February 15, 2014

Physicians’ perception and attitude toward electronic medical record

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Springerplus. 2014; 3: 63.
Published online 2014 February 3. doi:  10.1186/2193-1801-3-63
PMCID: PMC3918096

Physicians’ perception and attitude toward electronic medical record

Parvin Lakbalacorresponding author and Kavoos Dindarloo
Author information ► Article notes ► Copyright and License information ►

Abstract

Implementation of an electronic medical record (EMR) system increases efficiency of health services, quality of care and patient satisfaction. Successful implementation of EMRs depends on many factors. The path to quality improvement and financial gain with EMRs lies in getting the greatest number of Physicians to use the system. The main objective of this research is to explore physicians, attitude and perceptions of importance EMRs function, anticipated utilization of EMR functions and also issue impact EMRs. The cross-sectional study was conducted on 133 specialist physicians of three teaching hospitals of Hormozgan Medical Sciences University. The most important finding in this study was the Entry/Display of Diagnoses and Medications (96.3%) and Prescription Alerts drug-drug, allergy and dose checking and formulary management (96.2%) were of greatest importance to respondents. Nuclear medicine, Time trended Clinical Data Display, decision support capabilities, and medical management reporting generated percentage suggesting less than weekly usage. Only a small number of respondents addressed physicians’ resistance in compare to another issues impact on EMRs. Understanding physician perceptions and attitude will allow for the development of targeted education to demonstrate the advantages and implementation of EMRs in further and improve physician perceptions of EMRs.
Keywords: Electronic Medical Record (EMR), Attitude, Perception, Specialist physicians

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The Relation of Multiple Sclerosis with Allergy and Atopy: A Case Control Study

Iranian Journal of Allergy, Asthma and Immunology 2013. 12(2):182-189.

Parisa Karimi, Seyedeh Zalfa Modarresi, Mohammad Ali Sahraian, Raheleh Shokouhi Shoormasti, Maryam Mahlooji, Anoushirvan Kazemnejad, Zahra Pourpak

Abstract


Multiple Sclerosis (MS) and Allergy are believed to up regulate T helper cell type 1 (Th1) and T helper cell type 2 (Th2)  responses, respectively. It has been shown that disequilibrium in the ratio of Th1/Th2 activities may increase frequency of one disease and decrease the frequency of the other. The aim of this study was to investigate the relation of MS with allergy and atopy in new diagnosed MS patients.
This case-control study was conducted on 40 new diagnosed MS patients and the same number of normal controls. All of the patients were diagnosed (according to McDonald criteria) at most 2 years prior to the study. Demographic data and clinical characteristics of both groups were recorded in a questionnaire. The total IgE and allergen specific IgE in the serum were measured in all the cases.
Forty MS patients (female/male: 4.71) with mean age of 30.55±9.5 years and 40 healthy controls entered in this study. History of allergy was observed in 20(50%) of MS patients (including 15 (37.5%) rhinitis, 6 (15%) conjunctivitis, 3 (7.5%) urticaria and eczema, 1 (2.5%) asthma), and 20 (50%) of the controls (including 8 (20%) rhinitis, 4 (10%) conjunctivitis, 7 (17.5%) urticaria and eczema, 1 (2.5%) asthma). The differences between the two groups were not statistically significant. Neither the serum total IgE, nor the frequency of specific IgE against Weed mix, Grass Mix, Tree mix1, Tree mix 2, Dermatophagoides Farinae, Dermatophagoides pteronyssinus and Epidermal and animal proteins mix differed statistically between the two groups. There was also no significant relationship between MS clinical manifestations and allergy prevalence and also between MS and atopy.
The results of this study as some other similar studies showed the same prevalence of allergy in MS patients and controls and also demonstrated no relation between MS and atopy.

Keywords


Allergy; Atopy; Multiple Sclerosis; Specific IgE; Total IgE

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Iranian Journal of Allergy, Asthma and Immunology, Bimonthly

ISSN: 1735-1502 (Print), ISSN: 1735-5249(Electronic), Published by:
Tehran University of Medical Sciences

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February 12, 2014

The impact of environmental factors on quality of life and symptoms of children with allergic rhinitis

Brazilian Journal of Otorhinolaryngology

Print version ISSN 1808-8694

Braz. j. otorhinolaryngol. vol.79 no.5 São Paulo Sept./Oct. 2013

http://dx.doi.org/10.5935/1808-8694.20130102 

ORIGINAL ARTICLES

Therezita Maria Peixoto Patury Galvão Castro1, Diogo Ramalho Tavares Marinho2, Camila Carvalho Cavalcante2
1Doctoral Student, Otorhinolaryngology Course, FCMSCSP (Assistant Professor, Otorhinolaryngology Course, UNCISAL, UFAL).
2Sixth-year medical student, UFAL (Sixth-year medical student, UFAL).
ABSTRACT
Allergic rhinitis is an inflammation of the nasal mucosa caused by exposure to allergens, which impairs the cognitive capabilities of the affected.
OBJECTIVE:
To correlate the mean scores of quality of life of children and adolescents with symptoms of allergic rhinitis and the presence of household environmental factors described in the literature as allergy triggers.
METHOD:
This cross-sectional retrospective cohort study included 120 children and adolescents presenting clinical manifestations of allergic rhinitis. The subjects were divided into two groups based on the number of allergy-triggering environmental factors seen in their households. Scale PedsQL 4.0 was used to quantify quality of life and allow further comparisons between groups.
RESULTS:
No statistically significant differences (p > 0.05) were seen in the PedsQL mean scores when participant quality of life was analyzed vis-a-vis triggering environmental factors. However, the incidence of allergy manifestations was higher in children exposed to more environmental factors.
CONCLUSION:
The studied environmental factors were not correlated with patient quality of life. However, the analysis of patient households and symptoms indicates the environment played a role in the onset of allergy events.
Keywords: assisted living facilities; perennial allergic rhinitis; quality of life

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Single centre 20 year survey of antiepileptic drug-induced hypersensitivity reactions

 2013;65(2):399-409.

Błaszczyk B, Szpringer M, Czuczwar SJ, Lasoń W.

Abstract

BACKGROUND:

Epilepsy is a chronic neurological disease which affects about 1% of the human population. There are 50 million patients in the world suffering from this disease and 2 million new cases per year are observed. The necessary treatment with antiepileptic drugs (AEDs) increases the risk of adverse reactions. In case of 15% of people receiving AEDs, cutaneous reactions, like maculopapular or erythematous pruritic rash, may appear within four weeks of initiating therapy with AEDs.

METHODS:

This study involved 300 epileptic patients in the period between September 1989 and September 2009. A cutaneous adverse reaction was defined as a diffuse rash, which had no other obvious reason than a drug effect, and resulted in contacting a physician.

RESULTS:

Among 300 epileptic patients of Neurological Practice in Kielce (132 males and 168 females), a skin reaction to at least one AED was found in 30 patients. As much as 95% of the reactions occurred during therapies with carbamazepine, phenytoin, lamotrigine or oxcarbazepine. One of the patients developed Stevens-Johnson syndrome.

CONCLUSION:

Some hypersensitivity problems of epileptic patients were obviously related to antiepileptic treatment. Among AEDs, gabapentin, topiramate, levetiracetam, vigabatrin, and phenobarbital were not associated with skin lesions, although the number of patients in the case of the latter was small.
PMID:
 
23744424
 
[PubMed - indexed for MEDLINE] 
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Sustained efficacy and safety of a 300IR daily dose of a sublingual solution of birch pollen allergen extract in adults with allergic rhinoconjunctivitis: results of a double-blind, placebo-controlled study

Research

Open Access

Margitta Worm, Sabina Rak, Frédéric de Blay, Hans-Jorgen Malling, Michel Melac, Véronique Cadic and Robert K Zeldin
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Clinical and Translational Allergy 2014, 4:7  doi:10.1186/2045-7022-4-7
Published: 11 February 2014

Abstract (provisional)

Background

Allergic rhinoconjunctivitis (ARC) due to birch pollen is a growing health concern in Europe. Here, we report the efficacy and safety of 300IR birch pollen sublingual solution administered discontinuously for 2 consecutive years to patients with birch-associated allergic rhinoconjunctivitis.

Methods

Birch pollen-allergic adults were randomized in this double blind study to 300IR birch pollen sublingual solution or placebo, daily, starting 4 months before and continuing through the pollen season for two pollen seasons. Randomization was stratified according to the presence or absence of oral allergy syndrome (OAS). The primary efficacy endpoint was the Average Adjusted Symptom Score (AAdSS) over the second pollen season and was analyzed by ANCOVA. Secondary efficacy endpoints included the AAdSS over the first pollen period. Safety was evaluated by means of adverse event monitoring.

Results

574 patients (284 in the active group and 290 in the placebo group) were randomized and 496 completed the study. Over the second pollen period, the least square (LS) mean AAdSS was significantly lower in the 300IR group than in the placebo group (LS mean difference -2.04, 95% CI [-2.69, -1.40], (p -0.0001) with a relative reduction of 30.6%. Results were consistent in patients with and without OAS (-33.6% and -28.4%, respectively). A significant reduction in LS mean AAdSS was also observed over the first pollen season. The most frequently reported adverse events were application site reactions: oral pruritus, throat irritation, and mouth edema. There were no reports of anaphylaxis.

Conclusions

Pre- and co-seasonal treatment with 300IR birch pollen sublingual solution demonstrated sustained clinical efficacy over 2 pollen seasons and was well tolerated in adults with birch pollen-associated allergic rhinoconjunctivitis. Efficacy results were consistent in patients with and without oral allergy syndrome.
Trial registration: ClinicalTrials.gov: NCT01731249

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Regulatory T cells as immunotherapy


Front. Immunol., 11 February 2014 | doi: 10.3389/fimmu.2014.00046


imageBenjamin D. Singer*, imageLandon S. King and imageFranco R. D’Alessio
  • Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
Regulatory T cells (Tregs) suppress exuberant immune system activation and promote immunologic tolerance. Because Tregs modulate both innate and adaptive immunity, the biomedical community has developed an intense interest in using Tregs for immunotherapy. Conditions that require clinical tolerance to improve outcomes – autoimmune disease, solid organ transplantation, and hematopoietic stem cell transplantation – may benefit from Treg immunotherapy. Investigators have designed ex vivo strategies to isolate, preserve, expand, and infuse Tregs. Protocols to manipulate Treg populations in vivo have also been considered. Barriers to clinically feasible Treg immunotherapy include Treg stability, off-cell effects, and demonstration of cell preparation purity and potency. Clinical trials involving Treg adoptive transfer to treat graft versus host disease preliminarily demonstrated the safety and efficacy of Treg immunotherapy in humans. Future work will need to confirm the safety of Treg immunotherapy and establish the efficacy of specific Treg subsets for the treatment of immune-mediated disease.
Keywords: regulatory T cells, immunotherapeutics, inflammation, tolerance, adoptive transfer, expansion
Citation: Singer BD, King LS and D’Alessio FR (2014) Regulatory T cells as immunotherapy.Front. Immunol. 5:46. doi: 10.3389/fimmu.2014.00046
Received: 16 December 2013; Paper pending published: 13 January 2014;
Accepted: 27 January 2014; Published online: 11 February 2014.
Edited by:
Nurit Hollander, Tel Aviv University, Israel
Reviewed by:
Luuk Hilbrands, Radboud University Nijmegen Medical Centre, Netherlands
Shimon Slavin, International Center for Cell Therapy & Cancer Immunotherapy, Israel
Copyright: © 2014 Singer, King and D’Alessio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Benjamin D. Singer, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Fourth Floor, Baltimore, MD 21224, USA e-mail: bsinger9@jhmi.edu
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Interleukin 1-β, Interleukin-1 Receptor Antagonist, and Interleukin 18 in Children with Acute Spontaneous Urticaria 

BioMed Research International
Volume 2013 (2013), Article ID 605262, 7 pages
http://dx.doi.org/10.1155/2013/605262
Clinical Study
E. Machura,1 M. Szczepańska,1 B. Mazur,2 M. Barć-Czarnecka,1 and A. Kasperska-Zając3
1Department of Pediatrics, Medical University of Silesia, Ulica 3-go Maja 13-15, 41-800 Zabrze, Poland
2Department of Microbiology and Immunology, Medical University of Silesia, Ulica Jordana 19, 41-808 Zabrze, Poland
3Chair and Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, Ulica M. Curie-Skłodowskiej 10, 41-800 Zabrze, Poland
Received 11 April 2013; Revised 21 September 2013; Accepted 10 October 2013
Academic Editor: Ralph Mösges
Copyright © 2013 E. Machura et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Very little is known about the role of interleukin-1β (IL-1β) and interleukin-18 (IL-18) in urticaria.Material and Methods. Serum levels of IL-1β, IL-1 receptor antagonist (IL-1RA), and IL-18 were measured in 56 children with urticaria and in 41 healthy subjects. Results. Serum IL-1β did not differ between children with acute urticaria and controls. Children with single episode of urticaria had higher levels of IL-1RA and IL-18 than healthy subjects. In children with single episode of urticaria, level of IL-1RA correlated with C-reactive protein (CRP), D-dimer, and IL-1β levels. In subjects with recurrence of urticaria IL-1RA was positively correlated with WBC and D-dimer levels. No correlation of cytokine levels and urticaria severity scores (UAS) in all children with urticaria was observed. In children with single episode of urticaria UAS correlated with CRP level. In the group with single episode of urticaria and in children with symptoms of upper respiratory infection, IL-1RA and IL-18 levels were higher than in controls. The former was higher than in noninfected children with urticaria. In conclusion, this preliminary study documents that serum IL-1RA and IL-18 levels are increased in some children with acute urticaria. However further studies are necessary to define a pathogenic role of IL-1β, IL-1RA, and IL-18 in urticaria.
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February 10, 2014

Gene-metabolite expression in blood can discriminate allergen-induced isolated early from dual asthmatic responses

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PLoS One. 2013; 8(7): e67907.
Published online 2013 July 2. doi:  10.1371/journal.pone.0067907
PMCID: PMC3699462

Gene-Metabolite Expression in Blood Can Discriminate Allergen-Induced Isolated Early from Dual Asthmatic Responses

Amrit Singh,1,2,3 Masatsugu Yamamoto,1,2,5 Sarah H. Y. Kam,1,2 Jian Ruan,1,2 Gail M. Gauvreau,4 Paul M. O'Byrne,4J. Mark FitzGerald,2,5,6 Robert Schellenberg,1,5 Louis-Philippe Boulet,7 Gabriella Wojewodka,8 Cynthia Kanagaratham,8 Juan B. De Sanctis,8,9 Danuta Radzioch,8 and Scott J. Tebbutt1,2,3,5,*
Yi-Hsiang Hsu, Editor
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Abstract

Some asthmatic individuals undergoing allergen inhalation challenge develop an isolated early response whereas others develop a dual response (early plus late response). In the present study we have used transcriptomics (microarrays) and metabolomics (mass spectrometry) of peripheral blood to identify molecular patterns that can discriminate allergen-induced isolated early from dual asthmatic responses. Peripheral blood was obtained prior to (pre-) and 2 hours post allergen inhalation challenge from 33 study participants. In an initial cohort of 14 participants, complete blood counts indicated significant differences in neutrophil and lymphocyte counts at pre-challenge between early and dual responders. At post-challenge, significant genes (ALOX15, FADS2 and LPCAT2) and metabolites (lysolipids) were enriched in lipid metabolism pathways. Enzymes encoding for these genes are involved in membrane biogenesis and metabolism of fatty acids into pro-inflammatory and anti-inflammatory mediators. Correlation analysis indicated a strong negative correlation between ALOX15, FADS2, and IL5RAexpression with 2-arachidonoylglycerophosphocholine levels in dual responders. However, measuring arachidonic acid and docosahexaenoic acid levels in a validation cohort of 19 participants indicated that the free form of DHA (nmoles/µg of protein) was significantly (p = 0.03) different between early and dual responders after allergen challenge. Collectively these results may suggest an imbalance in lipid metabolism which dictates pro- (anti-) inflammatory and pro-resolving mechanisms. Future studies with larger sample sizes may reveal novel mechanisms and therapeutic targets of the late phase asthmatic response.

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