terça-feira, 24 de junho de 2014

Triggers, treatment of immediate-type allergic reactions


Sudden allergic reactions can be fatal. The most common triggers of such reactions, also known as anaphylaxis, are wasp and bee venoms, legumes (pulses), animal proteins, and analgesics (painkillers). The incidence of anaphylaxis is age-dependent. In the current issue of Deutsches Ärzteblatt International, Margitta Worm (Berlin) and her co-authors describe the causes and treatment methods for anaphylaxis, based on data from the anaphylaxis registry of the German-speaking countries.

Worm and co-authors analyzed the data from the registry, which covers Germany, Austria, and Switzerland, for information on triggers, symptoms, and treatment from 2006 to 2013; they also evaluated data recorded from ADAC air rescue callouts in 2010 and 2011. A total of 4141 persons were affected by anaphylaxis (52.5% female, 47.5% male), 3168 adults and 973 children. Among children, boys were affected more often than girls (640 boys), whereas among adults, women were the more often affected. Most cases (85%) were classified as severity grade II or III. Grade IV reactions, which are very severe, were less frequently reported: 3% of adult cases and 0.9% of pediatric cases. Among children, foods were the most frequent triggers of allergic reactions; among adults, the most frequent triggers were insect venoms. Of these, wasp stings were reported most often (70%), bee stings more rarely (20%).

Analysis of medical emergency cases showed that epinephrine was used to treat only 14.5% of patients in the anaphylaxis registry with grade III reactions and 43.9% of those with grade IV reactions. Of the patients who had to be treated by air rescue personnel, 19% and 78% respectively received epinephrine. Epinephrine was not used often enough, even though it is recommended in the treatment guidelines for reactions from grade II upward.


Story Source:

The above story is based on materials provided by Deutsches Aerzteblatt International. Note: Materials may be edited for content and length.


Journal Reference:

  1. Worm M, Eckermann O, Dölle S, Aberer W, Beyer K, Hawranek T, Hompes S, Koehli A, Mahler V, Nemat K, Niggemann B, Pföhler C, Rabe U, Reissig A, Rietschel E, Scherer K, Treudler R, Ruëff F. Triggers and treatment of anaphylaxis: an analysis of 4000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int, 2014; 111: 367%u201375 DOI: 10.3238/arztebl.2014.0367

Menthol cigarettes linked to increased smoking among teens

 

June 20, 2014

University of Waterloo

Teens who use menthol cigarettes smoke more cigarettes per day than their peers who smoke non-menthols, says a new study. The findings mark the first time that menthol cigarettes have been directly linked to elevated nicotine addiction among youth. "The appeal of menthol cigarettes among youth stems from the perception that they are less harmful than regular cigarettes. The minty taste helps mask the noxious properties, but the reality is that they are just as dangerous as any unflavoured cigarette," said the lead author of the paper.


Teens who use menthol cigarettes smoke more cigarettes per day than their peers who smoke non-menthols, says a new study. The findings from the Propel Centre for Population Health Impact at the University of Waterloo mark the first time that menthol cigarettes have been directly linked to elevated nicotine addiction among youth.

"The appeal of menthol cigarettes among youth stems from the perception that they are less harmful than regular cigarettes. The minty taste helps mask the noxious properties, but the reality is that they are just as dangerous as any unflavoured cigarette," said Sunday Azagba, a scientist at Propel and lead author on the paper.

Published in Cancer Causes and Control, the study found that menthol users smoked an average of 43 cigarettes a week, close to double the 26 smoked by non-menthol users. The study also found that menthol smokers were almost three times more likely to report that they intend to continue smoking in the next year.

Despite the well-documented health risks associated with tobacco use,  high school students from Grades  are current smokers. Research shows that the majority of long-term adult smokers start smoking during their adolescence. The national Youth Smoking Survey has found that 32 per cent of smokers in high school smoke menthols.

"There is a growing concern that the high popularity of menthol cigarettes among youth may hinder the recent progress in preventing other young people from smoking because many of them may experiment with menthol rather than unflavoured brands," said Azagba.

In July 2010, Canada implemented a ban on the sale of most flavoured cigarettes, little cigars and blunt wraps, but not menthol. Alberta is the only province to include a ban on menthol cigarettes in provincial legislation, though it is not yet in force. In April 2014, the European Union (EU) adopted a new Tobacco Products Directive that will see all 28 EU countries implement a ban on menthol cigarettes.

"Our findings indicate that youth smoking of menthol cigarettes is a serious concern," said Azagba. "It's clear moving forward that we need new laws to ban all added flavours in all tobacco products."

Many babies born before full-term without medical reason

 

June 20, 2014

University of Minnesota Academic Health Center

The first of its kind research is out showing who is having early elective deliveries between 37 and 39 weeks gestation, and whether these deliveries happen following labor induction or cesarean. Labor induction or cesarean delivery without medical reason before a baby is considered full-term at 39 weeks, or an 'early elective delivery,' is associated with health problems for mothers and babies.  


New University of Minnesota research out this week is the first of its kind to show who is having early elective deliveries between 37 and 39 weeks gestation, and whether these deliveries happen following labor induction or cesarean.

Labor induction or cesarean delivery without medical reason before a baby is considered full-term at 39 weeks, or an "early elective delivery," is associated with health problems for mothers and babies.

The study, led by University of Minnesota School of Public Health Assistant Professor Katy Kozhimannil, Ph.D., M.P.A., in collaboration with Children's Hospital of Philadelphia researchers Michelle Macheras, M.A., and Scott A. Lorch, M.D., M.S.C.E., appears in this month's edition of the journal Medical Care.

The chance of early elective induction was higher among women:

  • 35 years of age or older, white with higher education levels
  • Who were privately insured
  • Who gave birth at rural or nonteaching hospitals

Early elective cesareans were more likely for women:

  • Less than 20 years old or over 35 years old
  • Who were black
  • Who had higher education levels
  • Who gave birth at smaller-volume hospitals

"There are misunderstandings about when a baby is ready to be born," said Kozhimannil. "Since our findings show there are differences in who is having an early elective delivery, the importance of a full-term birth needs to be communicated to all women, not just those who may traditionally be considered high risk for elective procedure or high risk for poor outcomes."

Kozhimannil explained that contrary to the commonly-held belief that babies born after 37 weeks are considered "term," the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine say a pregnancy is full term only after 39 weeks.

The study found that infants born by early elective cesareans were 60 percent more likely to stay longer in the hospital and more than twice as likely to have respiratory distress compared to infants born on or after 39 weeks. Infants born via early elective induction were also more likely to stay in the hospital longer than expected.

"While prior work has shown that early elective delivery policies can be highly effective within particular healthcare systems, there is a need to address this issue at the population level," said Kozhimannil. "It is our hope that this study will add fuel to the ongoing efforts to educate pregnant women and influence clinical and policy environments to facilitate healthy, full-term deliveries whenever possible."

Antidepressant use during pregnancy may lead to childhood obesity, diabetes

 

June 21, 2014

McMaster University

Maternal use of a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, resulted in increased fat accumulation and inflammation in the liver of the adult offspring, researchers have demonstrated for the first time in an animal model. This raises new concerns about the long-term metabolic complications in children born to women who take SSRI antidepressants during pregnancy.


Women who take antidepressants during pregnancy may be unknowingly predisposing their infants to type 2 diabetes and obesity later in life, according to new research from McMaster University.

The study finds a correlation between the use of the medication fluoxetine during pregnancy and an increased risk of obesity and diabetes in children.

Currently, up to 20 per cent of woman in the United States and approximately seven per cent of Canadian women are prescribed an antidepressant during pregnancy.

"Obesity and Type 2 diabetes in children is on the rise and there is the argument that it is related to lifestyle and availability of high calorie foods and reduced physical activity, but our study has found that maternal antidepressant use may also be a contributing factor to the obesity and diabetes epidemic," said the study's senior investigator Alison Holloway, associate professor of obstetrics and gynecology at McMaster University.

Previous studies have found that pregnant women are particularly vulnerable to depression and it is estimated that up to one in five pregnant women have symptoms of depression during pregnancy.

"While it is known that these drugs can increase the risk of obesity in adults, it is unknown whether a woman's antidepressant use during pregnancy increases the risk of metabolic disturbances in her children," Holloway says, adding the goal of their project was to determine whether maternal exposure to a commonly used antidepressant is related to the development of fatty liver, an outcome commonly seen with obesity, in the offspring.

"We have demonstrated for the first time in an animal model that maternal use of a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, resulted in increased fat accumulation and inflammation in the liver of the adult offspring, raising new concerns about the long-term metabolic complications in children born to women who take SSRI antidepressants during pregnancy," says PhD student Nicole De Long, who presented this research on June 22nd at the joint meeting of the International Society of Endocrinology and The Endocrine Society.

Their study does not suggest women should avoid taking antidepressants during pregnancy, only that there may be risks associated with antidepressants that haven't been previously identified, Holloway says.

"The benefit of the study is it may help in the identification of a high-risk group of children who may require specific interventions to prevent obesity and type 2 diabetes later in life," she says.

The next stage of their research will be to understand the mechanistic pathways behind why these drugs pose a risk. "If we can understand how the antidepressant causes adverse metabolic outcomes in the offspring than we can design therapeutic strategies to prevent the damage while allowing women who require these drugs to be treated but reduce the potential harm to the offspring.

New mobile app provides faster, more accurate measurement of respiratory rate


A new mobile app developed by researchers at the Child & Family Research Institute (CFRI) at BC Children's Hospital and the University of British Columbia can measure respiratory rate in children roughly six times faster than the standard manual method.

According to findings published this month in PLOS One, RRate can reliably measure respiratory rate in an average of 9.9 seconds. Currently, health care workers typically measure respiratory rate by counting a patient's breaths for 60 seconds using a stop watch.

"Mobile phones are changing how we administer health care, especially in rural settings and developing countries where access to medical devices is limited," says Dr. Walter Karlen, who co-led the study with Dr. Heng Gan. "With this app, we can give health care workers with few resources faster and more accurate measurements, help them make better decisions, and give them more time with their patients."

Dr. Karlen is a UBC Postdoctoral Fellow. At the time of this study, Dr. Gan was a Clinical Research Fellow. Both are working with Dr. Mark Ansermino and Dr. Guy Dumont at CFRI, UBC and BC Children's.

Researchers say this simple, but innovative piece of technology is a big step towards better diagnoses for children with pneumonia and other respiratory illnesses. Pneumonia is the leading cause of death of children worldwide according to the World Health Organization. With timely and accurate diagnosis, children with pneumonia can often be saved with simple interventions such as antibiotics.

RRate allows workers to measure respiratory rate by tapping the touch screen every time the child inhales. In addition to calculating the rate of inhalations during a given time, the app also provides an animation of a breathing baby, allowing for a direct comparison with the breathing patient. A free, non-study version of the app is available online.

"We are leveraging the phone's capabilities of computing, touch screen, and vibrational feedback to measure respiratory rate faster and with more confidence," says Dr. Karlen.

Researchers collected data from 30 subjects who used the app while watching videos of children breathing at different rates. Using these findings, they developed an algorithm that enabled the app to produce accurate measurements in the least amount of time.

The next stage of this research is to further improve the diagnosis of pneumonia in low-resource settings by combining this app with the Phone Oximeter. Developed by CFRI and UBC researchers, the Phone Oximeter provides non-invasive measurements of blood oxygen levels using a light sensor and a mobile phone.

New ultrastiff, ultralight material developed

 

This microscope image shows a single unit of the structure developed by the team, called a stretch-dominated octet truss unit cell, made from a polymer using 3-D microstereolithography.

What's the difference between the Eiffel Tower and the Washington Monument? Both structures soar to impressive heights, and each was the world's tallest building when completed. But the Washington Monument is a massive stone structure, while the Eiffel Tower achieves similar strength using a lattice of steel beams and struts that is mostly open air, gaining its strength from the geometric arrangement of those elements.

Now engineers at MIT and Lawrence Livermore National Laboratory (LLNL) have devised a way to translate that airy, yet remarkably strong, structure down to the microscale -- designing a system that could be fabricated from a variety of materials, such as metals or polymers, and that may set new records for stiffness for a given weight.

The new design is described in the journal Science by MIT's Nicholas Fang; former postdoc Howon Lee, now an assistant professor at Rutgers University; visiting research fellow Qi "Kevin" Ge; LLNL's Christopher Spadaccini and Xiaoyu "Rayne" Zheng; and eight others.

The design is based on the use of microlattices with nanoscale features, combining great stiffness and strength with ultralow density, the authors say. The actual production of such materials is made possible by a high-precision 3-D printing process called projection microstereolithography, as a result of the joint research collaboration between the Fang and Spadaccini groups since 2008.

Normally, Fang explains, stiffness and strength declines with the density of any material; that's why when bone density decreases, fractures become more likely. But using the right mathematically determined structures to distribute and direct the loads -- the way the arrangement of vertical, horizontal, and diagonal beams do in a structure like the Eiffel Tower -- the lighter structure can maintain its strength.

A pleasant surprise

The geometric basis for such microstructures was determined more than a decade ago, Fang says, but it took years to transfer that mathematical understanding "to something we can print, using a digital projection -- to convert this solid model on paper to something we can hold in our hand." The result was "a pleasant surprise to us," he adds, performing even better than anticipated.

"We found that for a material as light and sparse as aerogel [a kind of glass foam], we see a mechanical stiffness that's comparable to that of solid rubber, and 400 times stronger than a counterpart of similar density. Such samples can easily withstand a load of more than 160,000 times their own weight," says Fang, the Brit and Alex d'Arbeloff Career Development Associate Professor in Engineering Design. So far, the researchers at MIT and LLNL have tested the process using three engineering materials -- metal, ceramic, and polymer -- and all showed the same properties of being stiff at light weight.

"This material is among the lightest in the world," LLNL's Spadaccini says. "However, because of its microarchitected layout, it performs with four orders of magnitude higher stiffness than unstructured materials, like aerogels, at a comparable density."

Light material, heavy loads

This approach could be useful anywhere there's a need for a combination of high stiffness (for load bearing), high strength, and light weight -- such as in structures to be deployed in space, where every bit of weight adds significantly to the cost of launch. But Fang says there may also be applications at smaller scale, such as in batteries for portable devices, where reduced weight is also highly desirable.

Another property of these materials is that they conduct sound and elastic waves very uniformly, meaning they could lead to new acoustic metamaterials, Fang says, that could help control how waves bend over a curved surface.

Others have suggested similar structural principles over the years, such as a proposal last year by researchers at MIT's Center for Bits and Atoms (CBA) for materials that could be cut out as flat panels and assembled into tiny unit cells to make larger structures. But that concept would require assembly by robotic systems that have yet to be developed, says Fang, who has discussed this work with CBA researchers. This technique, he says, uses 3-D printing technology that can be implemented now.

Martin Wegener, a professor of mechanical engineering at Karlsruhe Institute of Technology in Germany who was not involved in this research, says, "Achieving metamaterials that are ultralight in weight, yet stiffer than you would expect from usual scaling laws for elastic solids, is of obvious technological interest. The paper makes an interesting contribution in this direction."

The work was supported by the U.S. Defense Advanced Research Projects Agency and LLNL.

Microscope maps surfaces at resolutions below 100 nanometers: Microparticles get the whole picture

 

June 19, 2014

The Agency for Science, Technology and Research

Microscopes are conventionally used to image tiny features. However, their resolution is inherently limited by the wavelength of light. This limitation means that they can resolve only structures larger than a few hundred nanometers. Now scientists have demonstrated an alternative optical approach capable of mapping surfaces at resolutions below 100 nanometers.


Now, Leonid Krivitsky and Boris Luk'yanchuk at the A*STAR Data Storage Institute in Singapore and co-workers have demonstrated an alternative optical approach capable of mapping surfaces at resolutions below 100 nanometers.

Diffraction is the tendency for all waves, including light, to spread out when they pass near an object or through a gap. This effect means that optical imaging systems cannot resolve objects smaller than roughly half the wavelength of the illuminating light. Thus, for red light with a wavelength of about 600 nm, the resolution will be approximately 300 nanometers.

Luk'yanchuk and his colleagues previously showed that a micrometer-scale transparent bead placed on a surface can circumvent this so-called diffraction limit. They demonstrated that light passing through the bead, when collected by a conventional microscope, can create an image of the surface beneath it with a resolution of 50 nanometers. However, generating a complete two-dimensional map requires scanning the bead across the surface -- not easy to perform in a controlled way when the sphere is only 6 micrometers across. "We have now improved this superresolution technique by developing a method to controllably move the imaging microspheres," says Krivitsky.

Krivitsky and his team accomplished such spatial scanning using a tiny pipette with a tip just 1 or 2 micrometers wide. Computer simulations confirmed that the presence of the pipette would not adversely affect the superresolution capability of the microspheres. To fasten the pipette to the bead, they sucked the air out from within its cavity.

The team then connected the other end of the pipette to a mechanical stage, which could move in steps as small as 20 nanometers. Importantly, the vacuum inside the pipette created a bond tight enough to ensure that the bead did not disconnect as it was dragged across a surface. The researchers demonstrated the effectiveness of their system by successfully imaging trial samples with features as small as 75 nanometers.

While other techniques, such as near-field scanning microscopy, can perform sub-diffraction-limit imaging, they require very expensive systems. "The real advantages of our technique are its simplicity and its price," says Krivitsky. "The idea could be applied to a variety of superresolution applications such as sample inspection, microfabrication and bioimaging."