Long term treatment with montelukast and levocetirizine combination in persistent allergic rhinitis: review of recent evidence

Allergic rhinitis is the most prevalent of the atopic disorders, affecting 25% to 35% of persons, depending on the population studied. Considered by non-sufferers to be a trivial disease, allergic rhinitis delivers a significant personal impact on quality of life. Antihistamines have been successfully used for years in the treatment of seasonal/persistent allergic rhinitis. The new generation antihistaminics are all safe, with negligible sedative effects, excellent tolerability and have no influence on cardiac parameters. Montelukast when used as monotherapy is efficacious and improves quality of life. Combination therapy (montelukast plus levocetirizine) is a more effective strategy than monotherapy in the treatment of persistent allergic rhinitis.

Correlation of Oncotype DX Recurrence Score with Cyclin D1 and ErbB2

Background: The Oncotype DX assay predicts the risk of recurrence in patients with stage I-II ER+, node negative breast cancer treated with tamoxifen. It is not understood if the Oncotype DX assay predicts the natural aggressiveness of an individual breast cancer or if it identifies a subtype of tamoxifen resistant breast cancer. In clinical practice, a high recurrence score (RS) on Oncotype DX is interpreted as a more aggressive tumor and is used to justify the use of chemotherapy. However, if the RS was actually predictive of tamoxifen resistance, patients may benefit from the use of an aromatase inhibitor, and chemotherapy may be unnecessary. Cyclin D1 and ErbB2 are two biomarkers shown to predict tamoxifen resistance.Cyclin D1 is overexpressed in approximately 35% of breast cancers. The Austrian Breast and Colorectal Cancer Study Group assessed expression of Cyclin D1 in patients taking tamoxifen within the ABCSG trial 05 and ABCSG trial 06. In both trials, Cyclin D1 overexpression correlated with a lower relapse free survival and overall survival compared to patients without Cyclin D1 overexpression.Erb2 is overexpressed in 15-30% of breast cancers. In the Gruppo Universitario Napoletano 1 trial, ER+ patients with early stage node negative breast cancer who overexpressed ErbB2 had no improvement in progression free survival and overall survival with 2 years of adjuvant tamoxifen therapy. Additional retrospective studies have supported initial reports of an association between overexpression of ErbB2 and tamoxifen resistance.Methods: 69 patients who had the Oncotype DX assay performed and had unstained pathology slides available were assessed for ErbB2 and Cyclin D1 expression. ErbB2 overexpression status was also obtained in another 74 patients who had the Oncotype DX assay performed. ErbB2 overexpression was determined from a review of medical records where ErbB2 was defined as being positive if immunohistochemical (IHC) staining intensity was 3+ with >90% of cells expressing ErbB2 or FISH revealed an amplification of >2.0. IHC analysis of Cyclin D1 was performed according to standard protocol and using commercially available antibodies. Scoring of slides for Cyclin D1 staining were performed by blinded pathologists who assessed both extent and intensity of nuclear staining for Cyclin D1.Results: The median Oncotype Dx RS within ErbB2+ patients was significantly higher than ErbB2- patients (36.5 vs. 18 p<0.0001), and approximately 50% of patients within each RS grouping (high, intermediate, and low) overexpressed cyclin D1.Conclusion: ErbB2 overexpression among high RS patients suggests the Oncotype DX assay may predict tamoxifen resistance and other markers for tamoxifen resistance need to be correlated with the RS. Although preliminary analysis of the IHC staining for Cyclin D1 does not correlate with a high RS, high Cyclin D1 expression among patients within the low RS subgroup is concerning since this subgroup may have an increased likelihood of disease relapse when treated with adjuvant tamoxifen alone.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3035.

Precision lifetime measurements of He(-) in a cryogenic electrostatic ion-beam trap

We have developed a small purely electrostatic ion-beam trap which may be operated in thermal equilibrium at precisely controlled temperatures down to 10 K. Thus, we avoid magnetic field induced mixing of quantum states and may effectively eliminate any influence from absorption of photons from blackbody radiation. We report the first correction-free measurement of the lifetime of the 1s2s2p {4}P{5/2}{0} level of 4He(-) yielding the high-precision result 359.0 +/- 0.7 micros. This result is an essential proof-of-principle for cryogenic electrostatic storage rings and traps for atomic and molecular physics.

Methodologic issues in the study of the relationship between histologic indicators of intraamniotic infection and clinical outcomes

GOAL

To determine the structure of the relationships of the histology scores for acute intraamniotic infection collected in the Collaborative Perinatal Project (CPP).

MATERIALS AND METHODS

44,427 subjects of the CPP had complete histology scores available for the 9 measures that related to acute intraamniotic infection (i.e., neutrophil infiltrates in umbilical cord, amnion of extraplacental membranes and chorionic plate, decidua, chorionic plate and fetal chorionic vessels). Confirmatory factor analysis was used to determine the relationships among the different markers of maternal inflammatory responses (in amnion, chorion and decidua) and fetal inflammatory responses (in umbilical cord and fetal chorionic vessels).

RESULTS

A single CFA model could not be developed across all CPP sites. A well-fit model was developed from the Boston site (N=10,803) and the factor loadings applied to the histology scores from the other CPP sites. The resultant scores for the latent variables (maternal and fetal inflammatory responses) were compared across sites. There was not only considerable variability in factor loadings, and the signs of factor loadings were also inconsistent across sites.

CONCLUSION

Histopathology scores of neutrophil infiltrates performed by different observers do not have the same interrelationships and, by extension, the latent variables they are supposed to reflect may not be equivalent. The lack of measurement invariance renders their use as indicators of the underlying processes of maternal and fetal inflammatory responses problematic in analysis with any clinical outcome.

Conservative management of major abdominal wound dehiscence in premature babies - a seven-year experience

AIM

The aim of the study was to analyse our experience of managing complete abdominal wound dehiscence in preterm neonates non operatively, when primary closure was not possible. We used intrasite gel (a carboxymethyl cellulose polymer which helps in wound debridement and healing) and occlusive duoderme dressings.

MATERIALS AND METHODS

There were seven neonates who developed abdominal dehiscence following laparotomy between January 2000 and December 2006. All had complete abdominal dehiscence with visible intestines. The defect was allowed to granulate and epithelialise by the application of intrasite gel and duoderme dressings. Dressings were changed every 3 days, or earlier, if necessary.

RESULTS

All babies responded well, i.e. their wounds healed without the need for immediate surgery. One patient actually had a stoma in the middle of the wound which was managed with stoma bags during the same period. The period of total epithelialisation ranged from 21 to 108 days. Two patients developed adhesive intestinal obstruction requiring surgery, at 2 and 3 months after the start of treatment. On follow-up, 2/7 patients had developed an incisional hernia.

CONCLUSION

Abdominal wound dehiscence can be successfully managed conservatively with intrasite gel and duoderme dressings, even if bowel is visible. This is potentially lifesaving in severely premature and septic babies in whom primary closure is not desirable. However, some patients do develop adhesive intestinal obstruction or a faecal fistula, either as a result of their primary illness or of this treatment. We believe that this series is the first of its kind to be reported in the world literature.

FDC of montelukast with levocetirizine: focus on bilayer technology

Allergic rhinitis is the most common allergic disease worldwide and affects about 18% to 40% of the general population. Anti-allergic medicines (eg, some antihistamines) can cause adverse events such as somnolence and can have an additional negative impact on quality of life. Combining montelukast with levocetirizine gives additional benefits in comparison with either drug alone and could be considered for patients whose quality of life is impaired by persistent allergic rhinitis. Montelukast sodium is alkaline, stable and levocetirizine dihydrochloride is acid stable, when we prepare a matrix tablet, both the drugs would be in contact and make it unstable during the shelf life of the formulation. Hence it is recommended to prepare bilayer tablet, as it improves and increases the stability of both the drugs in combination. Bilayer tablet of montelukast with levocetirizine is more stable with respect to stability studies, in comparison to matrix tablet.

Outcomes after autologous stem cell transplantation in relapsed or refractory Hodgkin disease: The Duke experience

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Background: High dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) offers patients with relapsed or refractory Hodgkin's disease (HD) the possibility of durable long term remission. We examined the characteristics and outcomes of patients treated at Duke University Medical Center between May 1997 and May 2006. Methods: We performed a retrospective chart review on all patients with relapsed or refractory HD who received HDT followed by ASCT at our institution. Various prognostic factors were also analyzed for their impact on overall survival (OS) and disease free survival (DFS). Results: Sixty-one patients received HDT followed by ASCT for relapsed or refractory HD. Median age was 33 years (range: 16 years to 64 years). The patient population was comprised primarily of males (64%), Caucasians (80%), and patients with nodular sclerosing histology (77%). Fifty-six percent of patients had primary refractory HD. At the time of relapse, 44% of patients had stage I-II disease, and 21% had B symptoms. For patients with relapsed disease, the median time from initial diagnosis to relapse was 17 months. Most patients (64%) received cyclophosphamide, etoposide, and BCNU chemotherapy as HDT. Thirty-one percent of patients received consolidative radiotherapy after HDT. Twenty-eight percent of patients had chemotherapy- responsive disease prior to undergoing HDT. Following ASCT, 46/61 (75%) of patients achieved a complete response. Transplant-related deaths occurred in 2/61 (3%) patients. With a median follow-up of 2.5 years (range: 3 months to 8.8 years), the actuarial 5-year OS and DFS were 79% and 50%, respectively. The most common post-therapy complication was pneumonitis, which occurred in 62% of patients. Three (5%) patients developed second malignancies. On univariate analysis, gender, stage at diagnosis, stage at relapse, presence of B symptoms at relapse, and the interval to first relapse did not significantly affect OS or DFS. Conclusions: Our results confirm that HDT followed by ASCT offers an excellent chance for long-term DFS and OS in patients with relapsed or refractory HD, with a low risk of treatment-related mortality.

No significant financial relationships to disclose.

The relationship between older cancer survivors’ reports of depression, anxiety and pain to health providers’ findings and mortality

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Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments.

No significant financial relationships to disclose.

Jejunal atresia in an infant with triple-X syndrome

A 33-year-old woman presented at 31 weeks' gestation with polyhydramnios that required repeated amniodrainage. An antenatal scan at 32 weeks showed dilated fetal bowel loops, which were not confirmed on subsequent scans. The amniotic fluid karyotype confirmed 47,XXX. After birth, jejunal obstruction was confirmed. To our knowledge, this is the first report of an association of triple-X syndrome and jejunal atresia.

Familial syndromic duodenal atresia: Feingold syndrome

Familial duodenal atresia occurs as part of Feingold syndrome. Other features of this variable autosomal dominant condition include tracheo-oesophageal fistula and oesophageal atresia, microcephaly, hand and foot anomalies, facial dysmorphism, and developmental delay. We report a father and two sons with Feingold syndrome. One has bilateral dysplastic kidneys which have not been reported previously.

Severe jejunoileitis after placement of a feeding jejunostomy: a series of four cases and a review of the literature

Feeding jejunostomy is a recognized method of managing feeding difficulties and failure to thrive in neurologically impaired children. There are, however, significant associated complications. The authors report 4 cases of the potentially fatal complication of severe jejunoileitis, which has not been reported previously in children. The possible underlying mechanisms are discussed.

Effect of collective response on electron capture and excitation in collisions of highly charged ions with fullerenes

Projectile deexcitation Lyman x-ray emission following electron capture and K excitation has been studied in collisions of bare and Li-like sulphur ions (of energy 110 MeV) with fullerenes (C(60)/C(70)) and different gaseous targets. The intensity ratios of different Lyman x-ray lines in collisions with fullerenes are found to be substantially lower than those for the gas targets, both for capture and excitation. This has been explained in terms of a model based on "solidlike" effect, namely, wakefield induced stark mixing of the excited states populated via electron capture or K excitation: a collective phenomenon of plasmon excitation in the fullerenes under the influence of heavy, highly charged ions.

Staphylococcal submandibular lymphadentitis of childhood

The presentation of two patients with the condition is described. The difficulty of finding an underlying cause of the infection is discussed, and the importance of a history of recent head and neck infection emphasised. Recommendations are made for appropriate antibiotic therapy to cover Staphylococci as well as the more common Streptococci.

Assessment of industrial effluent and its impact on soil and plants

The present study deals with the assessment of industrial water of an electronic component manufacturing unit with electroplating and its subsequent effects on soil and plants receiving the effluent. The physico-chemical parameters of the effluent samples showed higher value than that of ground water. The treated effluent was within the permissible limit. Microtox test was conducted and determined the degree of toxicity of untreated, treated effluents as well as the water sample collected at effluent discharge point of receiving river (confluence point). The physico- mechanical parameters of the soil samples were not changed due to irrigation of the treated effluent, but the concentration of metals were comparatively higher than the control soil. Higher accumulation of metals was found in the plant parts in naturally growing weeds and cultivated crop plant irrigated with treated effluent. Elevated accumulation of metals in Eichhornia crassipes and Marsilea sp. growing along the effluent channel has been identified as a potential source of biomonitoring of metals particularly for Cu and Ca and can be utilised for the removal of heavy metal from wastewater.

Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma

AIM

To investigate the safety of bronchoscopy and endobronchial biopsy in children with difficult asthma, and discuss the ethical issues associated with the procedure.

METHODS

A three year prospective observational study was performed in two tertiary paediatric respiratory centres specialising in the management of children with difficult asthma. A total of 48 children with difficult asthma and 35 non-asthmatic children were studied.

RESULTS

Flexible bronchoscopy was performed under general anaesthesia in 38 children with difficult asthma, and rigid bronchoscopy was performed in 10, following a two week course of prednisolone. Endobronchial biopsy was performed in 47 patients. Perioperative complications occurred in one asthmatic undergoing flexible bronchoscopy (desaturation) and in two undergoing rigid bronchoscopy (desaturation in one, and bronchospasm and desaturation in one). There were no cases of significant bleeding or pneumothorax among the asthmatics. Flexible bronchoscopy was performed in 35 non-asthmatic patients with a variety of clinical indications. The total number of perioperative complications was greater in the non-asthmatics undergoing flexible bronchoscopy than in the asthmatics (17 complications in 35 children versus one in 38). Fever requiring hospital admission was documented in two asthmatics following bronchoscopy. Four asthmatics reported an increase in symptoms in the week following bronchoscopy.

CONCLUSIONS

Bronchoscopy and endobronchial biopsy under general anaesthesia can be performed safely in children with difficult asthma, when the bronchoscopist and anaesthetist are suitably trained. The procedure is acceptable to the families involved.

Inguinal hernias in premature babies: wait or operate?

There are several contentious issues in the management of inguinal hernias in premature neonates. They include the timing of surgery, the management of incarceration, the role of routine contralateral groin exploration and the type of anaesthesia. In this article we re-emphasize the importance of delaying surgery until the baby is ready for discharge from the neonatal unit. Regular examinations and manual reduction of these hernias should be performed in order to detect incarcerations early.

CONCLUSION

With this approach, it may be possible to minimize the morbidity resulting from incarceration, and at the same time avoid the respiratory and testicular complications resulting from an early surgical/anaesthetic intervention.

Adenosine induced monomorphic ventricular tachycardia

Polymorphic ventricular tachycardia has been reported following the administration of adenosine for the treatment of SVT. We present a case of monomorphic ventricular tachycardia in a 75-year-old man following the intravenous administration of adenosine for stress testing.

Schistosoma haematobium infection in children in Britain

OBJECTIVE

To highlight the existence of Schistosoma haematobium in certain ethnic minority groups in Britain and in English citizens who have recently visited Africa and the Middle East, so that general practitioners and paediatric nephrologists/urologists are aware of its occurrence and consider it among the differential diagnoses in children presenting with haematuria.

PATIENTS AND METHODS

Over a 2-year period, six consecutive boys (mean age 13.5 years, range 8-15) presented with haematuria and were subsequently diagnosed to be infected with S. haematobium. All patients were from Africa and had recently visited their native country. There had all reported paddling in freshwater lakes and streams.

RESULTS

Dysuria and haematuria was noted 2-3 months after the infection. Terminal urine samples taken after exercise at midday were positive for S. haematobium ova. Praziquantel anti-schistosomal chemotherapy was effective in treating the infection.

CONCLUSION

S. haematobium infection is treatable in the early stages and the changes are reversible before the development of fibrotic lesions, which may result in anatomical obstruction. A terminal urine sample taken at midday after exercise was diagnostic in showing Schistosoma ova in all cases. This infection must be considered in the differential diagnoses of haematuria in some ethnic minority British citizens and in those Britons who have visited Africa or the Middle East in the recent past.