Disentangling the heterogeneity of allergic respiratory diseases by latent class analysis reveals novel phenotypes

Background Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached. Aim To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis. Methods Seven hundred and twenty‐eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA‐classes. Results A six‐class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non‐allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA‐classes. Conclusion Novel severe phenotypes of participants with co‐occurrence of ocular, nasal and bronchial symptoms, and exacerbation‐prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.info:eu-repo/semantics/publishedVersio

Control of allergic rhinitis and asthma test – a formal approach to the development of a measuring tool

<p>Abstract</p> <p>Background</p> <p>The concurrent management of allergic rhinitis and asthma (ARA) has been recommended by Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. However, a tool capable of assessing simultaneously the control of upper and lower airways diseases is lacking.</p> <p>Aim</p> <p>To describe the studies conducted to design the control of ARA test (CARAT) questionnaire.</p> <p>Methods</p> <p>We performed a literature review to generate a list of potentially important items for the assessment of control of ARA. A formal consensus development process, that used an innovative web-based application, was designed – 111 experts in ARA and 60 patients participated. At the final consensus meeting, 25 primary and secondary care physicians formulated the questions and response options. A qualitative feasibility study (n = 31 patients) was conducted to evaluate the comprehensibility of the questionnaire while testing two different designs.</p> <p>Results</p> <p>Thirty-four potentially important items were identified. All the steps of the consensus process were completed in 2.5 months. The opinions of experts and patients lead to the formulation of 17 questions. At the feasibility study the instructions and wording problems were corrected and a semi-tabular format was chosen.</p> <p>Conclusion</p> <p>A tool to measure the control of allergic rhinitis and asthma was developed using a comprehensive set of methodological steps ensuring the design quality and the face and content validity. Additional validation studies to assess the psychometric properties of the questionnaire have started.</p

Available and affordable complementary treatments for COVID-19 : From hypothesis to pilot studies and the need for implementation

Vaccination is a highly effective preventive measure against COVID-19. However, complementary treatments are needed to better control the disease. Fermented vegetables and spices, agonists of the antioxidant transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and TRPA1/V1 channels (Transient Receptor Potential Ankyrin 1 and Vanillin 1), may help in the control of COVID-19. Some preliminary clinical trials suggest that curcumin (spice) can prevent some of the COVID-19 symptoms. Before any conclusion can be drawn and these treatments recommended for COVID-19, the data warrant confirmation. In particular, the benefits of the foods need to be assessed in more patients, through research studies and large trials employing a double-blind, placebo-controlled design.Peer reviewe

Estimating cardiovascular risk in patients with type 2 diabetes: a national multicenter study in Brazil

According to Brazilian National Data Survey diabetes is the fifth cause for hospitalization and is one of the ten major causes of mortality in this country.Aimsto stratify the estimated cardiovascular risk (eCVR) in a population of type 2 diabetics (T2DM) according to the Framingham prediction equations as well as to determine the association between eCVR with metabolic and clinical control of the disease.MethodsFrom 2000 to 2001 a cross-sectional multicenter study was conducted in 13 public out-patients diabetes/endocrinology clinics from 8 Brazilian cities. the 10-year risk of developing coronary heart disease (CHD) was estimated by the prediction equations described by Wilson et al (Circulation 1998). LDL equations were preferably used; when patients missed LDL data we used total cholesterol equations instead.ResultsData from 1382 patients (59.0% female) were analyzed. Median and inter-quartile range (IQ) of age and duration of diabetes were 57.4 (51-65) and 8.8 (3-13) years, respectively without differences according to the gender. Forty-two percent of these patients were overweight and 35.4% were obese (the prevalence of higher BMI and obesity in this T2DM group was significantly higher in women than in men; p 20%) in 738 (53.4%), intermediate in 202 (14.6%) and low in 442 (32%) patients. Men [25.1(15.4-37.3)] showed a higher eCVR than women [18.8 (12.4-27.9) p < 0.001]. the most common risk factor was high LDL-cholesterol (80.8%), most frequently found in women than in men (p = 0.01). the median of risk factors present was three (2-4) without gender differences. Overall we observed that 60 (4.3%) of our patients had none, 154(11.1%) one, 310 (22.4%) two, 385 (27.9%) three, 300 (21.7%) four, 149 (10.5%) five and six, (2%) six risk factors. A higher eCVR was noted in overweight or obese patients (p = 0.01 for both groups). No association was found between eCVR with age or a specific type of diabetes treatment. A correlation was found between eCVR and duration of diabetes (p < 0.001), BMI (p < 0.001), creatinine (p < 0.001) and triglycerides levels (p < 0.001) but it was not found with HbA1c, fasting blood glucose and postprandial glucose. A higher eCVR was observed in patients with retinopathy (p < 0.001) and a tendency in patients with microalbuminuria (p = 0.06). Conclusion: our study showed that in this group of Brazilian T2DM the eCVR was correlated with the lipid profile and it was higher in patients with microvascular chronic complications. No correlation was found with glycemic control parameters. These data could explain the failure of intensive glycemic control programs aiming to reduce cardiovascular events observed in some studies.Univ Estado Rio de Janeiro, Diabet Unit, Rio de Janeiro, BrazilUniv São Paulo Scholl Med, Hosp Clin, Lab Clin & Expt Gatroenterol LIM07, São Paulo, BrazilUniv Fed Maranhao, Div Endocrinol, Sao Luis, BrazilUniv Estadual Campinas, Div Endocrinol, Campinas, BrazilCtr Estudos Diabet & Endocrinol Estado Bahia CEDE, Salvador, BA, BrazilUniv Fed Parana, Div Endocrinol, BR-80060000 Curitiba, Parana, BrazilHosp Agamenon Magalhaes, Div Endocrinol, Recife, PE, BrazilPosto Assistencia Med Jaguribe, Joao Pessoa, Paraiba, BrazilSanta Casa Porto Alegre, Div Endocrinol, Porto Alegre, RS, BrazilInst Assistencia & Previdencia Servidor Estado Ba, Div Endocrinol, Salvador, BA, BrazilSanta Casa Belo Horizonte, Diabet Unit, Belo Horizonte, MG, BrazilHosp Geral Goiania, Div Endocrinol, Goiania, Go, BrazilSecretaria Municipal Saude Brasilia, Brasilia, DF, BrazilUniversidade Federal de São Paulo, Div Endocrinol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, São Paulo, BrazilWeb of Scienc

How Supraphysiological Oxygen Levels in Standard Cell Culture Affect Oxygen-Consuming Reactions.

Most mammalian tissue cells experience oxygen partial pressures in vivo equivalent to 1-6% O2 (i.e., physioxia). In standard cell culture, however, headspace O2 levels are usually not actively regulated and under these conditions are ~18%. This drives hyperoxia in cell culture media that can affect a wide variety of cellular activities and may compromise the ability of in vitro models to reproduce in vivo biology. Here, we review and discuss some specific O2-consuming organelles and enzymes, including mitochondria, NADPH oxidases, the transplasma membrane redox system, nitric oxide synthases, xanthine oxidase, and monoamine oxidase with respect to their sensitivities to O2 levels. Many of these produce reactive oxygen and/or nitrogen species (ROS/RNS) as either primary end products or byproducts and are acutely sensitive to O2 levels in the range from 1% to 18%. Interestingly, many of them are also transcriptional targets of hypoxia-inducible factors (HIFs) and chronic cell growth at physioxia versus 18% O2 may alter their expression. Aquaporins, which facilitate hydrogen peroxide diffusion into and out of cells, are also regulated by HIFs, indicating that O2 levels may affect intercellular communication via hydrogen peroxide. The O2 sensitivities of these important activities emphasize the importance of maintaining physioxia in culture.Peer Reviewe

Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Environmental factors can influence dengue reported cases

Introduction: Global climate changes directly affect the natural environment and contribute to an increase in the transmission of diseases by vectors. Among these diseases, dengue is at the top of the list. The aim of our study was to understand the consequences of temporal variability of air temperature in the occurrence of dengue in an area comprising seven municipalities of the Greater Sao Paulo. Method: Characterization of a temporal trend of the disease in the region between 2010 and 2013 was performed through analysis of the notified number of dengue cases over this period. Our analysis was complemented with meteorological (temperature) and pollutant concentration data (PM10). Results: We observed that the months of January, February, March, April and May (from 2010 to 2013) were the ones with the highest number of notified cases. We also found that there is a statistical association of moisture and PM10 with the reported cases of dengue. Conclusion: Although the temperature does not statistically display an association with recorded cases of dengue, we were able to verify that temperature peaks coincide with dengue outbreak peaks. Future studies on environmental pollution and its influence on the development of Aedes aegypti mosquito during all stages of its life cycle, and the definition of strategies for better monitoring, including campaigns and surveillance, would be compelling.ABC, FM, Santo Andre, SP, BrazilCoimbra Hlth Sch, Environm Hlth IPC, EsTesC, Coimbra, PortugalEsTesC, Coimbra Hlth Sch, Dept Ciencias Complementares IPC, Coimbra, PortugalFMABC, Gestao Saude Ambiental, Santo Andre, SP, BrazilUniv Fed Sao Paulo Unifesp, Biol Sci Dept, Diadema, SP, BrazilUniv Fed Sao Paulo Unifesp, Biol Sci Dept, Diadema, SP, BrazilWeb of Scienc