Immunological role of nasal staphylococcus aureus carriage in patients with persistent allergic rhinitis

Nasal carriage of staphylococcus aureus (S.aureus) exerts immunomodulatory effect in patients with atopic dermatitis and it may contribute to airway inflammation and allergic response in patients with allergic rhinitis. We Aim to investigate the frequency of nasal S.aureus carriage in patients with persistent allergic rhinitis and its possible influence on their symptoms and immune markers. We chosed 20 non smoker patients with house dust mite (HDM) allergy causing allergic rhinitis and 20 non smoker healthy subjects matched for age and sex. For all subjects rhinoscopy was done, skin prick test, nasal culture for S.aureus, nasal interleukin 4,nasal total IgE, serum total IgE and serum specific IgE(SSIgE) for HDM. Nasal S.aureus was detected in 16/20 patients (80%) and 5/20 (25%) in healthy subjects with highly significant statistical difference p<0.01. Correlation of nasal staph.aureus count and different systemic and local immune markers revealed highly significant positive correlation between nasal S.aureus count and serum total IgE (r = 0.78, p<0.01) and significant positive correlation with SSIgE (HDM) (r = 0.53, p<0.05), nasal total IgE (r = 0.39, p<0.05) and nasal IL-4 (r = 0.55, p<0.05). Nasal staph.aureus actively modulated the immune reaction in persistent allergic rhinitis patients by promoting local IgE production, so we recommend early detection and treatment of S.aureus carriage in patients

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Letter to the editor: Immunological role of nasal staphylococcus aureus carriage in patients with persistent allergic rhinitis

Nasal carriage of staphylococcus aureus (S.aureus) exerts immunomodulatory effect in patients with  atopic dermatitis and it may contribute to airway inflammation and allergic response in patients with  allergic rhinitis. We Aim to investigate the frequency of nasal S.aureus carriage in patients with persistent allergic rhinitis and its possible influence on their symptoms and immune markers. We chosed 20 non smoker patients with house dust mite (HDM) allergy causing allergic rhinitis and 20 non smoker healthy subjects matched for age and sex. For all subjects rhinoscopy was done, skin prick test, nasal culture for S.aureus, nasal interleukin 4,nasal total IgE, serum total IgE and serum specific IgE(SSIgE) for HDM. Nasal S.aureus was detected in 16/20 patients (80%) and 5/20 (25%) in healthy subjects with highly significant statistical difference p&lt;0.01. Correlation of nasal staph.aureus count and different systemic and local immune markers revealed highly significant positive correlation between nasal S.aureus count and serum total IgE (r = 0.78, p&lt;0.01) and significant positive correlation with SSIgE (HDM) (r = 0.53, p&lt;0.05), nasal total IgE (r = 0.39, p&lt;0.05) and nasal IL-4 (r = 0.55, p&lt;0.05). Nasal staph.aureus actively modulated the immune reaction in persistent allergic rhinitis patients by promoting local IgE production, so we recommend early detection and treatment of S.aureus carriage in patients. Key words: nasal staphylococcus, allergic rhinitis, Egyp

Familial history of hypertension as a predictor of increased arterial stiffness in normotensive offspring

Background: Increased arterial stiffness can be used as a prognostic marker of arterial hypertension. The relationship between arterial stiffness and arterial hypertension seems to be reciprocal. Objective: Evaluation of changes of the arterial elastic prosperities in normotensive subjects, with and without parental history of hypertension. Subjects and Methods: One hundred and ten normotensive individuals, aged 20–30 years, were divided into two groups: group-A (n = 57) and group-B (n = 53) subjects with positive and negative parental history of hypertension, respectively. Systolic, diastolic and pulse pressures were measured using mercury sphygmomanometer. The elastic properties of the ascending aorta and the common carotid arteries were assessed using M-mode echo and B-mode imaging, respectively. Stiffness index of the digital volume pulse (SIDVP) was measured in the right index finger using photoplethysmography. Results: Group A subjects showed higher aortic stiffness index (p = 0.002), carotid stiffness index (p = 0.001), carotid pulse wave velocity (p ⩽ 0.001) and stiffness index of digital volume pulse (p = 0.001). Group A subjects showed lower aortic distensibility (p = 0.001), aortic strain (p = 0.004), changes in aortic diameter (p = 0.022), carotid distension (p = 0.026), carotid distensibility coefficient (p ⩽ 0.001) and carotid compliance coefficient (p = 0.002). Conclusion: The aortic and carotid stiffness parameters and SIDVP were higher in normotensive offspring of hypertensive parents. This finding could direct the attention towards the increased cardiovascular risk in this group and thus prompt earlier and tighter prevention of cardiovascular risk factors

Effect of underwater treadmill program on gait speed, balance and lower extremity function in stroke patients

Objective: The purpose of this study was to determine whether using an underwater treadmill program could enhance gait speed, balance and lower extremity function. Study design: Randomized control trial. Methods: Forty post-stroke male patients with abnormalities in gait and balance were divided randomly into two equal groups: Study group (A): was given a program for an underwater treadmill. A treadmill program on the ground was given to the control group (B). The ten-meter walk test was used to assess the gait speed of patients in both groups. Assessment of functional capacity utilizing the lower extremity functional scale and the Posturomed device for balance. For all groups, assessments were performed before and after the four-week therapy period. Results: Post treatment results revealed a significant increase in gait speed in both groups but no significant difference between them. More significant increase in balance and lower extremity function in the study group (A) than in control group (B) Conclusion: Underwater treadmill training program is an effective program in improving, balance, gait speed and lower extremity function in stroke patients