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Having a penicillin allergy label associates with a higher risk for antibiotic resistance and increased health care use. We sought to assess the accuracy of skin tests and specific IgE quantification in the diagnostic evaluation of patients reporting a penicillin/β-lactam allergy. We performed a systematic review and diagnostic accuracy meta-analysis, searching on MEDLINE, Scopus, and Web of Science. We included studies conducted in patients reporting a penicillin allergy and in whom skin tests and/or specific IgE quantification were performed and compared with drug challenge results. We quantitatively assessed the accuracy of diagnostic tests with bivariate random-effects meta-analyses. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. Studies' quality was evaluated using QUADAS-2 criteria. We included 105 primary studies, assessing 31,761 participants. Twenty-seven studies were assessed by bivariate meta-analysis. Skin tests had a summary sensitivity of 30.7% (95% CI, 18.9%-45.9%) and a specificity of 96.8% (95% CI, 94.2%-98.3%), with a partial area under the summary receiver-operating characteristic curve of 0.686 (I 2 = 38.2%). Similar results were observed for subanalyses restricted to patients reporting nonimmediate maculopapular exanthema or urticaria/angioedema. Specific IgE had a summary sensitivity of 19.3% (95% CI, 12.0%-29.4%) and a specificity of 97.4% (95% CI, 95.2%-98.6%), with a partial area under the summary receiver-operating characteristic curve of 0.420 (I 2 = 8.5%). Projected predictive values mainly reflect the low frequency of true penicillin allergy. Skin tests and specific IgE quantification appear to have low sensitivity and high specificity. Because current evidence is insufficient for assessing the role of these tests in stratifying patients for delabeling, we identified key requirements needed for future studies. [ABSTRACT FROM AUTHOR]

Summary Background Obesity has been linked to autonomic dysfunction, which is thought to be one of the main contributors for hypertension, cardiac remodelling and death. Exercise and diet-based weight loss are the mainstay therapy for obesity, but there is a paucity of data regarding the effect of weight changes in autonomic nervous system (ANS) activity. Objective To describe the impact of weight changes in autonomic nervous system. Methods A systematic literature search of four biomedical databases was performed evaluating effects of weight changes, thorough diet and/or exercise-based interventions, in the following ANS outcomes: heart rate variability, namely low frequency (LF)/high frequency (HF) ratio (LF/HF ratio), normalized units of LF (LFnu) and HF (HFnu), muscle sympathetic nerve activity (MSNA), noradrenaline spillover rate (NA-SR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), baroreflex sensitivity and pupillometry. Quality appraisal was performed using the GRADE methodology and, where fitting, studies with comparable outcomes were pooled for meta-analysis. Results Twenty-seven studies - 7 controlled clinical trials and 20 observational studies - were included. Weight gain was reported in 4 studies and weight loss in all the other studies. Interventions inducing weight changes included: hypocaloric or hypercaloric diets, exercise (strength, endurance or aerobic training) and hypocaloric diet coupled with exercise programs. Most studies which resulted in weight loss reported decreases in LF/HF ratio, LFnu, MSNA burst frequency and incidence, NA-SR, and an increase of baroreflex sensitivity, HF, HFnu and RMSSD, pointing to a parasympathetic nervous system activation. Meta-analysis regarding weight loss interventions showed a significant pooled effect size (95% CI) with a decreased of MSNA burst frequency −5.09 (−8.42, −1.75), MSNA incidence −6.66 (−12.40, −0.62), however this was not significant for SDNN 14.32 (−4.31, 32.96). Weight gain was associated with an increase in LF/HF, LFnu, MSNA burst frequency and incidence. The weight loss effects were potentiated by the association of hypocaloric diet with exercise. Nevertheless, weight changes effects in these outcomes were based in low or very low quality of evidence. Conclusions Diet and exercise based weight loss appears to increase parasympathetic and decrease sympathetic activity, the opposing effects being observed with weight gain. These findings are not uniformly reported in the literature, possibly due to differences in study design, methodology, characteristics of the participants and techniques used to estimate autonomic nervous activity. [ABSTRACT FROM AUTHOR]

Copyright of Pesquisa Veterinaria Brasileira is the property of Colegio Brasileiro de Patologia Animal - CBPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Portuguese Journal of Public Health / Revista Portuguesa de Saúde Pública is the property of Revista Portuguesa de Saúde Pública - Escola Nacional de Saúde Pública and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: A functional polymorphism within butyrophilin-like 2 (BTNL2) gene has been described as a potential risk factor for sarcoidosis. The association between chronicity and the rs2076530 SNP A allele has also been reported. This study evaluates the BTNL2 rs2076530 G/A allele associations with sarcoidosis susceptibility and disease evolution in a Portuguese cohort of patients. A case-control study of 151 patients and 150 controls was performed. Allele frequencies were compared with Chi-square test in a univariate analysis and with logistic regression in a multivariate analysis. BTNL2 rs206530 A allele frequencies were significantly higher in sarcoidosis with no linkage disequilibrium with HLA-DRB1 alleles, except in the subgroup of patients with Löfgren syndrome where the determinant allele was HLA-DRB1*03. The A allele was also increased in those with isolated thoracic disease, with no differences regarding radiological stages or disease evolution. HLA-DRB1*03, besides the association with Löfgren syndrome was significantly related with disease resolution. Our data confirms the association of BTNL2 rs2076530 A allele with sarcoidosis susceptibility in a Portuguese population. We found independent genetic risk factors in clinically distinct disease phenotypes: BTNL2 rs2076530 A allele in patients without Löfgren syndrome or with isolated thoracic disease, and HLA-DRB1*03 in Löfgren syndrome or disease resolution. [ABSTRACT FROM AUTHOR]

Summary: Background: Pulmonary sarcoidosis is frequently characterized by a CD4+/CD8+ ratio ≥3.5 in bronchoalveolar lavage fluid (BALF), although up to 40% of the cases present a normal or even decreased ratio, pointing out its variability and limitation as a diagnostic marker for sarcoidosis. Lung lymphocytes within the bronchial epithelium, the alveolar walls, and BALF express the integrin CD103. Our aim was to compare the expression of CD103 in BALF T-lymphocytes between sarcoidosis and other interstitial lung diseases (ILD) and to evaluate its relevance as a BALF diagnostic marker for sarcoidosis. Methods: A total of 86 patients with ILD (mean age ± standard deviation, 42.6 ± 16.6 years; 60.5% female), who underwent BALF as part of their initial diagnostic work-up, were enrolled into 2 groups: sarcoidosis (n = 41) and other ILD (n = 45). Area under the receiver operating characteristic (ROC) curve (AUC) was used to describe the performance of CD103 for sarcoidosis diagnosis. Results: Sarcoidosis patients presented a significantly reduced CD103 expression in BALF T-lymphocytes, more pronounced in the CD4+ subset. The BALF CD103+CD4+/CD4+ ratio for a cutoff point of 0.45 was associated with a better diagnostic performance for sarcoidosis (AUC: 0.86 [95% confidence interval (95% CI): 0.78–0.94]; sensitivity: 81%; specificity: 78%), even for those with a CD4+/CD8+ ratio <3.5 (AUC: 0.79 [95% CI: 0.64–0.93]; sensitivity: 75%; specificity: 78%). Conclusions: Assessment of CD103 expression in BALF CD4+ T-lymphocytes may be a reliable tool for sarcoidosis diagnosis, independently of CD4+/CD8+ ratio, pointing out the relevance of evaluating the CD103+CD4+/CD4+ ratio in the ILD diagnostic work-up. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study determines the prevalence of gambling difficulties in a consecutive sample of psychiatric inpatients and compares it with a nonpsychiatric inpatient sample. In addition, the gambling prevalence among all psychiatric disorders is analyzed. Method: An observational study was conducted in psychiatric patients and sex- and age-matched nonpsychiatric patients. The psychiatric group (n = 100) included all consecutive patients admitted to the psychiatric unit of our hospital. The nonpsychiatric group (n = 100) included psychiatrically healthy inpatients from any other hospital unit. The National Opinion Research Center Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Screen for Gambling Problems was used to screen for gambling behavior. Results: Gambling difficulties were experienced by 3% (2% pathological gambling and 1% problem gambling) of nonpsychiatric inpatients and 9% (8% pathological gambling and 1% problem gambling) of psychiatric inpatients, including 6 with psychotic disorders, 1 with mood disorder, 1 with adjustment disorder, and 1 with eating disorder. There were no statistical differences in gambling prevalence between groups. In terms of comorbidity, patients with psychotic disorder had a higher prevalence of gambling problems than other psychiatric disorders (P = .045). Conclusions: A higher prevalence of gambling disorders was found in psychiatric inpatients than in nonpsychiatric inpatients. It may be advisable for therapists to routinely assess for gambling difficulties as part of the psychiatric evaluation. [Copyright &y& Elsevier]

Summary: We postulated that high level swimming can promote airway inflammation and thus asthma by enhancing local vascular permeability. We aimed to test this hypothesis by a cross-sectional study comparing swimmers (n = 13, 17 ± 3 years, competing 7 ± 4 years, training 18±3 h per week), asthmatic-swimmers (n = 6, 17 ± 2 years, competing 8 ± 3 years, training 16 ± 4 h per week), and asthmatics (n = 19, 14 ± 3 years). Subjects performed induced sputum and had exhaled nitric oxide, lung volumes, and airway responsiveness determined. Airway vascular permeability index was defined as the ratio of albumin in sputum and serum. Results from the multiple linear regression showed each unit change in airway vascular permeability index was associated with an increase of 0.97% (95%CI: 0.02 to 1.92; p = 0.047) in sputum eosinophilis, and of 2.64% (95%CI:0.96 to 4.31; p = 0.006) in sputum neutrophils after adjustment for confounders. In a general linear model no significant differences between airway vascular permeability between index study groups existed, after controlling for sputum eosinophilis and neutrophils. In conclusion, competitive swimmers training in chlorine-rich pools have similar levels of airway vascular permeability than asthmatics. Although competitive swimming has been associated with asthma, airway inflammation and airway hyperesponsiveness do not seem to be dependent on increased airway vascular permeability. [Copyright &y& Elsevier]

Background: Elite swimmers are at increased risk of asthma, which has been related to chronic effects of pool chlorine environment. However acute effects of swimming on rhinitis remain unknown. Objective: We aimed to assess the nasal response to exercise in competitive swimmers compared with competitive runners. Methods: Measurements of nasal symptoms, peak nasal inspiratory flow, lung function, dyspnea, and of airway inflammation were obtained before and after a training session of 19 international-level swimmers and 13 professional runners. Exercise-induced rhinitis was defined as a fall in peak nasal inspiratory flow above 20% from baseline and atopy by positivity to skin-prick testing. Changes within groups were compared using paired t test and differences compared by analysis of covariance. Results: Prevalence of exercise-induced rhinitis was similar between swimmers and runners, respectively 21% and 23%. Contrary to runners, swimmers experienced a decrease in nasal inspiratory flow levels and increase in sneezing, nasal congestion, itching, and postnasal drip after exercise. However, difference in changes was only significant for postnasal drip (p = 0.050). All subjects experiencing exercise-induced rhinitis were nonatopic. An overall improvement in nasal flows, sneezing, and itching after exercise was observed in atopic athletes, although no significant differences in changes compared with nonatopic athletes existed. Conclusion: Swimmers, contrary to runners, experience a worsening of nasal function after training. Although these differences were only significant for postnasal drip, our results provide support to the existence of a 'swimming-induced rhinitis' independent of the atopic status of the athlete. [ABSTRACT FROM AUTHOR]

Summary: Objective: We studied the prevalence of asthma and allergy in non-elite marathon runners and investigated the effects of probiotic supplementation on allergic inflammatory markers. Methods: Asthma and allergies were surveyed by questionnaire, and blood eosinophils, serum eosinophil cationic protein (ECP), total IgE, and Phadiatop® were measured in 141 Finnish marathon runners who took part in the Helsinki City Marathon. They were also randomized to receive either Lactobacillus GG (LGG) or placebo during the 3 months of the pollen season prior to the marathon. Results: Lifetime prevalence of physician-diagnosed asthma was 4.3% (six out of 139 athletes), of allergic rhinitis 17.3% (24/139), of food allergy 5.0% (7/139), and of atopic eczema 4.3% (6/139). Prevalence of atopy was 31% (35/112), and 21% (24/112) of the athletes were sensitized to birch pollen. Asthma or allergy medication was used by 20% (28/139) of the athletes. During pollen season, serum ECP increased significantly in all athletes, and total IgE and Phadiatop® in atopics. The marathon induced a significant eosinopenia but had no effect on serum ECP or total IgE. No differences in changes were seen between groups receiving LGG or placebo. Conclusion: Non-elite marathon runners have asthma and allergies similar to Finnish general population. LGG supplementation did not prevent the increase of allergic markers during the pollen season, or the eosinopenia induced by the marathon. [Copyright &y& Elsevier]