Background There is uncertainty regarding the prevalence of allergies to plant food. Objective To assess the prevalence of allergies to plant food according to the different subjective and objective ...assessment methods. Methods Our systematic search of population-based studies (since 1990) in the literature database MEDLINE focused on fruits, vegetables/legumes, tree nuts, wheat, soy, cereals, and seeds. Prevalence estimates were categorized by food item and method used (food challenges, skin prick test, serum IgE, parent/self-reported symptoms), complemented by appropriate meta-analyses. Results We included 36 studies with data from a total of over 250,000 children and adults. Only 6 studies included food challenge tests with prevalences ranging from 0.1% to 4.3% each for fruits and tree nuts, 0.1% to 1.4% for vegetables, and <1% each for wheat, soy, and sesame. The prevalence of sensitization against any specific plant food item assessed by skin prick test was usually <1%, whereas sensitization assessed by IgE against wheat ranged as high as 3.6% and against soy as high as 2.9%. For fruit and vegetables, prevalences based on perception were generally higher than those based on sensitization, but for wheat and soy in adults, sensitization was higher. Meta-analyses showed significant heterogeneity between studies regardless of food item or age group. Conclusion Population-based prevalence estimates for allergies to plant products determined by the diagnostic gold standard are scarce. There was considerable heterogeneity in the prevalence estimates of sensitization or perceived allergic reactions to plant food.
Contemporary perspectives on vaginal pH and lactobacilli Linhares, Iara M., MD, PhD; Summers, Paul R., MD; Larsen, Bryan, PhD ...
American journal of obstetrics and gynecology,
02/2011, Letnik:
204, Številka:
2
Journal Article
Recenzirano
Ever since the pH of the vagina was found to be much more acidic than blood and interstitial fluids, a belief going back more than a century has persisted that the vagina is protected from pathogenic ...organisms by the high level of hydronium ions present. A corollary of this belief is that the pH of the vagina and antipathogen activity is due to colonizing Lactobacilli . Unfortunately, this dogma lacks empirical research support. The vaginal pH is determined by the interplay between vaginal physiological processes and microbiology. An acidic vaginal pH and Lactobacilli are components of multiple defense mechanisms active in protection against infection in the lower female genital tract.
We present the first laser guide star adaptive optics (LGSAO) observations of the Galactic center. LGSAO has dramatically improved the quality and robustness with which high angular resolution ...infrared images of the Galactic center can be obtained with the Keck II 10 m telescope. Specifically, Strehl ratios of 0.7 and 0.3 at L' (3.8 km) and K' (2.1 km), respectively, are achieved in these LGSAO images; these are at least a factor of 2 higher and a factor of 4-5 more stable against atmospheric fluctuations than the Strehl ratios delivered thus far with the Keck natural guide star AO system on the Galactic center. Furthermore, these observations are the first that cover a large area (76 x 76) surrounding the central black hole at diffraction-limited resolution for an 8-10 m class telescope. During our observations, the infrared counterpart to the central supermassive black hole, Sgr A*-IR, showed significant infrared intensity variations, with observed L' magnitudes ranging from 12.6 to 14.5 mag and a decrease in flux density of a factor of 2 over an 8 minute interval. The faintest end of our L' detections, 1.3 mJy (dereddened), is the lowest level of emission yet observed for this source by a factor of 3. No significant variation in the location of Sgr A*-IR is detected as a function of either wavelength or intensity. Previous claims of such positional variations are easily attributable to a nearby (0.09 or 720 AU, projected), extended, very red source, which we suggest arises from a locally heated dust feature. Near a peak in its intensity, we obtained the first measurement of Sgr A*-IR's K'- L' color; its K' - L' of 3.0 c 0.2 mag (observed) or 1.4 c 0.2 (dereddened) corresponds to an intrinsic spectral index of a = -0.5 c 0.3 for F sub( )8 super(a). This is significantly bluer than other recent infrared measurements from the literature, which suggest a = -4 c 1. Because our measurement was taken at a time when Sgr A* was 66 times brighter in the infrared than the other measurements, we posit that the spectral index of the emission arising from the vicinity of our Galaxy's central black hole may depend on the strength of the flare, with stronger flares giving rise to a higher fraction of high-energy electrons in the emitting region.
Summary
Background
Recent evidence suggests that embryonated eggs of the porcine whipworm Trichuris suis ova (TSO) may be an effective treatment for inflammatory bowel disease (IBD).
Aim
To assess ...the safety and tolerability of TSO following a single dose in patients with Crohn's disease.
Methods
This was a sequential dose‐escalation (500, 2500 and 7500 viable embryonated TSO), randomised, double‐blind, placebo‐controlled study to evaluate the safety of a single dose of oral suspension TSO in patients with Crohn's disease. Twelve patients were randomised into each of three cohorts. Patients were assessed 1, 3, 5, 7, 9, 11 and 14 days following dosing (via a telephone call and diary symptom collection through 14 days postdose) for adverse events, changes to concomitant medications and gastrointestinal (GI) signs and symptoms. Patients were again assessed at Months 1, 2 and 6.
Results
Eighteen males and 18 females were enrolled, ages 20 to 54 years. All patients were dosed and completed the initial 2‐month follow‐up period (five patients did not attend their 6‐month study visit). GI disorders were reported with the highest frequency; 7 (25.9%) TSO‐treated patients and 3 (33.3%) placebo‐treated patients. No dose‐dependent relationship was observed, with 3 (33.3%) placebo, 4 (44.4%) TSO 500, 0 (0.0%) TSO 2500 and 3 (33.3%) TSO 7500 patients experiencing at least one GI event, and no clinically meaningful changes in GI signs and symptoms.
Conclusions
A single dose of Trichuris suis ova up to 7500 ova was well tolerated and did not result in short‐ or long‐term treatment‐related side effects. Clinicaltrials.gov NCT01576461.
Abstract Background Cholelithiasis affects an estimated 20 million people in the United States yearly; 20% of symptomatic patients will develop acute cholecystitis (AC). A recent single-center study ...estimating test characteristics of point-of-care ultrasonography (POCUS) for the detection of AC, as defined by gallstones plus sonographic Murphy’s or pericholecystic fluid or gallbladder wall-thickening, resulted in a sensitivity and specificity of 87% (95% confidence interval CI 66–97) and 82% (95% CI 74–88), respectively. No prior studies have been conducted to estimate the test characteristics of POCUS for the purpose of excluding acute calculous cholecystitis. Objective To determine whether the finding of gallstones alone on POCUS has high sensitivity, high negative predictive value, and low negative likelihood ratio for the exclusion of AC. Methods We conducted an analysis using data from a prospective cross-sectional single-center study of POCUS test to estimate the test characteristics using a simplified definition of a positive test – the presence of gallstones alone. Clinical follow-up and pathology reports were used as the reference standard. Test characteristics were calculated and compared to the standard definition, gallstones plus one secondary finding. Results The overall prevalence of AC was 14% (23 pathology-confirmed cases of 164 included patients). The sensitivity of the simplified definition was 100% (95% CI 85.7–100), negative predictive value 100% (95% CI 92.2–100), and negative likelihood ratio was < 0.1, compared to a sensitivity of 87% (95% CI 66–97%), negative predictive value 97% (95% CI 93–99%), and negative likelihood ratio of 0.16 (95% CI 0.06–0.5). Conclusion Simplifying the definition of the test findings on POCUS to gallstones alone has excellent sensitivity and negative predictive value for the exclusion of AC. This finding, if broadly validated prospectively, confirms the practice of excluding acute calculous cholecystitis using POCUS in emergency department patients.
The objective of this study was to determine the validity and inter-rater reliability of radiographic assessment of sagittal deformity of femoral neck fractures.
This is a retrospective cohort study.
...Level 1 trauma center.
Thirty-one patients 65 years or older who sustained low-energy, Garden type I/II femoral neck fractures imaged with biplanar radiographs and either computed tomography or magnetic resonance imaging were included.
Preoperative sagittal tilt was measured on lateral radiographs and compared with the tilt identified on advanced imaging. Fractures were defined as "high-risk" if posterior tilt was ≥20 degrees or anterior tilt was >10 degrees.
Of 31 Garden type I/II femoral neck fractures, advanced imaging identified 10 high-risk fractures including 8 (25.8%) with posterior tilt ≥20 degrees and 2 (6.5%) with anterior tilt >10 degrees. Overall, there was no significant difference between sagittal tilt measured using lateral radiographs and advanced imaging (
= 0.84), and the 3 raters had good agreement between their measurements of sagittal tilt on lateral radiographs (interclass correlation coefficient 0.79, 95% confidence interval 0.65, 0.88,
< 0.01). However, for high-risk fractures, radiographic measurements from lateral radiographs alone resulted in greater variability and underestimation of tilt by 5.2 degrees (95% confidence interval -18.68, 8.28) when compared with computed tomography/magnetic resonance imaging. Owing to this underestimation of sagittal tilt, the raters misclassified high-risk fractures as "low-risk" in most cases (averaging 6.3 of 10, 63%, range 6 - 7) when using lateral radiographs while low-risk fractures were rarely misclassified as high-risk (averaging 1.7 of 21, 7.9%, range 1 - 3,
= 0.01).
Lateral radiographs frequently lead surgeons to misclassify high-risk sagittal tilt of low-energy femoral neck fractures as low-risk. Further research is necessary to improve the assessment of sagittal plane deformity for these injuries.
Level IV diagnostic study.
Teratogenicity Associated With Pre-Existing and Gestational Diabete Allen, Victoria M., MD, MSc, FRCSC; Armson, B. Anthony, MD, MSc, FRCSC; Wilson, R. Douglas, MD, MSc, FRCSC ...
Journal of obstetrics and gynaecology Canada,
2007, Letnik:
29, Številka:
11
Journal Article
Recenzirano
Abstract Objective To review the teratogenesis associated with pre-existing and gestational diabetes, to provide guidelines to optimize prevention and diagnosis of fetal abnormalities in women with ...diabetes, and to identify areas specific to fetal abnormalities and diabetes requiring further research. Options Pre-conception counselling, pre-conception and first trimester folic acid supplementation, and glycemic control. Outcomes Increased awareness of fetal abnormalities associated with pre-existing and gestational diabetes. Evidence The Cochrane Library and Medline were searched for English-language articles, published from 1990 to February 2005, relating to pre-existing and gestational diabetes and fetal abnormalities. Search terms included pregnancy, diabetes mellitus, pre-existing diabetes, type 1 diabetes, type 2 diabetes, insulin dependent diabetes, gestational diabetes, impaired glucose tolerance, congenital anomalies, malformations, and stillbirth. Additional publications were identified from the bibliographies of these articles as well as the Science Citation Index. All study types were reviewed. Randomized controlled trials were considered evidence of the highest quality, followed by cohort studies. Key studies and supporting data for each recommendation are summarized with evaluative comments and referenced. Values The evidence collected was reviewed by the Genetics and Maternal Fetal Medicine Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. Recommendations 1. Experimental studies suggest that hyperglycemia is the major teratogen in diabetic pregnancies, but other diabetes-related factors may also affect fetal outcomes. Further research using animal models is required to clarify the teratogenic factors associated with pre-existing and gestational diabetes. (II-3C) 2. Prospective and retrospective cohort studies have demonstrated an increased risk of congenital abnormalities with pre-existing diabetes. Further studies that include outcomes from first and second trimester pregnancy terminations, account for potential confounding variables, and use appropriate control groups are required. (II-2A) 3. Prospective and retrospective cohort studies have demonstratedan increased risk of congenital abnormalities with gestational diabetes. This observation is probably related to the inclusion of women with unrecognized type 2 diabetes. Clarification of the relationship between gestational diabetes and congenital abnormalities by studies that include outcomes from first and second trimester pregnancy terminations, account for potential confounding variables, and use appropriate control groups are required. (II-2A) 4. In some women, type 2 diabetes may be identified for the first time in pregnancy. Pre-conception recognition of women at high risk for type 2 diabetes and optimal glycemic control may reduce the risk of congenital anomalies. (II-2A) 5. Second generation sulfonylureas have not been associated with congenital abnormalities in human studies. The use of biguanides may be associated with other adverse perinatal outcomes. The use of other oral antihyperglycemic agents is not recommended in pregnancy. (II-2A) 6. The risk of congenital anomalies is increased in the offspring of obese women with diabetes. A healthy diet and regular exercise may help optimize pre-pregnancy weight and reduce the risk of congenital anomalies. (II-2A) 7. Accurate determination of gestational age is required in women with diabetes. Given the increased risk of congenital abnormalities, they should be offered appropriate biochemical and ultrasonographic screening and a detailed evaluation of fetal cardiac structures. (II-2A) 8. Women with diabetes should be offered pre-conception counselling with a multidisciplinary team to optimize general health and glycemic control and to review the risks of congenital anomalies. (II-2A) 9. A careful history should be obtained to identify other factors, such as a positive family history or advanced maternal age, that may further increase the risk of congenital structural or chromosomal abnormalities. (II-2A) 10. Pregnancy in women with diabetes should be planned. Good contraceptive advice and pre-pregnancy counselling are essential. Euglycemia should be maintained before and during pregnancy. (II-2A) 11. All women with diabetes should be counselled regarding intake of foods high in folic acid, folate-fortified foods, and appropriate folic acid supplementation of 4 to 5 mg per day pre-conceptionally and in the first 12 weeks of gestation. (II-2A) 12. A substantial number of women with diabetes do not access pre-conception care programs. Strategies are needed to improve access to such programs and to maximize interventions associated with improved pregnancy outcomes, such as folic acid use. (II-2A) Validation These guidelines have been reviewed by the Genetics Committee and the Maternal Fetal Medicine Committee of the SOGC. Final approval has been given by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. Sponsors The Society of Obstetricians and Gynaecologists of Canada
Objective This study was designed to test the hypothesis that simulator-based transesophageal echocardiographic training was a more effective method of training anesthesia residents with no prior ...experience in echocardiography as compared with conventional methods of training (books, articles, and web-based resources). Study Design A prospective randomized study. Setting An academic medical center (teaching hospital). Participants The participants consisted of first-year anesthesia residents. Intervention The study design was composed of 2 groups: a control group (group 1, conventional group) and a study group (group 2, simulator group). The residents belonging to group 2 (simulator group) received a 90-minute simulator-based teaching session moderated by a faculty experienced in transesophageal echocardiography. Residents belonging to group 1 (conventional group) were asked to review the guidelines of the comprehensive intraoperative transesophageal echocardiographic examination published by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. They also were encouraged to use other learning resources (eg, textbooks, electronic media, and web-based resources) to understand the underlying concepts of echocardiography. Written pre- and post-test was administered to both groups. Measurements and Main Results The groups were compared for the pretest scores by the nonparametric Mann-Whitney U test. Pre- and post-test scores were compared with a Wilcoxon paired test in the individual groups. The results showed a statistically significant difference between the scores of the 2 groups with better scores in the simulation group in the post-training test. Conclusion The simulator-based teaching model for transesophageal echocardiography is a better method of teaching the basic concepts of transesophageal echocardiography like anatomic correlation, structure identification, and image acquisition.
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