Epidemiologic studies continue to find an increased prevalence of rhinitis, asthma, and atopy in more westernized countries. Both allergic and nonallergic rhinitis are risk factors for development of asthma, particularly in adulthood. In patients who have both asthma and rhinitis, treatment of the latter decreases the likelihood of emergency department visits or hospitalization for asthma. The protective effect of intranasal cortico-steroids is much greater than that of antihistamines. This mirrors the effect on rhinitis symptoms, in which nasal corticosteroids are much more effective than antihistamines, leukotriene receptor antagonists, or the combination of both. In patients with severe asthma, sinus mucosal thickening on computed tomography (CT) correlates with the severity of lower airway disease indicated by sputum eosinophilia, exhaled nitrous oxide (NO), functional residual capacity, and diffusing capacity. Preseasonal specific immunotherapy (SIT) is less effective, but additive to treatment with omalizumab. It is also somewhat less effective in reducing nasal symptoms than nasal corticosteroids; however, it is superior to them for reducing lower airway inflammation. SIT in children with only allergic rhinitis reduces both the incidence of asthma and bronchial hyperresponsiveness to methacholine. High-dose sublingual immunotherapy appears to be safe and effective, but less effective than injection immunotherapy. It is not clear that there are cost savings with sublingual immunotherapy, as home administration savings may be offset by the much larger amount of allergen extracts required. New approaches to allergen immunotherapy, designed to increase efficacy and safety, include conjugation of allergens to immunostimulatory sequences and encapsulation in liposomes. Cross-reactivity between inhalants and foods demonstrated by skin prick tests is more predictive of clinically important sensitivity than is that demonstrated by RAST testing. The latter, because of cross-reacting profilins, is often clinically irrelevant.
Henna dye is obtained from the leaves of an indigenous tree, Lawsonia inermis. Contact dermatitis to henna is rarely reported. It is usually related to additives, especially oils or paraphenylenediamine. We report the case of a 9-year- old boy who developed an eczematous reaction at the site of application of a henna tattoo.
A henna tattoo was applied on the arm of a healthy 9-year-old boy on a Mediterranean beach. Four days later, the child noted pruritus followed multiple small papules and vesicles overlying the pattern of tattoo. He was treated with topical mometasone for 20 days, which produced gradual improvement and resolution.
Two months later, a patch test (True test) was performed on the upper back. The results were observed after 48 and 96 hours and showed positive reactions to p-phenylenediamine, PPD mix (black rubber mix) and paraben mix and was negative to natural henna.
Skin painting with henna is traditionally performed in Muslims or Hindus. The painting is usually performed on the hair, palms, soles of the feet and nails with henna that gives a red color. The addition of p-phenylenediamine to the henna mixture darkens the color. The mixtures used by the "artists" contained natural henna (a rare sensitizer) and chemical coloring agents: diaminotoluenes and diaminobenzenes such as paraphenylenediamine. Today, paint-on tattoos drawn on the skin by street or beach artists are very fashionable among Europeans in holiday resorts. Because of the worldwide fashion of skin painting, future cases of sensitization to p-phenylenediamine are expected.
To review an individual community gastroenterologist's experience with inflammatory bowel disease (IBD). The aspects studied were distribution of disease, need for hospital admission, immunosuppressants, systemic steroids, and surgery and its indications. The incidence of cancer was also reviewed.
The charts of all IBD patients (n=373) seen between 1993 and 1996 by an individual gastroenterologist in an urban community hospital were reviewed for the aforementioned information. Patients seen during this period may have been diagnosed with IBD before or during the period of 1993 to 1996.
Of the 373 patients, 219 had Crohn's disease (CD) and 154 had ulcerative colitis (UC). The most common age of onset for both groups was 20 to 29 years. Distal UC and distal Crohn's colitis patients rarely required surgery, hospitalization, systemic steroids or immunosuppressants. Eighty per cent of patients with small bowel CD and 51% of those with ileocolonic CD required at least one operation. Of the UC patients, 10.4% required surgery. Of the UC patients undergoing surveillance for cancer, none developed cancer but one developed significant dysplasia.
In both CD and UC the site of the inflammation plays a major role in determining the need for hospitalization, surgery, systemic steroids and immunosuppressants. Distal UC, the most common form of UC in this group of patients, is a very benign disease. Of all forms of IBD, small bowel CD had the greatest need for hospitalization, surgery and systemic steroids.
In June 2000, bear meat infected with Trichinella nativa was consumed by 78 individuals in 2 northern Saskatchewan communities. Interviews and blood collections were performed on exposed individuals at the onset of the outbreak and 7 weeks later. All exposed individuals were treated with mebendazole or albendazole, and symptomatic patients received prednisone. Confirmed cases were more likely to have consumed dried meat, rather than boiled meat (P
Acute idiopathic facial paralysis, or Bell's palsy, is frequently encountered in clinical practice. The present study compares knowledge of Bell's palsy assessment and management between a group of family physicians and otolaryngologists practising in Nova Scotia. Respondents completed a questionnaire and statistical analyses were performed on selected data. There were similarities regarding Bell's palsy assessment and management, but there were notable differences in the ability to distinguish Bell's palsy on the basis of symptomatic complaints, specific counselling strategies, length of patient follow-up, and use of appropriate diagnostic tests. This needs assessment suggests several areas where a family physician continuing medical education program on management of acute facial paralysis may be beneficial.
The aim of this cross-sectional study was to investigate whether periodontal condition is associated with hypertension and systolic blood pressure.
The study population consisted of dentate, non-diabetic, non-smoking individuals aged 30-49 years (n = 1296) in the national Health 2000 Survey in Finland. The number of teeth with deepened (=4 mm) and deep (=6 mm) periodontal pockets and the number of sextants with gingival bleeding were used as explanatory variables. Hypertension and systolic blood pressure were used as outcome variables.
There was no consistent association between the number of teeth with deepened (=4 mm) (OR 0.98, 95% CI 0.95-1.01) or deep (=6 mm) (OR 1.01, 95% CI 0.90-1.12) periodontal pockets and hypertension after adjusting for confounding factors. Nor was there any essential association between the number of bleeding sextants and hypertension.
Periodontal pocketing and gingival bleeding did not appear to be related to hypertension in non-diabetic, non-smoking individuals aged 30-49 years. Further studies using experimental study designs would be required to determine the role of infectious periodontal diseases in the development or progression of hypertension.
Acute bacterial meningitis (ABM) is a highly lethal disease. Available data support the use of corticosteroids in high-income countries, but the effect on mortality is still controversial. The effects of corticosteroids on mortality and sequelae were evaluated in the national Swedish quality registry. In total, during 1995-2014 1746 adults with ABM were included, of whom 989 were treated with corticosteroids (betamethasone, n = 766; dexamethasone, n = 248; methylprednisolone, n = 2), 498 were not given corticosteroids and in 259 patients data for corticosteroids were missing. Fatal outcome was observed in 8.9% of the patients in the corticosteroid-treated group vs. 17.9% in the non-corticosteroid-treated group (p
The clinical epidemiological studies included in this thesis fall into three parts. The first part includes studies on birth outcome in women with ulcerative colitis. The second part includes pharmacoepidemiological studies on birth outcome after anti-inflammatory drug therapy in pregnancy, including patients with ulcerative colitis and Crohn's disease. The third part (and the latest publications) includes birth outcome in women with Crohn's disease; and the methods of cohort establishment in these studies are developed and improved due to the knowledge gathered from conducting the earlier studies. The birth outcomes in women with ulcerative colitis are examined in a nationwide, Danish, cohort of women based on data from the Danish National Hospital Discharge Registry and the Danish Medical Birth Registry, and within a Hungarian case-control data set. Our data suggest: 1) Significantly increased risk of preterm birth when women give birth 0-6 months after establishment of the diagnosis. It is considered whether the increased risk may be influenced by disease activity around the time of establishing the diagnosis. 2) No increased risk of giving birth to children with low birth weight, intrauterine growth retardation or congenital abnormalities (evaluated overall). 3) Significantly increased risk of some selected congenital abnormalities (limb deficiencies, obstructive urinary and multiple congenital abnormalities). No other studies have examined the risk of selected congenital abnormalities in children born by women with ulcerative colitis. The pharmacoepidemiological studies on birth outcomes after use of anti-inflammatory drug therapy in pregnancy, including women with ulcerative colitis and Crohn's disease, are based on data from the Hungarian case-control data set, a countywide Danish prescription Database, the Danish National Hospital Discharge Registry, the Danish Medical Birth Registry, and review of selected medical records. After exposure to sulfasalazine during pregnancy our data suggest. No significantly increased overall relative risk of congenital abnormalities and no significantly increased risks of selected congenital abnormalities. After exposure to 5-aminosalicylic acid during pregnancy our data suggest. No significantly increased relative risk of low birth weight, intrauterine growth retardation or congenital abnormalities (evaluated overall). A significantly increased relative risk of preterm birth and stillbirth in ulcerative colitis women, compared to women with no prescription of reimbursed medicine in pregnancy - and also after comparing with women with chronic inflammatory bowel disease not taking 5-aminosalicylic acid during pregnancy. It is not clear whether these associations are causal or influenced by confounding by disease activity in particular. After maternal exposure to azathioprine/6-mercaptopurine during pregnancy our data suggest. An increased relative risk of preterm birth, congenital abnormalities, and perinatal mortality - also after using controls with similar underlying diseases. It is difficult to rule out an influence of uncontrolled confounding. These were the first published data from a controlled observational study on exposed women with chronic inflammatory bowel disease. After preconceptional paternal use of azathioprine/6-mercaptopurine our data suggest An increased risk of congenital abnormalities, although not significantly increased. The birth outcomes in women with Crohn's disease are examined in nationwide sub-cohorts classified according to type of anti-inflammatory drug exposure during pregnancy, and based on data from the Danish National Hospital Discharge Registry, the nationwide Danish Prescription Database and the Danish Medical Birth Registry. Furthermore, birth outcomes are examined in Crohn's disease women with disease activity during pregnancy, based on data from review of hospital records, the Danish National Hospital Discharge Registry and the Danish Medical Birth Registry. Our data suggest: 1) The risk of adverse birth outcomes in women with Crohn's disease varies according to the type of anti-inflammatory drug therapy in pregnancy. 2) Reassuring results according to low birth weight, intrauterine growth retardation, preterm birth and congenital abnormalities after use of sulfasalazine/5-aminosalicylic acid or steroids. 3) Worrisome findings of a significantly increased risk of preterm birth and an increased risk of congenital abnormalities (not significantly increased) after prescription of azathioprine/6-mercaptopurine during pregnancy. Some residual confounding by disease activity may have been left in the analyses of preterm birth. In Crohn's disease women with disease activity during pregnancy our data suggest: 1) A significantly increased relative risk of preterm birth in women with the highest degree of disease activity during pregnancy. 2) Disease activity does not seem to increase the risk of low birth weight, intrauterine growth retardation or congenital abnormalities. This study is the first epidemiological study of the risk of adverse birth outcomes in Crohn's disease women with disease activity during pregnancy, compared to women with no activity during pregnancy, and in which confounders have been taken into consideration. Exceeding the studies included in my previous PhD thesis, this thesis provides new evidence on the following subjects: i) the risk of selected congenital abnormalities in children of women with ulcerative colitis, ii) pharmacoepidemiological studies on the risk of adverse birth outcome after maternal azathioprine/6-mercaptopurine exposure in pregnancy, and the risk of congenital abnormalities in children fathered by men treated with azathioprine/6-mercaptopurine before conception, iii) the risk of adverse birth outcome in women with Crohn's disease according to type of anti-inflammatory drug treatment in pregnancy (sulfasalazine/5-aminosalicylic acid, steroids or azathioprine/6-mercaptopurine), and iv) the impact of disease activity in women with Crohn's disease on adverse birth outcome. We learned from the studies in this thesis that the traditional way of reporting birth outcome in women with chronic inflammatory bowel disease, i.e. without having valid information on the type of underlying disease, concurrent therapeutic drug treatment and disease activity, is of limited value. The studies show that the risk of specific adverse birth outcome in women with ulcerative colitis and Crohn's disease depends on several factors including the time of birth in relation the début of disease, the type of underlying disease (ulcerative colitis or Crohn's disease), the type of anti-inflammatory drug treatment during pregnancy, and the degree of disease activity during pregnancy. At the same time one also has to realize that the existing evidence is still limited, especially in the field of reproductive safety after therapeutic drug treatment during pregnancy and possible effects of preconceptional therapeutic drug exposure.