WorldWideScience

Sample records for onset adult asthma

  1. Respiratory Infections Precede Adult-Onset Asthma

    OpenAIRE

    2011-01-01

    BACKGROUND: Respiratory infections in early life are associated with an increased risk of developing asthma but there is little evidence on the role of infections for onset of asthma in adults. The objective of this study was to assess the relation of the occurrence of respiratory infections in the past 12 months to adult-onset asthma in a population-based incident case-control study of adults 21-63 years of age. METHODS/PRINCIPAL FINDINGS: We recruited all new clinically diagnosed cases of a...

  2. Respiratory infections precede adult-onset asthma.

    Directory of Open Access Journals (Sweden)

    Aino Rantala

    Full Text Available BACKGROUND: Respiratory infections in early life are associated with an increased risk of developing asthma but there is little evidence on the role of infections for onset of asthma in adults. The objective of this study was to assess the relation of the occurrence of respiratory infections in the past 12 months to adult-onset asthma in a population-based incident case-control study of adults 21-63 years of age. METHODS/PRINCIPAL FINDINGS: We recruited all new clinically diagnosed cases of asthma (n = 521 during a 2.5-year study period and randomly selected controls (n = 932 in a geographically defined area in South Finland. Information on respiratory infections was collected by a self-administered questionnaire. The diagnosis of asthma was based on symptoms and reversible airflow obstruction in lung function measurements. The risk of asthma onset was strongly increased in subjects who had experienced in the preceding 12 months lower respiratory tract infections (including acute bronchitis and pneumonia with an adjusted odds ratio (OR 7.18 (95% confidence interval [CI] 5.16-9.99, or upper respiratory tract infections (including common cold, sinusitis, tonsillitis, and otitis media with an adjusted OR 2.26 (95% CI 1.72-2.97. Individuals with personal atopy and/or parental atopy were more susceptible to the effects of respiratory infections on asthma onset than non-atopic persons. CONCLUSIONS/SIGNIFICANCE: This study provides new evidence that recently experienced respiratory infections are a strong determinant for adult-onset asthma. Reducing such infections might prevent onset of asthma in adulthood, especially in individuals with atopy or hereditary propensity to it.

  3. Adult-onset eosinophilic asthma

    NARCIS (Netherlands)

    de Groot, J.C.

    2017-01-01

    In the last decades, it has been recognized that asthma is not a single disease, but comprises several clinical syndromes, which all share respiratory symptoms and lung function abnormalities, associated with different types of airway inflammation. These syndromes are now known as different asthma p

  4. Association between mental disorders and subsequent adult onset asthma

    NARCIS (Netherlands)

    Alonso, Jordi; de Jonge, Peter; Lim, Carmen C. W.; Aguilar-Gaxiola, Sergio; Bruffaerts, Ronny; Caldas-de-Almeida, Jose Miguel; Liu, Zhaorui; O'Neill, Siobhan; Stein, Dan J.; Viana, Maria Carmen; Al-Hamzawi, Ali Obaid; Angermeyer, Matthias C.; Borges, Guilherme; Ciutan, Marius; de Girolamo, Giovanni; Fiestas, Fabian; Maria Haro, Josep; Hu, Chiyi; Kessler, Ronald C.; Lepine, Jean Pierre; Levinson, Daphna; Nakamura, Yosikazu; Posada-Villa, Jose; Wojtyniak, Bogdan J.; Scott, Kate M.

    2014-01-01

    Background and objectives: Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain

  5. Interleukin 6 SNP rs1800797 associates with the risk of adult-onset asthma.

    Science.gov (United States)

    Lajunen, T K; Jaakkola, J J K; Jaakkola, M S

    2016-04-01

    Interleukin 6 (IL6) is an inflammatory cytokine that has been suggested to have an important role in the pathogenesis of asthma. IL6 single-nucleotide polymorphisms (SNPs) have been associated with levels of IL6, and with childhood and prevalent adult asthma. A recent study also suggested that IL6 SNPs associate especially with atopic asthma. However, association of IL6 SNPs with adult-onset asthma has not been studied. In a population-based study of 467 incident adult-onset asthma cases and 613 disease-free controls from South Finland, we analyzed association of 6 tagging SNPs of the IL6 locus with the risk of adult-onset asthma and with atopy. Asthma was clinically diagnosed, and atopy was defined based on Phadiatop test. IL6 SNP rs1800797 associated with the risk of adult-onset asthma in a log additive model, with adjusted odds ratio (aOR) 1.31 (95% confidence interval 1.09-1.57), and especially with the risk of atopic adult-onset asthma when compared with non-atopic controls, aOR 1.46 (95% CI 1.12-1.90). This is the first study to show an association of IL6 with adult-onset asthma, and especially with atopic adult-onset asthma.

  6. Perceived stress and risk of adult-onset asthma and other atopic disorders

    DEFF Research Database (Denmark)

    Rod, N H; Kristensen, T S; Lange, Peter;

    2012-01-01

    of adult-onset asthma, allergic rhinitis, atopic dermatitis, and asthma/bronchitis medication. METHODS: Participants (n = 9785) from the Copenhagen City Heart Study, Denmark, free of atopic disorders at baseline in 1981-1983 were asked questions on stress intensity and frequency. They were followed...... for first-time asthma hospitalization in nationwide registers until 2010, with...

  7. Clinical Manifestations and Treatment of Adult-Onset Asthma and Periocular Xanthogranuloma

    Directory of Open Access Journals (Sweden)

    Rodrigo Cavallazzi

    2009-01-01

    Full Text Available BACKGROUND: Adult-onset asthma and periocular xanthogranuloma is an uncommon and recently described disease. Little is known about the condition because only a few case reports and series are available.

  8. Perceived stress and risk of adult-onset asthma and other atopic disorders

    DEFF Research Database (Denmark)

    Rod, N H; Kristensen, T S; Lange, Peter

    2012-01-01

    of adult-onset asthma, allergic rhinitis, atopic dermatitis, and asthma/bronchitis medication. METHODS: Participants (n = 9785) from the Copenhagen City Heart Study, Denmark, free of atopic disorders at baseline in 1981-1983 were asked questions on stress intensity and frequency. They were followed...

  9. Cluster Analysis on Longitudinal Data of Patients with Adult-Onset Asthma.

    Science.gov (United States)

    Ilmarinen, Pinja; Tuomisto, Leena E; Niemelä, Onni; Tommola, Minna; Haanpää, Jussi; Kankaanranta, Hannu

    Previous cluster analyses on asthma are based on cross-sectional data. To identify phenotypes of adult-onset asthma by using data from baseline (diagnostic) and 12-year follow-up visits. The Seinäjoki Adult Asthma Study is a 12-year follow-up study of patients with new-onset adult asthma. K-means cluster analysis was performed by using variables from baseline and follow-up visits on 171 patients to identify phenotypes. Five clusters were identified. Patients in cluster 1 (n = 38) were predominantly nonatopic males with moderate smoking history at baseline. At follow-up, 40% of these patients had developed persistent obstruction but the number of patients with uncontrolled asthma (5%) and rhinitis (10%) was the lowest. Cluster 2 (n = 19) was characterized by older men with heavy smoking history, poor lung function, and persistent obstruction at baseline. At follow-up, these patients were mostly uncontrolled (84%) despite daily use of inhaled corticosteroid (ICS) with add-on therapy. Cluster 3 (n = 50) consisted mostly of nonsmoking females with good lung function at diagnosis/follow-up and well-controlled/partially controlled asthma at follow-up. Cluster 4 (n = 25) had obese and symptomatic patients at baseline/follow-up. At follow-up, these patients had several comorbidities (40% psychiatric disease) and were treated daily with ICS and add-on therapy. Patients in cluster 5 (n = 39) were mostly atopic and had the earliest onset of asthma, the highest blood eosinophils, and FEV1 reversibility at diagnosis. At follow-up, these patients used the lowest ICS dose but 56% were well controlled. Results can be used to predict outcomes of patients with adult-onset asthma and to aid in development of personalized therapy (NCT02733016 at ClinicalTrials.gov). Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Adult-Onset Asthma to Coronary Heart Disease and Stroke

    Science.gov (United States)

    Asthma has been associated with atherosclerotic disease in several studies with some evidence that this association may be limited to women. However, most previous studies have failed to account for the heterogeneity of asthma subtypes. We previously reported increased carotid intima medial thickne...

  11. A longitudinal study of adult-onset asthma incidence among HMO members

    Directory of Open Access Journals (Sweden)

    Rosiello Richard A

    2003-08-01

    Full Text Available Abstract Background HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. Methods We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. Results The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469 of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8, and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59% and allergy (14%. New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7% cases. Twenty-three of these (72% indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Conclusion Computerized HMO records can be successfully used to identify AOA. Manual review of these records is

  12. Distinguishing adult-onset asthma from COPD: a review and a new approach

    Directory of Open Access Journals (Sweden)

    Abramson MJ

    2014-09-01

    Full Text Available Michael J Abramson,1 Jennifer L Perret,2,3 Shyamali C Dharmage,2 Vanessa M McDonald,4 Christine F McDonald3 1School of Public Health and Preventive Medicine, Monash University, 2Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia; 3Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia; 4Priority Research Centre for Asthma and Respiratory Disease, University of Newcastle, Newcastle, Australia Abstract: Adult-onset asthma and chronic obstructive pulmonary disease (COPD are major public health burdens. This review presents a comprehensive synopsis of their epidemiology, pathophysiology, and clinical presentations; describes how they can be distinguished; and considers both established and proposed new approaches to their management. Both adult-onset asthma and COPD are complex diseases arising from gene–environment interactions. Early life exposures such as childhood infections, smoke, obesity, and allergy influence adult-onset asthma. While the established environmental risk factors for COPD are adult tobacco and biomass smoke, there is emerging evidence that some childhood exposures such as maternal smoking and infections may cause COPD. Asthma has been characterized predominantly by Type 2 helper T cell (Th2 cytokine-mediated eosinophilic airway inflammation associated with airway hyperresponsiveness. In established COPD, the inflammatory cell infiltrate in small airways comprises predominantly neutrophils and cytotoxic T cells (CD8 positive lymphocytes. Parenchymal destruction (emphysema in COPD is associated with loss of lung tissue elasticity, and small airways collapse during exhalation. The precise definition of chronic airflow limitation is affected by age; a fixed cut-off of forced expiratory volume in 1 second/forced vital capacity leads to overdiagnosis of COPD in the elderly. Traditional approaches to distinguishing between asthma and COPD have highlighted age of onset

  13. Association of genetic variants in chromosome 17q21 and adult-onset asthma in a Chinese Han population

    Directory of Open Access Journals (Sweden)

    Gong Yaoqin

    2011-10-01

    Full Text Available Abstract Background Genome-wide association studies of asthma have identified a novel region containing ORMDL3 at chromosome 17q21 that is strongly associated with childhood-onset asthma and significantly linked to ORMDL3 transcript abundance. These results have been successfully replicated in childhood-onset asthma cohorts in several ethnic groups. In this study, we aimed to evaluate the association of polymorphisms in ORMDL3, GSDMB, ZPBP2 and IKZF3 and adult-onset asthma in a Chinese Han population. Methods We genotyped 5 single nucleotide polymorphisms (SNPs at chromosome 17q21 in 1,366 Han Chinese people comprising 710 patients with adult-onset asthma and 656 healthy controls. We compared the 2 groups in terms of allele and haplotype frequencies. Transcript levels were measured in leukocytes from 61 asthma patients by quantitative real-time PCR. Results We found the 5 SNPs significantly associated with asthma (PORMDL3 and GSDMB in leukocytes (all p Conclusions Our replication study suggests that variants in 17q21 are significantly associated with risk of adult-onset asthma and gene expression in a Chinese Han population.

  14. Association of ADAM33 gene polymorphisms with adult-onset asthma and its severity in an Indian adult population

    Indian Academy of Sciences (India)

    Priya Tripathi; Shally Awasthi; Rajendra Prasad; Nuzhat Husain; Subramaniam Ganesh

    2011-08-01

    ADAM33, a member of the ADAM (a disintegrin and metalloprotease) gene family, is an asthma susceptibility gene originally identified by positional cloning. In the present study, we investigated the possible association of five single-nucleotide polymorphisms (SNPs) in the ADAM33 (rs511898, rs528557, rs44707, rs597980 and rs2787094) with adult-onset asthma in an Indian population. The study included 175 patients with mild intermittent ($n = 44$), mild persistent ($n = 108$) or moderate persistent ($n = 23$) subgroups of asthma, and 253 nonasthmatic control individuals. SNPs were genotyped with the help of restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) method, and data were analysed using chi-square test and logistic regression model. Bonferroni’s correction for multiple comparisons was applied for each hypothesis. Genotypes and allele frequencies of SNPs rs511898 and rs528557 were significantly associated with adult-onset asthma ($P = 0.010-\\lt 0.001$). A significant association of the homozygous mutant genotype and mutant alleles of SNPs rs2787094, rs44707 and rs597980 with the asthma was also observed ($P = 0.020-\\lt 0.001$). A positive association between asthma and haplotypes AGCCT, GGCCT, AGACT, GCAGT, GGACT, ACCCC and AGACC were also found ($P = 0.036-\\lt 0.001$, OR $= 2.07-8.49$). Haplotypes AGCGT, GCAGC, ACAGC, ACAGT, GGAGC and GGCGT appear to protect against asthma ($P = 0.013-\\lt 0.0001$, OR $= 0.34-0.10$). Our data suggest that ADAM33 gene polymorphisms serve as genetic risk factors for asthma in Indian adult population.

  15. Late-Onset Asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2017-01-01

    Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case......, to objectively confirm asthma. If necessary, a trial of oral or inhaled corticosteroid might be necessary. Asthma can be diagnosed when increased airflow variability is identified in a symptomatic patient, and if the patient does not have a history of exposure, primarily smoking, known to cause chronic...... obstructive pulmonary disease, the diagnosis is asthma even if the patient does not have fully reversible airflow obstruction. Pharmacological therapy in patients with late-onset asthma follows international guidelines, including treatment with the lowest effective dose of inhaled corticosteroid to minimize...

  16. Adult onset asthma and interaction between genes and active tobacco smoking: The GABRIEL consortium

    Science.gov (United States)

    Postma, D. S.; Moffatt, M. F.; Jarvis, D.; Ramasamy, A.; Wjst, M.; Omenaas, E. R.; Bouzigon, E.; Demenais, F.; Nadif, R.; Siroux, V.; Polonikov, A. V.; Solodilova, M.; Ivanov, V. P.; Curjuric, I.; Imboden, M.; Kumar, A.; Probst-Hensch, N.; Ogorodova, L. M.; Puzyrev, V. P.; Bragina, E. Yu; Freidin, M. B.; Nolte, I. M.; Farrall, A. M.; Cookson, W. O. C. M.; Strachan, D. P.; Koppelman, G. H.; Boezen, H. M.

    2017-01-01

    Background Genome-wide association studies have identified novel genetic associations for asthma, but without taking into account the role of active tobacco smoking. This study aimed to identify novel genes that interact with ever active tobacco smoking in adult onset asthma. Methods We performed a genome-wide interaction analysis in six studies participating in the GABRIEL consortium following two meta-analyses approaches based on 1) the overall interaction effect and 2) the genetic effect in subjects with and without smoking exposure. We performed a discovery meta-analysis including 4,057 subjects of European descent and replicated our findings in an independent cohort (LifeLines Cohort Study), including 12,475 subjects. Results First approach: 50 SNPs were selected based on an overall interaction effect at p<10−4. The most pronounced interaction effect was observed for rs9969775 on chromosome 9 (discovery meta-analysis: ORint = 0.50, p = 7.63*10−5, replication: ORint = 0.65, p = 0.02). Second approach: 35 SNPs were selected based on the overall genetic effect in exposed subjects (p <10−4). The most pronounced genetic effect was observed for rs5011804 on chromosome 12 (discovery meta-analysis ORint = 1.50, p = 1.21*10−4; replication: ORint = 1.40, p = 0.03). Conclusions Using two genome-wide interaction approaches, we identified novel polymorphisms in non-annotated intergenic regions on chromosomes 9 and 12, that showed suggestive evidence for interaction with active tobacco smoking in the onset of adult asthma. PMID:28253294

  17. Regular use of non-steroidal anti-inflammatory drugs increases the risk of adult-onset asthma: a population-based follow-up study

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; Kyvik, Kirsten Ohm; Skadhauge, Lars Rauff;

    2009-01-01

    BACKGROUND: Little is known about the relation between regular use of non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of asthma at the population level. The aim of this study was to examine a possible association between intake of NSAIDs and risk of adult-onset asthma. METHODS: Using...... data from two multidisciplinary postal questionnaire surveys concerning health and lifestyle, we prospectively studied 19 349 adult twins enrolled in the nationwide Danish Twin Registry. RESULTS: We found a higher prevalence of new-onset asthma in subjects who used NSAIDs (other than aspirin) regularly...

  18. Experiences of Racism and the Incidence of Adult-Onset Asthma in the Black Women’s Health Study

    Science.gov (United States)

    Yu, Jeffrey; O’Connor, George T.; Brown, Timothy A.; Cozier, Yvette C.; Palmer, Julie R.; Rosenberg, Lynn

    2014-01-01

    Background: Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses of the relation of experiences of racism with asthma incidence in the Black Women’s Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Methods: Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. Results: The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score (P for trend racism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Conclusions: Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance. PMID:23887828

  19. Experiences of racism and the incidence of adult-onset asthma in the Black Women's Health Study.

    Science.gov (United States)

    Coogan, Patricia F; Yu, Jeffrey; O'Connor, George T; Brown, Timothy A; Cozier, Yvette C; Palmer, Julie R; Rosenberg, Lynn

    2014-03-01

    Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses of the relation of experiences of racism with asthma incidence in the Black Women's Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score (P for trendracism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance.

  20. Individual traffic-related air pollution and new onset adult asthma:A GIS-based pilot study

    DEFF Research Database (Denmark)

    Lysbeck Hansen, Carl; Jensen, Steen Solvang; Baelum, Jesper

    individual traffic-related air pollution exposure and new onset asthma and wheeze. It is recommended that the analytic methods developed in this pilot study are used in a larger prospective cohort to investigate individual traffic-related air pollutants as a risk factor for the development of new asthma......The background for the project is that traffic-related air pollution may provoke the onset of asthma. The objective of this pilot study is to investigate the relation between asthma and wheeze debut and individually estimated exposure to traffic-related air pollutants with a validated exposure...... successfully identified for all study participants (N=33). Using AirGIS traffic-related air pollutant levels from both urban background and street level were estimated for the 10 year study period on an hourly basis. Individual levels of air pollutants in the years preceding debut of asthma or wheeze were...

  1. 成人期起病支气管哮喘临床及炎症特点分析%Clinical and inflammatory characteristics of adult-onset asthma

    Institute of Scientific and Technical Information of China (English)

    张锋英; 俞烽; 杭晶卿

    2016-01-01

    目的:了解成人期起病支气管哮喘临床特点及相关细胞因子分析。方法根据哮喘起病年龄,分为成人期起病组和儿童期起病组,检测肺功能、外周血总IgE、IL-1、IL-4、IL-6、IL-8、IL-10以及肿瘤坏死因子-α等炎症因子,诱导痰细胞计数及分类,两组进行比较。结果共入选哮喘患者161例,成人期起病患者103例,儿童期起病患者58例。成人期起病组与儿童期起病组有过敏史者分别为71.8%和94.8%( P0.05)。结论无论哮喘起病年龄早晚,过敏仍是哮喘起病主要因素。成人期起病哮喘FEV1%与病程无显著相关。血及诱导痰嗜酸性粒细胞、血清白介素、TNF-α等在不同年龄起病哮喘中无差异。%Objective To understand the clinical and inflammatory characteristics of adult-onset asthma. Methods According to the age of asthma onset, patients were divided into the adult-onset and childhood-onset groups. All patients were given lung function tests. Total IgE, interleukin-1, interleukin-4, interleukin-6, interleu-kin-8, interleukin-10 and tumor necrosis factor alpha in peripheral blood were measured. Cell counting and classify in induced sputum were also analyzed. Results There were 161 patients with asthma, 103 of whom were with adult-on-set asthma and 58 with childhood-onset asthma. 71. 8% patients had a history of allergy in the adult-onset group and 94. 8% in the childhood-onset group, respectively (P0. 05). Conclu-sion Regardless of onset age of asthma, allergy is still a major factor of asthma. The level of FEV1% has no relation with asthma duration, and there is no significant difference in eosinophils in blood and induced sputum, serum IL-1, IL-4, IL-6, IL-8, IL-10 and TNF-α in different onset age.

  2. Individual traffic-related air pollution and new onset adult asthma:A GIS-based pilot study

    DEFF Research Database (Denmark)

    Lysbeck Hansen, Carl; Jensen, Steen Solvang; Baelum, Jesper

    The background for the project is that traffic-related air pollution may provoke the onset of asthma. The objective of this pilot study is to investigate the relation between asthma and wheeze debut and individually estimated exposure to traffic-related air pollutants with a validated exposure...... demonstrated. A tendency towards higher levels of nitrogen oxides exposure during the year prior to debut was seen in wheeze cases. Substantial problems in determining time of onset were encountered. This pilot study successfully demonstrated the feasibility of using AirGIS to study correlations between...... individual traffic-related air pollution exposure and new onset asthma and wheeze. It is recommended that the analytic methods developed in this pilot study are used in a larger prospective cohort to investigate individual traffic-related air pollutants as a risk factor for the development of new asthma...

  3. Environment and asthma in adults.

    Science.gov (United States)

    Le Moual, Nicole; Jacquemin, Bénédicte; Varraso, Raphaëlle; Dumas, Orianne; Kauffmann, Francine; Nadif, Rachel

    2013-09-01

    The present review addresses recent advances and especially challenging aspects regarding the role of environmental risk factors in adult-onset asthma, for which the causes are poorly established. In the first part of the review, we discuss aspects regarding some environmental risk factors for adult-onset asthma: air pollution, occupational exposures with a focus on an emerging risk represented by exposure to cleaning agents (both at home and in the workplace), and lifestyle and nutrition. The second part is focused on perspectives and challenges, regarding relevant topics on which research is needed to improve the understanding of the role of environmental factors in asthma. Aspects of exposure assessment, the complexity of multiple exposures, the interrelationships of the environment with behavioral characteristics and the importance of studying biological markers and gene-environment interactions to identify the role of the environment in asthma are discussed. We conclude that environmental and lifestyle exposures play an important role in asthma or related phenotypes. The changes in lifestyle and the environment in recent decades have modified the specific risk factors in asthma even for well-recognized risks such as occupational exposures. To better understand the role of the environment in asthma, the use of objective (quantitative measurement of exposures) or modern tools (bar code, GPS) and the development of multidisciplinary collaboration would be very promising. A better understanding of the complex interrelationships between socio-economic, nutritional, lifestyle and environmental conditions might help to study their joint and independent roles in asthma.

  4. Individual traffic-related air pollution and new onset adult asthma: A GIS-based pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Sherson, D.; Lysbeck Hansen, C. (Hospital of Vejle, Dept. of Occupational and Environmental Medicine, (Denmark)); Solvang Jensen, S.; Hertel, O. (Univ. of Aarhus, National Environmental Research Institute (Denmark)); Baelum, J. (Odense Univ. Hospital, Dep. of Occupational and Environmental Medicine (Denmark)); Skadhauge, L. (Haderslev Hospital, Dep. of Occupational and Environmental Medicine (Denmark)); Siersted, H.C. (Odense Univ. Hospital, Dep. of Respiratory Medicine (Denmark)); Omland, OE. (Aalborg Hospital, Dep. of Occupational Medicine (Denmark)); Thomsen, G. (South-West Jutland Hospital Esbjerg, Dep. of Occupational and Environmental Medicine (Denmark)); Sigsgaard, T. (Univ. of Aarhus, Institute of Occupational and Environmental Medicine (Denmark))

    2008-03-15

    The objective of this pilot study is to investigate the relation between asthma and wheeze debut and individually estimated exposure to traffic-related air pollutants with a validated exposure system (AirGIS). A non-smoking cohort with recently acquired asthma or wheeze as well as matched controls was identified from a large cross-sectional study. All residential and working addresses with corresponding time periods for a 10 year period were successfully identified for all study participants (N=33) and exposure estimated for both urban background and street level. Individual levels of air pollutants in the years preceding debut of asthma or wheeze were analyzed using survival analysis. No significant correlations between exposure levels and onset of disease or symptom were demonstrated. A tendency towards higher levels of nitrogen oxides exposure during the year prior to debut was seen in wheeze cases. Substantial problems in determining time of onset were encountered. It is recommended that the analytic methods developed in this pilot study are used in a larger prospective cohort to investigate individual trafficrelated air pollutants as a risk factor for the development of new asthma and wheeze. (au)

  5. Genetics of onset of asthma

    NARCIS (Netherlands)

    Dijk, F. Nicole; de Jongste, Johan C.; Postma, Dirkje S.; Koppelman, Gerard H.

    2013-01-01

    Purpose of review Most asthma starts early in life. Defining phenotypes of asthma at this age is difficult as many preschool children have asthma-like respiratory symptoms. This review discusses progress in defining early wheezing phenotypes and describes genetic factors associated with the age of o

  6. Genetics of onset of asthma

    NARCIS (Netherlands)

    Dijk, F. Nicole; de Jongste, Johan C.; Postma, Dirkje S.; Koppelman, Gerard H.

    Purpose of review Most asthma starts early in life. Defining phenotypes of asthma at this age is difficult as many preschool children have asthma-like respiratory symptoms. This review discusses progress in defining early wheezing phenotypes and describes genetic factors associated with the age of

  7. Identification of asthma clusters in two independent Korean adult asthma cohorts.

    Science.gov (United States)

    Kim, Tae-Bum; Jang, An-Soo; Kwon, Hyouk-Soo; Park, Jong-Sook; Chang, Yoon-Seok; Cho, Sang-Heon; Choi, Byoung Whui; Park, Jung-Won; Nam, Dong-Ho; Yoon, Ho-Joo; Cho, Young-Joo; Moon, Hee-Bom; Cho, You Sook; Park, Choon-Sik

    2013-06-01

    Asthma is a heterogeneous airway disease with various clinical phenotypes. It is crucial to clearly identify clinical phenotypes to achieve better asthma management. We used cluster analysis to classify the clinical groups of 724 asthmatic patients from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), and in 1843 subjects from another independent Korean asthma cohort of Soonchunhyang University Asthma Genome Research Centre (SCH) (Bucheon, Republic of Korea). Hierarchical cluster analysis was performed by Ward's method, followed by κ-means cluster analysis. Cluster analysis of the COREA cohort indicated four asthma subtypes: 1) smoking asthma; 2) severe obstructive asthma; 3) early-onset atopic asthma; and 4) late-onset mild asthma. An independent cluster analysis of the SCH cohort also indicated four clusters that were similar to the COREA clusters. Our results indicate that adult Korean asthma patients can be classified into four distinct clusters.

  8. Genetic influence on the age at onset of asthma

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; Duffy, David Lorenzo; Kyvik, Kirsten Ohm;

    2010-01-01

    Although the genetics of asthma susceptibility have been frequently explored, little is known about genetic factors that influence the age at onset of asthma.......Although the genetics of asthma susceptibility have been frequently explored, little is known about genetic factors that influence the age at onset of asthma....

  9. Immunity to endotoxin and Asp299Gly polymorphism of TLR-4 in adult patients with early and late onset of asthma

    Directory of Open Access Journals (Sweden)

    Yu. A. Bisyuk

    2015-06-01

    Full Text Available Aim. The gene polymorphism of Asp299Gly TLR-4 may be associated with the risk of asthma development. Methods and results. The gene polymorphism of TLR-4 (Asp299Gly receptor has been researched in 262 early-onset and in 69 late-onset asthma patients. The state of anti-endotoxin immunity was assessed by determination of specific antibodies to the endotoxin of A, M, G classes and sCD14 by ELISA. The polymorphism was analyzed by the allele-specific polymerase chain reaction with electrophoretic detection. It was estimated that the risk of early-onset asthma in the population of Crimea is associated with genotypes AG and GG (Asp299Gly of TLR-4. There were increased levels of anti-endotoxin IgM and decreased of sIgA in patients with late-onset asthma and AA genotype as compared to other genotypes. Conclusion. The gene polymorphism of Asp299Gly TLR-4 is associated with the risk of early-onset asthma development in Crimea population.

  10. Adult onset tic disorders

    OpenAIRE

    Chouinard, S; Ford, B.

    2000-01-01

    BACKGROUND—Tic disorders presenting during adulthood have infrequently been described in the medical literature. Most reports depict adult onset secondary tic disorders caused by trauma, encephalitis, and other acquired conditions. Only rare reports describe idiopathic adult onset tic disorders, and most of these cases represent recurrent childhood tic disorders.
OBJECTIVE—To describe a large series of patients with tic disorders presenting during adulthood, to compare cl...

  11. Japanese Guideline for Adult Asthma

    Directory of Open Access Journals (Sweden)

    Ken Ohta

    2011-01-01

    Full Text Available Adult bronchial asthma (hereinafter, asthma is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause an intractable asthma. The number of patients with asthma has increased, while the number of patients who die from asthma has decreased (1.7 per 100,000 patients in 2009. The aim of asthma treatment is to enable patients with asthma to lead a healthy life without any symptoms. A partnership between physicians and patients is indispensable for appropriate treatment. Long-term management with agents and elimination of causes and risk factors are fundamental to asthma treatment. Four steps in pharmacotherapy differentiate mild to intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid (ICS, varying from low to high doses. Long-acting β2 agonists (LABA, leukotriene receptor antagonists, and theophylline sustained-release preparation are recommended as concomitant drugs, while anti-IgE antibody therapy is a new choice for the most severe and persistent asthma. Inhaled β2 agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, etc., are used as needed against acute exacerbations. Allergic rhinitis, chronic obstructive pulmonary disease (COPD, aspirin induced asthma, pregnancy, and cough variant asthma are also important factors that need to be considered.

  12. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms

    OpenAIRE

    2016-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident ...

  13. Regular inhaled corticosteroids in adult-onset asthma and the risk for future cancer: a population-based cohort study with proper person-time analysis

    Directory of Open Access Journals (Sweden)

    Kok VC

    2015-03-01

    Full Text Available Victor C Kok,1,2 Jorng-Tzong Horng,2,3 Hsu-Kai Huang,3 Tsung-Ming Chao,4 Ya-Fang Hong5 1Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan; 2Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan; 3Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan; 4Statistics Unit, Department of Applied Geomatics, Chien Hsin University, Jhongli, Taiwan; 5Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan Background: Recent studies have shown that inhaled corticosteroids (ICS can exert anti-inflammatory effects for chronic airway diseases, and several observational studies suggest that they play a role as cancer chemopreventive agents, particularly against lung cancer. We aimed to examine whether regular ICS use was associated with a reduced risk for future malignancy in patients with newly diagnosed adult-onset asthma. Methods: We used a population-based cohort study between 2001 and 2008 with appropriate person-time analysis. Participants were followed up until the first incident of cancer, death, or to the end of 2008. The Cox model was used to derive an adjusted hazard ratio (aHR for cancer development. Kaplan–Meier cancer-free survival curves of two groups were compared. Results: The exposed group of 2,117 regular ICS users and the nonexposed group of 17,732 non-ICS users were assembled. After 7,365 (mean, 3.5 years; standard deviation 2.1 and 73,789 (mean, 4.1 years; standard deviation 2.4 person-years of follow-up for the ICS users and the comparator group of non-ICS users, respectively, the aHR for overall cancer was nonsignificantly elevated at 1.33 with 95% confidence interval (CI, 1.00–1.76, P=0.0501. The Kaplan–Meier curves for overall cancer-free proportions of both groups were not significant (log-rank, P=0.065. Synergistic interaction of concurrent presence of regular ICS use was

  14. [Association between unplanned pregnancy and adolescence onset asthma].

    Science.gov (United States)

    Vázquez-Nava, Francisco; Gil-Lara, Bertoldo; Cruz-Torres, Leoncio; Vázquez-Rodríguez, Carlos F; Vázquez-Rodríguez, Eliza M; Felizardo-Ávalos, Jorge; Llanes-Castillo, Arturo; Córdova-Fernández, José A

    2013-01-01

    The association between asthma and pregnancy has been documented previously. The relationship between unplanned pregnancy and onset asthma in adolescence has not been studied. To determine the association between unplanned pregnancy and adolescence onset asthma. A cross-sectional study was done gathering information about asthma, unplanned pregnancy, family atopy and active or passive smoking in 3,130 adolescents aged 13-19 years. Asthma diagnosis was established through a selfquestionnaire based on the International Study of Asthma and Allergy in Childhood. Odds ratios for asthma were determined using logistic regression model and chi-squared test. Mean age of the participants was 16.37 ± 1.93 years. The prevalence of active smoking was 16.1%, of passive smoking 40% and of family atopy 9.8%. From the pregnant adolescents (785), 59.5% reported had planned not to have a child before pregnancy. Prevalence of wheezing during the year prior to the study was 9.3% and of wheezing during the pregnancy 2%. The prevalence of adolescence onset asthma was 5.4%. The age of initiation of asthma in the adolescence was 14.75 ± 1.60 years. The analysis showed that unplanned pregnancy has a slight risk for the development of asthma during adolescence. (Crude OR=1.03; CI 95% 1.02-1.05; p=0.000). Unplanned pregnancy, family atopy, active smoking and smoking friends are associated with the onset-asthma in the adolescence.

  15. Intake of paracetamol and risk of asthma in adults

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; Kyvik, Kirsten Ohm; Skadhauge, Lars

    2008-01-01

    Intake of paracetamol has been associated with development of asthma. The aim of this study was to address a possible association between intake of paracetamol and risk of adult-onset asthma. Using a multidisciplinary postal questionnaire survey concerning health and lifestyle we prospectively...... studied 19,349 adult twins enrolled in the nationwide Danish Twin Registry. There was a higher prevalence of new-onset asthma in subjects who reported frequent intake of paracetamol at baseline compared with subjects without this determinant (12.0% vs. 4.3%), OR = 3.03 (1.51-6.11), p = 0.005. The result...... remained significant after adjusting for sex, age, smoking, BMI, hay fever, eczema, and intake of medications other than paracetamol, OR = 2.16 (1.03-4.53), p = 0.041. Frequent intake of paracetamol is an independent risk factor for adult-onset asthma....

  16. Adult-onset tic disorders

    NARCIS (Netherlands)

    Eapen, [No Value; Lees, AJ; Lakke, JPWF; Trimble, MR; Robertson, MM

    2002-01-01

    We report on 8 patients with adult-onset motor tics and vocalisations. Three had compulsive tendencies in childhood and 3 had a family history of tics or obsessive-compulsive behaviour. In comparison with DSM-classified, younger-onset Gilles de la Tourette syndrome, adult-onset tic disorders are mor

  17. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms.

    Science.gov (United States)

    Kankaanranta, Hannu; Kauppi, Paula; Tuomisto, Leena E; Ilmarinen, Pinja

    2016-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes.

  18. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms

    Directory of Open Access Journals (Sweden)

    Hannu Kankaanranta

    2016-01-01

    Full Text Available Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2, and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes.

  19. Occupational Exposure and New-onset Asthma in a Population-based Study in Northern Europe (RHINE)

    DEFF Research Database (Denmark)

    Lillienberg, Linnéa; Andersson, Eva; Janson, Christer

    2014-01-01

    OBJECTIVES: In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. METHODS: The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 1989-1992 and again 1999-2001. Asthma wa...... among cleaners, spray painters, plumbers, and hairdressers were confirmed....

  20. Japanese Guideline for Adult Asthma 2014

    Directory of Open Access Journals (Sweden)

    Ken Ohta

    2014-01-01

    Full Text Available Adult bronchial asthma (hereinafter, asthma is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause intractable asthma. The number of patients with asthma has increased, and that of patients who die from asthma has decreased (1.5 per 100,000 patients in 2012. The aim of asthma treatment is to enable patients with asthma to lead a normal life without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management with antiasthmatic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high. Long-acting 02-agonists, leukotriene receptor antagonists, and sustained-release theophylline are recommended as concomitant drugs, while anti-immunoglobulin E antibody therapy has been recently developed for the most severe and persistent asthma involving allergic reactions. Inhaled 02-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks. Allergic rhinitis, chronic obstructive pulmonary disease, aspirin-induced asthma, pregnancy, asthma in athletes, and coughvariant asthma are also important issues that need to be considered.

  1. Adult onset pityriasis rubra pilaris

    Directory of Open Access Journals (Sweden)

    Sehgal Virendra

    2008-01-01

    Full Text Available Pityriasis rubra pilaris (PRP has always been an intriguing topic ever since its inception. It is a group of chronic disorders characterized by reddish orange plaques with pityriasiform scaling showing follicular keratoses, palmoplantar keratoderma, and sometimes, erythroderma. It occurs all over the world but with racial variations. Its incidence might vary and the age at onset, behavior, clinical appearance, and prognosis are considered to be very important for its classification. It may manifest either as Type I classical adult onset PRP, Type II atypical adult (onset PRP, or Type VI PRP (HIV-associated PRP pityriasis rubra pilaris in contrast to classical juvenile (Type III and circumscribed juvenile (Type IV encountered among children. Its diagnosis is largely clinical with microscopic pathology being a useful supplement, but it continues to be a therapeutic dilemma. We review the epidemiology of adult onset PRP here and take stock of the prevalent treatment options.

  2. Obesity-related asthma in adults.

    Science.gov (United States)

    Bhatt, Nikunj A; Lazarus, Angeline

    2016-08-01

    Obesity as a risk factor for asthma has been identified in previous studies. Additionally, a disproportionate number of patients with severe or difficult-to-control asthma are obese. Patients with obesity-related asthma tend to have worse asthma control and quality of life disproportionate to their pulmonary function tests, are less responsive to corticosteroid therapy, and are more likely to have obesity-related comorbidities such as obstructive sleep apnea and gastroesophageal disease that complicate asthma treatment. With the increasing prevalence of obesity, the prevalence of asthma is anticipated to grow proportionally. Addressing weight loss and encouraging activity is essential in the management of obesity-related asthma. This article briefly overviews the epidemiology, unique distinguishing features, potential mechanisms, and approach to management of patients with obesity-related asthma in adults.

  3. Adult onset Leigh syndrome

    Directory of Open Access Journals (Sweden)

    Pandit Lekha

    2007-01-01

    Full Text Available Leigh syndrome is a rare progressive mitochondrial disorder of oxidative metabolism. Though it has been reported in infancy and childhood, it is rarely described in adults. The authors describe a patient who had clinical and magnetic resonance imaging features diagnostic of Leigh syndrome, with supportive biochemical and muscle histochemistry evidence.

  4. Genetic influence on the age at onset of asthma: a twin study

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; Duffy, David Lorenzo; Kyvik, Kirsten Ohm

    2010-01-01

    Although the genetics of asthma susceptibility have been frequently explored, little is known about genetic factors that influence the age at onset of asthma.......Although the genetics of asthma susceptibility have been frequently explored, little is known about genetic factors that influence the age at onset of asthma....

  5. Lung Disease Including Asthma and Adult Vaccination

    Science.gov (United States)

    ... Healthcare Professionals Lung Disease including Asthma and Adult Vaccination Language: English Español (Spanish) Recommend on Facebook Tweet ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...

  6. Adult-onset food allergy.

    Science.gov (United States)

    Kivity, Shmuel

    2012-01-01

    The prevalence of food allergy is increasing in both the pediatric and adult populations. While symptom onset occurs mostly during childhood, there are a considerable number of patients whose symptoms first begin to appear after the age of 18 years. The majority of patients with adult-onset food allergy suffer from the pollen-plant allergy syndromes. Many of them manifest their allergy after exercise and consuming food to which they are allergic. Eosinophilic esophagitis, an eosinophilic inflammation of the esophagus affecting individuals of all ages, recently emerged as another allergic manifestation, with both immediate and late response to the ingested food. This review provides a condensed update of the current data in the literature on adult-onset allergy.

  7. PERSISTENCE AND NEW-ONSET OF ASTHMA AND CHRONIC-BRONCHITIS EVALUATED LONGITUDINALLY IN A COMMUNITY POPULATION-SAMPLE OF ADULTS

    NARCIS (Netherlands)

    POSTMA, DS; LEBOWITZ, MD

    1995-01-01

    Background: Some patients with chronic obstructive pulmonary disease may share the clinical characteristics of those with asthma; their disease is sometimes called ''asthmatic bronchitis.'' Whether there is a difference between asthmatics who do and do not develop chronic bronchitis is not yet

  8. Asthma in adults and its association with chronic rhinosinusitis: The GA(2) LEN survey in Europe

    DEFF Research Database (Denmark)

    Jarvis, D; Newson, R; Lotvall, J;

    2011-01-01

    . Asthma in adults and its association with chronic rhinosinusitis: The GA(2) LEN survey in Europe. Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02709.x ABSTRACT: Background:  The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population......-based epidemiological surveys. Methods:  The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps...... association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20-3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57-13.17). CRS in the absence of nasal allergies was positively associated with late-onset asthma...

  9. Adult-onset mitochondrial myopathy.

    Science.gov (United States)

    Fernandez-Sola, J.; Casademont, J.; Grau, J. M.; Graus, F.; Cardellach, F.; Pedrol, E.; Urbano-Marquez, A.

    1992-01-01

    Mitochondrial diseases are polymorphic entities which may affect many organs and systems. Skeletal muscle involvement is frequent in the context of systemic mitochondrial disease, but adult-onset pure mitochondrial myopathy appears to be rare. We report 3 patients with progressive skeletal mitochondrial myopathy starting in adult age. In all cases, the proximal myopathy was the only clinical feature. Mitochondrial pathology was confirmed by evidence of ragged-red fibres in muscle histochemistry, an abnormal mitochondrial morphology in electron microscopy and by exclusion of other underlying diseases. No deletions of mitochondrial DNA were found. We emphasize the need to look for a mitochondrial disorder in some non-specific myopathies starting in adult life. Images Figure 1 Figure 2 PMID:1589382

  10. Predicting adult asthma in childhood

    NARCIS (Netherlands)

    Vonk, JM; Boezen, HM

    2006-01-01

    PURPOSE OF REVIEW: There still is no cure for asthma. Early identification of patients at risk for disease progression may lead to better treatment opportunities and hopefully better disease outcomes in adulthood. Recent literature on childhood risk factors associated with the outcome of asthma in a

  11. Asthma symptoms in obese adults

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2016-01-01

    The association between asthma and obesity is well-described, but not straightforward, and according to current guidelines asthma control is more difficult to achieve in obese patients. The currently available studies evaluating response to pharmacological asthma therapy in obese patients show...... that these patients have an altered, in general less favorable, response to both reliever and controller medication compared to normal weight patients. However, at present, the limited available evidence precludes evidence-based recommendations. The 'obesity-related asthma' phenotype has different characteristics......, including association with atopy and type of airway inflammation, compared to 'classic' asthma. Furthermore, weight loss in patients with this phenotype leads to an improvement in symptoms, lung function, and airway responsiveness, as well as a reduction in medication utilization and hospital admissions...

  12. Parental stress and the onset and course of childhood asthma.

    Science.gov (United States)

    Yamamoto, Noriko; Nagano, Jun

    2015-01-01

    The influence of a caregiver's stress on the development of childhood asthma is an important aspect of the treatment and prevention of illness. Many cross-sectional studies have investigated the association between parenting attitude and/or caregiver's stress and childhood asthma morbidity, but prospective studies are more advantageous than cross-sectional studies in interpreting a causal relationship from the results. We here present an overview of prospective studies that have reported a relationship between parental stress and the morbidity or course of childhood asthma and discuss the role of parental mental health in its prevention and treatment. Almost all of the studies referred to in this paper show that caregiver (mostly mothers) stress contributed to the onset and to a poor prognosis, while only a few studies have examined the adverse effect of paternal stress on childhood asthma. Their results are inconsistent, and there is insufficient data examining specific stress-related properties that can be targeted in intervention studies. Not only maternal but also paternal influence should be considered in future studies, and it will be important to assess specific stress-related properties that can be the foundation of specific intervention methods.

  13. Epidemiology of adult asthma in Asia: toward a better understanding

    OpenAIRE

    Song, Woo-Jung; Kang, Min-Gyu; Chang, Yoon-Seok; Cho, Sang-Heon

    2014-01-01

    Asia is the world's most dynamic area. Asthma is a major chronic disease in Asia, like other continents. However, unlike childhood asthma, the epidemiological burden of asthma in Asian adults has been unclear. Here we reviewed the currently available literatures on the epidemiology of adult asthma in the Asian community populations. Adult asthma prevalence was generally lower in Asian than in Europe, but the increasing trends suggested the disease burden to rise in the near future. However, f...

  14. Asthma in Adults Fact Sheet

    Science.gov (United States)

    ... News: Expanding Nationwide Medicaid Asthma Care Coverage Blog: Yoga, Tai Chi and Your Lungs: The Benefits of ... number of items"); $("#local_list_xml").quickPagination(); }, error: function() { console.log("An error occurred while processing XML ...

  15. The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice.

    Directory of Open Access Journals (Sweden)

    Motoyasu Iikura

    Full Text Available Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.The relation between various infections and adult asthma exacerbations was investigated in clinical practice.The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation.

  16. Cardiac arrhythmias in adult patients with asthma

    DEFF Research Database (Denmark)

    Warnier, Miriam J; Rutten, Frans H; Kors, Jan A;

    2012-01-01

    OBJECTIVE: The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias and electrocardio......OBJECTIVE: The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias...... and electrocardiographic characteristics of arrhythmogenicity (ECG) and to explore the role of β2-mimetics. METHODS: A cross-sectional study was conducted among 158 adult patients with a diagnosis of asthma and 6303 participants without asthma from the cohort of the Utrecht Health Project-an ongoing, longitudinal, primary...... or flutter). Secondary outcomes were tachycardia, bradycardia, PVC, atrial fibrillation or flutter, mean heart rate, mean corrected QT (QTc) interval length, and prolonged QTc interval. RESULTS: Tachycardia and PVCs were more prevalent in patients with asthma (3% and 4%, respectively) than those without...

  17. The level of specialist assessment of adult asthma is influenced by patient age

    DEFF Research Database (Denmark)

    Porsbjerg, C; Sverrild, A; Stensen, L;

    2014-01-01

    is sparse. AIM: To examine the impact of patient age on the type and proportion of diagnostic tests performed in patients undergoing specialist assessment for asthma. METHODS: Data from a clinical population consisting of all patients consecutively referred over a 12 months period to a specialist clinic...... adults, and were more frequently smokers. However, a regression analysis showed that older age was associated with a lower likelihood of diagnostic assessment with a reversibility test, a bronchial challenge test, or measurement of exhaled NO, independently of a known diagnosis of asthma, smoking habits......BACKGROUND: Late onset asthma is associated with more severe disease and higher morbidity than in younger asthma patients. This may in part relate to under recognition of asthma in older adults, but evidence on the impact of patient age on diagnostic assessment of asthma in a specialist setting...

  18. Asthma - what to ask the doctor - adult

    Science.gov (United States)

    What to ask your doctor about asthma - adult ... For what side effects should I call the doctor? How will I know when my inhalers are ... worse and that I need to call the doctor? What should I do when I feel short ...

  19. Role of Asthma Education in the Management of Adult Asthma

    Directory of Open Access Journals (Sweden)

    Johanne Côté

    1995-01-01

    Full Text Available When a patient is newly diagnosed as having asthma, he or she is often prescribed new medication without getting much information on the disease and its treatment. This article emphasizes the need to educate asthmatics. Asthma treatment should begin with a proper adjustment of the medication, allowing asthmatics to lead a normal life. All asthmatics should be shown how to use their inhalation device properly. They should he knowledgeable about the basic aspects of asthma, airway inflammation and bronchoconstriction, use or medication and early symptoms heralding an asthma attack. Environmental factors that may trigger an asthma attack should be explained. Patients should be able to self-monitor asthma using either symptom severity or a peak flow meter. Because asthma is an unpredictable disease, patients should have a self-action plan to implement when their asthma deteriorates.

  20. New-onset asthma and the effect of environment and occupation among farming and nonfarming rural subjects.

    Science.gov (United States)

    Omland, Øyvind; Hjort, Charlotte; Pedersen, Ole Find; Miller, Martin R; Sigsgaard, Torben

    2011-10-01

    Many factors, including environmental exposures, have been related to the increase in the prevalence of asthma, but only few have been tested for in longitudinal studies. We studied farming students to determine whether their environment during childhood and as adults was a factor determining subsequent onset of asthma. From 1994 to 1998, new cases of asthma were identified by means of an annual posted questionnaire followed by a telephone interview in a prospective cohort consisting of 1964 farming-school students and 407 nonfarming subjects aged 16 to 26 years. For each case, we selected a control subject from the cohort with no asthma in a case-based design, and all underwent an interview and a clinical examination. We found 122 new cases of asthma. In a multiple regression model the odds ratio for new asthma was 3.3 (95% CI, 1.7-6.3) for smoking; 3.4 (95% CI, 1.6-7.0), 2.5 (95% CI, 1.1-5.3), and 7.0 (95% CI, 1.2-41.6) for exposure to swine, dairy production, and welding, respectively; and 11.7 (95% CI, 2.4-56.4) for bronchial hyperresponsiveness at baseline. Being born and raised on a farm significantly reduced the risk odds ratio (0.5 [95% CI, 0.3-0.98]), whereas atopy had no influence. Exposure to swine and dairy confinements, welding, smoking, and bronchial hyperresponsiveness are risk factors for nonallergic asthma, and being born and raised on a farm reduces the subsequent risk. These findings support the theory that immune and inflammatory responses can be influenced by environmental exposure to early childhood, reducing the risk of asthma later in life. Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  1. Are there reasons why adult asthma is more common in females?

    NARCIS (Netherlands)

    Melgert, Barbro N.; Ray, Anuradha; Hylkema, Macbteld N.; Timens, Wim; Postma, Dirkje S.

    2007-01-01

    Many epidemiological studies suggest that women are at increased risk of developing adult-onset asthma and also suffer from more severe disease than men. These gender differences appear to be the product of biological sex differences as well as sociocultural and environmental differences. The biolog

  2. General and abdominal obesity and incident asthma in adults: the HUNT study.

    Science.gov (United States)

    Brumpton, Ben; Langhammer, Arnulf; Romundstad, Pål; Chen, Yue; Mai, Xiao-Mei

    2013-02-01

    Measures of body mass index (BMI) and waist circumference define general obesity and abdominal obesity respectively. While high BMI has been established as a risk factor for asthma in adults, waist circumference has seldom been investigated. To determine the association between BMI, waist circumference and incident asthma in adults, we conducted a prospective study (n=23,245) in a population living in Nord-Trøndelag, Norway in 1995-2008. Baseline BMI and waist circumference were measured and categorised as general obesity (BMI ≥30.0 kg·m(2)) and abdominal obesity (waist circumference ≥88 cm in females and ≥102 cm in males). Incident asthma was self-reported new-onset cases during an 11-yr follow-up period. Odds ratios for asthma associated with obesity were calculated using multivariable logistic regression. General obesity was a risk factor for asthma in females (OR 1.96, 95% CI 1.52-2.52) and males (OR 1.84, 95% CI 1.30-2.59). In females, after additional adjustment for BMI, abdominal obesity remained a risk factor for asthma development (OR 1.46, 95% CI 1.04-2.05). Abdominal obesity seems to increase the risk of incident asthma in females in addition to BMI, indicating that using both measures of BMI and waist circumference in females may be a superior clinical assessment for asthma risk than any measure alone.

  3. Prediction of early-onset asthma in genetically at-risk children.

    Science.gov (United States)

    Mrazek, D A; Klinnert, M; Mrazek, P J; Brower, A; McCormick, D; Rubin, B; Ikle, D; Kastner, W; Larsen, G; Harbeck, R; Jones, J

    1999-02-01

    The W.T. Grant Foundation Asthma Risk Study was designed to prospectively examine children who were considered at a genetically increased risk for the development of asthma. The respective contributions of 11 potential risk factors, both environmental and biological, were assessed in order to determine their relative roles in affecting the early onset of asthma. This is a report of an inception cohort of children born to asthmatic mothers and followed for a 3-year period. All 150 families were recruited from the general community and living within 2 h of the National Jewish Center for Immunology and Respiratory Medicine (Denver, CO). Mothers in the index risk sample had been previously diagnosed with asthma and were recruited during their pregnancy through physician referrals and media solicitation. The index sample of 150 families was 92% Caucasian and predominantly middle class. The mean age of mothers was 29.3 years, and of fathers, 31.1 years. The main outcome was the determination of the early onset of asthma and its association with quantified risk factors. By age 3 years, 14 of the 150 children had developed asthma. Frequent illness, IgE levels at age 6 months, parenting difficulties, and early eczema were significantly associated with the onset of asthma (P = 0.003, P = 0.006, P = 0.01, and P = 0.03, respectively). Only frequent illness, elevated serum IgE levels, and parenting difficulties entered a predictive model where they were independently related to the development of asthma.

  4. Adult Onset Langerhans’ Cell Histiocytosis

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    Rahime İnci

    2014-12-01

    Full Text Available Langerhans’ cell histiocytosis (LCH is a group of diseases of unknown cause resulting from abnormal proliferation of bone marrow-originated dendritic cells called histiocytes. The incidence is between 0.5-5.4 per million. More common in childhood, it is extremely rare in adults. In adults, pulmonary involvement with Langerhans’ cell histiocytosis usually occurs as a single-system disease. In this article, the clinical, radiological and histopathological findings of a 51-year-old male patient with both skin, bone and pulmonary involvement were presented and discussed with recent literature.

  5. Adult-onset unilateral disabling pansclerotic morphea

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    Adarshlata Singh

    2014-01-01

    Full Text Available Disabling pansclerotic morphea (DPM is a rare, severe, and mutilating form of morphea, involving the dermis, subcutaneous tissue, fat, muscle, and even bone. It is usually seen before the age of 14 years, with the patient complaining of arthralgia and stiffness at the time of onset. We report a case of unilateral adult-onset DPM with sparing of the face. Within a few months of onset, painful contracture deformities of the hand, elbow, and shoulder joints developed, impairing the patient′s normal daily activities. We are reporting this case because of the unusual presentation: DPM in an adult, with history of trauma in childhood and rapid onset of complications, is rare.

  6. A study of asthma severity in adult twins

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; van der Sluis, Sophie; Kyvik, Kirsten Ohm

    2012-01-01

    twins from the Danish Twin Registry, a total of 575 subjects (256 intact pairs and 63 single twins) who themselves and/or their co-twins reported a history of asthma at a questionnaire survey were clinically examined. The severity of asthma symptoms was graded according to a clinical interview...... of asthma symptoms and objectively measured asthma-related traits, respectively, seem to differ. Please cite this paper as: Thomsen SF, van der Sluis S, Kyvik KO and Backer V. A study of asthma severity in adult twins. Clin Respir J 2011; DOI:10.1111/j.1752-699X.2011.00273.x....

  7. [Adult-onset rare diseases].

    Science.gov (United States)

    Pfliegler, György; Kovács, Erzsébet; Kovács, György; Urbán, Krisztián; Nagy, Valéria; Brúgós, Boglárka

    2014-03-01

    The present paper is focusing on rare diseases manifesting in late childhood or adulthood. A part of these syndromes are not of genetic origin, such as relatively or absolutely rare infections, autoimmune diseases, tumours, or diseases due to rare environmental toxic agents. In addition, even a large proportion of genetic disorders may develop in adulthood or may have adult forms as well, affecting are almost each medical specialization. Examples are storage disorders (e.g. adult form of Tay-Sachs disease, Gaucher-disease), enzyme deficiencies (e.g. ornithin-transcarbamylase deficiency of the urea cycle disorders), rare thrombophilias (e.g. homozygous factor V. Leiden mutation, antithrombin deficiency), or some rare monogenic disorders such as Huntington-chorea and many others. It is now generally accepted that at least half of the 6-8000 "rare diseases" belong either to the scope of adult-care (e.g. internal medicine, neurology), or to "age-neutral" specialities such as ophtalmology, dermatology etc.).

  8. Long-term ambient ozone concentration and the incidence of asthma in nonsmoking adults: The Ahsmog study

    Energy Technology Data Exchange (ETDEWEB)

    McDonnell, W.F. [Environmental Protection Agency, Research Triangle Park, NC (United States). National Health and Environmental Effects Research Lab.; Abbey, D.E.; Nishino, N. [Loma Linda Univ., CA (United States). School of Public Health; Lebowitz, M.D. [Univ. of Arizona Coll. of Medicine, Tucson, AZ (United States).

    1999-02-01

    The authors conducted a prospective study of a cohort of 3091 nonsmokers, ages 27 to 87 years, to evaluate the association between long-term ambient ozone exposure and development of adult-onset asthma. Over a 15-year period, 3.2% of males and 4.3% of females reported new doctor diagnoses of asthma. For males, they observed a significant relationship between report of doctor diagnosis of asthma and 20-year mean 8-h average ambient ozone concentration. The authors observed no such relationship for females. Other variables significantly related to development of asthma were a history of ever-smoking for males, and for females, number of years worked with a smoker, age, and a history of childhood pneumonia or bronchitis. Addition of other pollutants to the models did not diminish the relationship between ozone and asthma for males. These data suggest that long-term exposure to ambient ozone is associated with development of asthma in adult males.

  9. Adult onset sporadic ataxias: a diagnostic challenge

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    Orlando Graziani Povoas Barsottini

    2014-03-01

    Full Text Available Patients with adult onset non-familial progressive ataxia are classified in sporadic ataxia group. There are several disease categories that may manifest with sporadic ataxia: toxic causes, immune-mediated ataxias, vitamin deficiency, infectious diseases, degenerative disorders and even genetic conditions. Considering heterogeneity in the clinical spectrum of sporadic ataxias, the correct diagnosis remains a clinical challenge. In this review, the different disease categories that lead to sporadic ataxia with adult onset are discussed with special emphasis on their clinical and neuroimaging features, and diagnostic criteria.

  10. Diagnosis and Management of Asthma in Adults: A Review.

    Science.gov (United States)

    McCracken, Jennifer L; Veeranki, Sreenivas P; Ameredes, Bill T; Calhoun, William J

    2017-07-18

    Asthma affects about 7.5% of the adult population. Evidence-based diagnosis, monitoring, and treatment can improve functioning and quality of life in adult patients with asthma. Asthma is a heterogeneous clinical syndrome primarily affecting the lower respiratory tract, characterized by episodic or persistent symptoms of wheezing, dyspnea, and cough. The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry. Identifying clinically important allergen sensitivities is useful. Inhaled short-acting β2-agonists provide rapid relief of acute symptoms, but maintenance with daily inhaled corticosteroids is the standard of care for persistent asthma. Combination therapy, including inhaled corticosteroids and long-acting β2-agonists, is effective in patients for whom inhaled corticosteroids alone are insufficient. The use of inhaled long-acting β2-agonists alone is not appropriate. Other controller approaches include long-acting muscarinic antagonists (eg, tiotropium), and biological agents directed against proteins involved in the pathogenesis of asthma (eg, omalizumab, mepolizumab, reslizumab). Asthma is characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation. Management of persistent asthma requires avoidance of aggravating environmental factors, use of short-acting β2-agonists for rapid relief of symptoms, and daily use of inhaled corticosteroids. Other controller medications, such as long-acting bronchodilators and biologics, may be required in moderate and severe asthma. Patients with severe asthma generally benefit from consultation with an asthma specialist for consideration of additional treatment, including injectable biologic agents.

  11. Asthma

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    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  12. New-onset asthma among soldiers serving in Iraq and Afghanistan.

    Science.gov (United States)

    Szema, Anthony M; Peters, Michael C; Weissinger, Kristen M; Gagliano, Christy A; Chen, John J

    2010-01-01

    Since June 4, 2004, asthma diagnosed and symptomatic after the age of 12 years has been an exclusion criterion for military enlistment unless exempted via medical waiver. The Department of Defense determined that 13% of U.S. Army Medic visits in Iraq are for new-onset acute respiratory illness; case reports of veterans with asthma that began in Iraq and Afghanistan War zones have surfaced. This prompted our study to determine whether new asthma is diagnosed more frequently among Iraq/Afghanistan War troops versus stateside-based troops. Retrospective review of asthma diagnoses among computerized charts for military personnel discharged from active duty and examined between March 1, 2004 and May 1, 2007, at the Veterans Affairs Medical Center (VAMC), Northport, NY, classified soldiers by (1) deployment status-whether they were stationed in Iraq/Afghanistan for a 1-year tour of duty or stationed in the United States, and (2) VA diagnosis of asthma per International Classification of Disease codes. Associations between deployment and asthma statuses were evaluated/stratified by gender/age group. Eligibility criteria entailed (1) residence in Long Island, (2) aged 18-45 years, and (3) both U.S. military service and discharge dates between March 1, 2004 and May 1, 2007. Out of 6233 patients who served between 2004 and 2007 and were followed at the Northport VAMC, 290 new-onset/prevalent asthma cases were identified. Deployment to Iraq was associated with a significantly higher risk of asthma compared with stateside soldiers (6.6% versus 4.3%; with a crude odds ratio, 1.58; 95% CI, 1.18, 2.11). These associations persist when stratified by gender and age group. Deployment to Iraq and Afghanistan is associated with new-onset asthma. Etiologic studies, surveillance, incidence, epidemiology, and assessing response to therapy are recommended.

  13. Adult onset moyamoya disease: Institutional experience

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    Swati Dayanand Chinchure

    2011-01-01

    Full Text Available Moyamoya disease is a progressive steno-occlusive disease of bilateral carotid forks with the formation of fine collateral vascular network and is an angiographic diagnosis. We analyzed case records of 11 patients with "adult-onset moyamoya disease." Six patients presented with intracranial hemorrhage (intracerebral and/or intraventricular and 5 with focal ischemia. Angiography revealed bilateral Internal carotid artery involvement in 8 patients and unilateral involvement in 3. Posterior cerebral artery involvement was seen in 3 patients. Saccular aneurysm involving posterior circulation was seen in only 1 patient. Although rare, adult-onset moyamoya disease should be considered as one of the causes for intracerebral and intraventricular hemorrhage in adults.

  14. The influence of asthma onset and severity on malocclusion prevalence in children and adolescents

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    Luiz Sekio Tanaka

    2012-02-01

    Full Text Available OBJECTIVE: The influence of asthma, its severity levels and onset time on malocclusion occurrence were investigated. METHODS: The sample was composed by 176 children/adolescents, of both genders, aged 3 to 15 years, that were divided in two groups. The asthma group (AG enrolled 88 children/adolescents that were seen at the Breathe Londrina Program. The asthma-free group (AFG enrolled 88 preschool and school children recruited in 2 public schools. Malocclusion diagnosis was made according to WHO criteria (OMS, 1999. RESULTS: A higher prevalence in malocclusions in asthmatic patients in mixed dentition was observed when compared to controls (p0.05 and permanent dentition (p>0.05. A significant association was seen between asthma onset time and marked maxillary overjet (p<0.05, and open bite (p<0.05 in the mixed dentition, being both conditions more common among those that have presented the symptoms of asthma prior to 12 months of age. CONCLUSION: The results of this study indicate that the early manifestation of asthma at first year of life can cause dentofacial changes. Therefore, the prompt diagnostic of the illness, as well as the establishment of a proper therapy could improve the symptoms and chronic complications of asthma and also reduce its impact on craniofacial development.

  15. Adult attention deficit hyperactivity disorder is associated with asthma

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    Halmøy Anne

    2011-08-01

    Full Text Available Abstract Background Attention deficit hyperactivity disorder (ADHD is increasingly recognized as a common disorder not only in children, but also in the adult population. Similarly, asthma also has a substantial prevalence among adults. Previous studies concerning a potential relationship between ADHD and asthma have not presented consistent results. Methods A cross-sectional study of 594 adult patients diagnosed with ADHD, compared with 719 persons from the general population. Information was collected between 1997 and 2005 using auto-questionnaires rating past and present symptoms of ADHD, co-morbid conditions, including asthma, and work status. Results The prevalence of asthma was significantly higher in the ADHD patient group compared to the controls, 24.4% vs. 11.3% respectively (OR = 2.54, 95% CI 1.89-3.44, and controls with asthma scored higher on ratings of both past and present symptoms of ADHD. Female ADHD patients had a significantly higher prevalence of asthma compared to male ADHD patients (30.9% vs. 18.2%, OR = 2.01, CI 1.36-2.95, but in controls a slight female preponderance was not statistically significant. In both ADHD patients and controls, having asthma was associated with an increased prevalence of symptoms of mood- and anxiety disorders. Conclusions The present findings point to a co-morbidity of ADHD and asthma, and these patients may represent a clinical and biological subgroup of adult patients with ADHD.

  16. Adult onset tics after peripheral injury.

    Science.gov (United States)

    Erer, Sevda; Jankovic, Joseph

    2008-01-01

    We describe a case with adult onset motor tics after peripheral trauma. A 43-year-old man suffered a left shoulder dislocation during a motorcycle accident 21 years ago. Within 2 weeks after the injury, he noticed the gradual onset of involuntary jerking movements of his left shoulder, which was markedly exacerbated after second left shoulder injury 2 years later. The involuntary movements are phenomenologically identical to tics typically associated with Tourette syndrome (TS), but without the involvement of any other body part and without phonic tics or the typical TS co-morbidities, such as attention deficit or obsessive-compulsive disorder.

  17. Adult Asthma Consensus Guidelines Update 2003

    Directory of Open Access Journals (Sweden)

    Catherine Lemière

    2004-01-01

    Full Text Available BACKGROUND: Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies have highlighted the need to incorporate new information into the asthma guidelines.

  18. Monosodium glutamate intake, dietary patterns and asthma in Chinese adults.

    Directory of Open Access Journals (Sweden)

    Zumin Shi

    Full Text Available OBJECTIVES: Emerging evidence shows that diet is related to asthma. The aim of this analysis was to investigate the association between monosodium glutamate (MSG intake, overall dietary patterns and asthma. METHODS: Data from 1486 Chinese men and women who participated in the Jiangsu Nutrition Study (JIN were analyzed. In this study, MSG intake and dietary patterns were quantitatively assessed in 2002. Information on asthma history was collected during followed-up in 2007. RESULTS: Of the sample, 1.4% reported ever having asthma. MSG intake was not positively associated with asthma. There was a significant positive association between 'traditional' (high loadings on rice, wheat flour, and vegetable food pattern and asthma. No association between 'macho' (rich in meat and alcohol, 'sweet tooth' (high loadings on cake, milk, and yoghurt 'vegetable rich' (high loadings on whole grain, fruit, and vegetable food patterns and asthma was found. Smoking and overweight were not associated with asthma in the sample. CONCLUSION: While a 'Traditional' food pattern was positively associated with asthma among Chinese adults, there was no significant association between MSG intake and asthma.

  19. Attendance at chlorinated indoor pools and risk of asthma in adult recreational swimmers.

    Science.gov (United States)

    Ferrari, Marcello; Schenk, Kai; Mantovani, William; Papadopoulou, Christina; Posenato, Chiara; Ferrari, Pietro; Poli, Albino; Tardivo, Stefano

    2011-05-01

    To study a potential correlation between attendance at chlorinated indoor pools and the onset of asthma in adult leisure swimmers. 1136 adult swimmers attending indoor pools in the city of Verona completed a modified ECRHS questionnaire. The cumulative time spent in the pools was calculated on the basis of the mean frequency and duration of weekly swim activity for every year of attendance. The median value (320 h) was used to divide participants into 2 groups. Other questions concerned the family history of allergies, the medical diagnosis and the onset of asthma. The prevalence of respiratory symptoms in the study group was compared with that of a general population sample. New-onset asthma, first identified at least 12 months after the start of regular pool attendance, was more prevalent among swimmers characterized by a higher cumulative pool attendance (23/514, 4.5%) than in swimmers who were attending indoor pools less frequently (2/508, 0.4%; ratio 11.1, 95% CI 2.6-47.4). The statistical analysis revealed an independent association between the cumulative lifetime hours spent in indoor swimming pools and new onset asthma (relative risk 1.05, 95% CI 1.02-1.07). Respiratory symptoms were less frequent in the study population versus a general population sample (prevalence ratio 0.26-0.68). Attendance at chlorinated indoor pools may constitute a risk factor for developing asthma in leisure adult swimmers. Future research and efforts should aim at improving disinfection techniques, hygiene and ventilation in indoor swimming pools in order to provide an unobjectionable ambient for salubrious swim activities. Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. Greater risk of incident asthma cases in adults with Allergic Rhinitis and Effect of Allergen Immunotherapy: A Retrospective Cohort Study

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    Piccillo Giovita

    2005-12-01

    Full Text Available Abstract Asthma and rhinitis are often co-morbid conditions. As rhinitis often precedes asthma it is possible that effective treatment of allergic rhinitis may reduce asthma progression. The aim of our study is to investigate history of allergic rhinitis as a risk factor for asthma and the potential effect of allergen immunotherapy in attenuating the incidence of asthma. Hospital-referred non-asthmatic adults, aged 18–40 years between 1990 and 1991, were retrospectively followed up until January and April 2000. At the end of follow up, available subjects were clinically examined for asthma diagnosis and history of allergen specific immunotherapy, second-hand smoking and the presence of pets in the household. A total of 436 non-asthmatic adults (332 subjects with allergic rhinitis and 104 with no allergic rhinitis nor history of atopy were available for final analyses. The highest OR (odds ratio associated with a diagnosis of asthma at the end of follow-up was for the diagnosis of allergic rhinitis at baseline (OR, 7.8; 95%CI, 3.1–20.0 in the model containing the covariates of rhinitis diagnosis, sex, second-hand smoke exposure, presence of pets at home, family history of allergic disorders, sensitization to Parietaria judaica; grass pollen; house dust mites; Olea europea: orchard; perennial rye; and cat allergens. Female sex, sensitization to Parietaria judaica and the presence of pets in the home were also significantly predictive of new onset asthma in the same model. Treatment with allergen immunotherapy was significantly and inversely related to the development of new onset asthma (OR, 0.53; 95%CI, 0.32–0.86. In the present study we found that allergic rhinitis is an important independent risk factor for asthma. Moreover, treatment with allergen immunotherapy lowers the risk of the development of new asthma cases in adults with allergic rhinitis.

  1. Adult-Onset Metachromatic Leukodystrophy: Two Cases

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    Gaye Eryaşar

    2011-12-01

    Full Text Available Metachromatic Leukodystrophy(MLD is a lisosomal storage disorder which is characterized with arylsulphatase A deficiency. Enzyme deficiency results with demiyelination and storage of sulphatides in central nervous system.According to onset age;the disease has three major clinical forms as late infantile,juvenile and adult form. It is a rare disorder. For the patients who did not develop neurological findings bone marrow or hematopoietic stem cell transplantation may be effective as treatment.

  2. Current asthma deaths among adults in Japan

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    Tsugio Nakazawa

    2004-01-01

    Full Text Available Recent asthma deaths were examined from yearly reports of the Ministry of Health, Labor and Welfare of Japan and from reports published by the Japan Asthma Death Investigation Committee on 811 deaths over the period 1992–2000. The rate and number of recent asthma deaths in Japan have been decreasing rapidly. Most asthma deaths were of patients aged 70–90 years and there has been a marked trend for increased asthma deaths in the elderly. As for the circumstances surrounding the deaths, sudden death, unstable sudden aggravation and intermittent aggravation were mainly noted. Respiratory infections, fatigue and stress were the major courses of fatal attacks contributing to deaths due to asthma. Many of the patients who died from asthma had been diagnosed as having as moderate to severe asthma and many had non-atopic asthma. There are some reports that suggest that the recent decrease in asthma deaths in Japan is correlated with the use of inhaled cortico- steroids.

  3. Adult-onset opsoclonus-myoclonus syndrome.

    Science.gov (United States)

    Klaas, James P; Ahlskog, J Eric; Pittock, Sean J; Matsumoto, Joseph Y; Aksamit, Allen J; Bartleson, J D; Kumar, Rajeev; McEvoy, Kathleen F; McKeon, Andrew

    2012-12-01

    BACKGROUND Little is known about adult-onset opsoclonus-myoclonus syndrome (OMS) outside of individual case reports. OBJECTIVE To describe adult-onset OMS. DESIGN Review of medical records (January 1, 1990, through December 31, 2011), prospective telephone surveillance, and literature review (January 1, 1967, through December 31, 2011). SETTING Department of Neurology, Mayo Clinic, Rochester, Minnesota. PATIENTS Twenty-one Mayo Clinic patients and 116 previously reported patients with adult-onset OMS. MAIN OUTCOME MEASURES Clinical course and longitudinal outcomes. RESULTS The median age at onset of the 21 OMS patients at the Mayo Clinic was 47 years (range, 27-78 years); 11 were women. Symptoms reported at the first visit included dizziness, 14 patients; balance difficulties, 14; nausea and/or vomiting, 10; vision abnormalities, 6; tremor/tremulousness, 4; and altered speech, 2. Myoclonus distribution was extremities, 15 patients; craniocervical, 8; and trunk, 4. Cancer was detected in 3 patients (breast adenocarcinoma, 2; and small cell lung carcinoma, 1); a parainfectious cause was assumed in the remainder of the patients. Follow-up of 1 month or more was available for 19 patients (median, 43 months; range, 1-187 months). Treatment (median, 6 weeks) consisted of immunotherapy and symptomatic therapy in 16 patients, immunotherapy alone for 2, and clonazepam alone for 1. Of these 19 patients, OMS remitted in 13 and improved in 3; 3 patients died (neurologic decline, 1; cancer, 1; and myocardial infarction, 1). The cause of death was of paraneoplastic origin in 60 of 116 literature review patients, with the most common carcinomas being lung (33 patients) and breast (7); the most common antibody was antineuronal nuclear antibody type 2 (anti-Ri, 15). Other causes were idiopathic in origin, 38 patients; parainfectious, 15 (human immunodeficiency virus, 7); toxic/metabolic, 2; and other autoimmune, 1. Both patients with N -methyl-D-aspartate receptor antibody had

  4. Prevalence, age at onset, and risk factors of self-reported asthma among Swedish adolescent elite cross-country skiers.

    Science.gov (United States)

    Eriksson, L M; Irewall, T; Lindberg, Anne; Stenfors, Nikolai

    2017-03-17

    The objective of the study was to compare the prevalence of self-reported physician-diagnosed asthma and age at asthma onset between Swedish adolescent elite skiers and a reference group and to assess risk factors associated with asthma. Postal questionnaires were sent to 253 pupils at the Swedish National Elite Sport Schools for cross-country skiing, biathlon, and ski-orienteering ("skiers") and a random sample of 500 adolescents aged 16-20, matched for sport school municipalities ("reference"). The response rate was 96% among the skiers and 48% in the reference group. The proportion of participants with self-reported physician-diagnosed asthma was higher among skiers than in the reference group (27 vs. 19%, p = 0.046). Female skiers reported a higher prevalence of physician-diagnosed asthma compared to male skiers (34 vs. 20%, p = 0.021). The median age at asthma onset was higher among skiers (12.0 vs. 8.0 years; p < 0.001). Female sex, family history of asthma, nasal allergy, and being a skier were risk factors associated with self-reported physician-diagnosed asthma. Swedish adolescent elite cross-country skiers have a higher asthma prevalence and later age at asthma onset compared to a reference population. Being an adolescent elite skier is an independent risk factor associated with asthma. This article is protected by copyright. All rights reserved.

  5. Breathing exercises for adults with asthma.

    Science.gov (United States)

    2015-11-01

    Asthma is a common long-term condition that remains poorly controlled in many people despite the availability of pharmacological interventions, evidence-based treatment guidelines and care pathways.(1) There is considerable public interest in the use of non-pharmacological approaches for the treatment of asthma.(2) A survey of people with asthma reported that many have used complementary and alternative medicine, often without the knowledge of their clinical team.(3) Such interventions include breathing techniques, herbal products, homeopathy and acupuncture. The role of breathing exercises within the management of asthma has been controversial, partly because early claims of effectiveness were exaggerated.(4) UK national guidance and international guidelines on the management of asthma have included the option of breathing exercise programmes as an adjuvant to pharmacological treatment.(5,6) Here we discuss the types of breathing exercises used and review the evidence for their effectiveness.

  6. NAC Manchester Asthma and Allergy Study (NACMAAS): risk factors for asthma and allergic disorders in adults.

    Science.gov (United States)

    Simpson, B M; Custovic, A; Simpson, A; Hallam, C L; Walsh, D; Marolia, H; Campbell, J; Woodcock, A

    2001-03-01

    Asthma and atopic disorders are the most common chronic diseases in the developed countries. Knowledge of the risk factors for these disorders may facilitate the development of preventive strategies aimed at reducing prevalence rates. To investigate the risk factors for asthma and allergic diseases in a large number of adults who are the parents of children in the National Asthma Campaign Manchester Asthma and Allergy Study. All pregnant women and their partners attending "Booking" antenatal clinics were invited to take part in the study. Questionnaire data were collected including the history of asthma and other atopic diseases, pet ownership and smoking habits, and skin prick tests were performed. The prevalence of atopy and the risk factors for asthma and allergic disorders were investigated in all subjects who completed the questionnaire and underwent skin testing. Statistical analysis was carried out using logistic regression. Initially, risk factors were assessed by univariate analysis to see how each potential explanatory variable affected the probability of having allergic disease. Variables were then tested in a forward stepwise multivariate analysis. In 5687 adult subjects there was a very high (48.2%) prevalence of atopy, and 9.7% of subjects had a diagnosis of asthma. In a multivariate regression analysis sensitization to dust mite, cat, dog and mixed grasses were all independently associated with asthma. The odds ratios for current asthma increased with the increasing number of positive skin tests (any two allergens - OR 4.3, 95% CI 3.3-5.5; any three allergens - OR 7.0 95% CI 5.3-9.3; all four allergens - OR 10.4, 95% CI 7.7-14; P Dog ownership (OR 1.31, 95% CI 1.10-1.57; P = 0.003) and current smoking (OR 1.36, 95% CI 1.15-1.62; P = 0.0004) were significantly and directly associated with "asthma ever". Thirteen per cent of participants reported a history of eczema. In the multivariate analysis the strongest independent associate of eczema was

  7. ACADEMIC PERFORMANCE IN CHILDREN WITH NEW-ONSET SEIZURES AND ASTHMA: A PROSPECTIVE STUDY

    Science.gov (United States)

    Dunn, David W.; Johnson, Cynthia S.; Austin, Joan K.; Perkins, Susan M.

    2007-01-01

    The study purpose was to compare teacher ratings of academic performance (TRP) over 24 months between children with new-onset seizures (N = 121) and new-onset asthma (N = 54) ages 4 to 14 years. At each data collection point (baseline, 12 months, 24 months), children with seizures were placed into two groups according to their recurrent seizure status (yes/no) during that period. Longitudinal linear mixed models were used to explore differences between the asthma group and the two seizure groups and to identify if differences in TRP in children with seizures were associated with age, gender, or use of medication. In the seizure sample, scores for children in both groups (with and without recurrent seizures) initially declined at 12 months; however, at 24 months, children who did not have recurrent seizures improved while children who continued to have recurrent seizures declined. There was a trend for younger children to decline more than older children. PMID:17293164

  8. Advances in the diagnosis and management of asthma in older adults.

    LENUS (Irish Health Repository)

    Al-Alawi, Mazen

    2013-12-28

    Global estimates on ageing predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis and management in clinical practice require optimization. This review aims to provide an update for clinicians highlighting advances in the understanding of the ageing process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Ageing impacts airway responses, immune function and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence and side effect profiles persist in the older patient while novel recording devices developed to aid detection of an adequate inhalation evaluates treatment effectiveness and compliance more accurately than previously attainable. Anti-cytokine therapies improve control of brittle asthma while bronchial thermoplasty is an option in refractory cases. Multi-dimensional intervention strategies prove best in the management of asthma in the older adult which remains a condition that is not rare but rarely diagnosed in this patient population.

  9. Long-term mortality among adults with asthma

    DEFF Research Database (Denmark)

    Ali, Zarqa; Dirks, Christina Glattre; Ulrik, Charlotte Suppli

    2013-01-01

    ABSTRACT BACKGROUND: Data from long-term follow-up studies of well-characterised patients with asthma are limited. We studied all-cause and cause-specific mortality, and risk factors, in a large cohort of adults with asthma. METHODS: A total of 1.075 adult asthmatics were recruited consecutively...... from an out-patient clinic in 1974 to 1990, and followed up until the end of 2011. Subjects were classified as having allergic or non-allergic asthma on the basis of detailed history, spirometric tests, tests for IgE-mediated allergy (skin prick tests and RAST), and bronchial challenge tests...... compared with controls (261 cases vs. 124 controls; relative risk (RR) 2.1, 95% confidence interval (CI) 1.4 to 3.0; pasthma was significantly associated with age (p

  10. Diagnosis and management of asthma in older adults.

    LENUS (Irish Health Repository)

    Chotirmall, Sanjay Haresh

    2009-05-01

    Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.

  11. Tezepelumab in Adults with Uncontrolled Asthma.

    Science.gov (United States)

    Corren, Jonathan; Parnes, Jane R; Wang, Liangwei; Mo, May; Roseti, Stephanie L; Griffiths, Janet M; van der Merwe, René

    2017-09-07

    In some patients with moderate-to-severe asthma, particularly those with noneosinophilic inflammation, the disease remains uncontrolled. This trial evaluated the efficacy and safety of tezepelumab (AMG 157/MEDI9929), a human monoclonal antibody specific for the epithelial-cell-derived cytokine thymic stromal lymphopoietin (TSLP), in patients whose asthma remained uncontrolled despite treatment with long-acting beta-agonists and medium-to-high doses of inhaled glucocorticoids. In this phase 2, randomized, double-blind, placebo-controlled trial, we compared subcutaneous tezepelumab at three dose levels with placebo over a 52-week treatment period. The primary end point was the annualized rate of asthma exacerbations (events per patient-year) at week 52. The use of tezepelumab at a dose of 70 mg every 4 weeks (low dose; 145 patients), 210 mg every 4 weeks (medium dose; 145 patients), or 280 mg every 2 weeks (high dose; 146 patients) resulted in annualized asthma exacerbation rates at week 52 of 0.26, 0.19, and 0.22, respectively, as compared with 0.67 in the placebo group (148 patients). Thus, exacerbation rates in the respective tezepelumab groups were lower by 61%, 71%, and 66% than the rate in the placebo group (Ptezepelumab groups than in the placebo group (difference, 0.12 liters with the low dose [P=0.01], 0.11 liters with the medium dose [P=0.02], and 0.15 liters with the high dose [P=0.002]). A total of 2 patients in the medium-dose group, 3 in the high-dose group, and 1 in the placebo group discontinued the trial regimen because of adverse events. Among patients treated with long-acting beta-agonists and medium-to-high doses of inhaled glucocorticoids, those who received tezepelumab had lower rates of clinically significant asthma exacerbations than those who received placebo, independent of baseline blood eosinophil counts. (Funded by MedImmune [a member of the AstraZeneca Group] and Amgen; PATHWAY ClinicalTrials.gov number, NCT02054130 .).

  12. Recognition of asthma in adolescents and young adults

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Postma, Dirkje S; Backer, Vibeke

    2005-01-01

    Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability in such s...... in such studies. Data from a survey of a population sample of adolescents and young adults (n = 609; 288 males), aged 13-23 years, were analyzed to investigate whether AHR, PEF variability, and BR can be used interchangeably as markers of asthma in an epidemiological setting....

  13. New onset of asthma and job status change among world trade center responders and workers.

    Science.gov (United States)

    Kim, Hyun; Baron, Sherry; Baidwan, Navneet K; Schwartz, Adam; Moline, Jacqueline

    2017-09-14

    Despite the high rates, the consequences of new onset asthma among the World Trade Center (WTC) responders in terms of the change in job status have not been studied. This study consists of a cohort of 8132 WTC responders out of the total 25 787 responders who held a full-time job at the baseline visit, and participated in at least one follow-up visit. Overall, 34% of the study cohort changed their job status from full-time at a follow-up visit. Multivariable models showed that asthmatics were respectively 27% and 47% more likely to have any job status change and get retired, and twice as likely to become disabled as compared to non-asthmatics. With asthma incidence from WTC exposure, negative job status change should be considered as a potential long-term consequence of WTC exposure. © 2017 Wiley Periodicals, Inc.

  14. Asthma in adult patients presenting with symptoms of acute bronchitis in general practice

    NARCIS (Netherlands)

    Thiadens, HA; Postma, DS; de Bock, GH; Huysman, DAN; van Houwelingen, HC; Springer, MP

    Objectives - To investigate the association between asthma and acute bronchitis in adults and to ascertain criteria to help general practitioners (GPs) differentiate between acute bronchitis and asthma. Design - Descriptive study. Setting - Primary health care centre in The Netherlands. Patients -

  15. Adult-onset Still's disease: Clinical cases

    Directory of Open Access Journals (Sweden)

    G. R. Imametdinova

    2014-01-01

    Full Text Available The annual incidence of adult-onset Still's disease (AOSD worldwide is 0.16 cases per 100,000 persons. Its leading symptoms are joint involvement, fever, skin rash, and neutrophilic leukocytosis in the absence of rheumatoid factor and anticyclic citrullinated peptide antibodies in serum and synovial fluid. In its initial stage, there may be monoarthritis more commonly of the wrist, hip, or knee. Then the lesion assumes the pattern of oligo- or polyarthritis. Musculoskeletal involvement appearing as arthralgia, arthritis, and myalgia is noted in all patients. In the majority of patients, articular involvement progresses and destructive polyarthritis develops. Symmetric involvement of the carpophalangeal and distal interphalangeal joints is frequently detected. Skin lesion manifests itself as maculopapular or roseolous rashes on the chest, back, shoulders, occasionally on the legs, or in the areas of mechanical irritation. A sore throat with the signs of pharyngitis is a characteristic early symptom of the disease. There may be involvements of the liver, cardiovascular system, lung, as well as lymphadenopathy, or splenomegaly. The chronic course of the disease is more frequently noted.The paper describes two cases of AOSD. One case demonstrates that the physician has no experience in diagnosing and managing patients with AOSD, resulting in the misinterpretation of the increase in disease activity when the subclinical doses of methotrexate (MT are used, which has been regarded as a therapeutic complication. The use of the adequate dose of MT could achieve a clinical and laboratory remission and discontinue glucocorticoids (GC.In the other case of recurrent AOSD and mild clinical symptoms, the unreasonable use of high GC doses gave rise to adverse reactions.

  16. Adult-onset Still's disease: Clinical cases

    Directory of Open Access Journals (Sweden)

    G. R. Imametdinova

    2014-12-01

    Full Text Available The annual incidence of adult-onset Still's disease (AOSD worldwide is 0.16 cases per 100,000 persons. Its leading symptoms are joint involvement, fever, skin rash, and neutrophilic leukocytosis in the absence of rheumatoid factor and anticyclic citrullinated peptide antibodies in serum and synovial fluid. In its initial stage, there may be monoarthritis more commonly of the wrist, hip, or knee. Then the lesion assumes the pattern of oligo- or polyarthritis. Musculoskeletal involvement appearing as arthralgia, arthritis, and myalgia is noted in all patients. In the majority of patients, articular involvement progresses and destructive polyarthritis develops. Symmetric involvement of the carpophalangeal and distal interphalangeal joints is frequently detected. Skin lesion manifests itself as maculopapular or roseolous rashes on the chest, back, shoulders, occasionally on the legs, or in the areas of mechanical irritation. A sore throat with the signs of pharyngitis is a characteristic early symptom of the disease. There may be involvements of the liver, cardiovascular system, lung, as well as lymphadenopathy, or splenomegaly. The chronic course of the disease is more frequently noted.The paper describes two cases of AOSD. One case demonstrates that the physician has no experience in diagnosing and managing patients with AOSD, resulting in the misinterpretation of the increase in disease activity when the subclinical doses of methotrexate (MT are used, which has been regarded as a therapeutic complication. The use of the adequate dose of MT could achieve a clinical and laboratory remission and discontinue glucocorticoids (GC.In the other case of recurrent AOSD and mild clinical symptoms, the unreasonable use of high GC doses gave rise to adverse reactions.

  17. Precursors in adolescence of adult-onset bipolar disorder.

    Science.gov (United States)

    Hiyoshi, Ayako; Sabet, Julia A; Sjöqvist, Hugo; Melinder, Carren; Brummer, Robert J; Montgomery, Scott

    2017-08-15

    Although the estimated contribution of genetic factors is high in bipolar disorder, environmental factors may also play a role. This Swedish register-based cohort study of men examined if physical and psychological characteristics in late adolescence, including factors previously linked with bipolar disorder (body mass index, asthma and allergy), are associated with subsequent bipolar disorder in adulthood. Unipolar depression and anxiety are analysed as additional outcomes to identify bipolar disorder-specific associations. A total of 213,693 men born between 1952 and 1956, who participated in compulsory military conscription assessments in late adolescence were followed up to 2009, excluding men with any psychiatric diagnoses at baseline. Cox regression estimated risk of bipolar disorder, depression and anxiety in adulthood associated with body mass index, asthma, allergy, muscular strength stress resilience and cognitive function in adolescence. BMI, asthma and allergy were not associated with bipolar disorder. Higher grip strength, cognitive function and stress resilience were associated with a reduced risk of bipolar disorder and the other disease outcomes. The sample consisted only of men; even though the characteristics in adolescence pre-dated disease onset, they may have been the consequence of prodromal disease. Associations with body mass index and asthma found by previous studies may be consequences of bipolar disorder or its treatment rather than risk factors. Inverse associations with all the outcome diagnoses for stress resilience, muscular strength and cognitive function may reflect general risks for these psychiatric disorders or intermediary factors. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Clinical Characteristics of Pediatric-Onset and Adult-Onset Multiple Sclerosis in Hispanic Americans.

    Science.gov (United States)

    Langille, Megan M; Islam, Talat; Burnett, Margaret; Amezcua, Lilyana

    2016-07-01

    Multiple sclerosis can affect pediatric patients. Our aim was to compare characteristics between pediatric-onset multiple sclerosis and adult-onset multiple sclerosis in Hispanic Americans. This was a cross-sectional analysis of 363 Hispanic American multiple scleroses cases; demographic and clinical characteristics were analyzed. A total of 110 Hispanic patients presented with multiple sclerosis before age 18 and 253 as adult multiple sclerosis. The most common presenting symptoms for both was optic neuritis. Polyfocal symptoms, seizures, and cognitive symptoms at presentation were more prevalent in pediatric-onset multiple sclerosis (P ≤ .001). Transverse myelitis was more frequent in adult-onset multiple sclerosis (P ≤ .001). Using multivariable analysis, pediatric-onset multiple sclerosis (adjusted odds ratio, 0.3OR 95% confidence interval 0.16-0.71, P = .004) and being US born (adjusted odds ratio, 0.553, 95% confidence interval 0.3-1.03, P = .006) were less likely to have severe ambulatory disability. Results suggest that pediatric-onset multiple sclerosis and adult-onset multiple sclerosis in Hispanics have differences that could be important for treatment and prognosis.

  19. Adult-onset Satoyoshi syndrome and response to plasmapheresis

    Directory of Open Access Journals (Sweden)

    Rajeshwari Aghoram

    2016-01-01

    Full Text Available Satoyoshi syndrome is a rare disease characterized by alopecia, recurrent muscle spasms, diarrhea, and skeletal abnormalities Adult-onset disease is reported only in five patients. Most of the reports have not characterized the nature of muscle spasm in the disease. In this paper, we report the first case of adult-onset Satoyoshi syndrome from India and the clinical and electrophysiological response to plasmapheresis.

  20. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women

    NARCIS (Netherlands)

    Berube, Jean-Christophe; Gaudreault, Nathalie; Lavoie-Charland, Emilie; Sbarra, Laura; Henry, Cyndi; Madore, Anne-Marie; Pare, Peter D.; van den Berge, Maarten; Nickle, David; Laviolette, Michel; Laprise, Catherine; Boulet, Louis-Philippe; Bosse, Yohan

    2016-01-01

    Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs) associated with asthma in French Canadian adult women. A pooling-based genome-wide association study

  1. Early-onset atopic dermatitis in children: which are the phenotypes at risk of asthma? Results from the ORCA cohort.

    Directory of Open Access Journals (Sweden)

    Flore Amat

    Full Text Available Atopic dermatitis (AD is known to predate asthma and other atopic disorders described under the term "atopic march". However, this classic sequence is not always present and only a few studies have addressed children at risk of developing asthma. The objective of this study is to define early-onset AD phenotypes leading to asthma.We performed a cluster analysis with 9 variables of 214 infants with early-onset AD prospectively enrolled in the ORCA cohort and followed each year on the occurrence of asthma until the age of 6.We identified 3 clusters - cluster 1 (n = 94 with low to no sensitization to food (27.7% or aeroallergens (10.6% and moderate AD severity (SCORAD 25.29 +/- 14.6 called "AD with low sensitization"; - cluster 2 (n = 84 characterized by a higher AD severity (SCORAD 32.66+/-16.6 and frequent sensitization to food (98.9% or aeroallergens (26.2%, most likely multiple (96.4% for food allergens, called "AD with multiple sensitizations" - cluster 3 (n = 36 with parental history, moderate AD severity (SCORAD 24.46+/-15.7, moderate rate of sensitization to food allergens (38.9% (exclusively single with no sensitization to aeroallergens, called "AD with familial history of asthma". Percentages of children suffering from asthma at the age of 6 were higher in clusters 2 and 3 (36.1% and 33.3% respectively versus 14.9% in cluster 1, p<0.01.Two phenotypes in infants with early-onset AD convey a higher risk of developing asthma during childhood: multiple sensitization and familial history of asthma.

  2. Adult-onset nemaline myopathy presenting as respiratory failure.

    LENUS (Irish Health Repository)

    Kelly, Emer

    2008-11-01

    Nemaline myopathy is a rare congenital myopathy that generally presents in childhood. We report a case of a 44-year-old man who presented with severe hypoxic hypercapnic respiratory failure as the initial manifestation of nemaline myopathy. After starting noninvasive ventilation, his pulmonary function test results improved substantially, and over the 4 years since diagnosis his respiratory function remained stable. There are few reported cases of respiratory failure in patients with adult-onset nemaline myopathy, and the insidious onset in this case is even more unusual. This case highlights the varied presenting features of adult-onset nemaline myopathy and that noninvasive ventilation improves respiratory function.

  3. Atopy and new-onset asthma in young Danish farmers and CD14, TLR2, and TLR4 genetic polymorphisms: a nested case-control study

    DEFF Research Database (Denmark)

    Smit, L A M; Bongers, S I M; Ruven, H J T;

    2007-01-01

    BACKGROUND: Evidence exists that exposure to high levels of microbial agents such as endotoxin in the farm environment decreases the risk of atopic sensitization. Genetic variation in innate immunity genes may modulate the response to microbial agents and thus influence susceptibility to asthma...... and atopy. OBJECTIVE: To study potential associations between single nucleotide polymorphisms (SNPs) in CD14, Toll-like receptor 2 (TLR2), and TLR4 genes, and atopy and new-onset asthma in young farmers. METHODS: A nested case-control study was conducted within a cohort of 1901 young Danish farmers. We....../-651 promoter polymorphisms are associated with atopy prevalence among young adults exposed to farm environments. Udgivelsesdato: 2007-Nov...

  4. Proteomic Analysis Reveals the Deregulation of Inflammation-Related Proteins in Acupuncture-Treated Rats with Asthma Onset

    Directory of Open Access Journals (Sweden)

    Yu-Dong Xu

    2012-01-01

    Full Text Available Although the beneficial effects of acupuncture in asthma treatment have been well documented, little is known regarding the biological basis of this treatment. Changes in the lung proteome of acupuncture-treated rats with asthma onset were comparatively analyzed using a two-dimensional gel electrophoresis (2DE and mass-spectrometry- (MS- based proteomic approach. Acupuncture on specific acupuncture points appeared to improve respiratory function and reduce the total number of leukocytes and eosinophils in bronchoalveolar lavage fluid in OVA-induced asthma onset. Image analysis of 2DE gels revealed 32 differentially expressed acupuncture-specific protein spots in asthma onset; 30 of which were successfully identified as 28 unique proteins using LC-MS/MS. Bioinformatic analyses indicated that these altered proteins are most likely involved in inflammation-related biological functions, and the functional associations of these proteins result in an inflammation signaling pathway. Acupuncture regulates the pathway at different levels by regulating several key nodal proteins, including downregulating of proinflammatory proteins (e.g., S100A8, RAGE, and S100A11 and upregulating of anti-inflammatory proteins (e.g., CC10, ANXA5, and sRAGE. These deregulated inflammation-related proteins may mediate, at least in part, the antiasthmatic effect of acupuncture. Further functional investigation of these acupuncture-specific effector proteins could identify new drug candidates for the prophylaxis and treatment of asthma.

  5. Proteomic Analysis Reveals the Deregulation of Inflammation-Related Proteins in Acupuncture-Treated Rats with Asthma Onset

    Science.gov (United States)

    Xu, Yu-Dong; Cui, Jian-Mei; Wang, Yu; Yin, Lei-Miao; Gao, Chang-Ke; Liu, Xiao-Yan; Wei, Ying; Liu, Yan-Yan; Jiang, Yong-Liang; Shan, Chun-Xiao; Yang, Yong-Qing

    2012-01-01

    Although the beneficial effects of acupuncture in asthma treatment have been well documented, little is known regarding the biological basis of this treatment. Changes in the lung proteome of acupuncture-treated rats with asthma onset were comparatively analyzed using a two-dimensional gel electrophoresis (2DE) and mass-spectrometry- (MS-) based proteomic approach. Acupuncture on specific acupuncture points appeared to improve respiratory function and reduce the total number of leukocytes and eosinophils in bronchoalveolar lavage fluid in OVA-induced asthma onset. Image analysis of 2DE gels revealed 32 differentially expressed acupuncture-specific protein spots in asthma onset; 30 of which were successfully identified as 28 unique proteins using LC-MS/MS. Bioinformatic analyses indicated that these altered proteins are most likely involved in inflammation-related biological functions, and the functional associations of these proteins result in an inflammation signaling pathway. Acupuncture regulates the pathway at different levels by regulating several key nodal proteins, including downregulating of proinflammatory proteins (e.g., S100A8, RAGE, and S100A11) and upregulating of anti-inflammatory proteins (e.g., CC10, ANXA5, and sRAGE). These deregulated inflammation-related proteins may mediate, at least in part, the antiasthmatic effect of acupuncture. Further functional investigation of these acupuncture-specific effector proteins could identify new drug candidates for the prophylaxis and treatment of asthma. PMID:23304218

  6. Fetal programming, epigenetics, and adult onset disease.

    Science.gov (United States)

    Lane, Robert H

    2014-12-01

    How early life events program adult disease is undergoing a transition from the broad field of maternal malnutrition to the current relevant issues of food deserts and prematurity. Although many adult diseases and morbidities associate with various early life events and programming, the morbidities of insulin resistance, cardiovascular disease, and obesity seem to be common end points of many early life events despite potential confounders. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Adult-onset idiopathic chondrolysis of the hip.

    Science.gov (United States)

    Yapp, Liam Z; McClymont, Liusaidh; Beggs, Ian; Gaston, Paul; Salter, Donald M

    2017-05-01

    We report the case of a 23-year-old man diagnosed with adult-onset idiopathic chondrolysis of the hip. Chondrolysis of the hip is a disorder most frequently seen in children who have suffered with slipped capital femoral epiphyses. Idiopathic chondrolysis of the hip is extremely rare and to our knowledge, its onset has never been documented in adults aged over 20. With reference to the available medical literature, we summarise the current clinical management of this unusual but important cause of young adult hip pain.

  8. Pure Red Cell Aplasia with Adult Onset Still's Disease

    OpenAIRE

    Nicholas Robillard; Paul Nguyen; Robert Wistaff; Mikhael Laskine

    2013-01-01

    Adult Onset Still’s Disease (AOSD) is a rare inflammatory syndrome mostly seen in young adults. Known for its wide range of clinical manifestations, AOSD often presents with nonremitting systemic signs and symptoms. Many rare case associations have been described with AOSD, but only few with pure red cell aplasia (PRCA). We are presenting a fourth known case of a young female adult with AOSD and PRCA in the literature.

  9. Asthma is a risk factor for new onset chronic migraine: Results from the American migraine prevalence and prevention study.

    Science.gov (United States)

    Martin, Vincent T; Fanning, Kristina M; Serrano, Daniel; Buse, Dawn C; Reed, Michael L; Lipton, Richard B

    2016-01-01

    To test the hypothesis that in persons with episodic migraine (EM), asthma is a risk factor for the onset of chronic migraine (CM). Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. Herein, we assess the influence of asthma on the clinical course of EM. To be eligible for this observational cohort study, AMPP Study participants had to meet criteria for EM in 2008, complete the validated six-item asthma questionnaire from the European Community Respiratory Health Survey (ECRHS) in 2008, and provide follow-up data in 2009. Using the ECRHS, we defined asthma as a binary variable (present or absent) based on an empirical cut score and developed a Respiratory Symptom Severity Score (RSSS) based on the number of positive responses (no severity = 0 positive responses, low severity = 1-2 positive responses, moderate severity = 3-4 positive responses, high severity = 5-6 positive responses). Chronic migraine was the primary outcome measure and was defined as those with ≥15 headache days per month on the 2009 AMPP Study survey. We used logistic regression in separate models to assess the influence of asthma as a binary variable (Model 1) and RSSS score categories (Model 2 using no respiratory symptoms as the reference) on CM onset after adjusting for sociodemographic factors, headache day frequency, migraine preventive medication use, and medication overuse. The eligible sample for this study included 4446 individuals with EM in 2008 of whom 17% had asthma. This group had a mean age of 50.4 and was 80.8% female. In 2009, new onset CM developed in 2.9% (131/4446) of the 2008 EM cohort, including 5.4% (40/746) of the asthma subgroup and 2.5% (91/3700) of the non-asthma subgroup. In comparison to those without asthma, the adjusted odds for individuals with asthma and EM in 2008 to develop CM in 2009 were greater than two (adjusted odds ratio [aOR] 2.1; 95% CI: 1.4-3.1). Using

  10. Acceptance of Asthma Pharmacogenetic Study by Children and Adults

    Science.gov (United States)

    Wu, Ann Chen; Davis, Robert; Tantisira, Kelan; Dutta-Linn, M. Maya; Hemmes, Mia; Weiss, Scott T.

    2012-01-01

    Background Pharmacogenetic testing may change clinical medicine by allowing clinicians to tailor medications based on a patient’s genetic makeup, however, these tests must first be validated in large, real-life populations of subjects that include children. A dearth of knowledge exists for whether pediatric populations are as willing as adult populations to provide samples for such studies. Objective (1) To assess whether pediatric and adult patients with persistent asthma are willing to provide specimens for DNA extraction and genetic studies. (2) To assess whether patients’ willingness to provide blood as compared to buccal smear specimens differ. Methods Of 644 patients ages 4–38 years who had three or more prescription fills for inhaled corticosteroids in one year, 60% (385) were randomized to the blood specimen group and 40% (259) were randomized to the buccal smear group in order to study acceptance of different biospecimen collection methods. Research assistants contacted subjects to obtain consent, perform a phone survey, and request a specimen. Results There were no baseline differences between subjects randomized to the blood specimen group versus buccal smear group with respect to age, gender, or number of dispensings of inhaled corticosteroids. Of 259 subjects in the buccal smear group, 30% (78) provided samples, and of 385 subjects in the blood specimen group, 16% (60) provided samples. Subjects randomized to the buccal smear group were more likely to provide specimens for genetic study compared to subjects randomized to the blood specimen group (RR 1.21; 95% CI 1.10 – 1.32), even after adjusting for age. Pediatric subjects were more likely to provide specimens for genetic study than adult subjects with 23% (113) of pediatric subjects providing samples and 15% (25) of adult subjects providing samples (p=0.03). Conclusion Children with asthma are as likely to participate in genetic studies as adults. Both children and adult subjects are more

  11. 'Get Your Life Back': process and impact evaluation of an asthma social marketing campaign targeting older adults

    National Research Council Canada - National Science Library

    Evers, Uwana; Jones, Sandra C; Iverson, Don; Caputi, Peter

    2013-01-01

    Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma...

  12. Adult-Onset Asthma Might Raise Heart Risks

    Science.gov (United States)

    ... for 14 years. Researchers led by Dr. Matthew Tattersall published their findings Aug. 24 in the Journal ... and be aggressive in modifying any risk factors," Tattersall said in a journal news release. He is ...

  13. Clinical and inflammatory markers in asthma and COPD phenotyping

    NARCIS (Netherlands)

    de Nijs, S.B.

    2013-01-01

    Based on the studies described in this thesis, we conclude that adult-onset respiratory diseases (asthma and COPD) are heterogeneous conditions characterized by different clinical features and inflammatory characteristics. The first part of the thesis focused on phenotypes of adult-onset asthma. We

  14. Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013

    Science.gov (United States)

    Park, Sohyun; Akinbami, Lara J.; McGuire, Lisa C.; Blanck, Heidi M.

    2016-01-01

    Objectives Sugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association. Methods We analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥18 years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none, <1 time/day, once/day, ≥2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier. Results Overall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥2 times/day. There was no difference in asthma prevalence with SSB intake <1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥2 times/day (aOR=1.66, 95%CI=1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults. Conclusions Frequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults. PMID:27496394

  15. Secular trends of allergic asthma in Danish adults. The Copenhagen Allergy Study

    DEFF Research Database (Denmark)

    Linneberg, A; Nielsen, N H; Madsen, F

    2001-01-01

    Numerous studies have reported increases in asthma prevalence among children world-wide. Less is known about similar trends in adults. We aimed to investigate whether the prevalence of allergic asthma symptoms had increased in an adult general population. Two cross-sectional surveys using identical...

  16. Assessing the association of obesity and asthma morbidity in older adults.

    Science.gov (United States)

    Xu, Kevin Y; Wisnivesky, Juan P; Martynenko, Melissa; Mhango, Grace; Busse, Paula J; Wolf, Michael S; Holguin, Fernando; Federman, Alex D

    2016-07-01

    Obesity is a robust predictor of poor asthma control in younger adults. Given the high prevalence of asthma and obesity in older Americans, weight reduction could benefit asthma management in this population. To assess the association between obesity and asthma outcomes among older adults. We recruited from urban primary care clinics a prospective cohort of nonsmoking individuals with asthma who were 60 years or older without a history of other respiratory diseases. At baseline, body mass index (BMI) measurements were classified as normal (BMI, 18-25), overweight (BMI, 25-30), or obese (BMI, >30). Measures of asthma morbidity (Asthma Control Questionnaire [ACQ], and Mini Asthma Quality of Life Questionnaire [Mini-AQLQ]) and asthma-related resource utilization (inpatient or outpatient) were taken at baseline and at 3- and 12-month interviews. We used generalized estimating equation models to assess associations between obesity and asthma outcomes after controlling for potential confounders. Of the 437 older adults with asthma in the study, 17% had a normal BMI, 32% were overweight, and 51% were obese. Unadjusted analyses revealed that obesity was associated with lower ACQ scores (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09-1.31) and poorer Mini-AQLQ scores (OR, 1.21; 95% CI, 1.11-1.33). Adjusted analyses revealed no significant association between obesity and ACQ (OR, 1.05; 95% CI, 0.96-1.15) and Mini-AQLQ (OR, 1.08; 95% CI, 0.99-1.19). Our study suggests that obesity is not independently associated with worse asthma outcomes in older adults, reflecting potential differences in the mechanisms that link obesity with asthma control in older vs younger populations. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Adult-onset acute rheumatic fever.

    Science.gov (United States)

    Nakashima, Dainari; Ueda, Kohei; Tsukuda, Kyozo; Utsu, Noriaki; Kohki, Shimazu; Fushimi, Hiroaki; Miyakoshi, Kazuho

    2012-01-01

    A 62-year-old man was hospitalized for acute rheumatic fever. He had previously suffered from rheumatic fever at 15 years of age. The rheumatic fever was complicated by carditis, which caused valve disease that required surgical treatment. The incidence of rheumatic fever has decreased in most developed countries with improvements in sanitary conditions. The low incidence of this disease makes a timely and accurate diagnosis difficult. Due to the fact that both the first occurrence and recurrence of acute rheumatic fever can occur in the elderly and adults, this potential disease should not be overlooked when making a differential diagnosis.

  18. Alcohol-Induced Developmental Origins of Adult-Onset Diseases.

    Science.gov (United States)

    Lunde, Emilie R; Washburn, Shannon E; Golding, Michael C; Bake, Shameena; Miranda, Rajesh C; Ramadoss, Jayanth

    2016-07-01

    Fetal alcohol exposure may impair growth, development, and function of multiple organ systems and is encompassed by the term fetal alcohol spectrum disorders (FASD). Research has so far focused on the mechanisms, prevention, and diagnosis of FASD, while the risk for adult-onset chronic diseases in individuals exposed to alcohol in utero is not well explored. David Barker's hypothesis on Developmental Origins of Health and Disease (DOHaD) suggests that insults to the milieu of the developing fetus program it for adult development of chronic diseases. In the 25 years since the introduction of this hypothesis, epidemiological and animal model studies have made significant advancements in identifying in utero developmental origins of chronic adult-onset diseases affecting cardiovascular, endocrine, musculoskeletal, and psychobehavioral systems. Teratogen exposure is an established programming agent for adult diseases, and recent studies suggest that prenatal alcohol exposure correlates with adult onset of neurobehavioral deficits, cardiovascular disease, endocrine dysfunction, and nutrient homeostasis instability, warranting additional investigation of alcohol-induced DOHaD, as well as patient follow-up well into adulthood for affected individuals. In utero epigenetic alterations during critical periods of methylation are a key potential mechanism for programming and susceptibility of adult-onset chronic diseases, with imprinted genes affecting metabolism being critical targets. Additional studies in epidemiology, phenotypic characterization in response to timing, dose, and duration of exposure, as well as elucidation of mechanisms underlying FASD-DOHaD inter relation, are thus needed to clinically define chronic disease associated with prenatal alcohol exposure. These studies are critical to establish interventional strategies that decrease incidence of these adult-onset diseases and promote healthier aging among individuals affected with FASD.

  19. Childhood Exposure to Ambient Air Pollutants and the Onset of Asthma: An Administrative Cohort Study in Québec

    Science.gov (United States)

    Tétreault, Louis-Francois; Doucet, Marieve; Gamache, Philippe; Fournier, Michel; Brand, Allan; Kosatsky, Tom; Smargiassi, Audrey

    2016-01-01

    Background: Although it is well established that air pollutants can exacerbate asthma, the link with new asthma onset in children is less clear. Objective: We assessed the association between the onset of childhood asthma with both time of birth and time-varying exposures to outdoor air pollutants. Method: An open cohort of children born in the province of Québec, Canada, was created using linked medical–administrative databases. New cases of asthma were defined as one hospital discharge with a diagnosis of asthma or two physician claims for asthma within a 2 year period. Annual ozone (O3) levels were estimated at the child’s residence for all births 1999–2010, and nitrogen dioxide (NO2) levels during 1996–2006 were estimated for births on the Montreal Island. Satellite based concentrations of fine particles (PM2.5) were estimated at a 10 km × 10 km resolution and assigned to residential postal codes throughout the province (1996–2011). Hazard ratios (HRs) were assessed with Cox models for the exposure at the birth address and for the time-dependent exposure. We performed an indirect adjustment for secondhand smoke (SHS). Results: We followed 1,183,865 children (7,752,083 person-years), of whom 162,752 became asthmatic. After controlling for sex and material and social deprivation, HRs for an interquartile range increase in exposure at the birth address to NO2 (5.45 ppb), O3 (3.22 ppb), and PM2.5 (6.50 μg/m3) were 1.04 (95% CI: 1.02, 1.05), 1.11 (95% CI: 1.10, 1.12), and 1.31 (95% CI: 1.28, 1.33), respectively. Effects of O3 and PM2.5 estimated with time-varying Cox models were similar to those estimated using exposure at birth, whereas the effect of NO2 was slightly stronger (HR = 1.07; 95% CI: 1.05, 1.09). Conclusions: Asthma onset in children appears to be associated with residential exposure to PM2.5, O3 and NO2. Citation: Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. 2016. Childhood exposure to ambient air

  20. Adult onset glycogen storage disease type II (adult onset Pompe disease): report and magnetic resonance images of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Del Gaizo, Andrew [Emory University School of Medicine, Radiology Resident, Atlanta, GA (United States); Banerjee, Sima [Emory University School of Medicine, Musculoskeletal Radiology Department, Atlanta, GA (United States); Terk, Michael [Emory University School of Medicine, Radiology, Division of Musculoskeletal Imaging, Atlanta, GA (United States)

    2009-12-15

    Glycogen storage disease type II (GSDII), also referred to as Pompe disease or acid maltase deficiency, is a rare inherited condition caused by a deficiency in acid alpha-glucosidase (GAA) enzyme activity. The condition is often classified by age of presentation, with infantile and late onset variants (Laforet et al. J Neurology 55:1122-8, 2000). Late onset tends to present with progressive proximal muscle weakness and respiratory insufficiency (Winkel et al. J Neurology 252:875-84, 2005). We report two cases of biopsy confirmed adult onset GSDII, along with key Magnetic Resonance (MR) images. (orig.)

  1. Asthma Among Employed Adults, by Industry and Occupation - 21 States, 2013.

    Science.gov (United States)

    Dodd, Katelynn E; Mazurek, Jacek M

    2016-12-02

    Workers in various industries and occupations are at risk for work-related asthma* (1). Data from the 2006-2007 adult Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS), an in-depth asthma survey conducted with respondents who report an asthma diagnosis, from 33 states indicated that up to 48% of adult current asthma might be related to work and could therefore potentially be prevented (2). Identification of the industries and occupations with increased prevalence of asthma might inform work-related asthma intervention and prevention efforts. To assess the industry-specific and occupation-specific proportions of adults with current asthma by state, CDC analyzed data from the 2013 BRFSS industry and occupation module, collected from 21 states for participants aged ≥18 years who, at the time of the survey interview, were employed or had been out of work for industries and occupations to assess for asthma among workers, identify workplace exposures, and guide the design and evaluation of effective work-related asthma prevention and education programs (1).

  2. The Prevalence of Severe Asthma and Low Asthma Control Among Danish Adults

    DEFF Research Database (Denmark)

    von Bülow, Anna; Kriegbaum, Margit; Backer, Vibeke;

    2014-01-01

    BACKGROUND: The prevalence of severe asthma is unknown. However, international expert statements estimate that severe asthma represents 5% to 10 % of the entire asthma population. OBJECTIVE: Based on register data from a nationwide population, we wanted to investigate the prevalence of severe...... asthma, the extent of asthma control, and contact with specialist care. METHODS: A descriptive cross-sectional register study was performed. By using a nationwide prescription database, we identified current patients with asthma (age, 18-44 years) in 2010. Severity was classified as severe versus mild......-moderate asthma according to the level of antiasthma treatment. We investigated prescription drug use, hospitalizations, emergency department visits, and outpatient clinic visits according to severity. RESULTS: Among a nationwide population, we identified 61,583 current patients with asthma. Based on the level...

  3. Perceived Stress, Severity of Asthma, and Quality of Life in Young Adults with Asthma

    Directory of Open Access Journals (Sweden)

    Tomoaki Kimura

    2009-01-01

    Conclusions: A major variable related to the disease-specific quality of life was perceived stress, followed by the severity of asthma. Stress management of patients with asthma may improve their quality of life.

  4. Does early-onset multiple sclerosis differ from adult-onset form in Iranian people

    Directory of Open Access Journals (Sweden)

    Fereshteh Ashtari

    2010-01-01

    Full Text Available Background: Few studies have attempted to delineate the clinical profile of multiple Sclerosis (MS among people of Asia. This study sought to identify the characteristics of early-onset Multiple Sclerosis (EOMS comparison to adult-onset form (AOMS in Isfahan, IRAN. Methods: This prospective study was conducted on 104 youths with multiple sclerosis beginning before the age of 16 years and 123 patients with adult-onset multiple sclerosis. Patients were observed for a mean period of 5 years. The common presenting symptoms, MRI finding, course of disease and disability score were compared between the two groups. Results: The mean onset age of disease in youths and adults were 14 ± 1.9 and 27.7 ± 8.06 years, respectively. Female/male ratio was 4.47:1 in EOMS and 3.92:1 in AOMS, this ratio was 7:1 in early childhood MS (≤ 10 year. The most common presenting symptom was optic neuritis in the EOMS group and paresthesia in AOMS. Optic neuritis was common in AOMS too, but brainstem/cerebellar signs were more common in EOMS than AOMS. Seizure occurred more frequently in EOMS than in the AOMS group (12.6% vs. 1.6%, respectively, p < 0.001. MRI showed that brainstem plaques were more prevalent in the EOMS compared with the AOMS group. Conclusions: It was concluded that early-onset MS does not significantly differ from adult form in terms of major clinical manifestation and course of disease, however Seizure is more common in EOMS, and brainstem and cerebellar symptoms as presenting symptom are more common.

  5. Asthma diagnosis is not associated with obesity in a population of adults from Madrid

    OpenAIRE

    2011-01-01

    Background: Several studies have suggested a relationship between asthma and obesity; however, this relationship is unclear when obesity is compared with bronchial hyperresponsiveness to methacholine. Aim: To determine whether obesity is associated with a diagnosis of asthma. Methods: We conducted a cross-sectional study in a population of Spanish adults in the north of Madrid, Spain between 2003 and 2007. The patients included had experienced asthma symptoms during the previous y...

  6. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  7. [Results of an educational program for adults with asthma].

    Science.gov (United States)

    Segura Méndez, N; Espínola Reyna, G; Juárez Morales, D; Vázquez Estupiñan, F; Salas Ramírez, M; Ortiz Vázquez, J U; Mejía Ortega, J

    2001-01-01

    Asthma is a world health problem. Education of asthmatic patient has been proposed as a choice for diminishing mortality due to asthma. To demonstrate that educational programs for asthmatic patients help to reduce disease's severity, crises and hospitalizations number and encourage a bigger therapeutic compliance. 80 asthmatic patients were divided into two groups; first one received educational curse and second one does not. All patients received treatment according to international guides, including monthly consultation, flow-meter, and symptoms day book; an initial and final evaluation was made about disease's knowledge. Course consisted of a workshop including crisis management, use of inhaled medication, flow-metry and relaxation techniques. We studied 76 patients, with a mean age of 34 years; 36 were assigned to group 1 and 40 to group 2. Initial assessment of both groups was of 7.8, while final evaluation of groups 1 and 2 was of 9.3 and 8.4, respectively. Group 1 had lesser number of hospitalizations than group 2 (p-0.005), lesser number of emergency consultations (p-0.005) and a higher overall improvement than group 2, in which only 8 patients got well. A third part of the group 1 abandoned treatment, while patients that abandoned treatment in group 2 accounted for 79% (p < 0.0005). Educational programs for asthmatic adult patients diminish severity of disease, number of crises and hospitalizations, and also increase therapeutic compliance.

  8. Adult-onset Nemaline Myopathy Coexisting With Myasthenia Gravis

    Science.gov (United States)

    Cao, Lingling; Wang, Yanling; Liu, Xiaofeng; Hu, Yanxia; Li, Nianchun; Qiu, Guoping; Luo, Yun; Li, Weidong

    2016-01-01

    Abstract Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder which is characterized by fluctuating muscle fatigue. However, the association of MG with nemaline myopathy is rarely reported. Here we report a case of MG coexisting with adult-onset nemaline myopathy. A 55-year-old man endured fluctuating muscle weakness with positive acetylcholine receptor and titin antibodies. After the patient was administrated cholinergic drugs and immunosuppression, the muscle weakness of the patient had mildly been alleviated. Electromyography showed a progressive decrement in the amplitude of muscle action potential at low frequency. Muscle biopsy showed numerous nemalines in the muscle fibers. This is the first reported case of nemalines present in the muscle fibers of adult patient with MG. The pathogenesis of nemaline may be related to titin antibody in adult-onset nemaline myopathy with MG. PMID:26825889

  9. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    Science.gov (United States)

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  10. Persistent Airflow Obstruction in Young Adult Asthma Patients

    Directory of Open Access Journals (Sweden)

    Kiyoshi Sekiya

    2012-01-01

    Conclusions: In this study, patients not undergoing treatment for asthma were examined. History of childhood asthma and smoking history may be the risk factors for persistent airway obstruction in the asthma patients with mild subjective symptoms. Tests on the bronchodilator change in FEV1 should be performed in patients with history of childhood asthma and smoking history, even if they have only mild subjective symptoms.

  11. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20-35 ...

  12. Promoting Self-Management in Adults with Asthma: An Overview of the UAB Program.

    Science.gov (United States)

    Bailey, William C.; And Others

    1987-01-01

    A study at the University of Alabama/Birmingham (UAB) compared adult asthma patients receiving a self-care workbook with those receiving only asthma pamphlets. Outcomes were assessed in five areas: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions. (Author/CH)

  13. Effects of mometasone, fluticasone, and montelukast on bone mineral density in adults with asthma

    DEFF Research Database (Denmark)

    Maspero, Jorge; Backer, Vibeke; Yao, Ruji;

    2014-01-01

    asthma. METHODS: Adults with mild-moderate persistent asthma who did not receive ICS for ≥3 months were randomized to MF 400 μg once daily (QD) in the evening (pm), MF 200 μg QD pm, montelukast sodium (ML) 10 mg QD pm, or fluticasone propionate (FP) 250 μg twice daily. Included patients had 25-hydroxy...

  14. Asthma 1-2-3: a low literacy multimedia tool to educate African American adults about asthma.

    Science.gov (United States)

    Sobel, Rina M; Paasche-Orlow, Michael K; Waite, Katherine R; Rittner, Sarah S; Wilson, Elizabeth A H; Wolf, Michael S

    2009-08-01

    Asthma 1-2-3 is a newly-developed low-literacy multimedia education tool designed to promote asthma self-care concepts among African American adults. An expert panel (n = 10) informed content development for the tool. The video script and storyboard imagery were shown to 30 African Americans recruited from the American Lung Association, whose reactions and comments guided further revisions. The final version was pilot tested in three diverse community settings in Chicago to determine the efficacy of Asthma 1-2-3 at improving patient understanding of asthma and its symptoms. In all, 130 adults participated in the pilot test. Knowledge scores significantly improved from pretest to posttest following presentation of the developed tool for subjects across all literacy levels (Pretest: Mean = 4.2 [SD = 1.6]; Posttest: M = 6.8 [SD = 2.0], P < 0.001). Symptom pathophysiology concepts were the least understood. Individuals with low literacy had less total knowledge score gains compared to those with marginal and adequate literacy (1.8, 2.6, and 3.2 respectively; P = 0.002). The multimedia tool significantly improved understanding of asthma. Individuals with limited literacy may require additional instruction, repeated viewing, or added tangible cues (i.e. supplementary print materials) to support knowledge retention. In general, feedback from the target population was particularly helpful in the development of the tool and its initial evaluation, and should be considered as a necessary step in the creation of other patient education materials.

  15. Adult Onset Still's Disease and Rocky Mountain Spotted Fever

    Science.gov (United States)

    Persad, Paul; Patel, Rajendrakumar; Patel, Niki

    2010-01-01

    Adult Still's Disease was first described in 1971 by Bywaters in fourteen adult female patients who presented with symptoms indistinguishable from that of classic childhood Still's Disease (Bywaters, 1971). George Still in 1896 first recognized this triad of quotidian (daily) fevers, evanescent rash, and arthritis in children with what later became known as juvenile inflammatory arthritis (Still, 1990). Adult Onset Still's Disease (AOSD) is an inflammatory condition of unknown etiology characterized by an evanescent rash, quotidian fevers, and arthralgias. Numerous infectious agents have been associated with its presentation. This case is to our knowledge the first presentation of AOSD in the setting of Rocky Mountain Spotted Fever. Although numerous infectious agents have been suggested, the etiology of this disorder remains elusive. Nevertheless, infection may in fact play a role in triggering the onset of symptoms in those with this disorder. Our case presentation is, to our knowledge, the first case of Adult Onset Still's Disease associated with Rocky Mountain spotted fever (RMSF). PMID:20811570

  16. Adult Onset Still's Disease and Rocky Mountain Spotted Fever

    Directory of Open Access Journals (Sweden)

    Paul Persad

    2010-01-01

    Full Text Available Adult Still's Disease was first described in 1971 by Bywaters in fourteen adult female patients who presented with symptoms indistinguishable from that of classic childhood Still's Disease (Bywaters, 1971. George Still in 1896 first recognized this triad of quotidian (daily fevers, evanescent rash, and arthritis in children with what later became known as juvenile inflammatory arthritis (Still, 1990. Adult Onset Still's Disease (AOSD is an inflammatory condition of unknown etiology characterized by an evanescent rash, quotidian fevers, and arthralgias. Numerous infectious agents have been associated with its presentation. This case is to our knowledge the first presentation of AOSD in the setting of Rocky Mountain Spotted Fever. Although numerous infectious agents have been suggested, the etiology of this disorder remains elusive. Nevertheless, infection may in fact play a role in triggering the onset of symptoms in those with this disorder. Our case presentation is, to our knowledge, the first case of Adult Onset Still's Disease associated with Rocky Mountain spotted fever (RMSF.

  17. Asthma

    Science.gov (United States)

    ... 1.25 million of those individuals have severe asthma, a condition that can be difficult to control and treat. Learn more about his research by visiting the NHLBI Laboratory of Asthma and Lung Inflammation website: http://www.nhlbi.nih. ...

  18. Management of asthma in adults: do the patients get what they need--and want?

    DEFF Research Database (Denmark)

    Backer, V; Ulrik, Charlotte Suppli; Harving, H

    2007-01-01

    Suboptimal asthma control may be caused by a combination of factors, such as nonadherence to guidelines, lack of compliance, and poor asthma education. The aim was to assess patients' knowledge of asthma and different management strategies, including patients' attitudes toward involvement....... In conclusion, this study of adult asthmatic patients revealed an important deficit in patient education, little use of lung function measurements, and poor compliance with guidelines for asthma management. Furthermore, asthmatic patients want more education, although they do not use it when provided...... by their doctor, indicating that change in educational strategy is needed....

  19. Psychological, academic, and work functioning in college students with childhood-onset asthma.

    Science.gov (United States)

    Carpentier, Melissa Y; Mullins, Larry L; Van Pelt, Jill C

    2007-03-01

    This study investigated differences in psychological, academic, and work functioning between college students with and without asthma and identified predictors of functioning. Both participants with asthma (n = 121) and age-and gender-matched healthy control subjects (n = 121) completed measures of psychological distress, provided information on missed school and work days, and consented to have their grade point averages released from the registrar. College students with asthma also completed measures of illness uncertainty and illness intrusiveness. Participants with asthma reported greater anxiety, general psychological distress, and more missed school and work days compared to healthy control subjects. Within the asthma group, both illness uncertainty and illness intrusiveness independently predicted anxious and depressive symptoms and general psychological distress; illness intrusiveness also predicted missed school days. Although enrollment in college implies resilient functioning, college students with asthma remain at risk for problems with psychological and academic functioning.

  20. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women.

    Science.gov (United States)

    Bérubé, Jean-Christophe; Gaudreault, Nathalie; Lavoie-Charland, Emilie; Sbarra, Laura; Henry, Cyndi; Madore, Anne-Marie; Paré, Peter D; van den Berge, Maarten; Nickle, David; Laviolette, Michel; Laprise, Catherine; Boulet, Louis-Philippe; Bossé, Yohan

    2016-01-01

    Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs) associated with asthma in French Canadian adult women. A pooling-based genome-wide association study was performed in 240 allergic asthmatic and 120 allergic nonasthmatic women. The top associated SNPs were selected for individual genotyping in an extended cohort of 349 asthmatic and 261 nonasthmatic women. The functional impact of asthma-associated SNPs was investigated in a lung expression quantitative trait loci (eQTL) mapping study (n = 1035). Twenty-one of the 38 SNPs tested by individual genotyping showed P values lower than 0.05 for association with asthma. Cis-eQTL analyses supported the functional contribution of rs17801353 associated with C3AR1 (P = 7.90E - 10). The asthma risk allele for rs17801353 is associated with higher mRNA expression levels of C3AR1 in lung tissue. In silico functional characterization of the asthma-associated SNPs also supported the contribution of C3AR1 and additional genes including SYNE1, LINGO2, and IFNG-AS1. This pooling-based GWAS in French Canadian adult women followed by lung eQTL mapping suggested C3AR1 as a functional locus associated with asthma. Additional susceptibility genes were suggested in this homogenous subgroup of asthma patients.

  1. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women

    Directory of Open Access Journals (Sweden)

    Jean-Christophe Bérubé

    2016-01-01

    Full Text Available Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs associated with asthma in French Canadian adult women. A pooling-based genome-wide association study was performed in 240 allergic asthmatic and 120 allergic nonasthmatic women. The top associated SNPs were selected for individual genotyping in an extended cohort of 349 asthmatic and 261 nonasthmatic women. The functional impact of asthma-associated SNPs was investigated in a lung expression quantitative trait loci (eQTL mapping study (n=1035. Twenty-one of the 38 SNPs tested by individual genotyping showed P values lower than 0.05 for association with asthma. Cis-eQTL analyses supported the functional contribution of rs17801353 associated with C3AR1 (P=7.90E-10. The asthma risk allele for rs17801353 is associated with higher mRNA expression levels of C3AR1 in lung tissue. In silico functional characterization of the asthma-associated SNPs also supported the contribution of C3AR1 and additional genes including SYNE1, LINGO2, and IFNG-AS1. This pooling-based GWAS in French Canadian adult women followed by lung eQTL mapping suggested C3AR1 as a functional locus associated with asthma. Additional susceptibility genes were suggested in this homogenous subgroup of asthma patients.

  2. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women

    Science.gov (United States)

    Bérubé, Jean-Christophe; Gaudreault, Nathalie; Lavoie-Charland, Emilie; Sbarra, Laura; Henry, Cyndi; Madore, Anne-Marie; Paré, Peter D.; van den Berge, Maarten; Nickle, David; Laviolette, Michel; Laprise, Catherine; Boulet, Louis-Philippe; Bossé, Yohan

    2016-01-01

    Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs) associated with asthma in French Canadian adult women. A pooling-based genome-wide association study was performed in 240 allergic asthmatic and 120 allergic nonasthmatic women. The top associated SNPs were selected for individual genotyping in an extended cohort of 349 asthmatic and 261 nonasthmatic women. The functional impact of asthma-associated SNPs was investigated in a lung expression quantitative trait loci (eQTL) mapping study (n = 1035). Twenty-one of the 38 SNPs tested by individual genotyping showed P values lower than 0.05 for association with asthma. Cis-eQTL analyses supported the functional contribution of rs17801353 associated with C3AR1 (P = 7.90E − 10). The asthma risk allele for rs17801353 is associated with higher mRNA expression levels of C3AR1 in lung tissue. In silico functional characterization of the asthma-associated SNPs also supported the contribution of C3AR1 and additional genes including SYNE1, LINGO2, and IFNG-AS1. This pooling-based GWAS in French Canadian adult women followed by lung eQTL mapping suggested C3AR1 as a functional locus associated with asthma. Additional susceptibility genes were suggested in this homogenous subgroup of asthma patients. PMID:27445529

  3. Adult onset pigmentary orthochromatic leukodystrophy with ovarian dysgenesis.

    Science.gov (United States)

    Verghese, J; Weidenheim, K; Malik, S; Rapin, I

    2002-11-01

    Pigmentary type of orthochromatic leukodystrophy (POLD) is an adult-onset leukodystrophy, characterized pathologically by the presence of glial and microglial cytoplasmic pigment inclusions. The complete phenotype, genotype and pathogenetic mechanisms in POLD have not been elucidated. We followed for 18 years a woman with autopsy-proven POLD, who presented with 'frontal' dementia and spasticity. Her further course was marked by progressive mutism, apraxia and seizures. Her sister had died of the same disease after a much more rapidly progressing course. These sisters had primary infertility with pathologic evidence of streak ovaries. Diagnosis was confirmed in both cases by post-mortem examination. POLD is a rare cause of adult-onset leukodystrophy presenting with dementia. Ovarian dysgenesis is extremely rare in the absence of demonstrable chromosomal abnormalities and extends the clinical spectrum of POLD.

  4. Risk factors for asthma in young adults: a co-twin control study

    DEFF Research Database (Denmark)

    Thomsen, S F; Ulrik, C S; Kyvik, K O;

    2006-01-01

    BACKGROUND: The liability to asthma is influenced both by genetic and environmental factors. The objective of this study was to identify risk factors for asthma in young adult twin pairs during an 8-year period. METHODS: From the birth cohorts 1953-1982 of the Danish Twin Registry, 6,090 twin pairs...... who were initially unaffected with respect to asthma at a nationwide questionnaire-based study in 1994 participated in a similar follow-up study in 2002. Subjects were regarded incident asthma cases when responding affirmatively to the question 'Do you have, or have you ever had asthma'? in 2002....... Pairs in which only one twin developed asthma -- discordant pairs -- were identified and conditional logistic regression was applied to detect effects of risk factors. RESULTS: A total of 126 monozygotic (MZ) and 273 dizygotic (DZ) discordant twin pairs were identified. In MZ twins hay fever (OR = 3...

  5. Asthma mortality in Danish children and young adults, 1973-1994

    DEFF Research Database (Denmark)

    Jørgensen, I M; Bülow, S; Jensen, V B

    2000-01-01

    in Denmark increased in adolescents during 1973-1987 and decreased from 1988 to 1994. A possible explanation may be an increased awareness of asthma symptoms combined with a steadily improved treatment of asthma. Even in children and young adults under the age of 20 yrs, validity problems still make......Several reports indicate that asthma mortality has increased during the last few decades. International comparisons reveal some striking differences in the pattern of asthma mortality. The authors investigated the asthma mortality rate in the Danish child and youth population 1973-1994 and studied...... the validity of death certificates. The authors reviewed all death certificates coded as asthma death in the International Classification of Diseases (ICD 8-ICD 10 (1994)) and adjacent respiratory code numbers for the age group 1-19 yrs. Hospital records and autopsy reports were assessed to validate the cause...

  6. Underdiagnosis of asthma in young adults presenting for USAF basic training.

    Science.gov (United States)

    Nish, W A; Schwietz, L A

    1992-09-01

    The underdiagnosis of asthma has not been well studied previously. The purpose of this study was to determine whether the diagnosis of asthma had been made previously in young adults who were subsequently shown to have asthma upon entering military service. Questionnaires were answered by all airmen basic referred to the Allergy-Immunology Clinic at Wilford Hall United States Air Force Medical Center over an 11-month period. There were 192 airmen basic referred to rule out asthma, primarily because of respiratory symptoms with exercise. These airmen were evaluated by history, physical examination, pulmonary function tests and, in 67%, by histamine or exercise challenge test also. In those diagnosed with asthma, the evaluating allergist then determined whether the diagnosis of asthma had been made previously considered or not considered. In airmen basic diagnosed by our clinic with asthma, the diagnosis had been made previously in 45%, considered in 25%, and not considered in 30%. Undiagnosed asthmatic airmen tended to have mild and primarily exercise-induced disease. We conclude that there is a high incidence of underdiagnosis of asthma in the population studied. Exercise-induced asthma accounted for most of the undiagnosed asthma.

  7. Season of Birth and Risk for Adult Onset Glioma

    Directory of Open Access Journals (Sweden)

    Jimmy T. Efird

    2010-04-01

    Full Text Available Adult onset glioma is a rare cancer which occurs more frequently in Caucasians than African Americans, and in men than women. The etiology of this disease is largely unknown. Exposure to ionizing radiation is the only well established environmental risk factor, and this factor explains only a small percentage of cases. Several recent studies have reported an association between season of birth and glioma risk. This paper reviews the plausibility of evidence focusing on the seasonal interrelation of farming, allergies, viruses, vitamin D, diet, birth weight, and handedness. To date, a convincing explanation for the occurrence of adult gliomas decades after a seasonal exposure at birth remains elusive.

  8. "Petrified ears" with idiopathic adult-onset pituitary insufficiency

    Directory of Open Access Journals (Sweden)

    Yashpal Gogate

    2012-01-01

    Full Text Available "Petrified ears" or calcification of auricular cartilage is an uncommonly reported condition. The most common causes of this phenomenon are local trauma, frost bite, and inflammation. Adrenal insufficiency is the most frequent systemic disease associated with auricular calcification. We present a case of idiopathic adult-onset pituitary insufficiency with hypocortisolism and bilateral auricular calcification. Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.

  9. Adult-Onset Acquired Partial Lipodystrophy Accompanied by Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Yusuke Muto

    2015-04-01

    Full Text Available Lipodystrophy is a group of metabolic disorders, possibly caused by autoimmune disease. In this report, we describe a case of adult-onset acquired partial lipodystrophy accompanied by rheumatoid arthritis without a family history. Interestingly, immunohistochemical staining revealed dense infiltration of IL-27-producing cells as well as MMP-7- and MMP-28-expressing cells, both of which have been reported to facilitate the development of autoimmune disease. Our present case might suggest possible mechanisms for acquired partial lipodystrophy.

  10. Adult-onset Leigh′s disease: A rare entity

    Directory of Open Access Journals (Sweden)

    Shaik Afshan Jabeen

    2016-01-01

    Full Text Available Leigh syndrome (LS is a heterogeneous familial or sporadic neurodegenerative disorder. It is typically seen in infancy or childhood, although rare cases of adult onset have been described. The authors describe a 37-year-old woman who presented with protracted gastrointestinal symptoms followed by acute brain stem syndrome with severe metabolic acidosis and who subsequently showed dramatic clinical and neuroradiological improvement.

  11. Difficult asthma in adults: recognition and approaches to management.

    Science.gov (United States)

    Harrison, B D W

    2005-09-01

    Difficult asthma must be distinguished from severe asthma. It is then important in patients with suspected difficult asthma to ensure that the diagnosis is correct, and that if the patient has asthma that the attributed symptoms are indeed all genuinely due to the asthma and not to coexisting physical or psychogenic respiratory conditions. It is also important to be alert when there is discordance between symptoms and objective lung function in order to recognize both poor perceivers and over-reactors. Difficult asthma can occur in patients with objectively mild, moderate or severe disease, but the consequences are most dramatic in patients with severe asthma. Asthma may be difficult for the patient, for the clinician or both because of disease factors, doctor or nurse therapist factors, and/or patient factors. Investigation requires access to the full range of respiratory, imaging and allergy tests. It also requires a multidisciplinary approach involving ear, nose and throat specialists and speech therapists, and access to psychiatric and psychological assessment and therapies. Poor compliance is associated with significantly poorer asthma and asthma-related health outcomes. Poor compliance can be recognized in two-thirds of such patients by their not attending scheduled appointments. Poor compliance is significantly associated with anxiety, social deprivation and adverse family circumstances, and these characteristics and adversities probably contribute to the poorly compliant behaviour. In difficult asthma it is important to identify and manage the condition causing the symptoms rather than prescribing more and more asthma therapy. Recognizing psychosocial adversity is essential. A structured approach is essential. There remains a small number of patients with genuine steroid-resistant asthma, some with predominately neutrophilic rather than eosinophilic airway inflammation, and others for whom the secondary gain of continuing symptoms is overwhelming. There is

  12. Pregnancy outcomes in women with childhood-onset and adult-onset systemic lupus erythematosus: a comparative study.

    Science.gov (United States)

    Saavedra, Miguel Ángel; Miranda-Hernández, Dafhne; Sánchez, Antonio; Morales, Sara; Cruz-Domínguez, Pilar; Medina, Gabriela; Jara, Luis Javier

    2016-10-01

    To compare the maternal and fetal outcomes between childhood-onset and adult-onset systemic lupus erythematosus (SLE), we reviewed the medical records of SLE pregnant women treated from January 2005 to August 2013. For comparison, patients were allocated to one of the two groups, those pregnant patients with SLE onset before 18 years of age (childhood-onset) and ≥18 years (adult-onset). The patients were evaluated at least once in each trimester and postpartum. Relevant maternal and fetal outcomes were extracted, such as lupus flare, preeclampsia/eclampsia, rate of liveborns, fetal loss (spontaneous abortion and stillbirth), term delivery, preterm birth, neonatal death, low birth weight, low birth weight at term, and congenital malformations. We studied 186 pregnancies (in 180 women), 58 of them had childhood-onset SLE, and the remaining 128 had adult-onset SLE. The rate of maternal and fetal complications was similar in both groups. Multivariate analysis showed that active SLE before pregnancy, primigravida, renal flare, preeclampsia, lupus flare, anticardiolipin antibodies, and low serum complement were associated with an increased risk of poor maternal and fetal outcomes. The diagnosis of childhood-onset had no impact on maternal-fetal outcome. The maternal and fetal outcome in women with childhood-onset SLE is similar to that reported in women with adult-onset SLE. Pregnancy in women with childhood-onset SLE should not be contraindicated if the disease is well controlled.

  13. Cigarette Smoking and Alcohol Use among Adolescents and Young Adults with Asthma

    Directory of Open Access Journals (Sweden)

    Elizabeth Burgess Dowdell

    2011-01-01

    Full Text Available Asthma is one of the most common, serious chronic diseases in pediatric and young adult populations. Health-risk behaviors, including cigarette smoking and alcohol use, may exacerbate chronic diseases and complicate their management. The aim of this study was to longitudinally analyze rates of cigarette smoking and alcohol use in adolescents and young adults who have asthma and those who do not have asthma. A secondary analysis of data from the National Longitudinal Study of Adolescent Health was undertaken. Individuals with asthma were found to exhibit increasing rates of cigarette smoking and alcohol use as they aged. When an adolescent with a chronic health issue begins health-risk-taking behaviors, behavior change interventions must be planned. Pediatric nurses, practitioners, and clinicians are uniquely positioned to assess for health-risk behaviors in youth with asthma and to intervene with plans of care that are tailored for the needs of this vulnerable population.

  14. ‘Get Your Life Back’: process and impact evaluation of an asthma social marketing campaign targeting older adults

    OpenAIRE

    Evers, Uwana; Jones, Sandra C; Iverson, Don; Caputi, Peter

    2013-01-01

    Background Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community. Methods A cohort of older adults in an intervention region (n = 316) and a control region ...

  15. Rhinovirus Wheezing Illness and Genetic Risk of Childhood-Onset Asthma

    DEFF Research Database (Denmark)

    Calışkan, Minal; Bochkov, Yury A; Kreiner-Møller, Eskil

    2013-01-01

    illnesses. The associations of 17q21 variants with asthma were restricted to children who had had HRV wheezing illnesses, resulting in a significant interaction effect with respect to the risk of asthma. Moreover, the expression levels of ORMDL3 and of GSDMB were significantly increased in HRV...

  16. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen;

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20...... survey to 4.8% in the second survey (pSmoking decreased...... significantly from 62% in 1976-8 to 45% in 1991-4 (pyoung adults in Copenhagen over a 15 year period. The severity of asthma, as judged by the level of FEV(1), has also increased. These findings cannot be explained...

  17. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen;

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20...... significantly from 62% in 1976-8 to 45% in 1991-4 (pyoung adults in Copenhagen over a 15 year period. The severity of asthma, as judged by the level of FEV(1), has also increased. These findings cannot be explained...

  18. Asthma

    OpenAIRE

    Kim, Harold; Mazza, Jorge

    2011-01-01

    Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs) represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA) inhalers are pr...

  19. Asthma

    OpenAIRE

    Kim Harold; Mazza Jorge

    2011-01-01

    Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs) represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA) inhale...

  20. Ten-year follow-up of cluster-based asthma phenotypes in adults. A pooled analysis of three cohorts.

    Science.gov (United States)

    Boudier, Anne; Curjuric, Ivan; Basagaña, Xavier; Hazgui, Hana; Anto, Josep M; Bousquet, Jean; Bridevaux, Pierre O; Dupuis-Lozeron, Elise; Garcia-Aymerich, Judith; Heinrich, Joachim; Janson, Christer; Künzli, Nino; Leynaert, Bénédicte; de Marco, Roberto; Rochat, Thierry; Schindler, Christian; Varraso, Raphaëlle; Pin, Isabelle; Probst-Hensch, Nicole; Sunyer, Jordi; Kauffmann, Francine; Siroux, Valérie

    2013-09-01

    The temporal stability of adult asthma phenotypes identified using clustering methods has never been addressed. Longitudinal cluster-based methods may provide novel insights in the study of the natural history of asthma. To compare the stability of cluster-based asthma phenotype structures a decade apart in adults and to address the individuals' phenotypic transition across these asthma phenotypes. The latent transition analysis was applied on longitudinal data (twice, 10 yr apart) from 3,320 adults with asthma who took part in the European Community Respiratory Health Survey, the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults, or the Epidemiological Study on Genetics and Environment of Asthma. Nine variables covering personal and phenotypic characteristics measured twice, 10 years apart, were simultaneously considered. Latent transition analysis identifies seven asthma phenotypes (prevalence range, 8.4-20.8%), mainly characterized by the level of asthma symptoms (low, moderate, high), the allergic status, and pulmonary function. Phenotypes observed 10 years apart showed strong similarities. The probability of membership in the same asthma phenotype at both times varied across phenotypes from 54 to 88%. Different transition patterns were observed across phenotypes. Transitions toward increased asthma symptoms were more frequently observed among nonallergic phenotypes as compared with allergic phenotypes. Results showed a strong stability of the allergic status over time. Adult asthma phenotypes identified by a clustering approach, 10 years apart, were highly consistent. This study is the first to model the probabilities of transitioning over time between comprehensive asthma phenotypes.

  1. Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units.

    Science.gov (United States)

    Edwards, Jeffrey D; Vasilevskis, Eduard E; Yoo, Erika J; Houtrow, Amy J; Boscardin, W John; Dudley, R Adams; Okumura, Megumi J

    2015-02-01

    The purpose of the study is to compare demographics, intensive care unit (ICU) admission characteristics, and ICU outcomes among adults with childhood-onset chronic conditions (COCCs) admitted to US pediatric and adult ICUs. Retrospective cross-sectional analyses of 6088 adults aged 19 to 40 years admitted in 2008 to 70 pediatric ICUs that participated in the Virtual Pediatric Intensive Care Unit Performance Systems and 50 adult ICUs that participated in Project IMPACT. Childhood-onset chronic conditions were present in 53% of young adults admitted to pediatric units, compared with 9% of those in adult units. The most common COCC in both groups were congenital cardiac abnormalities, cerebral palsy, and chromosomal abnormalities. Adults with COCC admitted to pediatric units were significantly more likely to be younger, have lower functional status, and be nontrauma patients than those in adult units. The median ICU length of stay was 2 days, and the intensive care unit mortality rate was 5% for all COCC patients with no statistical difference between pediatric or adult units. There are marked differences in characteristics between young adults with COCC admitted to pediatric ICUs and adult ICUs. Barriers to accommodating these young adults may be reasons why many such adults have not transitioned from pediatric to adult critical care. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. A case of adult onset disseminated juvenile xanthogranuloma

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    Havva Hilal Ayvaz

    2016-01-01

    Full Text Available Juvenile xanthogranuloma (JX is a rare, benign, non-Langerhans histiocytic proliferative disease that etiology is unknown. It is usually seen in children and infants. JX in adult is very rare. A 41-year-old female patient was admitted to our clinic with papules on her face, torso and extremities. A few lesions had occured 3 years ago on her face, they disseminated all over her body after having a traffic accident one year ago which for she had operations and she also concurrently was diagnosed asdiabetes mellitus (DM. Based on clinical and histopathological findings, the diagnosis of JX was made. There is no systemic involvement of JX detected. JX seen in adults are very rare and usually associated with hematological malignancy. The present case is a rare adult onset disseminated JX case without malignancy

  3. The Association of Health Literacy with Illness and Medication Beliefs Among Older Adults with Asthma

    Science.gov (United States)

    Federman, Alex D.; Wolf, Michael; Sofianou, Anastasia; Wilson, Elizabeth A.H.; Martynenko, Melissa; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2013-01-01

    Background Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. Methods Asthmatics ≥ 60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the Self Regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models. Results Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2 to 2.82; OR: 2.22, 95% CI: 1.29 to 3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β = 0.92, p = .05), despite recognizing their necessity (β = -1.36, p = .01). Conclusions Older asthmatics with low HL endorse erroneous asthma beliefs. Practice implications Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions. PMID:23523196

  4. Evolution of asthma severity in a cohort of young adults: is there any gender difference?

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    Chantal Raherison

    Full Text Available INTRODUCTION: Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics METHODS: Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998-2002, as part of the European Community Respiratory Health Survey (ECRHS. All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA Guidelines. Another quantitative score (Ronchetti further considering hospitalizations was also analysed. RESULTS: The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7. At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent, 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09 with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of

  5. Prevalence and Risk Factors for Depression in Korean Adult Patients with Asthma: Is There a Difference between Elderly and Non-Elderly Patients?

    OpenAIRE

    Choi, Gil-Soon; Shin, Yoo Seob; Kim, Joo Hee; Choi, Seon Yoon; Lee, Soo-Keol; Nam, Young-Hee; Lee, Young-Mok; Park, Hae-Sim; ,

    2014-01-01

    Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (≥65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQ...

  6. A Study Of Sporadic Adult Onset Degenerative Cerebellar Ataxias

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    Sinha K K

    1999-01-01

    Full Text Available Twenty-four cases of sporadic olivo-ponto-cerebellar atrophy (OPCA of adult onset were studied over a period of two years. Results suggest that this disorder has its usual onset in the 5th and 6th decade of life with a male: female ratio of 2:1. It manifests clinically with gait ataxia in all, dysarthria, other cerebellar signs and autonomic involvement in vast majority. There were features of basal ganglia involvement in some. No known identifiable environmental cause was found and genetically they are quite distinct from the known autosomal dominant spinocerebellar ataxias though sporadic occurrence in recessive inheritance or a de novo mutation could not be ruled out completely, but it is unlikely.

  7. New onset of idiopathic bilateral ear tics in an adult.

    Science.gov (United States)

    Agrawal, Amit; Shrestha, Rabin

    2009-04-01

    Tic disorders are commonly considered to be childhood syndromes. Newly presenting tic disorders during adulthood are uncommon and mostly described in relation to an acquired brain lesion or as incidental tics, particularly in context with other neurological or psychiatric diseases. Tic disorder involving the ears is extremely uncommon with only few studies in English literature. In the present case, we describe an adult patient with new-onset idiopathic tics disorder involving both ears, causing social embarrassment. In addition, our patient had recent onset of the tics without any childhood or family history of tic disorders. The single most important component of management is an accurate diagnosis. At the same time, tics should be differentiated from other movement disorders such as chorea, stereotypy, and dystonias.

  8. The need to differentiate between adults and children when treating severe asthma.

    Science.gov (United States)

    Fainardi, Valentina; Saglani, Sejal

    2015-08-01

    Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally. Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.

  9. Occupational irritants and asthma: an Estonian cross-sectional study of 34,000 adults.

    Science.gov (United States)

    Dumas, Orianne; Laurent, Emeline; Bousquet, Jean; Metspalu, Andres; Milani, Lili; Kauffmann, Francine; Le Moual, Nicole

    2014-09-01

    Occupational exposures make important contributions to asthma morbidity. The role of low/moderate level irritant exposures remains unclear. We aimed to determine which occupational exposures are associated with asthma in an eastern European country with low asthma prevalence. The Estonian Genome Center of University of Tartu collected data from 50 077 adults in 2002-2011. Asthma was assessed through a questionnaire regarding diagnosed diseases, current health status and medication. Exposures to 22 agents during the current and longest held jobs were estimated using an asthma-specific job-exposure matrix. Analyses included 34 015 subjects (aged 18-65 years, 67.0% females), of which 1209 (3.6%) reported asthma (608 with physician-confirmed diagnosis). After adjusting for age, sex and smoking habits, lifetime occupational exposure to known asthmagens (20.4%) was significantly associated with physician-diagnosed asthma (OR 1.28, 95% CI 1.03-1.59), especially high molecular weight agents (flour: OR 2.36, 95% CI 1.31-4.27; animals: OR 1.62, 95% CI 1.00-2.60). Exposure to low/moderate levels of irritants (17.4%) was associated with physician-diagnosed asthma (OR 1.88, 95% CI 1.48-2.37). More pronounced associations were observed in subjects reporting current treated asthma. Beyond confirming the effect of known asthmagens (which are well-known, mostly from observations in western countries), the results provide evidence for a role of low/moderate exposure to irritants. This finding, observed in a country with a low prevalence of asthma and atopy, provides new insight into the understanding of asthma heterogeneity.

  10. An unusual cause of adult onset cerebellar ataxia with hypogonadism

    Directory of Open Access Journals (Sweden)

    Menon Ramshekhar

    2009-01-01

    Full Text Available We report an unusual case of sporadic adult onset cerebellar ataxia with hypogonadism. A 40-year-old unmarried man presented with progressive ataxia and dysarthria along with complaints of non-development of secondary sexual characteristics and erectile dysfunction. There were complaints of intermittent diarrhea. Clinical examination revealed a pan-cerebellar syndrome with features of hypoandrogenism. No eye movement abnormalities were evident. There were signs of malabsorption. Investigations confirmed the presence of auto-antibodies found in celiac disease, and a duodenal biopsy confirmed the same. Hypoandrogenism was postulated to be due to hypergonadotropic hypogonadism which has been mentioned in a few patients of celiac disease. However, the pattern seen in our patient was of a hypogonadotropic hypogonadism. This is probably secondary to an autoimmune hypophysitis seen in some patients in the absence of other clinical manifestations. Autoantibody testing should be a diagnostic necessity in any adult with a sporadic cerebellar ataxia.

  11. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey

    NARCIS (Netherlands)

    Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas de Almeida, Jose Miguel; De Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean-Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C.

    Objective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18

  12. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey

    NARCIS (Netherlands)

    Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas de Almeida, Jose Miguel; De Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean-Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C.

    2015-01-01

    Objective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18 countr

  13. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey

    NARCIS (Netherlands)

    Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas de Almeida, Jose Miguel; De Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean-Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C.

    2015-01-01

    Objective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18 countr

  14. Transforming growth factor- 1 C-509T polymorphism, oxidant stress, and early-onset childhood asthma.

    Science.gov (United States)

    Salam, Muhammad T; Gauderman, W James; McConnell, Rob; Lin, Pi-Chu; Gilliland, Frank D

    2007-12-15

    Transforming growth factor (TGF)-beta1 is involved in airway inflammation and remodeling, two key processes in asthma pathogenesis. Tobacco smoke and traffic emissions induce airway inflammation and modulate TGF-beta1 gene expression. We hypothesized that the effects of functional TGF-beta1 variants on asthma occurrence vary by these exposures. We tested these hypotheses among 3,023 children who participated in the Children's Health Study. Tagging single-nucleotide polymorphisms rs4803457 C>T and C-509T (a functional promoter polymorphism) accounted for 94% of the haplotype diversity of the upstream region. Exposure to maternal smoking in utero was based on smoking by biological mother during pregnancy. Residential distance from nearest freeway was calculated based on residential address at study entry. Children with the -509TT genotype had a 1.8-fold increased risk of early persistent asthma (95% confidence interval [CI], 1.11-2.95). This association varied marginally significantly by in utero exposure to maternal smoking. Compared with children with the -509CC/CT genotype with no in utero exposure to maternal smoking, those with the -509TT genotype with such exposure had a 3.4-fold increased risk of early persistent asthma (95% CI, 1.46-7.80; interaction, P = 0.11). The association between TGF-beta1 C-509T and lifetime asthma varied by residential proximity to freeways (interaction P = 0.02). Children with the -509TT genotype living within 500 m of a freeway had over three-fold increased lifetime asthma risk (95% CI, 1.29-7.44) compared with children with CC/CT genotype living > 1500 m from a freeway. Children with the TGF-beta1 -509TT genotype are at increased risk of asthma when they are exposed to maternal smoking in utero or to traffic-related emissions.

  15. NSAIDs in the Treatment of Adult Asthma: Sodium Cromoglycate and Nedocromil Sodium

    Directory of Open Access Journals (Sweden)

    Michel-Y Rouleau

    1995-01-01

    Full Text Available Among nonsteroidal anti-inflammatory drugs used in the treatment of adult asthma, sodium cromoglycate and nedocromil sodium are the most frequently prescribed. These medications have a similar efficacy profile in asthma although it has been suggested that nedocromil is more powerful than cromoglycate, particularly in its steroid sparing effects. Both drugs have been recommended as alternatives to steroids in the treatment of mild asthma. They are useful in the prevention of bronchospasm induced by exposure to allergens or to a variety of other stimuli. In comparison with theophylline or low dose inhaled steroids, cromoglycate and nedocromil have shown a similar antiasthmatic efficacy, although this is variable among patients.

  16. Asthma in adult hospitalized patient: a standardized care plan

    Directory of Open Access Journals (Sweden)

    Carmen Aranzazu Bermúdez Martín

    2008-03-01

    Full Text Available Asthma is a chronic inflammatory disease of the airway that affects more than 300 millions people all around the world with independence of the sociocultural level of development. The fact of being an illness with a high prevalence, makes that costs generated by asthma is higher than those generated by AIDS and tuberculosis together.As asthma has a complex ethiology and treatment, is extremely important to get the patient to understand his illness, its therapeutics and persuade him to get a coping style that makes it possible to put into practise a number of measures in order to decrease the illness consequences.

  17. Asthma

    Science.gov (United States)

    ... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  18. Atypical Cutaneous Manifestations in Adult Onset Still’s Disease

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    Champa Nataraja

    2016-01-01

    Full Text Available Adult Onset Still’s Disease (AOSD, an adult variant of systemic onset juvenile idiopathic arthritis, is a rare systemic inflammatory disorder of unknown aetiology. The rarity of this disease is associated with low index of suspicion and delayed diagnosis in patients suffering from it and in the presence of atypical features the diagnosis can be further challenging. This is a case report on a 24-year-old woman, who was a diagnostic dilemma for 2 years due to the nonspecific symptoms of recurrent fever, generalized maculopapular persistent pruritic and tender rash, and polyarthralgia. She was initially diagnosed as leukocytoclastic vasculitis on a skin biopsy and was managed by a dermatologist with various medications including NSAIDs, hydroxychloroquine, dapsone, colchicine, cyclosporine, and high doses of oral steroids with minimal response. Subsequently, she has had multiple admissions with similar symptoms with raised inflammatory markers and negative septic workup. On one occasion, her iron study revealed hyperferritinaemia which led to the suspicion of AOSD. Once the rheumatic fever and infectious, malignant, autoimmune, and lymphoproliferative disorders were excluded, she was diagnosed as probable AOSD and managed successfully with IL-1 (interleukin-1 receptor antagonist, Anakinra, with remarkable and lasting response both clinically and biochemically.

  19. Adult-onset Still's disease: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Siddiqui M

    2016-03-01

    Full Text Available Mariam Siddiqui,1 Michael S Putman,2 Anisha B Dua,11Department of Rheumatology, 2Department of Internal Medicine, The University of Chicago Medical Center, Chicago, IL, USA Abstract: Adult-onset Still's disease (AOSD – a multi-systemic inflammatory condition characterized by high fevers, polyarthritis, an evanescent rash, and pharyngitis – has been a challenging condition to diagnose expediently and treat effectively. Questions remain regarding the underlying pathophysiology and etiology of AOSD. Pathognomonic diagnostic tests and reliable biomarkers remain undiscovered. Over the past decade, important progress has been made. Diagnostic criteria employing glycosylated ferritin have improved specificity. More important, novel biologic therapies have offered important clues to AOSD's underlying pathophysiology. Cytokine-specific biologic therapies have been instrumental in providing more effective treatment for disease refractory to conventional treatment. While IL-1 therapy has demonstrated efficacy in refractory disease, novel therapies targeting IL-6 and IL-18 show great promise and are currently under investigation. Keywords: adult-onset Still's disease, biomarkers, therapeutics

  20. Lifetime Increased Risk of Adult Onset Atopic Dermatitis in Adolescent and Adult Patients with Food Allergy

    Directory of Open Access Journals (Sweden)

    Hsu-Sheng Yu

    2016-12-01

    Full Text Available Food allergy can result in life-threatening anaphylaxis. Atopic dermatitis (AD causes intense itching and impaired quality of life. Previous studies have shown that patients with classical early-onset AD tend to develop food allergy and that 10% of adults with food allergies have concomitant AD. However, it is not known whether late-onset food allergy leads to adult-onset AD, a recently recognized disease entity. Using an initial cohort of one-million subjects, this study retrospectively followed-up 2851 patients with food allergy (age > 12 years for 14 years and compared them with 11,404 matched controls. While 2.8% (81 of the 2851 food allergy patients developed AD, only 2.0% (227 of the 11,404 controls developed AD. Multivariate regression analysis showed that food allergy patients were more likely to develop AD (adjusted hazard ratio = 2.49, p < 0.0001. Controls had a 1.99% risk of developing AD, while food allergy patients had a significantly higher risk (7.18% and 3.46% for patients with ≥3 and <3 food allergy claims, respectively of developing adult-onset AD. This is the first study to describe the chronological and dose-dependent associations between food allergy in adolescence and the development of adult-onset AD.

  1. Occupational and environmental lung disease: occupational asthma.

    Science.gov (United States)

    Stenton, S C

    2010-01-01

    Occupational exposures cause 10-15% of new-onset asthma in adults, and that represents a considerable health and economic burden. Exposure to many causative agents is now well controlled but workplace practices are constantly evolving and new hazards being introduced. Overall, there is no good evidence that the incidence of occupational asthma is decreasing. Evidence-based guidelines such as those published by the British Occupational Health research Foundation and Standards of Care documents should help raise awareness of the problem and improve management. Key targets include the control of occupational exposures, a high index of suspicion in any adult with new onset asthma, and early detailed investigation.

  2. Advances in adult asthma diagnosis and treatment in 2012: potential therapeutics and gene-environment interactions.

    Science.gov (United States)

    Apter, Andrea J

    2013-01-01

    In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment.

  3. assessment of socioeconomic status and control of asthma in adults

    African Journals Online (AJOL)

    management, although asthma cannot be cured, but it ... Department of Family Medicine, University College Hospital, Ibadan, Nigeria. 3. Department of Medicine ... are the most widely used indicators of socioeconomic status (SES). Studies ...

  4. Risk Factors Precipitating Exacerbations in Adult Asthma Patients ...

    African Journals Online (AJOL)

    Data from Australia, Canada and Spain report that acute asthma accounted for 1 to 12% ... However, circumstances differ in the public sector in South Africa and other ... presenting at Kalafong Hospital\\'s emergency unit were chosen as cases.

  5. Recognition of asthma in adolescents and young adults

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Postma, Dirkje S; Backer, Vibeke

    2005-01-01

    Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability in such s......Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability...

  6. Poor asthma control and exposure to traffic pollutants and obesity in older adults.

    Science.gov (United States)

    Epstein, Tolly G; Ryan, Patrick H; LeMasters, Grace K; Bernstein, Cheryl K; Levin, Linda S; Bernstein, Jonathan A; Villareal, Manuel S; Bernstein, David I

    2012-06-01

    Environmental and host predictors of asthma control in older asthmatic patients (>65 years old) are poorly understood. To examine the effects of residential exposure to traffic exhaust and other environmental and host predictors on asthma control in older adults. One hundred four asthmatic patients 65 years of age or older from allergy and pulmonary clinics in greater Cincinnati, Ohio, completed the validated Asthma Control Questionnaire (ACQ), pulmonary function testing, and skin prick testing to 10 common aeroallergens. Patients had a physician's diagnosis of asthma, had significant reversibility in forced expiratory volume in 1 second or a positive methacholine challenge test result, and did not have chronic obstructive pulmonary disease. The mean daily residential exposure to elemental carbon attributable to traffic (ECAT) was estimated using a land-use regression model. Regression models were used to evaluate associations among independent variables, ACQ scores, and the number of asthma exacerbations, defined as acute worsening of asthma symptoms requiring prednisone use, in the past year. In the adjusted model, mean daily residential exposure to ECAT greater than 0.39 μg/m(3) was significantly associated with poorer asthma control based on ACQ scores (adjusted β = 2.85; 95% confidence interval [CI], 0.58-5.12; P = .02). High ECAT levels were also significantly associated with increased risk of asthma exacerbations (adjusted odds ratio, 3.24; 95% CI, 1.01-10.37; P = .05). A significant association was found between higher body mass index and worse ACQ scores (adjusted β = 1.15; 95% CI, 0.53-1.76; P obesity, and nonatopic status are associated with poorer asthma control among older asthmatic patients. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Adult Onset Vitiligo: Multivariate Analysis Suggests the Need for a Thyroid Screening.

    Science.gov (United States)

    Lazzeri, L; Colucci, R; Cammi, A; Dragoni, F; Moretti, S

    2016-01-01

    Background. There are limited epidemiological studies evaluating the effect of age at onset on disease features in vitiligo. Objectives. To identify factors associated with adult onset vitiligo in comparison with childhood onset vitiligo. Patients and Methods. We retrospectively collected medical records of 191 patients. Such records included clinical examination, personal and familial medical history, laboratory evaluations, concomitant vitiligo treatment and drug assumption. Results. 123 patients with a disease onset after the age of 40 (adult onset vitiligo) were compared with 68 patients who developed vitiligo before the age of 12 (childhood onset vitiligo). Multivariate analysis revealed that personal history of thyroid diseases (P = 0.04; OR 0.4), stress at onset (P = 0.002; OR = 0.34), personal history of autoimmune thyroid disease (ATD) (P = 0.003; OR = 0.23), and thyroid nodules (P = 0.001; OR 0.90) were independently associated with adult onset vitiligo, whereas family history of dermatological diseases (P = 0.003; OR = 2.87) and Koebner phenomenon (P < 0.001; OR = 4.73) with childhood onset vitiligo. Moreover, in the adult onset group, concomitant thyroid disease preceded vitiligo in a statistically significant number of patients (P = 0.014). Conclusions. Childhood onset and adult onset vitiligo have different clinical features. In particular, ATD and thyroid nodules were significantly associated with adult onset vitiligo, suggesting that a thyroid screening should be recommended in this group of patients.

  8. Bacterial capsular polysaccharide prevents the onset of asthma through T-cell activation.

    Science.gov (United States)

    Johnson, Jenny L; Jones, Mark B; Cobb, Brian A

    2015-04-01

    Over the last four decades, increases in the incidence of immune-mediated diseases in the Western world have been linked to changes in microbial exposure. It is becoming increasingly clear that the normal microbiota in the gut can profoundly alter susceptibility to a wide range of diseases, such as asthma, in which immune homeostasis is disrupted, yet the mechanisms governing this microbial influence remains poorly defined. In this study, we show that gastrointestinal exposure to PSA, a capsular polysaccharide derived from the commensal bacterium Bacteroides fragilis, significantly limits susceptibility to the induction of experimental asthma. We report that direct treatment of mice with PSA generates protection from asthma, and this effect can be given to a naïve recipient by adoptive transfer of CD4(+) T cells from PSA-exposed mice. Remarkably, we found that these PSA-induced T cells are not canonical FoxP3(+) regulatory T cells, but that they potently inhibit both Th1 and Th2 models of asthma in an IL-10-dependent fashion. These findings reveal that bacterial polysaccharides link the microbiota with the peripheral immune system by activating CD4(+)Foxp3(-) T cells upon exposure in the gut, and they facilitate resistance to unnecessary inflammatory responses via the production of IL-10. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Low molecular weight chemical-induced occupational asthma : The focus on alveolar macrophages

    NARCIS (Netherlands)

    Valstar, Dingena Labine

    2004-01-01

    Asthma is a very common disorder and its prevalence has increased over the past two to three decades. The proportion of cases attributable to occupational exposure at the workplace is estimated at ~10% of adult-onset asthma. Most cases of occupational asthma are caused by low molecular weight

  10. Incidence of rhinitis and asthma related to welding in Northern Europe.

    NARCIS (Netherlands)

    Storaas, T.; Zock, J.P.; Morano, A.E; Holm, M.; Bjornsson, E.; Forsberg, B.; Janson, C.; Norbäck, D.; Omenass, E.; Schlünssen, V.; Torén, K.; Svanes, C.

    2015-01-01

    Welding-related asthma is well recognised but less is known about rhinitis in relation to welding. The aim here, was to study associations between welding, rhinitis and asthma in a general population sample, and factors influencing selection into and out of a welding occupation. Adult-onset asthma

  11. Efficacy of Anakinra in Refractory Adult-Onset Still's Disease

    Science.gov (United States)

    Ortiz-Sanjuán, Francisco; Blanco, Ricardo; Riancho-Zarrabeitia, Leyre; Castañeda, Santos; Olivé, Alejandro; Riveros, Anne; Velloso-Feijoo, María.L.; Narváez, Javier; Jiménez-Moleón, Inmaculada; Maiz-Alonso, Olga; Ordóñez, Carmen; Bernal, José A.; Hernández, María V.; Sifuentes-Giraldo, Walter A.; Gómez-Arango, Catalina; Galíndez-Agirregoikoa, Eva; Blanco-Madrigal, Juan; Ortiz-Santamaria, Vera; del Blanco-Barnusell, Jordi; De Dios, Juan R.; Moreno, Mireia; Fiter, Jordi; Riscos, Marina de los; Carreira, Patricia; Rodriguez-Valls, María J.; González-Vela, M. Carmen; Calvo-Río, Vanesa; Loricera, Javier; Palmou-Fontana, Natalia; Pina, Trinitario; Llorca, Javier; González-Gay, Miguel A.

    2015-01-01

    Abstract Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34.4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2–6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3–47.5] mg/day at ANK onset to 5 [0–10] at 12 months. After a median [IQR] follow-up of 16 [5–50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations. PMID:26426623

  12. MRI in a case of adult-onset citrullinemia

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Y.F.; Huang, Y.C.; Liu, H.M. [Dept. of Radiology, National Taiwan University Hospital, Taipei (Taiwan); Hwu, W.L. [Dept. of Medical Genetics, National Taiwan University Hospital, Taipei (Taiwan)

    2001-10-01

    A 42-year-old man presented with a history of repeated episodes of consciousness disturbance for 5 years. The MRI showed abnormally high signal intensities on T2-weighted images at bilateral cingulate gyri, temporal lobes and insular regions, mimicking the finding of herpes simplex encephalitis. Hyperammonemia was disclosed. Serial work-up led to the diagnosis of adult-onset citrullinemia, deficiency of argininosuccinate synthetase. The clinical symptoms improved after diet control and medication. Follow-up MRI showed resolution of the abnormal signal intensities. The MRI findings of citrullinemia and other urea-cycle defects might be attributed to hyperammonemic encephalopathy, but the manifestations were varied. Similar distribution of the abnormalities in the MRI could be found in some reported cases and indicates probably vulnerable sites of hyperammonemic brain injury. (orig.)

  13. Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. Adult Growth Hormone Deficiency Study Group

    DEFF Research Database (Denmark)

    Attanasio, A F; Lamberts, S W; Matranga, A M

    1997-01-01

    The onset of adult GH deficiency may be during either adulthood (AO) or childhood (CO), but potential differences have not previously been examined. In this study the baseline and GH therapy (12.5 micrograms/kg per day) data from CO (n = 74; mean age 29 yr) and AO (n = 99; mean age 44 yr) GH-defi...

  14. The impact of obesity on medication use and expenditures among nonelderly adults with asthma.

    Science.gov (United States)

    Sarpong, Eric M

    2014-08-01

    Obesity contributes substantially to health resource use and costs. This study examines the impact of obesity on medication use and expenditures among nonelderly adults with asthma using the Medical Expenditure Panel Survey. Obese classes II/III individuals were more likely to have current asthma, seek treatment for asthma, use more medications, and have higher medication and health care expenditures compared with normal weight individuals. Multivariate results indicate that if obese classes II/III were normal weight the probability of asthma treatment would decrease by 8.0 percentage points. Conditional on any asthma treatment, if obese classes II/III were normal weight the mean number of total prescribed medications would decrease by 19.42 fills, and expected expenditures on total prescribed medications and health care would decrease by $1,738.68 and $3,682.58, respectively. These results suggest that, all else equal, reduction in body weight may help reduce health resource use and expenditures for nonelderly adults with asthma.

  15. Culture-specific programs for children and adults from minority groups who have asthma.

    Science.gov (United States)

    McCallum, Gabrielle B; Morris, Peter S; Brown, Ngiare; Chang, Anne B

    2017-08-22

    People with asthma who come from minority groups often have poorer asthma outcomes, including more acute asthma-related doctor visits for flare-ups. Various programmes used to educate and empower people with asthma have previously been shown to improve certain asthma outcomes (e.g. adherence outcomes, asthma knowledge scores in children and parents, and cost-effectiveness). Models of care for chronic diseases in minority groups usually include a focus of the cultural context of the individual, and not just the symptoms of the disease. Therefore, questions about whether tailoring asthma education programmes that are culturally specific for people from minority groups are effective at improving asthma-related outcomes, that are feasible and cost-effective need to be answered. To determine whether culture-specific asthma education programmes, in comparison to generic asthma education programmes or usual care, improve asthma-related outcomes in children and adults with asthma who belong to minority groups. We searched the Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, Embase, review articles and reference lists of relevant articles. The latest search fully incorporated into the review was performed in June 2016. Randomised controlled trials (RCTs) comparing the use of culture-specific asthma education programmes with generic asthma education programmes, or usual care, in adults or children from minority groups with asthma. Two review authors independently selected, extracted and assessed the data for inclusion. We contacted study authors for further information if required. In this review update, an additional three studies and 220 participants were added. A total of seven RCTs (two in adults, four in children, one in both children and adults) with 837 participants (aged from one to 63 years) with asthma from ethnic minority groups were eligible for inclusion in this review. The methodological quality of

  16. Insulin resistance as a predictor of incident asthma-like symptoms in adults

    DEFF Research Database (Denmark)

    Thuesen, B H; Husemoen, L L N; Hersoug, L-G

    2009-01-01

    BACKGROUND: There is accumulating evidence that obesity is associated with an increased risk of asthma. It has been hypothesized that insulin resistance may be involved in obesity-induced asthma, but till date there is no prospective data on this issue. OBJECTIVE: To investigate the association...... of obesity and insulin resistance with the incidence of asthma-like symptoms in adults. METHODS: Out of a random sample of 12 934 persons from a general population, 6784 (52.5%) were included and participated in a health examination in 1999-2001. After 5 years they were re-invited and 4516 (66.......6%) participated at follow-up. At baseline three obesity measures were considered: body mass index, waist circumference, and waist-to-hip ratio. In addition, fasting glucose and insulin were measured for determination of insulin resistance. Information on asthma-like symptoms at baseline and follow-up were...

  17. Management of asthma in adults: do the patients get what they need--and want?

    DEFF Research Database (Denmark)

    Backer, V; Ulrik, Charlotte Suppli; Harving, H;

    2007-01-01

    Suboptimal asthma control may be caused by a combination of factors, such as nonadherence to guidelines, lack of compliance, and poor asthma education. The aim was to assess patients' knowledge of asthma and different management strategies, including patients' attitudes toward involvement...... in treatment decisions. The participants (n=509) were recruited from all parts of Denmark through a web-based panel (Zapera Danmarkspanel). A questionnaire concerning asthma knowledge, compliance, and treatment was fulfilled through the Internet. Among the participating adult asthmatic patients, signs...... function measured and peak flow monitoring was reported by 5%. Written action plans were provided for 12% of patients and 50% had had their inhaler technique checked. Although 59% of patients were instructed to adjust their controller therapy if needed, only 23% reported that they had done so...

  18. Risk of asthma in adult twins with type 2 diabetes and increased body mass index

    DEFF Research Database (Denmark)

    Thomsen, S F; Duffy, D L; Kyvik, K O

    2011-01-01

    AIM: To examine the relationship between asthma, type 2 diabetes and increased body mass index (BMI) in adult twins. METHODS: We performed record linkage between questionnaire-defined asthma and BMI, and hospital discharge diagnoses of type 2 diabetes in 34,782 Danish twins, 20-71 years of age....... RESULTS: The risk of asthma was increased in subjects with type 2 diabetes relative to nondiabetic subjects both in men (13.5%vs 7.5%), P = 0.001 and in women (16.6%vs 9.6%), P = 0.001. The result remained significant after adjustment for age, BMI, smoking, symptoms of chronic bronchitis, marital status...... and zygosity, men: OR = 1.70 (1.07-2.70), P = 0.026; women: OR = 1.88 (1.24-2.85), P = 0.003. In this analysis, BMI remained a highly significant predictor for asthma independently of diabetes status in women, P

  19. The impact of asthma control on salivary cortisol level in adult asthmatics.

    Science.gov (United States)

    Shin, Yoo Seob; Liu, Jing Nan; Kim, Joo-Hee; Nam, Young-Hee; Choi, Gil Soon; Park, Hae-Sim

    2014-09-01

    Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of this study is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206 adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma Control Test (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5±15.3 years with mean asthma duration of 9.1±11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients (68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%±18.4%, and the methacholine PC20 was 9.6±8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9±3.6, and there were 71 (34.5%) patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantly lower FEV1 (84.6%±17.6% vs 91.1%±18.5%, P=0.018), lower AQOL scores (46.0±13.9 vs 73.8±26.3, Pcortisol levels (0.14±0.08 vs 0.18±0.11 µg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels (P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17±0.12 vs 0.16±0.08, P=0.725) when analyzed according to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring the morning salivary cortisol level might be a simple and new way to assess asthma control status.

  20. A pharmacy management service for adults with asthma: a cluster randomised controlled trial.

    Science.gov (United States)

    Wong, Lai-Yan; Chua, Siew-Siang; Husin, Abdul-Rahman; Arshad, Hanisah

    2017-05-03

    Although clinical guidelines are available for the management of asthma, this health condition is still poorly managed in many countries. To assess the effects of a Pharmacy Management Service (PharMS) on asthma control of adult patients. This study comprised of a cluster randomised controlled trial (RCT) that was conducted from April 2014 to July 2015 at four government health clinics. The control participants received usual pharmacy service, while the intervention participants were recruited into the PharMS. Each participant was monitored for 6 months, and the outcome measures included asthma control using the Asthma Control Test (ACT), inhaler technique using a checklist and medication adherence using the Malaysian Medication Adherence Scale. A total of 157 participants were recruited: 77 in the control and 80 in the intervention group. At the end of the study, 90% of the intervention participants achieved well-controlled asthma compared to 28.6% in the control group (P < 0.001). The differences in the proportion of participants with correct inhaler technique was also significant, with an adjusted effect size of 0.953 (P < 0.001). In addition, the intervention participants showed significantly higher medication adherence than the control group (92.5% versus 45.5%, P < 0.001). The Generalised Estimated Equation analysis further confirmed that the PharMS (P < 0.001) was significantly related to an improvement in the ACT scores. A community-based asthma management program, the PharMS, that provided asthma education and skill training by a trained pharmacist, resulted in positive and significant improvements in clinical and management outcomes of adult asthma patients.

  1. Prevalence of and Risk Factors for Asthma in Off-Reserve Aboriginal Children and Adults in Canada

    Directory of Open Access Journals (Sweden)

    Hsiu-Ju Chang

    2012-01-01

    Full Text Available Only a few studies have investigated asthma morbidity in Canadian Aboriginal children. In the present study, data from the 2006 Aboriginal Peoples Survey were used to determine the prevalence and risk factors for asthma in Canadian Aboriginal children six to 14 years of age and adults 15 to 64 years of age living off reserve. The prevalence of asthma was 14.3% in children and 14.0% in adults. Children and adults with Inuit ancestry had a significantly lower prevalence of asthma than those with North American Indian and Métis ancestries. Factors significantly associated with ever asthma in children included male sex, allergy, low birth weight, obesity, poor dwelling conditions and urban residence. In adults, factors associated with ever asthma varied among Aboriginal groups; however, age group, sex and urban residence were associated with ever asthma in all four Aboriginal groups. The prevalence of asthma was lower in Aboriginal children and higher in Aboriginal adults compared with that reported for the Canadian population. Variation in the prevalence of and risk factors for asthma among Aboriginal ancestry groups may be related to genetic and environmental factors that require further investigation.

  2. Prenatal Particulate Air Pollution and Asthma Onset in Urban Children. Identifying Sensitive Windows and Sex Differences.

    Science.gov (United States)

    Hsu, Hsiao-Hsien Leon; Chiu, Yueh-Hsiu Mathilda; Coull, Brent A; Kloog, Itai; Schwartz, Joel; Lee, Alison; Wright, Robert O; Wright, Rosalind J

    2015-11-01

    The influence of particulate air pollution on respiratory health starts in utero. Fetal lung growth and structural development occurs in stages; thus, effects on postnatal respiratory disorders may differ based on timing of exposure. We implemented an innovative method to identify sensitive windows for effects of prenatal exposure to particulate matter with a diameter less than or equal to 2.5 μm (PM2.5) on children's asthma development in an urban pregnancy cohort. Analyses included 736 full-term (≥37 wk) children. Each mother's daily PM2.5 exposure was estimated over gestation using a validated satellite-based spatiotemporal resolved model. Using distributed lag models, we examined associations between weekly averaged PM2.5 levels over pregnancy and physician-diagnosed asthma in children by age 6 years. Effect modification by sex was also examined. Most mothers were ethnic minorities (54% Hispanic, 30% black), had 12 or fewer years of education (66%), and did not smoke in pregnancy (80%). In the sample as a whole, distributed lag models adjusting for child age, sex, and maternal factors (education, race and ethnicity, smoking, stress, atopy, prepregnancy obesity) showed that increased PM2.5 exposure levels at 16-25 weeks gestation were significantly associated with early childhood asthma development. An interaction between PM2.5 and sex was significant (P = 0.01) with sex-stratified analyses showing that the association exists only for boys. Higher prenatal PM2.5 exposure at midgestation was associated with asthma development by age 6 years in boys. Methods to better characterize vulnerable windows may provide insight into underlying mechanisms.

  3. Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods.

    Science.gov (United States)

    Maciejewski, Matthew L; Chen, Shih-Yin; Au, David H

    2009-07-01

    Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies. We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods. Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective. Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.

  4. Dietary intake of flavonoids and asthma in adults

    NARCIS (Netherlands)

    Garcia, V.; Arts, I.C.W.; Sterne, J.A.C.; Thompson, R.L.; Shaheen, S.O.

    2005-01-01

    Epidemiological studies have suggested that a high consumption of apples may protect against asthma and chronic obstructive pulmonary disease. This effect has been attributed to their high flavonoid content, but few studies have investigated the relationship between flavonoid intake and obstructive

  5. Challenges in the Management of Bronchial Asthma Among Adults ...

    African Journals Online (AJOL)

    to be relevant for inclusion in the review was retrieved. .... education of patients by the health‑care providers to enable the ..... Policy 2011;99:250‑4. 12. ... Practice of asthma management among doctors in south‑east ... hospital in Malaysia.

  6. Dietary intake of flavonoids and asthma in adults

    NARCIS (Netherlands)

    Garcia, V.; Arts, I.C.W.; Sterne, J.A.C.; Thompson, R.L.; Shaheen, S.O.

    2005-01-01

    Epidemiological studies have suggested that a high consumption of apples may protect against asthma and chronic obstructive pulmonary disease. This effect has been attributed to their high flavonoid content, but few studies have investigated the relationship between flavonoid intake and obstructive

  7. Experimental study on onset of asthma like symptoms by diesel exhausts particles (DEP); Diesel haiki biryushi (DEP) ni yoru zensoku yo byotai no hassho ni kansuru jikkenteki kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    Sagai, M. [National Research Inst. for Environmental Studies, Tsukuba (Japan)

    1995-03-10

    By experiments using mice, facts which suggest that diesel exhaust particles (DEP) produce a large amount of superoxide (O2{sup -})by chemical or biochemical reaction and this superoxide causes lung injury with a result of asthma like symptoms. It is verified, by the use of mice, that four fundamental symptoms of the onset of asthma like symptoms, i.e. rise of blood vessel permeability, mucus hypersecretion, inflammation accompanying chronic eosinophil infiltration, and airway hyperresponsiveness, are caused by DEP. It can be derived from the fact that mankind asthma may also be caused by DEP. The knowledge obtained by this experiment, which indicates that DEP causes chronic inflammation accompanying eosinophil infiltration, may add important information to the study on the causal relationship of DEP with asthma symptoms. 31 refs., 15 figs., 1 tab.

  8. Protective effect of early prenatal stress on the induction of asthma in adult mice: Sex-specific differences.

    Science.gov (United States)

    Vargas, Mauro Henrique Moraes; Campos, Natália Evangelista; de Souza, Rodrigo Godinho; da Cunha, Aline Andrea; Nuñez, Nailê Karine; Pitrez, Paulo Márcio; Donadio, Márcio Vinícius Fagundes

    2016-10-15

    Adversities faced during the prenatal period can be related to the onset of diseases in adulthood. However, little is known about the effects on the respiratory system. This study aimed to evaluate the effects of prenatal stress in two different time-points during pregnancy on pulmonary function and on the inflammatory profile of mice exposed to an asthma model. Male and female BALB/c mice were divided into 3 groups: control (CON), prenatal stress from the second week of pregnancy (PNS1) and prenatal stress on the last week of pregnancy (PNS2). Both PNS1 and PNS2 pregnant females were submitted to restraint stress. As adults, fear/anxiety behaviors were assessed, and animals were subjected to an asthma model induced by ovalbumin. Pulmonary function, inflammatory parameters in bronchoalveolar lavage (BAL) and histology were evaluated. There was a significant decrease in the number of entries and time spent in the central quadrant on the open field test for the PNS1 animals. Females (PNS1) showed improved pulmonary function (airway resistance, tissue damping and pulmonary elastance), significant increase in the percentage of neutrophils and lymphocytes and a decrease in eosinophils when compared to controls. There was a significant decrease in inflammatory cytokines in BAL of both males (IL-5 and IL-13) and females (IL-4, IL-5 and IL-13) from PNS1 and PNS2 when compared to the CON group. Prenatal stress starting from the beginning of pregnancy reduces the impact of asthma development in adult female mice, showing an improved pulmonary function and a lower inflammatory response in the lungs.

  9. Asthma as a risk factor for zoster in adults: A population-based case-control study.

    Science.gov (United States)

    Kwon, Hyo Jin; Bang, Duk Won; Kim, Eun Na; Wi, Chung-Il; Yawn, Barbara P; Wollan, Peter C; Lahr, Brian D; Ryu, Euijung; Juhn, Young J

    2016-05-01

    We recently reported an increased risk of herpes zoster (shingles or zoster) in children with asthma, but little is known about whether the same is true for adults with asthma. We determined whether asthma is associated with an increased risk of zoster in adults. This study was designed as a population-based case-control study. Zoster cases during the study period were identified among adults (aged ≥50 years) who resided in Olmsted County, Minnesota. We compared the frequency of asthma between zoster cases and birthday- and sex-matched control subjects (1:2 matching) without a history of zoster. Asthma status was ascertained based on predetermined criteria. A conditional logistic regression model was used to assess the association of asthma with risk of zoster. A total of 371 zoster cases and their 742 matched control subjects were enrolled. Of the 371 cases, 246 (66%) were female, 348 (94%) were white, and the mean ± SD age was 66.8 ± 10.7 years. Twenty-three percent (n = 87) of zoster cases had a history of asthma compared with 15% (n = 114) of control subjects. Controlling for pertinent covariates and confounders, there was a significant association between a history of asthma and risk of zoster (adjusted odds ratio, 1.70; 95% CI, 1.20-2.42; P = .003). The population attributable risk percentage for asthma was about 10%. Asthma is an unrecognized risk factor for zoster in adults. Consideration should be given to immunizing adults with asthma aged more than 50 years as a target group. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  10. Coverage and predictors of adherence to influenza vaccination among Spanish children and adults with asthma.

    Science.gov (United States)

    Jiménez-García, R; Hernández-Barrera, V; Carrasco-Garrido, P; de Andrés, A Lopez; de Miguel Diez, J; de Miguel, A Gil

    2010-02-01

    Influenza infections are frequently implicated in the exacerbation of asthma. The aim of this study was to assess vaccination coverage among Spanish children and adults with asthma and to describe the factors associated(predictors) with vaccination, using data from the 2006 Spanish National Health Survey. Subjects were classified as asthma sufferers if they answered affirmatively to the question, "Has your doctor told you that you (or your child) currently suffer from asthma?" Influenza vaccination status was assessed via the question, "Did you (or your child) have a flu shot in the latest campaign?" The following were analyzed as possible predictors of influenza vaccination: sociodemographic variables;health-related and lifestyle variables; variables linked to the use of healthcare services. A total of 38,329 records of individuals aged over 6 months were analyzed, and of these, 2,337 were classified as asthmatics. Among asthmatics, overall influenza coverage was 32.6% (18.8% among children, and 38% among adults).Whereas the sole variable that predicted a higher coverage among children was parents' negative perception of their child's health, among adults positive predictors included older age, lower educational level, suffering from concomitant chronic disease, and non- or ex-smoker status. The overall influenza vaccination coverage among subjects who suffer from asthma in Spain is very low. Special attention should be paid to children, younger adults, and smokers, since these subjects have the lowest adherence to vaccine recommendations. Strategies focused on health-care providers and patients must be urgently implemented to improve influenza vaccination coverage among asthma sufferers.

  11. Evaluation of a statewide medical home program on children and young adults with asthma.

    Science.gov (United States)

    Hamburger, Robert; Berhane, Zekarias; Gatto, Molly; Yunghans, Suzanne; Davis, Renee K; Turchi, Renee M

    2015-01-01

    Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated. We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures. A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.

  12. The Contribution of Interleukin-10 Promoter Genotypes to Susceptibility to Asthma in Adults.

    Science.gov (United States)

    Hsia, Te-Chun; Chang, Wen-Shin; Wang, Shengyu; Shen, Te-Chun; Hsiao, Wan-Yun; Liu, Chin-Jung; Liang, Shinn-Jye; Chen, Wei-Chun; Tu, Chih-Yen; Tsai, Chia-Wen; Hsu, Chin-Mu; Bau, Da-Tian

    2015-01-01

    Accumulating evidence suggests that inflammatory processes play a role in asthma etiology, and interleukin-10 (IL10) is an important immunosuppressive cytokine. The present study aimed to evaluate the contribution of IL10 promoter A-1082G (rs1800896), T-819C (rs3021097), A-592C (rs1800872) genetic polymorphisms to the risk of asthma in Taiwan. Associations of three IL10 polymorphic genotypes with risk of asthma were investigated among 198 patients with asthma and 453 non-asthmatic healthy controls, by polymerase chain reaction-restriction fragment length polymorphism genotyping method. The results showed that the percentages of TT, TC and CC for IL-10 T-819C genotypes were differentially represented at 63.1%, 32.3% and 4.6%, respectively, in the patient group and 53.0%, 36.4% and 10.6%, respectively, in the healthy control group (p for trend=0.0114). The CC genotype carriers were at lower risk for asthma (odds ratio=0.36, 95% confidence interval=0.17-0.76, p=0.0055). There was no difference in the distribution of A-1082G or A-592C genotype between the asthma and non-asthma groups. The protective effects of the CC genotype were obvious among males, but not females, and those aged 25 up to 40 years but not those aged over 40 years. The CC genotype of IL10 T-819C compared to the TT genotype may have a protective effect on asthma risk in younger adults (25-40 years old), and males in Taiwan. Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  13. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

    DEFF Research Database (Denmark)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J

    2015-01-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe ast...

  14. A preliminary study on the association of single nucleotide polymorphisms of interleukin 4 (IL4, IL13, IL4 receptor alpha (IL4Rα & Toll-like receptor 4 (TLR4 genes with asthma in Indian adults

    Directory of Open Access Journals (Sweden)

    Parisa Davoodi

    2015-01-01

    Full Text Available Background & objectives: Interleukin 4 (IL4 and IL13 genes are believed to be responsible for inflammation of the airways in asthmatics. These share a common receptor component called IL4Rα which is another potentially important candidate gene linked to asthma phenotypes. Another gene Toll-like receptor 4 (TLR4 might affect the incidence or progression of asthma through the expression of proinflammatory genes. Several single nucleotide polymorphisms (SNPs in IL4, IL13, IL4Rα and TLR4 have been reported to be linked to asthma or related phenotypes in several ethnic populations using linkage studies and association studies. However, the results have not been consistent. We investigated five SNPs (C-589T and C-33T of IL4, G+2044A of IL13, A+1902G of IL4Rα, and A+896G of TLR4 in patients with adult onset asthma to evaluate their role in manifestation and severity of asthma. Methods: Adult (>18 yr of age patients with asthma (n=100 and healthy controls (n=50 were included in the study. Genotyping was performed using sequenom MassARRAY technology. Results: The mutant alleles of the C-589T and C-33T SNPs in the promoter region of IL4 were present in 4 per cent patients with asthma but absent from the control group suggesting that the variations in IL4 may contribute to asthma occurrence. The SNPs of other genes were seen in both controls and patients. Interpretation & conclusions: The results suggest the possible association between the genetic distribution of C-589T and C-33T SNPs of IL4 with asthma in Indian adults.

  15. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults: Executive Summary

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  16. National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society.

    OpenAIRE

    1995-01-01

    OBJECTIVE--To ascertain the standard of care for hospital management of acute severe asthma in adults. DESIGN--Questionnaire based retrospective multicentre survey of case records. SETTING--36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland. PATIENTS--All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management. MAIN MEASURES--Main recommendations ...

  17. [Acute hepatitis in a patient with adult onset Still disease].

    Science.gov (United States)

    Gallo, M; Calvanese, A; Oscuro, F; Gallo, A; Caso, P; Annibale, E; Farinato, N

    1997-04-01

    Liver abnormalities in the course of Adult Onset Still's Disease (AOSD), both in form of hepatomegaly and elevation of hepatic enzymes, have been reported in up to three-quarts of the affected patients. These abnormalities may reflect disease activity or may be induced by drugs. Only in a few of this patients a liver biopsy was performed. However liver histology has shown, generally, non specific abnormalities or even normal pictures. We have recently observed a 47-year-old woman with a febrile illness started five months before, who after pertinent investigation was diagnosed as AOSD (according to criteria of Yamaguchi et al.). Apart from laboratory findings characteristic of an inflammatory disease, in absence of drug therapies the biochemical data showed raised levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and aminoglutamil transferase. Serological tests for either viral hepatitis viruses (HAV, HBV, HCV) or other viruses were negative. Ultrasonographic examination of gallbladder and bile ducts did not find gallstones or other abnormalities. A liver biopsy was performed, which histopathologic examination showed moderate fatty methamorphosis with focal areas of hepatocellular swelling with minimal necrosis, mild Kuppfer cell hyperplasia, portal and sinusoidal infiltrates of mononuclear cells. This picture consisted with the diagnosis of an acute unspecific reactive hepatitis.

  18. Comparing endophenotypes in adult-onset primary torsion dystonia.

    LENUS (Irish Health Repository)

    Bradley, David

    2012-02-01

    Adult-onset primary torsion dystonia (AOPTD) has an autosomal dominant pattern of inheritance with markedly reduced penetrance; the genetic causes of most forms of AOPTD remain unknown. Endophenotypes, markers of sub-clinical gene carriage, may be of use detecting non-manifesting gene carriers in relatives of AOPTD patients. The aim of this study was to compare the utility of the spatial discrimination threshold (SDT) and temporal discrimination threshold (TDT) as potential endophenotypes in AOPTD. Data on other published candidate endophenotypes are also considered. Both SDT and TDT testing were performed in 24 AOPTD patients and 34 of their unaffected first degree relatives; results were compared with normal values from a control population. Of the 24 AOPTD patients 5 (21%) had abnormal SDTs and 20 (83%) had abnormal TDTs. Of the 34 first degree relatives 17 (50%) had abnormal SDTs and 14 (41%) had abnormal TDTs. Discordant results on SDT and TDT testing were found in 16 (67%) AOPTD patients and 21 (62%) first degree relatives. TDT testing has superior sensitivity compared to SDT testing in AOPTD patients; although false positive TDTs are recognised, the specificity of TDT testing in unaffected relatives is not determinable. The high level of discordance between the two tests probably relates methodological difficulties with SDT testing. The SDT is an unreliable AOPTD endophenotype; TDT testing fulfils criteria for a reliable endophenotype with a high sensitivity.

  19. Treatment of adult-onset still's disease: up to date.

    Science.gov (United States)

    Yoo, Dae Hyun

    2017-09-01

    Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology, and approximately 60-70% of patients may develop a chronic polyphasic form of the disease or a chronic polyarthritis. Due to rarity of disease, treatment of AOSD is not based on controlled study, but on case based experiences. Areas covered: Recently, the application of anti-cytokine therapy based on pathophysiology has resulted in significant progress in the treatment of AOSD. Here, we review current knowledge of the pathogenesis, disease progression, currently available biomarkers of disease activity, standard therapeutic agents, utility of biologic agents, future perspectives for treatment and treatment of macrophage activation syndrome. Expert commentary: Accumulated clinical data suggest that chronic disease can be classified into two subsets: dominant systemic disease, and the arthritis subgroup. IL-1 inhibitors may be more efficient for systemic manifestations and IL-6 inhibitor for both joint involvement and systemic manifestations. TNF inhibitors must be reserved for patients with purely chronic articular manifestations. For ideal management of patients, it is very important to measure disease activity accurately during follow up, but no single biomarker has been classified as ideal. New therapeutic agents and composite biomarkers are needed to improve the outcome of patients with AOSD by identifying disease activity properly.

  20. Warming up Improves Speech Production in Patients with Adult Onset Myotonic Dystrophy

    Science.gov (United States)

    de Swart, B.J.M.; van Engelen, B.G.M.; Maassen, B.A.M.

    2007-01-01

    This investigation was conducted to study whether warming up decreases myotonia (muscle stiffness) during speech production or causes adverse effects due to fatigue or exhaustion caused by intensive speech activity in patients with adult onset myotonic dystrophy. Thirty patients with adult onset myotonic dystrophy (MD) and ten healthy controls…

  1. Obesity's Effects on the Onset of Functional Impairment among Older Adults

    Science.gov (United States)

    Jenkins, Kristi Rahrig

    2004-01-01

    Purpose: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health…

  2. Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype

    DEFF Research Database (Denmark)

    Hawa, Mohammed I; Kolb, Hubert; Schloot, Nanette

    2013-01-01

    OBJECTIVESSpecific autoantibodies characterize type 1 diabetes in childhood but are also found in adult-onset diabetes, even when initially non-insulin requiring, e.g., with latent autoimmune diabetes (LADA). We aimed to characterize adult-onset autoimmune diabetes.RESEARCH DESIGN AND METHODSWe c...

  3. Inverse Relationship Between Helicobacter Pylori Infection and Asthma Among Adults Younger than 40 Years

    OpenAIRE

    Lim, Joo Hyun; Kim, Nayoung; Lim, Seon Hee; Kwon, Jin-Won; Shin, Cheol Min; Chang, Yoon-Seok; Kim, Joo Sung; Jung, Hyun Chae; Cho, Sang-Heon

    2016-01-01

    Abstract Recent studies have suggested that Helicobacter pylori could prevent allergic disease, particularly in children. However, whether this is true in adults is controversial. The aim of this study was to investigate whether there is negative association between H. pylori infection and asthma among adults in an area with a high prevalence of H. pylori. This was a cross-sectional study using 2011 health surveillance data. Blood samples were taken from all participants to measure serum H. p...

  4. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults.

    Science.gov (United States)

    Denning, David W; Pleuvry, Alex; Cole, Donald C

    2013-05-01

    Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and may lead to chronic pulmonary aspergillosis (CPA) yet global burdens of each have never been estimated. Antifungal therapy has a place in the management of ABPA and is the cornerstone of treatment in CPA, reducing morbidity and probably mortality. We used the country-specific prevalence of asthma from the Global Initiative for Asthma (GINA) report applied to population estimates to calculate adult asthma cases. From five referral cohorts (China, Ireland, New Zealand, Saudi Arabia and South Africa), we estimated the prevalence of ABPA in adults with asthma at 2.5% (range 0.72-3.5%) (scoping review). From ABPA case series, pulmonary cavitation occurred in 10% (range 7-20%), allowing an estimate of CPA prevalence worldwide using a deterministic scenario-based model. Of 193 million adults with active asthma worldwide, we estimate that 4,837,000 patients (range 1,354,000-6,772,000) develop ABPA. By WHO region, the ABPA burden estimates are: Europe, 1,062,000; Americas, 1,461,000; Eastern Mediterranean, 351,000; Africa, 389,900; Western Pacific, 823,200; South East Asia, 720,400. We calculate a global case burden of CPA complicating ABPA of 411,100 (range 206,300-589,400) at a 10% rate with a 15% annual attrition. The global burden of ABPA potentially exceeds 4.8 million people and of CPA complicating ABPA ˜ 400,000, which is more common than previously appreciated. Both conditions respond to antifungal therapy justifying improved case detection. Prospective population and clinical cohort studies are warranted to more precisely ascertain the frequency of ABPA and CPA in different locations and ethnic groups and validate the model inputs.

  5. Physical activity and incident asthma in adults: the HUNT Study, Norway

    Science.gov (United States)

    Brumpton, Ben M; Langhammer, Arnulf; Ferreira, Manuel A R; Chen, Yue; Mai, Xiao-Mei

    2016-01-01

    Objective We aimed to investigate the associations of physical activity and change in physical activity with incident asthma in a cohort of Norwegian adults. Design We conducted a prospective cohort study using data on self-reported physical activity from 3 waves of the Nord-Trøndelag Health Study. Physical activity was reported at the first and second surveys (1985–1986 and 1995–1997). Physical activity was defined from the second survey as inactive or active and the active group was further defined as very low, low, moderate and high. Change in physical activity was defined from the first and second surveys. Setting A large population-based health survey in Norway. Participants We followed 18 894 adults over 11 years who were free from asthma at baseline in 1995–1997. Outcome Incident asthma was reported in the third survey (2006–2008). Results The cumulative incidence of asthma was 3.6% over the 11 years. The adjusted OR for incident asthma among active participants compared with inactive participants was 0.95 (95% CI 0.69 to 1.34). The adjusted OR for those who were active in the first or second survey versus those who were inactive in both surveys was 0.64 (95% CI 0.34 to 1.38); however, this association was strongly attenuated in sensitivity analysis (OR 0.93, 95% CI 0.38 to 3.09). Conclusions We did not observe statistically significant associations of physical activity or change in physical activity with incident asthma in adults over the 11-year follow-up. PMID:27864254

  6. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial.

    Science.gov (United States)

    Castro, Mario; King, Tonya S; Kunselman, Susan J; Cabana, Michael D; Denlinger, Loren; Holguin, Fernando; Kazani, Shamsah D; Moore, Wendy C; Moy, James; Sorkness, Christine A; Avila, Pedro; Bacharier, Leonard B; Bleecker, Eugene; Boushey, Homer A; Chmiel, James; Fitzpatrick, Anne M; Gentile, Deborah; Hundal, Mandeep; Israel, Elliot; Kraft, Monica; Krishnan, Jerry A; LaForce, Craig; Lazarus, Stephen C; Lemanske, Robert; Lugogo, Njira; Martin, Richard J; Mauger, David T; Naureckas, Edward; Peters, Stephen P; Phipatanakul, Wanda; Que, Loretta G; Sheshadri, Ajay; Smith, Lewis; Solway, Julian; Sullivan-Vedder, Lisa; Sumino, Kaharu; Wechsler, Michael E; Wenzel, Sally; White, Steven R; Sutherland, E Rand

    2014-05-01

    In asthma and other diseases, vitamin D insufficiency is associated with adverse outcomes. It is not known if supplementing inhaled corticosteroids with oral vitamin D3 improves outcomes in patients with asthma and vitamin D insufficiency. To evaluate if vitamin D supplementation would improve the clinical efficacy of inhaled corticosteroids in patients with symptomatic asthma and lower vitamin D levels. The VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma) randomized, double-blind, parallel, placebo-controlled trial studying adult patients with symptomatic asthma and a serum 25-hydroxyvitamin D level of less than 30 ng/mL was conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by January 2014. After a run-in period that included treatment with an inhaled corticosteroid, 408 patients were randomized. Oral vitamin D3 (100,000 IU once, then 4000 IU/d for 28 weeks; n = 201) or placebo (n = 207) was added to inhaled ciclesonide (320 µg/d). If asthma control was achieved after 12 weeks, ciclesonide was tapered to 160 µg/d for 8 weeks, then to 80 µg/d for 8 weeks if asthma control was maintained. The primary outcome was time to first asthma treatment failure (a composite outcome of decline in lung function and increases in use of β-agonists, systemic corticosteroids, and health care). Treatment with vitamin D3 did not alter the rate of first treatment failure during 28 weeks (28% [95% CI, 21%-34%] with vitamin D3 vs 29% [95% CI, 23%-35%] with placebo; adjusted hazard ratio, 0.9 [95% CI, 0.6-1.3]). Of 14 prespecified secondary outcomes, 9 were analyzed, including asthma exacerbation; of those 9, the only statistically significant outcome was a small difference in the overall dose of ciclesonide required to maintain asthma control (111.3 µg/d [95% CI, 102.2-120.4 µg/d] in the vitamin D3 group vs 126

  7. Sporadic late-onset nemaline myopathy as a rare cause of slowly progressive muscle weakness with young adult onset.

    Science.gov (United States)

    Maeda, Meiko Hashimoto; Ohta, Hikari; Izutsu, Koji; Shimizu, Jun; Uesaka, Yoshikazu

    2015-05-01

    Sporadic late-onset nemaline myopathy (SLONM) is a rare intractable acquired myopathy characterized by progressive muscle weakness and atrophy, usually with middle to late adult onset. Autologous peripheral blood stem cell transplantation (auto-PBSCT) has been reported to be a promising treatment for SLONM. In this study we performed clinical characterization, muscle histopathological analysis, and muscle power monitoring after auto-PBSCT in a 27-year-old HIV-negative man with monoclonal gammopathy. He showed improved muscle strength after treatment with high-dose melphalan and auto-PBSCT. Considering the recent reports of successful treatment of SLONM, early and correct diagnosis of this condition in association with monoclonal gammopathy is important. SLONM should be added to the list of diseases to consider in the differential diagnosis of progressive muscle weakness with young adult onset. © 2014 Wiley Periodicals, Inc.

  8. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey.

    Science.gov (United States)

    Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas de Almeida, Jose Miguel; De Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean-Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C

    2015-07-01

    The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on

  9. Adult-onset autoimmune diabetes: current knowledge and implications for management.

    Science.gov (United States)

    Buzzetti, Raffaella; Zampetti, Simona; Maddaloni, Ernesto

    2017-09-08

    Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus.

  10. Inverse Relationship Between Helicobacter Pylori Infection and Asthma Among Adults Younger than 40 Years: A Cross-Sectional Study.

    Science.gov (United States)

    Lim, Joo Hyun; Kim, Nayoung; Lim, Seon Hee; Kwon, Jin-Won; Shin, Cheol Min; Chang, Yoon-Seok; Kim, Joo Sung; Jung, Hyun Chae; Cho, Sang-Heon

    2016-02-01

    Recent studies have suggested that Helicobacter pylori could prevent allergic disease, particularly in children. However, whether this is true in adults is controversial. The aim of this study was to investigate whether there is negative association between H. pylori infection and asthma among adults in an area with a high prevalence of H. pylori.This was a cross-sectional study using 2011 health surveillance data. Blood samples were taken from all participants to measure serum H. pylori IgG status. Information on demographics, socioeconomic status, and medical history, including asthma and other allergic conditions were collected by a questionnaire.Of the 15,032 patients, 9492 (63.1%) had a history of H. pylori infection, 359 (2.4%) had asthma, and 3277 (21.8%) had other allergic conditions. H. pylori infection was positively correlated with age (OR, 1.050; 95% CI, 1.047-1.053, P Asthma history was positively correlated with age (OR, 1.022; 95% CI, 1.013-1.032, P asthma in the total participants (OR, 1.041; 95% CI, 1.021-1.062, P asthma (OR, 0.503; 95% CI, 0.280-0.904, P = 0.021). Other allergic conditions were not related with H. pylori infection among the total and those asthma among young adults suggests that the underlying immune mechanism induced by H. pylori infection may affect allergic reactions associated with asthma in young adults.

  11. Adult onset Still's disease: review of 41 cases.

    Science.gov (United States)

    Riera, E; Olivé, Al; Narváez, J; Holgado, S; Santo, P; Mateo, L; Bianchi, M M; Nolla, J M

    2011-01-01

    To describe the clinical, laboratory and radiological features, treatment and prognosis of patients with adult onset Still's disease (AOSD). Specific clinical features were retrospectively recorded in 41 patients fulfilling the Yamaguchi criteria. Patients were reviewed in two academic hospitals with a referral area of 700,000-1,000,000 inhabitants. Laboratory tests including haemogram, ferritin, biochemistry and autoimmunity were reviewed. Radiological studies, treatment and ACR functional class were determined. Forty-one patients with AOSD were identified, 25 of whom were female. Mean age at diagnosis: 38.19 years (range 17-68). Feverish polyarthritis was the most common clinical presentation. Acute phase reactants were invariably high in all patients. Serum ferritin levels were elevated in 86% of patients. Anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) were negative in all patients except one. The course of the disease was monocyclic in 44% of the patients, polycyclic in 26%, and chronic articular in 30%. ACR class was as follows: 29 (72.5%) class I, 7 (17.5%) class II, 2 (5%) class III and 2 (5%) class IV. As for the treatment received, aspirin or NSAIDs controlled the disease in eight patients (19.5%) and high-dose corticosteroids (0.5-1 mg/kg/day) in 32 (78%). Almost half of the patients (49%) required an additional diseasemodifying agent, usually methotrexate. Finally, in seven of them (17%) a biological treatment with TNF-α or specially anti-IL-1 had to be added to control the disease. The clinical and laboratory findings were similar to previous studies. Anti-CCP antibodies were almost always negative. A monocyclic course was associated with a good prognosis. Most of the patients were in ACR functional class I and II. Biological agents were required in 7 patients (17%).

  12. A review of standard pharmacological therapy for adult asthma – Steps 1 to 5.

    Science.gov (United States)

    Patel, Mitesh; Shaw, Dominick

    2015-05-01

    The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimize the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into steps 1 to 5, with each step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids that reduce airway inflammation. Systemic treatments include medications that act on specific biological pathways, such as the leukotriene or immunoglobulin E pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at steps 1 to 5 based on British guidelines and consider future options for new treatments.

  13. Asthma prevalence disparities and differences in sociodemographic associations with asthma, between Native Hawaiian/Other Pacific Islander, Asian, and White adults in Hawaii - Behavioral Risk Factor Surveillance System (BRFSS), 2001-2010.

    Science.gov (United States)

    Jessop, H; Li, D; Katz, A R; Hurwitz, E L

    2017-03-30

    Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults. We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios. Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender. Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study's model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii.

  14. Asthma in Children

    Science.gov (United States)

    ... have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness, ...

  15. Comparison of outcomes in adults with pediatric-onset morphea and those with adult-onset morphea: a cross-sectional study from the morphea in adults and children cohort.

    Science.gov (United States)

    Condie, Daniel; Grabell, Daniel; Jacobe, Heidi

    2014-12-01

    Few studies have examined outcomes in adults with pediatric-onset morphea. The objective of the present study was to compare clinical outcomes and health-related quality of life (HRQOL) in adults with onset of morphea in childhood to those in patients with adult onset of morphea. Participants in the study were drawn from the Morphea in Adults and Children cohort and included 68 adults with pediatric-onset morphea and 234 patients with adult-onset morphea. Outcome measures included the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT), physical examination findings, and HRQOL questionnaires. Adults with pediatric-onset morphea were younger, had longer disease duration, and were more likely to have the linear subtype of morphea. Patients with pediatric-onset disease were less likely to have active disease. Among patients with active disease, those with pediatric-onset morphea had less disease activity as measured by the LoSCAT. Patients with pediatric-onset disease had higher severity of disease damage when measured by the physician's global assessment of damage, but had similar levels of disease damage when measured by the Localized Scleroderma Skin Damage Index. Patients with pediatric-onset disease had more favorable HRQOL scores for all measures, all of which were statistically significantly different from those in patients with adult-onset morphea. Adults with pediatric-onset morphea differ from patients with adult-onset disease with respect to disease subtype, severity of disease activity and damage, and levels of HRQOL. Copyright © 2014 by the American College of Rheumatology.

  16. Relationships between adult asthma and oxidative stress markers and pH in exhaled breath condensate: a systematic review.

    Science.gov (United States)

    Aldakheel, F M; Thomas, P S; Bourke, J E; Matheson, M C; Dharmage, S C; Lowe, A J

    2016-06-01

    Oxidative stress has a recognized role in the pathophysiology of asthma. Recently, interest has increased in the assessment of pH and airway oxidative stress markers. Collection of exhaled breath condensate (EBC) and quantification of biomarkers in breath samples can potentially indicate lung disease activity and help in the study of airway inflammation, and asthma severity. Levels of oxidative stress markers in the EBC have been systematically evaluated in children with asthma; however, there is no such systematic review conducted for adult asthma. A systematic review of oxidative stress markers measured in EBC of adult asthma was conducted, and studies were identified by searching MEDLINE and SCOPUS databases. Sixteen papers met the inclusion criteria. Concentrations of exhaled hydrogen ions, nitric oxide products, hydrogen peroxide and 8-isoprostanes were generally elevated and related to lower lung function tests in adults with asthma compared to healthy subjects. Assessment of EBC markers may be a noninvasive approach to evaluate airway inflammation, exacerbations, and disease severity of asthma, and to monitor the effectiveness of anti-inflammatory treatment regimens. Longitudinal studies, using standardized analytical techniques for EBC collection, are required to establish reference values for the interpretation of EBC markers in the context of asthma.

  17. Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus: A systematic review and meta-analysis.

    Science.gov (United States)

    Bundhun, Pravesh Kumar; Kumari, Alka; Huang, Feng

    2017-09-01

    Systemic lupus erythematosus (SLE) affects people in childhood (childhood onset) or in adulthood (adult onset). Observational studies that have previously compared childhood-onset versus adult-onset SLE were often restricted to 1 ethnic group, or to a particular area, with a small sample size of patients. We aimed to systematically compare childhood-onset versus adult-onset SLE through a meta-analysis. Electronic databases were searched for relevant publications comparing childhood-onset with adult-onset SLE. Adverse clinical features were considered as the endpoints. The Newcastle Ottawa Scale (NOS) was used to assess the methodological quality of the studies and RevMan software (version 5.3) was used to carry out this analysis whereby risk ratios (RRs) and 95% confidence intervals (95% CIs) were used as the statistical parameters. A total number of 10,261 participants (1560 participants with childhood-onset SLE and 8701 participants with adult-onset SLE) were enrolled. Results of this analysis showed that compared with childhood-onset SLE, pulmonary involvement was significantly higher with adult-onset SLE (RR: 1.51, 95% CI: 1.18-1.93; P = .001), whereas renal involvement was significantly higher with childhood-onset SLE (RR: 0.65, 95% CI: 0.55-0.77; P = .00001). Raynaud phenomenon and photosensitivity were significantly higher in adult-onset SLE (RR: 1.29, 95% CI: 1.04-1.60; P = .02) and (RR: 1.08, 95% CI: 1.01-1.17; P = .03), respectively. Malar rash significantly favored adult-onset SLE (RR: 0.84, 95% CI: 0.75-0.94; P = .002). Childhood-onset SLE was associated with significantly higher hemolytic anemia, thrombocytopenia, leukocytopenia, and lymphopenia. Seizure and ocular manifestations were significantly higher with childhood-onset SLE (RR: 0.57, 95% CI: 0.47-0.70; P = .00001) and (RR: 0.34, 95% CI: 0.21-0.55; P = .00001), respectively, whereas pleuritis was significantly higher with adult-onset SLE (RR: 1.45, 95% CI: 1

  18. Late Onset of Prescription Drug Abuse or Dependence Among Older Adults: Implications for Treatment

    Directory of Open Access Journals (Sweden)

    Kathy Lay

    2007-12-01

    Full Text Available Prescription drug abuse and dependence is an increasing concern for older adults. This article describes issues specific to older adults with late onset abuse or dependence on prescription sedatives and/or opiates.The older adult with late onset should not be viewed as having the same issues as individuals who have a life pat- tern of drug and alcohol abuse/dependence.A chart review of older adults in a treatment program contrasts late onset prescription dependence clients (n=12 and early onset addiction clients (n=104 and outlines differences and similarities between the two samples. Social workers need to understand the specific and changing needs of older adults as they relate to assessment and treatment of drug abuse and dependence.

  19. Exposure to house dust phthalates in relation to asthma and allergies in both children and adults.

    Science.gov (United States)

    Ait Bamai, Yu; Shibata, Eiji; Saito, Ikue; Araki, Atsuko; Kanazawa, Ayako; Morimoto, Kanehisa; Nakayama, Kunio; Tanaka, Masatoshi; Takigawa, Tomoko; Yoshimura, Takesumi; Chikara, Hisao; Saijo, Yasuaki; Kishi, Reiko

    2014-07-01

    Although an association between exposure to phthalates in house dust and childhood asthma or allergies has been reported in recent years, there have been no reports of these associations focusing on both adults and children. We aimed to investigate the relationships between phthalate levels in Japanese dwellings and the prevalence of asthma and allergies in both children and adult inhabitants in a cross-sectional study. The levels of seven phthalates in floor dust and multi-surface dust in 156 single-family homes were measured. According to a self-reported questionnaire, the prevalence of bronchial asthma, allergic rhinitis, allergic conjunctivitis, and atopic dermatitis in the 2 years preceding the study was 4.7%, 18.6%, 7.6%, and 10.3%, respectively. After evaluating the interaction effects of age and exposure categories with generalized liner mixed models, interaction effects were obtained for DiNP and bronchial asthma in adults (Pinteraction=0.028) and for DMP and allergic rhinitis in children (Pinteraction=0.015). Although not statistically significant, children had higher ORs of allergic rhinitis for DiNP, allergic conjunctivitis for DEHP, and atopic dermatitis for DiBP and BBzP than adults, and liner associations were observed (Ptrendphthalates levels collected from multi-surfaces. This study suggests that the levels of DMP, DEHP, DiBP, and BBzP in floor dust were associated with the prevalence of allergic rhinitis, conjunctivitis, and atopic dermatitis in children, and children are more vulnerable to phthalate exposure via household floor dust than are adults. The results from this study were shown by cross-sectional nature of the analyses and elaborate assessments for metabolism of phthalates were not considered. Further studies are needed to advance our understanding of phthalate toxicity.

  20. The relationship between CAG repeat length and age of onset differs for Huntington's disease patients with juvenile onset or adult onset.

    Science.gov (United States)

    Andresen, J Michael; Gayán, Javier; Djoussé, Luc; Roberts, Simone; Brocklebank, Denise; Cherny, Stacey S; Cardon, Lon R; Gusella, James F; MacDonald, Marcy E; Myers, Richard H; Housman, David E; Wexler, Nancy S

    2007-05-01

    Age of onset for Huntington's disease (HD) varies inversely with the length of the disease-causing CAG repeat expansion in the HD gene. A simple exponential regression model yielded adjusted R-squared values of 0.728 in a large set of Venezuelan kindreds and 0.642 in a North American, European, and Australian sample (the HD MAPS cohort). We present evidence that a two-segment exponential regression curve provides a significantly better fit than the simple exponential regression. A plot of natural log-transformed age of onset against CAG repeat length reveals this segmental relationship. This two-segment exponential regression on age of onset data increases the adjusted R-squared values by 0.012 in the Venezuelan kindreds and by 0.035 in the HD MAPS cohort. Although the amount of additional variance explained by the segmental regression approach is modest, the two slopes of the two-segment regression are significantly different from each other in both the Venezuelan kindreds [F(2, 439) = 11.13, P= 2 x 10(-5)] and in the HD MAPS cohort [F(2, 688) = 38.27, P= 2 x 10(-16)]. In both populations, the influence of each CAG repeat on age of onset appears to be stronger in the adult-onset range of CAG repeats than in the juvenile-onset range.

  1. Juvenile rheumatoid arthritis and asthma, but not childhood-onset systemic lupus erythematosus are associated with FCRL3 polymorphisms in Mexicans.

    Science.gov (United States)

    Ramírez-Bello, J; Jiménez-Morales, S; Espinosa-Rosales, F; Gómez-Vera, J; Gutiérrez, A; Velázquez Cruz, R; Baca, V; Orozco, L

    2013-04-01

    A regulatory single nucleotide polymorphism located in the 5' region (-169T/C) of the Fc receptor-like 3 (FCRL3_3) gene has been associated with both susceptibility and protection in immune diseases. This case-control study aimed to evaluate the association between FCRL3 polymorphisms and juvenile rheumatoid arthritis (JRA), asthma, and childhood-onset systemic lupus erythematosus (SLE) in a Mexican population. We performed PCR-based genotyping to identify four FCRL3 single nucleotide polymorphisms (FCRL3_3 to FCRL3_6) in patients with JRA (n=202), asthma (n=239), or childhood-onset SLE (n=377), and healthy controls (n=400). The case-control analysis showed a male-gender dependent association between the FCRL3_3C, FCRL3_5C, and FCRL3_6A alleles and either JRA (OR=0.57, p=0.003; OR=0.55, p=0.002; OR=0.53, p=0.0007, respectively) or asthma (OR=0.72, p=0.04; OR=0.74, p=0.05; OR=0.70, p=0.02, respectively). As expected, minor alleles of these SNPs with the CGCA haplotype were also significantly associated with JRA (OR=0.35, p=0.00005) and asthma (OR=0.61, p=0.007). We found no association between FCRL3 SNPs or haplotypes and childhood-onset SLE. These results supported the notion that FCRL3 is involved in the etiology of several immune diseases. Our results also suggested that SNPs located in the FCRL3 gene were protective against JRA and asthma in male Mexican patients.

  2. Adult-onset Still's disease with atypical cutaneous manifestations

    Science.gov (United States)

    Narváez Garcia, Francisco Javier; Pascual, María; López de Recalde, Mercè; Juarez, Pablo; Morales-Ivorra, Isabel; Notario, Jaime; Jucglà, Anna; Nolla, Joan M.

    2017-01-01

    Abstract The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests available, and diagnosis is usually based on a symptom complex and the well-described typical evanescent rash seen in the majority of patients. However, in recent years, other atypical cutaneous manifestations of AOSD have been reported. These atypical skin eruptions often present in addition to the typical evanescent rash but may also be the only skin manifestation, resulting in delayed diagnosis because of under-recognition. In this study, we present 3 new cases of AOSD with atypical cutaneous manifestations diagnosed during a 30-year period in our department and review 78 additional cases previously reported (PubMed 1990–2016). These 81 patients form the basis of the present analysis. The overall prevalence of atypical cutaneous manifestations in our AOSD population was 14%. These manifestations may appear at any time over the course of the disease, and usually occur in patients who have persistent and severe disease, with a considerable frequency of clinical complications (23%), including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome. The most representative and frequent lesion among the nonclassical skin rashes is the development of persistent pruritic papules and/or plaques. Interestingly, these lesions show a distinctive histological pattern. Other, less frequently observed lesions include urticaria and urticaria-like eruptions, generalized or widespread non-pruritic persistent erythema, vesiculopustular eruptions, a widespread peau d’orange appearance of the skin, and edema of the eyelids mimicking dermatomyositis without any accompanying skin lesion. The great majority of these patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy

  3. Differences between early and late onset adult depression

    DEFF Research Database (Denmark)

    Drachmann Bukh, Jens; Bock, Camilla; Vinberg, Maj

    2011-01-01

    episode depression were systematically recruited. Characteristics including psychiatric co-morbidity, personality disorders and traits, stressful life events prior to onset, family history, and treatment outcome were assessed by structured interviews and compared by chi-square tests for categorical data...... prevalence of co-morbid personality disorders, higher levels of neuroticism, and a lower prevalence of stressful life events preceding onset compared to patients with later age-of-onset. There were no differences in severity of the depressive episode, treatment outcome or family loading of psychiatric......, t-tests for continuous parametric data and Mann-Whitney U-test for continuous nonparametric data. Logistic and multiple regression analyses were used to adjust the analyses for potentially confounding variables. Results: Patients with early onset of depression were characterised by a higher...

  4. Self-Management Behaviors among Older Adults with Asthma: Associations with Health Literacy

    Science.gov (United States)

    Federman, Alex D.; Wolf, Michael S.; Sofianou, Anastasia; Martynenko, Melissa; O’Connor, Rachel; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2014-01-01

    Background/Objectives: Older adults asthmatics experience high rates of morbidity and mortality yet little is known about their self-management behaviors. We examined self-management behaviors, including medication adherence and inhaler technique, among older adults and their association with health literacy. Design: Observational cohort study. Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three Federally Qualified Health Centers in New York City, NY and Chicago, IL. Participants: Adults with moderate or severe persistent asthma, ages 60 years and older (n=433). Measurements: Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Results: The mean age was 67 years and 36% had marginal or low health literacy. Adherence was low (38%) overall and worse among individuals with low health literacy (22% vs. 47%, p<0.0001) and after adjusting for demographic factors and health status (odds ratio [OR] 0.48, 95% confidence [CI] 0.31-0.73). Similarly, inhaler technique was poor: only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse among those with low health literacy (MDI technique: OR 0.57, 95% CI 0.38-0.85; DPI technique: OR 0.42, 95% CI 0.25 to 0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion: Adherence to medications and inhaler technique are poor among older asthmatics, and worse among those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique, and use low-literacy communication strategies to support self-management in older asthmatics. PMID:24779482

  5. Atopy is a risk factor for adult asthma in urban community of Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    O M Ige

    2012-01-01

    Full Text Available Rationale: Factors affecting asthma course are not clearly elucidated in urban communities in developing countries. Furthermore, the interaction between factors such as atopy, environmental exposure, urbanization, and helminthic infections in modulating asthma have not been well investigated. Objectives: To determine factors, which affect asthma in adults being evaluated at urban tertiary health center of Southwestern part of Nigeria. Materials and Methods: A random sample of 24 (12 males, 12 females consecutive asthmatics seen in the Outpatient Pulmonary Clinic of University College Hospital of Ibadan and 27 (13 males, 14 females age and gender-matched controls underwent evaluation, which included blood tests for eosinophils, serum IgE, allergy skin tests to eight common environmental allergens, and spirometry. The modified version of the questionnaire of the International study of Asthma and Allergies in Children (ISAAC Phase III used by the same study group of researchers in Nigeria was used to assess the asthma symptoms. Wilcoxon sign-rank tests were used to compare eosinophil counts, percentage eosinophils, and allergic skin test between the two groups, while paired t test was used to compare spirometry variables. Results: Asthmatics had significantly more positive skin reaction to house dust mite and mould than controls (P<0.05. Total serum IgE was also significantly higher in asthmatics than in controls (mean 210 vs 60 IU/mL; P=0.003. However, no significant differences were observed in total eosinophil counts. No significant difference in the degree of intestinal helminthes infection in the two groups, which means stool parasitism was similar. FEV 1 % was significantly lower in asthmatics (P=0.02 but FEV 1 was similar between the two groups (P=0.02. Conclusion: The elevated levels of IgE and positive skin reactions to some of the common environmental allergens suggests an important role of atopy in the expression of asthma in this

  6. Analysis on related risk factors of onset of asthma in children%儿童哮喘发病的相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    何少为; 薛幸

    2012-01-01

    目的:探讨儿童哮喘发病的相关危险因素,为预防儿童哮喘提供理论依据.方法:选择2008年12月~ 2011年12月120例哮喘患儿为病例组,同时选择无呼吸道疾病的儿童240例为对照组,采用单因素和多因素非条件Logistic回归分析法,分析儿童哮喘发病的危险因素.结果:过敏史、特应性、家族有哮喘史、家族有过敏史、近期有严重的呼吸道感染和父母一方吸烟是儿童哮喘发病的相关危险因素.结论:对于有哮喘危险因素的患儿,应预防呼吸道感染,减少过敏原的接触,防止被动吸烟.%Objective; To explore the related risk factors of onset of asthma in children, and provide a theoretical basis for preventing childhood asthma. Methods: One hundred and twenty children with asthma were selected as case group from December 2008 to December 2011 , and 240 children without respiratory diseases during the same period were selected as control group; non - conditional univariate and multivariate logistic regression analysis were adopted to analyze the risk factors of onset of asthma in children. Results: The related risk factors of onset of asthma in children included allergic history, idiocrasy, family histories of asthma and allergy, severe respiratory infection in the recent period, and smoking of one of the parent. Conclusion; For the children with risk factors of asthma, respiratory infection should be prevented, exposure to allergens should be reduced, and passive smoking should be avoided.

  7. Is Chronic Asthma Associated with Shorter Leukocyte Telomere Length at Midlife?

    Science.gov (United States)

    Shalev, Idan; Sears, Malcolm R.; Hancox, Robert J.; Lee Harrington, Hona; Houts, Renate; Moffitt, Terrie E.; Sugden, Karen; Williams, Benjamin; Poulton, Richie; Caspi, Avshalom

    2014-01-01

    Rationale: Asthma is prospectively associated with age-related chronic diseases and mortality, suggesting the hypothesis that asthma may relate to a general, multisystem phenotype of accelerated aging. Objectives: To test whether chronic asthma is associated with a proposed biomarker of accelerated aging, leukocyte telomere length. Methods: Asthma was ascertained prospectively in the Dunedin Multidisciplinary Health and Development Study cohort (n = 1,037) at nine in-person assessments spanning ages 9–38 years. Leukocyte telomere length was measured at ages 26 and 38 years. Asthma was classified as life-course-persistent, childhood-onset not meeting criteria for persistence, and adolescent/adult-onset. We tested associations between asthma and leukocyte telomere length using regression models. We tested for confounding of asthma-leukocyte telomere length associations using covariate adjustment. We tested serum C-reactive protein and white blood cell counts as potential mediators of asthma-leukocyte telomere length associations. Measurements and Main Results: Study members with life-course-persistent asthma had shorter leukocyte telomere length as compared with sex- and age-matched peers with no reported asthma. In contrast, leukocyte telomere length in study members with childhood-onset and adolescent/adult-onset asthma was not different from leukocyte telomere length in peers with no reported asthma. Adjustment for life histories of obesity and smoking did not change results. Study members with life-course-persistent asthma had elevated blood eosinophil counts. Blood eosinophil count mediated 29% of the life-course-persistent asthma-leukocyte telomere length association. Conclusions: Life-course-persistent asthma is related to a proposed biomarker of accelerated aging, possibly via systemic eosinophilic inflammation. Life histories of asthma can inform studies of aging. PMID:24956257

  8. [Kimura's disease: an unrecognized cause of adult-onset nephrotic syndrome with minimal change disease].

    Science.gov (United States)

    Shehwaro, N; Langlois, A-L; Gueutin, V; Debchi, L; Charlotte, F; Rouvier, P; Rottembourg, J; Izzedine, H

    2014-02-01

    Kimura's disease (KD) is an angiolymphoid proliferative disorder of soft tissue with eosinophilia, with a predilection for head and neck regions in young Oriental men. Kidney disease is thought to be rare in KD. About a case of adult-onset nephrotic syndrome with minimal change disease, we comment Kimura's disease and its associated kidney damage. Kimura disease should be suspected and included in the diagnosis of adult-onset nephrotic syndrome with minimal change disease.

  9. Dioxin (TCDD) Induces Epigenetic Transgenerational Inheritance of Adult Onset Disease and Sperm Epimutations

    OpenAIRE

    Mohan Manikkam; Rebecca Tracey; Carlos Guerrero-Bosagna; Skinner, Michael K.

    2012-01-01

    Environmental compounds can promote epigenetic transgenerational inheritance of adult-onset disease in subsequent generations following ancestral exposure during fetal gonadal sex determination. The current study examined the ability of dioxin (2,3,7,8-tetrachlorodibenzo[p]dioxin, TCDD) to promote epigenetic transgenerational inheritance of disease and DNA methylation epimutations in sperm. Gestating F0 generation females were exposed to dioxin during fetal day 8 to 14 and adult-onset disease...

  10. Comparison of Neuropsychological Functioning Between Adults With Early- and Late-Onset DSM-5 ADHD.

    Science.gov (United States)

    Lin, Yu-Ju; Gau, Susan Shur-Fen

    2017-09-01

    We aimed to compare the visually dependent neuropsychological functioning among adults with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD who recalled symptom onset by and after age 7 and non-ADHD controls. We divided the participants, aged 17 to 40 years, into three groups-(a) ADHD, onset DSM-5 criteria for diagnosing adult ADHD are not too lax regarding neuropsychological functioning.

  11. Sporadic adult onset primary torsion dystonia is a genetic disorder by the temporal discrimination test.

    LENUS (Irish Health Repository)

    Kimmich, Okka

    2012-02-01

    Adult-onset primary torsion dystonia is an autosomal dominant disorder with markedly reduced penetrance; patients with sporadic adult-onset primary torsion dystonia are much more prevalent than familial. The temporal discrimination threshold is the shortest time interval at which two stimuli are detected to be asynchronous and has been shown to be abnormal in adult-onset primary torsion dystonia. The aim was to determine the frequency of abnormal temporal discrimination thresholds in patients with sporadic adult-onset primary torsion dystonia and their first-degree relatives. We hypothesized that abnormal temporal discrimination thresholds in first relatives would be compatible with an autosomal dominant endophenotype. Temporal discrimination thresholds were examined in 61 control subjects (39 subjects <50 years of age; 22 subjects >50 years of age), 32 patients with sporadic adult-onset primary torsion dystonia (cervical dystonia n = 30, spasmodic dysphonia n = 1 and Meige\\'s syndrome n = 1) and 73 unaffected first-degree relatives (36 siblings, 36 offspring and one parent) using visual and tactile stimuli. Z-scores were calculated for all subjects; a Z > 2.5 was considered abnormal. Abnormal temporal discrimination thresholds were found in 1\\/61 (2%) control subjects, 27\\/32 (84%) patients with adult-onset primary torsion dystonia and 32\\/73 (44%) unaffected relatives [siblings (20\\/36; 56%), offspring (11\\/36; 31%) and one parent]. When two or more relatives were tested in any one family, 22 of 24 families had at least one first-degree relative with an abnormal temporal discrimination threshold. The frequency of abnormal temporal discrimination thresholds in first-degree relatives of patients with sporadic adult-onset primary torsion dystonia is compatible with an autosomal dominant disorder and supports the hypothesis that apparently sporadic adult-onset primary torsion dystonia is genetic in origin.

  12. Outdoor PM2.5, Ambient Air Temperature, and Asthma Symptoms in the Past 14 Days among Adults with Active Asthma.

    Science.gov (United States)

    Mirabelli, Maria C; Vaidyanathan, Ambarish; Flanders, W Dana; Qin, Xiaoting; Garbe, Paul

    2016-12-01

    Relationships between air quality and health are well-described, but little information is available about the joint associations between particulate air pollution, ambient temperature, and respiratory morbidity. We evaluated associations between concentrations of particulate matter ≤ 2.5 μm in diameter (PM2.5) and exacerbation of existing asthma and modification of the associations by ambient air temperature. Data from 50,356 adult respondents to the Asthma Call-back Survey from 2006-2010 were linked by interview date and county of residence to estimates of daily averages of PM2.5 and maximum air temperature. Associations between 14-day average PM2.5 and the presence of any asthma symptoms during the 14 days leading up to and including the interview date were evaluated using binomial regression. We explored variation by air temperature using similar models, stratified into quintiles of the 14-day average maximum temperature. Among adults with active asthma, 57.1% reported asthma symptoms within the past 14 days, and 14-day average PM2.5 ≥ 7.07 μg/m3 was associated with an estimated 4-5% higher asthma symptom prevalence. In the range of 4.00-7.06 μg/m3 of PM2.5, each 1-μg/m3 increase was associated with a 3.4% [95% confidence interval (CI): 1.1, 5.7] increase in symptom prevalence; across categories of temperature from 1.1 to 80.5°F, each 1-μg/m3 increase was associated with increased symptom prevalence (1.1-44.4°F: 7.9%; 44.5-58.6°F: 6.9%; 58.7-70.1°F: 2.9%; 70.2-80.5°F: 7.3%). These results suggest that each unit increase in PM2.5 may be associated with an increase in the prevalence of asthma symptoms, even at levels as low as 4.00-7.06 μg/m3. Citation: Mirabelli MC, Vaidyanathan A, Flanders WD, Qin X, Garbe P. 2016. Outdoor PM2.5, ambient air temperature, and asthma symptoms in the past 14 days among adults with active asthma. Environ Health Perspect 124:1882-1890; http://dx.doi.org/10.1289/EHP92.

  13. ADULT ONSET ACUTE OTITIS MEDIA - A PRELIMINARY REPORT

    Directory of Open Access Journals (Sweden)

    Mukta

    2014-05-01

    Full Text Available Acute otitis media is a common disease of children with typical symptomatology & is not infrequent in adults. Literature available on adult acute otitis media is limited. This study has been carried out to assess the presentation, progression & outcome of disease in adults. 90 patients presenting with signs & symptoms consistent with acute otitis media were examined, evaluated & followed up. Earache was the commonest symptom present in 65 patients. Spontaneous perforation was present in 37 patients. Earache, ear discharge & hearing loss are the commonest symptoms in adults & rate of spontaneous perforation is higher compared to children.

  14. Adolescent-onset substance use disorders predict young adult mortality

    Science.gov (United States)

    Clark, Duncan B.; Martin, Christopher S.; Cornelius, Jack R.

    2009-01-01

    This study determined whether adolescent-onset substance use disorders (SUDs) prospectively predicted early mortality. Among 870 adolescents, 21 young adulthood deaths were observed. Adolescent SUDs, as well as gender, ethnic group, hazardous substance use, and drug trafficking, predicted these deaths. Among African American males with SUDs, 23% died by age 25. PMID:18486875

  15. Polymorphisms and haplotypes of the chromosome locus 17q12-17q21.1 contribute to adult asthma susceptibility in Slovenian patients.

    Science.gov (United States)

    Žavbi, Mateja; Korošec, Peter; Fležar, Matjaž; Škrgat Kristan, Sabina; Marc Malovrh, Mateja; Rijavec, Matija

    2016-06-01

    One of the major asthma susceptibility loci is 17q12-17q21.1, but the relationship between this locus and adult asthma is unclear. Association analysis of 13 single nucleotide polymorphisms (SNPs) and haplotypes from 17q12-17q21.1 was performed in 418 adult patients with asthma and 288 controls from Slovenia. Single SNP analysis revealed only marginal associations with adult asthma for SNPs located in GSDMA, GSDMB, ORMDL3 and ZPBP2 genes, and rs7219080 was the most highly associated. Analyses of asthma phenotypes found no association with atopy or lung function, but rs2305480 and rs8066582 were associated with childhood asthma and rs9916279 was associated with asthma in smokers. Notably, haplotypes consisting of rs9916279, rs8066582, rs1042658, and rs2302777 harbouring PSMD3, CSF3 and MED24 genes were highly associated with asthma. The four most common haplotypes, TCCG, TTTA, CCCA and TTCA, were more frequent in patients with asthma, whereas TTCG, TCCA, TCTA and TTTG were more frequent in controls. Only 3% of asthma patients belonged to haplotypes TTCG, TCCA, TCTA and TTTG compared with nearly one-third (31%) of controls. Associations confirmed that the 17q12-17q21.1 locus harbours a genetic determinant for asthma risk in adults and suggest that in addition to the previously known ORMDL3-GSDM locus, CSF3-PSMD3-MED24 also plays a role in asthma pathogenesis.

  16. Is there an association between postural balance and pulmonary function in adults with asthma?

    Directory of Open Access Journals (Sweden)

    Vivian Pinto de Almeida

    2013-11-01

    Full Text Available OBJECTIVE: Asthma may cause systemic repercussions due to its severity and the effects of treatment. Our objective was to compare posture, balance, functional capacity, and quality of life (QOL according to the severity of disease, as assessed by pulmonary function levels. METHOD: This cross-sectional study evaluated fifty individuals with asthma. We compared two groups of adult individuals who were divided according to the median of the forced expiratory volume in one second (FEV1 as follows: group A  =  FEV1>74% predicted; group B  =  FEV1<74% predicted. All patients underwent the following tests: spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide (DLco, respiratory muscle strength, posture assessment, stabilometry, six-minute walking distance (6MWD, and QOL. RESULTS: All pulmonary function variables exhibited statistically significant differences between the two groups, except for the DLco. The maximal inspiratory pressure (MIP, maximal expiratory pressure (MEP, and 6MWD were lower in group B. The maximal mediolateral velocity and the mediolateral displacement were significantly different, while the postural changes and QOL were similar between the groups. CONCLUSIONS: In adult individuals with asthma, the pulmonary function is associated with balance control in the mediolateral direction but does not influence the postural changes or QOL.

  17. Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database.

    Science.gov (United States)

    Lee, Yoo Ju; Kwon, Sun-Hong; Hong, Sung-Hyun; Nam, Jin Hyun; Song, Hyun Jin; Lee, Jong Seop; Lee, Eui-Kyung; Shin, Ju-Young

    2017-03-01

    Although asthma exacerbation comprises a large burden of the total asthma-related costs, few studies have examined the frequency and cost of acute exacerbation according to asthma severity. This study investigated asthma-related health care utilization and costs according to the severity of asthma. We conducted a descriptive study using the national health insurance claims database between January 1 and December 31, 2014. We included adult patients with asthma (18 years of age and older) who had ≥2 claims with for an asthma diagnosis and were prescribed ≥1 asthma medications. They were classified into 3 asthma severity levels (level 1 = mild, level 2 = moderate, and level 3 = severe), based on individual medication prescriptions. Acute exacerbation was defined as having a corticosteroid burst, an emergency department visit, or hospitalization. Health care utilization, acute exacerbation, and direct costs associated with asthma were compared according to asthma severity levels. Of the 36,687 adult asthma patients, level 1 had the largest proportion of patients (81.2%), followed by level 2 (18.2%), and level 3 (0.6%). The average number of asthma-related outpatient visits was 4.5 for level 1, 7.2 for level 2, and 11.9 for level 3 (P cost per patient was $174 for level 1, $634 for level 2, and $1635 for level 3 (P costs associated with asthma exacerbation dramatically increased and accounted for 15.1% of the total cost in level 1 patients, 19.5% in level 2 patients, and 40.8% in level 3 patients (P costs of acute exacerbation increased as asthma severity increased. In patients with severe asthma, acute exacerbation and the relative cost ratio in South Korea were higher than those in other countries. Proper management is required to avoid acute exacerbations and to reduce the burden of asthma, particularly in patients with severe asthma. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  18. Cyclic Vomiting Syndrome (CVS: is there a difference based on onset of symptoms - pediatric versus adult?

    Directory of Open Access Journals (Sweden)

    Kumar Nilay

    2012-05-01

    Full Text Available Abstract Background Cyclic Vomiting Syndrome (CVS is a well-recognized functional gastrointestinal disorder in children but its presentation is poorly understood in adults. Genetic differences in pediatric-onset (presentation before age 18 and adult-onset CVS have been reported recently but their clinical features and possible differences in response to therapy have not been well studied. Methods This was a retrospective review of 101 CVS patients seen at the Medical College of Wisconsin between 2006 and 2008. Rome III criteria were utilized to make the diagnosis of CVS. Results Our study population comprised of 29(29% pediatric-onset and 72 (71% adult-onset CVS patients. Pediatric-onset CVS patients were more likely to be female (86% vs. 57%, p = 0.005 and had a higher prevalence of CVS plus (CVS + neurocognitive disorders as compared to adult-onset CVS patients (14% vs. 3%, p = 0.05. There was a longer delay in diagnosis (10 ± 7 years in the pediatric-onset group when compared to (5 ± 7 years adult-onset CVS group (p = 0.001. Chronic opiate use was less frequent in the pediatric-onset group compared to adult-onset patients (0% vs. 23%, p = 0.004. Aside from these differences, the two groups were similar with regards to their clinical features and the time of onset of symptoms did not predict response to standard treatment. The majority of patients (86% responded to treatment with tricyclic antidepressants, anticonvulsants (topiramate, coenzyme Q-10, and L-carnitine. Non-response to therapy was associated with coalescence of symptoms, chronic opiate use and more severe disease as characterized by longer episodes, greater number of emergency department visits in the year prior to presentation, presence of disability and non-compliance on univariate analysis. On multivariate analysis, only compliance to therapy was associated with a response. (88% vs. 38%, Odds Ratio, OR 9.6; 95% Confidence Interval [CI], 1.18-77.05. Conclusion Despite reported

  19. Adult onset Hallervorden-Spatz disease with psychotic symptoms.

    Science.gov (United States)

    del Valle-López, Pilar; Pérez-García, Rosa; Sanguino-Andrés, Rosa; González-Pablos, Emilio

    2011-01-01

    Hallervorden-Spatz disease is a rare neurological disorder characterized by pyramidal and extrapyramidal manifestations, dysarthria and dementia. Its onset is usually in childhood and most patients have a fatal outcome in few years. A high percentage of cases are hereditary with a recessive autosomal pattern. In the majority of the patients reported, a mutation of the gene that encodes the pantothenate kinase (PANK2) located in the 20p13-p12.3 chromosome that causes iron storage in the basal ganglia of the brain has been found. Its diagnosis is based on clinical symptoms as well as specific MRI imaging findings. The most common psychiatric features are cognitive impairment as well as depressive symptoms. There are few documented cases with psychotic disorders. We present the case of a patient with late onset Hallervorden-Spatz disease and psychotic symptoms that preceded the development of neurological manifestations. The pathophysiology and the treatment of psychotic symptomatology are presented and discussed. Key words: Psicosis, Hallervorden-Spatz, late onset, Basal ganglia.

  20. Prevalence and severity of self-reported asthma in young adults, 1976-2004

    DEFF Research Database (Denmark)

    Browatzki, A; Ulrik, Charlotte Suppli; Lange, P

    2009-01-01

    index, especially >30 kg.m(-2), was associated with a lower percentage predicted FEV1 (pasthma and obesity on FEV1. The proportion of smokers declined from 60 to 38% (pasthma have continued......The aim of the present study was to describe the prevalence and severity of asthma in young Danish adults over three decades. Males and females aged 20-35 yrs were sampled from the population of Copenhagen for the three surveys (1976-1978, 1991-1993 and 2001-2004). A total of 3,285 (46% male......) subjects answered a questionnaire, and had their height, weight, forced expiratory volume in 1 s (FEV1) and forced vital capacity measured. The prevalence of self-reported asthma was 1.5, 4.7 and 6.9%, respectively, in the three surveys (pasthma was observed in both...

  1. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma

    DEFF Research Database (Denmark)

    Nguyen, Vivi Q; Ulrik, Charlotte S

    2016-01-01

    BACKGROUND: Maintenance therapy with oral corticosteroid (OCS) is used, although not based on evidence, for patients with severe asthma, but OCS is associated with serious adverse effects; therefore, management strategies aimed at steroid sparing are important. OBJECTIVE: To provide an update...... oral steroidsparing strategies (n = 5), the following lowered the OCS dose: Internet-based tapering strategy (44% reduction in OCS dose), inhaled corticosteroids (mometasone furoate [mean daily OCS dose reduction of 39% and 31% in patients treated with 800 mcg/day and 1600 mcg/day, respectively......), masitinib (78% reduction in OCS dose), mepolizumab (50%83% reduction in OCS dose), and omalizumab (30%64% of enrolled patients achieved a reduction in OCS dose, and one study reported a dose reduction of 45%). CONCLUSIONS: In adults with severe asthma, several corticosteroid-sparing interventions were shown...

  2. Surgical management of adult-onset cystic hygroma in the axilla

    Directory of Open Access Journals (Sweden)

    Francesca McCaffrey

    2015-01-01

    CONCLUSION: As the incidence of adult-onset cystic hygroma is rare, the nature and reporting of their management is limited. This case report contributes to the body of literature which serves to elucidate the optimal management of this perinatal condition in adults.

  3. An Interleukin 13 Polymorphism Is Associated with Symptom Severity in Adult Subjects with Ever Asthma.

    Directory of Open Access Journals (Sweden)

    Simone Accordini

    Full Text Available Different genes are associated with categorical classifications of asthma severity. However, continuous outcomes should be used to catch the heterogeneity of asthma phenotypes and to increase the power in association studies. Accordingly, the aim of this study was to evaluate the association between single nucleotide polymorphisms (SNPs in candidate gene regions and continuous measures of asthma severity, in adult patients from the general population. In the Gene Environment Interactions in Respiratory Diseases (GEIRD study (www.geird.org, 326 subjects (aged 20-64 with ever asthma were identified from the general population in Verona (Italy between 2007 and 2010. A panel of 236 SNPs tagging 51 candidate gene regions (including one or more genes was analysed. A symptom and treatment score (STS and pre-bronchodilator FEV1% predicted were used as continuous measures of asthma severity. The association of each SNP with STS and FEV1% predicted was tested by fitting quasi-gamma and linear regression models, respectively, with gender, body mass index and smoking habits as potential confounders. The Simes multiple-test procedure was used for controlling the false discovery rate (FDR. SNP rs848 in the IL13 gene region (IL5/RAD50/IL13/IL4 was associated with STS (TG/GG vs TT genotype: uncorrected p-value = 0.00006, FDR-corrected p-value = 0.04, whereas rs20541 in the same gene region, in linkage disequilibrium with rs848 (r(2 = 0.94 in our sample, did not reach the statistical significance after adjusting for multiple testing (TC/CC vs TT: uncorrected p-value = 0.0003, FDR-corrected p-value = 0.09. Polymorphisms in other gene regions showed a non-significant moderate association with STS (IL12B, TNS1 or lung function (SERPINE2, GATA3, IL5, NPNT, FAM13A only. After adjusting for multiple testing and potential confounders, SNP rs848 in the IL13 gene region is significantly associated with a continuous measure of symptom severity in adult subjects with ever

  4. An Interleukin 13 Polymorphism Is Associated with Symptom Severity in Adult Subjects with Ever Asthma.

    Science.gov (United States)

    Accordini, Simone; Calciano, Lucia; Bombieri, Cristina; Malerba, Giovanni; Belpinati, Francesca; Lo Presti, Anna Rita; Baldan, Alessandro; Ferrari, Marcello; Perbellini, Luigi; de Marco, Roberto

    2016-01-01

    Different genes are associated with categorical classifications of asthma severity. However, continuous outcomes should be used to catch the heterogeneity of asthma phenotypes and to increase the power in association studies. Accordingly, the aim of this study was to evaluate the association between single nucleotide polymorphisms (SNPs) in candidate gene regions and continuous measures of asthma severity, in adult patients from the general population. In the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (www.geird.org), 326 subjects (aged 20-64) with ever asthma were identified from the general population in Verona (Italy) between 2007 and 2010. A panel of 236 SNPs tagging 51 candidate gene regions (including one or more genes) was analysed. A symptom and treatment score (STS) and pre-bronchodilator FEV1% predicted were used as continuous measures of asthma severity. The association of each SNP with STS and FEV1% predicted was tested by fitting quasi-gamma and linear regression models, respectively, with gender, body mass index and smoking habits as potential confounders. The Simes multiple-test procedure was used for controlling the false discovery rate (FDR). SNP rs848 in the IL13 gene region (IL5/RAD50/IL13/IL4) was associated with STS (TG/GG vs TT genotype: uncorrected p-value = 0.00006, FDR-corrected p-value = 0.04), whereas rs20541 in the same gene region, in linkage disequilibrium with rs848 (r(2) = 0.94) in our sample, did not reach the statistical significance after adjusting for multiple testing (TC/CC vs TT: uncorrected p-value = 0.0003, FDR-corrected p-value = 0.09). Polymorphisms in other gene regions showed a non-significant moderate association with STS (IL12B, TNS1) or lung function (SERPINE2, GATA3, IL5, NPNT, FAM13A) only. After adjusting for multiple testing and potential confounders, SNP rs848 in the IL13 gene region is significantly associated with a continuous measure of symptom severity in adult subjects with ever

  5. A sequence variant on 17q21 is associated with age at onset and severity of asthma

    NARCIS (Netherlands)

    Halapi, Eva; Gudbjartsson, Daniel F; Jonsdottir, Gudrun M; Bjornsdottir, Unnur S; Thorleifsson, Gudmar; Helgadottir, Hafdis; Williams, Carolyn; Koppelman, Gerard H; Heinzmann, Andrea; Boezen, Hendrika; Jonasdottir, Aslaug; Blondal, Thorarinn; Gudjonsson, Sigurjon A; Jonasdottir, Adalbjorg; Thorlacius, Theodora; Henry, Amanda P; Altmueller, Janine; Krueger, Marcus; Shin, Hyoung Doo; Uh, Soo-Taek; Cheong, Hyun Sub; Jonsdottir, Brynja; Ludviksson, Bjorn R; Ludviksdottir, Dora; Gislason, David; Park, Choon-Sik; Deichmann, Klaus; Thompson, Philip J; Wjst, Matthias; Hall, Ian P; Postma, Dirkje S; Gislason, Thorarinn; Kong, Augustine; Jonsdottir, Ingileif; Thorsteinsdottir, Unnur; Stefansson, Kari

    A sequence variant (rs7216389-T) near the ORMDL3 gene on chromosome 17q21 was recently found to be associated with childhood asthma. We sought to evaluate the effect of rs7216389-T on asthma subphenotypes and its correlation with expression levels of neighboring genes. The association of rs7216389-T

  6. Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure

    NARCIS (Netherlands)

    Schuttelaar, M L A; Kerkhof, M; Jonkman, M F; Koppelman, G H; Brunekreef, B; de Jongste, J C; Wijga, A; McLean, W H I; Postma, D S

    2009-01-01

    BACKGROUND: Filaggrin gene (FLG) mutations contribute to the development of eczema and asthma, but their contribution to sensitization and hay fever remains unclear. METHODS: FLG mutations R501X, 2282del4 and R2447X were genotyped in the Prevention and Incidence of Asthma and Mite Allergy birth

  7. Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure

    NARCIS (Netherlands)

    Schuttelaar, M L A; Kerkhof, M; Jonkman, M F; Koppelman, G H; Brunekreef, B; de Jongste, J C; Wijga, A; McLean, W H I; Postma, D S

    2009-01-01

    BACKGROUND: Filaggrin gene (FLG) mutations contribute to the development of eczema and asthma, but their contribution to sensitization and hay fever remains unclear. METHODS: FLG mutations R501X, 2282del4 and R2447X were genotyped in the Prevention and Incidence of Asthma and Mite Allergy birth coho

  8. Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure.

    NARCIS (Netherlands)

    Schuttelaar, M.L.; Kerkhof, M.; Jonkman, M.F.; Koppelman, G.H.; Brunekreef, B.; de Jongste, J.C.; Wijga, A.; McLean, W.H.; Postma, D.S.

    2009-01-01

    Background: Filaggrin gene (FLG) mutations contribute to the development of eczema and asthma, but their contribution to sensitization and hay fever remains unclear. Methods: FLG mutations R501X, 2282del4 and R2447X were genotyped in the Prevention and Incidence of Asthma and Mite Allergy birth coho

  9. Association between untreated carious lesions and asthma in adults at Rabat University Hospital, Morocco: a cross sectional study.

    Science.gov (United States)

    Chala, Sanaa; Rouiffi, Saloua; Soualhi, Mouna; Bourkadi, Jamal Eddine; Abouqal, Redouane; Abdallaoui, Faïza

    2017-06-26

    Depending on risk factors, cumulative risk of developing more dental caries by age has been reported. However, the association between dental caries and asthma is less studied among adults. The aims of this study were to evaluate the severity of untreated carious lesions in a population of asthmatic adults and to evaluate the mediation of socio-economic and oral health behaviour variables. The study involved participants with diagnosed asthma (N = 100) and control (N = 100) subjects attending a tertiary hospital. Groups were matched by age and gender. Asthma was the exposure of interest. The outcome measure was the rate of carious lesions. Recorded variables included demographics, socio-economic status, tooth brushing habits and oral health status using WHO criteria. Poisson regression analysis examined the association between asthma and untreated dental caries. The adjusted model, after the inclusion of individuals' behaviours regarding oral health, social determinants and asthma, revealed a significant association between the number of untreated carious lesions and asthma (PR = 1.23; 95% CI 1.23-1.58; p carious lesions. Looking forward, better understanding of the association between asthma and oral health may require exploiting the interactions of behavioural, social determinant and biological factors.

  10. Effects of nebulized sodium cromoglycate on adult patients with severe refractory asthma.

    Science.gov (United States)

    Sano, Yasuyuki; Adachi, Mitsuru; Kiuchi, Takahiro; Miyamoto, Terumasa

    2006-03-01

    Many patients with severe refractory asthma, which is insufficiently controlled by additional high-dose of inhaled corticosteroids, require oral corticosteroids and/or immunosuppressant. Clinicians should seek for suitable medications, for its' chronic use may induce high risk of side effects. The purpose of this study was to evaluate the efficacy and safety of nebulized sodium cromoglycate (3-4 times/day) in adult severe asthmatic patients with poorly controlled asthmatic symptoms, despite treatments with high-dose inhaled corticosteroids. Adult patients with severe asthma (n=251) were enrolled in a randomized clinical trial at 30 medical centers in Japan. Isotonic saline was used as placebo. The study was conducted for 10 weeks; with initial 2 weeks of observation followed by 8 weeks of treatments. Efficacy was primarily evaluated based on improvements in morning peak expiratory flow after treatment. All patients who applied inhalation of nebulized sodium cromoglycate (SCG group) or saline (Controls) were treated with high-dose of inhaled corticosteroids (median of beclomethasone dipropionate equivalent dose: 1600 microg/days) and second-line control therapy including oral corticosteroids. There was no significant difference in morning peak expiratory flow between SCG group and controls. However, when patients were stratified into atopic and non-atopic groups, morning peak expiratory flow had significantly improved in the atopic SCG group compared to atopic Controls. Additional inhalation of nebulized sodium cromoglycate with inhaled corticosteroids is effective even in patients with severe atopic asthma. This finding shows that nebulized sodium cromoglycate is expected to be new second-line therapeutic option in severe asthma.

  11. Adult-onset hemiplegic migraine with cortical enhancement and oedema.

    Science.gov (United States)

    Cha, Y-H; Millett, D; Kane, M; Jen, J; Baloh, R

    2007-10-01

    We present genetically identical twin patients who experienced late-onset migraine with visual and somatosensory auras and later developed hemiplegic migraines associated with severe cortical oedema and enhancement. Both positron emission tomography and electroencephalography showed an increase in activity contralateral to the hemiplegic side. Brain biopsy during the attack showed reactive astrogliosis and microgliosis. Mutations in CACNA1A, ATP1A2, SLC1A3 and NOTCH3 were ruled out by sequencing. This report shows the clinical and genetic evaluation of a severe form of familial hemiplegic migraine as well as the evolution of the imaging changes.

  12. Predictors of Relapse in Adult-Onset Nephrotic Minimal Change Disease.

    Science.gov (United States)

    Lee, Hajeong; Yoo, Kyung Don; Oh, Yun Kyu; Kim, Dong Ki; Oh, Kook-Hwan; Joo, Kwon Wook; Kim, Yon Su; Ahn, Curie; Han, Jin Suk; Lim, Chun Soo

    2016-03-01

    Minimal change disease (MCD) is a well-known benign primary glomerulonephritis because of its distinct rare tendency to progress to end-stage renal disease. However, factors associated with relapse in adults are not well known. We aimed to identify predictors of relapse in adult-onset MCD patients.A retrospective cohort of 195 patients with adult-onset primary MCD with nephritic syndrome and disease onset between 1979 and 2013 was followed up for >12 months. The number of relapses was counted and predictors of relapse were analyzed.A total of 195 patients were included. Median age at diagnosis was 38 years (IQR, 23-53 years) and 113 (57.9%) were men. During 81 months (IQR, 44-153 months) of follow-up, 92% of patients achieved remission after initial treatment. However, only 60 (32.8%) did not experience a relapse and 11 patients failed to remit. Among the remaining 124 patients, 65 experienced a relapse once or twice and 59 experienced a relapse more than twice. Younger onset age, increased severity of nephrotic features such as lower serum albumin levels and higher cholesterol level were associated with relapse. Interestingly, the grade of mesangial proliferation was lower in patients who experienced a relapse. Initial combined treatment with corticosteroids (CS) and cyclophosphamide reduced the number of relapses. In addition, patients with shorter treatment duration tended to experience relapse more often. Multivariate analysis showed that younger onset age, combined mesangial proliferation, initial treatment regimen, and treatment duration were independent risk factors for relapse. Progression to end-stage renal disease was developed in only a patient.In conclusion, more than two-thirds of adult-onset nephrotic MCD patients experienced relapse, although their renal progression was rare. Younger onset age, CS without cyclophosphamide treatment, and shorter treatment duration were independent risk factors for relapse in adult-onset MCD patients.

  13. Niemann-Pick type C: focus on the adolescent/adult onset form.

    Science.gov (United States)

    Di Lazzaro, Vincenzo; Marano, Massimo; Florio, Lucia; De Santis, Stefano

    2016-11-01

    Niemann-Pick disease type C (NP-C) is an inherited sphingolipidosis characterized by progressive neurological deterioration and early mortality. The symptomatology and disease progression of NP-C are markedly affected by the age at onset of neurological manifestations, and categorization into early-infantile, late-infantile, juvenile, adolescent/adult neurological onset forms can aid evaluation of disease course and responses to therapy. Here, we review current information on the detection, diagnosis, monitoring and treatment of NP-C, with a focus on the adolescent/adult-onset form. A recent analysis indicated that the combined incidence of NP-C related to NPC1 gene mutations (NPC1) and NP-C related to NPC2 gene mutations (NPC2) is approximately 1 case in every 89 000 live births. In particular, late-onset phenotypes might well provide a greater contribution to the overall incidence than has previously been reported. Some neuropathological features in NP-C are held in common with other advanced age-onset diseases such as Alzheimer's disease. Visceral symptoms such as splenomegaly are frequently asymptomatic in patients with adolescent/adult-onset NP-C, and are only occasionally detected during routine ultrasound assessments. In contrast, most patients with adolescent/adult-onset exhibit some degree of slowly progressive, non-disease-specific movement disorders (e.g. cerebellar ataxia), and/or more pathognomonic neurological signs such as vertical supranuclear gaze palsy. An increasing number of adolescent/adult-onset cases have been reported following initial recognition of cognitive impairment and/or psychiatric signs. The recent development and implementation of new clinical screening tools (e.g. the NP-C suspicion index) and biomarkers (e.g. plasma oxysterols) should help identify patients who warrant further investigation and possible treatment.

  14. Prevalence of asthma among adult females and males in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2001-2004.

    Science.gov (United States)

    McHugh, Michelle K; Symanski, Elaine; Pompeii, Lisa A; Delclos, George L

    2009-10-01

    The prevalence of asthma has increased over the last three decades with females exhibiting a higher prevalence of asthma than males. The objective of this study was to obtain gender-specific estimates of the prevalence of current and ever asthma and describe the relationships between risk factors and asthma by gender in US men and women ages 20 to 85. Data for this study came from two cycles (2001-2002 and 2003-2004) of National Health and Nutrition Examination Survey (NHANES) and included 9,243 eligible adults: 4,589 females and 4,654 males. Multiple logistic regression was used to investigate gender-specific associations between race/ethnicity, body mass index (BMI), sociodemographic characteristics, and smoking habits for current asthma and ever asthma. The prevalence of current asthma was 8.8% for women and 5.8% for men, while the prevalence of ever having been diagnosed with asthma was higher (13.7% and 10.4% for women and men, respectively). Current asthma was less prevalent in Mexican American women (1.9%) and men (0.9%) born in Mexico as compared to Mexican Americans born in the U.S. (8.7% and 5.2% for women and men, respectively) or for any other ethnic group. Approximately 20% of extremely obese women and men had ever been diagnosed with asthma; among this group, 15% reported they had current asthma. Results from multiple logistic regression models indicate that extreme obesity and living in poverty were strongly associated with current and ever asthma for both women and men, as was former smoking and ever asthma for men. As compared to previous NHANES reports, our results indicate that the prevalence of asthma among U.S. adults continues to increase. Further, our findings of marked differences among subgroups of the population suggest asthma-related disparities for impoverished persons and greater prevalence of asthma among obese and extremely obese US adults.

  15. Effects of meteorological factors on daily hospital admissions for asthma in adults: a time-series analysis.

    Directory of Open Access Journals (Sweden)

    Yue Zhang

    Full Text Available There is limited evidence for the impacts of meteorological changes on asthma hospital admissions in adults in Shanghai, China.To quantitatively evaluate the short-term effects of daily mean temperature on asthma hospital admissions.Daily hospital admissions for asthma and daily mean temperatures between January 2005 and December 2012 were analyzed. After controlling for secular and seasonal trends, weather, air pollution and other confounding factors, a Poisson generalized additive model (GAM combined with a distributed lag non-linear model were used to explore the associations between temperature and hospital admissions for asthma.During the study periods, there were 15,678 hospital admissions for asthma by residents of Shanghai, an average 5.6 per day. Pearson correlation analysis found a significant negative correlation (r = -0.174, P<0.001 between asthma hospitalizations and daily mean temperature (DMT. The DMT effect on asthma increased below the median DMT, with lower temperatures associated with a higher risk of hospital admission for asthma. Generally, the cold effect appeared to be relatively acute, with duration lasting several weeks, while the hot effect was short-term. The relative risk of asthma hospital admissions associated with cold temperature (the 25th percentile of temperature relative to the median temperature was 1.20 (95% confidence interval [CI], 1.01∼1.41 at lag0-14. However, warmer temperatures were not associated with asthma hospital admissions.Cold temperatures may trigger asthmatic attacks. Effective strategies are needed to protect populations at risk from the effects of cold.

  16. Chronic adult asthma care – maxi- mising the potential of the ...

    African Journals Online (AJOL)

    2009-01-29

    Jan 29, 2009 ... services, chronic care, asthma, diabetes, motivational interviewing, audit and organisational change. 32. Table I. ... ASSESS CONTROL OF ASTHMA. See criteria .... basic health literacy regarding asthma and medication will ...

  17. Asthma, smoking and chronic cough in rural and urban adult communities in The Gambia.

    Science.gov (United States)

    Walraven, G E; Nyan, O A; Van Der Sande, M A; Banya, W A; Ceesay, S M; Milligan, P J; McAdam, K P

    2001-11-01

    Asthma is reported to be rare in traditional rural communities, but is thought to be increasing as lifestyles become more urbanized or 'western'. A community-based survey of non-communicable diseases was conducted from October 1996 to June 1997, and included comparison of the prevalence of asthma, smoking and chronic cough in rural and urban Gambia. A cluster sample survey was conducted in a random sample of rural and urban adults (> or = 15 years of age). Subjects were asked about respiratory symptoms using a locally adapted version based on the IULTD questionnaire. Spirometry (basal, methacholine provocation and reversibility with a bronchodilator) and skin prick tests were performed on a randomly selected subsample of all subjects and those who, when interviewed, said they wheezed or had been diagnosed as asthmatic by a doctor. Out of 2166 participants in the urban population, 4.1% reported having had wheezing or whistling in the chest in the previous 12 months, 3.6% reported doctor-diagnosed asthma, and 0.6% chronic cough. In the rural population with 3223 participants these figures were 3.3%, 0.7% and 1.2%, respectively. Wheeze was more common in women, cough for 3 months of the year was more common in the age-groups 45+. Those who reported that they currently smoked accounted for 34% in urban and 42% in rural men. Figures were much lower for women (1.5% and 6.0%). Seven out of 574 randomly selected subjects (1.4%) exhibited bronchial hyper-responsiveness to methacholine challenge. Four of 133 (3.0%) people with self-reported wheeze and 3/69 (4.3%) participants with doctor-diagnosed asthma reacted positively on bronchial provocation with methacholine. There was a remarkably high prevalence of positive skin prick tests to aeroallergens: 38% in participants with a history of wheeze and 27% in those without. The prevalence of wheeze (particularly in association with bronchial hyper-responsiveness) was low in both rural and urban Gambia. This is in contrast to the

  18. An integrated model of environmental factors in adult asthma lung function and disease severity: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Katz Patricia P

    2010-05-01

    Full Text Available Abstract Background Diverse environmental exposures, studied separately, have been linked to health outcomes in adult asthma, but integrated multi-factorial effects have not been modeled. We sought to evaluate the contribution of combined social and physical environmental exposures to adult asthma lung function and disease severity. Methods Data on 176 subjects with asthma and/or rhinitis were collected via telephone interviews for sociodemographic factors and asthma severity (scored on a 0-28 point range. Dust, indoor air quality, antigen-specific IgE antibodies, and lung function (percent predicted FEV1 were assessed through home visits. Neighborhood socioeconomic status, proximity to traffic, land use, and ambient air quality data were linked to the individual-level data via residential geocoding. Multiple linear regression separately tested the explanatory power of five groups of environmental factors for the outcomes, percent predicted FEV1 and asthma severity. Final models retained all variables statistically associated (p Results Mean FEV1 was 85.0 ± 18.6%; mean asthma severity score was 6.9 ± 5.6. Of 29 variables screened, 13 were retained in the final model of FEV1 (R2 = 0.30; p 2 = 0.16; p 1 as an independent variable to the severity model further increased its explanatory power (R2 = 0.25. Conclusions Multivariate models covering a range of individual and environmental factors explained nearly a third of FEV1 variability and, taking into account lung function, one quarter of variability in asthma severity. These data support an integrated approach to modeling adult asthma outcomes, including both the physical and the social environment.

  19. Polymorphisms of IL-4, IL-4Rα, and AICDA Genes in Adult Allergic Asthma

    Institute of Scientific and Technical Information of China (English)

    崔天盆; 王琳; 吴健民; 胡丽华; 谢俊刚

    2003-01-01

    Summary: The relationship between 3 polymorphisms sites [interleulin-4 (IL-4), IL-4 receptor (IL-4R) α chain and activation-induced cytidine deaminase (AICDA)] and adult allergic asthma in Chinawas studied. By using case-control method, DNA and clinical data were obtained from allergic asth-matic patients and compared with those in the control subjects. The subjects were genotyped for theIL-4 C-589T promoter polymorphism, the IL-4R α chain Q576R and the AICDA C8408T by poly-merase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The resultsshowed that the IL-4 C-589T was not associated with adult allergic asthma in China. However, theIL-4R α chain 576R/R and AICDA 8408T/T frequency was significantly increased in allergic asthmagroup as compared with that in the control group [odd ratio (OR)= 3. 797 and 9. 127, respectively;P<0.01)] and was correlated with the increased plasma total IgE. These data suggested that theIL-4R α chain 576R/R and AICDA 8408T/T genotypes confer genetic susceptibility to adult allergicasthma in China.

  20. Features of the Humoral Immune Response in School-age Children with Early-Onset Bronchial Asthma Depending on Acetylation Polymorphism

    Directory of Open Access Journals (Sweden)

    U.I. Marusyk

    2015-07-01

    Full Text Available The objective of the work was to study the individual indicators of the humoral immune system in school-age children with early-onset bronchial asthma (BA, considering acetylation phenotypes to improve treatment outcomes. There has been carried out a comprehensive examination of 34 school-age children with early-onset BA (disease first manifested at an early age. Depending on the course of the disease, patients were divided into two clinical groups. The first clinical group included 16 patients with slow acetylation (average content of acetylated sulfadimine in urine was less than 75.0 %. The second clinical group consisted of 18 pupils with fast acetylation (average level of acetylated sulfadimine in urine was over 75.0 %. All children underwent immunological blood test of II–III levels. The studies found that slow acetylation in patients with early-onset asthma increases the risk of reduction in the amount of interleukin-8 in blood serum < 5.3 pg/ml with odds ratio (OR 4.5 (95% confident interval (CI: 2.3–8.9, as well as the risk of higher concentration of IL-4 more than 4.0 pg/ml (OR = 1.9 that is associated with atopic inflammation of the body and allows you to personalize treatment tactics in these patients.

  1. The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia

    OpenAIRE

    McMahon, Catherine M.; Bamini Gopinath; Julie Schneider; Jennifer Reath; Louise Hickson; Leeder, Stephen R; Paul Mitchell; Robert Cowan

    2013-01-01

    Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older ...

  2. Audiovisual Integration Delayed by Stimulus Onset Asynchrony Between Auditory and Visual Stimuli in Older Adults.

    Science.gov (United States)

    Ren, Yanna; Yang, Weiping; Nakahashi, Kohei; Takahashi, Satoshi; Wu, Jinglong

    2017-02-01

    Although neuronal studies have shown that audiovisual integration is regulated by temporal factors, there is still little knowledge about the impact of temporal factors on audiovisual integration in older adults. To clarify how stimulus onset asynchrony (SOA) between auditory and visual stimuli modulates age-related audiovisual integration, 20 younger adults (21-24 years) and 20 older adults (61-80 years) were instructed to perform an auditory or visual stimuli discrimination experiment. The results showed that in younger adults, audiovisual integration was altered from an enhancement (AV, A ± 50 V) to a depression (A ± 150 V). In older adults, the alterative pattern was similar to that for younger adults with the expansion of SOA; however, older adults showed significantly delayed onset for the time-window-of-integration and peak latency in all conditions, which further demonstrated that audiovisual integration was delayed more severely with the expansion of SOA, especially in the peak latency for V-preceded-A conditions in older adults. Our study suggested that audiovisual facilitative integration occurs only within a certain SOA range (e.g., -50 to 50 ms) in both younger and older adults. Moreover, our results confirm that the response for older adults was slowed and provided empirical evidence that integration ability is much more sensitive to the temporal alignment of audiovisual stimuli in older adults.

  3. Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK

    Directory of Open Access Journals (Sweden)

    P. Demoly

    2009-06-01

    Full Text Available The objectives of this article were to estimate the prevalence of asthma control and describe the characteristics of at least well-controlled (ALWC versus not well-controlled (NWC asthmatics. Data were obtained from the European National Health and Wellness Survey, an internet-based, cross-sectional study of 37,476 adults in France, Germany, Italy, Spain and the UK. Analysis was limited to 2,337 respondents who self-reported a physician diagnosis. Based on the Asthma Control Test (ACT, respondents were grouped as ALWC (ACT 20 and NWC (ACT 19. The prevalence of diagnosed asthma across five countries was estimated to be 5.8% (14 million extrapolated for the European Union population. Of these, 50.4% (7.1 million were NWC. Compared with ALWC, NWC were older (15.8 versus 15.0%; p<0.001, less likely to be college educated (28.7 versus 36.3%; p<0.001 and more likely to be obese (30.0 versus 22.7%; p<0.001, experience depression (28.0 versus 18.7%; p<0.001 and smoke (34.7 versus 25.0%; p<0.001. The NWC had more occasions of contact with healthcare providers and were more likely to use controller and rescue medications, but with less adherence. A substantial portion of asthmatics are NWC. However, the proportion of NWC asthmatics found in this study was less than in previously reported. Patients and physicians need to be educated on the importance of asthma control and adherence to treatments.

  4. Personality traits among ADHD adults: implications of late-onset and subthreshold diagnoses.

    Science.gov (United States)

    Faraone, S V; Kunwar, A; Adamson, J; Biederman, J

    2009-04-01

    Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish onset prior to the DSM-IV criterion of age 7 or if the number of symptoms does not achieve the DSM threshold for diagnosis. Previous work has assessed the validity of such diagnoses based on psychiatric co-morbidity, family history and neuropsychological functions but none of these studies have used personality as a validation criterion. We compared four groups of adults: (1) full ADHD subjects who met all DSM-IV criteria for childhood-onset ADHD; (2) late-onset subjects who met all criteria except the age at onset criterion, (3) subthreshold subjects who did not meet full symptom criteria and (4) non-ADHD subjects who did not meet any of the above criteria. Diagnoses were made by using the Structured Clinical Interview for DSM-IV (SCID) and the Temperament and Character Inventory (TCI) was used to assess personality traits. We found that full ADHD and late-onset ADHD showed similar personality profiles with significant deviations on all TCI scales except reward dependence and self-transcendence. By contrast, subthreshold cases only showed deviations on novelty seeking and self-directiveness. These data call into question the stringent age of onset of ADHD symptom criteria for adults when making retrospective diagnoses of ADHD. Subthreshold ADHD seems to be a milder form of the disorder that is consistent with dimensional views of the disorder.

  5. Asthma and obesity

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ali, Zarqa; Nilas, Lisbeth

    2012-01-01

    Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma....

  6. Asthma and occupation in the 1958 birth cohort.

    Science.gov (United States)

    Ghosh, Rebecca Elisabeth; Cullinan, Paul; Fishwick, David; Hoyle, Jennifer; Warburton, Chris J; Strachan, David P; Butland, Barbara K; Jarvis, Debbie

    2013-04-01

    To examine the association of adult onset asthma with lifetime exposure to occupations and occupational exposures. We generated lifetime occupational histories for 9488 members of the British 1958 birth cohort up to age 42 years. Blind to asthma status, jobs were coded to the International Standard Classification of Occupations 1988 and an Asthma Specific Job Exposure Matrix (ASJEM) with an expert re-evaluation step. Associations of jobs and ASJEM exposures with adult onset asthma were assessed in logistic regression models adjusting for sex, smoking, social class at birth and childhood hay fever. Of the 7406 cohort members with no asthma or wheezy bronchitis in childhood, 639 (9%) reported asthma by age 42 years. Adult onset asthma was associated with 18 occupations, many previously identified as risks for asthma (eg, farmers: OR 4.26, 95% CI 2.06 to 8.80; hairdressers: OR 1.88, 95% CI 1.24 to 2.85; printing workers: OR 3.04, 95% CI 1.49 to 6.18). Four were cleaning occupations and a further three occupations were likely to use cleaning agents. Adult onset asthma was associated with five of the 18 high-risk specific ASJEM exposures (flour exposure: OR 2.12, 95% CI 1.17 to 3.85; enzyme exposure: OR 2.32, 95% CI 1.22 to 4.42; cleaning/disinfecting products: OR 1.67, 95% CI 1.26 to 2.22; metal and metal fumes: OR 1.45, 95% CI 1.02 to 2.07; textile production: OR 1.71, 95% CI 1.12 to 2.61). Approximately 16% (95% CI 3.8% to 27.1%) of adult onset asthma was associated with known asthmagenic occupational exposures. This study suggests that about 16% of adult onset asthma in British adults born in the late 1950s could be due to occupational exposures, mainly recognised high-risk exposures.

  7. Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults.

    Science.gov (United States)

    Veronese, Nicola; Trevisan, Caterina; Bolzetta, Francesco; De Rui, Marina; Zambon, Sabina; Musacchio, Estella; Sartori, Leonardo; Stubbs, Brendon; Perissinotto, Egle; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

    2016-09-01

    A number of small cross sectional studies have demonstrated that hypovitaminosis D (represented by low 25 hydroxyvitamin D (25OHD) levels) is associated with orthostatic hypotension (OH). We investigated if hypovitaminosis D is associated with the onset of OH in older adults over a follow-up of 4.4 years. 25OHD was categorized using sex-specific quartiles; OH was defined as a drop of ≤20 mm Hg in systolic or ≤10 mm Hg in diastolic blood pressure hypovitaminosis D predicts the onset of OH in older adults, particularly in women.

  8. Rocuronium as muscle relaxant for electroconvulsive therapy in a patient with adult-onset muscular dystrophy.

    Science.gov (United States)

    Bryson, Ethan O; Aloysi, Amy S; Katz, Maya; Popeo, Dennis; Kellner, Charles H

    2011-12-01

    Adult-onset muscular dystrophy is an inherited myopathy characterized by a variable degree of progressive muscle weakness and degeneration. Although not usually fatal, significant muscle weakness results in an up-regulation of acetylcholine receptors on the less responsive postjunctional muscles. The resulting profound potassium release when these receptors are stimulated by the depolarizing muscle relaxant succinylcholine can result in potentially fatal cardiac arrhythmias. We report a case of electroconvulsive therapy safely administered in a 61-year-old man with adult-onset muscular dystrophy requiring muscle relaxation with rocuronium.

  9. Adult-onset Still's disease and cardiac tamponade: a rare association.

    Science.gov (United States)

    Carrilho-Ferreira, Pedro; Silva, Doroteia; de Jesus Silva, Maria; André, Rui; Varela, Manuel Gato; Diogo, António Nunes

    2015-06-01

    Adult-onset Still's disease is a rare disorder with potentially severe clinical features, including cardiac involvement. This systemic inflammatory disease of unknown origin should be considered in the differential diagnosis of pericarditis, with or without pericardial effusion. Cardiac tamponade is a very rare sequela that requires an invasive approach, such as percutaneous or surgical pericardial drainage, in addition to the usual conservative therapy. The authors describe a case of adult-onset Still's disease rendered more difficult by pericarditis and cardiac tamponade, and they briefly review the literature on this entity.

  10. [Adult onset Still's disease as a diagnostics challenge in case of fever of unknown origin].

    Science.gov (United States)

    Debski, Marcin; Stepniewski, Piotr; Wróbel, Michał

    2013-01-01

    Fever of unknown origin is often a diagnostic challenge. Here we present a case of 55-year-old woman with a history of a few months fever, progressing weakness and salmon-coloured, macular skin rash. The differential diagnosis included neoplasmatic conditions, infections and connective tissue disorders. Finally adult onset Still's disease was suspected. Glucocorticosteroid treatment was induced. During the therapy a central nervous system infection occurred, which was fatal for the patient. The presented clinical case shows that among many causes of fever of unknown origin, adult onset Still's disease should be taken into account.

  11. The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia

    Directory of Open Access Journals (Sweden)

    Catherine M. McMahon

    2013-01-01

    Full Text Available Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1 early identification of persons with chronic hearing impairment; (2 appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss.

  12. The need for improved detection and management of adult-onset hearing loss in australia.

    Science.gov (United States)

    McMahon, Catherine M; Gopinath, Bamini; Schneider, Julie; Reath, Jennifer; Hickson, Louise; Leeder, Stephen R; Mitchell, Paul; Cowan, Robert

    2013-01-01

    Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being) is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1) early identification of persons with chronic hearing impairment; (2) appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss.

  13. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma.

    Science.gov (United States)

    Woodcock, Ashley; Forster, Louise; Matthews, Edward; Martin, Jeannett; Letley, Louise; Vickers, Madge; Britton, John; Strachan, David; Howarth, Peter; Altmann, Daniel; Frost, Christopher; Custovic, Adnan

    2003-07-17

    The effectiveness of avoidance of house-dust-mite allergen (Dermatophagoides pteronyssinus 1 [Der p1]) in the management of asthma is uncertain. We conducted a double-blind, randomized, placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma. The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through 12. Der p1 was measured in mattress dust in a 10 percent random subsample of homes at entry and at 6 and 12 months. The prevalence of sensitivity to dust-mite allergen was 65.4 percent in the group supplied with allergen-impermeable bed covers (active-intervention group) and 65.1 percent in the control group supplied with non-impermeable bed covers. The concentration of Der p1 in mattress dust was significantly lower in the active-intervention group at 6 months (geometric mean, 0.58 microg per gram vs. 1.71 microg per gram in the control group; P=0.01) but not at 12 months (1.05 microg per gram vs. 1.64 microg per gram; P=0.74). The mean morning peak expiratory flow rate improved significantly in both groups (from 410.7 to 419.1 liters per minute in the active-intervention group, Pimpermeable covers, as a single intervention for the avoidance of exposure to dust-mite allergen, seem clinically ineffective in adults with asthma. Copyright 2003 Massachusetts Medical Society

  14. Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings: A Practice-Based Network Assessment.

    Science.gov (United States)

    Yawn, Barbara P; Rank, Matthew A; Cabana, Michael D; Wollan, Peter C; Juhn, Young J

    2016-04-01

    To assess primary care adherence to 2007 US asthma guidelines. Patients with persistent asthma aged 5 to 65 years from 22 primary care participating practices provided the data for this analysis of baseline information from the pragmatic randomized clinical trial the Asthma Tools Study. Using a combination of abstracted medical record data and patient-reported demographic information, we assessed the medical record documentation for elements of the 2007 US asthma guidelines. Elements assessed included documentation of (1) assessment of control, (2) factors that affect control (medication adherence evaluation, inhaler technique education, and evaluation for triggers), (3) self-management support (action plan), and (4) asthma medications prescribed (short-acting β-agonists and daily maintenance therapy). The baseline data was collected from March 16, 2009, to May 1, 2014. In 1176 patients (285 children, 211 tweens, and 680 adults) from 16 family medicine and 6 pediatric practices across the United States, documented guideline adherence was highest for prescription of medications (88.0% for short-acting β-agonists and 70.4% for maintenance medications) and lowest for an asthma action plan (3.1%). Documentation of control (15.0%) and factors that affect control (inhaler technique education, 7.6%; medication adherence assessment, 32.5%; and allergy evaluation, 32.5%) was not common and even less common for adults compared with children. A total of 22.2% of the enrolled patients had no asthma-related visit in the year before enrollment. Adherence to the nonmedication elements were higher in practices located in cities of more than 250,000 people and cities that used electronic medical records. Older patient age was negatively associated with guideline adherence. Adherence to asthma guidelines is poor in primary care practices, leaving many opportunities for improvement. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc

  15. Adult onset of xanthelasmoid mastocytosis: Report of a rare entity

    Directory of Open Access Journals (Sweden)

    Nafiseh Sadat Nabavi

    2016-01-01

    Full Text Available Xanthelasmoid or pseudoxanthomatous mastocytosis is an extremely rare variant of diffuse cutaneous mastocytosis. Herein, we describe an adult male with cutaneous mastocytosis showing multiple widespread yellowish ovoid papules like eruptive xanthoma. A 60-year-old male visited our outpatient clinic with a 1-year history of generalized yellowish, ovoid, and skin color papular eruption located on the trunk, groin, extremities, with the modest pruritus. Vital signs were stable, and Darier′s sign was negative. No other subjective and objective signs were detected during the examination. No abnormality was detected in his diagnostic laboratory tests. Skin biopsy was taken, and histopathologic examination revealed proliferation of mast cells with ovoid and spindle nuclei with distinct cytoplasm borders around the capillaries, which was compatible with mastocytosis. Antihistamine was prescribed for pruritus control which was successful, but eruptions were persistent, and even 1-year phototherapy was not useful.

  16. Efficacy of growth hormone therapy in adults with childhood-onset growth hormone deficiency

    OpenAIRE

    Kim, Ja Hye; Cho, Ja Hyang; Yoo, Han-Wook; Choi, Jin-Ho

    2014-01-01

    Purpose Growth hormone (GH) plays a key role in the regulation of body composition, lipid metabolism, and quality of life in adults with GH deficiency (GHD). This study investigated changes in laboratory findings and body composition after GH recommencement for adult GHD and analyzed correlation between GH interruption period and endocrine or anthropometric parameters. Methods A total of 45 patients (17 females and 28 males) diagnosed with childhood-onset GHD (CO-GHD) were investigated and al...

  17. Phenotypes Determined by Cluster Analysis in Moderate to Severe Bronchial Asthma.

    Science.gov (United States)

    Youroukova, Vania M; Dimitrova, Denitsa G; Valerieva, Anna D; Lesichkova, Spaska S; Velikova, Tsvetelina V; Ivanova-Todorova, Ekaterina I; Tumangelova-Yuzeir, Kalina D

    2017-06-01

    Bronchial asthma is a heterogeneous disease that includes various subtypes. They may share similar clinical characteristics, but probably have different pathological mechanisms. To identify phenotypes using cluster analysis in moderate to severe bronchial asthma and to compare differences in clinical, physiological, immunological and inflammatory data between the clusters. Forty adult patients with moderate to severe bronchial asthma out of exacerbation were included. All underwent clinical assessment, anthropometric measurements, skin prick testing, standard spirometry and measurement fraction of exhaled nitric oxide. Blood eosinophilic count, serum total IgE and periostin levels were determined. Two-step cluster approach, hierarchical clustering method and k-mean analysis were used for identification of the clusters. We have identified four clusters. Cluster 1 (n=14) - late-onset, non-atopic asthma with impaired lung function, Cluster 2 (n=13) - late-onset, atopic asthma, Cluster 3 (n=6) - late-onset, aspirin sensitivity, eosinophilic asthma, and Cluster 4 (n=7) - early-onset, atopic asthma. Our study is the first in Bulgaria in which cluster analysis is applied to asthmatic patients. We identified four clusters. The variables with greatest force for differentiation in our study were: age of asthma onset, duration of diseases, atopy, smoking, blood eosinophils, nonsteroidal anti-inflammatory drugs hypersensitivity, baseline FEV1/FVC and symptoms severity. Our results support the concept of heterogeneity of bronchial asthma and demonstrate that cluster analysis can be an useful tool for phenotyping of disease and personalized approach to the treatment of patients.

  18. A comparison between nailfold capillaroscopy patterns in adulthood in juvenile and adult-onset systemic sclerosis

    DEFF Research Database (Denmark)

    Ingegnoli, Francesca; Boracchi, Patrizia; Gualtierotti, Roberta

    2015-01-01

    OBJECTIVE: Qualitative capillaroscopy patterns in juvenile- and adult-onset systemic sclerosis (SSc) were studied in adulthood using data from the EULAR Scleroderma Trials and Research (EUSTAR) database. METHODS: Data collected between June 2004 and April 2013 were examined with focus...

  19. Myotonia and flaccid dysarthria in patients with adult onset myotonic dystrophy.

    NARCIS (Netherlands)

    Swart, B.J.M. de; Engelen, B.G.M. van; Kerkhof, J.P. van de; Maassen, B.A.M.

    2004-01-01

    BACKGROUND: Myotonia and weakness are the most important components of dysarthric speech in myotonic dystrophy. OBJECTIVE: To specify and quantify possible defects in speech execution in patients with adult onset myotonic dystrophy. METHODS: Studies on speech production were done on 30 mildly affect

  20. Childhood psychosocial stressors and adult onset arthritis : Broad spectrum risk factors and allostatic load

    NARCIS (Netherlands)

    Von Korff, Michael; Alonso, Jordi; Ormel, Johan; Angermeyer, Matthais; Bruffaerts, Ronny; Fleiz, Clara; de Girolamo, Giovanni; Kessler, Ronald C.; Kovess-Masfety, Viviane; Posada-Villa, Jose; Scott, Kate M.; Uda, Hidenori

    2009-01-01

    Neural, endocrine, and immune stress mediators are hypothesized to increase risks of diverse chronic diseases, including arthritis. Retrospective data from the World Mental Health Surveys (N = 18,309) were employed to assess whether adult onset of arthritis was associated with childhood adversities

  1. High risk of adrenal insufficiency in adults previously treated for idiopathic childhood onset growth hormone deficiency

    DEFF Research Database (Denmark)

    Lange, Martin; Feldt-Rasmussen, Ulla; Svendsen, Ole Lander;

    2003-01-01

    The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients w...

  2. Distal spinal muscular atrophy as a major feature in adult-onset ataxia telangiectasia.

    NARCIS (Netherlands)

    Hiel, J.A.P.; Engelen, B.G.M. van; Weemaes, C.M.R.; Broeks, A.; Verrips, A.; Laak, H.J. ter; Vingerhoets, H.M.; Heuvel, L.P.W.J. van den; Lammens, M.M.Y.; Gabreëls, F.J.M.; Last, J.I.; Taylor, A.M.R.

    2006-01-01

    The authors report four adult-onset ataxia telangiectasia (AT) patients belonging to two families lacking pronounced cerebellar ataxia but displaying distal spinal muscular atrophy. AT was proven by genetic studies showing ATM mutations and a reduced level of ATM. ATM activity, as measured by phosph

  3. Physical Therapists' Perceptions of Providing Services to Adults with Childhood-Onset Neuromotor Disabilities

    Science.gov (United States)

    Compton-Griffith, Kelsi N.; Cicirello, Nancy A.; Turner, Anne

    2011-01-01

    Adults with childhood-onset neuromotor disabilities face problems accessing health care services. There are often challenges finding primary care providers or specialized providers, such as physical therapists, who are knowledgeable about neuromotor disabilities. The purpose of this study was to determine the perceptions of physical therapists…

  4. Association between obesity and asthma - epidemiology, pathophysiology and clinical profile.

    Science.gov (United States)

    Muc, Magdalena; Mota-Pinto, Anabela; Padez, Cristina

    2016-12-01

    Obesity is a risk factor for asthma, and obese asthmatics have lower disease control and increased symptom severity. Several putative links have been proposed, including genetics, mechanical restriction of the chest and the intake of corticosteroids. The most consistent evidence, however, comes from studies of cytokines produced by the adipose tissue called adipokines. Adipokine imbalance is associated with both proinflammatory status and asthma. Although reverse causation has been proposed, it is now acknowledged that obesity precedes asthma symptoms. Nevertheless, prenatal origins of both conditions complicate the search for causality. There is a confirmed role of neuro-immune cross-talk mediating obesity-induced asthma, with leptin playing a key role in these processes. Obesity-induced asthma is now considered a distinct asthma phenotype. In fact, it is one of the most important determinants of asthma phenotypes. Two main subphenotypes have been distinguished. The first phenotype, which affects adult women, is characterised by later onset and is more likely to be non-atopic. The childhood obesity-induced asthma phenotype is characterised by primary and predominantly atopic asthma. In obesity-induced asthma, the immune responses are shifted towards T helper (Th) 1 polarisation rather than the typical atopic Th2 immunological profile. Moreover, obese asthmatics might respond differently to environmental triggers. The high cost of treatment of obesity-related asthma, and the burden it causes for the patients and their families call for urgent intervention. Phenotype-specific approaches seem to be crucial for the success of prevention and treatment.

  5. Temporal discrimination threshold: VBM evidence for an endophenotype in adult onset primary torsion dystonia.

    LENUS (Irish Health Repository)

    Bradley, D

    2012-02-01

    Familial adult-onset primary torsion dystonia is an autosomal dominant disorder with markedly reduced penetrance. Most adult-onset primary torsion dystonia patients are sporadic cases. Disordered sensory processing is found in adult-onset primary torsion dystonia patients; if also present in their unaffected relatives this abnormality may indicate non-manifesting gene carriage. Temporal discrimination thresholds (TDTs) are abnormal in adult-onset primary torsion dystonia, but their utility as a possible endophenotype has not been examined. We examined 35 adult-onset primary torsion dystonia patients (17 familial, 18 sporadic), 42 unaffected first-degree relatives of both familial and sporadic adult-onset primary torsion dystonia patients, 32 unaffected second-degree relatives of familial adult-onset primary torsion dystonia (AOPTD) patients and 43 control subjects. TDT was measured using visual and tactile stimuli. In 33 unaffected relatives, voxel-based morphometry was used to compare putaminal volumes between relatives with abnormal and normal TDTs. The mean TDT in 26 control subjects under 50 years of age was 22.85 ms (SD 8.00; 95% CI: 19.62-26.09 ms). The mean TDT in 17 control subjects over 50 years was 30.87 ms (SD 5.48; 95% CI: 28.05-33.69 ms). The upper limit of normal, defined as control mean + 2.5 SD, was 42.86 ms in the under 50 years group and 44.58 ms in the over 50 years group. Thirty out of thirty-five (86%) AOPTD patients had abnormal TDTs with similar frequencies of abnormalities in sporadic and familial patients. Twenty-two out of forty-two (52%) unaffected first-degree relatives had abnormal TDTs with similar frequencies in relatives of sporadic and familial AOPTD patients. Abnormal TDTs were found in 16\\/32 (50%) of second-degree relatives. Voxel-based morphometry analysis comparing 13 unaffected relatives with abnormal TDTs and 20 with normal TDTs demonstrated a bilateral increase in putaminal grey matter in unaffected relatives with abnormal

  6. Suppurative necrotizing granulomatous lymphadenitis in adult-onset Still’s disease: a case report

    Directory of Open Access Journals (Sweden)

    Assimakopoulos Stelios F

    2012-10-01

    Full Text Available Abstract Introduction Lymphadenopathy is found in about 65% of patients with adult-onset Still’s disease and is histologically characterized by an intense, paracortical immunoblastic hyperplasia. Adult-onset Still’s disease has not been previously described as an etiology of suppurative necrotizing granulomatous lymphadenitis. Case presentation We describe a 27-year-old Greek man who manifested prolonged fever, abdominal pain, increased inflammatory markers, episodic skin rash and mesenteric lymphadenopathy histologically characterized by necrotizing granulomatous adenitis with central suppuration. Disease flares were characterized by systemic inflammatory response syndrome with immediate clinico-laboratory response to corticosteroids but the patient required prolonged administration of methylprednisolone at a dose of above 12mg/day for disease control. After an extensive diagnostic work-up, which ruled out any infectious, malignant, rheumatic or autoinflammatory disease the patient was diagnosed as having adult-onset Still’s disease. The patient is currently treated with 4mg of methylprednisolone, 100mg of anakinra daily and methotrexate 7.5mg for two consecutive days per week and exerts full disease remission for six months. Conclusion To the best of our knowledge this is the first report of suppurative necrotizing granulomatous lymphadenitis attributed to adult-onset Still’s disease. This case indicates that the finding of a suppurative necrotizing granulomatous lymphadenitis should not deter the consideration of adult-onset Still’s disease as a potential diagnosis in a compatible clinical context; however, the exclusion of other diagnoses is a prerequisite.

  7. Beating and insulting children as a risk for adult cancer, cardiac disease and asthma.

    Science.gov (United States)

    Hyland, Michael E; Alkhalaf, Ahmed M; Whalley, Ben

    2013-12-01

    The use of physical punishment for children is associated with poor psychological and behavioral outcomes, but the causal pathway is controversial, and the effects on later physical health unknown. We conducted a cross-sectional survey of asthma, cancer, and cardiac patients (150 in each category, 75 male) recruited from outpatient clinics and 250 healthy controls (125 male). All participants were 40-60 years old and citizens of Saudi Arabia, where the use of beating and insults is an acceptable parenting style. Demographic data and recalled frequency of beatings and insults as a child were assessed on an 8-point scale. Beating and insults were highly correlated (ρ = 0.846). Propensity score matching was used to control for demographic differences between the disease and healthy groups. After controlling for differences, more frequent beating (once or more per month) and insults were associated with a significantly increased risk for cancer (RR = 1.7), cardiac disease (RR = 1.3) and asthma (RR = 1.6), with evidence of increased risk for cancer and asthma with beating frequency of once every 6 months or more. Our results show that a threatening parenting style of beating and insults is associated with increased risk for somatic disease, possibly because this form of parenting induces stress. Our findings are consistent with previous research showing that child abuse and other early life stressors adversely affect adult somatic health, but provide evidence that the pathogenic effects occur also with chronic minor stress. A stress-inducing parenting style, even when normative, has long term adverse health consequences.

  8. Childhood Lung Function Predicts Adult Chronic Obstructive Pulmonary Disease and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome.

    Science.gov (United States)

    Bui, Dinh S; Burgess, John A; Lowe, Adrian J; Perret, Jennifer L; Lodge, Caroline J; Bui, Minh; Morrison, Stephen; Thompson, Bruce R; Thomas, Paul S; Giles, Graham G; Garcia-Aymerich, Judith; Jarvis, Debbie; Abramson, Michael J; Walters, E Haydn; Matheson, Melanie C; Dharmage, Shyamali C

    2017-07-01

    The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors. To investigate the role of childhood lung function in adult COPD phenotypes. Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV1/FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression. At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV1/FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone. Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.

  9. Immunosuppression in early postnatal days induces persistent and allergen-specific immune tolerance to asthma in adult mice.

    Directory of Open Access Journals (Sweden)

    Yan Chen

    Full Text Available Bronchial asthma is a chronic airway inflammatory condition with high morbidity, and effective treatments for asthma are limited. Allergen-specific immunotherapy can only induce peripheral immune tolerance and is not sustainable. Exploring new therapeutic strategies is of great clinical importance. Recombinant adenovirus (rAdV was used as a vector to make cells expressing cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (CTLA4Ig a soluble CTLA4 immunoglobulin fusion protein. Dendritic cells (DCs were modified using the rAdVs together with allergens. Then these modified DCs were transplanted to mice before allergen sensitization. The persistence and specificity of immune tolerance were evaluated in mice challenged with asthma allergens at 3 and 7 months. DCs modified by CTLA4Ig showed increased IL-10 secretion, decreased IL-12 secretion, and T cell stimulation in vitro. Mice treated with these DCs in the early neonatal period developed tolerance against the allergens that were used to induce asthma in the adult stage. Asthma symptoms, lung damage, airway reactivity, and inflammatory response all improved. Humoral immunity indices showed that this therapeutic strategy strongly suppressed mice immune responses and was maintained for as long as 7 months. Furthermore, allergen cross-sensitization and challenge experiments demonstrated that this immune tolerance was allergen-specific. Treatment with CTLA4Ig modified DCs in the early neonatal period, inducing persistent and allergen-specific immune tolerance to asthma in adult mice. Our results suggest that it may be possible to develop a vaccine for asthma.

  10. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q

    Energy Technology Data Exchange (ETDEWEB)

    Wirtz, M.K.; Samples, J.R.; Kramer, P.L. [Oregon Health Sciences Univ., Portland, OR (United States)] [and others

    1997-02-01

    Glaucoma is the third-leading cause of blindness in the world, affecting >13.5 million people. Adult-on-set primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. We present a family in which adult-onset POAG is inherited as an autosomal dominant trait. Twelve affected family members were identified from 44 at-risk individuals. The disease-causing gene was mapped to chromosome 3q21-24, with analysis of recombinant haplotypes suggesting a total inclusion region of 11.1 cM between markers D3S3637 and D3S1744. This is the first report of mapping of an adult-onset POAG gene to chromosome 3q, gene symbol GLC1C. 57 refs., 3 figs., 3 tabs.

  11. Adult-onset Nemaline Myopathy Coexisting With Myasthenia Gravis: A Case Report.

    Science.gov (United States)

    Cao, Lingling; Wang, Yanling; Liu, Xiaofeng; Hu, Yanxia; Li, Nianchun; Qiu, Guoping; Luo, Yun; Li, Weidong

    2016-01-01

    Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder which is characterized by fluctuating muscle fatigue. However, the association of MG with nemaline myopathy is rarely reported. Here we report a case of MG coexisting with adult-onset nemaline myopathy. A 55-year-old man endured fluctuating muscle weakness with positive acetylcholine receptor and titin antibodies. After the patient was administrated cholinergic drugs and immunosuppression, the muscle weakness of the patient had mildly been alleviated. Electromyography showed a progressive decrement in the amplitude of muscle action potential at low frequency. Muscle biopsy showed numerous nemalines in the muscle fibers. This is the first reported case of nemalines present in the muscle fibers of adult patient with MG. The pathogenesis of nemaline may be related to titin antibody in adult-onset nemaline myopathy with MG.

  12. Fatal asthma or anaphylaxis?

    OpenAIRE

    Rainbow, J; Browne, G

    2002-01-01

    The incidence of anaphylaxis is under-reported. Children with asthma are frequently atopic and prone to allergic reactions. Parents and clinicians may attribute wheeze of rapid onset to acute severe asthma, rather than recognising an anaphylactic event. Two cases of fatal anaphylaxis are reported who were initially diagnosed as acute severe asthma, and responded poorly to bronchodilator treatment. Survivors of "acute asphyxic asthma" should be screened for reactions to common allergens that p...

  13. Prevalence, determinants and clinical correlates of vitamin D deficiency in adults with inhaled corticosteroid-treated asthma in London, UK.

    Science.gov (United States)

    Jolliffe, David A; Kilpin, Kate; MacLaughlin, Beverley D; Greiller, Claire L; Hooper, Richard L; Barnes, Neil C; Timms, Peter M; Rajakulasingam, Raj K; Bhowmik, Angshu; Choudhury, Aklak B; Simcock, David E; Hyppönen, Elina; Corrigan, Christopher J; Walton, Robert T; Griffiths, Christopher J; Martineau, Adrian R

    2016-11-05

    Vitamin D deficiency is common in children with asthma, and it associates with poor asthma control, reduced forced expiratory volume in one second (FEV1) and increased requirement for inhaled corticosteroids (ICS). Cross-sectional studies investigating the prevalence, determinants and clinical correlates of vitamin D deficiency in adults with asthma are lacking. We conducted a multi-centre cross-sectional study in 297 adults with a medical record diagnosis of ICS-treated asthma living in London, UK. Details of potential environmental determinants of vitamin D status, asthma control and medication use were collected by questionnaire; blood samples were taken for analysis of serum 25(OH)D concentration and DNA extraction, and participants underwent measurement of weight, height and fractional exhaled nitric oxide concentration (FeNO), spirometry and sputum induction for determination of lower airway eosinophil counts (n=35 sub-group). Thirty-five single nucleotide polymorphisms (SNP) in 11 vitamin D pathway genes (DBP, DHCR7, RXRA, CYP2R1, CYP27B1, CYP24A1, CYP3A4 CYP27A1, LRP2, CUBN, VDR) were typed using Taqman allelic discrimination assays. Linear regression was used to identify environmental and genetic factors independently associated with serum 25(OH)D concentration, and to determine whether vitamin D status was independently associated with Asthma Control Test (ACT) score, ICS dose, FeNO, forced vital capacity (FVC), FEV1 or lower airway eosinophilia. Mean serum 25(OH)D concentration was 50.6nmol/L (SD 24.9); 162/297 (54.5%) participants were vitamin D deficient (serum 25(OH)D concentration D status was associated with higher body mass index (P=0.014), non-White ethnicity (P=0.036), unemployment (P for trend=0.012), lack of vitamin D supplement use (PD status was not found to associate with any marker of asthma control investigated. Vitamin D deficiency is common among UK adults with ICS-treated asthma, and classical environmental determinants of serum 25(OH

  14. Prognostic factors and outcomes of adult-onset hemophagocytic lymphohistiocytosis: a retrospective analysis of 34 cases

    Directory of Open Access Journals (Sweden)

    Masafumi Oto

    2015-06-01

    Full Text Available Adult-onset hemophagocytic lymphohistiocytosis (HLH has features that are distinct from that of HLH in pediatric patients. The clinical records at the Japanese Red Cross Kumamoto Hospital were reviewed. We retrospectively analyzed 34 patients who fulfilled the diagnostic criteria of HLH-2004. The median age of patients was 60.0 (range 15-86. Underlying diseases were diagnosed in 17 patients. They consisted of malignant lymphoma (n=3, other neoplastic disease (n=3, viral infection (n=4, collagen vascular disease (n=3, Kikuchi’s disease (n=3 and drug (n=1. Underlying diseases were not diagnosed in 17 patients despite examination. The treatments were steroids (n=18, dexamethasone + cyclosporine A (CSA + etoposide (n=4, multidrug chemotherapy (n=2, steroids and CSA (n=3. Eleven patients died during observation. In a multivariate analysis, the significant predictor for death was age at onset (hazard ratio, 1.22; 95%CI, 1.02-1.44; P=0.027. Autopsy was performed in 4 cases, but the underlying disease remained unknown in 3 of those cases. Adult-onset HLH has high diversity and various outcomes. The mechanism of adult-onset HLH is not fully understood and further research is required.

  15. Adult-Onset Type 1 Diabetes and Pregnancy: Three Case Reports

    Directory of Open Access Journals (Sweden)

    Barbara Bonsembiante

    2013-01-01

    Full Text Available From 5% to 10% of diabetic patients have type 1 diabetes. Here we describe three cases of adult-onset type 1 diabetes in pregnancy treated at our clinic between 2009 and 2012. Two patients came for specialist examination during pregnancy, the third after pregnancy. These women had no prior overt diabetes and shared certain characteristics, that is, no family diabetes history, age over 35, normal prepregnancy BMI, need for insulin therapy as of the early weeks of pregnancy, and high-titer anti-GAD antibody positivity. The patients had persistent diabetes after delivery, suggesting that they developed adult-onset type 1 diabetes during pregnancy. About 10% of GDM patients become pancreatic autoantibody positive and the risk of developing overt diabetes is higher when two or more autoantibodies are present (particularly GAD and ICA. GAD-Ab shows the highest sensitivity for type 1 diabetes prediction. We need to bear in mind that older patients might conceivably develop an adult-onset type 1 diabetes during or after pregnancy. So we suggest that women with GDM showing the described clinical features shall be preferably tested for autoimmunity. Pregnant patients at risk of type 1 diabetes should be identified to avoid the maternal and fetal complications and the acute onset of diabetes afterwards.

  16. Correlation study on the daily exercise and asthma control in adult patients with asthma%成年哮喘患者日常运动和哮喘控制的相关性研究

    Institute of Scientific and Technical Information of China (English)

    朱巧巧

    2016-01-01

    目的:研究成年哮喘患者日常活动和哮喘控制的关联。方法:收治哮喘患者214例,患者完成哮喘控制问卷(ACG)、哮喘生活质量问卷(AQLQ)和空闲时间体力活动(LTPA)。结果:LTPA与哮喘控制存在关联(β=0.013),适度LTPA的哮喘患者哮喘控制明显优于非活动患者。与夏季LTPA(β=0.019)相比,冬季LTPA(β=0.027)与ACQ评分联系更密切。LTPA和哮喘控制无相关性。结论:较高强度LTPA与成年哮喘患者更好的哮喘控制相关。%Objective:To study the correlation of daily exercise and asthma control in adult patients with asthma.Methods:214 patients with asthma were selected.The patients completed the asthma control questionnaire(ACG) and the asthma quality of life questionnaire(AQLQ) and leisure time physical activity(LTPA).Results:LTPA and asthma control had correlation(β=0.013).The asthma control of asthma patients with moderate LTPA was significantly better than that of non active patients.Compared with the summer LTPA( β =0.019),the relation between winter LTPA( β =0.027) and the ACQ score was more close.There was no correlation between LTPA and asthma control.Conclusion:Higher intensity of LTPA is associated with better asthma control in adult patients with asthma.

  17. Asthma Control and Its Relationship with Obstructive Sleep Apnea (OSA in Older Adults

    Directory of Open Access Journals (Sweden)

    Mihaela Teodorescu

    2013-01-01

    Full Text Available Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA. Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger and 154 aged 60–75 (older. Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ, asthma severity step (1–4, severe if step 3 or 4, established OSA diagnosis, continuous positive airway pressure (CPAP use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual (OR=6.67. This relationship was of greater magnitude than in younger subjects (OR=2.16. CPAP use attenuated the likelihood of severe asthma in older subjects by 91% (P=0.005, much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients.

  18. [Adult-onset Still's disease with pulmonary and cardiac involvement and response to intravenous immunoglobulin].

    Science.gov (United States)

    Neto, Nilton Salles Rosa; Waldrich, Leandro; de Carvalho, Jozélio Freire; Pereira, Rosa Maria Rodrigues

    2009-01-01

    Cardiopulmonary manifestations of adult-onset Still's disease (AOSD) include pericarditis, pleural effusion, transient pulmonary infiltrates, pulmonary interstitial disease and myocarditis. Serositis are common but pneumonitis and myocarditis are not and bring elevated risk of mortality. They may manifest on disease onset or flares. Previously reported cases were treated with high-dose glucocorticoids and immunosupressants and, when refractory, intravenous immunoglobulin (IVIG). We report an AOSD patient whose flare presented with severe pleupneumonitis and myopericarditis and, following nonresponse to a methylprednisolone pulse, high dose of prednisone and cyclosporine A, recovered after a 2-day 1g/kg/day IVIG infusion.

  19. Career readiness, developmental work personality and age of onset in young adult central nervous system survivors.

    Science.gov (United States)

    Strauser, David; Wagner, Stacia; Wong, Alex W K; O'Sullivan, Deidre

    2013-04-01

    The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult central nervous system (CNS) survivors. Participants for this study consisted of 43 individuals whose age range from 18 to 30 (M = 21.64, SD = 3.46), an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80). Packets were distributed to survivors who were participating in a psychosocial cancer treatment program. Participants completed multiple career instruments and a demographic form. Differences between groups and among the variables were examined and size effect sizes were analyzed. Young adult CNS survivors had significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors with CNS cancer with those between the ages of 6 and 12 reported significantly lower levels when compared to individuals diagnosed before age 6 and after the age of 13. Young adult CNS survivors at an increased risk for having lower levels of work personality and career readiness then a norm group comparison. Age of onset (between 6 and 12) may be at significant risk factor for developing poor or dysfunctional work and career behaviors. • Young adults with central nervous system (CNS) cancer are at particular risk for experiencing difficulties related to career and employment. • Work personality and career readiness are two constructs that have been found to be related to one's ability to meet the demands of work. • Young adult CNS cancer survivors have lower levels of work personality and career readiness. • Individuals diagnosed between the ages of 6 and 12 may be at particular risk and may need specific vocational rehabilitation interventions. • The results of this study point to the need for comprehensive career and vocational services for young adult CNS cancer survivors.

  20. Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients.

    Science.gov (United States)

    Bir, Shyamal C; Patra, Devi Prasad; Maiti, Tanmoy K; Sun, Hai; Guthikonda, Bharat; Notarianni, Christina; Nanda, Anil

    2016-09-01

    OBJECTIVE Adult-onset hydrocephalus is not commonly discussed in the literature, especially regarding its demographic distribution. In contrast to pediatric hydrocephalus, which is related to a primary CSF pathway defect, its development in adults is often secondary to other pathologies. In this study, the authors investigated the epidemiology of adult-onset hydrocephalus as it pertains to different etiologies and in reference to age, sex, and race distributions. METHODS The authors retrospectively reviewed the clinical notes of 2001 patients with adult-onset hydrocephalus who presented to Louisiana State University Health Sciences Center within a 25-year span. Significant differences between the groups were analyzed by a chi-square test; p hydrocephalus in this population was 77 ± 30 per year, with a significant increase in incidence in the past decade (55 ± 3 [1990-2003] vs 102 ± 6 [2004-2015]; p Hydrocephalus in a majority of the patients had a vascular etiology (45.5%) or was a result of a tumor (30.2%). The incidence of hydrocephalus in different age groups varied according to various pathologies. The incidence was significantly higher in males with normal-pressure hydrocephalus (p = 0.03) or head injury (p = 0.01) and higher in females with pseudotumor cerebri (p hydrocephalus was significantly higher in Caucasian patients (p = 0.0002) than in those of any other race. CONCLUSIONS Knowledge of the demographic variations in adult-onset hydrocephalus is helpful in achieving better risk stratification and better managing the disease in patients. For general applicability, these results should be validated in a large-scale meta-analysis based on a national population database.

  1. Effects of Age, Gender, Bolus Volume, Bolus Viscosity, and Gustation on Swallowing Apnea Onset Relative to Lingual Bolus Propulsion Onset in Normal Adults

    Science.gov (United States)

    Hiss, Susan G.; Strauss, Monica; Treole, Kathleen; Stuart, Andrew; Boutilier, Susan

    2004-01-01

    The purpose of this study was to ascertain the normal relation of swallowing apnea (SA) onset relative to lingual bolus propulsion along with factors that may alter this relation. Forty adults, composed of 10 men and 10 women in each of 2 age groups (i.e., 20-30 and 63-79 years) participated. SA onset was assessed during 5- and 20-ml bolus volumes…

  2. Obesity and onset of depression among U.S. middle-aged and older adults.

    Science.gov (United States)

    Xiang, Xiaoling; An, Ruopeng

    2015-03-01

    This paper aims to examine the relationship between obesity and onset of depression among U.S. middle-aged and older adults. Data came from 1994 to 2010 waves of the Health and Retirement Study. Study sample consisted of 6514 community-dwelling adults born between 1931 and 1941 who were free of clinically relevant depressive symptoms in 1994. Body mass index (BMI) was calculated from self-reported height/weight. Body weight status was classified into normal weight (18.5kg/m(2)≤BMIobesity (BMI≥30kg/m(2)). A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and time-dependent Cox proportional hazards model were performed to examine the association between body weight status and onset of clinically relevant depressive symptoms. Unhealthy body weight was associated future onset of depression. Compared with their normal weight counterparts, overweight and obese participants were 13% (hazard ratio [HR]=1.13, 95% confidence interval [CI]=1.04-1.23) and 9% (HR=1.09, 95% CI=1.01-1.18) more likely to have onset of clinically relevant depressive symptoms during the 16years of follow-up, respectively. The relationship between obesity and depression onset appeared stronger among females and non-Hispanic whites than their male and racial/ethnic minority counterparts. Health care providers should be aware of the potential risk for depression among obese older adults. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Adult-onset Still's disease as a mask of Hodgkin lymphoma.

    Science.gov (United States)

    Dudziec, Ewa; Pawlak-Buś, Katarzyna; Leszczyński, Piotr

    2015-01-01

    Adult-onset Still's disease is a rare disorder, which creates difficulties in making a proper diagnosis. Ambiguous symptoms and results of auxiliary tests, lack of unequivocal diagnostic tests and the need to exclude other causes of the disease are major problems in clinical practice. A case of a 22-year-old woman with dominated recurrent fever, significantly elevated inflammation markers and arthritis is presented. Based on clinical signs after exclusion of infection, hematological and other reasons, the patient was diagnosed with adult-onset Still's disease. Standard treatment, with high doses of glucocorticoids and a disease-modifying drug, was applied, without the anticipated effects. The diagnostic tests were conducted again due to the lack of clinical improvement, increase of inflammatory markers and unusual response to treatment. A new symptom of significance, i.e. mediastinal lymphadenopathy, was found. After the histopathological examination of lymph nodes, Hodgkin's disease was diagnosed and targeted therapy for hematological malignancy was applied.

  4. Very long chain acyl-coenzyme A dehydrogenase deficiency with adult onset

    DEFF Research Database (Denmark)

    Smelt, A H; Poorthuis, B J; Onkenhout, W;

    1998-01-01

    Very long chain acyl-coenzyme A (acyl-CoA) dehydrogenase (VLCAD) deficiency is a severe disorder of mitochondrial beta-oxidation in infants. We report adult onset of attacks of painful rhabdomyolysis. Gas chromatography identified strongly elevated levels of tetradecenoic acid, 14:1(n-9), tetrade......Very long chain acyl-coenzyme A (acyl-CoA) dehydrogenase (VLCAD) deficiency is a severe disorder of mitochondrial beta-oxidation in infants. We report adult onset of attacks of painful rhabdomyolysis. Gas chromatography identified strongly elevated levels of tetradecenoic acid, 14:1(n-9......), tetradecadienoic acid, 14:2(n-6), and hexadecadienoic acid, 16:2(n-6). Palmitoyl-CoA and behenoyl-CoA dehydrogenase in fibroblasts were deficient. Muscle VLCAD activity was very low. DNA analysis revealed compound heterozygosity for two missense mutations in the VLCAD gene. The relatively mild clinical course may...

  5. Sources and prevalence of self-reported asthma diagnoses in adults in urban and rural settings of Bangladesh.

    Science.gov (United States)

    Bartlett, Emily; Parr, John; Lindeboom, Wietze; Khanam, Masuma Akter; Koehlmoos, Tracy Pérez

    2013-01-01

    This study provides data on the sources of asthma diagnoses in the adult Bangladeshi population in urban and rural settings. The paper also reports the prevalence of self-reported asthma diagnoses and associated socio-demographic factors. A cross-sectional study was conducted in three communities: two rural settings and one urban setting, with a total sample size of 32,665 subjects. Pre-existing surveillance data provided individual socio-demographic factors. Provider categories were based on previous research describing provider plurality in Bangladesh. Descriptive statistics, univariate regression and multivariate regression analyses were performed. Bachelor of Medicine, Bachelor of Surgery (MBBS) generalists provided the largest proportion of diagnoses in both urban (54.6%) and rural (42.4%) sites. The largest proportion of non-MBBS-trained healthcare workers providing diagnoses of asthma was spiritual healers (13.3%) in the urban settings and village doctors (42.4%) in rural settings. The overall prevalence of self-reported asthma diagnoses was 5.0% in the urban population and 3.5% in the rural population. The results highlight the importance of non-MBBS doctors in serving the healthcare needs of the Bangladeshi population. This study reveals a higher prevalence of self-reported asthma diagnoses in the urban setting than in rural ones, which is consistent with international literature on the topic.

  6. Ciclesonide improves health-related quality of life in adults and adolescents with mild-to-moderate persistent asthma.

    Science.gov (United States)

    Nathan, Robert A; Kanter, Lewis; Ostrom, Nancy K

    2008-01-01

    Health-related quality of life (HRQOL) provides information on patients' everyday physical, emotional, and social difficulties that traditional measurements of asthma severity (pulmonary function assessments and asthma symptom scores) may not reflect. Our objective is to evaluate the effect of ciclesonide (CIC) on HRQOL in a combined analysis of two identical, 12-week, multicenter, double-blind, parallel-group, placebo-controlled trials. Patients (N=1015) with mild-to-moderate asthma (aged >or=12 years; forced expiratory volume in 1 s 60-85% predicted at randomization after administration of single-blind placebo during baseline [5-28 days]) were randomized to receive placebo or CIC 80, 160, or 320 microg (ex-actuator) once daily. HRQOL was assessed using the Juniper Asthma Quality-of-Life Questionnaire (AQLQ). The overall AQLQ score and individual domain scores (activity limitation, symptoms, emotional function, and exposure to environmental stimuli) were recorded at baseline, week 4 and week 12. Statistically significant improvements (por=0.5 improvement) by week 4, which was sustained through to week 12, compared with placebo (week 12: CIC80, 47.1%; CIC160, 50%; CIC320, 50.6%; placebo, 31%). In this combined analysis, once-daily CIC significantly improved HRQOL compared with placebo, in adults/adolescents with mild-to-moderate persistent asthma.

  7. Urticaria and dermographism in patients with adult-onset Still's disease.

    Science.gov (United States)

    Criado, Paulo Ricardo; de Carvalho, Jozélio Freire; Ayabe, Liliane Akemi; Brandt, Hebert Roberto Clivati; Romiti, Ricardo; Maruta, Celina W

    2012-08-01

    Adult-onset Still's disease (AOSD) patients typically present with arthralgia, fever, lymphadenopathy and a transient salmon maculopapular rash. Only approximately 25 cases of AOSD with urticaria were described in the literature. In this article, the authors report three additional cases of AOSD with urticarial and dermographic lesions who had a good clinical response to glucocorticoid and antihistamines. A review of the literature concerning this issue is also herein written.

  8. A Case of Adult Onset Still's Disease Misdiagnosed as Septic Arthritis

    OpenAIRE

    Song, Sang Jun; Bae, Dae Kyung; Noh, Jung Ho; Seo, Geon Wook; Nam, Dong Cheol

    2011-01-01

    We present a case of adult onset Still's disease (AOSD) that was misdiagnosed as septic arthritis of the shoulder and knee. A forty-nine-year-old woman was admitted for pain in the left knee. The patient's medical history showed that she had undergone arthroscopic irrigation twice and an open debridement under the diagnosis of septic shoulder at another hospital. The laboratory and joint fluid analysis findings led us to suspect septic knee. Arthroscopic irrigation and antibiotics treatment w...

  9. Serum Vitamin D Levels and Vitamin D Supplement in Adult Patients with Asthma Exacerbation

    Science.gov (United States)

    Chantveerawong, Teerapol; Pradubpongsa, Panitan; Sangasapaviliya, Atik

    2016-01-01

    Introduction. Vitamin D deficiency has been linked to an increased risk of asthma exacerbations. Objective. This study aimed to compare vitamin D status during the period of severe asthma exacerbations and investigate if vitamin D supplementation improves asthma control. Methods. A total of 47 asthmatic patients and 40 healthy subjects participated in this study. Serum 25-hydroxyvitamin D (25(OH)D), asthma control test (ACT) score, and % predicted peak expiratory flow rate were evaluated in the period with and without severe asthma exacerbations. After that, we provided vitamin D2 supplements to the patients with low vitamin D levels for 3 months. Results. At the period of asthma exacerbation, the prevalence of vitamin D deficiency and insufficiency was 38.29% and 34.04%. There was no significant difference in the levels of serum 25(OH)D with and without asthma exacerbations but the levels were significantly higher in the healthy group. Serum 25(OH)D levels significantly correlated with ACT score. Moreover, vitamin D2 supplementation improved asthma control in uncontrolled asthma group. Conclusions. Hypovitaminosis D was common in asthmatic patients but was not the leading cause of asthma exacerbations. Serum 25(OH)D levels correlated with the ability to control asthma. Improving vitamin D status might be a benefit in uncontrolled asthmatic patients. PMID:27974898

  10. Dioxin (TCDD induces epigenetic transgenerational inheritance of adult onset disease and sperm epimutations.

    Directory of Open Access Journals (Sweden)

    Mohan Manikkam

    Full Text Available Environmental compounds can promote epigenetic transgenerational inheritance of adult-onset disease in subsequent generations following ancestral exposure during fetal gonadal sex determination. The current study examined the ability of dioxin (2,3,7,8-tetrachlorodibenzo[p]dioxin, TCDD to promote epigenetic transgenerational inheritance of disease and DNA methylation epimutations in sperm. Gestating F0 generation females were exposed to dioxin during fetal day 8 to 14 and adult-onset disease was evaluated in F1 and F3 generation rats. The incidences of total disease and multiple disease increased in F1 and F3 generations. Prostate disease, ovarian primordial follicle loss and polycystic ovary disease were increased in F1 generation dioxin lineage. Kidney disease in males, pubertal abnormalities in females, ovarian primordial follicle loss and polycystic ovary disease were increased in F3 generation dioxin lineage animals. Analysis of the F3 generation sperm epigenome identified 50 differentially DNA methylated regions (DMR in gene promoters. These DMR provide potential epigenetic biomarkers for transgenerational disease and ancestral environmental exposures. Observations demonstrate dioxin exposure of a gestating female promotes epigenetic transgenerational inheritance of adult onset disease and sperm epimutations.

  11. Clinical and genetic characteristics of sporadic adult-onset degenerative ataxia.

    Science.gov (United States)

    Giordano, Ilaria; Harmuth, Florian; Jacobi, Heike; Paap, Brigitte; Vielhaber, Stefan; Machts, Judith; Schöls, Ludger; Synofzik, Matthis; Sturm, Marc; Tallaksen, Chantal; Wedding, Iselin M; Boesch, Sylvia; Eigentler, Andreas; van de Warrenburg, Bart; van Gaalen, Judith; Kamm, Christoph; Dudesek, Ales; Kang, Jun-Suk; Timmann, Dagmar; Silvestri, Gabriella; Masciullo, Marcella; Klopstock, Thomas; Neuhofer, Christiane; Ganos, Christos; Filla, Alessandro; Bauer, Peter; Tezenas du Montcel, Sophie; Klockgether, Thomas

    2017-09-05

    To define the clinical phenotype and natural history of sporadic adult-onset degenerative ataxia and to identify putative disease-causing mutations. The primary measure of disease severity was the Scale for the Assessment and Rating of Ataxia (SARA). DNA samples were screened for mutations using a high-coverage ataxia-specific gene panel in combination with next-generation sequencing. The analysis was performed on 249 participants. Among them, 83 met diagnostic criteria of clinically probable multiple system atrophy cerebellar type (MSA-C) at baseline and another 12 during follow-up. Positive MSA-C criteria (4.94 ± 0.74, p 10 years were designated sporadic adult-onset ataxia of unknown etiology/non-MSA (SAOA/non-MSA). Compared with MSA-C, SAOA/non-MSA patients had lower SARA scores (13.6 ± 6.0 vs 16.0 ± 5.8, p = 0.0200) and a slower annual SARA increase (1.1 ± 2.3 vs 3.3 ± 3.2, p = 0.0013). In 11 of 194 tested participants (6%), a definitive or probable genetic diagnosis was made. Our study provides quantitative data on the clinical phenotype and progression of sporadic ataxia with adult onset. Screening for causative mutations with a gene panel approach yielded a genetic diagnosis in 6% of the cohort. NCT02701036. © 2017 American Academy of Neurology.

  12. Dioxin (TCDD) induces epigenetic transgenerational inheritance of adult onset disease and sperm epimutations.

    Science.gov (United States)

    Manikkam, Mohan; Tracey, Rebecca; Guerrero-Bosagna, Carlos; Skinner, Michael K

    2012-01-01

    Environmental compounds can promote epigenetic transgenerational inheritance of adult-onset disease in subsequent generations following ancestral exposure during fetal gonadal sex determination. The current study examined the ability of dioxin (2,3,7,8-tetrachlorodibenzo[p]dioxin, TCDD) to promote epigenetic transgenerational inheritance of disease and DNA methylation epimutations in sperm. Gestating F0 generation females were exposed to dioxin during fetal day 8 to 14 and adult-onset disease was evaluated in F1 and F3 generation rats. The incidences of total disease and multiple disease increased in F1 and F3 generations. Prostate disease, ovarian primordial follicle loss and polycystic ovary disease were increased in F1 generation dioxin lineage. Kidney disease in males, pubertal abnormalities in females, ovarian primordial follicle loss and polycystic ovary disease were increased in F3 generation dioxin lineage animals. Analysis of the F3 generation sperm epigenome identified 50 differentially DNA methylated regions (DMR) in gene promoters. These DMR provide potential epigenetic biomarkers for transgenerational disease and ancestral environmental exposures. Observations demonstrate dioxin exposure of a gestating female promotes epigenetic transgenerational inheritance of adult onset disease and sperm epimutations.

  13. 'SIMPLES': a structured primary care approach to adults with difficult asthma.

    Science.gov (United States)

    Ryan, Dermot; Murphy, Anna; Ställberg, Björn; Baxter, Noel; Heaney, Liam G

    2013-09-01

    The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having 'difficult asthma'. Some will have difficult, 'therapy resistant' asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a 'difficult asthma' clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.

  14. Traffic exposure associated with allergic asthma and allergic rhinitis in adults. A cross-sectional study in southern Sweden

    Directory of Open Access Journals (Sweden)

    Montnémery Peter

    2009-05-01

    Full Text Available Abstract Background There is conflicting evidence that traffic-related air pollution is a risk factor for allergic conditions. Few studies have investigated this in adults. In adults, a high proportion of asthma, rhinitis and eczema is triggered by non-allergic factors. We investigated traffic as a risk factor for allergic versus non-allergic asthma and rhinitis, and eczema, in adults. A questionnaire from 2000 (n = 9319, 18–77 years provided individual data about disease outcome and self-reported traffic exposure. Additional exposure assessments were obtained using Geographical Informations Systems (GIS. Residential addresses were linked to the national Swedish Road Database and to a pollutant database with modelled annual means of NOx (Nitrogen Oxids. Results Living within 100 m from a road with a traffic intensity of >10 cars/min (24 hour mean was associated with prevalence of current asthma reported to be triggered by allergic factors (OR = 1.83, 95% CI = 1.23–2.72 and with allergic rhinitis (OR = 1.30, 95%CI = (1.05–1.61. No relation was seen with asthma or rhinitis triggered by other factors. Living within 100 m of a road with >10 cars/min was also associated with hand-eczema during the last 12 months (OR = 1.63, 95% CI = 1.19–2.23, but not with allergic eczema or diagnosed hand-eczema. Consistent results were seen using self-reported traffic, but the associations with NOx were less consistent. Conclusion Exposure to traffic was associated with a higher prevalence of allergic asthma and allergic rhinitis, but not with asthma or rhinitis triggered by non-allergic factors. This difference was suggested by the overall pattern, but only clear using GIS-measured traffic intensity as a proxy for traffic exposure. An association was also found with hand-eczema during the last 12 months. We suggest that asthma and rhinitis should not be treated as homogenous groups when estimating effects from traffic in adults.

  15. The Efficacy and Safety of Antiinterleukin 13, a Monoclonal Antibody, in Adult Patients With Asthma

    Science.gov (United States)

    Luo, Jian; Liu, Dan; Liu, Chun-Tao

    2016-01-01

    Abstract Effects of antiinterleukin 13 therapies in patients with asthma remain inconsistent. Therefore, we aimed to further clarify the efficacy and safety of antiinterleukin 13 therapies in adult asthmatics by a systematic review and meta-analysis. Randomized controlled trials which reported pulmonary functions, fraction of exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ), rescue use of short-acting-β-agonist (SABA), and rate of asthmatic exacerbation and adverse events were identified in Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), American College of Physician (ACP) Journal Club, and ISI Web of Science, reference lists and by manual searches. Randomized-effect models were used in meta-analysis to calculate pooled mean difference and relative risks (RR). Eight studies with 957 patients were enrolled. Systematic review showed that treatment with antiinterleukin 13 antibodies could significantly improve peak expiratory flow (PEF), decrease FeNO and asthmatic exacerbation, but could not decrease blood and sputum eosinophil levels, improve FEV1, inhibit methacholine PC20, or reduce ACQ scores. Two studies reported opposite results in reducing rescue use of SABA. Meta-analysis showed that antiinterleukin 13 monoclonal therapies could significantly decrease asthmatic exacerbation (RR 0.55, 95% CI: 0.31–0.96, z = 2.10, P = 0.04), but did not significantly improve the FEV1 (95% CI: −1.03 to 2.22, z = 0.72, P = 0.47) or increasing adverse events (RR 1.00, 95% CI: 0.91–1.10, z = 0.00, P = 1.00). Antiinterleukin 13 monoclonal therapies could be safely used to improve PEF, decrease FeNO and asthmatic exacerbation, and probably reduce rescue use of SABA, but could not decrease blood and sputum eosinophil levels, improve FEV1, inhibit methacholine PC20, or reduce ACQ scores. PMID:26871775

  16. Assessing the Dim Light Melatonin Onset in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability

    Science.gov (United States)

    Baker, Emma K.; Richdale, Amanda L.; Hazi, Agnes; Prendergast, Luke A.

    2017-01-01

    This study assessed melatonin levels and the dim light melatonin onset (DLMO) in adults with Autism Spectrum Disorder (ASD) and also investigated the relationships between melatonin and objectively measured sleep parameters. Sixteen adults with ASD (ASD-Only), 12 adults with ASD medicated for comorbid diagnoses of anxiety and/or depression…

  17. Efficacy of a House Dust Mite Sublingual Allergen Immunotherapy Tablet in Adults With Allergic Asthma

    DEFF Research Database (Denmark)

    Virchow, J Christian; Backer, Vibeke; Kuna, Piotr;

    2016-01-01

    IMPORTANCE: The house dust mite (HDM) sublingual allergen immunotherapy (SLIT) tablet is a potential novel treatment option for HDM allergy-related asthma. OBJECTIVES: To evaluate the efficacy and adverse events of the HDM SLIT tablet vs placebo for asthma exacerbations during an inhaled corticos......IMPORTANCE: The house dust mite (HDM) sublingual allergen immunotherapy (SLIT) tablet is a potential novel treatment option for HDM allergy-related asthma. OBJECTIVES: To evaluate the efficacy and adverse events of the HDM SLIT tablet vs placebo for asthma exacerbations during an inhaled...... moderate or severe asthma exacerbation during the ICS reduction period. Secondary outcomes were deterioration in asthma symptoms, change in allergen-specific immunoglobulin G4 (IgG4), change in asthma control or asthma quality-of-life questionnaires, and adverse events. RESULTS: Among 834 randomized...... in allergen-specific IgG4. However, there was no significant difference for change in asthma control questionnaire or asthma quality-of-life questionnaire for either dose. There were no reports of severe systemic allergic reactions. The most frequent adverse events were mild to moderate oral pruritus (13...

  18. [Moderate asthma in adults: diagnosis and management in general medical practice].

    Science.gov (United States)

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  19. The History and Timing of Depression Onset as Predictors of Young-Adult Self-Esteem

    Science.gov (United States)

    Lloyd, Donald A.; Ueno, Koji

    2010-01-01

    Depression often emerges early in the lifecourse and is consistently shown to be associated with poor self-esteem. The three main objectives of the current study are to (1) evaluate the association between a history major depression and self-esteem in young adulthood; (2) assess the relationship between timing of depression onset and young adult self-esteem; and (3) help rule out the alternative interpretation that the relationship between major depression and self-esteem is due to state dependence bias stemming from recent depressive symptoms and stressful life events. To address these objectives we use data from a two-wave panel study based on a community sample of young adults in Miami-Dade County, Florida (n = 1,197). Results indicated a history of major depression during sensitive periods of social development is associated with negative changes in self-esteem over a two-year period during the transition to young adulthood. Among those with a history of depression, earlier onset was more problematic than later onset for young adult self-esteem, although the difference disappeared once the level of self-esteem two years prior was controlled. The linkages between the history and timing of depression onset with self-esteem were observed net of recent depressive symptoms and stressful life events, and thus robust to an alternative interpretation of state dependence. The findings support the argument that major depression, especially if it develops earlier during child-adolescent development, has negative consequences for one’s self-esteem. PMID:21860585

  20. Chinese new immigrant mothers' perception about adult-onset non-communicable diseases prevention during childhood.

    Science.gov (United States)

    Wang, Linda Dong Ling; Lam, Wendy Wing Tak; Wu, Joseph Tsz Kei; Fielding, Richard

    2015-12-01

    Many non-communicable diseases (NCDs) are largely preventable via behaviour change and healthy lifestyle, which may be best established during childhood. This study sought insights into Chinese new immigrant mothers' perceptions about adult-onset NCDs prevention during childhood. Twenty-three semi-structured interviews were carried out with new immigrant mothers from mainland China who had at least one child aged 14 years or younger living in Hong Kong. Interviews were audio taped, transcribed and analysed using a Grounded Theory approach. The present study identified three major themes: perceived causes of adult NCDs, beliefs about NCDs prevention and everyday health information practices. Unhealthy lifestyle, contaminated food and environment pollution were perceived as the primary causes of adult NCDs. Less than half of the participants recognized that parents had responsibility for helping children establish healthy behaviours from an early age to prevent diseases in later life. Most participants expressed helplessness about chronic diseases prevention due to lack of knowledge of prevention, being perceived as beyond individual control. Many participants experienced barriers to seeking health information, the most common sources of health information being interpersonal conversation and television. Participants' everyday information practice was passive and generally lacked awareness regarding early prevention of adult-onset NCDs. Updated understanding of this issue has notable implications for future health promotion interventions. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

    Science.gov (United States)

    Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

    2014-04-01

    Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. The social behavior of male rats administered an adult-onset calorie restriction regimen.

    Science.gov (United States)

    Govic, Antonina; Levay, Elizabeth A; Kent, Stephen; Paolini, Antonio G

    2009-03-23

    The behavioral outcomes of a calorie restricted diet are often neglected in favour of a more physiological examination of the consequences of calorie restriction (CR). This is especially the case with social behavior. A few findings within the maternal CR literature suggest that adult male social behavior is altered by this regimen. Despite the paucity of findings within the maternal CR literature, a systematic investigation of the behavioral phenotype of males administered an adult-onset CR is completely lacking and was the focus of the current study. Adult male hooded Wistar rats were administered a three week CR, with one group receiving a 25% CR and another group receiving a 50% CR before male-to-male social behavior was examined and compared with ad libitium fed males. Various behavioral elements were modulated by CR, both the CR25% and 50% group initiated contact sooner and engaged in greater social activity compared to the ad libitum fed controls. The CR25% group also demonstrated less non-social (self-grooming) behavior and a greater frequency of walkovers compared to all groups, indicating a propensity towards dominance. The CR50% group demonstrated greater environmental assessment/exploration, as measured by the frequency of rearing. As with the maternal CR literature, an adult-onset chronic CR induces a more socially active behavioral phenotype and reduces interest in non-social behavior in the moderately CR group. Taken together, the social behavioral phenotype can be modulated by a CR initiated and maintained during adulthood.

  3. Allergy in severe asthma

    NARCIS (Netherlands)

    Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

    2017-01-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-

  4. [Genetic counseling for adults: the risk of late-onset inherited diseases].

    Science.gov (United States)

    Dürr, Alexandra; Feingold, Josué

    2011-04-01

    Genetic counselling for adults is not classical since it deals with prospective assessment of risk in developing disease. 1% of adults have a monogenic disease, or are carriers of a genotype predisposing to a disease. Situations that need genetic counselling are: confirmation of a diagnosis of an inherited disease already known in the family; discovery of a new genetic disease in an adult with no family history of the disease (reduced penetrance); and presymptomatic and prenatal diagnosis for late onset diseases. The prescription of presymptomatic testing is limited to the intervention of multidisciplinary teams, bringing together medical expertise and notified to needed. This is a special situation because it is not always followed by a preventive action or treatment.

  5. Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis.

    Science.gov (United States)

    Kim, Mi Ae; Shin, Seung Woo; Park, Jong Sook; Uh, Soo Taek; Chang, Hun Soo; Bae, Da Jeong; Cho, You Sook; Park, Hae Sim; Yoon, Ho Joo; Choi, Byoung Whui; Kim, Yong Hoon; Park, Choon Sik

    2017-11-01

    Asthma is a heterogeneous disease characterized by various types of airway inflammation and obstruction. Therefore, it is classified into several subphenotypes, such as early-onset atopic, obese non-eosinophilic, benign, and eosinophilic asthma, using cluster analysis. A number of asthmatics frequently experience exacerbation over a long-term follow-up period, but the exacerbation-prone subphenotype has rarely been evaluated by cluster analysis. This prompted us to identify clusters reflecting asthma exacerbation. A uniform cluster analysis method was applied to 259 adult asthmatics who were regularly followed-up for over 1 year using 12 variables, selected on the basis of their contribution to asthma phenotypes. After clustering, clinical profiles and exacerbation rates during follow-up were compared among the clusters. Four subphenotypes were identified: cluster 1 was comprised of patients with early-onset atopic asthma with preserved lung function, cluster 2 late-onset non-atopic asthma with impaired lung function, cluster 3 early-onset atopic asthma with severely impaired lung function, and cluster 4 late-onset non-atopic asthma with well-preserved lung function. The patients in clusters 2 and 3 were identified as exacerbation-prone asthmatics, showing a higher risk of asthma exacerbation. Two different phenotypes of exacerbation-prone asthma were identified among Korean asthmatics using cluster analysis; both were characterized by impaired lung function, but the age at asthma onset and atopic status were different between the two.

  6. Pesticide methoxychlor promotes the epigenetic transgenerational inheritance of adult-onset disease through the female germline.

    Directory of Open Access Journals (Sweden)

    Mohan Manikkam

    Full Text Available Environmental compounds including fungicides, plastics, pesticides, dioxin and hydrocarbons can promote the epigenetic transgenerational inheritance of adult-onset disease in future generation progeny following ancestral exposure during the critical period of fetal gonadal sex determination. This study examined the actions of the pesticide methoxychlor to promote the epigenetic transgenerational inheritance of adult-onset disease and associated differential DNA methylation regions (i.e. epimutations in sperm. Gestating F0 generation female rats were transiently exposed to methoxychlor during fetal gonadal development (gestation days 8 to 14 and then adult-onset disease was evaluated in adult F1 and F3 (great-grand offspring generation progeny for control (vehicle exposed and methoxychlor lineage offspring. There were increases in the incidence of kidney disease, ovary disease, and obesity in the methoxychlor lineage animals. In females and males the incidence of disease increased in both the F1 and the F3 generations and the incidence of multiple disease increased in the F3 generation. There was increased disease incidence in F4 generation reverse outcross (female offspring indicating disease transmission was primarily transmitted through the female germline. Analysis of the F3 generation sperm epigenome of the methoxychlor lineage males identified differentially DNA methylated regions (DMR termed epimutations in a genome-wide gene promoters analysis. These epimutations were found to be methoxychlor exposure specific in comparison with other exposure specific sperm epimutation signatures. Observations indicate that the pesticide methoxychlor has the potential to promote the epigenetic transgenerational inheritance of disease and the sperm epimutations appear to provide exposure specific epigenetic biomarkers for transgenerational disease and ancestral environmental exposures.

  7. Pesticide methoxychlor promotes the epigenetic transgenerational inheritance of adult-onset disease through the female germline.

    Science.gov (United States)

    Manikkam, Mohan; Haque, M Muksitul; Guerrero-Bosagna, Carlos; Nilsson, Eric E; Skinner, Michael K

    2014-01-01

    Environmental compounds including fungicides, plastics, pesticides, dioxin and hydrocarbons can promote the epigenetic transgenerational inheritance of adult-onset disease in future generation progeny following ancestral exposure during the critical period of fetal gonadal sex determination. This study examined the actions of the pesticide methoxychlor to promote the epigenetic transgenerational inheritance of adult-onset disease and associated differential DNA methylation regions (i.e. epimutations) in sperm. Gestating F0 generation female rats were transiently exposed to methoxychlor during fetal gonadal development (gestation days 8 to 14) and then adult-onset disease was evaluated in adult F1 and F3 (great-grand offspring) generation progeny for control (vehicle exposed) and methoxychlor lineage offspring. There were increases in the incidence of kidney disease, ovary disease, and obesity in the methoxychlor lineage animals. In females and males the incidence of disease increased in both the F1 and the F3 generations and the incidence of multiple disease increased in the F3 generation. There was increased disease incidence in F4 generation reverse outcross (female) offspring indicating disease transmission was primarily transmitted through the female germline. Analysis of the F3 generation sperm epigenome of the methoxychlor lineage males identified differentially DNA methylated regions (DMR) termed epimutations in a genome-wide gene promoters analysis. These epimutations were found to be methoxychlor exposure specific in comparison with other exposure specific sperm epimutation signatures. Observations indicate that the pesticide methoxychlor has the potential to promote the epigenetic transgenerational inheritance of disease and the sperm epimutations appear to provide exposure specific epigenetic biomarkers for transgenerational disease and ancestral environmental exposures.

  8. Predicting abscesses in adults with community-onset monomicrobial Enterobacteriaceae bacteremia: microorganisms matters.

    Science.gov (United States)

    Lee, Chung-Hsun; Lee, Ching-Chi; Hsieh, Chih-Chia; Hong, Ming-Yuan; Chi, Chih-Hsien

    2016-01-01

    Enterobacteriaceae is a leading pathogen of community-onset bacteremia. This study aims to establish a predictive scoring algorithm to identify adults with community-onset Enterobacteriaceae bacteremia who are at risk for abscesses. Of the total 1262 adults, 152 (12.0%) with abscess occurrence were noted. The 6 risk factors significantly associated with abscess occurrence-liver cirrhosis, diabetes mellitus, thrombocytopenia and high C-reactive protein (>100 mg/L) at bacteremic onset, delayed defervescence, and bacteremia-causing Klebsiella pneumoniae-were each assigned +1 point to form the scoring algorithm. In contrast, the elderly, fatal comorbidity (McCabe classification), and bacteremia-causing Escherichia coli were each assigned -1 point, owing to their negative associations with abscess occurrence. Using the proposed scoring algorithm, a cut-off value of +1 yielded a high sensitivity (85.5%) and an acceptable specificity (60.4%). Although the proposed predictive model needs further validation, this simple scoring algorithm may be useful for the early identification of abscesses by clinicians.

  9. Adult onset leukodystrophy with neuroaxonal spheroids: Clinical, neuroimaging and neuropathologic observations

    Science.gov (United States)

    Freeman, Stefanie H.; Hyman, Bradley T.; Sims, Katherine B.; Hedley-Whyte, E. T.; Vossough, Arastoo; Frosch, Matthew P.; Schmahmann, Jeremy D.

    2009-01-01

    Pigmented orthochromatic leukodystrophy (POLD) and Hereditary diffuse leukoencephalopathy with spheroids HDLS are two adult onset leukodystrophies with neuroaxonal spheroids presenting with prominent neurobehavioral, cognitive, and motor symptoms. These are familial or sporadic disorders characterized by cerebral white matter degeneration including myelin and axonal loss, gliosis, macrophages, and axonal spheroids. We report clinical, neuroimaging and pathological correlations of four women ages 34–50 years with adult onset leukodystrophy. Their disease course ranged from 1.5–8 years. Three patients had progressive cognitive and behavioral changes whereas one had acute onset. Neuroimaging revealed white matter abnormalities characterized by symmetric, bilateral, T2 hyperintense and T1 hypointense MRI signal involving frontal lobe white matter in all patients. Extensive laboratory investigations were negative apart from abnormalities in some mitochondrial enzymes and immunologic parameters. Autopsies demonstrated severe leukodystrophy with myelin and axonal loss, axonal spheroids, and macrophages with early and severe frontal white matter involvement. The extent and degree of changes outside the frontal lobe appeared to correlate with disease duration. The prominent neurobehavioral deficits and frontal white matter disease provides clinical-pathologic support for association pathways linking distributed neural circuits subserving cognition. These observations lend further support to the notion that white matter disease alone can account for dementia. PMID:18422757

  10. A unique case of pica of adult onset with interesting psychosexual aspects

    Directory of Open Access Journals (Sweden)

    Suddhendu Chakraborty

    2011-01-01

    Full Text Available Pica has been considered as the ingestion of inedible substances or atypical food combinations. Pica has been reported widely in pediatric age group and often found to be co existing with obsessive compulsive or major depressive disorder. Reports of pica in elderly age group are relatively uncommon and rarely does it have an adult onset. In this article we present a case of adult onset pica. A young lady with unusual sensation in her abdomen was found to consume iron nails over years and there was history of dyspareunia since her marriage three months back. On query it was known that the lady is having same sex relationship over years. There unique conglomeration of cultural, psychodynamic and physiological determinants which together is responsible for this unusual habit of this lady. Moreover the onset of the disease at a late age and different psychodynamic issues make the case all the more interesting. Whether the pica is an eating disorder or obsessive compulsive disorder is still controversial. Pica has been mentioned in Diagnostic and Statistical Manual IV TR. The present case report warrants the need to look into this entity more closely with regards to its occurrence and etiology.

  11. Juvenile versus adult-onset ankylosing spondylitis -- clinical, radiographic, and social outcomes. a systematic review.

    Science.gov (United States)

    Jadon, Deepak R; Ramanan, Athimalaipet V; Sengupta, Raj

    2013-11-01

    Ankylosing spondylitis (AS) has 2 main modes of onset: juvenile-onset AS (JoAS) and adult-onset AS (AoAS). It is not known whether JoAS is a subtype of AS, or AS modulated by early age of onset and longer disease duration. We performed a systematic review of the literature, identifying 12 articles and 1 abstract directly comparing JoAS and AoAS cohorts, with observational study design. Patients with JoAS appear to have more peripheral joint involvement both clinically and radiographically (especially knees and ankles) and more root joint involvement (hips and shoulders); they are more likely to proceed to hip arthroplasty and often initially present with peripheral rather than axial symptoms. Patients with AoAS appear to have more axial symptoms and radiographic disease, particularly in the lumbar spine, and worse axial metrology. In terms of other characteristics, more evidence is needed to confidently state whether JoAS and AoAS are different.

  12. Asthma in adolescents, during the transition from child to adult, effects on physiological parameters and health related quality of life

    OpenAIRE

    2010-01-01

    The aims of this thesis were to evaluate physiological and allergic aspects and consequences of asthma and possible correlation between Health Related Quality of Life (HRQOL) and atopy, lung function, bronchial hyper-responsiveness and regular physical exercise. Possible risk factors for deterioration among patients in their late teenage years prior to and following transfer to adult healthcare were examined. The study was designed to investigate possible differences between...

  13. An official American Thoracic Society Workshop Report: presentations and discussion of the fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between asthma in the workplace and non-work-related asthma.

    Science.gov (United States)

    Malo, Jean-Luc; Tarlo, Susan M; Sastre, Joaquin; Martin, James; Jeebhay, Mohamed F; Le Moual, Nicole; Heederik, Dick; Platts-Mills, Thomas; Blanc, Paul D; Vandenplas, Olivier; Moscato, Gianna; de Blay, Frédéric; Cartier, André

    2015-07-01

    The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.

  14. Self-Esteem, Self-Focused Attention, and the Mediating Role of Fear of Negative Evaluation in College Students with and without Asthma

    Science.gov (United States)

    Junghans-Rutelonis, Ashley N.; Suorsa, Kristina I.; Tackett, Alayna P.; Burkley, Edward; Chaney, John M.; Mullins, Larry L.

    2015-01-01

    Objective: The current study investigated the mediating role of fear of negative evaluation on the relationship between self-focused attention and self-esteem among college students with and without asthma. Participants: Young adults with (n = 148) and without (n = 530) childhood-onset asthma were recruited from a college student population.…

  15. Self-Esteem, Self-Focused Attention, and the Mediating Role of Fear of Negative Evaluation in College Students with and without Asthma

    Science.gov (United States)

    Junghans-Rutelonis, Ashley N.; Suorsa, Kristina I.; Tackett, Alayna P.; Burkley, Edward; Chaney, John M.; Mullins, Larry L.

    2015-01-01

    Objective: The current study investigated the mediating role of fear of negative evaluation on the relationship between self-focused attention and self-esteem among college students with and without asthma. Participants: Young adults with (n = 148) and without (n = 530) childhood-onset asthma were recruited from a college student population.…

  16. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy in the Pediatric Population Clinical Characterization and Comparison with Adult-Onset Disease

    NARCIS (Netherlands)

    Te Riele, Anneline S J M; James, Cynthia A.; Sawant, Abhishek C.; Bhonsale, Aditya; Groeneweg, Judith A.; Mast, Thomas P.; Murray, Brittney; Tichnell, Crystal; Dooijes, Dennis; Van Tintelen, J. Peter; Judge, Daniel P.; van der Heijden, Jeroen F.; Crosson, Jane; Hauer, Richard N W; Calkins, Hugh; Tandri, Harikrishna

    2015-01-01

    Objectives The aims of this study were to determine the clinical characteristics and outcomes of pediatric-onset arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to compare these with those of adult-onset ARVD/C. Background Improved early detection and increased awareness of AR

  17. Adult-onset temporal lobe epilepsy, cognitive decline, multi-antiepileptic drug hypersensitivity, and Hashimoto's encephalopathy: Two case studies ☆

    OpenAIRE

    Sadan, Ofer; Seyman, Estelle; Ash, Elissa L.; Kipervasser, Svetlana; Neufeld, Miri Y.

    2013-01-01

    Hashimoto's encephalopathy is defined by the coexistence of encephalopathy and antithyroid antibodies. We report two cases of adult-onset temporal lobe epilepsy with subacute cognitive decline, high titers of antithyroid antibodies, multi-antiepileptic drug hypersensitivity, and good response to immunomodulatory treatment. The relevance of multidrug hypersensitivity in the setting of adult-onset epilepsy and the importance of searching for autoimmune causes for epilepsy are discussed.

  18. A rare case of adult-onset nesidioblastosis treated successfully with diazoxide.

    Science.gov (United States)

    Arao, Tadashi; Okada, Yosuke; Hirose, Akiko; Tanaka, Yoshiya

    2006-02-01

    A 54-year-old man was admitted to our hospital for evaluation of hypoglycemia. He had frequent episodes of loss of concentration before dinner. The ratio of IRI to plasma glucose (PG) was 0.8-1.0. Abdominal CT revealed no pancreatic tumor, and angiography of splenic artery showed no definite tumor stain within the pancreas. Based on the results of selective arterial calcium stimulation and hepatic venous sampling (ASVS), the provisional diagnosis was a small insulinoma in the pancreatic body. The patient underwent subtotal distal pancreatectomy. However, histopathological and immunohistochemical examinations of the resected tissue showed hypertrophy of islets of Langerhans islands and beta cells around pancreatic ducts. The final diagnosis was adult-onset nesidioblastosis. Postoperatively, the patient continued to exhibit hyperinsulinemia and nighttime hypoglycemia. Octreotide, voglibose and diet therapies failed to improve the nocturnal hypoglycemia. However, treatment with diazoxide at a starting dose of 200 mg/day resulted in immediate amelioration of nocturnal hypoglycemia. This is the first Japanese adult case of nesidioblastosis treated successfully with diazoxide. This case report suggests that diazoxide may be effective for adult-onset nesidioblastosis in a manner similar to that described for pediatric cases.

  19. Predictive value of respiratory symptoms for the diagnosis of pollen-induced seasonal asthma among children and adults in Inner Mongolia

    Directory of Open Access Journals (Sweden)

    Ma TT

    2017-08-01

    Full Text Available Ting Ting Ma,1–3 Yan Zhuang,1 Hai Ying Gong,4 Anthony Chauang Yii,5 Xue Yan Wang,1 Huan Zhong Shi2,3 1Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, 2Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, 3Center of Medical Research, Beijing Institute of Respiratory Diseases, 4Fangshan District Center for Disease Control and Prevention, Beijing, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore Background: The diagnosis of asthma is made on the basis of variable respiratory symptoms and supported by objective evidence of variable airflow limitation. However, spirometry and bronchoprovocation tests may not be routinely available in resource-scarce settings or in the context of large-scale epidemiological studies. There is a gap in knowledge about the predictive value of respiratory symptoms for the diagnosis of pollen-induced asthma.Objective: The aim of this study was to investigate the predictive value of self-reported respiratory symptoms for diagnosing pollen-induced asthma.Patients and methods: We recruited 1,161 patients with respiratory symptoms who presented to the respiratory medicine outpatient clinic of two central hospitals in Inner Mongolia during the pollen season of July–September 2015. All patients were interviewed by a respiratory physician and completed a questionnaire survey, lung function tests and skin prick tests for common inhaled allergens.Results: A total of 392 patients (33.8% were diagnosed with asthma and 292 (25.2%, 160 adults, 132 children with pollen-induced asthma. Respiratory symptoms of cough, wheezing, dyspnea, chest pain and nocturnal awakenings due to breathlessness were all associated with increased odds of being diagnosed with pollen-induced asthma, with cough being the most common symptom in

  20. Clinical and MRI features of supratentorial gliomas with adult-onset epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takahiro; Yamaura, Akira (Chiba Univ. (Japan). School of Medicine); Watanabe, Osamu

    1992-02-01

    Although some patients with supratentorial gliomas develop epilepsy in their clinical course, the details of adult-onset epilepsy with gliomas have not been fully evaluated. This paper reports on 15 cases of supratentorial glioma with the sole symptom of adult-onset epilepsy and characterizes their clinical and MRI features. The patients, 5 males and 10 females, developed the first epilepsy at the mean age of 37 years. Generalized seizure was encountered in all cases and focal seizure alone was never seen. Seizure was satisfactorily controlled with anticonvulsants in all except 2 cases. The tumor was located in the frontal lobe (9 cases) or temporal lobe (6 cases). Histologically, there were 12 astrocytomas, 2 glioblastomas, and 1 oligoastrocytoma. Of these, 12 were benign gliomas. Surprisingly, CT scan and MRI revealed tumors larger than predicted. The abnormal intensity region was delineated most prominently on T[sub 2]-weighted SE image and was broader on T[sub 2]-weighted spin echo image than on T[sub 1]-weighted spin echo and inversion recovery image. The authors conclude that gliomas presenting with epilepsy tend to be histologically benign, are predominantly seen in middle-aged women, and are located in the frontal and temporal lobes. Although a tumor may be large enough to be detected on CT scan or MRI, as in the present study, histological examination is needed to establish the diagnosis. Additionally, gliomas with equivocal abnormalities on CT and MRI do evolve despite further neurological deficits, so meticulous evaluation including stereotactic biopsy is the method of choice. Finally, T[sub 2]-weighted SE image in the coronal plane is advocated for patients with adult-onset epilepsy to achieve accurate diagnosis and to initiate early treatment. (author).

  1. Acrolein and asthma attack prevalence in a representative sample of the United States adult population 2000-2009.

    Directory of Open Access Journals (Sweden)

    B Rey deCastro

    Full Text Available BACKGROUND: Acrolein is an air toxic and highly potent respiratory irritant. There is little epidemiology available, but US EPA estimates that outdoor acrolein is responsible for about 75 percent of non-cancer respiratory health effects attributable to air toxics in the United States, based on the Agency's 2005 NATA (National-Scale Air Toxics Assessment and acrolein's comparatively potent inhalation reference concentration of 0.02 µg/m3. OBJECTIVES: Assess the association between estimated outdoor acrolein exposure and asthma attack reported by a representative cross-sectional sample of the adult United States population. METHODS: NATA 2005 chronic outdoor acrolein exposure estimates at the census tract were linked with residences oif adults (≥18 years old in the NHIS (National Health Interview Survey 2000-2009 (n = 271,348 subjects. A sample-weighted logistic regression model characterized the association between the prevalence of reporting at least one asthma attack in the 12 months prior to survey interview and quintiles of exposure to outdoor acrolein, controlling for potential confounders. RESULTS: In the highest quintile of outdoor acrolein exposure (0.05-0.46 µg/m3, there was a marginally significant increase in the asthma attack pOR (prevalence-odds ratio [95% CI]  = 1.08 [0.98∶1.19] relative to the lowest quintile. The highest quintile was also associated with a marginally significant increase in prevalence-odds (1.13 [0.98∶1.29] in a model limited to never smokers (n = 153,820. CONCLUSIONS: Chronic exposure to outdoor acrolein of 0.05-0.46 µg/m3 appears to increase the prevalence-odds of having at least one asthma attack in the previous year by 8 percent in a representative cross-sectional sample of the adult United States population.

  2. Adult onset primary focal dystonia of the foot: an orthopaedic intervention.

    Science.gov (United States)

    Logan, Loretta; Resseque, Barbara; Dontamsetti, Monica Sakshi

    2016-03-30

    A 54-year-old woman presented to a foot centre with a chief symptom of cramping in her toes, which, she believed, was of a secondary cause originating from a bunion. She was treated conservatively; however, she returned a month later as the symptoms had progressed to painful cramping of toes, toe-curling and instability while walking, due to involuntary movement of her toes. It was believed that the patient presented with a rare case of primary adult onset focal foot dystonia. This case report explains dystonia further in detail and delves into the different treatment and management options available today, including the unique orthopaedic intervention provided for this patient.

  3. Piriform sinus carcinoma with a paraneoplastic syndrome misdiagnosed as adult onset Still's disease: a case report.

    Science.gov (United States)

    Yang, Liu; Li, Wen; Du, Jintao

    2015-01-01

    Paraneoplastic syndromes (PS) occur less commonly in association with otolaryngologic neoplasms than other carcinomas such as those of lung or breast. Piriform sinus carcinoma with PS is extremely rare. We here report a case of piriform sinus carcinoma accompanied by PS that was initially misdiagnosed as adult onset Still's disease and describe our diagnosis and treatment. One lesson we have drawn from the experience of this misdiagnosis is that PS symptoms may manifest before the primary tumor is evident and complicate the diagnostic process.

  4. Adult onset segmental cavernous hemangioma, varicose veins and limb atrophy (klippel-trenaunay-Weber syndrome variant

    Directory of Open Access Journals (Sweden)

    Sawhney MPS

    1990-01-01

    Full Text Available A 22 year-old woman presented with multiple soft, compressible, protuberant, bluish cutaneous lesions as well as firm, non-compressible, subcutaneous masses and varicose veins affecting the right upper limb of three years duration. There was atrophy of soft tissue of forearm by 2.5 cm. X-ray showed soft tissue densities, multiple phleboliths and hypoplastic forearm bones. Histopathological examination from cutaneous lesions revealed cavernous hemangioma. Adult onset cavernous hemangioma involving one upper limb and breast with multiple phleboliths and limb atrophy is a very unusual presentation of Klippel-Trenaunay-Weber syndrome.

  5. ASTHMA AND MENTAL HEALTH SYMPTOMS AMONG ADULT ARAB AMERICANS IN THE DETROIT AREA

    Science.gov (United States)

    The burden of managing chronic health problems such as asthma is often compounded by psychological distress and debilitating mental health problems associated with these conditions. In this study we assessed the relationship between asthma and self-reported mental health symptom...

  6. Mental disorders among adults with asthma : results from the World Mental Health Survey

    NARCIS (Netherlands)

    Scott, Kate M.; Von Korff, Michael; Ormel, Johan; Zhang, Ming-yuan; Bruffaerts, Ronny; Alonso, Jordi; Kessler, Ronald C.; Tachimori, Hisateru; Karam, Elie; Levinson, Daphna; Bromet, Evelyn J.; Posada-Villa, Jose; Gasquet, Isabelle; Angermeyer, Matthias C.; Borges, Guilherme; de Girolamo, Giovanni; Herman, Allen; Haro, Josep Maria

    2007-01-01

    Objective: Our objectives were (a) to determine which common mental disorders are associated with asthma in the general population after controlling for age and sex, and (b) to assess whether the associations of mental disorders with asthma are consistent across diverse countries. Method: Eighteen p

  7. Mental disorders among adults with asthma: results from the World Mental Health Survey

    NARCIS (Netherlands)

    Scott, K.M.; Von Korff, M.; Ormel, J.; Zhang, M.Y.; Bruffaerts, R.; Alonso, J.; Kessler, R.C.; Tachimori, H.; Karam, E.; Levinson, D.; Bromet, E.J.; Posada-Villa, J.; Gasquet, I.; Angermeyer, M.C.; Borges, G.; De Girolamo, G.; Herman, A.; Haro, J.M.

    2007-01-01

    Objective: Our objectives were (a) to determine which common mental disorders are associated with asthma in the general population after controlling for age and sex, and (b) to assess whether the associations of mental disorders with asthma are consistent across diverse countries. Method: Eighteen p

  8. Guidance on the diagnosis and management of asthma among adults in resource limited settings

    NARCIS (Netherlands)

    Kirenga, Bruce J.; Schwartz, Jeremy I.; de Jong, Corina; van der Molen, Thys; Okot-Nwang, Martin

    2015-01-01

    BACKGROUND: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. ME

  9. Asthma, Smoking and BMI in Adults with Intellectual Disabilities: A Community-Based Survey

    Science.gov (United States)

    Gale, L.; Naqvi, H.; Russ, L.

    2009-01-01

    Background: Recent research evidence from the general population has shown that tobacco smoking and raised body mass index (BMI) are associated with worse asthma outcomes. There are indications that asthma morbidity and mortality may be higher among people with intellectual disabilities (ID) than the general population, but the reason for this is…

  10. Prevalence of asthma symptoms among adults aged 20-44 years in Canada

    DEFF Research Database (Denmark)

    Manfreda, J; Becklake, M R; Sears, M R;

    2001-01-01

    Reported prevalence rates of asthma vary within and between countries around the world. These differences suggest environmental factors in addition to genetic factors in the cause of the disease and may provide clues for preventive strategies. We examined the variability of asthma-related symptom...

  11. Are Patients with Childhood Onset of Insomnia and Depression More Difficult to Treat Than Are Those with Adult Onsets of These Disorders? A Report from the TRIAD Study

    Science.gov (United States)

    Edinger, Jack D.; Manber, Rachel; Buysse, Daniel J.; Krystal, Andrew D.; Thase, Michael E.; Gehrman, Phillip; Fairholme, Christopher P.; Luther, James; Wisniewski, Stephen

    2017-01-01

    Study Objectives: To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. Methods: This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. Results: The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group

  12. Asthma mortality in Danish children and young adults, 1973-1994

    DEFF Research Database (Denmark)

    Jørgensen, I M; Bülow, S; Jensen, V B

    2000-01-01

    Several reports indicate that asthma mortality has increased during the last few decades. International comparisons reveal some striking differences in the pattern of asthma mortality. The authors investigated the asthma mortality rate in the Danish child and youth population 1973-1994 and studied...... the validity of death certificates. The authors reviewed all death certificates coded as asthma death in the International Classification of Diseases (ICD 8-ICD 10 (1994)) and adjacent respiratory code numbers for the age group 1-19 yrs. Hospital records and autopsy reports were assessed to validate the cause...... of death. Age-standardized and age-specific mortality rates were calculated. From 1973 to 1987 there was a significant upward trend in the mortality. On subdivision, this trend was limited to the age group 15-19 yrs. Generally the mortality rate decreased from 1988 to 1994. Four per cent coded as asthma...

  13. Asthma and American Indians/Alaska Natives

    Science.gov (United States)

    ... Minority Population Profiles > American Indian/Alaska Native > Asthma Asthma and American Indians/Alaska Natives In 2014, 218, ... Native American adults reported that they currently have asthma. American Indian/Alaska Native children are 30% more ...

  14. High risk of adrenal insufficiency in adults previously treated for idiopathic childhood onset growth hormone deficiency

    DEFF Research Database (Denmark)

    Lange, Martin; Feldt-Rasmussen, Ulla; Svendsen, Ole Lander;

    2003-01-01

    The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients...... were retested with an ITT to evaluate adult GH status. In five patients, an arginine and a synacthen test were performed instead of an ITT. Eleven of 25 patients had a subnormal cortisol response to ITT or synacthen. Ten patients had a GH peak less than 3.0 microg/liter (0.5. +/- 0.5 microg....../liter), whereas 16 patients displayed a normal GH response (12.3 +/- 10.6 microg/liter) after ITT. IGF-I values were decreased in the patients with a pathological retest as well as in patients with a normal GH response compared with controls (P

  15. Socioeconomic status and self-reported asthma in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

    Directory of Open Access Journals (Sweden)

    Cunningham Joan

    2010-08-01

    Full Text Available Abstract Background Asthma is more common among Indigenous than non-Indigenous Australian adults, but little is known about socioeconomic patterning of asthma within the Indigenous population, or whether it is similar to the non-Indigenous population. Methods I analysed weighted data on self-reported current diagnosed asthma and a range of socio-economic and demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05. Results Current asthma prevalence was higher for Indigenous than non-Indigenous people in every age group. After adjusting for age and sex, main language and place of residence were significantly associated with asthma prevalence in both populations. Traditional SES variables such as education, income and employment status were significantly associated with asthma in the non-Indigenous but not the Indigenous population. For example, age-and sex-adjusted relative odds of asthma among those who did not complete Year 10 (versus those who did was 1.2 (95% confidence interval (CI 1.0-1.5 in the non-Indigenous population versus 1.0 (95% CI 0.8-1.3 in the Indigenous population. Conclusions The socioeconomic patterning of asthma among Indigenous Australians is much less pronounced than for other chronic diseases such as diabetes and kidney disease, and contrasts with asthma patterns in the non-Indigenous population. This may be due in part to the episodic nature of asthma, and the well-known challenges in diagnosing it, especially among people with limited health literacy and/or limited access to health care, both of which are more likely in the Indigenous population. It may also reflect the importance of exposures occurring across the socioeconomic spectrum among Indigenous Australians, such as racism, and discrimination, marginalization and dispossession, chronic stress and exposure to

  16. Spirometry-Adjusted Fraction of Exhaled Nitric Oxide Allows Asthma Diagnosis in Children, Adolescents, and Young Adults.

    Science.gov (United States)

    Grzelewski, Tomasz; Stelmach, Włodzimierz; Stelmach, Rafał; Janas, Anna; Grzelewska, Aleksandra; Witkowski, Konrad; Makandjou-Ola, Eusebio; Majak, Paweł; Stelmach, Iwona

    2016-02-01

    Recently, it has been proved that fractional exhaled nitric oxide (FENO) results are in disagreement with other measurements of asthma control. The objective of this work is to present and validate new lung function/lung inflammation ratios. This is a retrospective, cross-sectional study in which we evaluated data from medical documentation of 1,529 pediatric and adolescent subjects and a small number (2% of the studied population) of young adults, who presented symptoms suggestive of asthma (age range 4-24 y). We are the first to analyze results obtained in this manner (before the introduction of controlled medication): FENO, spirometry, specific resistance of the airways, diagnosis of allergic diseases, and allergen sensitization (specific immunoglobulin E results). Cut-off points for the new indicators allowed us to diagnose asthma in the study participants: for FVC/FENO ratio, 0.17 L/ppb; for FEV1/FENO ratio, 0.15 L/ppb; for forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%)/FENO ratio, 0.16 L/s/ppb; for FENO/FVC ratio, 11.00 ppb/L; for FENO/FEV1 ratio, 12.53 ppb/L; and for FENO/FEF25-75% ratio, 11.81 ppb/L/s. Only the ratios described above were closely correlated with the diagnosis of asthma and with one another. They significantly differed between subjects with asthma and healthy subjects as well as between females and males. Only FEF25-75%/FENO and FENO/FEF25-75% values were significant predictors of any sensitization in the studied subjects. We found higher sensitivity than specificity and higher positive predictive value than negative predictive value for FVC/FENO, FEV1/FENO, and FEF25-75%/FENO and found a mirror image for reverse parameters. However, the positive predictive values and negative predictive values were not clearly convincing with respect to diagnostic accuracy in the case of the new parameters proposed. We propose new lung function/lung inflammation ratios by which it may become possible to diagnose asthma in

  17. Adult-Onset Still’s Disease Masquerading as Sepsis in an Asplenic Active Duty Soldier

    Directory of Open Access Journals (Sweden)

    Nathan T. Jaqua

    2012-01-01

    Full Text Available This is a case of a 26-year-old active duty male with a history of idiopathic thrombocytopenic purpura (ITP and surgical asplenia who presented with a one-week history of fevers, myalgias, arthralgias, and rigors. His evaluation upon presentation was significant for a temperature of 103 degrees F, white blood cell count of 36 K with a granulocytic predominance, and elevated transaminases. He was treated empirically with broad-spectrum antibiotics with concern for a systemic infection with an encapsulated organism. During his stay, he developed four SIRS criteria and was transferred to the progressive care unit for suspected sepsis. He continued to have twice-daily fevers and a faint, salmon-colored centripetal rash was eventually observed during his febrile episodes. After a nondiagnostic microbiologic and serologic workup, he was diagnosed with adult-onset Still’s Disease and started on intravenous methylprednisolone with brisk response. He was discharged on oral prednisone and was started on anakinra. Adult-onset Still’s disease is a rare condition that presents with varying severity, and this is the first reported case, to our knowledge, of its diagnosis in an asplenic patient. Its management in the setting of asplenia is complicated by the need for antibiotic therapy with each episode of fever.

  18. Prenatal Testing for Adult-Onset Conditions: the Position of the National Society of Genetic Counselors.

    Science.gov (United States)

    Hercher, Laura; Uhlmann, Wendy R; Hoffman, Erin P; Gustafson, Shanna; Chen, Kelly M

    2016-12-01

    Advances in genetic testing and the availability of such testing in pregnancy allows prospective parents to test their future child for adult-onset conditions. This ability raises several complex ethical issues. Prospective parents have reproductive rights to obtain information about their fetus. This information may or may not alter pregnancy management. These rights can be in conflict with the rights of the future individual, who will be denied the right to elect or decline testing. This paper highlights the complexity of these issues, details discussions that went into the National Society of Genetic Counselors (NSGC) Public Policy Task Force's development of the Prenatal testing for Adult-Onset Conditions position statement adopted in November 2014, and cites relevant literature on this topic through December 2015. Issues addressed include parental rights and autonomy, rights of the future child, the right not to know, possible adverse effects on childhood and the need for genetic counseling. This paper will serve as a reference to genetic counselors and healthcare professionals when faced with this situation in clinical practice.

  19. Similarities in speech and white matter characteristics in idiopathic developmental stuttering and adult-onset stuttering

    Science.gov (United States)

    Chang, Soo-Eun; Synnestvedt, Anna; Ostuni, John

    2009-01-01

    Adult-onset stuttering (AS) typically occurs following neurological and/or psychological trauma, considered different from developmental stuttering (DS), which starts during early childhood with few if any new cases reported after adolescence. Here we report four cases of AS, two with apparent psychological trigger and two without, none with evidence of neurological injury, and none conforming to previously reported characteristics of psychogenic stuttering. We asked whether this group of AS would have similar speech and neuroanatomical characteristics to those with DS. We conducted blinded analyses of speech samples in both AS cases and 14 cases of DS on type, frequency, and loci of disfluencies. Diffusion tensor imaging (DTI) was conducted to compare white matter tracts using fractional anisotropy (FA). We found that AS did not differ significantly from DS in any of the speech characteristics measured. On DTI, DS had significantly increased FA relative to controls in the right superior longitudinal tract. AS cases showed a similar trend for increases in these regions when compared to controls. The results of this study suggest that symptoms of idiopathic stuttering can begin during adulthood, and that similar neuroanatomical differences from controls may be associated with both developmental and adult onset idiopathic stuttering. PMID:20640049

  20. Examination of validity in spoken language evaluations: Adult onset stuttering following mild traumatic brain injury.

    Science.gov (United States)

    Roth, Carole R; Cornis-Pop, Micaela; Beach, Woodford A

    2015-01-01

    Reports of increased incidence of adult onset stuttering in veterans and service members with mild traumatic brain injury (mTBI) from combat operations in Iraq and Afghanistan lead to a reexamination of the neurogenic vs. psychogenic etiology of stuttering. This article proposes to examine the merit of the dichotomy between neurogenic and psychogenic bases of stuttering, including symptom exaggeration, for the evaluation and treatment of the disorder. Two case studies of adult onset stuttering in service members with mTBI from improvised explosive device blasts are presented in detail. Speech fluency was disrupted by abnormal pauses and speech hesitations, brief blocks, rapid repetitions, and occasional prolongations. There was also wide variability in the frequency of stuttering across topics and conversational situations. Treatment focused on reducing the frequency and severity of dysfluencies and included educational, psychological, environmental, and behavioral interventions. Stuttering characteristics as well as the absence of objective neurological findings ruled out neurogenic basis of stuttering in these two cases and pointed to psychogenic causes. However, the differential diagnosis had only limited value for developing the plan of care. The successful outcomes of the treatment serve to illustrate the complex interaction of neurological, psychological, emotional, and environmental factors of post-concussive symptoms and to underscore the notion that there are many facets to symptom presentation in post-combat health.

  1. A rare presentation of adult onset Still’s disease in an elderly patient

    Directory of Open Access Journals (Sweden)

    Mariya Apostolova

    2011-10-01

    Full Text Available Adult onset Still’s disease (AOSD is a rare inflammatory disorder of unknown etiology that usually affects young adults. Very few patients older than 70-year-old have been reported. Clinical features include quotidian fevers, arthralgias, arthritis, pharyngitis, lymphadenopathy and an evanescent rash. AOSD should be considered in the differential diagnosis of fever of unknown origin. Early diagnosis is often difficult since it is a diagnosis of exclusion and the presence of infectious, neoplastic and autoimmune conditions needs to be ruled out before the diagnosis is made. No specific laboratory tests are available to aid in the diagnosis of AOSD. As a result, a set of diagnostic criteria that define the clinical features of this condition, termed the Yamaguchi criteria, have been most commonly used to establish the diagnosis. We describe the case of a 72-year-old Caucasian male with past medical history significant for generalized anxiety disorder, depression, BPH, and hypertriglyceridemia, who presented to a tertiary institution complaining of profound generalized weakness and weight loss that started three weeks prior to presentation. Initial laboratory studies showed leukocytosis, elevated ESR, CRP, ferritin and liver dysfunction. Cultures, ANA and rheumatoid factor studies were negative. The patient underwent further extensive workup that excluded the presence of infectious, neoplastic and autoimmune disorders and was subsequently diagnosed with AOSD and new onset diabetes mellitus. For the management of AOSD he was started on prednisone with significant improvement in markers of inflammation, symptoms and level of function.

  2. Asthma in goldminers

    African Journals Online (AJOL)

    -term and fy this stered, cturnal hort-. Asthma in goldminers. Robert L Cowie, Salmon K. Mabena. Objectives. ... family history of asthma were compared in the two groups. The age of onset ... mines, and the disease had developed 13.4 ± 8.22 years ..... Chan-Yeung M, lam S, Koener S. Clinical features and natural history of.

  3. Axial mitochondrial myopathy in a patient with rapidly progressive adult-onset scoliosis.

    Science.gov (United States)

    Hiniker, Annie; Wong, Lee-Jun; Berven, Sigurd; Truong, Cavatina K; Adesina, Adekunle M; Margeta, Marta

    2014-01-01

    Axial myopathy can be the underlying cause of rapidly progressive adult-onset scoliosis; however, the pathogenesis of this disorder remains poorly understood. Here we present a case of a 69-year old woman with a family history of scoliosis affecting both her mother and her son, who over 4 years developed rapidly progressive scoliosis. The patient had a history of stable scoliosis since adolescence that worsened significantly at age 65, leading to low back pain and radiculopathy. Paraspinal muscle biopsy showed morphologic evidence of a mitochondrial myopathy. Diagnostic deficiencies of electron transport chain enzymes were not detected using standard bioassays, but mitochondrial immunofluorescence demonstrated many muscle fibers totally or partially deficient for complexes I, III, IV-I, and IV-IV. Massively parallel sequencing of paraspinal muscle mtDNA detected multiple deletions as well as a 40.9% heteroplasmic novel m.12293G > A (MT-TL2) variant, which changes a G:C pairing to an A:C mispairing in the anticodon stem of tRNA Leu(CUN). Interestingly, these mitochondrial abnormalities were not detected in the blood of either the patient or her son, suggesting that the patient's rapidly progressive late onset scoliosis was due to the acquired paraspinal mitochondrial myopathy; the cause of non-progressive scoliosis in the other two family members currently remains unexplained. Notably, this case illustrates that isolated mitochondrial myopathy can underlie rapidly-progressive adult-onset scoliosis and should be considered in the differential diagnosis of the primary axial myopathy.

  4. Efficacy of Retigabine in Adjunctive Treatment of Partial Onset Seizures in Adults

    Directory of Open Access Journals (Sweden)

    Michele Y. Splinter

    2013-01-01

    Full Text Available Objective To evaluate efficacy and tolerability of retigabine (ezogabine, US adopted name in the adjunctive treatment of partial-onset seizures in adults. Retigabine is the first anticonvulsant in its class, decreasing neuronal excitability by opening voltage-gated potassium channels. Methods MEDLINE and EMBASE were systematically searched using search terms retigabine and ezogabine for randomized controlled trials published from 1980 through August 17, 2013. Additionally, articles relating to pharmacology, pharmacokinetics, tolerability and interactions were examined for inclusion. Published abstracts and websites of the Food and Drug Administration and European Medication Agency were reviewed for additional relevant information. Results One phase IIb and two phase III trials were identified. Retigabine has been reported to have dose dependent efficacy in adjunctive treatment of resistant partial-onset seizures in adults in doses of 600, 900 and 1200 mg/day. Similar to other anticonvulsants, the most common adverse events were central nervous system related. Retigabine has several unique adverse events compared to other anticonvulsants: urinary retention and, with extended use, pigment changes to the skin and retina. Retigabine is metabolized by glucuronidation and acetylation. There are few drug interactions with retigabine. Conclusions Retigabine has been shown to have efficacy when used as adjunctive therapy in partial-onset seizures. It has a novel mechanism of action, activation of voltage-gated potassium channels. It has less drug interactions than many other anticonvulsants because it is not metabolized through the P-450 system. Its place in therapy has yet to be determined, especially with recent reports of pigment discoloration of skin and the retina with extended use.

  5. Sensorimotor Oscillations Prior to Speech Onset Reflect Altered Motor Networks in Adults Who Stutter

    Science.gov (United States)

    Mersov, Anna-Maria; Jobst, Cecilia; Cheyne, Douglas O.; De Nil, Luc

    2016-01-01

    Adults who stutter (AWS) have demonstrated atypical coordination of motor and sensory regions during speech production. Yet little is known of the speech-motor network in AWS in the brief time window preceding audible speech onset. The purpose of the current study was to characterize neural oscillations in the speech-motor network during preparation for and execution of overt speech production in AWS using magnetoencephalography (MEG). Twelve AWS and 12 age-matched controls were presented with 220 words, each word embedded in a carrier phrase. Controls were presented with the same word list as their matched AWS participant. Neural oscillatory activity was localized using minimum-variance beamforming during two time periods of interest: speech preparation (prior to speech onset) and speech execution (following speech onset). Compared to controls, AWS showed stronger beta (15–25 Hz) suppression in the speech preparation stage, followed by stronger beta synchronization in the bilateral mouth motor cortex. AWS also recruited the right mouth motor cortex significantly earlier in the speech preparation stage compared to controls. Exaggerated motor preparation is discussed in the context of reduced coordination in the speech-motor network of AWS. It is further proposed that exaggerated beta synchronization may reflect a more strongly inhibited motor system that requires a stronger beta suppression to disengage prior to speech initiation. These novel findings highlight critical differences in the speech-motor network of AWS that occur prior to speech onset and emphasize the need to investigate further the speech-motor assembly in the stuttering population. PMID:27642279

  6. Sensorimotor oscillations prior to speech onset reflect altered motor networks in adults who stutter

    Directory of Open Access Journals (Sweden)

    Anna-Maria Mersov

    2016-09-01

    Full Text Available Adults who stutter (AWS have demonstrated atypical coordination of motor and sensory regions during speech production. Yet little is known of the speech-motor network in AWS in the brief time window preceding audible speech onset. The purpose of the current study was to characterize neural oscillations in the speech-motor network during preparation for and execution of overt speech production in AWS using magnetoencephalography (MEG. Twelve AWS and twelve age-matched controls were presented with 220 words, each word embedded in a carrier phrase. Controls were presented with the same word list as their matched AWS participant. Neural oscillatory activity was localized using minimum-variance beamforming during two time periods of interest: speech preparation (prior to speech onset and speech execution (following speech onset. Compared to controls, AWS showed stronger beta (15-25Hz suppression in the speech preparation stage, followed by stronger beta synchronization in the bilateral mouth motor cortex. AWS also recruited the right mouth motor cortex significantly earlier in the speech preparation stage compared to controls. Exaggerated motor preparation is discussed in the context of reduced coordination in the speech-motor network of AWS. It is further proposed that exaggerated beta synchronization may reflect a more strongly inhibited motor system that requires a stronger beta suppression to disengage prior to speech initiation. These novel findings highlight critical differences in the speech-motor network of AWS that occur prior to speech onset and emphasize the need to investigate further the speech-motor assembly in the stuttering population.

  7. Asthma Basics

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Asthma Basics KidsHealth > For Parents > Asthma Basics A A ... Asthma Categories en español Asma: aspectos fundamentales About Asthma Asthma is a common lung condition in kids ...

  8. Asthma and obesity.

    Science.gov (United States)

    Boulet, L-P

    2013-01-01

    The prevalence and incidence of asthma have increased among obese children and adults, particularly among women. Obesity seems to be a predisposing factor for the development of asthma, but the underlying mechanisms of its influence are still uncertain. Various hypotheses have been proposed to explain the link between obesity and asthma such as a common genetic predisposition, developmental changes, altered lung mechanics, the presence of a systemic inflammatory process, and an increased prevalence of associated comorbid conditions. Over-diagnosis of asthma does not seem to be more frequent in obese compared to non-obese subjects, but the added effects of obesity on respiratory symptoms can affect asthma control assessment. Obesity can make asthma more difficult to control and is associated with a reduced beneficial effect of asthma medications. This could be due to a change in asthma phenotype, particularly evidenced as a less eosinophilic type of airway inflammation combined to the added effects of changes in lung mechanics. Weight loss is associated with a universal improvement of asthma and should be part of asthma management in the obese patient. Additional research should be conducted to better determine how obesity influences the development and clinical expression of asthma, establish the optimal management of asthma in this population and determine how obesity affects long-term asthma outcomes in these patients.

  9. Prospective impact of panic disorder and panic-anxiety on asthma control, health service use, and quality of life in adult patients with asthma over a 4-year follow-up.

    Science.gov (United States)

    Favreau, Helene; Bacon, Simon L; Labrecque, Manon; Lavoie, Kim L

    2014-02-01

    Background Panic disorder (PD) is a common anxiety disorder among asthmatic patients with overlapping symptoms (e.g., hyperventilation). However, the longitudinal impact of PD on asthma control remains poorly understood. This study assessed the impact of PD and panic-anxiety on asthma control over a 4.3-year follow-up in 643 adult asthmatic patients. Methods Consecutive patients presenting to a tertiary asthma clinic underwent a sociodemographic, medical history, and psychiatric (Primary Care Evaluation of Mental Disorders) interview and completed questionnaires including the Anxiety Sensitivity Index (ASI) to assess panic-anxiety. At follow-up, patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) questionnaires and reported emergency department visits and hospitalizations during the follow-up. Results Baseline frequency of PD was 10% (n = 65). In fully adjusted models, analyses revealed that PD and ASI scores predicted worse follow-up ACQ total scores (β = 0.292, p = .037; β = 0.012, p = .003) but not AQLQ total scores. ASI scores also predicted greater nocturnal and waking symptoms, activity limitations, and bronchodilator use on the ACQ (β = 0.012-0.018, p anxiety sensitivity are prospectively associated with poorer asthma control and may be important targets for treatment.

  10. Novel case of Trevor’s disease: Adult onset and later recurrence

    Science.gov (United States)

    Khalsa, Amrit S; Kumar, Neil S; Chin, Matthew A; Lackman, Richard D

    2017-01-01

    Dysplasia epiphysealis hemimelica (DEH), or Trevor’s disease, is an osteocartilaginous epiphyseal overgrowth typically occurring in children. The literature reports 6 adult cases and none describe recurrence requiring additional procedures. We present a new-onset proximal tibial DEH in an adult recurring approximately 3 years after open excision. A 39-year-old female presented with a history of right knee pain, swelling, and instability. Physical examination revealed a firm proximal tibial mass. Computed tomography (CT) imaging showed an exophytic, lobulated, sclerotic mass involving the anterolateral margin of the lateral tibial plateau. Magnetic resonance imaging was suggestive of an osteochondroma. The patient underwent curettage of the lesion due to its periarticular location. Histology revealed benign and reactive bone and cartilage consistent with periosteal chondroma. Two and a half years later, the patient presented with a firm, palpable mass larger than the initial lesion. CT revealed a lateral tibial plateau sclerotic mass consistent with recurrent intra-articular DEH. A complete excision was performed and histology showed sclerotic bone with overlying cartilage consistent with exostosis. DEH is a rare epiphyseal osteocartilaginous outgrowth frequently occurring in the long bones of children less than 8 years old. DEH resembles an osteochondroma due to its pediatric presentation and similar histologic appearance. Adult-onset cases comprise less than 1% of reported cases. Recurrence rate after surgical intervention is unknown. Only 1 such case, occurring in a child, has been described. Clinicians contemplating operative treatment for DEH should note the potential for recurrence and consider complete excision. A follow-up period of several years may be warranted to identify recurrent lesions. PMID:28144583

  11. Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study.

    Science.gov (United States)

    Baca, Christine B; Barry, Frances; Vickrey, Barbara G; Caplan, Rochelle; Berg, Anne T

    2017-05-01

    We aimed to compare long-term social outcomes in young adults with childhood-onset epilepsy (cases) with neurologically normal sibling controls. Long-term social outcomes were assessed at the 15-year follow-up of the Connecticut Study of Epilepsy, a community-based prospective cohort study of children with newly diagnosed epilepsy. Young adults with childhood-onset epilepsy with complicated (abnormal neurologic exam findings, abnormal brain imaging with lesion referable to epilepsy, intellectual disability (ID; IQ < 60) or informative history of neurologic insults to which the occurrence of epilepsy might be attributed), and uncomplicated epilepsy presentations were compared to healthy sibling controls. Age, gender, and matched-pair adjusted generalized linear models stratified by complicated epilepsy and 5-year seizure-free status estimated adjusted odds ratios (aORs) and 95% confidence intervals [CIs] for each outcome. The 15-year follow-up included 361 individuals with epilepsy (59% of initial cases; N = 291 uncomplicated and N = 70 complicated epilepsy; mean age 22 years [standard deviation, SD 3.5]; mean epilepsy onset 6.2 years [SD 3.9]) and 173 controls. Social outcomes for cases with uncomplicated epilepsy with ≥5 years terminal remission were comparable to controls; cases with uncomplicated epilepsy <5 years seizure-free were more likely to be less productive (school/employment < 20 h/week) (aOR 3.63, 95% CI 1.83-7.20) and not to have a driver's license (aOR 6.25, 95% CI 2.85-13.72). Complicated cases with epilepsy <5 years seizure-free had worse outcomes across multiple domains; including not graduating high school (aOR 24.97, 95% CI 7.49-83.30), being un- or underemployed (<20 h/week) (aOR 11.06, 95% CI 4.44-27.57), being less productively engaged (aOR 15.71, 95% CI 6.88-35.88), and not living independently (aOR 10.24, 95% CI 3.98-26.36). Complicated cases without ID (N = 36) had worse outcomes with respect to productive engagement (aOR 6.02; 95% CI 2

  12. Recognition of asthma in adolescents and young adults : Which objective measure is best?

    NARCIS (Netherlands)

    Ulrik, CS; Postma, DS; Backer, [No Value

    2005-01-01

    Background. Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability

  13. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults

    DEFF Research Database (Denmark)

    Bjermer, Leif; Bisgaard, Hans; Bousquet, Jean;

    2003-01-01

    patients whose symptoms remained uncontrolled by inhaled corticosteroids were randomised to add montelukast or salmeterol. PARTICIPANTS: Patients (15-72 years; n = 1490) had a clinical history of chronic asthma for > or = 1 year, a baseline forced expiratory volume in one second (FEV1) value 50......OBJECTIVES: To assess the effect of montelukast versus salmeterol added to inhaled fluticasone propionate on asthma exacerbation in patients whose symptoms are inadequately controlled with fluticasone alone. Design and setting A 52 week, two period, double blind, multicentre trial during which......-90% predicted, and a beta agonist improvement of > or = 12% in FEV1. MAIN OUTCOME MEASURES: The primary end point was the percentage of patients with at least one asthma exacerbation. RESULTS: 20.1% of the patients in the group receiving montelukast and fluticasone had an asthma exacerbation compared with 19...

  14. Allergy and Asthma Health Magazine

    Science.gov (United States)

    ... Of Age Older Adults Allergy and Asthma Health Magazine Women Infant, Children and Teenagers Living With Lung ... written by Respiratory Experts Like no other health magazine, Allergy & Asthma Health Magazine is published by people ...

  15. Obesity and asthma.

    Science.gov (United States)

    Gibson, Peter G

    2013-12-01

    There is a global epidemic of asthma and obesity that is concentrated in Westernized and developed countries. A causal association in some people with asthma is suggested by observations that obesity precedes the onset of asthma and that bariatric surgery for morbid obesity can resolve asthma. The obese asthma phenotype features poor asthma control, limited response to corticosteroids, and an exaggeration of the physiological effects of obesity on lung function, which includes a reduction in expiratory reserve volume and airway closure occurring during tidal breathing. Obesity has important implications for asthma treatment. Increasing corticosteroid doses based on poor asthma control, as currently recommended in guidelines, may lead to overtreatment with corticosteroids in obese asthma. Enhanced bronchodilation, particularly of the small airways, may reduce the component of airway closure due to increased bronchomotor tone and suggests that greater emphasis should be placed on long-acting bronchodilators in obese asthma. The societal implications of this are important: with increasing obesity there will be increasing asthma from obesity, and the need to identify successful individual and societal weight-control strategies becomes a key goal.

  16. Hidden in plain sight: macrophage activation syndrome complicating Adult Onset Still's Disease.

    Science.gov (United States)

    Benitez, Lourdes; Vila, Salvador; Mellado, Robert Hunter

    2010-01-01

    Hemophagocytic Lymphystiocytosis is a rare and fatal complication of rheumatic diseases, particularly Adult Onset Still's Disease (AOSD). It may be precipitated with immunosuppressive drugs and with viral and bacterial infections. A diagnosis depends on a high index of suspicion associated to certain clinical manifestations (fever, rash, Splemomegaly, any cytology blood dyscrasia, hipertrigliceridemia, hiperfibrinogenemia, and others), as well as pathologic evidence of hemophagocitosis from bone marrow biopsy or tissue samples of affected organs. Therapy consists of high dose corticosteroids and immunosuppressive drugs. We present a 42 year old woman with AOSD in remission who developed HLH in spite of receiving therapy with high dose steroids and immunosuppressive drugs. She had 2 negative bone marrow aspirates. Evidence of Hemophagocytosis was detected in both bone marrow biopsies. Timely evaluation and recognition of the signs and symptoms of HLH is crucial for the prompt management and a decrease in the mortality associated with this disease.

  17. Adult onset Still's disease accompanied by acute respiratory distress syndrome: A case report.

    Science.gov (United States)

    Xi, Xiao-Tu; Wang, Mao-Jie; Huang, Run-Yue; Ding, Bang-Han

    2016-09-01

    Adult onset Still's disease (AOSD) is a systemic inflammatory disorder characterized by rash, leukocytosis, fever and arthralgia/arthritis. The most common pulmonary manifestations associated with AOSD are pulmonary infiltrates and pleural effusion. The present study describes a 40-year-old male with AOSD who developed fever, sore throat and shortness of breath. Difficulty breathing promptly developed, and the patient was diagnosed with acute respiratory distress syndrome (ARDS). The patient did not respond to antibiotics, including imipenem, vancomycin, fluconazole, moxifloxacin, penicillin, doxycycline and meropenem, but was sensitive to glucocorticoid treatment, including methylprednisolone sodium succinate. ARDS accompanied by AOSD has been rarely reported in the literature. In conclusion, in a patient with ARDS who does not respond to antibiotic treatment, the involvement of AOSD should be considered.

  18. Adult Onset Still’s Disease: A Review on Diagnostic Workup and Treatment Options

    Directory of Open Access Journals (Sweden)

    Rajesh Gopalarathinam

    2016-01-01

    Full Text Available Adult onset Still’s disease (AOSD is a rare systemic inflammatory disease of unknown etiology and pathogenesis that presents in 5 to 10% of patients as fever of unknown origin (FUO accompanied by systemic manifestations. We report an interesting case of a 33-year-old African-American male who presented with one-month duration of FUO along with skin rash, sore throat, and arthralgia. After extensive workup, potential differential diagnoses were ruled out and the patient was diagnosed with AOSD based on the Yamaguchi criteria. The case history, incidence, pathogenesis, clinical manifestations, differential diagnoses, diagnostic workup, treatment modalities, and prognosis of AOSD are discussed in this case report.

  19. Genetic counseling issues in predictive genetic testing for familial adult-onset neurologic diseases.

    Science.gov (United States)

    Burson, C M; Markey, K R

    2001-09-01

    Genetic counseling is important in any genetic testing situation in order to address the various issues related to obtaining a genetic diagnosis. Presymptomatic testing for adult-onset neurodegenerative disease, in particular, presents a complex counseling scenario. It is imperative to discuss the potential impact of test results on patients' family dynamics, insurability and employability, family planning, and future health in addition to ascertaining a complete understanding of recurrence, inheritance, and testing parameters. The Huntington disease presymptomatic testing protocol is well-defined and has been used for more than 10 years. These guidelines, which protect both patient and provider, can now be applied to other diseases as further presymptomatic testing capabilities are realized.

  20. Rituximab in AdultOnset Still’s Disease: Case Report

    Directory of Open Access Journals (Sweden)

    G Mehrpoor

    2009-01-01

    Full Text Available Summary: Adult-onset Still’s disease (AOSD is a rare systemic inflammatory disorder of unknown etiology. It is characterized by high grade fever, skin rash, arthritis, leukocytosis, increased ESR, CRP and liver enzyme levels and high levels of ferritin. The treatment of AOSD includes NSAIDs, steroids, and disease-modifying antirheumatic drugs (DMARDs. Recently biologic agents have been used for treatment of some rheumatologic disorders. Rituximab(MabThera, an anti-CD20 monoclonal antibody is one of the biologic agents which is used by only a few researchers for treatment of refractory AOSD. Herein, we describe a 23 year old woman, who was treated with Rituximab ,three years after diagnosis of AOSD .She did not respond to Metotroxate and Cellcept .After administration of Rituximab, clinical and laboratory remission was achieved .

  1. Adult Onset Still's Disease With Different Antibodies: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Maryam Mobini

    2016-11-01

    Full Text Available  Adult-onset Still’s disease (AOSD is a rare systemic inflammatory disorder of unknown etiology. There is not currently any specific serological markers for AOSD , and  diagnosis still relying on the exclusion of other likely diagnoses. Yamaguchi’s criteria are used as a diagnostic criterion which contains negative serologic markers for other collagen vascular diseases including systemic lupus erythematosus and rheumatoid arthritis. Here we report a 28-year-old woman with arthralgia, fever, rash, leukocytosis, lymphadenopathy, sore throat, abnormal liver function and negative rheumatoid factor and ANA but  seropositive for anti-CCP, anti-dsDNA, and C-ANCA. It seems that despite AOSD is considered as a seronegativedisorder; it should be remembered in patients with compatible findings who are seropositive.

  2. Limited diagnostic value of procalcitonin in early diagnosis of adult onset Still's disease.

    Science.gov (United States)

    Gowin, Ewelina; Wysocki, Jacek

    2016-01-01

    A 17-year-old female patient was referred to the Infectious Diseases Ward because of fever lasting for 14 days. On admission to the hospital the patient was in a generally good state, without any abnormalities on physical examination. Laboratory investigation revealed elevated inflammatory markers. Diagnostic imaging comprising chest X-ray, abdominal ultrasonography, and echocardiography showed no abnormalities. During the hospitalization, there occurred episodes of fever with skin rash and musculoskeletal pain of the lower limbs. Procalcitonin concentrations continued to increase. C-reactive protein concentrations decreased during therapy, starting from 191 mg/l. On the 23(rd) day of the disease, edema of the feet, ankles, and knees appeared. On the basis of the clinical picture and after excluding other possible causes of fever, the patient was diagnosed with adult onset Still's disease. The procalcitonin concentration was normalized after 5 days of steroid therapy. The patient was discharged under ambulatory rheumatologic supervision.

  3. Limited diagnostic value of procalcitonin in early diagnosis of adult onset Still’s disease

    Science.gov (United States)

    Wysocki, Jacek

    2016-01-01

    A 17-year-old female patient was referred to the Infectious Diseases Ward because of fever lasting for 14 days. On admission to the hospital the patient was in a generally good state, without any abnormalities on physical examination. Laboratory investigation revealed elevated inflammatory markers. Diagnostic imaging comprising chest X-ray, abdominal ultrasonography, and echocardiography showed no abnormalities. During the hospitalization, there occurred episodes of fever with skin rash and musculoskeletal pain of the lower limbs. Procalcitonin concentrations continued to increase. C-reactive protein concentrations decreased during therapy, starting from 191 mg/l. On the 23rd day of the disease, edema of the feet, ankles, and knees appeared. On the basis of the clinical picture and after excluding other possible causes of fever, the patient was diagnosed with adult onset Still’s disease. The procalcitonin concentration was normalized after 5 days of steroid therapy. The patient was discharged under ambulatory rheumatologic supervision. PMID:27826176

  4. Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia.

    Science.gov (United States)

    Pun, Stephanie

    2016-12-01

    Hip dysplasia is a treatable developmental disorder that presents early in life but if neglected can lead to chronic disability due to pain, decreased function, and early osteoarthritis. The main causes of hip dysplasia in the young adult are residual childhood developmental dysplasia of the hip (DDH) and adolescent-onset acetabular dysplasia. These two distinct disease processes affect the growing hip during different times of development but result in a similar deformity and pathomechanism of hip degeneration. Routine screening for DDH and counseling regarding risks for acetabular dysplasia in families with a history of early hip osteoarthritis may allow early identification and intervention in these hips with anatomical risk factors for joint degeneration.

  5. Adult Onset Still's Disease With Different Antibodies: A Case Report and Review of Literature.

    Science.gov (United States)

    Mobini, Maryam; Ghasemian, Roya; Zameni, Fatemeh

    2016-10-01

     Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. There is not currently any specific serological markers for AOSD , and  diagnosis still relying on the exclusion of other likely diagnoses. Yamaguchi's criteria are used as a diagnostic criterion which contains negative serologic markers for other collagen vascular diseases including systemic lupus erythematosus and rheumatoid arthritis. Here we report a 28-year-old woman with arthralgia, fever, rash, leukocytosis, lymphadenopathy, sore throat, abnormal liver function and negative rheumatoid factor and ANA but  seropositive for anti-CCP, anti-dsDNA, and C-ANCA. It seems that despite AOSD is considered as a seronegativedisorder; it should be remembered in patients with compatible findings who are seropositive.

  6. Adult-onset nemaline myopathy in a dog presenting with persistent atrial standstill and primary hypothyroidism.

    Science.gov (United States)

    Nakamura, R K; Russell, N J; Shelton, G D

    2012-06-01

    A nine-year-old neutered female mixed breed dog presented for evaluation following a five-day history of lethargy, inappetence, weakness, abdominal distension and generalised muscle atrophy. Persistent vatrial standstill with a junctional rhythm was identified on electrocardiogram. Echocardiogram identified moderate dilation of all cardiac chambers and mild thickening of the mitral and tricuspid valves. Serology was negative for Neospora caninum and Toxoplasma gondii. Permanent pacemaker implantation was performed in addition to endomyocardial and skeletal muscle biopsies. Cryosections from the biceps femoris muscle showed numerous nemaline rod bodies while endomyocardial biopsies were possibly consistent with end-stage myocarditis. Rod bodies have rarely been reported in the veterinary literature. To the authors' knowledge, this is the first report of adult-onset nemaline rod myopathy and hypothyroidism with concurrent cardiac disease in a dog. © 2012 British Small Animal Veterinary Association.

  7. Macrophage Activation Syndrome Associated with Adult-Onset Still’s Disease Successfully Treated with Anakinra

    Directory of Open Access Journals (Sweden)

    Aswini Kumar

    2016-01-01

    Full Text Available Macrophage activation syndrome (MAS is a potentially fatal complication of Adult-Onset Still’s disease (Still’s disease. Whereas an increasing body of evidence supports interleukin-1 (IL-1 blockade as a promising treatment for Still’s disease, whether it is therapeutic for MAS associated with Still’s disease remains unclear. We report a 34-year-old Caucasian man with one-decade history of TNF-blockade-responsive seronegative arthritis who presented with abrupt onset of fever, serositis, bicytopenia, splenomegaly, hepatitis, and disseminated intravascular coagulation. Striking hyperferritinemia was noted without evidence of infection, malignancy, or hemophagocytosis on bone marrow biopsy. NK cells were undetectable in the peripheral blood, whereas soluble IL-2 receptor was elevated. His multiorgan disease resolved in association with methylprednisolone pulse therapy, Anakinra, and a tapering course of prednisone. This case reinforces the notion that Still’s disease is inherently poised to manifest MAS as one of the clinical phenotypes by shedding light on the role of IL-1 underlying both Still’s disease and related MAS.

  8. Occasional detection of thymic epithelial tumor 4 years after diagnosis of adult onset Still disease

    Science.gov (United States)

    Lococo, Filippo; Bajocchi, Gianluigi; Caruso, Andrea; Valli, Riccardo; Ricchetti, Tommaso; Sgarbi, Giorgio; Salvarani, Carlo

    2016-01-01

    Abstract Background: Thymoma is a T cell neoplasm arising from the thymic epithelium that due to its immunological role, frequently undercover derangements of immunity such a tumors and autoimmune diseases. Methods: Herein, we report, to the best of our knowledge, the first description of an association between thymoma and adult onset Still disease (AOSD) in a 47-year-old man. The first one was occasionally detected 4 years later the diagnosis of AOSD, and surgically removed via right lateral thoracotomy. Histology confirmed an encapsulated thymic tumor (type AB sec. WHO-classification). Results: The AOSD was particularly resistant to the therapy, requiring a combination of immunosuppressant followed by anti-IL1R, that was the only steroids-sparing treatment capable to induce and maintain the remission. The differential diagnosis was particularly challenging because of the severe myasthenic-like symptoms that, with normal laboratory tests, were initially misinterpreted as fibromyalgia. The pathogenic link of this association could be a thymus escape of autoreactive T lymphocytes causing autoimmunity. Conclusion: Clinicians should be always include the possibility of a thymoma in the differential diagnosis of an unusual new onset of weakness and normal laboratories data, in particular once autoimmune disease is present in the medical history. PMID:27603335

  9. Clinical features and prognosis of adult-onset Still's disease: 75 cases from China.

    Science.gov (United States)

    Liu, Zhenzhen; Lv, Xiaoju; Tang, Guangmin

    2015-01-01

    This study evaluated the clinical characteristics, treatment outcomes, and complications of patients with adult onset Still's disease (AOSD) in our local Chinese population. Patients with AOSD attending our hospital from 2008 to 2011 were identified and followed up. Their clinical and laboratory features at presentation, as well as their disease progression, treatments, and outcomes were recorded and compared with other reported series. A total of 75 patients with AOSD were identified. Forty-four were female. Thirty-nine had disease onset between 16 and 35 years of age. The most common presenting features were fever (96%), arthritis (57.33%), rash (78.67%), and sore throat (49.3%). The acute phase response was marked in most patients, with elevated erythrocyte sedimentation rates (77.05%) and C-reactive protein levels (84.06%). Hyperferritinemia was present in 74.14% of cases, and serum ferritin (SF) levels declined after treatment in most cases. Liver abnormalities were usually transient, but were more severe in 5 patients. Most patients (92%) required corticosteroid therapy; of these, 33.3% also received disease-modifying antirheumatic drugs or immunosuppressive drugs. Sixty-four and 45.33% patients with AOSD achieved partial and complete remission, respectively, after 2 weeks of treatment, and 92% and 74.67%, respectively, after 1 month. The cumulative relapse rate was 45.3%. Patients with AOSD had complex symptoms with no specific laboratory findings. Reduced SF levels after treatment and liver abnormalities may be used to follow treatment outcome.

  10. Adult-onset NREM parasomnia with hypnopompic hallucinatory pain: a case report.

    Science.gov (United States)

    Mantoan, Laura; Eriksson, Sofia H; Nisbet, Angus P; Walker, Matthew C

    2013-02-01

    We report the case of a 43-year-old woman presenting with nocturnal episodes of pain and screaming during sleep starting at age 30. There was no childhood or family history of parasomnia. The events had gradually become more frequent over the years, occurring in the first half of the night within 2 h of sleep onset. There were no triggers, and she had partial amnesia for the events. A diagnosis of adult-onset sleep terrors was made on clinical grounds and supported polysomnographically. Seizures and periodic limb movements were excluded as triggering factors. There was some mild sleep disordered breathing (predominantly non-desaturating hypopnea with a propensity for REM sleep of debatable significance). Imaging of the brain and spine and neurophysiological investigations ruled out lesions, entrapments, or neuropathies as possible causes of pain. Treatment (clonazepam, paroxetine, or gabapentin) was poorly tolerated and made no difference to the nocturnal episodes, while trazodone worsened them. This is the first report of hypnopompic psychic pain in association with a NREM parasomnia. We hypothesize that the pain may represent a sensory hallucination analogous to the more commonly recognized visual NREM parasomnia-associated hypnopompic visual hallucinations and that, as such, it may arise during arousal of the sensory neocortex as confabulatory response.

  11. Childhood attachment, childhood sexual abuse, and onset of masturbation among adult sexual offenders.

    Science.gov (United States)

    Smallbone, Stephen W; McCabe, Billee-Anne

    2003-01-01

    Written autobiographies of 48 incarcerated adult male sexual offenders (22 rapists, 13 intrafamilial child molesters, and 13 extrafamilial child molesters) were used to generate retrospective self-report measures of their childhood maternal and paternal attachment, childhood sexual abuse experiences, and onset of masturbation. Contrary to expectation, the offenders as a combined group more often reported secure than they did insecure childhood maternal and paternal attachment. There were no differences between the three offender subgroups with respect to maternal attachment; however the rapists and the intrafamilial child molesters were more likely to report insecure paternal attachment than were the extrafamilial child molesters. There were no differences between these offender subgroups in the frequency with which childhood sexual abuse was reported. However, offenders with insecure paternal attachment were more likely to report having been sexually abused than were those with secure paternal attachment. Sexually abused offenders in turn reported earlier onset of masturbation than did those who were not sexually abused. These results are consistent with contemporary attachment models linking insecure childhood attachment to childhood sexual abuse, and with traditional conditioning models linking childhood sexual abuse, early masturbation, and sexual offending.

  12. Delayed Onset Muscle Soreness After Inspiratory Threshold Loading in Healthy Adults

    Science.gov (United States)

    Mathur, Sunita; Sheel, A. William; Road, Jeremy D.; Reid, W. Darlene

    2010-01-01

    Purpose: Skeletal muscle damage occurs following high-intensity or unaccustomed exercise; however, it is difficult to monitor damage to the respiratory muscles, particularly in humans. The aim of this study was to use clinical measures to investigate the presence of skeletal muscle damage in the inspiratory muscles. Methods: Ten healthy subjects underwent 60 minutes of voluntary inspiratory threshold loading (ITL) at 70% of maximal inspiratory pressure. Maximal inspiratory and expiratory mouth pressures, delayed onset muscle soreness on a visual analogue scale and plasma creatine kinase were measured prior to ITL, and at repeated time points after ITL (4, 24 and 48 hours post-ITL). Results: Delayed onset muscle soreness was present in all subjects 24 hours following ITL (intensity = 22 ± 6 mm; significantly higher than baseline p = 0.02). Muscle soreness was reported primarily in the anterior neck region, and was correlated to the amount of work done by the inspiratory muscles during ITL (r = 0.72, p = 0.02). However, no significant change was observed in maximal inspiratory or expiratory pressures or creatine kinase. Conclusions: These findings suggest that an intense bout of ITL results in muscle soreness primarily in the accessory muscles of inspiration, however, may be insufficient to cause significant muscle damage in healthy adults. PMID:20467514

  13. Multimodal Image Analysis in Acquired Vitelliform Lesions and Adult-Onset Foveomacular Vitelliform Dystrophy

    Directory of Open Access Journals (Sweden)

    Ricardo Rocha Bastos

    2016-01-01

    Full Text Available Purpose. To characterize vitelliform lesions (VLs in adult-onset foveomacular vitelliform dystrophy (AOFVD and acquired vitelliform (AVL patients using multimodal image analysis. Methods. Retrospective study of twenty-eight eyes from nineteen patients diagnosed with AVL or AOFVD. They were evaluated by color fundus photographs, fundus autofluorescence (FAF, fluorescein angiography (FA, and spectral-domain optical coherence tomography (SD-OCT. Results. Bilateral VLs were associated with AOFVD (p=0.013. Regular and centered VLs were associated with AOFVD (p=0.004 and p=0.016, whereas irregular and noncentered lesions were more frequent in AVL patients. Visual acuity, greatest linear dimension (GLD, lesion height (LH, and pseudohypopyon were similar between groups. Whereas median LH and GLD in AVL group diminished significantly during follow-up (p=0.009 and p=0.001, AOFVD lesions tended to become larger and thicker. Conclusions. When consulting a patient presenting a VL with unknown age of onset, familial history, or previous retinal diseases, some aspects of multimodal imaging assessment may lead the ophthalmologist to a correct diagnosis.

  14. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Children aged 5–17 Years Asthma Severity among Adults with Current Asthma Asthma Severity among Children with ... Effective Interventions Background Methodology Results Community-Based Interventions Adults – Home Adults – Hospital Emergency Departments Adults – Hospital Inpatients ...

  15. Combination formoterol and budesonide as maintenance and reliever therapy versus inhaled steroid maintenance for chronic asthma in adults and children.

    Science.gov (United States)

    Cates, Christopher J; Lasserson, Toby J

    2009-04-15

    Traditionally inhaled treatment for asthma has been considered as preventer and reliever therapy. The combination of formoterol and budesonide in a single inhaler introduces the possibility of using a single inhaler for both prevention and relief of symptoms (single inhaler therapy). The aim of this review is to compare formoterol and corticosteroid in single inhaler for maintenance and relief of symptoms with inhaled corticosteroids for maintenance and a separate reliever inhaler. We last searched the Cochrane Airways Group trials register in September 2008. Randomised controlled trials in adults and children with chronic asthma. Two review authors independently assessed studies for inclusion and extracted the characteristics and results of each study. Authors or manufacturers were asked to supply unpublished data in relation to primary outcomes. Five studies on 5,378 adults compared single inhaler therapy with current best practice, and did not show a significant reduction in participants with exacerbations causing hospitalisation (Peto OR 0.59; 95% CI 0.24 to 1.45) or treated with oral steroids (OR 0.83; 95% CI 0.66 to 1.03). Three of these studies on 4281 adults did not show a significant reduction in time to first severe exacerbation needing medical intervention (HR 0.96; 95% CI 0.85 to 1.07). These trials demonstrated a reduction in the mean total daily dose of inhaled corticosteroids with single inhaler therapy (mean reduction ranged from 107 to 267 micrograms/day, but the trial results were not combined due to heterogeneity). The full results from four further studies on 4,600 adults comparing single inhaler therapy with current best practice are awaited.Three studies including 4,209 adults compared single inhaler therapy with higher dose budesonide maintenance and terbutaline for symptom relief. No significant reduction was found with single inhaler therapy in the risk of patients suffering an asthma exacerbation leading to hospitalisation (Peto OR 0

  16. Acute EEG findings in HIV-infected Zambian adults with new-onset seizure

    Science.gov (United States)

    Elafros, Melissa A.; Sikazwe, Izukanji; Birbeck, Gretchen L.; Kalungwana, Lisa; Potchen, Michael J.; Bositis, Christopher M.; Koralnik, Igor J.; Theodore, William H.

    2015-01-01

    Objective: To describe acute EEG findings in HIV-infected adults with new-onset seizure, assess baseline clinical characteristics associated with EEG abnormalities, and evaluate the relationship between EEG abnormalities and recurrent seizure. Methods: Eighty-one HIV-infected adults with new-onset seizure had EEG recordings during their index admission. Baseline characteristics assessed included HIV stage, seizure semiology, serum and CSF studies, neuroimaging, cognitive function based on the Zambian Mini-Mental State Examination and International HIV Dementia Scale, and psychiatric symptoms using the Shona Symptom Questionnaire. We evaluated the relationship between baseline characteristics and EEG abnormalities. Patients were followed for seizure recurrence, and the association between acute EEG abnormalities and seizure recurrence was assessed. Death was a secondary outcome. Results: Fifty-five patients had abnormal EEGs (68%): 18 (22%) had interictal spikes (12) or a recorded seizure (6). Among baseline clinical characteristics, more advanced HIV disease (p = 0.039) and any imaging abnormality (p = 0.027) were associated with abnormal EEGs. Cortical (p = 0.008) and white matter (p = 0.004) abnormalities were associated with slow posterior dominant rhythm. Patients were followed for a median of 303 days (interquartile range 103–560). Twenty-four (30%) died and 23 (28%) had recurrent seizures. EEG abnormalities were not associated with recurrent seizure. There was a nonsignificant association between seizures recorded during EEG and death (67% vs 26%, p = 0.051). Conclusions: EEG abnormalities are common in this population, particularly in patients with imaging abnormalities and advanced HIV. Acute EEG abnormalities were not associated with recurrent seizure, but high mortality rates during follow-up limited this analysis. PMID:25740861

  17. Severe asthma in children.

    Science.gov (United States)

    Guilbert, Theresa W; Bacharier, Leonard B; Fitzpatrick, Anne M

    2014-01-01

    Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of inhaled corticosteroids or oral corticosteroids. Children with severe asthma may fall into 2 categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, or poor adherence due to adverse psychological or environmental factors. In contrast, treatment resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline-based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting β-agonists and other add-on therapies, such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control, including reviewing the diagnosis and removing causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future.

  18. Severe asthma in children

    Science.gov (United States)

    Guilbert, TW; Bacharier, LB; Fitzpatrick, AM

    2015-01-01

    Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of ICS or oral corticosteroids. Children with severe asthma may fall into two categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, poor adherence due to adverse psychological or environmental factors. In contrast, treatment-resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting beta-agonists and other add on therapies such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control including reviewing the diagnosis and the removal of causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future. PMID:25213041

  19. Arterial blood gases and acid-base status of adult patients presenting with acute severe asthma at Kenyatta National Hospital, Nairobi.

    Science.gov (United States)

    Odhiambo, J A; Chwala, R D

    1992-06-01

    Forty adult patients with acute severe asthma were assessed for arterial blood gases and acid-base changes at presentation at the Casualty Unit, Kenyatta National Hospital, Nairobi, Kenya. Marked degrees of hypoxaemia (mean P(a)O2 of 8.02 kP(a)), hypocapnia (mean P(a)CO2 of 4.62kP(a)) with apparently normal pH (mean 7.384) were documented in the majority of these patients. Based on these findings, a significant number of the patients (68.5%) were either candidates (5.3%) or potential candidates (63.2%) for artificial ventilation. Records at this hospital suggest an increasing trend in asthma admissions and mortality. Additionally, Intensive Care Unit (ICU) admissions for asthma are associated with high mortality (54.4%). Pulsus paradoxicus emerged as the most significant (p = 0.002) clinical correlate to asthma severity. Central cyanosis was detected in none of the study patients suggesting that it is an unusual finding in the common presentation of acute severe asthma at this hospital. Its clinical detection would therefore imply an ominous clinical state. It is recommended that clinicians should take every opportunity to adequately assess their asthma patients before prescribing medications. They are also encouraged to more frequently request for blood gas studies in acute asthma. Those in charge of clinical teaching should direct appropriate efforts towards improved understanding of the pathophysiology and interpretation of acid-base disorders.

  20. Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a 4-decade longitudinal cohort study

    Science.gov (United States)

    Moffitt, Terrie E.; Houts, Renate; Asherson, Philip; Belsky, Daniel W; Corcoran, David L; Hammerle, Maggie; Harrington, Honalee; Hogan, Sean; Meier, Madeline; Polanczyk, Guilherme V.; Poulton, Richie; Ramrakha, Sandhya; Sugden, Karen; Williams, Benjamin; Rohde, Luis Augusto; Caspi, Avshalom

    2015-01-01

    Objective Despite a prevailing assumption that adult ADHD is a childhood-onset neurodevelopmental disorder, no prospective-longitudinal study has described the childhoods of the adult-ADHD population. We report follow-back analyses of ADHD cases diagnosed in adulthood, alongside follow-forward analyses of ADHD cases diagnosed in childhood, in one cohort. Method Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 38, with 95% retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, GWAS-derived polygenic risk, and life impairment indicators were assessed. Data sources were participants, parents, teachers, informants, neuropsychological testing, and administrative records. Adult ADHD diagnoses used DSM5 criteria, apart from onset-age and cross-setting corroboration, which were study outcomes. Results As expected, the childhood-ADHD group showed 6% prevalence, male excess, childhood comorbid disorders, neurocognitive deficits, polygenic risk, and, despite having outgrown their ADHD diagnosis, residual adult life impairment. As expected, the adult-ADHD group showed 3% prevalence, gender balance, adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood-ADHD and adult-ADHD groups comprised virtually non-overlapping sets; 90% of adult-ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult-ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. Conclusion Findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder's place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD. PMID:25998281

  1. Blood gas tensions in adult asthma: a systematic review and meta-regression analysis.

    Science.gov (United States)

    Johansen, Troels; Johansen, Peter; Dahl, Ronald

    2014-11-01

    The last half-century has seen substantial changes in asthma treatment and care. We investigated whether arterial blood gas parameters in acute and non-acute asthma have changed historically. We performed a systematic search of the literature for studies reporting P(aO2) , P(aCO2) and forced expiratory volume in 1 s, percentage of predicted (FEV1%). For each of the blood gas parameters, meta-regression analyses examined its association with four background variables: the publication year, mean FEV1%, mean age and female fraction in the respective studies. After screening, we included 43 articles comprising 61 datasets published between 1967 and 2013. In studies of habitual-state asthma, mean P(aO2) was positively associated with the publication year (p = 0.001) and negatively with mean age (p blood gas levels were unassociated with publication year and mean age, mean P(aO2) was positively associated with FEV1% (p arterial pH associated with any of the predictor variables. In studies of habitual-state asthma, mean reported P(aO2) and P(aCO2) levels were found to have increased since 1967. In acute asthma studies, mean P(aO2) and P(aCO2) were associated with mean FEV1% but not with either publication year or patient age.

  2. Adult Onset Still’s Disease: A Case Report with a Rare Clinical Manifestation and Pathophysiological Correlations

    Directory of Open Access Journals (Sweden)

    Katerina M. Antoniou

    2013-01-01

    Full Text Available Adult-onset Still’s disease is an inflammatory multisystemic disease of unknown etiology. Pleuritis is the most common pulmonary manifestation and pleural effusions are usually exudates with a predominance of neutrophils. We report a case of an eosinophilic pleural effusion as a novel and hitherto unrecognized manifestation of active adult-onset Still’s disease. We also observed a marked NLRP3 inflammasome activation with increased production of IL-1β which coincided with the development and resolved upon remission of the pleural effusion suggesting a possible novel pathogenetic pathway for the development of pleural effusions in the context of the auto-inflammatory disorders.

  3. P50 auditory sensory gating in first onset schizophrenics and normal healthy adults

    Institute of Scientific and Technical Information of China (English)

    WANG Hongxing; ZHANG Mingdao; CHEN Xingshi; LOU Feiying; LIANG Jianhua; CHEN Chong; SHI Tiantao; LU Qiulin

    2007-01-01

    The aim of this research was to investigate the variations of P50 auditory sensory gating(P50)in normal healthy adults and the first onset schizophrenics.By using the American Nicolet Bravo electromyography/evoked potential (EMG/EP)system,P50 was measured with conditioningtesting paradigm(paired-click stimuli S1 and S2 were used)in 58 first onset schizophrenics and 108 healthy adults,and the Positive and Negative Syndrome Scale(PANSS)was applied.The following three conclusions have been reached.(1)In normal control(NC)group,measured from central,anterior and posterior zone(Cz,Fz and Pz respectively),there were no statistical differences(P>0.05)between S1 and S2 evoked P50 peak latencies(S1-P50 and S2-P50);the amplitudes of S2-P50 [(2.2±1.4),(2.3±1.5)and(2.1±1.4)μV respectively] reduced significantly as compared with S1-P50 [(5.6±3.3),(5.6±3.9)and(4.9±2.8)μV respectively](P<0.01);the S2/S1 ration,S1-S2 difference,and 100(1-S2/S1)had no statistical differences(P>0.05).(2)Compared with NC,the schizophrenic group significantly showed lower S1-P50 amplitudes(P<0.01,except at Pz in which Z=2.030,P=0.042),higher S2-P50 amplitudes,higher S2/S1 ratio,lower S1-S2 difference,and more decreased 100(1-S2/S1)(P<0.01)at Cz,Fz and Pz.(3)No significant correlations were found among S2/S1 ratio,S1-S2,100(1-S2/S1)of sensory gating and PANSS(P>0.05)in schizophrenic group.The first onset schizophrenics had sensory gating deficits,which could be quantified by P50.

  4. Differences in B7 and CD28 family gene expression in the peripheral blood between newly diagnosed young-onset and adult-onset type 1 diabetes patients.

    Science.gov (United States)

    Pruul, K; Kisand, K; Alnek, K; Metsküla, K; Reimand, K; Heilman, K; Peet, A; Varik, K; Peetsalu, M; Einberg, Ü; Tillmann, V; Uibo, R

    2015-09-05

    Type-1 diabetes (T1D) is a heterogeneous autoimmune disease, and there are pathogenetic differences between young- and adult-onset T1D patients. We hypothesized that the expressions of genes involved in costimulatory immune system pathways in peripheral blood are differently regulated in young- and adult-onset T1D. Study group I consisted of 80 children, adolescents, and young adults (age range 1.4-21.4 y; 31 controls and 49 T1D patients). Study group II consisted of 48 adults (age range 22.0-78.4 y; 30 controls and 18 T1D patients). The mRNA expression levels of CD86, CD28, CD25, CD226, CD40, BTLA, GITR, PDCD1, FoxP3, TGF-β, ICOS, sCTLA4, flCTLA4, and CD80 were measured in peripheral blood. Genetic polymorphisms (HLA haplotypes; rs231806, rs231775, and rs3087243 in CTLA4; rs763361 in CD226; and rs706778 in CD25) and T1D-associated autoantibodies were analyzed. In group I, there was significantly lower expression of CD226 in T1D patients than in the controls. In group II, there were significantly higher expression levels of CD86 and TGF-β in T1D patients than in the controls. In the T1D patients in group I, the upregulated CD80 expression correlated with the expression of both CTLA4 splice variants (sCTLA4 and flCTLA4). In contrast, in group II, upregulated CD86 correlated with TGF-β and CD25. In group I, the inhibitory CD80-CTLA4 pathway was activated, whereas, in group II, the activation CD86-CD28 pathway and TGF-β production were activated. These results emphasize the differences between young-onset and adult-onset T1D in the regulation of costimulatory pathways. These differences should be considered when developing novel treatments for T1D.

  5. The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss

    Directory of Open Access Journals (Sweden)

    Swapna Sebastian

    2015-01-01

    Full Text Available Aim of the Study: The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy. Methodology: The quality of life scale questionnaire was administered on two groups. One group consisted of 10 adults with prelingual bilateral severe to profound hearing loss identified before the age of 3 years and who were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. Second group consisted of 10 adults with auditory neuropathy. Results and Discussion: Wilcoxon rank sum test was used to compare the domains across the groups and the gender distributions between two groups were analyzed using Fisher′s exact test. The results revealed that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains. The results indicated the fact that accepting a hearing loss during adulthood leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life. Loss of hearing is quite traumatic to adults. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.

  6. Cutaneous manifestations of adult-onset Still's disease: a case report and review of literature.

    Science.gov (United States)

    Cozzi, Alessandra; Papagrigoraki, Anastasia; Biasi, Domenico; Colato, Chiara; Girolomoni, Giampiero

    2016-05-01

    Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis characterized by high spiking fever, arthralgia or arthritis, sore throat, lymphadenopathy, hepatosplenomegaly, serositis, and transient cutaneous manifestations. Although more common in children, cases are seen also in adults. Cutaneous involvement is common and may be suggestive for the diagnosis. A case of AOSD in a 35-year-old man is reported here, presenting with urticarial maculopapular rash of trunk, high spiking fever, acute respiratory distress syndrome, and myopericarditis. Skin biopsy showed interstitial and perivascular mature CD15(+) neutrophils. A comprehensive review of literature showed that cutaneous involvement occurs in about 80 % of patients, with various clinical presentations. The most common skin manifestation is an evanescent salmon pink or erythematous maculopapular exanthema, predominantly on the trunk and proximal limbs, with rare involvement of face and distal limbs. Less common manifestations include persistent erythematous plaques and pustular lesions. A constant histopathologic finding is the presence of interstitial dermal neutrophils aligned between the collagen bundles. This pattern may provide an easy accessible clue for the definitive diagnosis of AOSD and exclude other diagnosis such as drug eruptions or infectious diseases.

  7. Self-rated health and reasons for non-vaccination against seasonal influenza in Canadian adults with asthma

    Science.gov (United States)

    Fisman, David; Gardy, Jennifer L.

    2017-01-01

    Introduction While seasonal influenza vaccination is recommended for individuals with asthma, uptake in this population is low. We examined how self-rated health impacts reasons for not being immunized against influenza in Canadian adults with asthma, focusing on those who have never been immunized. Methods We pooled four cycles of the Canadian Community Health Survey (cycles 3.1(2005), 2007/08, 2009/10 and 2011/12), grouping individuals by whether their reasons for not having been vaccinated were perceptual or technical. We used a multivariable logistic regression model, adjusted for confounders, to quantify the relationship between self-rated health and their reported reasons for not vaccinating. Results Among the 9,836 respondents, 84.4% cited perceptual barriers as a reason for not being vaccinated. After adjusting for socio-demographic characteristics and province of residence, we determined that reporting perceptual barriers was associated with self-rated health status, with the adjusted odds ratios ranging from 1.42 (95%CI: 0.97, 2.09) to 2.64 (95%CI: 1.74, 3.99) for fair and excellent health versus poor health, respectively. Each increase in self-rated health category was associated with greater odds of citing a perceptual rather than technical barrier as a reason for non-vaccination. Discussion Self-reported health influences people’s perception of the need for influenza vaccination. Viewing the results through the lens of the precaution adoption process model suggests that personalizing communication around both the risk of influenza and the effectiveness of the vaccine may improve uptake amongst adults with asthma. PMID:28207823

  8. Diagnostic Criteria for Adult-Onset Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA Syndrome

    Directory of Open Access Journals (Sweden)

    Luca Cantarini

    2017-08-01

    Full Text Available ObjectiveTo identify a set of variables that could discriminate patients with adult-onset periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA syndrome from subjects with fever of unknown origin (FUO.MethodsWe enrolled 74 adults diagnosed with PFAPA syndrome according to the currently used pediatric diagnostic criteria and 62 additional patients with FUO. After having collected clinical and laboratory data from both groups, univariate and multivariate analyses were performed to identify the variables associated with PFAPA diagnosis. Odds ratio (OR values, their statistical significance, and corresponding 95% confidence interval (CI were evaluated for each diagnostic factor both at the univariate and multivariate analyses. Diagnostic accuracy was evaluated by the area under receiver operating characteristic (ROC curve, while the leave-one-out cross-validation procedure was used to ensure that the model maintains the same diagnostic power when applied to new data.ResultsAccording to the multivariate analysis, the clinical variables that discriminated PFAPA patients were: fever episodes associated with cervical lymphadenitis (OR = 92; p < 0.0001, fever attacks associated with erythematous pharyngitis (OR = 231; p < 0.0001, increased inflammatory markers during fever attacks (OR = 588; p = 0.001, and the lack of clinical and laboratory signs of inflammation between flares (OR = 1202; p < 0.0001. These variables were considered for a diagnostic model which accounted for their OR values. The diagnostic accuracy of the proposed set of criteria corresponded to an area under ROC curve of 0.978 (95% CI 0.958–0.998, with a model sensitivity and specificity equal to 93.4% (95% CI 87.5–96.5% and 91.7% (95% CI 82.8–96.7%, respectively.Conclusionwe have provided herein a set of clinical diagnostic criteria for adult-onset PFAPA syndrome. Our criteria represent an easy-to-use diagnostic tool aimed

  9. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  10. Asthma medication use before and after the onset of type 1 diabetes in children and adolescents: A population-based cohort study

    NARCIS (Netherlands)

    Ahmadizar, Fariba; Maitland-Van Der Zee, Anke-Hilse; De Boer, Anthonius; Souverein, Patrick; Arets, Hubertus

    2015-01-01

    Background: It has been reported that patients with type 1 diabetes (T1DM) have a decreased lung function. Studies on the association of T1DM and asthma in children show controversial results. Objectives: The aim of this study was to quantify asthma medication use in children and adolescents with an

  11. Adult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diagnosis, aetiology and management

    Directory of Open Access Journals (Sweden)

    Benjamin G Challis

    2017-09-01

    Full Text Available Objective: In adults with hyperinsulinaemic hypoglycaemia (HH, in particular those with insulinoma, the optimal diagnostic and management strategies remain uncertain. Here, we sought to characterise the biochemical and radiological assessment, and clinical management of adults with HH at a tertiary centre over a thirteen-year period. Design: Clinical, biochemical, radiological and histological data were reviewed from all confirmed cases of adult-onset hyperinsulinaemic hypoglycaemia at our centre between 2003 and 2016. In a subset of patients with stage I insulinoma, whole-exome sequencing of tumour DNA was performed. Results: Twenty-nine patients were identified (27 insulinoma, including 6 subjects with metastatic disease; 1 pro-insulin/GLP-1 co-secreting tumour; 1 activating glucokinase mutation. In all cases, hypoglycaemia (glucose ≤2.2 mmol/L was achieved within 48 h of a supervised fast. At fast termination, subjects with stage IV insulinoma had significantly higher insulin, C-peptide and pro-insulin compared to those with insulinoma staged I–IIIB. Preoperative localisation of insulinoma was most successfully achieved with EUS. In two patients with inoperable, metastatic insulinoma, peptide receptor radionuclide therapy (PRRT with 177Lu-DOTATATE rapidly restored euglycaemia and lowered fasting insulin. Finally, in a subset of stage I insulinoma, whole-exome sequencing of tumour DNA identified the pathogenic Ying Yang-1 (YY1 somatic mutation (c.C1115G/p.T372R in one tumour, with all tumours exhibiting a low somatic mutation burden. Conclusion: Our study highlights, in particular, the utility of the 48-h fast in the diagnosis of insulinoma, EUS for tumour localisation and the value of PRRT therapy in the treatment of metastatic disease.

  12. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis

    Science.gov (United States)

    Quaranta, Nancy; Reynoso, Julieta; Balbi, Brenda; Vasquez, Julia

    2017-01-01

    Background Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. Material and methods We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). Results Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. Conclusion This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags. PMID:28319180

  13. The US Food and Drug Administration’s drug safety recommendations and long-acting beta2-agonist dispensing pattern changes in adult asthma patients: 2003–2012

    Science.gov (United States)

    Zhou, Esther H; Seymour, Sally; Goulding, Margie R; Kang, Elizabeth M; Major, Jacqueline M; Iyasu, Solomon

    2017-01-01

    Background Emerging safety issues associated with long-acting beta2-agonist (LABA) have led to multiple regulatory activities by the US Food and Drug Administration (FDA) since 2003, including Drug Safety Communications (DSCs) in 2010. These DSCs had three specific recommendations for the safe use of LABA products in adult asthma treatment. Methods We examined the initiation of LABA-containing products for adult asthma treatment using an intermittent time series approach in a claims database from 2003 to 2012. We assessed the alignment of dispensing patterns with the following 2010 FDA recommendations: 1) contraindicated use of single-ingredient (SI)-LABA without an asthma controller medication (ACM); 2) a LABA should only be used when asthma is not adequately controlled on inhaled corticosteroids (ICSs) or ACM; and 3) step-down asthma therapy (e.g., discontinue LABA) when asthma control is achieved. Results There were 477,922 adults (18–64 years old) dispensed a new LABA during 2003–2012. Among LABA initiators, patients who initiated an SI-LABA and who did “not” have an ACM dispensed on the same date decreased from >9% in 2003 (the initial labeling change) to <2% post 2010 DSCs (p-value <0.0001 in the segmented regression model). The proportion of asthma patients dispensed an ICS in 6 months prior to initiating LABA treatment did not increase. The proportion of patients with longer than 4 months of continuous treatment did not decrease over the study period. Conclusion Although the decrease in SI-LABA initiation is consistent with FDA’s recommendations, low ICS dispensing before initiating a LABA and LABA continuation practices require further efforts to move toward the recommended safe practices. PMID:28356763

  14. Pediatric Asthma

    Science.gov (United States)

    ... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

  15. Pediatric Asthma

    Science.gov (United States)

    ... Plan Asthma Epidemic Eating with Asthma Helping Your Child Cope With a Medical Condition Nasal Wash Guide Cleaning Dirty Items Impact on Families Asthma & Pets Peak Flow Meter Athletes & Asthma Helpful Tools for ...

  16. Montelukast or salmeterol combined with an inhaled steroid in adult asthma

    DEFF Research Database (Denmark)

    Bjermer, L; Bisgaard, H; Bousquet, J

    2000-01-01

    , Latin America, Middle East, Africa and the Asia-Pacific region in early 2000. The study will compare the oral LTRA montelukast with the inhaled LABA salmeterol, each administered on a background of inhaled fluticasone, on asthma attacks, quality of life, lung function, eosinophil levels, healthcare...

  17. Risk factors for asthma in young adults: a co-twin control study

    DEFF Research Database (Denmark)

    Thomsen, SF; Ulrik, Charlotte Suppli; Kyvik, KO;

    2006-01-01

    . Pairs in which only one twin developed asthma -- discordant pairs -- were identified and conditional logistic regression was applied to detect effects of risk factors. RESULTS: A total of 126 monozygotic (MZ) and 273 dizygotic (DZ) discordant twin pairs were identified. In MZ twins hay fever (OR = 3.......16, 95% CI: 1.29-7.73, P = 0.007) and exercise (OR for inactivity = 0.35, 95% CI: 0.13-0.91, P = 0.023) were significantly associated with asthma, whereas in DZ twins, hay fever (OR = 2.44, 95% CI: 1.44-4.13, P = 0.001), eczema (OR = 1.96, 95% CI: 1.02-3.78, P = 0.040), female sex (OR between males...... and females = 0.54, 95% CI: 0.36-0.80, P = 0.002), and increasing levels of body mass index (BMI; OR per unit = 1.11, 95% CI: 1.02-1.20, P = 0.009) were significant predictors of asthma. CONCLUSIONS: Hay fever, eczema, female sex, exercise and increasing levels of BMI were risk factors for asthma in young...

  18. Atopy, asthma, and lung function in relation to folate and vitamin B(12) in adults

    DEFF Research Database (Denmark)

    Thuesen, B H; Husemoen, L L N; Ovesen, L

    2010-01-01

    Recent studies suggested low serum folate and impaired folate metabolism as potential risk factors for development of asthma and atopic disease, but the results are inconsistent. The aim of this study was to investigate the relations of markers of folate and vitamin B12 (B12) deficiency...

  19. [Severe asthma].

    Science.gov (United States)

    González, Claudio D

    2016-01-01

    The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients' characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended.

  20. Steatogenesis in adult-onset type II citrullinemia is associated with down-regulation of PPARα.

    Science.gov (United States)

    Komatsu, Michiharu; Kimura, Takefumi; Yazaki, Masahide; Tanaka, Naoki; Yang, Yang; Nakajima, Takero; Horiuchi, Akira; Fang, Zhong-Ze; Joshita, Satoru; Matsumoto, Akihiro; Umemura, Takeji; Tanaka, Eiji; Gonzalez, Frank J; Ikeda, Shu-Ichi; Aoyama, Toshifumi

    2015-03-01

    SLC25A13 (citrin or aspartate-glutamate carrier 2) is located in the mitochondrial membrane in the liver and its genetic deficiency causes adult-onset type II citrullinemia (CTLN2). CTLN2 is one of the urea cycle disorders characterized by sudden-onset hyperammonemia due to reduced argininosuccinate synthase activity. This disorder is frequently accompanied with hepatosteatosis in the absence of obesity and ethanol consumption. However, the precise mechanism of steatogenesis remains unclear. The expression of genes associated with fatty acid (FA) and triglyceride (TG) metabolism was examined using liver samples obtained from 16 CTLN2 patients and compared with 7 healthy individuals. Although expression of hepatic genes associated with lipogenesis and TG hydrolysis was not changed, the mRNAs encoding enzymes/proteins involved in FA oxidation (carnitine palmitoyl-CoA transferase 1α, medium- and very-long-chain acyl-CoA dehydrogenases, and acyl-CoA oxidase 1), very-low-density lipoprotein secretion (microsomal TG transfer protein), and FA transport (CD36 and FA-binding protein 1), were markedly suppressed in CTLN2 patients. Serum concentrations of ketone bodies were also decreased in these patients, suggesting reduced mitochondrial β-oxidation activity. Consistent with these findings, the expression of peroxisome proliferator-activated receptor α (PPARα), a master regulator of hepatic lipid metabolism, was significantly down-regulated. Hepatic PPARα expression was inversely correlated with severity of steatosis and circulating ammonia and citrulline levels. Additionally, phosphorylation of c-Jun-N-terminal kinase was enhanced in CTLN2 livers, which was likely associated with lower hepatic PPARα. Collectively, down-regulation of PPARα is associated with steatogenesis in CTLN2 patients. These findings provide a novel link between urea cycle disorder, lipid metabolism, and PPARα.

  1. Adult-onset autosomal dominant centronuclear myopathy due to BIN1 mutations.

    Science.gov (United States)

    Böhm, Johann; Biancalana, Valérie; Malfatti, Edoardo; Dondaine, Nicolas; Koch, Catherine; Vasli, Nasim; Kress, Wolfram; Strittmatter, Matthias; Taratuto, Ana Lia; Gonorazky, Hernan; Laforêt, Pascal; Maisonobe, Thierry; Olivé, Montse; Gonzalez-Mera, Laura; Fardeau, Michel; Carrière, Nathalie; Clavelou, Pierre; Eymard, Bruno; Bitoun, Marc; Rendu, John; Fauré, Julien; Weis, Joachim; Mandel, Jean-Louis; Romero, Norma B; Laporte, Jocelyn

    2014-12-01

    Centronuclear myopathies are congenital muscle disorders characterized by type I myofibre predominance and an increased number of muscle fibres with nuclear centralization. The severe neonatal X-linked form is due to mutations in MTM1, autosomal recessive centronuclear myopathy with neonatal or childhood onset results from mutations in BIN1 (amphiphysin 2), and dominant cases were previously associated to mutations in DNM2 (dynamin 2). Our aim was to determine the genetic basis and physiopathology of patients with mild dominant centronuclear myopathy without mutations in DNM2. We hence established and characterized a homogeneous cohort of nine patients from five families with a progressive adult-onset centronuclear myopathy without facial weakness, including three sporadic cases and two families with dominant disease inheritance. All patients had similar histological and ultrastructural features involving type I fibre predominance and hypotrophy, as well as prominent nuclear centralization and clustering. We identified heterozygous BIN1 mutations in all patients and the molecular diagnosis was complemented by functional analyses. Two mutations in the N-terminal amphipathic helix strongly decreased the membrane-deforming properties of amphiphysin 2 and three stop-loss mutations resulted in a stable protein containing 52 supernumerary amino acids. Immunolabelling experiments revealed abnormal central accumulation of dynamin 2, caveolin-3, and the autophagic marker p62, and general membrane alterations of the triad, the sarcolemma, and the basal lamina as potential pathological mechanisms. In conclusion, we identified BIN1 as the second gene for dominant centronuclear myopathy. Our data provide the evidence that specific BIN1 mutations can cause either recessive or dominant centronuclear myopathy and that both disorders involve different pathomechanisms. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights

  2. The impact of idiopathic childhood-onset growth hormone deficiency (GHD) on bone mass in subjects without adult GHD

    DEFF Research Database (Denmark)

    Lange, Martin; Müller, Jørn; Svendsen, Ole Lander

    2005-01-01

    Despite seemingly adequate growth hormone (GH) treatment during childhood, children with GH deficiency (GHD) have reduced bone mineral density (BMD) at final height. The aim was to evaluate BMD and bone mineral content (BMC) in adults treated for idiopathic childhood-onset (CO) GHD, 18 years after...

  3. Delayed Circadian Rhythm in Adults with Attention-Deficit/Hyperactivity Disorder and Chronic Sleep-Onset Insomnia

    NARCIS (Netherlands)

    Kooij, J. J. Sandra; Boonstra, A. Marije; Gordijn, Marijke C. M.; Van Someren, Eus J. W.

    2010-01-01

    Background: Previous studies suggest circadian rhythm disturbances in children with attention-deficit/hyperactivity disorder (ADHD) and sleep-onset insomnia (SOI). We investigate here sleep and rhythms in activity and melatonin in adults with ADHD. Methods: Sleep logs and actigraphy data were collec

  4. Interleukin-1 receptor antagonist in neonates, children and adults, and in patients with pauci- and polyarticular onset juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Müller, K; Zak, M; Nielsen, S;

    2011-01-01

    patients with juvenile chronic arthritis (JCA) of the pauci- or polyarticular onset type. RESULTS: IL-1ra serum levels were found to differ significantly between the three age groups, being higher in neonates (569 pg/ml) than in children (70 pg/ml) and adults (177 pg/ml). IL-1ra production in E. coli...

  5. Perceived barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities

    NARCIS (Netherlands)

    Buffart, L.M.; Westendorp, T.; Berg-Emons, van den R.J.; Stam, H.; Roebroeck, M.E.

    2009-01-01

    OBJECTIVE: To explore the main barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities. DESIGN: Qualitative study using focus groups. PARTICIPANTS: Sixteen persons (12 men and 4 women) aged 22.4 (standard deviation 3.4) years, of whom 50% were

  6. Unilateral pulmonary artery stenosis and late-onset cataract in an adult: a case of suspected congenital rubella syndrome

    Institute of Scientific and Technical Information of China (English)

    LIU Yang; GUO Jun; ZHAO Rui-fu; WANG Lin

    2012-01-01

    Congenital rubella syndrome (CRS) is characterized by the triad of deafness,cataract and cardiovascular malformations.1 The great majority of the cases in the literature have been usually diagnosed in infancy and childhood because of various defects at birth.However,we report a rare case of suspected CRS in an adult with unilateral pulmonary artery stenosis and late-onset cataract.

  7. Delayed Circadian Rhythm in Adults with Attention-Deficit/Hyperactivity Disorder and Chronic Sleep-Onset Insomnia

    NARCIS (Netherlands)

    Kooij, J. J. Sandra; Boonstra, A. Marije; Gordijn, Marijke C. M.; Van Someren, Eus J. W.

    2010-01-01

    Background: Previous studies suggest circadian rhythm disturbances in children with attention-deficit/hyperactivity disorder (ADHD) and sleep-onset insomnia (SOI). We investigate here sleep and rhythms in activity and melatonin in adults with ADHD. Methods: Sleep logs and actigraphy data were collec

  8. Randomised, double-blind, placebo-controlled, cross-over single dose study of the bronchodilator duration of action of combination fluticasone furoate/vilanterol inhaler in adult asthma.

    Science.gov (United States)

    Braithwaite, Irene; Williams, Mathew; Power, Sharon; Pilcher, Janine; Weatherall, Mark; Baines, Amanda; Moynihan, Jackie; Kempsford, Rodger; Beasley, Richard

    2016-10-01

    Fluticasone furoate (FF)/vilanterol (VI) is a once-daily maintenance treatment for asthma and chronic obstructive pulmonary disease. The duration of bronchodilation beyond 24 h has not been determined previously. Adults aged 18-65 (n = 32), with asthma and reversibility to salbutamol (≥15% and ≥200 mL increase in forced expiratory volume in 1 s [FEV1]) participated in a double-blind, placebo-controlled, crossover study. Patients were admitted to a clinical trials unit for 72 h, and inhaled, in random order, placebo or FF/VI 100/25 mcg via ELLIPTA dry powder inhaler on two occasions 7-14 days apart. FEV1 was measured at baseline, 15 and 30 min, 1, 2, 4, 12, 24, 36, 48, 60, and 72 h. The differences in change in FEV1 from baseline between treatments and corresponding two-sided 95% confidence intervals (CI) were calculated at each time point. FF/VI produced a rapid onset of bronchodilation (adjusted mean difference in change from baseline in FEV1 versus placebo at 15 min, 252 mL [95% CI 182-322]). Maximum bronchodilation was observed at 12 h (adjusted mean difference in the change from baseline in FEV1, 383 mL [95% CI 285-481]). Bronchodilation was maintained throughout the 72-h assessment period (adjusted mean difference in the change in FEV1 from baseline at 72 h, 108 mL (95% CI 15-200]). FF/VI was well tolerated and no serious side effects were reported. A single dose of FF/VI 100/25 mcg showed evidence of a 72-h bronchodilator duration of action in adults with asthma. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma.

    Science.gov (United States)

    Hoskins, Gaylor; Williams, Brian; Abhyankar, Purva; Donnan, Peter; Duncan, Edward; Pinnock, Hilary; van der Pol, Marjon; Rauchhaus, Petra; Taylor, Anne; Sheikh, Aziz

    2016-12-08

    Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review. The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data. Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76-6.65) versus UC 6.1: SD 0.81 (CI 5.63-6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17. Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma. The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the

  10. Difficult Asthma

    Directory of Open Access Journals (Sweden)

    Ahmet Uslu

    2003-03-01

    Full Text Available Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.

  11. Difficult asthma

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

    Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.

  12. Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury.

    Science.gov (United States)

    Hwang, M; Zebracki, K; Vogel, L C

    2015-09-01

    Cross-sectional survey. To describe the medications taken by individuals who had sustained a spinal cord injury (SCI) in childhood or adolescence (age polypharmacy and its association with demographic, injury-related and psychosocial factors. Community. Structured interviews of adults with pediatric-onset SCI. Routine medications and secondary health conditions (SHCs) experienced were recorded. Polypharmacy was defined as the concomitant use of five or more different types of medications. Bivariate analyses and multiple regression models were conducted to determine associations between polypharmacy and demographic factors, injury-related factors, number of SHCs and psychosocial outcomes (FIM, SF-12v2 Health Survey, CHART, PHQ-9). A total of 159 participants (male, 63%; tetraplegia, 59%) with mean age 35.0±6.2 years (range, 26.7-50.9 years) were included. Most common routine medications were muscle relaxants (50.3%), bladder medications (48.5%), bowel agents (41.5%), analgesics (26.4%) and antidepressants (16.9%). Polypharmacy was present in 30.8% (n, 49) and was more prevalent in those with tetraplegia (40.2% vs 17.9%; P=0.003). Participants with polypharmacy were older, had lower FIM, CHART and SF-12v2 scores, and higher PHQ-9 scores. Regression models indicate the total number of SHCs, time since injury and tetraplegia to be significant positive predictors of polypharmacy. Duration of SCI and SHCs are risk factors for polypharmacy in this population of adults with SCI. Measures should be taken to prevent the occurrence of SHCs throughout adulthood so as to prevent the potentially adverse physiological effects and psychosocial outcomes associated with polypharmacy.

  13. Influence of house dust mite impermeable covers on health-related quality of life of adult patients with asthma: results of a randomized clinical trial.

    NARCIS (Netherlands)

    Bemt, L. van den; Vries, M.P. de; Cloosterman, S.G.M.; Thoonen, B.P.A.; Muris, J.W.M.; Goossens, M.; Wesseling, G.; Schayck, C.P. van

    2007-01-01

    The aim of this study was to evaluate the effect of house dust mite impermeable covers on asthma-specific health-related quality of life in adult asthmatic patients that were trained in guided self-management. In a 2-year randomized placebo-controlled clinical trial, information on the quality of li

  14. Influence of house dust mite impermeable covers on health-related quality of life of adult patients with asthma: results of a randomized clinical trial.

    NARCIS (Netherlands)

    Bemt, L. van den; Vries, M.P. de; Cloosterman, S.G.M.; Thoonen, B.P.A.; Muris, J.W.M.; Goossens, M.; Wesseling, G.; Schayck, C.P. van

    2007-01-01

    The aim of this study was to evaluate the effect of house dust mite impermeable covers on asthma-specific health-related quality of life in adult asthmatic patients that were trained in guided self-management. In a 2-year randomized placebo-controlled clinical trial, information on the quality of li

  15. Protective connections and educational attainment among young adults with childhood-onset chronic illness.

    Science.gov (United States)

    Maslow, Gary; Haydon, Abigail A; McRee, Annie-Laurie; Halpern, Carolyn T

    2012-08-01

    Youth with childhood-onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults with COCI. Data were collected from 10,925 participants in the National Longitudinal Study of Adolescent Health (Add Health). Protective factors present before 18 years of age included mentoring, parent relationship quality, school connectedness, and religious attendance. College graduation was the outcome of interest assessed when participants had a mean age of 28 years. Analysis was stratified by presence of COCI. About 2% of participants (N = 230) had 1 of 4 COCIs (cancer, diabetes, epilepsy, or heart disease). All 4 protective factors were associated with college graduation for youth without COCI. In the final multivariate model, only school connectedness was associated with college graduation for youth with COCI. School connectedness is of particular importance in promoting educational attainment for youth with COCI. © 2012, American School Health Association.

  16. Presymptomatic testing for adult onset polycystic kidney disease in at-risk kidney transplant donors.

    Science.gov (United States)

    Hannig, V L; Hopkins, J R; Johnson, H K; Phillips, J A; Reeders, S T

    1991-09-15

    Autosomal dominant adult-onset polycystic kidney disease (ADPKD) is estimated to have an incidence of 1/1,000 and accounts for approximately 10% of all end-stage renal disease in the United States. While relatives are attractive as renal donors due to their availability and the improved transplant success associated with living-related donors, they may coincidentally be at risk for ADPKD. Accurate presymptomatic testing for at-risk potential donors is critical for both the donor and the recipient. We report here 2 families in which presymptomatic testing for ADPKD was accomplished by DNA linkage analysis on several potential renal donors prior to transplant. This resulted in the protection of both donors and recipients by preventing the transplantation of a kidney affected by ADPKD. Thorough counseling prior to DNA analysis (including discussion of accuracy and possible testing outcomes of presymptomatic diagnosis of ADPKD, diagnosis of noncarrier status, false paternity, and non-informative study) was essential to provide informed consent and preserve confidentiality within the family. Confidentiality for potential donors found presymptomatically to be affected (with a 94% or greater probability) was especially difficult to maintain.

  17. Cyclic mood disorder heralding adult-onset autosomal dominant leucodystrophy: a clinical masquerader.

    Science.gov (United States)

    Jain, Rajendra S; Prakash, Swayam; Raghavendra, B S; Nagpal, Kadam; Handa, Rahul

    2014-06-01

    Leucodystrophies are a heterogeneous group of progressive white matter diseases which may be inherited in dominant, recessive or X-linked fashion depending on the type. Adrenoleucodystrophy (ALD) and metachromatic leucodystrophy (MLD) are rather commoner forms of leucodystrophies whereas krabbes disease, alexander disease, cannavans disease etc. are of less common type. Adult-onset autosomal dominant leucodystrophy (ADLD) is a lately described rarer form of leucodystrophy with perhaps no case report from India. Various leucodystrophies may have different clinical presentations, ranging from subtle cognitive and psychiatric manifestations to gross motor disabilities, visual impairment and seizure. Psychiatric manifestations in the form of psychoses and frank schizophrenia are commonly described in MLD. Depression though uncommonly reported in MLD, cyclic mood disorders have been rarely described in any form of leucodystrophies. We are reporting an eye opener, a case of ADLD which masqueraded as a rapid cyclic mood disorder for initial four years, later to be followed by progressive neurological signs and symptoms. To the best of our knowledge, this is perhaps the first case report of ADLD presenting as rapid cyclic mood disorder in the world literature.

  18. Differences in the effects of Asian dust on pulmonary function between adult patients with asthma and those with asthma–chronic obstructive pulmonary disease overlap syndrome

    Science.gov (United States)

    Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Sano, Hiroyuki; Ueda, Yasuto; Mikami, Masaaki; Yamamoto, Hiroyuki; Tokuyasu, Hirokazu; Kato, Kazuhiro; Konishi, Tatsuya; Tatsukawa, Toshiyuki; Shimizu, Eiji; Kitano, Hiroya

    2016-01-01

    Background Asian dust (AD) exposure exacerbates pulmonary dysfunction in patients with asthma. Asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS), characterized by coexisting symptoms of asthma and chronic obstructive pulmonary disease, is considered a separate disease entity. Previously, we investigated the effects of AD on pulmonary function in adult patients with asthma. Here, we present the findings of our further research on the differences in the effects of AD exposure on pulmonary function between patients with asthma alone and those with ACOS. Methods Between March and May 2012, we conducted a panel study wherein we monitored daily peak expiratory flow (PEF) values in 231 adult patients with asthma. These patients were divided into 190 patients with asthma alone and 41 patients with ACOS in this study. Daily AD particle levels were measured using light detection and ranging systems. Two heavy AD days (April 23 and 24) were determined according to the Japan Meteorological Agency definition. A linear mixed model was used to estimate the association between PEF and AD exposure. Results Increments in the interquartile range of AD particles (0.018 km−1) led to PEF changes of −0.50 L/min (95% confidence interval, −0.98 to −0.02) in patients with asthma alone and −0.11 L/min (−0.11 to 0.85) in patients with ACOS. The PEF changes after exposure to heavy AD were −2.21 L/min (−4.28 to −0.15) in patients with asthma alone and −2.76 L/min (−6.86 to 1.35) in patients with ACOS. In patients with asthma alone, the highest decrease in PEF values was observed on the heavy AD day, with a subsequent gradual increase over time. Conclusion Our results suggest that the effects of AD exposure on pulmonary function differ between patients with asthma alone and ACOS, with the former exhibiting a greater likelihood of decreased pulmonary function after AD exposure. PMID:26869784

  19. ETIOLOGICAL STRUCTURE OF VIRAL RESPIRATORY DISEASES IN ADULT PATIENTS WITH BRONCHIAL ASTHMA EXACERBATION AND CHRONICAL BRONCHIOLITIS OBLITERANS

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    V. Z. Krivitskaya

    2015-01-01

    Full Text Available Exacerbation of bronchial asthma (BA and common deterioration of health during chronic bronchiolitis obliterans (ChBO are associated with viral infections in adults in 64 and 83% respectively. Mixed virus-viral associations were shown in 21–25% of cases. Respiratory syncytial infections were diagnosed with the highest frequency (50% in patients with BA. Influenza A(H1N1pdm09 and adenoviral infections dominated in persons with ChBO in 50 and 42% of cases, respectively. Response of virus-specific IgG in patients with BA and ChBO indicates the acute course of influenza A(H1N1pdm09 (63% of seroconversions. There were no reactions of IgG which is specific to respiratory syncytial virus in 75% of cases and to adenovirus in 83% of cases, that is the risk factor for occurrence of latent/persistent infection. Presence of structural components of respiratory syncytial virus in the upper respiratory tract had been revealed in three patients with asthma within at least 21–28 days. Respiratory syncytial viral infections and pandemic influenza A(H1N1 pdm09 in patients with BA and ChBO are characterized by the presence of an allergic component, which is indicated by the high levels of virus-specific IgE in blood. An adenoviral infection, in contrast, has no such peculiarity. 

  20. Asthma, sports, and death.

    Science.gov (United States)

    DiDario, A Geoffrey; Becker, Jack M

    2005-01-01

    The impact of asthma on the general population has been described in detail in medical literature. However, asthma also has a significant impact on the pediatric and adult athlete. This is rarely reported in either the lay press or the medical literature. In 2003, Becker and coworkers conducted a retrospective analysis of the incidence of asthma as a direct cause of death in competitive athletes across the United States between 1993 and 2000. They sought to raise awareness that severe asthma exacerbations and even death can occur during sports from asthma in athletes, while still supporting the concept of maximal participation in sporting activities. To their knowledge, this remains the only published study looking specifically at this issue. Fortunately, fatal asthma events are infrequent in either the adult or the pediatric populations. Those rare cases involving athletes are commonly highlighted in the lay press when they do occur, e.g., when the victim is a college football player such as Rashidi Wheeler. Wheeler died of a fatal asthma exacerbation on August 3, 2002, during a conditioning drill as a member of the Northwestern University football team. Although he was known to have chronic asthma with no obvious barriers to health care, he nevertheless succumbed to his condition. Here, we report a similar, although less well-known, case of an adolescent who died as a direct result of an asthma exacerbation during a high school physical education class. We also offer a brief review of the literature regarding morbidity and mortality in athletes.

  1. Asthma in the Elderly

    Directory of Open Access Journals (Sweden)

    Domenico Lorenzo Urso

    2009-01-01

    Full Text Available Bronchial asthma is a common problem with enormous medical and economics impacts. It is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Asthma is not uncommon in the elderly patients. Prevalence of asthma is similar in older and younger adults. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. Correct diagnosis is demonstrated with spirometry. The goals of asthma treatment are to achieve and maintain control of symptoms and to prevent development of irreversible airflow limitation. Asthma drugs are preferably inhaled because this route minimizes systemic absorption and, thus, improves the ratio of the therapeutic benefit to the potential side-effects in elderly patients.

  2. Influence of house dust mite impermeable covers on health-related quality of life of adult patients with asthma: results of a randomized clinical trial.

    Science.gov (United States)

    van den Bemt, Lisette; de Vries, Marjolein P; Cloosterman, Sonja; Thoonen, Bart; Muris, Jean W M; Goossens, Marielle; Wesseling, Geertjan; van Schayck, Constant P

    2007-12-01

    The aim of this study was to evaluate the effect of house dust mite impermeable covers on asthma-specific health-related quality of life in adult asthmatic patients that were trained in guided self-management. In a 2-year randomized placebo-controlled clinical trial, information on the quality of life was collected. The improvement of Mini Asthma Quality of Life Questionnaire (AQLQ) score in the allergens-avoidance group (0.26) was comparable to the improvement in the placebo group (0.30) and not significant. HDM-impermeable covers for pillows, duvets, and mattresses did not result in improved health-related quality of life.

  3. Childhood asthma and physical activity

    DEFF Research Database (Denmark)

    Lochte, Lene; Nielsen, Kim G; Petersen, Poul Erik

    2016-01-01

    BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents....... The objectives of our study were to (1) summarize the evidence available on associations between PA and asthma prevalence in children and adolescents and (2) assess the role of PA in new-onset or incident asthma among children and adolescents. METHODS: We searched Medline, the Cochrane Library, and Embase......: We retrieved 1,571 titles and selected 11 articles describing three cohort and eight cross-sectional studies for inclusion. A meta-analysis of the cohort studies revealed a risk of new-onset asthma in children with low PA (OR [95 % CI] 1.32 [0.95; 1.84] [random effects] and 1.35 [1.13; 1.62] [fixed...

  4. Asthma essentials

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    Timothy Greene

    2013-12-01

    Full Text Available Asthma is a chronic, reversible obstructive disease that when in exacerbation can present to the emergency department in a spectrum of severity. Prompt recognition of the potentially severely ill asthmatic requires a careful history and physical exam while considering alternative diagnoses for the presenting symptoms. Early administration of salbutamol and corticosteroids is indicated in almost all patients with other medications such as ipratropium and magnesium and supportive modalities like BiPAP reserved for sicker patients. The global impact of asthma is increasing, especially amongst children. While the benign clinical presentation is most common and mortality has decreased in recent decades due to improved recognition and care, the ubiquity of the condition and frequent lack of regular outpatient management contribute to the disease claiming 250,000 lives worldwide annually. The emergency physician must be prepared to assess and appropriately manage both the young child with a mild wheeze and the adult in respiratory failure.

  5. Early life factors associated with adult onset systemic lupus erythematosus (SLE in women

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    Christine Gibson Parks

    2016-03-01

    the development of disease, but knowledge on specific risk factors is mostly limited to occupational exposures[1]. The developmental origins hypothesis has been proposed for many adult-onset, chronic inflammatory diseases, including systemic lupus erythematosus (SLE [2-6]. Exposures during and after gestation, including nutritional, infectious, chemical

  6. Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women.

    Science.gov (United States)

    Madhu, Chendrimada K; Hashim, Hashim; Enki, Doyo; Drake, Marcus J

    2017-01-01

    The study aims to evaluate bothersome lower urinary tract symptoms (LUTS), risk factors, and associated functional abnormalities in women reporting adult onset secondary nocturnal enuresis (SNE), to help understand factors associated with SNE. 12,795 women (age >18) attending a tertiary referral centre underwent a comprehensive standardized evaluation including urodynamic testing in accordance with the International Continence Society recommendations. Records of all patients reporting bedwetting while asleep were evaluated under various categories. Multiple logistic regression was used to identify statistically significant risk factors and urodynamic findings associated with SNE. The prevalence of SNE in women undergoing urodynamic testing for bothersome LUTS was 14.4% (1,838). High BMI (OR = 1.47, P < 0.001), cigarette smoking (OR = 2, P < 0.001), antidepressant usage (OR = 1.8, P < 0.001), neurological conditions (OR = 2.12, P < 0.001), and previous hysterectomy (OR = 1.19, P = 0.03) were significantly associated with SNE. Women with SNE significantly complained of overactive bladder (OAB) symptoms (OR = 1.65, P < 0.001) and slightly higher mean nocturia episodes (OR = 1.38, P < 0.0001). Low maximum urethral closure pressure (MUCP) (OR = 1.34, P < 0.0001) and detrusor overactivity incontinence (DOI) (OR = 1.75, P < 0.0001) were significantly associated with SNE. There was no significant association with the symptom of stress urinary incontinence (P = 0.264), urodynamic stress incontinence (P = 0.454) or detrusor overactivity (P = 0.231). Women with adult SNE usually present with OAB symptoms. SNE is associated with high BMI, cigarette smoking, antidepressant use, and neurological conditions. DOI and a low MUCP are possible pathophysiological mechanisms in SNE. Neurourol. Urodynam. 36:188-191, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  7. Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia.

    Science.gov (United States)

    Kim, Tackeun; Oh, Chang Wan; Kwon, O-Ki; Hwang, Gyojun; Kim, Jeong Eun; Kang, Hyun-Seung; Cho, Won-Sang; Bang, Jae Seung

    2016-06-01

    . CONCLUSIONS Direct or combined revascularization for patients with adult-onset moyamoya disease presenting with ischemia can prevent further stroke.

  8. Study of Tripterygium Associated with Nicotinamide in Treating Late-onset Autoimmune Diabetes Mellitus in Adults

    Institute of Scientific and Technical Information of China (English)

    刘江华; 段世芳; 刘志文; 刘宗汉; 曹仁贤; 文芳; 文格波

    2004-01-01

    Objective: To explore the effect of Tripterygium polyglycoside (TP) associated with nicotinamide on the islet cell function, immune parameters and lipoperoxide (LPO) in adult patients with late-onset autoimmune diabetes mellitus (LADA) Methods: Thirty-six cases of LADA were randomly divided into three groups: TP group (n= 12), treated with TP plus orally taken metformin; combined treatment group (n =12), treated with TP combined with nicotinamide and metformin, and control group (n = 12) treated with metformin alone. They were followed-up for 18 months. Results: (1) Compared with the control group after 9months of treatment, postprandial plasma glucose and LPO in combined treatment group were decreased (P <0.05), and the postprandial C-peptide was higher (P<0.05). At the 18th month, the value of postprandial C-peptide in the TP and combined treatment group was higher than that in the control group. The slL-2R level of both TP and combined treatment groups were lowered (P<0.01); (2) Islet cell antibody (ICA) positive of 5 cases in the TP group and 6 cases in the combined treatment group got converted to the negative respectively, while only one in the control group at the time (P<0.05) ; (3) The level of LPO in the combined treatment group was significantly lower than that in the TP group at the 18th month of treatment (P<0.05).Conclusion: TP combined with nicotinamide played a role in immunity regulation, decreasing the titer of islet cell antibody and slL-2R, which also reduced the production of LPO and had a tendency to improve islet cell function in early LADA patients.

  9. Advances in adult-onset Still's disease%成人Still病的研究进展

    Institute of Scientific and Technical Information of China (English)

    石晶; 聂振华

    2015-01-01

    成人Still病是一种炎症性自身免疫性疾病,其特征是高热、一过性皮疹、关节炎、肝脾肿大、多系统累及和实验室异常,包括中性粒细胞增多和高铁蛋白血症.研究表明,成人Still病患者促炎症细胞因子IL-1β、IL-6、IL-18均有升高,这些细胞因子诱导与维持Th17功能相关联.成人Still病的治疗主要包括非甾体抗炎药、糖皮质激素和抗风湿药物.生物制剂也常用于治疗成人Still病,不仅在治疗方面有应用前景,尚可部分解释该病的发病机制.%Adult-onset Still's disease (AOSD) is an inflammatory autoimmune disorder characterized by high fever,evanescent rash,arthritis,hepatosplenomegaly,multisystemic involvement and laboratory abnormalities including neutrophilic leukocytosis and hyperferritinaemia.It has been shown that some proinflammatory cytokines such as interleukin (IL)-1β,IL-6,and IL-18 are highly expressed in patients with AOSD.These cytokines are associated with the induction and maintenance of function of T helper type 17 (Th17) cells.The treatment of AOSD includes nonsteroidal anti-inflammatory drugs,glucocorticoids and antirheumatic drugs.Further more,biological agents are also usually used to treat AOSD,which not only have a promising prospect in clinical application,but also can partly explain the pathogenesis of this disease.

  10. Mental health among young adults in prison: the importance of childhood-onset conduct disorder

    Science.gov (United States)

    Anckarsäter, Henrik; Wallinius, Märta; Billstedt, Eva

    2017-01-01

    Background The psychiatric health burden of prisoners is substantial. However, there is a lack of high-quality studies of psychiatric disorders among young adults with a high risk of reoffending. Aims To investigate the lifetime prevalence of psychiatric disorders and use of mental health services among young male violent offenders and the impact of childhood-onset conduct disorder (COCD). Method A nationally representative cohort (n = 270, age 18–25) of male offenders was followed back in medical records and clinically assessed by gold standard methods. Lifetime prevalences are presented together with odds ratios (ORs) as risk estimates in relation to COCD. Results Previous use of psychiatric services among the participants was high but their lifetime psychiatric morbidity was even higher, with 93% meeting criteria for at least one Axis I disorder. The COCD group was overrepresented in most clinical categories and carried five times higher odds (OR = 5.1, 95% CI 2.0–12.8) of a psychotic disorder, three times higher odds (OR = 3.2, 95% CI 1.2–8.5) of a substance use disorder and two times higher odds of a mood disorder (OR = 2.3, 95% CI 1.3–4.0) or anxiety disorder (OR = 2.0, 95% CI 1.1–3.5). Conclusions The mental health burden is substantial among young violent offenders, and COCD is an important indicator of future mental health problems which must be a priority for public health efforts. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28357134

  11. Parental smoking in pregnancy and the risks of adult-onset hypertension.

    Science.gov (United States)

    de Jonge, Layla L; Harris, Holly R; Rich-Edwards, Janet W; Willett, Walter C; Forman, Michele R; Jaddoe, Vincent W V; Michels, Karin B

    2013-02-01

    Fetal exposure to parental smoking may lead to developmental adaptations and promote various diseases in later life. This study evaluated the associations of parental smoking during pregnancy with the risk of hypertension in the daughter in adulthood, and assessed whether these associations are explained by birth weight or body weight throughout life. We used data on 33086 participants of the Nurses' Health Study II and the Nurses' Mothers' Cohort. Cox proportional hazards models were used to examine the associations of maternal and paternal smoking during pregnancy with the nurse daughter, with self-reported physician-diagnosed hypertension from 1989 until 2007. Overall, 8575 (25.9%) mothers and 18874 (57.0%) fathers smoked during pregnancy. During follow-up, 7825 incident cases of adult-onset hypertension were reported. Both maternal and paternal smoking of ≥ 15 cigarettes/d during pregnancy were associated with increased risks of hypertension (rate ratio, 1.19; 95% CI, 1.09-1.29; and rate ratio, 1.18; 95% CI, 1.12-1.25, respectively) in the age-adjusted models. Further adjustment for birth weight did not affect the effect estimates appreciably, whereas additional adjustment for body shape and weight until age 18, or current body mass index, attenuated the associations with both maternal and paternal smoking (rate ratio, 1.07; 95% CI, 0.98-1.16; and rate ratio, 1.06; 95% CI, 1.01-1.12, respectively). The associations of parental smoking during pregnancy with the risk of hypertension in the offspring were largely explained by body weight throughout life, suggesting that these associations may not reflect direct intrauterine mechanisms.

  12. [Adult-onset Hartnup disease presenting with neuropsychiatric symptoms but without skin lesions].

    Science.gov (United States)

    Mori, E; Yamadori, A; Tsutsumi, A; Kyotani, Y

    1989-06-01

    Hartnup disease is an inborn abnormality of renal and intestinal transport involving the neutral amino acids. Intermittent pellagra-like rash, attacks of cerebellar ataxia and psychiatric disturbance are characteristic symptoms of this disease. We described here a patient with adult-onset Hartnup disease who presented unique neuropsychiatric symptoms but no dermatologic symptoms, and reported features of amino acids transport in this patient and his family. The patient, a man aged 37 years, was referred to us because of lasting daytime bruxism. He is the second child of healthy parents who are first cousin; his elder brother who has been mentally retarded became bed-ridden and died at 32 years of age. His younger brother is completely healthy. Although the patient's development in infancy has been slightly retarded, he completed compulsory 9-year education. At 29 years of age, he experienced episodes of diplopia, ataxic gait and insomnia, and at 33 years of age, of transient stupor. There had been no history of photosensitivity or dermatitis. On neurological examination, there were trunkal ataxia, increased muscular tone and decreased mental activity besides bruxism. These symptoms remained unchanged despite of several medications including trihexyphenidyl, diazepam, halloperidol, tiapride and sulpiride. Two months later, the patient became stuporous; bruxism and hypertonicity became exaggerated. Myerson's sign, sucking reflex and grasp reflex in both hand appeared. There was no dermal lesion. A cranial computed tomography revealed a small calcification in the right frontal subcortical region and a single photon emission tomography indicated possible bifrontal hypoperfusion. Electroencephalograms demonstrated non-specific slowing. Somatosensory evoked potentials and nerve conduction velocities were normal. There were constant indicanuria and amino-aciduria.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Imaging characteristics of adult onset Still's disease demonstrated with 18F-FDG PET/CT.

    Science.gov (United States)

    Jiang, Lei; Xiu, Yan; Gu, Taoying; Dong, Caihong; Wu, Bing; Shi, Hongcheng

    2017-09-01

    The diagnosis of adult onset Still's disease (AOSD) is non‑specific, and requires the exclusion of other diseases including infectious, inflammatory and malignant diseases. The current study aimed to summarize the imaging characteristics of fluorodeoxyglucose (18F‑FDG) positron emission tomography (PET)/computerized tomography (CT) in patients with AOSD. The 18F‑FDG PET/CT characteristic observations of 32 patients with definite AOSD were retrospectively reviewed based on visual interpretation and the semi‑quantitative index of standard uptake value of maximum (SUVmax). Among 32 patients, no normal case was observed. Abnormal FDG accumulation by the spleen, bone marrow and lymph nodes was the main observation of the PET/CT images. Totals of 27 (84.4%) and 26 cases (81.3%) were identified with diffusely elevated FDG uptake by the spleen and bone marrow, respectively, and the average SUVmax was 4.2±1.1 and 4.6±0.6, respectively. A total of 20 cases (62.5%) showed lymphadenopathy with FDG uptake, with the range of SUVmax from 2.2‑13.9. In addition, 7 patients (21.9%) were observed to exhibit effusion without FDG uptake, 1 case presented with abnormal FDG uptake by the skin, and another by the right shoulder joint. In addition, no abnormally elevated FDG uptake by the liver or large vessels was observed. Due to non‑specific imaging features, 18F‑FDG PET/CT could not be directly helpful in diagnosing AOSD. However, 18F‑FDG PET/CT serves important roles in evaluating the involved extent of AOSD, and guiding the biopsy of lymph nodes, bone marrow or other tissues, which may aid in the development of novel clinical management strategies.

  14. Heritability of self-reported asthma and allergy : A study in adult Dutch twins, siblings and parents

    NARCIS (Netherlands)

    Willemsen, Gonneke; van Beijsterveldt, Toos C. E. M.; van Baal, Caroline G. C. M.; Postma, Dirkje; Boomsma, Dorret I.

    2008-01-01

    The present study assessed the prevalence of asthma and allergy, and estimated the importance of genetic and environmental influences on asthma and allergy liability and their association. Longitudinal data on self-reported, doctor-diagnosed asthma and allergy were collected in over 14,000 individua

  15. Right pulmonary artery agenesis presenting with uncontrolled asthma in an adult: a case report

    Directory of Open Access Journals (Sweden)

    Thammasitboon Supat

    2011-08-01

    Full Text Available Abstract Introduction Unilateral absence of the pulmonary artery (UAPA or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. The clinical presentation is variable and many patients can be asymptomatic for many years and even throughout their lives. Case presentation We report the case of a 53-year-old African-American woman who was diagnosed with right pulmonary artery agenesis after presenting with uncontrolled asthma and recurrent bronchopulmonary infections. Conclusion In an unexplained case of recurrent respiratory infections and shortness of breath, the possibility of a rare congenital anomaly like UAPA should be considered and an appropriate evaluation should be done.

  16. Growth hormone effects on cortical bone dimensions in young adults with childhood-onset growth hormone deficiency

    DEFF Research Database (Denmark)

    Hyldstrup, L; Conway, G S; Racz, K

    2012-01-01

    Growth hormone (GH) treatment in young adults with childhood-onset GH deficiency has beneficial effects on bone mass. The present study shows that cortical bone dimensions also benefit from GH treatment, with endosteal expansion and increased cortical thickness leading to improved bone strength....... INTRODUCTION: In young adults with childhood-onset growth hormone deficiency (CO GHD), GH treatment after final height is reached has been shown to have beneficial effects on spine and hip bone mineral density. The objective of the study was to evaluate the influence of GH on cortical bone dimensions. METHODS......: Patients (n = 160; mean age, 21.2 years; 63% males) with CO GHD were randomised 2:1 to GH or no treatment for 24 months. Cortical bone dimensions were evaluated by digital x-ray radiogrammetry of the metacarpal bones every 6 months. RESULTS: After 24 months, cortical thickness was increased compared...

  17. Difficulties in diagnosis and treatment of adult-onset Still's disease concurrent with pericardial effusion as a leading clinical manifestation

    Directory of Open Access Journals (Sweden)

    V. Yu. Myachikova

    2016-01-01

    Full Text Available The paper considers a case of adult-onset Still's disease that occurred as acute pericarditis, two-spike hectic fever, and neutrophilic leukocytosis in a young man. It was difficult to establish a correct diagnosis because there were no characteristic clinical symptoms of Still's disease, such as salmon colored rash, arthralgia, and sore throat. The diagnosis of adult-onset Still's disease was verified on the basis of the classification criteria described by M. Yamaguchi et al. The special feature of the clinical case was the development of steroid resistance and the effective use of a combination of the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, given intravenously dropwise once every four weeks and methotrexate (15 mg/week orally. During this treatment, a sustained clinical and laboratory response was achieved, which could reduce the dose of glucocorticoids to the maintaining one.

  18. The diagnostic evaluation of patients with potential adult-onset autoinflammatory disorders: our experience and review of the literature.

    Science.gov (United States)

    Muscari, Isabella; Iacoponi, Francesca; Cantarini, Luca; Lucherini, Orso Maria; Simonini, Gabriele; Brizi, Maria Giuseppina; Vitale, Antonio; Frediani, Bruno; Cimaz, Rolando; Galeazzi, Mauro

    2012-11-01

    Hereditary periodic fever syndromes (HPFSs) are a group of inherited disorders of the innate immune system caused by mutations of genes involved in the regulation or activation of the inflammatory response, which belong to the category of autoinflammatory disorders. Most HPFs typically have an onset in pediatric age, while a limited number of patients experience disease onset during adulthood. The relative rarity and lack of information on adult-onset autoinflammatory diseases make it likely that genetic testing is often inconclusive. Recently, we have identified a set of variables related to the probability of detecting gene mutations in MEFV, responsible for familial Mediterranean fever, and TNFRSF1A, responsible for tumor necrosis factor receptor-associated periodic syndrome. In addition, we have proposed a diagnostic score for identifying those patients at high risk of carrying mutations in these genes. However, before the score can be recommended for application, further evaluation by means of longitudinal studies on different ethnicities and different populations deriving from other geographical areas is needed in order to definitively verify both its sensitivity and its specificity. The present manuscript offers our suggestions on how to establish a differential diagnosis for adult-onset HPFs, as well as a review of the literature, and we also provide a score revision available online. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. Cluster analysis of obesity and asthma phenotypes.

    Directory of Open Access Journals (Sweden)

    E Rand Sutherland

    Full Text Available BACKGROUND: Asthma is a heterogeneous disease with variability among patients in characteristics such as lung function, symptoms and control, body weight, markers of inflammation, and responsiveness to glucocorticoids (GC. Cluster analysis of well-characterized cohorts can advance understanding of disease subgroups in asthma and point to unsuspected disease mechanisms. We utilized an hypothesis-free cluster analytical approach to define the contribution of obesity and related variables to asthma phenotype. METHODOLOGY AND PRINCIPAL FINDINGS: In a cohort of clinical trial participants (n = 250, minimum-variance hierarchical clustering was used to identify clinical and inflammatory biomarkers important in determining disease cluster membership in mild and moderate persistent asthmatics. In a subset of participants, GC sensitivity was assessed via expression of GC receptor alpha (GCRα and induction of MAP kinase phosphatase-1 (MKP-1 expression by dexamethasone. Four asthma clusters were identified, with body mass index (BMI, kg/m(2 and severity of asthma symptoms (AEQ score the most significant determinants of cluster membership (F = 57.1, p<0.0001 and F = 44.8, p<0.0001, respectively. Two clusters were composed of predominantly obese individuals; these two obese asthma clusters differed from one another with regard to age of asthma onset, measures of asthma symptoms (AEQ and control (ACQ, exhaled nitric oxide concentration (F(ENO and airway hyperresponsiveness (methacholine PC(20 but were similar with regard to measures of lung function (FEV(1 (% and FEV(1/FVC, airway eosinophilia, IgE, leptin, adiponectin and C-reactive protein (hsCRP. Members of obese clusters demonstrated evidence of reduced expression of GCRα, a finding which was correlated with a reduced induction of MKP-1 expression by dexamethasone CONCLUSIONS AND SIGNIFICANCE: Obesity is an important determinant of asthma phenotype in adults. There is heterogeneity in

  20. Promotion of the Transition of Adult Patients with Childhood-Onset Chronic Diseases among Pediatricians in Japan

    OpenAIRE

    Yuko Ishizaki; Hirohiko Higashino; Kazunari Kaneko

    2016-01-01

    The transition of adult patients with childhood-onset chronic diseases (APCCD) from pediatric to adult health-care systems has recently received worldwide attention. However, Japan is lagging behind European countries and North America as this concept of health-care transition was introduced only 10 years ago. In Japan, before the introduction of this concept, APCCD were referred to as “carryover patients,” who were often considered a burden in pediatric practice. In the late 1990s, groups co...

  1. Solitary, adult-onset, intraosseous myofibroma of the finger: report of a case and review of literature.

    Science.gov (United States)

    Ma, Yihong; Siegal, Gene P; Wei, Shi

    2015-09-01

    Myofibroma is a rare benign neoplasm of myofibroblastic origin. It typically occurs in the skin and subcutaneous tissues of the head and neck in infants and young children as multicentric lesions known as infantile myofibromatosis. Intraosseous myofibromas are very rare and are typically destructive lesions that predominantly affect craniofacial bones in the setting of myofibromatosis. Solitary, intraosseous myofibromas in adults are exceedingly rare. Herein, we report a myofibroma involving the middle phalanx of the right index finger in a 58-year-old man who presented with a pathologic fracture. Twelve other cases of adult-onset, intraosseous myofibroma were compiled from the English language literature and integrated with this report.

  2. Association of polymorphisms of the CHI3L1 gene with asthma and atopy: a populations-based study of 6514 Danish adults

    DEFF Research Database (Denmark)

    Rathcke, Camilla Noelle; Holmkvist, Johan; Husmoen, Lise Lotte N;

    2009-01-01

    and lung function in a large population-based sample of adults. METHODS/PRINCIPAL FINDINGS: Eleven single nucleotide polymorphisms (SNPs) of CHI3L1 including rs4950928 were genotyped in 6514 individuals. Asthma was defined as self-reported history of physician-diagnosed asthma. Total IgE and specific Ig......BACKGROUND: YKL-40 is a chitinase-like glycoprotein encoded by the chitinase 3-like 1 gene, CHI3L1, localized at chromosome 1q32.1. Increased levels of serum YKL-40 have been reported to be a biomarker for asthma and a reduced lung function. Interestingly, the C-allele of the -131 C-->G (rs4950928......) polymorphism of CHI3L1 has been shown to associate with bronchial hyperresponsiveness and reduced lung function suggesting that variations in CHI3L1 may influence risk of asthma. The objective of the present study was to investigate the association of common variation in the CHI3L1 locus with asthma, atopy...

  3. Nutrition and Asthma

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    Gupta K

    2007-01-01

    Full Text Available Increase in the asthma prevalence in many countries over the recent decades, highlights the need for a greater understanding of the risk factors for asthma. Be-cause asthma is the result of interaction between genetic and environmental fac-tors, increasing prevalence is certainly the result of changes in environmental fac-tors because of process of wesernization. That is the reason for higher prevalence in countries where a traditional to a westernized lifestyle occurred earlier. This increasing prevalence has affected both rural and urban communities, suggesting that local environmental factors such as exposure to allergens or industrial air pol-lutions are not the sole cause. In the last few years, nutrition has represented an important conditioning factor of many cardiovascular, gastrointestinal and chronic pulmonary diseases. So it has been hypothesized that dietary constituents influence the immune system and thus, may also be actively involved in the onset of asthma and other allergic diseases. Dietary constituents can play beneficial as well as det-rimental role in asthma. The possible role of diet in the development of asthma can be described as follows: first, a food allergen can cause asthma. Second, there is role of breast-feeding for prevention of asthma later in life. Third, a low intake of antioxidative dietary constituents might be a risk factor for asthma. Moreover, role of cations such as sodium, potassium and magnesium has been described in development of asthma. Finally, intake of fatty acids specially the role of omega-3 and omega-6 fatty acids play important role in cause of asthma.

  4. An official american thoracic society statement: work-exacerbated asthma.

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    Henneberger, Paul K; Redlich, Carrie A; Callahan, David B; Harber, Philip; Lemière, Catherine; Martin, James; Tarlo, Susan M; Vandenplas, Olivier; Torén, Kjell

    2011-08-01

    Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work. The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research. Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus. WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful. WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions.

  5. Respiratory symptoms in adults are related to impaired quality of life, regardless of asthma and COPD: results from the European community respiratory health survey

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    Bakke Per S

    2010-09-01

    Full Text Available Abstract Background Respiratory symptoms are common in the general population, and their presence is related to Health-related quality of life (HRQoL. The objective was to describe the association of respiratory symptoms with HRQoL in subjects with and without asthma or COPD and to investigate the role of atopy, bronchial hyperresponsiveness (BHR, and lung function in HRQoL. Methods The European Community Respiratory Health Survey (ECRHS I and II provided data on HRQoL, lung function, respiratory symptoms, asthma, atopy, and BHR from 6009 subjects. Generic HRQoL was assessed through the physical component summary (PCS score and the mental component summary (MCS score of the SF-36. Factor analyses and linear regressions adjusted for age, gender, smoking, occupation, BMI, comorbidity, and study centre were conducted. Results Having breathlessness at rest in ECRHS II was associated with mean score (95% CI impairment in PCS of -8.05 (-11.18, -4.93. Impairment in MCS score in subjects waking up with chest tightness was -4.02 (-5.51, -2.52. The magnitude of HRQoL impairment associated with respiratory symptoms was similar for subjects with and without asthma/COPD. Adjustments for atopy, BHR, and lung function did not explain the association of respiratory symptoms and HRQoL in subjects without asthma and/or COPD. Conclusion Subjects with respiratory symptoms had poorer HRQoL; including subjects without a diagnosis of asthma or COPD. These findings suggest that respiratory symptoms in the absence of a medical diagnosis of asthma or COPD are by no means trivial, and that clarifying the nature and natural history of respiratory symptoms is a relevant challenge. Several community studies have estimated the prevalence of common respiratory symptoms like cough, dyspnoea, and wheeze in adults 123. Although the prevalence varies to a large degree between studies and geographical areas, respiratory symptoms are quite common. The prevalences of respiratory

  6. Diabetes distress in adult type 1 diabetes mellitus men and women with disease onset in childhood and in adulthood.

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    Lašaitė, Lina; Ostrauskas, Rytas; Žalinkevičius, Rimantas; Jurgevičienė, Nijolė; Radzevičienė, Lina

    2016-01-01

    To determine whether or not diabetes distress varies by age of type 1 diabetes mellitus (T1DM) onset and/or gender. A total of 700 adult T1DM patients were randomly selected from the Lithuanian Diabetes Registry; 214 of them (30.6%) agreed to participate and were recruited for the study. Diabetes distress (emotional burden, physician-related distress, regimen-related distress, interpersonal distress) was compared in 105 (42 men and 63 women) patients with T1DM diagnosed during 0-18years of life, and in 109 (61 men and 48 women) with T1DM diagnosed in adulthood, using Diabetes Distress Scale (DDS). Adult childhood-onset T1DM women have higher regimen-related distress (36.3±21.3 vs 26.6±16.2, p=0.016) than adulthood-onset women. Adult childhood-onset T1DM women experience higher diabetes distress (higher emotional burden (27.0±22.0 vs 15.6±16.4, p=0.006), physician-related distress (34.4±33.9 vs 20.7±29.4, p=0.024), total diabetes distress (41.2±13.6 vs 34.8±10.9, p=0.011)) than childhood-onset men. Adulthood-onset T1DM women experience higher physician-related distress (39.2±37.6 vs 23.4±32.5, p=0.013), but lower regimen-related distress (26.6±16.2 vs 35.8±21.6, p=0.014) than adulthood-onset men. In conclusion our findings reinforce the interdependence of psychological and biomedical factors in influencing health outcomes and support the need to provide psychological assessment and support to patients with T1DM. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Linking obesity and asthma.

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    Sutherland, E Rand

    2014-04-01

    A growing body of literature suggests that obesity has a significant impact on asthma risk, phenotype, and prognosis. Epidemiological studies have clearly demonstrated that asthma is more likely to occur in obese patients, and health status is impaired in obese individuals with asthma, with obese asthmatics experiencing more symptoms, worse quality of life, increased healthcare use, and increased asthma severity. However, obesity has well-described effects on lung function and mechanics that can lead to symptoms of dyspnea without causing the pathophysiologic changes of asthma. Adding to the challenges of evaluating this association, some studies have failed to demonstrate a robust relationship between obesity and traditional biomarkers of airway inflammation in adult asthmatics, leading to the conclusion that obesity does not necessarily worsen airway inflammation in asthma. In this regard, emerging data suggest that nonatopic mechanisms may be relevant in obese asthmatics, and that these mechanisms may have a direct impact on the response of obese asthmatics to asthma therapies, most notably inhaled glucocorticoids. This article will review selected aspects of the contributions of obesity-related airway and systemic inflammation to asthma, with a focus on the impact of obesity as a modifier of risk, prognosis, and therapeutic response in asthma.

  8. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects.

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    de Roos, E W; In 't Veen, J C C M; Braunstahl, G-J; Lahousse, L; Brusselle, G G O

    2016-09-01

    Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma.

  9. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control

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    Malin Axelsson

    2015-01-01

    Full Text Available Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews. Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3% but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2 agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma follow-up consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control. Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved.

  10. Mutation screen and association studies for the fatty acid amide hydrolase (FAAH gene and early onset and adult obesity

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    Rief Winfried

    2010-01-01

    Full Text Available Abstract Background The orexigenic effects of cannabinoids are limited by activation of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH. The aim of this study was to analyse whether FAAH alleles are associated with early and late onset obesity. Methods We initially assessed association of five single nucleotide polymorphisms (SNPs in FAAH with early onset extreme obesity in up to 521 German obese children and both parents. SNPs with nominal p-values ≤ 0.1 were subsequently analysed in 235 independent German obesity families. SNPs associated with childhood obesity (p-values ≤ 0.05 were further analysed in 8,491 adult individuals of a population-based cohort (KORA for association with adult obesity. One SNP was further analysed in 985 German obese adults and 588 normal and underweight controls. In parallel, we screened the FAAH coding region for novel sequence variants in 92 extremely obese children using single-stranded-conformation-polymorphism-analysis and denaturing HPLC and assessed the implication of the identified new variants for childhood obesity. Results The trio analysis revealed some evidence for an association of three SNPs in FAAH (rs324420 rs324419 and rs873978 with childhood obesity (two-sided p-values between 0.06 and 0.10. Although analyses of these variants in 235 independent obesity families did not result in statistically significant effects (two-sided p-values between 0.14 and 0.75, the combined analysis of all 603 obesity families supported the idea of an association of two SNPs in FAAH (rs324420 and rs2295632 with early onset extreme obesity (p-values between 0.02 and 0.03. No association was, however, found between these variants and adult obesity. The mutation screen revealed four novel variants, which were not associated with early onset obesity (p > 0.05. Conclusions As we observed some evidence for an association of the FAAH variants rs2295632 rs324420 with early onset but not adult obesity

  11. Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults.

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    Saif Ahmad

    Full Text Available BACKGROUND: Early diagnosis of sepsis enables timely resuscitation and antibiotics and prevents subsequent morbidity and mortality. Clinical approaches relying on point-in-time analysis of vital signs or lab values are often insensitive, non-specific and late diagnostic markers of sepsis. Exploring otherwise hidden information within intervals-in-time, heart rate variability (HRV has been documented to be both altered in the presence of sepsis, and correlated with its severity. We hypothesized that by continuously tracking individual patient HRV over time in patients as they develop sepsis, we would demonstrate reduced HRV in association with the onset of sepsis. METHODOLOGY/PRINCIPAL FINDINGS: We monitored heart rate continuously in adult bone marrow transplant (BMT patients (n = 21 beginning a day before their BMT and continuing until recovery or withdrawal (12+/-4 days. We characterized HRV continuously over time with a panel of time, frequency, complexity, and scale-invariant domain techniques. We defined baseline HRV as mean variability for the first 24 h of monitoring and studied individual and population average percentage change (from baseline over time in diverse HRV metrics, in comparison with the time of clinical diagnosis and treatment of sepsis (defined as systemic inflammatory response syndrome along with clinically suspected infection requiring treatment. Of the 21 patients enrolled, 4 patients withdrew, leaving 17 patients who completed the study. Fourteen patients developed sepsis requiring antibiotic therapy, whereas 3 did not. On average, for 12 out of 14 infected patients, a significant (25% reduction prior to the clinical diagnosis and treatment of sepsis was observed in standard deviation, root mean square successive difference, sample and multiscale entropy, fast Fourier transform, detrended fluctuation analysis, and wavelet variability metrics. For infected patients (n = 14, wavelet HRV demonstrated a 25% drop from

  12. 18F-FDG PET/CT in patients with adult-onset Still's disease.

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    Dong, Meng-Jie; Wang, Cai-Qin; Zhao, Kui; Wang, Guo-Lin; Sun, Mei-Ling; Liu, Zhen-Feng; Xu, Liqin

    2015-12-01

    (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) has become useful for the detection and diagnosis of inflammatory conditions, including rheumatic diseases, immunoglobulin (Ig) G4-related disease and giant cell arteritis. However, few articles based on small sample sizes (n = 7) diagnosed as adult-onset Still's disease (AOSD) have been published. The study aim was to observe the reliable characteristics and usefulness of (18)F-FDG PET/CT for the evaluation of consecutive patients with AOSD. Eligible patients were selected from among those who had undergone (18)F-FDG PET/CT between May 2007 and June 2014. Twenty-six consecutive AOSD patients were recruited retrospectively according to criteria set by Yamaguchi et al. All patients underwent evaluation by (18)F-FDG PET/CT. The characteristics and usefulness of (18)F-FDG PET/CT for evaluation of consecutive patients with AOSD were evaluated. All 26 patients had (18)F-FDG-avid lesion(s) related to their particular disease. Diffuse and homogeneous accumulation of (18)F-FDG was seen in the bone marrow (26/26; 100 %; maximum standardized uptake (SUVmax), 2.10-6.73) and spleen (25/26; 96.15 %). The SUVmax of affected lymph nodes was 1.3-9.53 (mean ± SD, 4.12 ± 2.24). The SUVmax and size factors (maximum diameter and areas) of affected lymph nodes were significantly different (P = 0.033 and P = 0.012, respectively). (18)F-FDG PET/CT showed the general distribution of (18)F-FDG accumulation. This factor helped to exclude malignant disease and aided the diagnosis of AOSD (42.3 %) in 11 cases when combined with clinical features and aided decisions regarding appropriate biopsy sites, such as the lymph nodes (n = 9) and bone marrow (n = 13). (18)F-FDG PET/CT is a unique imaging method for the assessment of metabolic activity throughout the body in subjects with AOSD. Characteristics or patterns of AOSD observed on (18)F-FDG PET/CT can be used for the

  13. Serum calprotectin--a promising diagnostic marker for adult-onset Still's disease.

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    Guo, Qian; Zha, Xicao; Li, Chun; Jia, Yuan; Zhu, Lei; Guo, Jianping; Su, Yin

    2016-01-01

    Calprotectin is a calcium-binding cytosolic protein, mainly expressed in immune cells, such as neutrophils, monocytes, and macrophages. Our study aimed to evaluate the diagnostic value of calprotectin for adult-onset Still's disease (AOSD), by comparing serum calprotectin concentrations in patients with AOSD (n = 46), rheumatoid arthritis (RA, n = 34), primary Sjögren syndrome (pSS, n = 40), systemic lupus erythematosus (SLE, n = 39), osteoarthritis (OA, n = 20), and healthy controls (HCs, n = 49). Calprotectin concentrations were significantly higher in patients with AOSD (55.26 ± 18.00 ng/ml), compared to patients with RA (39.17 ± 18.90 ng/ml), pSS (35.31 ± 19.47 ng/ml), SLE (32.21 ± 25.01 ng/ml), OA (19.24 ± 10.67 ng/ml), and HCs (8.46 ± 5.17 ng/ml). All the differences were highly significant (p < 0.001). Using receiver-operating characteristic curve, the cut-off value of calprotectin was defined as 45.488 ng/ml, and its sensitivity and specificity for AOSD diagnosis were 63.0 and 80.1%, respectively. The positive rate of calprotectin was significantly higher in AOSD cases compared to patients with other diseases and healthy controls (p < 0.001). Serum calprotectin was positively correlated with ferritin (r = 0.294, p < 0.05), and concentration of hemoglobin was significantly lower in calprotectin-positive patients compared to negative patients in AOSD (103.49 ± 20.21 g/l vs 115.71 ± 15.59 g/l, t = -2.142, p = 0.038). These findings suggest that serum calprotectin may serve as a promising marker for the diagnosis of AOSD and monitor disease activity to a certain extent.

  14. The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse.

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    Khalifa, Najat; Duggan, Conor; Howard, Rick; Lumsden, John

    2012-10-01

    Early-onset alcohol abuse (EOAA) was previously found to both mediate and moderate the effect of childhood conduct disorder (CD) on adult antisocial behavior (ASB) in an American community sample of young adults (Howard, R., Finn, P. R., Gallagher, J., & Jose, P. (2011). Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behavior. Journal of Forensic Psychiatry and Psychology. Advance online publication. doi:10.1080/14789949.2011.641996). This study tested whether this result would generalize to a British forensic sample comprising 100 male forensic patients with confirmed personality disorder. Results confirmed that those in whom EOAA co-occurred with CD showed the highest level of personality pathology, particularly Cluster B traits and antisocial/borderline comorbidity. Those with co-occurring CD with EOAA, compared with those showing only CD, showed more violence in their criminal history and greater recreational drug use. Regression analysis showed that both EOAA and CD predicted adult ASB when covariates were controlled. Further analysis showed that EOAA significantly mediated but did not moderate the effect of CD on ASB. The failure to demonstrate an exacerbating effect of EOAA on the relationship between CD and ASB likely reflects the high prevalence of CD in this forensic sample. Some implications of these findings are discussed.

  15. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

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    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  16. Occupational asthma

    Science.gov (United States)

    ... Names Asthma - occupational exposure; Irritant-induced reactive airways disease Images Spirometry Respiratory system References Lemiere C, Vandenplas O. Occupational allergy and asthma. In: Adkinson NF Jr., Bochner ...

  17. A simple, reliable quantitative score for grading chest X-ray in adult asthma

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    Al-Said A. Haffor

    2014-10-01

    Full Text Available The purpose of the present study was to rate the level of spread of the morphological changes on chest X-ray (CXR, using the modified Shwachman–Kulczycki (S–K rating scale, in relation to changes in routinely measurable parameters in outpatient clinic, such as frequency of respiration (FR, heart rate (HR, wheeze (WHZ and peak expiratory flow (PEF. Asthma patients were classified into 4 groups; Group-1 ⩽ 2 visits per week with reversible symptoms, Group-2 two visits per week with irreversible symptoms, Group-3: 3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. CXR for group-2 showed bilateral increase in perihelia marking, bronchovascular markings but normal lungs fields and ruled out for costophrenic angles. Group-3 showed hyperinflation, obvious perihelia marking associated with bronchial thickening and blocking as well as unfolding aorta, with significantly (p < 0.05 lower PEF, higher HR, FR and WHZ than group 1 and 2. There was also some evidence of bronchial edema with clearly observed fleeting terminal bronchial opacities. CXR for Group-4 showed, extensive atelectasis secondary to obstruction and infection due to bronchiolitis and/or signs of right heart failure. Intra-classcorrelation coefficient showed a significant (p < 0.05 reliability among evaluators of CXR, implying its consistent applicability. Based on the results of the present study it can be concluded that monitoring PEF, FR, WHZ and HR parameters in outpatient clinic can be an objective estimate of the S–K score in order to classify the severity of asthma-induced-morphological changes in CXR.

  18. [Occupational asthma in Hungary].

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    Endre, László

    2015-05-10

    Occupational asthma belongs to communicable diseases, which should be reported in Hungary. During a 24-year period between January 1990 and December 2013, 180 occupational asthma cases were reported in Hungary (52 cases between 1990 and 1995, 83 cases between 1996 and 2000, 40 cases between 2001 and 2006, and 5 cases between 2007 and 2013). These data are unusual, because according to the official report of the National Korányi Pulmonology Institute in Budapest, at least 14,000 new adult asthma cases were reported in every year between 2000 and 2012 in Hungary. Also, international data indicate that at least 2% of adult patients with asthma have occupational asthma and at least 50 out of 1 million employees develop occupational asthma in each year. In 2003, 631 new occupational asthma patients were reported in the United Kingdom, but only 7 cases in Hungary. Because it is unlikely that the occupational environment in Hungary is much better than anywhere else in the world, it seems that not all new occupational asthma cases are reported in Hungary. Of the 180 reported cases in Hungary, 55 were bakers or other workers in flour mills. There were 11 metal-workers, 10 health care assistants, 9 workers dealing with textiles (tailors, dressmakers, workers in textile industry) and 9 employees worked upon leather and animal fur. According to international data, the most unsafe profession is the animal keeper in scientific laboratories, but only 4 of them were reported as having occupational asthma during the studied 24 years in Hungary. Interestingly, 3 museologists with newly-diagnosed occupational asthma were reported in 2003, but not such cases occurred before or after that year. In this paper the Hungarian literature of occupational asthma is summarized, followed by a review on the classification, pathomechanism, clinical presentation, predisposing factors, diagnostics and therapeutic aspects of the disease. Epidemiological data of adult asthma in Hungary and data from

  19. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma.

    Science.gov (United States)

    Cohen, Jessica L; Mann, Devin M; Wisnivesky, Juan P; Home, Robert; Leventhal, Howard; Musumeci-Szabó, Tamara J; Halm, Ethan A

    2009-10-01

    A validated tool to assess adherence with inhaled corticosteroids (ICS) could help physicians and researchers determine whether poor asthma control is due to poor adherence or severe intrinsic asthma. To assess the performance of the Medication Adherence Report Scale for Asthma (MARS-A), a 10-item, self-reported measure of adherence with ICS. We interviewed 318 asthmatic adults receiving care at 2 inner-city clinics. Self-reported adherence with ICS was measured by MARS-A at baseline and 1 and 3 months. ICS adherence was measured electronically in 53 patients. Electronic adherence was the percentage of days patients used ICS. Patients with a mean MARS-A score of 4.5 or higher or with electronic adherence of more than 70% were defined as good adherers. We assessed internal validity (Cronbach alpha, test-retest correlations), criterion validity (associations between self-reported adherence and electronic adherence), and construct validity (correlating self-reported adherence with ICS beliefs). The mean patient age was 47 years; 40% of patients were Hispanic, 40% were black, and 18% were white; 53% had prior asthma hospitalizations; and 70% had prior oral steroid use. Electronic substudy patients were similar to the rest of the cohort in age, sex, race, and asthma severity. MARS-A had good interitem correlation in English and Spanish (Cronbach alpha = 0.85 and 0.86, respectively) and good test-retest reliability (r = 0.65, P self-reported adherence predicted high electronic adherence (odds ratio, 10.6; 95% confidence interval, 2.5-44.5; P self-reported adherence higher in those saying daily ICS use was important and ICS were controller medications (P = .04). MARS-A demonstrated good psychometric performance as a self-reported measure of adherence with ICS among English- and Spanish-speaking, low-income, minority patients with asthma.

  20. Urinary polyaromatic hydrocarbons are associated with adult emphysema, chronic bronchitis, asthma, and infections: US NHANES, 2011-2012.

    Science.gov (United States)

    Shiue, Ivy

    2016-12-01

    Links between environmental chemicals and human health have emerged over the last few decades, but the effects from polyaromatic hydrocarbons were less studied, compared to other commonly known environmental chemicals such as heavy metals, phthalates, arsenic, phenols, pesticides, etc. Therefore, the aim of the study was to examine the relationships of urinary polyaromatic hydrocarbons and adult respiratory health conditions using a large human sample in a national and population-based setting in recent years. Data were retrieved from United States National Health and Nutrition Examination Surveys, 2011-2012 including demographics, self-reported health conditions, and urinary polyaromatic hydrocarbons. Statistical analyses including chi-square test, t test, and survey-weighted logistic regression modeling were performed. Of 5560 American adults aged 20-80, urinary 2-hydroxyfluorene and 3-hydroxyfluorene were positively associated with emphysema (OR, 1.60, 95 % CI 1.26 to 2.03, P = 0.001 and OR, 1.42, 95 % CI 1.15 to 1.77, P = 0.003, respectively) and chronic bronchitis (OR, 1.42, 95 % CI 1.04 to 1.94, P = 0.031 and OR, 1.40, 95 % CI 1.03 to 1.91, P = 0.036, respectively), while 2-hydroxynaphthalene (2-naphthol) was likely to be borderline associated with emphysema and chronic bronchitis. Conversely, urinary 1-hydroxyphenanthrene, 3-hydroxyphenanthrene, 1-hydroxypyrene, and 4-hydroxyphenanthrene were inversely associated with asthma and infections. Urinary polyaromatic hydrocarbons are associated with adult respiratory health conditions, although the causality cannot be established. For future research, studies using large human sample across regions to longitudinally monitor would be suggested. For practice and policy-making, regulation on minimizing polyaromatic hydrocarbons exposure to protect respiratory health might need to be considered in future health and environmental policies and intervention programs.