, and the inhospital case-fatality rate of L. pneumophila pneumonia has decreased.

PMID: 23266795 [PubMed - as supplied by publisher]

Pathways associated with reduced quadriceps oxidative fibres and endurance in COPD.

Eur Respir J. 2012 Dec 20;

Authors: Natanek SA, Gosker HR, Slot IG, Marsh GS, Hopkinson NS, Moxham J, Kemp PR, Schols AM, Polkey MI

Abstract
Reduced quadriceps endurance in COPD is associated with a predominance of type II glycolytic over type I oxidative fibres (fibre shift, FS) and reduced muscle energy stores. Molecular mechanisms responsible for this remain unknown. We hypothesised that expression of known regulators of type I fibres and energy production in quadriceps muscle would differ in COPD patients with and without FS.We measured lung function, physical activity, exercise performance, quadriceps strength and endurance (non-volitionally) in 38 GOLD Stage I-IV COPD patients and 23 healthy age-matched controls. Participants had a quadriceps biopsy; type I and II fibre proportions were determined using immunohistochemistry and FS defined using published reference ranges. Calcineurin A, phosphorylated adenosine monophosphate kinase-alpha (phospho-AMPK) and protein kinase A-alpha catalytic subunits were measured by western blotting and modulators of calcineurin activity, calmodulin, 14-3-3 proteins, and myocyte-enriched calcineurin-interacting protein-1 mRNA measured by western blotting and qPCR respectively. Downstream, nuclear myocyte enhancer factor-2 capable of DNA-binding was quantified by transcription factor ELISA.Unexpectedly calcineurin expression was higher, while phospho-AMPK was lower, in COPD patients with than without FS. Phospho-AMPK levels correlated with quadriceps endurance in patients.Reduced phospho-AMPK may contribute to reduced quadriceps oxidative capacity and endurance in COPD.

PMID: 23258787 [PubMed - as supplied by publisher]