Cesarean Section and Development of Childhood Bronchial Asthma: Is There A Risk?

BACKGROUND: Asthma is a chronic inflammatory disease of the airways that results from complex interactions between multiple environmental and genetic influences. In recent years, studies have observed an increase in caesarean section rates, and have suggested a strong association with the rapid increase in the incidence of childhood asthma that cannot be explained by genetic factors alone. In this case-control study, we investigate the association between the developments of childhood asthma with the mode of delivery. We also explored the relationship between mode of delivery and control of asthma. METHODS: Two groups (509 pediatric patients in total) were assessed between January 1, 2017, and January 1, 2018. Part of these patients, 257 (50.4%) were asthmatic children visiting specialised clinics, and 252 (49.6%) controlled cases selected from a primary health care clinic from the same institution (control group). RESULTS: The Chi-square test revealed a significant association between cesarean sections and bronchial asthma (OR, 1.483 [95% CI, 1.013–21.71]; P = 0.042). However, the adjusted OR from our binary logistic regression model revealed this association to be insignificant (adjusted OR, 1.417 [95% CI, 0.885–2.269]; P = 0.804). The value of the chi-square of the model shows that the overall model is statistically significant at 1%. The Nagelkerke R square indicates that 34.9% of the variation in having asthma is explained by the risk factors included in the model. CONCLUSION: We do not believe that the rise in cesarean sections explains the increase in childhood bronchial asthma – at least not in our population. We also found no association between the mode of delivery and asthma control. We encourage further research into this topic, namely to recruit a larger number of patients, and to adjust for the significant risk factors found in our study

Multiple sclerosis: long-term outcomes in ethnic minorities. analysis of a UK population-based registry

Background and purpose Multiple sclerosis (MS) is most frequent in Caucasian populations. However, studies of MS in other ethnic groups may offer unique insights into genetic and environmental influences on the disease, and data on long-term outcomes in these patients is limited. In this work clinical features and time to disability milestones were investigated in ethnic minority (EM) patients with MS in a UK population and comparisons were made to a Caucasian cohort from the same region. Methods In all, 1949 MS patients (1866 Caucasian, 83 EM) were identified from a regional disease registry. Cox proportional hazards regression was used to analyse the time to Expanded Disability Status Scale (EDSS) 3.0, 4.0 and 6.0. Results Ethnic minority patients were younger at disease onset (28.6 years vs. 32.8 years, P = 0.001), and primary progressive MS was less common (EM 4.8%, Caucasian 11.6%, P = 0.03). After correction for clinical variables, ethnicity was associated with time to EDSS 3.0 [EM: hazard ratio (HR) 1.75, P < 0.0001] and 4.0 (HR 1.46, P = 0.03), but not 6.0 (HR 1.5, P = 0.05). Conclusions Ethnic minority patients reach early levels of fixed disability more rapidly than Caucasian patients, but this effect diminishes at later stages of the disease. This has implications for clinical management of these patients

The Impact of Psychosocial Factors of Physical Health Outcomes: A Review of the Biopsychosocial Model in Family Medicine

Discontent with the biological model of illness—which is still the predominant healthcare model—led to the development of the biopsychosocial model, which was described in Engel's seminal Science paper forty years ago. It is the foundation of the International Classification of Functioning (WHO ICF) developed by the World Health Organization Clinical outcomes for functional disorders and chronic diseases treated in family medicine may be improved by the biopsychosocial approach. Since clinical performance metrics and standards are biomedically focused, family medicine doctors have no financial incentive to implement the biopsychosocial paradigm in their practices. Implementing the biopsychosocial approach in family medicine may be hampered by workload and incompetence

Non-motor phenotypic subgroups in adult-onset idiopathic, isolated, focal cervical dystonia

Background: Non-motor symptoms are well established phenotypic components of adult-onset idiopathic, isolated, focal cervical dystonia (AOIFCD). However, improved understanding of their clinical heterogeneity is needed to better target therapeutic intervention. Here, we examine non-motor phenotypic features to identify possible AOIFCD subgroups. Methods: Participants diagnosed with AOIFCD were recruited via specialist neurology clinics (dystonia wales: n = 114, dystonia coalition: n = 183). Non-motor assessment included psychiatric symptoms, pain, sleep disturbance, and quality of life, assessed using self-completed questionnaires or face-to-face assessment. Both cohorts were analyzed independently using Cluster, and Bayesian multiple mixed model phenotype analyses to investigate the relationship between non-motor symptoms and determine evidence of phenotypic subgroups. Results: Independent cluster analysis of the two cohorts suggests two predominant phenotypic subgroups, one consisting of approximately a third of participants in both cohorts, experiencing increased levels of depression, anxiety, sleep impairment, and pain catastrophizing, as well as, decreased quality of life. The Bayesian approach reinforced this with the primary axis, which explained the majority of the variance, in each cohort being associated with psychiatric symptomology, and also sleep impairment and pain catastrophizing in the Dystonia Wales cohort. Conclusions: Non-motor symptoms accompanying AOIFCD parse into two predominant phenotypic sub-groups, with differences in psychiatric symptoms, pain catastrophizing, sleep quality, and quality of life. Improved understanding of these symptom groups will enable better targeted pathophysiological investigation and future therapeutic intervention

Paraneoplastic sensorimotor neuropathy and ventral cauda equina nerve root enhancement as initial presentation of small cell lung carcinoma: a case study

Background Paraneoplastic neurologic syndromes (PNS) are rare, however, are important to recognize as oftentimes they precede the detection of an occult malignancy. Our case highlights a rare circumstance of paraneoplastic radiculoneuropathy and the importance of recognizing PNS in antibody negative disease, as is the case in up to 16% of sensory neuronopathies, and the process of excluding other etiologies. Case presentation We discuss a 51-year-old man who presented with asymmetric subacute sensorimotor deficits in the lower limbs. Initial clinical examination showed weakness throughout the right lower limb and normal strength on the left with objective numbness in a mixed dermatomal and stocking-glove distribution. Electrophysiology was consistent with axonal sensorimotor neuropathy. Cerebrospinal fluid showed pleocytosis and elevated protein. Intravenous immunoglobulin treatment was given with some improvement in pain symptoms but no measurable motor improvement. Following clinical and electrophysiologic deterioration the patient was transferred to a tertiary centre. Magnetic resonance imaging of the spine showed smooth enhancement of the ventral caudal nerve roots. Chest computed tomography revealed left lower vascular scarring. Further positron emission tomography scan imaging identified fluorodeoxyglucose avid right lung lymphadenopathy. Bronchoscopy-guided biopsy revealed small cell lung carcinoma. Onconeural and antiganglioside antibodies were negative. The patient was then transferred to a medical oncology ward where he underwent chemoradiotherapy and subsequently experienced improvement in his motor function, supporting that his neurological condition was indeed secondary to a paraneoplastic process. Conclusions Onconeural negative paraneoplastic radiculoneuropathy can precede diagnosis of small cell lung carcinoma. If considered early and adequately investigated, it can allow earlier diagnosis and treatment of underlying malignancy, improving overall and neurological prognosis.Medicine, Faculty ofMedicine, Department ofNeurology, Division ofReviewedFacult