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Background: The number of Sp1–Egr1 binding tandem repeats at the ALOX5 promoter influences gene transcription and may modify the response to anti-leukotriene treatment. The relationship of ALOX5 variants to asthma severity and leukotriene production by eosinophils is unknown. Objective: To characterize ALOX5 mRNA expression and cysteinyl-leukotriene production by eosinophils from individuals bearing ALOX5 promoter deletional variants and their association with the severity of childhood asthma. Methods: Eosinophils from adult asthmatics bearing only variant alleles (with other than five tandem repeats on both chromosomes, non5/non5) or no variant alleles (5/5) were cultured in vitro and ALOX5 expression and leukotriene secretion were measured. A total of 621 children with mild or moderate-severe asthma were genotyped at the ALOX5 core promoter. Results: Asthmatics with non5/non5 genotype expressed less ALOX5 mRNA and produced less LTC4 into culture supernatants than 5/5 individuals (6.4 ± 2.0 and 20.0 ± 5.0 pg/ml, n = 5; P < 0.05). More asthmatic children bearing non5/non5 genotype had moderate-severe asthma than children with the 5/5 genotype (5.3% vs. 1.4%, P = 0.008). Multivariate logistic regression identified ALOX5 promoter genotype as a significant predictor of disease severity (OR = 3.647, 95% CI: 1.146–11.608, P = 0.03). Consistent with these findings, children bearing the non5/non5 genotype had greater bronchomotor response to exercise as measured by the maximum fall after exercise and the area under the exercise curve ( P < 0.05 for both). Conclusion: Our results suggest that children who express the asthma phenotype despite having a genetic variant that impairs their ability to express ALOX5 have more severe disease and thus are more likely to have asthma symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Asthma is a chronic disease characterized by airway inflammation. Viral infection initiates an immune inflammatory response that may produce asthma attacks. There is no effective preventing therapy for asthma attack during upper respiratory tract viral infections. OBJECTIVE: To investigate the efficacy of 5 days of Pelargonium sidoides therapy for preventing asthma attack during upper respiratory tract viral infections. METHODS: Sixty one asthmatic children with upper respiratory tract viral infection were enrolled in the study. The patients were randomized to receive Pelargonium sidoides daily for 5 days (n=30) or not (n=31). Before and after treatment, they all were examined and symptom scores were determined. Following five days treatment, children were evaluated whether or not they had an asthma attack. RESULTS: Treatment with Pelargonium sidoides was not associated with a statistically significant differences in fever and muscle aches (p>0.05, Chi-square test). There were significant differences in cough frequency and nasal congestion between the groups (p<0.05, Chi-square test). There were statistically significant differences in having asthma attack between the groups (p<0.05, Chi-square). Pelargonium sidoides group had less frequency of asthma attack. DISCUSSION: Our study shows that Pelargonium sidoides may prevent asthma attacks during upper respiratory tract viral infections. [ABSTRACT FROM AUTHOR]

Objective: Current evaluations of pediatric food allergies are very important, many studies have shown that the frequency of food allergies is increasing in the pediatric age group. In this study, we retrospectively investigated the epidemiology and clinical features to better understand the clinical effects of food allergy, to contribute to the literature on this subject, and to evaluate the data of our country., Methods: The epidemiological and clinical data of patients with food allergies diagnosed at the Erciyes University Pediatric Allergy Outpatient Clinic between 2014 and 2019 were analyzed. The outcomes were analyzed by a statistical analyzing program and compared with the literature., Results: As a result of our retrospective evaluation, we found that the mean age of 854 patients who were diagnosed with food allergy was 21.2±30.7 months (min 0 months, max 16.5 years). 512 (60%) of our patients were female, and 342 (40%) were male. The most common complaint was rash at the rate of 75.2% and followed by itching 27.6%, angioedema 10.5%, bloody defecation 10.5%, wheezing 8.4%, vomiting 8.3%, diarrhea 6.7%, frequent bronchiolitis 6.6%, cough 6.2%, and shortness of breath 4.4%. It was shown that 32.2% of the patient had multiple food allergies and the highest sensitivity rates were 65.9% with egg allergies and 39.2% with milk. In the classification, it was found that 75.1% of the patients who were followed up with food allergy had IgE-mediated food allergy, and 24.9% had a non-IgE-mediated food allergy., Conclusion: The results of this study of a 5-year cross-sectional evaluation of the patients diagnosed with food allergy and followed up in our clinic may contribute to the growing body of literature on pediatric-age food allergy., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2023 by Istanbul Provincial Directorate of Health.)

Background: Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists., Method: A pragmatic randomised open trial (September 2018-July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg., Results: Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47-1.50]., Conclusions: Neither intervention consistently impacted the outcome of 'calm', or 'asleep' and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.

Objectives: To assess the association between disordered eating and bipolar disorder (BD)., Methods/design: A case-control study, conducted between April and September 2018, enrolled 50 patients and 50 controls., Results: Higher eating attitude test scores were significantly associated with the presence of BD. This association remained after the introduction of other factors (marital status, family history of BD, shopping and gambling addictions, sleep quality, and insomnia severity) that were also associated with the presence of BD., Practical Implications: This study suggested that eating disorders are associated with BD type I, independent of mediating factors. Health care providers should consider pharmacological or psychotherapeutic interventions that could treat both syndromes sparingly., (© 2020 Wiley Periodicals LLC.)

Background: Agitated and aggressive behaviours are common in the psychiatric setting and rapid tranquilisation is sometimes unavoidable. A survey of Lebanese practice has shown that an intramuscular haloperidol, promethazine and chlorpromazine combination is a preferred form of treatment but there are no randomised trials of this triple therapy. Methods: This is a pragmatic randomised trial. Setting - the psychiatric wards of the Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. Participants - any adult patient in the hospital who displays an aggressive episode for whom rapid tranquilisation is unavoidable, who has not been randomised before, for whom there are no known contraindications. Randomisation - stratified (by ward) randomisation and concealed in closed opaque envelope by independent parties. Procedure - if the clinical situation arises requiring rapid tranquilisation, medical residents overseeing the patient will open a TREC-Lebanon envelope in which will be notification of which group of treatments should be preferred [Haloperidol + Promethazine + Chlorpromazine (HPC) or Haloperidol + Promethazine (HP)], along with forms for primary, secondary and serious adverse effects. Treatment is not given blindly. Outcome - primary outcome is calm or tranquil at 20 minutes post intervention. Secondary outcomes are calm/tranquil at 40, 60 and 120 minutes post intervention, asleep, adverse effects, use of straitjacket and leaving the ward. Follow-up will be up to two weeks post randomisation. Discussion: Findings from this study will compare the HPC versus HP combination used in Lebanon's psychiatry emergency routine practice. Trial registration: ClinicalTrials.gov NCT03639558. Registration date, August 21, 2018., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Dib JE et al.)

Purpose: To examine these temperaments among patients with substance use disorder (SUD) in the Lebanese population., Design: Case-control., Methods: Fifty-seven controls and 57 patients with SUD were enrolled between April and September 2017., Results: A significantly higher mean of depressive, irritable, and anxious temperaments was found in addicted patients as compared with the nonaddicts. However, the results of the multivariate analysis showed that anxious, hyperthymic, irritable temperaments would significantly increase the odds of addiction in participants (ORa = 25.20, 1.057, 1.168, 1.241, and 1.275). Cyclothymic temperament would significantly decrease the odds of addiction in participants (ORa = 0.817). Furthermore, suicidality was associated with depressive, anxious, and irritable temperaments., Practice Implications: Hyperthymic, irritable, and anxious temperaments were the main temperaments found in patients with SUD in Lebanon., (© 2018 Wiley Periodicals, Inc.)

Objectives: To evaluate the effect of psychosis on prognosis as measured by the course of a manic episode, symptoms severity and time to remission and identify existing differences in positive and negative symptoms between psychotic and non-psychotic patients., Study Design: 40 bipolar patients presenting with a diagnosis of acute mania were enrolled (18 psychotic patients and 22 non-psychotic patients) in this cross-sectional study. Subjects were required to complete two self-reported questionnaires, the Young Mania Rating Scale (YMRS) for manic symptoms, and Positive and Negative Symptoms Scale (PANSS) for psychotic symptoms. Rating scales were administered at baseline and then again after three weeks of pharmacologic treatment., Results: There were no differences in socio-demographic characteristics between psychotic and non-psychotic subjects. Psychosis was associated with higher scores on the YMRS and PANSS (increased symptoms severity), compared to non-psychotic patients. Both groups demonstrated clinical improvement and remission, with scores amongst psychotic patients remaining higher. Groups were similar in symptomatology except with regards to psychotic symptoms (the content, insight, delusions, hallucinations, grandiosity, poor rapport and unusual thoughts)., Conclusions: Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.

Background: Violent patients constitute 10% of all psychiatric admissions. Treatment options and clinical practice interventions vary across the globe and no survey of practice in a Middle Eastern setting exists. Surveying treatments in Lebanon will show treatment interventions used in this part of the world and, most importantly, provide the treatment options that could potentially be used for clinical trials pertaining to emergency psychiatry. Methods: A survey of clinicians' opinions and practice was conducted between July and August 2017 at the largest psychiatric hospital in Lebanon. Results: Five of seven experienced psychiatrists provided opinions when interviewed of their preferred intervention when dealing with an emergency psychiatric episode. Whilst this varied in detail, there was a consistent view that there should first be verbal control, then use of medications, and finally physical restrain of the patient. A total of 39 emergency episodes (28 people) occurred in the one month (64% men in their 30s). Bipolar disorder was the most frequent single diagnosis behind the aggression (n=16, 41%; 12 people 43%) but the combined schizophrenia-like illnesses underlay 18 of the 39 episodes (46%; 13/28 people 46%). In clinical life, we found evidence of high family involvement, but little attempts made at initial verbal control in the hospital. All 39 episodes involved administration of pharmacological interventions. Medications were used in 29 of cases (74%) and non-medication interventions used in the remaining 10/39 (26%). Conclusion: This survey provides some evidence that clinicians' preferences may not fully reflect clinical practice but also that experienced clinicians are using several clearly effective techniques to manage these very difficult situations. However, as for other parts of the world, treatment in Lebanon has limited or no underpinning by evidence from well-designed, conducted and reported evaluative studies.

Background: Human leukocyte antigen (HLA)-G is a non-classical major histocompatibility complex class I antigen characterized by limited polymorphism in its coding region, unique tissue expression pattern in physiologic conditions and immunomodulatory properties. Recently, the level of soluble (s)HLA-G was found to be higher in atopic asthma and allergic rhinitis, but this remains to be clarified in wheezy infants. The aim of the present study was therefore to investigate sHLA-G in wheezy infants., Methods: The subjects consisted of infants with persistent wheezing and positive modified asthma predictive index (mAPI; n = 30; persistent group) and those with transient wheezing and negative mAPI (n = 17; transient group). sHLA-G was measured in plasma using enzyme-linked immunosorbent assay. Total immunoglobulin E (IgE) and eosinophil count were measured, and skin testing was performed with a battery of 13 antigens with appropriate positive and negative controls., Results: sHLA-G was significantly higher in the persistent wheezing (positive mAPI) group compared with the transient wheezing (negative mAPI) group (P = 0.008). There was no significant difference in peripheral blood eosinophil count and total IgE between the groups., Conclusions: The increased sHLA-G in infants with persistent wheeze suggests that sHLA-G may be able to be used to distinguish persistent from transient wheeze. Further comprehensive studies are needed on this topic., (© 2016 Japan Pediatric Society.)

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening hypersensitivity drug reaction. Patients present with cutaneous rash, fever, lymphadenopathy, hematologic abnormalities with eosinophilia and atypical lymphocytes, and visceral organ involvement. The prognosis of DRESS syndrome is related to the degree of end-organ damage, and the mortality rate is approximately 10%., Case Report: We report a 9-year-old girl treated with only levetiracetam because of intracranial space occupying mass-related seizures. The patient developed pharyngitis accompanied by exudative membrane, bilateral cervical lymphadenopathy, tender hepatomegaly, skin rash, and fever after 19 days of levetiracetam therapy. Laboratory findings revealed leukocytosis, lymphocytosis with an atypical lymphocytosis, eosinophilia, thrombocytopenia, and elevated serum transaminases. Serologic studies of viruses were negative. The patient was diagnosed with DRESS syndrome and antiepileptic therapy was ceased immediately. The systemic signs and symptoms of the patient were improved after systemic steroid and antihistamine therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important that emergency physicians be aware of the possibility of DRESS syndrome when attending children that present with clinical viral infections. We would like to emphasize that obtaining a careful and detailed medication history is an essential part of clinical assessment for the diagnosis of DRESS syndrome., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Lipoxins could be potential modulators of inflammation in the lungs. To our knowledge, the role of exhaled breath condensate (EBC) lipoxin A4 (LXA4) in asthmatic children with exercise-induced bronchoconstriction (EIB) has not been investigated., Objective: The aim of our study was to determine the involvement of EBC LXA4 in EIB., Methods: Forty-five patients aged between 5 and 17 years were included in the study. Patients were divided into 2 groups: asthmatic children with a positive response to exercise (n = 17) and asthmatic children with a negative response to exercise (n = 28). Levels of LXA4 were determined in EBC before and immediately after the exercise challenge using ELISA., Results: EBC LXA4 levels were significantly increased immediately after exercise in asthmatic children with a positive response to the exercise challenge (P = .05). No significant differences were observed in children with a negative response to exercise (P > .05). There was an inverse correlation between LXA4 levels and the percent degree of reduction in forced expiratory volume in the first second (FEV1%) postexercise in children with a positive exercise challenge (P = .05, r = -0.50). No significant differences were observed in LXA4 levels between atopic and nonatopic asthmatics (P > .05, Mann-Whitney U test)., Conclusions: Levels of EBC LXA4 increased immediately after exercise in asthmatic children with a positive exercise challenge response. We hypothesize that airway LXA4 levels increase to compensate bronchoconstriction and suppress acute inflammation, and that spontaneous bronchodilatation after EIB may be due to LXA4.

The microbiological sanitary quality and safety of leafy greens and strawberries were assessed in the primary production in Belgium, Brazil, Egypt, Norway and Spain by enumeration of Escherichia coli and detection of Salmonella, Shiga toxin-producing E. coli (STEC) and Campylobacter. Water samples were more prone to containing pathogens (54 positives out of 950 analyses) than soil (16/1186) and produce on the field (18/977 for leafy greens and 5/402 for strawberries). The prevalence of pathogens also varied markedly according to the sampling region. Flooding of fields increased the risk considerably, with odds ratio (OR) 10.9 for Salmonella and 7.0 for STEC. A significant association between elevated numbers of generic E. coli and detection of pathogens (OR of 2.3 for STEC and 2.7 for Salmonella) was established. Generic E. coli was found to be a suitable index organism for Salmonella and STEC, but to a lesser extent for Campylobacter. Guidelines on frequency of sampling and threshold values for E. coli in irrigation water may differ from region to region.