Clinical profile of patients with Seronegative celiac disease

Background Celiac disease (1) mostly diagnosed base on positive serology and duodenal mucosal atrophy, but some patients have negative serology and their diagnosis have some limitation, it delay in diagnosis likely accompanied a poor prognosis and high risk of developing complications of CD. The aim of this study was determent clinical profile of patients with Seronegative CD (SNCD). Methods in this retrospective study, 1115+8 patients, that evaluated for CD with mucosal atrophy included between 2010 to2020. All patients with IgA deficiency other IgG based serology for diagnosis of celiac was done and if these antibodies were negative consider as possible SNCD. If they had positive DQ2-DQ8, and clinical symptoms or had positive challenge test after12 months of GFD were considered as SNCD. Results of total 1115 patients 27 (2.4%) had seronegative mucosal atrophy of duodenum and diagnosed as a SNCD (96.2% marsh3), the mean age and BMI in SNCD patients were significantly higher than other CD patients (p<0.05). Conclusion The prevalence of SNCD was 2.4% that likely related to over weighting, so clinicians should be considered high possible of seronegative CD in patients with over weighting and mucosal atrophy of duodenum.

Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis

The definition of primary hyperaldosteronism (PA) has shifted, as progress has been made in understanding the disease. PA can be produced by unilateral or bilateral cortical adrenal hyperproduction of aldosterone, due to hyperplasia, aldosterone-secreting cell clusters, aldosterone-producing macro or micro adenoma/s, and combinations of the above, or by an aldosterone-producing carcinoma. PA is a highly prevalent disease, affecting close to 10% of the hypertensive population. However, PA is clearly underdiagnosed. The purpose of this review is to address current knowledge of PA’s clinical manifestations, as well as current methods of diagnosis. PA is associated with a higher cardiovascular morbidity and mortality than essential hypertension with similar blood pressure control. Young hypertensive patients, those with a first-degree relative with PA or ictus, and/or those with apnea/hypopnea syndrome, moderate/severe/resistant hypertension, adrenal incidentaloma, and/or hypokalemia should be screened for PA. PA can induce atrial fibrillation (AF), and those patients should also be screened for PA. We propose the use of the Captopril challenge test (CCT), oral salt loading, or intravenous salt loading for PA diagnosis, given their availability in the majority of hospital centers. CCT could be first-line, since it is safe and easy to perform.

The Need for Testing—The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea

Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.

Assessment of Maternal and Fetal Outcomes According to Induction Methods Following Negative Oxytocin Challenge Test

Purpose: To evaluate maternal and perinatal outcomes in high-risk patients who had negative OCTs and to investigate the effects of methods of induction on the development of fetal distress. Methods: The hospital records of patients were reviewed retrospectively. Clinical data were obtained from medical records. Results: OCT was performed in 551 patients and was negative in 447 patients. Among patients with a negative OCT, labor induction was preferred in 427 (95.5%) patients. When fetal distress development was assessed according to the induction method used following a negative OCT, and fetal distress developed in 9.1% of 427 patients who underwent labor induction. Conclusion: When outcomes were considered in pregnant women with a negative OCT, it was observed that there were no fetal deaths and a limited number of newborns with low Apgar scores. Further randomized studies are needed to draw definitive conclusions.

Immunomodulatory and anti-inflammatory effects of N-acetylcysteine in ovalbumin-sensitized rats

Background Pro-inflammatory cytokines such as interleukin-5 (IL-5) and tumor necrosis factor-alpha (TNF-α) as well as immunoglobulin-E (IgE) appear to play a role in asthma. N-acetylcysteine (NAC), an antioxidant, might have clinical benefits in asthma prevention. The possible preventive effects of NAC against experimentally induced asthma in rats are investigated. The rats were allocated into five groups: a normal control, asthma control, a standard dexamethasone (DEXA, 1 mg/kg, orally) group, and two NAC groups (300 and 500 mg/kg, orally, respectively). Ovalbumin (OVA) sensitization was used to trigger asthma, which was then followed by an intra-nasal challenge. Test gents were administrated for 14 days before the challenge and during the three challenge days (20, 21, and 22). The tidal volume (TV) and peak expiratory flow rate (PEFR) as respiratory functions were determined. The pro-inflammatory cytokines as IL-5 and TNF-α were evaluated in lung homogenate. Serum IgE and absolute eosinophil count (AEC) in bronchoalveolar lavage fluid (BALF) were measured. In addition, the oxidative markers in lung tissue and nitrosative marker in BALF were assessed; finally, lungs were isolated for histopathological study. Results NAC restored lung functions, inhibited the asthma-dependent increase in TNF-α, IL-5, IgE, AEC, nitric oxide, and malondialdehyde levels. NAC further re-established lung glutathione content and superoxide dismutase activity, resulting in milder overall lung pathology. Conclusions Experimental bronchial asthma may be protected by NAC. The anti-asthmatic potential of NAC may be explained by its suppressant influence on IgE antibody formation, pro-inflammatory cytokines production, eosinophil infiltration, and oxidative stress.

Effect of Acute Levodopa Up-Titration on Blood Pressure in Patients With Early Stage Parkinson’s Disease: Results of a Levodopa Challenge Test

Objective: Levodopa up-titration is the primary therapeutic strategy as the Parkinson’s disease (PD) progresses. However, the effects of levodopa up-titration on blood pressure (BP) are inconclusive. This study aimed to investigate the effect of acute levodopa up-titration simulated by levodopa challenge test (LCT) on BP in patients with early stage PD.Methods: We monitored BP in 52 patients with early stage PD using a standardized standing test. BP was assessed in supine position after 10 min of rest and at 1 and 3 min after standing up. BP was measured in the “off-state” and the best “on-state” during LCT in the morning at hospital. In another day, “off-state” and the best “on-state” BP was measured before and after anti-PD drug uptake in the morning at home. Demographic and clinical features of the patients were evaluated and analyzed.Results: In the LCT, the prevalence of OH in the “off-state” and the best “on-state” was 11.5 and 13.5%, respectively. Additionally, the OH in the best “on-state” was associated with OH in the “off-state” and monoamine oxidase B inhibitor use. Although 38 (73.1%) patients experienced levodopa-induced hypotension during the LCT, no risk factors were identified. While BP reductions were observed after taking anti-PD drugs at home, no further reduction was seen during acute levodopa up-titration simulated by the LCT.Conclusion: Our results demonstrate that acute levodopa up-titration does not exacerbate BP reduction induced by anti-PD drugs at home. BP monitoring is critical for the management of patients with PD.

Micro-Aid Liquid 10 Promotes Growth Performance and Health Status of White Shrimp, Litopenaeus vannamei

An experiment was conducted to evaluate the effects of the Micro-Aid Liquid 10 (MAL10) (DPI Global, Porterville, CA, USA), a product made from yucca extract, on growth performance, gut microbiota, and resistance of white shrimp, Litopenaeus vannamei against infectious disease caused by Vibrio alginolyticus. MAL10 was added to shrimp rearing water at different levels of 0 (control), 0.25 mL m3−1 (W0.25), 0.5 mL m3−1 (W0.5), 1 mL m3−1 (W1), and 5 mL m3−1 (W5), respectively, once per week for 70 days. Growth performances, including final body weight, specific growth rate, average daily growth and percentage of weight gain, were significantly improved by adding the MAL10 at levels up to 5 mL m3−1, which may be due to the proliferation of B cells in hepatopancreas of MAL10-treated shrimp. No significant differences in the total viable count and Vibrio-like count in the gut of shrimp were recorded by spread plate method. In the challenge test, shrimp reared in the water supplemented with MAL10 at levels of 1–5 mL m3−1 had significantly lower cumulative mortality after a challenge test with V. alginolyticus compared to shrimp reared in the control, W0.25 and W0.5 groups. Next-generation sequencing indicated that the relative distribution of phylum Proteobacteria in control (80.4%) was higher than the W (77.4%). The proportion of Vibrio was primarily dominant genera in the shrimp intestine and highest in the control group compared to the W group, followed by Spongiimonas, Motilimonas, Demequina, and Shewanella genera. Although there was no statistically significant difference, higher α-diversity indices were recorded in the W5-treated group than in the control group. Therefore, it is considered that MAL10 could be used as a natural alternative in shrimp aquaculture to reduce the risk of infectious disease caused by pathogenic Vibrio and improve the growth performance of white shrimp.

Outcome of food intake and nutritional status after discontinuation of a cow’s-milk-free diet post negative oral food challenge in infants and children

Objective: To evaluate the outcome of food intake and nutritional status post discontinuation of a cow’s-milk-free diet after a negative oral food challenge.Methods: This was a prospective, uncontrolled study that evaluated food intake and nutritional status of a cohort of 80 infants and children under 5 years of age. Food intake and nutritional status were evaluated on the day of the oral food challenge test and after 30 days. Weight and height were measured on the day of the test and after 30 days.Results: The mean age of the patients was 18.7 ± 12.4 months, and 58.7% were male. After discontinuation of the elimination diet, the children showed daily intake increases in (P < 0.001), protein (P < 0.001), carbohydrates (P = 0.042), calcium from foods (P < 0.001), calcium from foods and supplements (P < 0.001), phosphorus (P < 0.001), and vitamin D from foods (P = 0.006). The Z-scores (n = 76) on the day of the oral food challenge test and 30 days after restarting the consumption of cow’s milk were as follows: weight-for-age (P < 0.001) and height-for-age (P < 0.001), respectively.Conclusion: Cow’s milk protein in the diet was associated with increased intake of energy, proteins, carbohydrates, calcium, phosphorus, and vitamin D, in addition to an increase in the Z-scores for weight-for-age and height-for-age.