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Sample records for feeding intolerance paralytic

  1. Probiotic Supplementation in Preterm: Feeding Intolerance and Hospital Cost.

    PubMed

    Indrio, Flavia; Riezzo, Giuseppe; Tafuri, Silvio; Ficarella, Maria; Carlucci, Barbara; Bisceglia, Massimo; Polimeno, Lorenzo; Francavilla, Ruggiero

    2017-08-31

    We hypothesized that giving the probiotic strain Lactobacillus reuteri (L. reuteri) DSM 17938 to preterm, formula-fed infants would prevent an early traumatic intestinal inflammatory insult modulating intestinal cytokine profile and reducing the onset of feeding intolerance. Newborn were randomly allocated during the first 48 h of life to receive either daily probiotic (10⁸ colony forming units (CFUs) of L. reuteri DSM 17938) or placebo for one month. All the newborns underwent to gastric ultrasound for the measurement of gastric emptying time. Fecal samples were collected for the evaluation of fecal cytokines. Clinical data on feeding intolerance and weight gain were collected. The costs of hospital stays were calculated. The results showed that the newborns receiving L. reuteri DSM 17938 had a significant decrease in the number of days needed to reach full enteral feeding (p < 0.01), days of hospital stay (p < 0.01), and days of antibiotic treatment (p < 0.01). Statistically significant differences were observed in pattern of fecal cytokine profiles. The anti-inflammatory cytokine interleukin (IL)-10, was increased in newborns receiving L. reuteri DSM 17938. Pro-inflammatory cytokines: IL-17, IL-8, and tumor necrosis factor (TNF)-alpha levels were increased in newborns given placebo. Differences in the gastric emptying and fasting antral area (FAA) were also observed. Our study demonstrates an effective role for L. reuteri DSM 17938 supplementation in preventing feeding intolerance and improving gut motor and immune function development in bottle-fed stable preterm newborns. Another benefit from the use of probiotics is the reducing cost for the Health Care service.

  2. Feeding intolerance as a result of small-intestine intussusception in a child with major burns.

    PubMed

    Kincaid, M Sean; Vavilala, Monica S; Faucher, Lee; Zimmerman, Jerry; Heimbach, David

    2004-01-01

    Feeding intolerance is common in critically ill children. We present an unusual case of jejunojejunal intussusception causing feeding intolerance in a child with major burns. An 18-month-old female was admitted to the intensive care unit after sustaining a 65% TBSA burn. Following a decompressive laparotomy for abdominal compartment syndrome, nasojejunal feeds were started immediately after surgery, which she did not tolerate. A plain abdominal radiograph revealed a collection of intraluminal air and an abdominal CT revealed a proximal jejunojejunal intussusception. The patient underwent laparotomy and an uncomplicated reduction of the small-bowel intussusception (SBI). Successful enteral feedings were commenced on hospital day 24, and the patient was discharged to home after approximately a 4.5-month hospitalization. The major learning point is that SBI can cause feeding intolerance in the child with major burns. Despite the low incidence of SBI in critically ill children, arriving at a timely diagnosis is essential because the consequences of a missed or delayed diagnosis include intestinal ischemia, necrosis, or perforation. Because SBI defies diagnosis by techniques traditionally used to diagnose intussusception involving the colon, clinical suspicion for intussusception is needed to facilitate the urgent diagnosis and correction of feeding intolerance caused by mechanical obstruction.

  3. Does the use of glycerin laxatives decrease feeding intolerance in preterm infants?

    PubMed

    Shah, Vibhuti; Chirinian, Nevart; Lee, Shoo

    2011-11-01

    Glycerin laxatives are often prescribed in the neonatal population for meconium evacuation and to promote enteral feeding. However, the literature regarding their effectiveness has not been systematically reviewed. To assess the effectiveness of glycerin enema or suppository in preventing feeding intolerance in preterm infants at ≤32 weeks' gestational age or weighing ≤1500 g at birth. The Medline, Embase, Cochrane Library, Scopus and Web of Science databases were searched to identify studies that evaluated glycerin enemas/suppositories for feeding intolerance. Using the Evidence Evaluation Worksheet adapted from the American Heart Association's International Liaison Committee on Resuscitation, eligible studies were scored for quality, level of evidence and direction of support. Two clinical studies that evaluated meconium evacuation and feeding intolerance were included. One study showed no difference in the time to complete meconium evacuation or establishment of full enteral feeds, while the other showed that the times to first meconium passage and full enteral feeding were significantly shorter, and the rate of sepsis was lower in the glycerin enema group. The evidence regarding the effectiveness of glycerin laxatives for improving feeding tolerance is inconclusive in infants at ≤32 weeks' gestational age or weighing ≤1500 g at birth.

  4. Does the use of glycerin laxatives decrease feeding intolerance in preterm infants?

    PubMed Central

    Shah, Vibhuti; Chirinian, Nevart; Lee, Shoo

    2011-01-01

    BACKGROUND: Glycerin laxatives are often prescribed in the neonatal population for meconium evacuation and to promote enteral feeding. However, the literature regarding their effectiveness has not been systematically reviewed. OBJECTIVE: To assess the effectiveness of glycerin enema or suppository in preventing feeding intolerance in preterm infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth. METHODS: The Medline, Embase, Cochrane Library, Scopus and Web of Science databases were searched to identify studies that evaluated glycerin enemas/suppositories for feeding intolerance. Using the Evidence Evaluation Worksheet adapted from the American Heart Association’s International Liaison Committee on Resuscitation, eligible studies were scored for quality, level of evidence and direction of support. RESULTS: Two clinical studies that evaluated meconium evacuation and feeding intolerance were included. One study showed no difference in the time to complete meconium evacuation or establishment of full enteral feeds, while the other showed that the times to first meconium passage and full enteral feeding were significantly shorter, and the rate of sepsis was lower in the glycerin enema group. CONCLUSION: The evidence regarding the effectiveness of glycerin laxatives for improving feeding tolerance is inconclusive in infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth. PMID:23115504

  5. Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

    PubMed Central

    Deane, Adam; Chapman, Marianne J; Fraser, Robert J; Bryant, Laura K; Burgstad, Carly; Nguyen, Nam Q

    2007-01-01

    Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted. PMID:17663503

  6. Growth of Infants with Intestinal Failure or Feeding Intolerance Does Not Follow Standard Growth Curves

    PubMed Central

    Morton, Danielle L.; Hawthorne, Keli M.

    2017-01-01

    Objective. Infants with intestinal failure or feeding intolerance are nutritionally compromised and are at risk for extrauterine growth restriction. The aim of the study was to evaluate growth velocities of infants with intestinal failure and feeding intolerance for the first three months of age and to determine growth percentiles at birth and at 40-week postmenstrual age (PMA). Methods. A chart review of infants followed by the Texas Children's Hospital Intestinal Rehabilitation Team was conducted from April 2012 to October 2014. Weekly weight, length, and head circumference growth velocities were calculated. Growth data were compared to Olsen growth curves to determine exact percentiles. Results. Data from infants (n = 164) revealed that average growth velocities of 3-month-old infants (weight gain, 19.97 g/d; length, 0.81 cm/week; head circumference, 0.52 cm/week) fluctuated and all were below expected norms. At discharge or death, average growth velocities had further decreased (length, 0.69 cm/week; head circumference, 0.45 cm/week) except for weight, which showed a slight increase (weight, 20.56 g/d). Weight, length, and head circumference percentiles significantly decreased from birth to 40-week PMA (P < 0.001). Conclusions. Growth of infants with intestinal failure or feeding intolerance did not follow standard growth curves. PMID:28357138

  7. Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants.

    PubMed

    Anabrees, Jasim; Shah, Vibhuti S; AlOsaimi, Ahlam; AlFaleh, Khalid

    2015-09-30

    Feeding intolerance is a common clinical problem among preterm infants. It may be an early sign of necrotising enterocolitis, sepsis or other serious gastrointestinal conditions, or it may result from gut immaturity with delayed passage of meconium. Glycerin laxatives stimulate passage of meconium by acting as an osmotic dehydrating agent and increasing osmotic pressure in the gut; they stimulate rectal contraction, potentially reducing the incidence of feeding intolerance. To assess the effectiveness and safety of glycerin laxatives (enemas/suppositories) for prevention or treatment of feeding intolerance in very low birth weight (VLBW) infants. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 4), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We restricted our search to all randomised controlled trials and applied no language restrictions. We searched the references of identified studies and reviews on this topic and handsearched for additional articles. We searched the database maintained by the US National Institutes of Health (www.clinicaltrials.gov) and European trial registries to identify ongoing trials. We considered only randomised or quasi-randomised controlled trials that enrolled preterm infants < 32 weeks' gestational age (GA) and/or < 1500 g birth weight. We included trials if they administered glycerin laxatives and measured at least one prespecified clinical outcome. We used standard methods of The Cochrane Collaboration and its Neonatal Group to assess methodological quality of trials, to collect data and to perform analyses. We identified three trials that evaluated use of prophylactic glycerin laxatives in preterm infants. We identified no trials that evaluated therapeutic use of glycerin laxatives for feeding intolerance. Our review showed that prophylactic administration of glycerin laxatives did not reduce the time required to achieve full enteral feeds and did

  8. Long-term intermittent feeding, but not caloric restriction, leads to redox imbalance, insulin receptor nitration, and glucose intolerance.

    PubMed

    Cerqueira, Fernanda M; da Cunha, Fernanda M; Caldeira da Silva, Camille C; Chausse, Bruno; Romano, Renato L; Garcia, Camila C M; Colepicolo, Pio; Medeiros, Marisa H G; Kowaltowski, Alicia J

    2011-10-01

    Calorie restriction is a dietary intervention known to improve redox state, glucose tolerance, and animal life span. Other interventions have been adopted as study models for caloric restriction, including nonsupplemented food restriction and intermittent, every-other-day feedings. We compared the short- and long-term effects of these interventions to ad libitum protocols and found that, although all restricted diets decrease body weight, intermittent feeding did not decrease intra-abdominal adiposity. Short-term calorie restriction and intermittent feeding presented similar results relative to glucose tolerance. Surprisingly, long-term intermittent feeding promoted glucose intolerance, without a loss in insulin receptor phosphorylation. Intermittent feeding substantially increased insulin receptor nitration in both intra-abdominal adipose tissue and muscle, a modification associated with receptor inactivation. All restricted diets enhanced nitric oxide synthase levels in the insulin-responsive adipose tissue and skeletal muscle. However, whereas calorie restriction improved tissue redox state, food restriction and intermittent feedings did not. In fact, long-term intermittent feeding resulted in largely enhanced tissue release of oxidants. Overall, our results show that restricted diets are significantly different in their effects on glucose tolerance and redox state when adopted long-term. Furthermore, we show that intermittent feeding can lead to oxidative insulin receptor inactivation and glucose intolerance.

  9. [Paralytic and non-paralytic pontine exotropia].

    PubMed

    Bogousslavsky, J; Regli, F

    1983-01-01

    Paralytic pontine exotropia is a form of the one-and-a half syndrome of Fisher, in which an acute lesion of the paramedian pontine reticular formation (PPRF) is present. We compared such a case with a case of pontine exotropia without lateral gaze palsy, but in which the alteration of the ipsilateral saccades suggested a partial lesion of the PPRF. We suggest to call this oculomotor disturbance "non paralytic pontine exotropia".

  10. Prevalence, Outcomes, and Management of Enteral Tube Feeding Intolerance: A Retrospective Cohort Study in a Tertiary Center.

    PubMed

    Wang, Kailun; McIlroy, Kerry; Plank, Lindsay D; Petrov, Max S; Windsor, John A

    2017-08-01

    Enteral tube feeding (ETF) is the most common form of artificial feeding in hospitalized patients, and the development of intolerance (ETFI) is the most common complication. This study aimed to determine the prevalence of ETFI, the clinical consequences, and the current management approach to ETFI in hospitalized adult patients. Adult patients receiving ETF were identified from a prospective database in the Nutrition Services at Auckland City Hospital. Further information was obtained by the review of clinical records for a 12-month period, up to December 2014. The prevalence of ETFI was 33% among 754 patients. ETFI more frequently occurred in the intensive care unit ( P < .05). Patients with ETFI were less likely to reach their feeding goal rate ( P < .01). Multivariate analysis showed that younger age, certain specialties, and acute mesenteric ischemia were independent predictors of ETFI ( P < .05). The management of ETFI was highly variable. Medication was the most common treatment, while changes in the feeding protocol such as reducing infusion rate and stopping and changing the route of ETF were also frequently attempted. ETFI is a frequent problem in adult hospitalized patients receiving ETF, and it is associated with poor clinical outcomes such as inadequate nutrition and complications of feeding. While the pathophysiology is poorly understood, there also appears to be no standard evidence-based treatment. Studies investigating the mechanisms and optimized management are therefore indicated.

  11. Glucose intolerance associated with early-life exposure to maternal cafeteria feeding is dependent upon post-weaning diet.

    PubMed

    Akyol, Asli; McMullen, Sarah; Langley-Evans, Simon C

    2012-04-01

    In addition to being a risk factor for adverse outcomes of pregnancy, maternal obesity may play a role in determining the long-term disease patterns observed in the resulting offspring, with metabolic and dietary factors directly programming fetal development. The present study evaluated the potential for feeding rats an obesogenic cafeteria diet (O) pre-pregnancy, during pregnancy, during lactation and for the offspring post-weaning, to programme glucose tolerance. Early-life exposure to an O diet had no significant effect on offspring food intake. Early-life programming associated with O feeding to induce maternal obesity was associated with reduced adiposity in offspring weaned onto low-fat chow. Adult offspring exposed to an O diet in early life and weaned on a chow diet had low fasting glucose and insulin concentrations and appeared to be more sensitive to insulin during an intraperitoneal glucose tolerance test. When weaned on an O diet, male offspring were more prone to glucose intolerance than females. On the basis of the area under the glucose curve, maternal O feeding at any point from pre-mating to lactation was associated with impaired glucose tolerance. The mechanism for this was not identified, although increased hepatic expression of Akt2 may have indicated disturbance of insulin signalling pathways. The observations in the present study confirm that maternal overnutrition and obesity during pregnancy are risk factors for metabolic disturbance in the resulting offspring. Although the effects on glucose homeostasis were independent of offspring adiposity, the programming of a glucose-intolerant phenotype was only observed when offspring were weaned on a diet that induced greater fat deposition.

  12. A 6th Vital Sign--Potential Use of Nasogastric Tube for Intra-abdominal Pressure Monitoring Method to Detect Feeding Intolerance in Very Low Birth-Weight Preterm Infants (<1500 g).

    PubMed

    Carter, Brigit M; Howard, Christina

    2015-06-01

    While various feeding strategies designed to optimize growth have been investigated and used in the clinical setting, the problem of not being able to recognize the warning signs of feeding intolerance early enough to prevent serious gastrointestinal complication commonly associated with very low birth-weight (VLBW) preterm infant remains. Currently, early stages of feeding intolerance are most often identified though nurse assessments. Additional methods to predict feeding intolerance in this population are needed. Currently, intra-abdominal pressure monitoring has been an effective method to predict intolerance to enteral nutrition in the adult and pediatric populations. There is supportive evidence for the use of noninvasive methods, such as nasogastric tubes, to effectively monitor IAP. While this may not be the gold standard method of using Foley catheters for measurement, it could provide predictive levels that are indicative of progression toward bowel inflammation. This review shows the potential for using noninvasive nasogastric tubes for monitoring intra-abdominal pressure and may provide direction for evaluating intra-abdominal pressures in VLBW preterm infants as a reliable method for early identification of feeding intolerance. The use of nasogastric tubes to monitor intra-abdominal pressure may provide an effective noninvasive tool to identify VLBW preterm infants progressing toward feeding intolerance and would add to assessment data. Development and testing of a reliable nasogastric tube monitoring device in the VLBW preterm infant population and identify predictive levels that indicate progression toward feeding intolerance is needed. Once IAP predictive levels are identified, provider interventions could be developed.

  13. Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis.

    PubMed

    Blaser, A Reintam; Starkopf, J; Kirsimägi, Ü; Deane, A M

    2014-09-01

    Clinicians and researchers frequently use the phrase 'feeding intolerance' (FI) as a descriptive term in enterally fed critically ill patients. We aimed to: (1) determine what is the most accepted definition of FI; (2) estimate the prevalence of FI; and (3) evaluate whether FI is associated with important outcomes. Systematic searches of peer-reviewed publications using PubMed, MEDLINE, and Web of Science were performed with studies reporting FI extracted. We identified 72 studies defining FI. In 33 studies, the definition was based on large gastric residual volumes (GRVs) together with other gastrointestinal symptoms, while 30 studies relied solely on large GRVs, six studies used inadequate delivery of enteral nutrition (EN) as a threshold, and three studies gastrointestinal symptoms without reference to GRV. The median volume used to define a 'large' GRV was 250 ml (ranges from 75 to 500 ml). The pooled proportion (n = 31 studies) of FI was 38.3% (95% CI 30.7-46.2). Five studies reported outcomes, all of them observed adverse outcome in FI patients. In three studies, respectively, FI was associated with increased mortality and ICU length-of-stay. In summary, FI is inconsistently defined but appears to occur frequently. There are preliminary data indicating that FI is associated with adverse outcomes. A standard definition of FI is required to determine the accuracy of these preliminary data. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. Lactose intolerance.

    PubMed

    Vandenplas, Yvan

    2015-01-01

    Lactose is the main carbohydrate in infant feeding, but its impact decreases as the child gets older and consumes less milk and dairy products. Congenital lactose intolerance is a very rare condition. However, lactase activity may be low and need to mature during the first weeks of life in many infants. However, the evidence that unabsorbed lactose is causing infantile crying and colic is contradictory. Unabsorbed lactose has a bifidogenic effect and improves calcium absorption. Lactose malabsorption may occur secondary and thus temporally to other etiologies such as infectious gastroenteritis, cow's milk allergy and celiac disease. One the cause is treated, lactase activity will gradually return to normal. The vast majority of Asian children will develop late onset congenital lactase deficiency. However, this entity only exceptionally causes symptoms before the age of 4-5 years. Symptoms are abdominal cramps, flatulence and watery, acid stools, and decrease the quality of life but lactose intolerance is not associated with "true disease". The diagnosis is made on clinical grounds and confirmed with a lactose breath test, if needed. These patients need to have a lifetime long reduced lactose intake to improve their quality of life.

  15. [Correction of paralytic lagophthalmos].

    PubMed

    Iskusnykh, N S; Grusha, Y O

    2015-01-01

    Current options for correction of paralytic lagophthalmos are either temporary (external eyelid weight placement, hyaluronic acid gel or botulinum toxin A injection) or permanent (various procedures for narrowing of the palpebral fissure, upper eyelid weights or spring implantation). Neuroplastic surgery (cross-facial nerve grafting, nerve anastomoses) and muscle transposition surgery is not effective enough. The majority of elderly and medically compromised patients should not be considered for such complicated and long procedures. Upper eyelid weight implantation thus appears the most reliable and simple treatment.

  16. A Novel Neonatal Feeding Intolerance and Necrotizing Enterocolitis Risk-Scoring Tool Is Easy to Use and Valued by Nursing Staff.

    PubMed

    Naberhuis, Jane; Wetzel, Christine; Tappenden, Kelly A

    2016-06-01

    Preterm infants are at increased risk of developing feeding intolerance and necrotizing enterocolitis. Comprehensive, targeted nursing assessments can evaluate the risk for and identify early signs of these conditions in an effort to prevent their destructive sequela. While the long-term goal is to develop a validated risk-scoring tool for the prediction of feeding intolerance and necrotizing enterocolitis, the objective of the preliminary phase presented here is to assess the ease of use and nurses' attitudes toward a novel feeding intolerance and necrotizing enterocolitis risk-scoring tool. A novel risk-scoring nursing tool was implemented in a University of Illinois-affiliated 48-bed level III neonatal intensive care unit. Data were collected from the electronic medical record of all preterm infants with parental consent during the initial 6-month study period. Scoring accuracy (accuracy of selection of risk factors based on electronic medical record data), ease of use, and nurses' attitudes toward the tool were assessed at the study site and by evaluators at a national neonatal nursing conference. Fourteen nurses scored 166 tools on the 63 enrolled infants. Sixteen tools (9.6%) contained errors. Mean study site tool ease of use was 8.1 (SD: 2.2) on a 10-point scale. Ninety percent of conference evaluators agreed/strongly agreed that the tool addressed important knowledge gaps. The tool is easy to use and valued by nurses. Following validation, widespread implementation is expected to be a clinically feasible means to improve infant clinical outcomes for minimal time and financial cost. Tool validation and refinement based on nursing feedback will improve its broad applicability and predictive utility.

  17. Paralytic shellfish poisoning.

    PubMed Central

    Acres, J.; Gray, J.

    1978-01-01

    Two cases of paralytic shellfish poisoning after ingestion of mussels occurred in October 1977 in Nova Scotia. The incidence of this type of poisoning is relatively high among persons living on the coast of the Bay of Fundy and the estuary of the St. Lawrence River. The causative organism, Gonyaulax tamarensis, elaborates an endotoxin, saxitoxin, that blocks neuromuscular transmission in the motor axon and muscle membrane while leaving the end-plate unaffected; it also suppresses conduction in the atrioventricular node and inhibits the respiratory centre. The clinical manifestations are unique and include numbness of the lips, tongue and fingertips within minutes of ingestion of the poisoned shellfish, then numbness of the legs, arms and neck, with general muscular incoordination, and finally respiratory distress and muscular paralysis. Treatment is symptomatic and prevention can only occur by public education. Images FIG. 2 FIG. 3 PMID:570450

  18. Correction of paralytic lagophthalmos.

    PubMed

    Anastassov, George E; Khater, Regina H; Anastassov, Yourii K

    2012-01-01

    Bell's palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions. The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin. If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.

  19. Fasting and nutrient-stimulated plasma peptide-YY levels are elevated in critical illness and associated with feed intolerance: an observational, controlled study

    PubMed Central

    Nguyen, Nam Q; Fraser, Robert JL; Chapman, Marianne; Bryant, Laura K; Wishart, Judith; Holloway, Richard H; Horowitz, Michael

    2006-01-01

    Introduction Delayed gastric emptying and feed intolerance occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Peptide YY (PYY) slows gastric emptying. The aim of this study was to determine fasting and nutrient-stimulated plasma PYY concentrations and their relationship to cholecystokinin (CCK) in critically ill patients. Methods Studies were performed in 19 unselected mechanically ventilated critically ill patients (12 males; 48 ± 7 years old) in a randomised, single-blind fashion. Subjects received a 60-minute duodenal infusion of Ensure® at either 1 or 2 kcal/minute. Blood samples were collected at baseline and at 20, 40, 60, and 180 minutes following commencement of the nutrient infusion for the measurement of plasma PYY and CCK concentrations (using radioimmunoassay). Patient data were compared to 24 healthy subjects (17 males; 43 ± 2 years old). Results Fasting PYY concentration was higher in patients (P < 0.05), particularly in those with feed intolerance (P < 0.05). Plasma PYY concentrations were higher in patients during nutrient infusion (area under the curve [AUC] at 1 kcal/minute: 2,265 ± 718 versus 1,125 ± 138 pmol/l.min, P < 0.05; at 2 kcal/minute: 2,276 ± 303 versus 1,378 ± 210 pmol/l.min, P = 0.01) compared to healthy subjects. The magnitude of PYY elevation was greater in patients during the 1 kcal/minute infusion (AUC: 441 ± 153 versus 186 ± 58 pmol/l.min, P < 0.05), but not the 2 kcal/minute infusion. Fasting and nutrient-stimulated plasma CCK concentrations were higher in patients (P < 0.05). There was a relationship between plasma PYY and CCK concentrations during fasting (r = 0.52, P < 0.05) and nutrient infusion (r = 0.98, P < 0.0001). Conclusion In critical illness, both fasting and nutrient-stimulated plasma PYY concentrations are elevated, particularly in patients with feed intolerance, in conjunction with increased CCK concentrations. PMID:17173662

  20. [Metabolic changes in patients with hereditary fructose intolerance. A contribution to the topic of fructose administration for parenteral feeding].

    PubMed

    Sachs, M; Asskali, F; Encke, A; Förster, H

    1991-11-15

    The literature contains a number of reports of death following the intravenous administration of fructose in patients with hereditary fructose intolerance (HFI). The aim of the present study was, therefore, to investigate the metabolic changes occurring during intravenous administration of fructose to patients with HFI, with the aim of identifying metabolic parameters that would permit the early diagnosis of HFI. Also, the deaths reported in the literature were analyzed. In three of our own patients with fruit intolerance known since childhood, and in volunteers with normal metabolism, a one-hour intravenous fructose tolerance test (1.7 g fructose/min) was performed. An analysis was done using the usual enzymatic and chemical methods: blood glucose, fructose, lactic acid, serum uric acid, ammonia, free fatty acids, inorganic phosphate, and serum amino acids (ion exchange chromatography). During fructose infusion, the following metabolic changes were detected: hypoglycemia (20 to 60 mg/dl), increase in blood fructose levels (up to 350 mg/dl), hypophosphatemia (2 to 3 mg/dl), hyperlacticacidemia (up to 60 mg/dl), elevation of plasma ammonia levels (up to 120 mg/dl), increased serum glutamate, and a decrease in serum glutamine, as also hyperuricemia (up to 10 mg/dl). On termination of the fructose infusion, these changes were completely reversible. Analysis of the deaths reported in the literature revealed a known intolerance to fruit or sweets, and that no regular metabolic studies were apparently performed. Although HFI is rare, use should be made of the known advantages of sugar substitutes in post-aggression metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Cold intolerance

    MedlinePlus

    Some causes of cold intolerance are: Anemia Anorexia nervosa Blood vessel problems, such as Raynaud phenomenon Chronic severe illness General poor health Underactive thyroid ( hypothyroidism ) Problem with the hypothalamus (a part ...

  2. [Lactose intolerance].

    PubMed

    Rosado, Jorge L

    2016-09-01

    The most common problem limiting milk consumption worldwide is lactose intolerance (LI), which is defined as the experience of gastrointestinal symptoms due to the intake of lactose-containing food. When symptoms ensue the intake of milk, the condition is referred as milk intolerance, and it may or may not be due to LI. The most common cause of LI is primary lactase deficiency which occurs in 30% of Mexican adults when one glass of milk is consumed (12-18 g of lactose). LI occurs in less than 15% of adults after the intake of this dose of lactose. Another cause of lactose intolerance is due to secondary lactase deficiency, which occurs because lactase is reduced due to diseases that affect the intestinal mucosa. Lactose intolerance can be eliminated or significantly reduced by elimination or reduction of the intake of milk and milk containing products. Recent studies demonstrate that when β-casein-A1 contained in milk is hydrolyzed it produces β-casomorphine-7 which is an opioid associated with milk intolerance.

  3. Chronic vitamin A-enriched diet feeding induces body weight gain and adiposity in lean and glucose-intolerant obese rats of WNIN/GR-Ob strain.

    PubMed

    Jeyakumar, Shanmugam M; Sheril, Alex; Vajreswari, Ayyalasomayajula

    2015-11-01

    What is the central question of this study? Previously, we reported that chronic feeding of a vitamin A-enriched diet to euglycaemic obese rats (WNIN/Ob) ameliorated obesity. Does this diet exert similar effects even with a different genetic background, i.e. obese rats of the WNIN/GR-Ob strain with impaired glucose tolerance? What is the main finding and its importance? Vitamin A-enriched diet aggravated weight gain and adiposity/obesity in both lean and glucose-intolerant obese rats of the WNIN/GR-Ob strain. Therefore, the role of genetic factors and their regulation by nutrients in determining health and disease conditions assumes greater significance in experimental and clinical research. Vitamin A and its metabolites are key regulators of the development of adipose tissue and its associated metabolic complications. Here, we tested, in a glucose-intolerant obese rat model (the WNIN/GR-Ob stain), whether feeding a vitamin A-enriched diet alters adiposity and its associated changes. For this purpose, 30-week-old male lean and obese rats were divided into two groups and received either stock diet or vitamin A-enriched diet [2.6 or 129 mg vitamin A (kg diet)(-1) , respectively] for 14 weeks. At the end, feeding of the vitamin A-enriched diet resulted in increased body weight gain/obesity and retroperitoneal white adipose tissue (RPWAT) in both lean and obese rats of the WNIN/GR-Ob strain, when compared with their respective control animals receiving stock diet, without affecting food intake. An improvement in hypertriglyceridaemia and circulatory non-esterified fatty acid levels and unaltered hepatic fatty acid oxidative and triglyceride secretory pathway proteins with vitamin A-enriched diet feeding are suggestive of enhanced hepatic clearance of circulatory lipids, resulting in increased hepatic triglyceride accumulation. Transcriptional analysis of RPWAT showed that feeding the vitamin A-enriched diet augmented the expression of adipogenic

  4. Alcohol Intolerance

    MedlinePlus

    ... ingredients commonly found in alcoholic beverages, especially in beer or wine, can cause intolerance reactions. These include: Sulfites or other preservatives Chemicals, grains or other ingredients Histamine, a byproduct of fermentation or brewing In some cases, reactions can be triggered by ...

  5. [Surgical treatment of paralytic lagophthalmos].

    PubMed

    Schrom, T; Bast, F

    2010-03-01

    Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

  6. Statin intolerance.

    PubMed

    Ahmad, Zahid

    2014-05-15

    The term statin intolerance refers to an inability to use statins because of muscle symptoms or elevated creatine kinase, and the major diagnostic challenge is to unambiguously link these to statin use. Roughly 5% to 10% of statin users develop statin intolerance, and because statin use is expected to increase--especially after recent updated guidelines have expanded the statin benefit groups--adverse effects from statins will become a growing issue. Unfortunately, the pathophysiology--and even the terminology--of statin-related muscle injury lacks clarity. Several risk factors have been identified, including advanced age, family history of myopathy and statin dose; many cases manifest only after patients are administered an interacting medication (e.g., azole antifungals, cimetidine, clarithromycin, erythromycin and cyclosporine). The diagnosis of myopathy remains challenging, especially because some patients can have normal serum creatine kinase levels despite demonstrable weakness and muscle biopsy-proven statin-induced myopathy. A statin withdrawal and rechallenge helps patients distinguish whether their myalgia symptoms are because of statins, but, in at least 1 clinical trial, even 5% of placebo-treated patients developed myalgias during a controlled withdrawal and rechallenge. No consensus exists for management of patients with statin intolerance. Many patients can eventually tolerate a statin but often at suboptimal doses. A subset of patients do well with nondaily regimens such as every other day or once weekly dosing. Some patients cannot tolerate statins at all, requiring nonstatin lipid-lowering medications--the benefit of which remains unclear with regard to preventing atherosclerotic events. Ultimately, statin intolerance undermines the drug adherence that is critical for achieving the benefits of lifelong lipid-lowering therapy. In conclusion, statin myopathy is a common challenge in lipid management, and further work is needed to establish a

  7. Intolerant tolerance.

    PubMed

    Khushf, G

    1994-04-01

    The Hyde Amendment and Roman Catholic attempts to put restrictions on Title X funding have been criticized for being intolerant. However, such criticism fails to appreciate that there are two competing notions of tolerance, one focusing on the limits of state force and accepting pluralism as unavoidable, and the other focusing on the limits of knowledge and advancing pluralism as a good. These two types of tolerance, illustrated in the writings of John Locke and J.S. Mill, each involve an intolerance. In a pluralistic context where the free exercise of religion is respected, John Locke's account of tolerance is preferable. However, it (in a reconstructed form) leads to a minimal state. Positive entitlements to benefits like artificial contraception or nontherapeutic abortions can legitimately be resisted, because an intolerance has already been shown with respect to those that consider the benefit immoral, since their resources have been coopted by taxation to advance an end that is contrary to their own. There is a sliding scale from tolerance (viewed as forbearance) to the affirmation of communal integrity, and this scale maps on to the continuum from negative to positive rights.

  8. Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis

    PubMed Central

    Zhao, Chenyan; Xie, Tingbin; Li, Jun; Cheng, Minhua; Shi, Jialiang; Gao, Tao; Xi, Fengchan; Shen, Juanhong; Cao, Chun

    2017-01-01

    Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25, p = 0.008) and SOFA scores (6.47 versus 3.54, p < 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%, p = 0.032) and longer intensive care unit stage (4 versus 16 d, p < 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0.001), neostigmine (77.78% versus 17.64%, p < 0.001), and colonoscopic decompression (75% versus 42.86%, p = 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment. PMID:28386273

  9. Enteral nutrition intolerance in critically ill septic burn patients.

    PubMed

    Lavrentieva, Athina; Kontakiotis, Theodore; Bitzani, Militsa

    2014-01-01

    The purpose of this study was to investigate the frequency of enteral feeding intolerance in critically ill septic burn patients, the effect of enteral feeding intolerance on the efficacy of feeding, the correlation between the infection marker (procalcitonin [PCT]) and the nutrition status marker (prealbumin) and the impact of feeding intolerance on the outcome of septic burn patients. From January 2009 to December 2012 the data of all burn patients with the diagnosis of sepsis who were placed on enteral nutrition were analyzed. Septic patients were divided into two groups: group A, septic patients who developed feeding intolerance; group B, septic patients who did not develop feeding intolerance. Demographic and clinical characteristics of patients were analyzed and compared. The diagnosis of sepsis was applied to 29% of all patients. Of these patients 35% developed intolerance to enteral feeding throughout the septic period. A statistically significant increase in mean PCT level and a decrease in prealbumin level was observed during the sepsis period. Group A patients had statistically significant lower mean caloric intake, higher PCT:prealbumin ratio, higher pneumonia incidence, higher Sequential Organ Failure Assessment Maximum Score, a longer duration of mechanical ventilation, and a higher mortality rate in comparison with the septic patients without gastric feeding intolerance. The authors concluded that a high percentage of septic burn patients developed enteral feeding intolerance. Enteral feeding intolerance seems to have a negative impact on the patients' nutritional status, morbidity, and mortality.

  10. Lactose intolerance.

    PubMed

    Roberson, Charlene M

    Although lactose intolerance is very common it is not a serious health condition. The diagnosis is relatively simple and minimally invasive. Treatment is geared towards a life-long plan of management. Persons who have difficulty digesting lactose will learn by trial and error what food items cause distress and learn to avoid offending milk sugars. In addition many products are available over-the-counter to aid in digestion of lactose. Often these additives enable the person to consume lactose. Adequate amounts of calcium may be consumed by eating a carefully chosen diet containing lactose free sources of calcium in order to maintain healthy bone, nerve, and muscle development.

  11. Red Tide and Paralytic Shellfish Poisoning

    ERIC Educational Resources Information Center

    Dale, Barrie; Yentsch, Clarice M.

    1978-01-01

    Discusses the nature and cause of paralytic shellfish poisoning (PSP). Includes toxic dinoflagellate ecology, taxonomy and life history, and chemistry of the toxins. Recent work with trace metals and directions of future research are also given. (MA)

  12. Red Tide and Paralytic Shellfish Poisoning

    ERIC Educational Resources Information Center

    Dale, Barrie; Yentsch, Clarice M.

    1978-01-01

    Discusses the nature and cause of paralytic shellfish poisoning (PSP). Includes toxic dinoflagellate ecology, taxonomy and life history, and chemistry of the toxins. Recent work with trace metals and directions of future research are also given. (MA)

  13. [Analgetic drug intolerance].

    PubMed

    Merk, H; Goerz, G

    1983-04-15

    Reactions as intolerance to aspirin and food additives were diagnosed in 41 cases during November 1979 -- March 1982. Allergy to pyrazolone-drugs were observed in 20 cases during the same period. 24% of the patients with intolerance to aspirin had also an intolerance to tartrazine. There were no familial occurrence of aspirin intolerance. Four patients had mainly asthma, 37 patients urticaria. New aspects of the pathogenesis of aspirin intolerance -- modulation of arachidonate metabolism and complement activation -- are discussed.

  14. Postsurgical decompression and immediate elemental feeding.

    PubMed

    Moss, G

    1977-05-01

    The paralytic ileus, poor nutritional state, and related complications that often develop following serious serious abdominal surgery have traditionally been accepted as unavoidable. Now, a nasogastric decompression and feeding tube is availabe that usually prevents paralytic ileus and also provides a complete liquid diet starting immedicately after the operation, thus speeding wound healing and recivery.

  15. What Causes Lactose Intolerance?

    MedlinePlus

    ... FOIA Jobs at NICHD Meetings, Conferences & Events Partnering & Donating to the ... intolerance? Skip sharing on social media links Share this: Page Content Not having enough lactase in the body is the cause of lactose intolerance. The names ...

  16. [Conceptual basics of paralytic lagophthalmos correction].

    PubMed

    Grusha, Ia O

    2013-01-01

    The article discusses complications of paralytic lagophthalmos, such as exposure keratopathy, keratitis, corneal lysis, as well as other exposure-related problems and abnormalities of eyelid position. Thorough analysis of surgical methods of eyelids malposition correction, besides conservative protective measures for the cornea, has been performed. The primary treatment goal in facial nerve paralysis is the prevention of severe corneal complications. The most effective methods of static correction of paralytic lagophthalmos, once of narrowing of palpebral fissure by means of circular suture, and different techniques of ectropion correction are discussed. Application results on an upper eyelid implant are presented. Indications for suture and permanent tarsorrhaphy in patients with facial paralysis are also observed.

  17. [Paralytic ileus secondary to podophyllin poisoning].

    PubMed

    Pottier, Y; Mullier, J P; Huysman, E; Paulet, P

    1989-01-01

    The authors report a case of general and local poisoning after erroneous intravaginal administration of podophyllin for warts. The clinical course mainly showed a 10 day paralytic ileus, vaginal and urethral lesions and a severe peripheral neurological illness: paresthesia, dysesthesia and ataxia. The authors stress the potential toxicity of podophyllin and recommend great caution in using this product.

  18. Unnecessary injections and paralytic poliomyelitis in India.

    PubMed

    Wyatt, H V; Mahadevan, S; Srinivasan, S

    1992-01-01

    The effect of prior injections on the pattern and severity of paralytic poliomyelitis has been examined by a retrospective analysis of case notes from an outpatient pediatric clinic in South India. Of 262 children with acute polio, 176 had received unnecessary injections < 48 h before paralysis and 12 had received diphtheria-pertussis-tetanus or provocative injections. Two children injected in the right arm had paralysis in that limb only. Children with no injections (controls) had an equal chance of paralysis (0.73) in each left and right leg. Children with injections in the right or left gluteus or in both had a 19% greater chance of paralysis in the injected leg(s), whereas uninjected legs had a 31% lower chance of paralysis. Injected leg muscles were weaker than those of control children. Legs of control children were stronger than those with one leg injected and much stronger than those with both injected. More than 96% of the children had at least one leg paralysed. Age and vaccine status did not affect the results of injections. After injections there was greater likelihood of death or lack of recovery of muscle strength. About three-quarters of the children had received unnecessary injections; of these 60% had more severe paralysis and a non-paralytic attack became paralytic in 40%. If oral medicines for fevers and diarrhoea replaced unnecessary injections, the prevalence and severity of paralytic polio would be reduced.

  19. Non-Traditional Vectors for Paralytic Shellfish Poisoning

    PubMed Central

    Deeds, Jonathan R.; Landsberg, Jan H.; Etheridge, Stacey M.; Pitcher, Grant C.; Longan, Sara Watt

    2008-01-01

    Paralytic shellfish poisoning (PSP), due to saxitoxin and related compounds, typically results from the consumption of filter-feeding molluscan shellfish that concentrate toxins from marine dinoflagellates. In addition to these microalgal sources, saxitoxin and related compounds, referred to in this review as STXs, are also produced in freshwater cyanobacteria and have been associated with calcareous red macroalgae. STXs are transferred and bioaccumulate throughout aquatic food webs, and can be vectored to terrestrial biota, including humans. Fisheries closures and human intoxications due to STXs have been documented in several non-traditional (i.e. non-filter-feeding) vectors. These include, but are not limited to, marine gastropods, both carnivorous and grazing, crustacea, and fish that acquire STXs through toxin transfer. Often due to spatial, temporal, or a species disconnection from the primary source of STXs (bloom forming dinoflagellates), monitoring and management of such non-traditional PSP vectors has been challenging. A brief literature review is provided for filter feeding (traditional) and non-filter feeding (non-traditional) vectors of STXs with specific reference to human effects. We include several case studies pertaining to management actions to prevent PSP, as well as food poisoning incidents from STX(s) accumulation in non-traditional PSP vectors. PMID:18728730

  20. Dietary fructose intolerance, fructan intolerance and FODMAPs

    PubMed Central

    Fedewa, Amy; Rao, Satish S. C.

    2014-01-01

    Dietary intolerances to fructose, fructans and FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) are common, yet poorly recognized and managed. Over the last decade, they have come to the forefront because of new knowledge on the mechanisms and treatment of these conditions. Patients with these problems often present with unexplained bloating, belching, distension, gas, abdominal pain or diarrhea. Here, we have examined the most up-to-date research on these food-related intolerances, discussed controversies, and have provided some guidelines for the dietary management of these conditions. Breath testing for carbohydrate intolerance appears to be standardized and essential for the diagnosis and management of these conditions, especially in the Western population. While current research shows that the FODMAP diet may be effective in treating irritable bowel syndrome, additional research is needed to identify more foods items that are high in FODMAPs, and to assess the long-term efficacy and safety of dietary interventions. PMID:24357350

  1. Injections and paralytic poliomyelitis in tropical Africa

    PubMed Central

    Guyer, Bernard; Bisong, Andrew Atem Ebako; Gould, Judith; Brigaud, Maryse; Aymard, Michele

    1980-01-01

    A case-control study was conducted in Yaoundé, United Republic of Cameroon, to evaluate the hypothesis that intramuscular inoculations predisposed young children to paralysis if they were later exposed to poliomyelitis virus. Thirty-three cases with lower motor neuron disease and 66 neighbourhood controls were studied. Poliovirus was isolated from 39% of the paralytic cases but from only 18% of the comparison group. Controls were more likely to have had serological evidence of previous exposure to all three poliovirus types while most of the paralytic cases had been exposed to a poliovirus for the first time. Two-thirds of the paralytic cases but only 11% of the comparison group had been ill, visited a medical facility, and received multiple injections, primarily with quinine and penicillin, in the month prior to the onset of poliomyelitis. There was a strong temporal relationship between these injections and the onset of paralysis. The increased relative risks (15 and 32, respectively) of paralysis associated with inoculations in the two weeks immediately prior to onset of disease were felt to represent the treatment of symptoms related to poliomyelitis. However, the increased relative risks (13 and 27, respectively) three and four weeks prior to onset were felt to be consistent with the hypothesis that intramuscular injections provoked paralysis. Overestimation of this measure of the effect because of bias in the control group is discussed. PMID:6249510

  2. NON-PARALYTIC POLIOMYELITIS IN THE CHIMPANZEE.

    PubMed

    Bodian, D; Howe, H A

    1945-03-01

    1. Thirteen cases of non-paralytic poliomyelitis infection in chimpanzees are described. Nine of these animals were excreting virus in. their stools at periods of from 3 days to 8 weeks following inoculation. 2. All animals killed during the acute stage showed lesions in the brain distributed in centers usually involved in, and compatible with the presence of, poliomyelitic infection. In 2 chimpanzees typical cord lesions were also present. No lesions were found in the brains of 4 control chimpanzees which had had no virus contact as far as known. The occurrence of a purely systemic or peripheral form of poliomyelitis, without lesions in the central nervous system, has thus not been established. 3. Four instances of arrest of the pathological process near the portal of entry into the brain, indicating partial resistance, are included in this series. One was a chimpanzee inoculated intranasally (A1-75) who had severe tuberculosis at the time of inoculation. The second was an animal convalescent after intracerebral inoculation (A1-74), who sustained a second infection limited to the olfactory bulbs when inoculated intranasally 2 months later with homologous virus. The third (A5-01) was inoculated orally with human stool, but contammation of the olfactory area resulted with infection of the olfactory bulbs and of the forebrain; virus was present in the stools of this animal. The fourth chimpanzee (A48) had suffered an initial non-paralytic attack after stomach tube inoculation, followed by a second attack about 9 months later after oral inoculation with part of the same virus-containing pool (human stools). The second attack consisted of a facial paralysis, with arrest of the pathological process near the facial nucleus. 4. Although cerebral lesions were light in some of the non-paralytic and inapparent infections, their presence in all indicates the action of virus on the central nervous system with the possibihty of production of at least partial local resistance

  3. Formula allergy and intolerance.

    PubMed

    Kerner, J A

    1995-03-01

    There are two major types of adverse reactions in infant formulas: (1) formula allergy/hypersensitivity, which is an immunologic response, and (2) formula intolerance, which is a nonimmunologic response. Formula intolerance can occur in infants with an underlying congenital or acquired enzyme deficiency (disaccharidase deficiency, galactosemia, hereditary fructose intolerance). The clinical presentation, diagnosis, and treatment of both reactions are reviewed in this article. The appropriateness of the use of a variety of infant formulas is discussed. Guidelines for the prevention of allergic disease are described as well.

  4. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems.

    PubMed

    Douglas, Pamela Sylvia

    2013-04-01

    This paper explores two areas in which the translation of research into practice may be improved in the management of cry-fuss behaviours in the first few months of life. Firstly, babies who cry excessively are often prescribed proton pump inhibitors, despite evidence that gastro-oesophageal reflux disease is very rarely a cause. The inaccuracy of commonly used explanatory mechanisms, the side-effects of acid-suppressive medications, and the failure to identify treatable problems, including feeding difficulty when the diagnosis of 'reflux' is applied, are discussed. Secondly, crying breastfed babies are still prescribed lactase or lactose-free formula, despite evidence that the problem of functional lactose overload is one of breastfeeding management. The mechanisms and management of functional lactose overload are discussed. These two problems of research translation need to be addressed because failure to identify and manage other causes of cry-fuss problems, including feeding difficulty, may have adverse outcomes for a small but significant minority of families.

  5. Lactose Intolerance (For Teens)

    MedlinePlus

    ... when a person eats something containing lactose, an enzyme in the small intestine called lactase breaks down ... intolerance do not produce enough of the lactase enzyme to break down lactose. Instead, undigested lactose sits ...

  6. Lactose Intolerance (For Teens)

    MedlinePlus

    ... lactose, an enzyme in the small intestine called lactase breaks it down into simpler sugar forms called ... lactose intolerance do not produce enough of the lactase enzyme to break down lactose. Instead, undigested lactose ...

  7. Idiopathic environmental intolerances: overview.

    PubMed

    Sparks, P J

    2000-01-01

    The editor discusses usage of the terms "iidiopathic environmental intolerance," "multiple chemical sensitivity," and "environmental illness." Also addressed are prevalence, theories of etiology, evaluation and treatment, and social and political implications.

  8. Lactose Intolerance (For Parents)

    MedlinePlus

    ... Doctors usually diagnose lactose intolerance through a simple hydrogen breath test. A person blows into a tube ... there is a higher than average level of hydrogen and methane in the breath. That's because undigested ...

  9. Hereditary fructose intolerance

    MedlinePlus

    ... in their blood and decrease their risk for gout. Outlook (Prognosis) Hereditary fructose intolerance may be mild ... fructose-containing foods due to their effects Bleeding Gout Illness from eating foods containing fructose or sucrose ...

  10. [Staged complex treatment of paralytic lagophthalmos (case report)].

    PubMed

    Gushchina, M B; Mal'kov, S A; Kovshun, E V; Yuzhakova, N S

    Paralytic lagophthalmos, resulting from facial nerve palsy, is a difficult medical and social issue that requires cooperation of different specialists. Complications that arise in paralytic lagophthalmos may cause significant vision loss and even eye loss. Various techniques of paralytic lagophthalmos correction are used to protect the cornea and restore eyelid anatomy and functions. These comprise palliative (conservative), surgical, and alternative treatments (such as botulinum toxin type A therapy). Surgical treatment of paralytic lagophthalmos patients often has to be staged and complex. This article presents a clinical case of a female patient with paralytic lagophthalmos complicated by corneal perforation. Her staged complex treatment included lower eyelid surgery, chemodenervation of the upper eyelid levator and optical reconstructive surgery. The following positive results were achieved: the protective function of the eyelids was restored, residual visual functions - preserved, the risk of eye loss - eliminated, and the asymmetry between the two halves of the face - corrected.

  11. NATURE OF NON-PARALYTIC AND TRANSITORY PARALYTIC POLIOMYELITIS IN RHESUS MONKEYS INOCULATED WITH HUMAN VIRUS

    PubMed Central

    Sabin, Albert B.; Ward, Robert

    1941-01-01

    1. The occurrence of non-paralytic poliomyelitis in monkeys inoculated with human or first passage virus was proved by histological examination of the nervous system and by isolation of the virus. 2. The non-paralytic infection was almost invariably associated with the destruction of an appreciable number of nerve cells in the spinal cord, and failure of the process to progress seemed to depend upon an equilibrium between the host and the virus, in which the latter occasionally persisted in an active state since it could produce the typical paralytic disease on passage to other monkeys. 3. While there were no reliable clinical or laboratory criteria, the diagnosis of non-paralytic poliomyelitis was made when the following changes were found in the spinal cord: (a) outfall of neurons confirmed by the presence of the reaction of degeneration in the nerve roots, and (b) foci of glial infiltration and perivascular cuffing in the gray matter. 4. Anterior horn cells showing diffuse chromatolysis and acidophilic, intranuclear inclusions were present 2 days after disappearance of paralysis of short duration, and nerve cells with marginated Nissl substance and eccentric nuclei were found side by side with obviously older lesions in monkeys with non-paralytic poliomyelitis. These cytologic changes were not present in monkeys sacrificed in still later stages of the disease. 5. The transitory character of the paralysis in some monkeys may depend in part on the fact that apparently normal function can be carried on with less than the normal number of nerve cells and in part on the probable, but not proved, possibility that not all nerve cells attacked by poliomyelitis virus are irreversibly damaged. PMID:19871110

  12. NATURE OF NON-PARALYTIC AND TRANSITORY PARALYTIC POLIOMYELITIS IN RHESUS MONKEYS INOCULATED WITH HUMAN VIRUS.

    PubMed

    Sabin, A B; Ward, R

    1941-05-31

    1. The occurrence of non-paralytic poliomyelitis in monkeys inoculated with human or first passage virus was proved by histological examination of the nervous system and by isolation of the virus. 2. The non-paralytic infection was almost invariably associated with the destruction of an appreciable number of nerve cells in the spinal cord, and failure of the process to progress seemed to depend upon an equilibrium between the host and the virus, in which the latter occasionally persisted in an active state since it could produce the typical paralytic disease on passage to other monkeys. 3. While there were no reliable clinical or laboratory criteria, the diagnosis of non-paralytic poliomyelitis was made when the following changes were found in the spinal cord: (a) outfall of neurons confirmed by the presence of the reaction of degeneration in the nerve roots, and (b) foci of glial infiltration and perivascular cuffing in the gray matter. 4. Anterior horn cells showing diffuse chromatolysis and acidophilic, intranuclear inclusions were present 2 days after disappearance of paralysis of short duration, and nerve cells with marginated Nissl substance and eccentric nuclei were found side by side with obviously older lesions in monkeys with non-paralytic poliomyelitis. These cytologic changes were not present in monkeys sacrificed in still later stages of the disease. 5. The transitory character of the paralysis in some monkeys may depend in part on the fact that apparently normal function can be carried on with less than the normal number of nerve cells and in part on the probable, but not proved, possibility that not all nerve cells attacked by poliomyelitis virus are irreversibly damaged.

  13. Distribution of paralytic toxins in California shellfish.

    PubMed

    Whitefleet-Smith, J L; Divan, C L; Schantz, E J; Schnoes, H K

    1985-01-01

    Samples of Saxidomus nuttali and Mytilus californianus collected during the 1981 dinoflagellate bloom at Bodega Bay, California, were analyzed for the presence of paralytic toxins. Neck tissue of S. nuttali contained saxitoxin (STX) and neoSTX (95% of the total toxicity), whereas the bodies contained neoSTX and a mixture of the gonyautoxins. In a sample of M. californianus the presence of neoSTX and the gonyautoxins was demonstrated, whereas a second sample, collected at a different site, contained almost exclusively neoSTX.

  14. [Fructose and fructose intolerance].

    PubMed

    Buzás, György Miklós

    2016-10-01

    Although fructose was discovered in 1794, it was realised in recent decades only that its malabsorption can lead to intestinal symptoms while its excessive consumption induces metabolic disturbances. Fructose is a monosaccharide found naturally in most fruits and vegetables. Dietary intake of fructose has gradually increased in the past decades, especially because of the consumption of high fructose corn syrup. With its 16.4 kg/year consumption, Hungary ranks secondly after the United States. Fructose is absorbed in the small intestine by facilitated transport mediated by glucose transporter proteins-2 and -5, and arrives in the liver cells. Here it is transformed enzymatically into fructose-1-phosphate and then, fructose-1,5-diphosphate, which splits further into glyceraldehyde and dihydroxyacetone-phosphate, entering the process of glycolysis, triglyceride and uric acid production. The prevalence of fructose intolerance varies strongly, depending on the method used. The leading symptoms of fructose intolerance are similar, but less severe than those of lactose intolerance. Multiple secondary symptoms can also occur. A symptom-based diagnosis of fructose intolerance is possible, but the gold standard is the H2 breath test, though this is less accurate than in lactose testing. Measuring fructosaemia is costly, cumbersome and not widely used. Fructose intolerance increases intestinal motility and sensitivity, promotes biofilm formation and contributes to the development of gastrooesophageal reflux. Long-term use of fructose fosters the development of dental caries and non-alcoholic steatohepatitis. Its role in carcinogenesis is presently investigated. The cornerstone of dietary management for fructose intolerance is the individual reduction of fructose intake and the FODMAP diet, led by a trained dietetician. The newly introduced xylose-isomerase is efficient in reducing the symptoms of fructose intolerance. Orv. Hetil., 2016, 157(43), 1708-1716.

  15. Lid loading for treatment of paralytic lagophthalmos.

    PubMed

    Yu, Yongchun; Sun, Jie; Chen, Lin; Liu, Lei

    2011-12-01

    Lagophthalmos secondary to facial palsy is a most clinically important condition that requires effective and early treatment because prolonged corneal exposure may cause corneal lesions, ranging from corneal spots to corneal ulceration and finally blindness. Lid loading is the therapy used most commonly to treat the condition. This method was first described in 1950, modified in 1966, and popularized in 1974. Since its inception, only several reviews have referred to the technology, but they talked about only parts of this technology and did not provide information on the technology overall. This review discusses lid loading in detail. This method now often uses gold and platinum as the material for the implant and should be done as early as possible in those patients whose paralytic lagophthalmos has little chance of being reversed. This method has shown good clinical results and given patients a better perspective. Of course, this method has its intrinsic complications such as allergic reactions, extrusion, and migration. However, with modification of the implant and the surgical procedure, the complication rate has decreased. In conclusion, although lid loading cannot solve all the problems associated with the paralyzed eyelid, it is a simple, reversible, and effective way to treat paralytic lagophthalmos.

  16. Intolerance of Uncertainty

    PubMed Central

    Beier, Meghan L.

    2015-01-01

    Multiple sclerosis (MS) is a chronic and progressive neurologic condition that, by its nature, carries uncertainty as a hallmark characteristic. Although all patients face uncertainty, there is variability in how individuals cope with its presence. In other populations, the concept of “intolerance of uncertainty” has been conceptualized to explain this variability such that individuals who have difficulty tolerating the possibility of future occurrences may engage in thoughts or behaviors by which they attempt to exert control over that possibility or lessen the uncertainty but may, as a result, experience worse outcomes, particularly in terms of psychological well-being. This topical review introduces MS-focused researchers, clinicians, and patients to intolerance of uncertainty, integrates the concept with what is already understood about coping with MS, and suggests future steps for conceptual, assessment, and treatment-focused research that may benefit from integrating intolerance of uncertainty as a central feature. PMID:26300700

  17. [Mechanisms of aspirin intolerance].

    PubMed

    Moneret-Vautrin, D A; Wayoff, M; Bonne, C

    1985-01-01

    Aspirin intolerance brings on cutaneous and/or respiratory reactions. The mechanisms are to be elucidated precisely, but are not IgE-mediated. 193 patients with nasal polyps are studied. With systematic aspirin oral challenge, 27% belong to the classical triad: asthma, polyps and aspirin sensitivity. Other drugs or chemicals intolerance are associated in 42%: alcohol, metabisulfites, benzoates, tartrazine, codeine... A link with the non-allergic eosinophilic rhinitis is suggested. A short review of several pathogenic hypothesis is discussed. Among a comparative study, the authors showed that the aspirin-intolerant patients' platelets have a quite normal arachidonic acid metabolism. The clue is probably towards an abnormal instability of cells membranes and excessive receptors sensitivity to leukotrienes.

  18. Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance.

    PubMed

    Fagundes-Neto, U; Viaro, T; Lifshitz, F

    1985-02-01

    The response of infants with diarrhea and lactose intolerance to feedings containing soy protein and sucrose (Sobee), and/or to a carbohydrate free formula (RCF), to which glucose polymers (GP) were added, was assessed in twenty patients. They all were less than ten months of age and had varying degrees of malnutrition. Eleven had acute diarrhea and nine had chronic diarrhea. None of them had classical enteropathogenic strains and parasites in the stools. All had lactose intolerance when feedings were begun with cow's milk formula and some also had sucrose intolerance when fed sucrose containing soy formulas. They had persistent loose stools and excreted feces with an acid pH and with carbohydrates, thus they were given dietary treatment with RCF with GP. There were 9 patients with acute diarrhea and lactose intolerance (1 of them also had sucrose intolerance), who improved on RCF with GP feedings; but 2 patients (lactose and sucrose intolerant) failed to respond to this diet. There were six patients with chronic diarrhea and lactose intolerance (four of them also had sucrose intolerance), who improved on RCF with GP formula, but there were three patients who failed on this treatment. These data show that some infants with diarrhea, malnutrition, and lactose-sucrose intolerance may also develop intolerance to GP and require further dietary management with glucose as the source of carbohydrate in the diet.

  19. Congenital paralytic vertical talus. An anatomical study.

    PubMed

    Specht, E E

    1975-09-01

    Dissections of the feet of a three-month-old infant with paralytic congenital vertical talus secondary to lumbar myelomeningocele were compared with a dissection of a normal foot. The major differences appeared to be absence of the plantar intrinsic muscles and dorsal dislocation of the talonavicular joint. It is postulated that the pathological process begins as a failure of the intrinsic muscles to oppose the unbalanced, active dorsiflexion forces of the anterior crural muscles. This imbalance then allows disruption of the talonavicular joint, mechanically the least stable joint in the mid-part of the foot. All dorsiflexion forces acting on the ankle then become ineffective and plantar flexion forces serve only to pull the calcaneus and talus into equinus, causing a "vertical" talus. Treatment must be directed at reducing the talonavicular dislocation, correcting the equinus deformity of the hind part of the foot, and substituting for the undeveloped plantar intrinsic muscles.

  20. Lactose Intolerance (For Kids)

    MedlinePlus

    ... aged cheeses, including cheddar. Yogurt that contains live cultures is more easily digested because it contains healthy bacteria that produce lactase. Even if you're lactose intolerant, you may be able to handle smaller portions of your favorite dairy products. It also may help to eat a food ...

  1. Evolution and Collective Intolerance

    ERIC Educational Resources Information Center

    Willhoite, Fred H., Jr.

    1977-01-01

    Examines behavioral and intellectual conformity as major attitudes in shaping political behavior. Manifestations of coercion within human and animal social units are presented, including religious intolerance, prohibition of artistic activity and literary expression, and rejection of outsiders. Available from: Managing Editor, Department of…

  2. Lactose intolerance in infants.

    PubMed

    Taylor, Cathy

    Cathy Taylor describes the pathophysiology and aetiology of lactose intolerance and how to diagnose and treat it. Management of the infant by the primary health care team is discussed, with emphasis on advice and nutritional support that can be recommended to parents.

  3. A case of clozapine‐induced paralytic ileus

    PubMed Central

    Rondla, Sandeep; Crane, Steven

    2007-01-01

    Clozapine is a prototypical second‐generation antipsychotic, which has been found to be associated with various adverse effects. Although emphasis has mainly been placed on its haematological and metabolic side effects, less attention has been paid to its anticholinergic effects. One such problem is that of a paralytic ileus. A case of a young man with psychosis who developed a paralytic ileus while on treatment with clozapine is described here. PMID:17251601

  4. [A case of brainstem infarction presenting with paralytic pontine exotropia and non-paralytic pontine exotropia].

    PubMed

    Takamatsu, K; Takizawa, T

    1991-11-01

    We reported a patient with brainstem infarction who presented paralytic pontine exotropia (PPE) in acute phase and non-paralytic pontine exotropia (NPPE) during the recovery phase. On March 10, 1991, a 60-year-old man was brought to our hospital with chief complaints of double vision and right hemiparesis. The ocular position of the left eye on forward gaze was fixed at the midline, while the right eye was abducted, and skew deviation was observed. On leftward gaze, neither eye could pass the midline, and on rightward gaze the right eye was abducted and monocular nystagmus was noted in the abducted right eye, which indicated paralytic pontine exotropia. T2-weighted MRI showed high signal intensity lesions in the left paramedian portion of the mid-pontine tegmentum beneath the fourth ventricle, and in the midline of the pontine base extending to the left side. The next day, similar disturbance of ocular movement was seen on rightward gaze, but the limitation of leftward gaze had improved and NPPE was noted to have developed. On the third day, there was no abduction of the right eye on forward gaze, but left MLF syndrome was still present. Seven days later, the disturbances of ocular movement disappeared. The lesion was considered to be due to partial impairment of the left paramedian pontine reticular formation in addition to the MLF. PPE caused by ischemia due to the perforating arteries of the brainstem, different from that due to basilar artery occlusion may recover after progression through NPPE and MLF syndromes. Hence, one-and-a-half syndrome, PPE, NPPE, and MLF syndromes are considered to be analogous to one another.

  5. [Hereditary fructose intolerance].

    PubMed

    Lopes, A I; Almeida, A G; Costa, A E; Costa, A; Leite, M

    1998-12-01

    Hereditary fructose intolerance (HFI) is a rare autosomal recessive, metabolic disorder, that results from a deficiency of aldolase B (fructose-biphosphate aldolase) in the liver, kidney and intestine. Recent molecular studies have identified the mutation A149P in most European patients. We describe the first case of HFI with molecular analysis in a Portuguese child, presenting the same mutation of the aldolase B gene. The role of molecular studies in the diagnosis of HFI risk patients and their families is emphasized.

  6. An argument for intolerance

    PubMed Central

    Catherwood, J.

    2000-01-01

    "Multiculturalism", "pluralism" and "tolerance" have become buzz words in applied ethics. While serious and well thought out work is going on in these areas, a misunderstanding of the importance of tolerance, and the difficulties raised by multicultural moral conflict seems common. In this paper I argue that intolerance of some cultural traditions is morally required, and suggest that the forging of a moral mono-culture is preferable to pluralism. Key Words: Pluralism • multicultural • tolerance • relativism PMID:11129841

  7. Hypothyroidism causing paralytic ileus and acute kidney injury - case report

    PubMed Central

    2011-01-01

    We present a patient with severe hypothyroidism complicated by paralytic ileus and acute kidney injury. A 65 year old male patient, diagnosed with hypothyroidism one year ago was transferred to our unit in a state of drowsiness and confusion. He was severely hypothyroid and had paralytic ileus and impaired renal function at the time of transfer. Hypokalaemia was present, and was likely to have contributed to the paralytic ileus and this together with dehydration was likely to have contributed to renal injury. Nonetheless, hypothyroidism is very likely to have been the principal precipitant of both these complications, and both paralytic ileus and acute kidney injury improved with thyroxine replacement. Unfortunately, the patient died unexpectedly eight days after admission to the unit. Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state created by thyroid hormone deficiency. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is thought to be due to an autonomic neuropathy affecting the intestines that is reversible with thyroxine replacement. To our knowledge, both these complications have not been observed in a single patient so far. It is important that clinicians are aware of these rare manifestations of hypothyroidism as in most occasions, thyroxine deficiency may be missed, and treatment can reverse the complications. PMID:21303532

  8. Hypothyroidism causing paralytic ileus and acute kidney injury - case report.

    PubMed

    Rodrigo, Chaturaka; Gamakaranage, Champika Sssk; Epa, Dhanesha S; Gnanathasan, Ariaranee; Rajapakse, Senaka

    2011-02-08

    We present a patient with severe hypothyroidism complicated by paralytic ileus and acute kidney injury. A 65 year old male patient, diagnosed with hypothyroidism one year ago was transferred to our unit in a state of drowsiness and confusion. He was severely hypothyroid and had paralytic ileus and impaired renal function at the time of transfer. Hypokalaemia was present, and was likely to have contributed to the paralytic ileus and this together with dehydration was likely to have contributed to renal injury. Nonetheless, hypothyroidism is very likely to have been the principal precipitant of both these complications, and both paralytic ileus and acute kidney injury improved with thyroxine replacement. Unfortunately, the patient died unexpectedly eight days after admission to the unit.Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state created by thyroid hormone deficiency. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is thought to be due to an autonomic neuropathy affecting the intestines that is reversible with thyroxine replacement. To our knowledge, both these complications have not been observed in a single patient so far.It is important that clinicians are aware of these rare manifestations of hypothyroidism as in most occasions, thyroxine deficiency may be missed, and treatment can reverse the complications.

  9. Lactose intolerance among Mexican Americans.

    PubMed

    Sowers, M F; Winterfeldt, E

    1975-07-01

    Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.

  10. [Research advancement about lactose intolerance].

    PubMed

    Yu, Qing; Yin, Shi-An

    2006-05-01

    Lactose intolerance associated with nutrition and health of human especially infant period of time and effect milk product intake. It is important significance to maintain health and cut down the aged risk of osteoporosis because lactose intolerance was understand about grouping, clinical symptom and diagnose. There are extensive perspective for understand prevent and control lactose intolerance for lactose gene polymorphism. It is effective method for earlier period detection gene screen with lactose typing for osteoporosis, however there are carry out multiplicity research in many ways to improve and control lactose intolerance

  11. Adult hereditary fructose intolerance.

    PubMed

    Burmeister, L A; Valdivia, T; Nuttall, F Q

    1991-04-01

    Hereditary fructose intolerance was diagnosed in a 69-year-old man on the basis of his medical history and the response to an intravenous fructose tolerance test. Three men of the same age as our patient were used as control subjects. Since the severity may vary and affected individuals self-impose fructose and sucrose restriction, they are essentially symptom free. The diagnosis can only be suspected by taking a careful dietary history. The prevalence of this condition in adults is unknown. It is rare but is likely to be more common than data in the literature would indicate.

  12. Adult hereditary fructose intolerance.

    PubMed

    Yasawy, Mohamed Ismail; Folsch, Ulrich Richard; Schmidt, Wolfgang Eckhard; Schwend, Michael

    2009-05-21

    Hereditary fructose intolerance (HFI) is an under-recognized, preventable life-threatening condition. It is an autosomal recessive disorder with subnormal activity of aldolase B in the liver, kidney and small bowel. Symptoms are present only after the ingestion of fructose, which leads to brisk hypoglycemia, and an individual with continued ingestion will exhibit vomiting, abdominal pain, failure to thrive, and renal and liver failure. A diagnosis of HFI was made in a 50-year-old woman on the basis of medical history, response to IV fructose intolerance test, demonstration of aldolase B activity reduction in duodenal biopsy, and molecular analysis of leukocyte DNA by PCR showed homozygosity for two doses of mutant gene. HFI may remain undiagnosed until adult life and may lead to disastrous complications following inadvertent fructose or sorbitol infusion. Several lethal episodes of HFI following sorbitol and fructose infusion have been reported. The diagnosis can only be suspected by taking a careful dietary history, and this can present serious complications.

  13. PARALYTIC EFFECTS OF "PARALYTIC SHELLFISH POISON" ON FROG NERVE AND MUSCLE.

    PubMed

    EVANS, M H

    1964-06-01

    A purified extract of toxic lamellibranchs, Saxidomus giganteus (Deshayes), containing "paralytic shellfish poison," has been tested for its effects on conduction and contraction in frog nerve and muscle. The poison was very toxic and concentrations within the range 0.025 to 0.1 mug/ml. paralysed isolated muscle preparations, with abolition of the muscle action potential. The poison did not readily penetrate the perineurium, but in desheathed sciatic nerves the conduction of nerve impulses was rapidly blocked by concentrations of 0.05 to 0.1 mug/ml. There was no evidence that the poison had any specific curarizing action at the neuromuscular junction, and the paralysis was not accompanied by any appreciable depolarization of the muscle membrane.

  14. Assessment of sodium channel mutations in Makah Tribal members of the U.S. Pacific Northwest as a potential mechanism of resistance to paralytic shellfish poisoning.

    PubMed

    Adams, Nicolaus G; Robertson, Alison; Grattan, Lynn M; Pendleton, Steve; Roberts, Sparkle; Tracy, J Kathleen; Trainer, Vera L

    2016-07-01

    The Makah Tribe of Neah Bay, Washington, has historically relied on the subsistence harvest of coastal seafood, including shellfish, which remains an important cultural and ceremonial resource. Tribal legend describes visitors from other tribes that died from eating shellfish collected on Makah lands. These deaths were believed to be caused by paralytic shellfish poisoning, a human illness caused by ingestion of shellfish contaminated with saxitoxins, which are produced by toxin-producing marine dinoflagellates on which the shellfish feed. These paralytic shellfish toxins include saxitoxin, a potent Na(+) channel antagonist that binds to the pore region of voltage gated Na(+) channels. Amino acid mutations in the Na(+) channel pore have been demonstrated to confer resistance to saxitoxin in softshell clam populations exposed to paralytic shellfish toxins present in their environment. Because of the notion of resistance to paralytic shellfish toxins, we aimed to determine if a resistance strategy was possible in humans with historical exposure to toxins in shellfish. We collected, extracted and purified DNA from buccal swabs of 83 volunteer Makah tribal members and sequenced the skeletal muscle Na(+) channel (Nav1.4) at nine loci to characterize potential mutations in the relevant saxitoxin binding regions. No mutations of these specific regions were identified after comparison to a reference sequence. This study suggests that any resistance of Makah Tribal members to saxitoxin is not a function of Nav1.4 modification but may be due to mutations in neuronal or cardiac sodium channels or some other mechanism unrelated to sodium channel function.

  15. [Orthostatic intolerance syndromes].

    PubMed

    Gónzalez-Hermosillo, J A

    2001-01-01

    In patients with an orthostatic intolerance, the hemodynamic response to standing, may identify an abnormality know as postural orthostatic tachycardia syndrome or orthostatic hypotension, that can often be treated without further testing. When the response to standing is normal, tilt-table testing may be useful in making the diagnosis of vasovagal syncope or postural orthostatic tachycardia syndrome and guiding treatment. In evaluating the results of tilt-table testing, an important consideration is the distinction between vasovagal syncope, and the dysautonomic response to tilt characterized by a gradual and progressive decrease in blood pressure that leads to syncope. Current practice patterns suggest that beta blockers, fludrocortisone, and midodrine are commonly used to treat patients with vasovagal syncope. These also suggest that patients with the postural orthostatic tachycardia syndrome, and with the dysautonomic response, are better treated with fludrocortisone and midodrine.

  16. [Internuclear ophthalmoplegia and non-paralytic pontine exotropia].

    PubMed

    Delreux, V; Ghilain, S; Laterre, C

    1987-01-01

    The authors discuss internuclear ophthalmoplegia associated with non-paralytic pontine exotropia of the contralateral eye. Impairment of the posterior oculogyric tract in its protuberantial segment, resulting in oculographic signs of alteration in the contralateral continuation. Seems to be responsible for the exotropia.

  17. Hereditary fructose intolerance.

    PubMed

    Ali, M; Rellos, P; Cox, T M

    1998-05-01

    Hereditary fructose intolerance (HFI, OMIM 22960), caused by catalytic deficiency of aldolase B (fructose-1,6-bisphosphate aldolase, EC 4.1.2.13), is a recessively inherited condition in which affected homozygotes develop hypoglycaemic and severe abdominal symptoms after taking foods containing fructose and cognate sugars. Continued ingestion of noxious sugars leads to hepatic and renal injury and growth retardation; parenteral administration of fructose or sorbitol may be fatal. Direct detection of a few mutations in the human aldolase B gene on chromosome 9q facilitates the genetic diagnosis of HFI in many symptomatic patients. The severity of the disease phenotype appears to be independent of the nature of the aldolase B gene mutations so far identified. It appears that hitherto there has been little, if any, selection against mutant aldolase B alleles in the population: in the UK, approximately 1.3% of neonates harbour one copy of the prevalent A149P disease allele. The ascendance of sugar as a major dietary nutrient, especially in western societies, may account for the increasing recognition of HFI as a nutritional disease and has shown the prevalence of mutant aldolase B genes in the general population. The severity of clinical expression correlates well with the immediate nutritional environment, age, culture, and eating habits of affected subjects. Here we review the biochemical, genetic, and molecular basis of human aldolase B deficiency in HFI, a disorder which responds to dietary therapy and in which the principal manifestations of disease are thus preventable.

  18. Hereditary fructose intolerance.

    PubMed Central

    Ali, M; Rellos, P; Cox, T M

    1998-01-01

    Hereditary fructose intolerance (HFI, OMIM 22960), caused by catalytic deficiency of aldolase B (fructose-1,6-bisphosphate aldolase, EC 4.1.2.13), is a recessively inherited condition in which affected homozygotes develop hypoglycaemic and severe abdominal symptoms after taking foods containing fructose and cognate sugars. Continued ingestion of noxious sugars leads to hepatic and renal injury and growth retardation; parenteral administration of fructose or sorbitol may be fatal. Direct detection of a few mutations in the human aldolase B gene on chromosome 9q facilitates the genetic diagnosis of HFI in many symptomatic patients. The severity of the disease phenotype appears to be independent of the nature of the aldolase B gene mutations so far identified. It appears that hitherto there has been little, if any, selection against mutant aldolase B alleles in the population: in the UK, approximately 1.3% of neonates harbour one copy of the prevalent A149P disease allele. The ascendance of sugar as a major dietary nutrient, especially in western societies, may account for the increasing recognition of HFI as a nutritional disease and has shown the prevalence of mutant aldolase B genes in the general population. The severity of clinical expression correlates well with the immediate nutritional environment, age, culture, and eating habits of affected subjects. Here we review the biochemical, genetic, and molecular basis of human aldolase B deficiency in HFI, a disorder which responds to dietary therapy and in which the principal manifestations of disease are thus preventable. Images PMID:9610797

  19. Dietary treatment of lactose intolerance in infants and children.

    PubMed

    Sinden, A A; Sutphen, J L

    1991-12-01

    During the past several years there have been many reports of alternative dietary therapies for primary and secondary lactose intolerance. We have learned that it is useful to feed through most episodes of mild diarrhea that previously would have been treated with clear liquid diets. Infant formulas, including both soy-protein and hydrolysate formulas with specially designed carbohydrate, protein, and fat components, are available to treat the infant with diarrheal syndromes and secondary lactase deficiency. Also, the diet can be supplemented with lactase. Specialized lactose-reduced products as well as cultured and fermented dairy products may be used in varying degrees for lactose-intolerant children. The ingestion of milk with food and fiber components in the diet has also been shown to improve symptoms of lactose intolerance. This review summarizes the essentials of diagnosis of and dietary therapy for lactose intolerance. Our findings indicate that a number of specialized formulas and products are available for successful dietary management of lactose intolerance in infants and children.

  20. Resource partitioning in tolerant and intolerant macaques.

    PubMed

    Rebout, Nancy; Desportes, Christine; Thierry, Bernard

    2017-09-01

    The clumped distribution of food resources promotes food defensibility and can lead to the monopolizing of resources by high-ranking individuals. However, the balance of power is set at different levels according to societies, meaning that resource partitioning should vary between them. This study investigates whether dominance asymmetry and resource partitioning are related in non-human primates by comparing two species with contrasting social styles, namely rhesus macaques (Macaca mulatta) which display strong social intolerance and a steep gradient of dominance, and Tonkean macaques (Macaca tonkeana), which exhibit higher levels of tolerance and more balanced dominance relationships. Study groups were kept in semi-free ranging conditions. Animals were provided with fruit in three different clumped conditions during 30-min trials. We found that higher-ranking rhesus macaques had priority for the access to fruit: these individuals spent longer in the feeding area in the first 10-min period of trials, while lower-ranking individuals had diminished access to fruit under the most clumped condition; this was associated with sustained agonistic interactions. Dominance effects were weaker in Tonkean macaques. They exhibited co-feeding between high- and low-ranking individuals in the first period; there was no significant effect of dominance even in the most clumped condition; and frequencies of agonistic interactions remained moderate relative to the number of individuals present in the feeding area. These results show that food resources were more equitably distributed among group members in tolerant macaques than in their intolerant counterparts. Dominance gradient and social tolerance may be considered as two aspects of the same phenomenon. © 2017 Wiley Periodicals, Inc.

  1. Upper eyelid platinum chain placement for treating paralytic lagophthalmos.

    PubMed

    Bianchi, B; Ferri, A; Leporati, M; Ferrari, S; Lanfranco, D; Ferri, T; Sesenna, E

    2014-12-01

    For the definitive treatment of lagophthalmos and satisfactory rehabilitation of the affected eye, different surgical strategies have been proposed, including static or dynamic procedures. Although some of these can have good results, lid loading is now the most common technique for treating paralytic long-term lagophthalmos. Among the different types of loading, the use of a platinum chain is preferred to the use of a standard gold weight because platinum has a higher density than gold and is also more biocompatible. In this paper authors retrospectively analyzed 43 patients with regards to functional and cosmetic results. Questionnaires were also employed to assess changes and improvements in the patients' quality of life. Analysis of the excellent results achieved confirmed that platinum chain lid loading should be considered as a first-line treatment for paralytic lagophthalmos rehabilitation. It is a simple, reliable, and effective technique that significantly improves the health-related quality of life of patients.

  2. Copepods induce paralytic shellfish toxin production in marine dinoflagellates

    PubMed Central

    Selander, Erik; Thor, Peter; Toth, Gunilla; Pavia, Henrik

    2006-01-01

    Among the thousands of unicellular phytoplankton species described in the sea, some frequently occurring and bloom-forming marine dinoflagellates are known to produce the potent neurotoxins causing paralytic shellfish poisoning. The natural function of these toxins is not clear, although they have been hypothesized to act as a chemical defence towards grazers. Here, we show that waterborne cues from the copepod Acartia tonsa induce paralytic shellfish toxin (PST) production in the harmful algal bloom-forming dinoflagellate Alexandrium minutum. Induced A. minutum contained up to 2.5 times more toxins than controls and was more resistant to further copepod grazing. Ingestion of non-toxic alternative prey was not affected by the presence of induced A. minutum. The ability of A. minutum to sense and respond to the presence of grazers by increased PST production and increased resistance to grazing may facilitate the formation of harmful algal blooms in the sea. PMID:16769640

  3. Paralytic lagophthalmos syndrome in the plastic and maxillofacial surgeon practice.

    PubMed

    Nerobeev, A I; Shurgaya, Ts M; Sayda, A S

    2016-01-01

    to identify and give an objective assessment of all changes in the periorbital region in paralysis orbicularis oculi muscle. With physical, laboratory and instrumental methods of research, we analyzed the survey of 33 patients with paralytic lagophthalmos. This survey has allowed us to identify the symptoms of periorbital changes characteristic of paralysis orbicularis oculi involved in lagophthalmos development. After analyzing the results of a survey of 33 patients with paralytic lagophthalmos, we identified 15 symptoms of changes in the periorbital region. In our opinion, lagophthalmos should be considered as a syndrome, including certain symptom in a particular case. For adequate closure of the optic fissure and obtaining a good aesthetic result is necessary to simultaneously remove more of the symptoms.

  4. Vaccine Associated Paralytic Poliomyelitis Unmasking Common Variable Immunodeficiency.

    PubMed

    Gomber, Sunil; Arora, Vanny; Dewan, Pooja

    2017-03-15

    Oral polio vaccine can rarely lead to Vaccine-associated paralytic poliomyelitis (VAPP). A 2-year-old child with asymmetric paralysis of lower limbs following first booster of oral polio vaccine; type 2 Vaccine-derived poliovirus (VDPV) isolated. Subsequently, the child was diagnosed to have common variable immunodeficiency. Paralysis gradually improved on follow-up; monthly intravenous immunoglobulin therapy started for primary immunodeficiency. We need to evaluate children with VAPP for underlying immunodeficiency.

  5. A survey for paralytic shellfish poisoning (PSP) in Vancouver Harbour.

    PubMed

    Yan, Tian; Zhou, Mingjiang; Tan, Zhijun; Li, Jun; Yu, Rencheng; Wang, Yunfeng

    2004-01-01

    Shellfish samples were collected from seven inter-tidal and two sub-tidal sites between 23 May and 8 June 1999 in Vancouver Harbour and were analysed for paralytic shellfish poisoning (PSP) using a mouse bioassay. PSP was detected in mussels collected at four sampling sites in English Bay and Burrard Inlet, at a concentration below 20 microg saxitoxin equivalents (STXeq)/100 g wet weight.

  6. Treatment of the periocular complex in paralytic lagophthalmos.

    PubMed

    Loyo, Myriam; Jones, Danielle; Lee, Linda N; Collar, Ryan M; Molendijk, Josher; Boahene, Kofi D; Ishii, Lisa E; Byrne, Patrick J

    2015-04-01

    Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins. The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012. One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures (P=.04) and more likely to require revision (P=.003). Medial canthopexy and direct brow lift were associated with the need for revision (P=.006, P=.03). Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients. © The Author(s) 2014.

  7. Strategies to overcome statin intolerance.

    PubMed

    Agouridis, Aris P; Nair, Devaki R; Mikhailidis, Dimitri P

    2015-06-01

    This editorial discusses several options to overcome statin intolerance in clinical practice. For example, switching to a different statin, changing statin dosing, using lipid-lowering drugs other than statins (e.g., ezetimibe, bile acid sequestrants and fibrates, alone or in combination), or combining statins with other lipid-lowering drugs. The authors focus on the potential mechanisms involved in statin-related myopathy. New lipid-lowering drugs currently in development (e.g., cholesterol ester transfer protein inhibitors [anacetrapib] and proprotein convertase subtilisin/kexin 9 inhibitors) inhibitors may help in the management of statin intolerance while achieving low-density lipoprotein cholesterol targets as set out by the guidelines.

  8. [Abdominal spasms, meteorism, diarrhea: fructose intolerance, lactose intolerance or IBS?].

    PubMed

    Litschauer-Poursadrollah, Margaritha; El-Sayad, Sabine; Wantke, Felix; Fellinger, Christina; Jarisch, Reinhart

    2012-12-01

    Meteorism, abdominal spasms, diarrhea, casually obstipation, flatulence and nausea are symptoms of fructose malabsorption (FIT) and/or lactose intolerance (LIT), but are also symptoms of irritable bowel syndrome (IBS). Therefore these diseases should be considered primarily in patients with digestive complaints. For diagnosis an H(2)-breath test is used.In 1,935 patients (526 m, 1,409 f) a fructose intolerance test and in 1,739 patients (518 m,1,221 f) a lactose intolerance test was done.FIT is found more frequently than LIT (57 versus 52 % in adults (p < 0,02) and in children 90 versus 62 % (p < 0,001)) and is in polyintolerances most frequently correlated to histamine intolerance (HIT). Headache (ca. 10 %), fatigue (ca. 5 %) and dizziness (ca. 3 %) may occur after the test, irrespective whether the test was positive or negative.In more than 2/3 of patients a diet reduced in fructose or lactose may lead to improvement or remission of these metabolic disorders. IBS, which is often correlated with FIT (183/221 patients = 83 %), can be improved by relevant but also not relevant diets indicating that irritable bowel disease seems to be caused primarily by psychological disorders.

  9. Genetics Home Reference: hereditary fructose intolerance

    MedlinePlus

    ... EP, Zee T, Tolan DR. Increased prevalence of mutant null alleles that cause hereditary fructose intolerance in ... F. Structural and functional analysis of aldolase B mutants related to hereditary fructose intolerance. FEBS Lett. 2002 ...

  10. Statin Intolerance: the Clinician's Perspective.

    PubMed

    Stulc, Tomáš; Ceška, Richard; Gotto, Antonio M

    2015-12-01

    Muscle problems and other adverse symptoms associated with statin use are frequent reasons for non-adherence and discontinuation of statin therapy, which results in inadequate control of hyperlipidemia and increased cardiovascular risk. However, most patients who experience adverse symptoms during statin use are able to tolerate at least some degree of statin therapy. Given the profound cardiovascular benefits derived from statins, an adequate practical approach to statin intolerance is, therefore, of great clinical importance. Statin intolerance can be defined as the occurrence of myalgia or other adverse symptoms that are attributed to statin therapy and that lead to its discontinuation. In reality, these symptoms are actually unrelated to statin use in many patients, especially in those with atypical presentations following long periods of treatment. Thus, the first step in approaching patients with adverse symptoms during the course of statin therapy is identification of those patients for whom true statin intolerance is unlikely, since most of these patients would probably be capable of tolerating adequate statin therapy. In patients with statin intolerance, an altered dosing regimen of very low doses of statins should be attempted and, if tolerated, should gradually be increased to achieve the highest tolerable doses. In addition, other lipid-lowering drugs may be needed, either in combination with statins, or alone, if statins are not tolerated at all. Stringent control of other risk factors can aid in reducing cardiovascular risk if attaining lipid treatment goals proves difficult.

  11. How Is Lactose Intolerance Diagnosed?

    MedlinePlus

    ... is a likely sign of problems digesting lactose. 1 Lactose intolerance test. For this test, blood samples are taken before and after a person drinks a beverage that contains lactose. The amount of sugar (glucose) in the blood is ... hydrogen breath test is preferred over this test. 3 Stool acidity ...

  12. Gastrointestinal food allergy and intolerance.

    PubMed

    Assa'ad, Amal H

    2006-10-01

    GI symptoms are a common manifestation of food allergy and intolerance. The primary physician is the first to evaluate these symptoms. A systematic evaluation using an accurate and detailed history, tests to identify the offending food(s), and procedures that may identify underlying pathologic disorders of the GI tract would lead to an accurate diagnosis and better targeted therapeutic interventions.

  13. [Hereditary fructose intolerance (author's transl)].

    PubMed

    Thanner, F

    1977-07-01

    Hereditary fructose intolerance (HFI) is the most important disturbance in human fructose metabolism. This paper deals with the present knowledge of biochemistry and pathophysiology of this inborn error of metabolism, which is often wrongly diagnosed and gives a detailed description of diagnostic and therapeutic procedures.

  14. Is it just lactose intolerance?

    PubMed

    Olivier, Celso Eduardo; Lorena, Sônia Letícia Silva; Pavan, Célia Regina; dos Santos, Raquel Acácia Pereira Gonçalves; dos Santos Lima, Regiane Patussi; Pinto, Daiana Guedes; da Silva, Mariana Dias; de Lima Zollner, Ricardo

    2012-01-01

    Acquired delayed-onset hypolactasia is a common autosomal recessive condition. Cow's milk allergies, conversely, are less common conditions that may manifest with equivalent symptoms and are able to simulate and/or aggravate lactose intolerance. This study was designed to evaluate the contribution of IgE-mediated cow's milk sensitization to the symptomatology of adult patients with lactose-free diet refractory lactose intolerance. Forty-six adult patients with lactose intolerance and persistent symptoms despite a lactose-free diet underwent skin-prick test to investigate cow's milk, goat's milk, and soy protein-specific-IgE. SDS-PAGE immunoblotting was used to investigate the presence of cow's milk protein-specific IgE. The percentage of patients who had skin reactions to whole cow's milk, alpha-lactalbumin, beta-lactoglobulin, caseins, goat's milk, and soy was 69.5, 36.9, 56.5, 56.5%, 54.3, and 50%, respectively. The percentage of patients with immunoblot-detected IgE specific for alpha-lactalbumin, beta-lactoglobulin, caseins, and bovine serum albumin was 21.7, 63, 67.3, and 2.1%, respectively. IgE-mediated sensitization to cow's milk is a frequent comorbidity in subjects with lactose-free diet refractory lactose intolerance and is worth consideration in patients with this condition.

  15. Application of Palpebral Spring in Asian Patients With Paralytic Lagophthalmos.

    PubMed

    Chan, Richie Chiu-Lung; Chan, Jimmy Yu-Wai

    Literature on palpebral springs is scarce, and even more so for the Asian population. In this study, the authors evaluated their experience with palpebral spring placement for paralytic lagophthalmos in an Asian population. The authors report the unique challenges encountered due to the distinctive features in Asian eyelids and how they overcome them. To the best of our knowledge, this is the first report on the application of palpebral springs in Asians. All patients treated for paralytic lagophthalmos in the Department of Surgery, Queen Mary Hospital, from November 2013 to December 2015, were included in this study. The authors retrieved and analyzed the demographic data, preoperative assessment details, and treatment outcomes. A total of 17 patients were recruited. The median interval between facial palsy occurrence and surgery was 66 months. Preoperatively, vertical palpebral fissure was 12.3 ± 1.7 mm with margin reflex distance 1 of 3.7 ± 0.3 mm and margin reflex distance 2 of 8.6 ± 1.6 mm. Lagophthalmos before surgery was 9.6 ± 2.3 mm. After the palpebral spring surgeries, vertical palpebral fissure was reduced to 9.1 ± 1.4 mm. margin reflex distance 1 is slightly reduced (3.3 ± 0.8 mm) and margin reflex distance 2 improved to 5.8 ± 1.0 mm. Lagophthalmos reduced significantly to 0.8 ± 1.3 mm. Seven patients required revision procedures. Palpebral spring is a safe and effective treatment for Asian patients with paralytic lagophthalmos. However, surgeons should be aware of the unique challenges associated with the anatomy of Asian eyelids. Special adaptation of the procedure is required to optimize the outcome.

  16. [Galveston technique in treatment of paralytic spine deformities].

    PubMed

    Kaczmarczyk, Jacek; Nowakowski, Andrzej; Balcerkiewicz, Karol; Szulc, Paweł

    2003-01-01

    The author's present their own experiences with the Galveston technique in treatment of paralytic spine deformities. Nineteen patients (6 boys and 13 girls) were treated (between 1996 and 2002) at the Swiebodzin Spine Centre and the Special Spine Surgery Unit in Poznań. All patients were unable to sit straight without external support, due to neurologic muscle weakness and pelvic obliquity. Surgical treatment lead to a marked improvement of the spinal deformity and also allowed the patients to sit-straight, without need of any support.

  17. Resection arthroplasty of the hip in paralytic dislocations.

    PubMed

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  18. The Meaning of Gender while Aging with Paralytic Polio

    PubMed Central

    Harrison, Tracie; Stuifbergen, Alexa; Walker, Janiece; Scott, Tiffany; Choban, Robin

    2010-01-01

    The purpose of this paper is to report the influence of gender on aging with childhood onset paralytic polio. The hermeneutic phenomenological exploration of gender was done using multiple qualitative interviews with 25 women, age 55 to 75 years of age, who had polio since before 14 years of age. We noted three themes: 1) The movement of her body, 2) Integrating body and gender, and 3) Gender discrepancies. Findings are discussed in the context of gendered expectations and the women’s bodies. PMID:21240713

  19. Measuring gender satisfaction among women aging with paralytic polio.

    PubMed

    Walker, Janiece L; Harrison, Tracie C

    2014-01-01

    In this study we tested the Gendered Outcome Scale as a measure of gender satisfaction among 295 women aging with the disabling effects of paralytic polio. Principal components analysis, reliability analyses, and content validity were analyzed on the scale. The scale had a Cronbach's alpha of.90. Younger women had more gender satisfaction (r =.181, p <.01), and women who had greater disability had greater gender satisfaction. (r = -.127, p <.05). The results support that the scale is a valid and reliable measure for determing gender satisfaction. Further work is needed to test the scale in diversified samples.

  20. Assessment of sodium channel mutations in Makah tribal members of the U.S. Pacific Northwest as a potential mechanism of resistance to paralytic shellfish poisoning.

    PubMed

    Adams, Nicolaus G; Robertson, Alison; Grattan, Lynn M; Pendleton, Steve; Roberts, Sparkle; Tracy, J Kathleen; Trainer, Vera L

    2016-07-01

    The Makah Tribe of Neah Bay, Washington, has historically relied on the subsistence harvest of coastal seafood, including shellfish, which remains an important cultural and ceremonial resource. Tribal legend describes visitors from other tribes that died from eating shellfish collected on Makah lands. These deaths were believed to be caused by paralytic shellfish poisoning, a human illness caused by ingestion of shellfish contaminated with saxitoxins, which are produced by toxin-producing marine dinoflagellates on which the shellfish feed. These paralytic shellfish toxins include saxitoxin, a potent Na(+) channel antagonist that binds to the pore region of voltage gated Na(+) channels. Amino acid mutations in the Na(+) channel pore have been demonstrated to confer resistance to saxitoxin in softshell clam populations exposed to paralytic shellfish toxins present in their environment. Because of the notion of resistance to paralytic shellfish toxins, the study aimed to determine if a resistance strategy was possible in humans with historical exposure to toxins in shellfish. We collected, extracted and purified DNA from buccal swabs of 83 volunteer Makah tribal members and sequenced the skeletal muscle Na(+) channel (Nav1.4) at nine loci to characterize potential mutations in the relevant saxitoxin binding regions. No mutations of these specific regions were identified after comparison to a reference sequence. This study suggests that any resistance of Makah tribal members to saxitoxin, if present, is not a function of Nav1.4 modification, but may be due to mutations in neuronal or cardiac sodium channels, or some other mechanism unrelated to sodium channel function. Published by Elsevier B.V.

  1. Assessment of sodium channel mutations in Makah Tribal members of the U.S. Pacific Northwest as a potential mechanism of resistance to paralytic shellfish poisoning

    PubMed Central

    Adams, Nicolaus G.; Robertson, Alison; Grattan, Lynn M.; Pendleton, Steve; Roberts, Sparkle; Tracy, J. Kathleen; Trainer, Vera L.

    2015-01-01

    The Makah Tribe of Neah Bay, Washington, has historically relied on the subsistence harvest of coastal seafood, including shellfish, which remains an important cultural and ceremonial resource. Tribal legend describes visitors from other tribes that died from eating shellfish collected on Makah lands. These deaths were believed to be caused by paralytic shellfish poisoning, a human illness caused by ingestion of shellfish contaminated with saxitoxins, which are produced by toxin-producing marine dinoflagellates on which the shellfish feed. These paralytic shellfish toxins include saxitoxin, a potent Na+ channel antagonist that binds to the pore region of voltage gated Na+ channels. Amino acid mutations in the Na+ channel pore have been demonstrated to confer resistance to saxitoxin in softshell clam populations exposed to paralytic shellfish toxins present in their environment. Because of the notion of resistance to paralytic shellfish toxins, we aimed to determine if a resistance strategy was possible in humans with historical exposure to toxins in shellfish. We collected, extracted and purified DNA from buccal swabs of 83 volunteer Makah tribal members and sequenced the skeletal muscle Na+ channel (Nav1.4) at nine loci to characterize potential mutations in the relevant saxitoxin binding regions. No mutations of these specific regions were identified after comparison to a reference sequence. This study suggests that any resistance of Makah Tribal members to saxitoxin is not a function of Nav1.4 modification but may be due to mutations in neuronal or cardiac sodium channels or some other mechanism unrelated to sodium channel function. PMID:27616973

  2. Effects of Maternal Magnesium Sulfate Treatment on Neonatal Feeding Tolerance.

    PubMed

    Belden, Meghan K; Gnadt, Sarah; Ebert, Ann

    2017-01-01

    To determine whether antenatal exposure to magnesium sulfate has an effect on neonatal enteral feeding tolerance. In this single-center, retrospective, observational study, charts of pregnant women who received intravenous magnesium sulfate infusions prior to delivery between July 1, 2012, and July 31, 2013, were reviewed. Neonates born at 24 weeks' gestational age or greater admitted to the neonatal intensive care unit (NICU) whose mothers received magnesium sulfate infusions prior to delivery were included. Neonates with independent factors that could lead to feeding intolerance were excluded. The primary outcome was incidence of neonatal enteral feeding intolerance measured by deviations from the NICU feeding protocol. Secondary outcomes included days on parenteral nutrition, incidence of necrotizing enterocolitis, time to first stool, and urine output in the first 72 hours of life. Cumulative maternal magnesium sulfate dose was significantly higher in the enteral feeding intolerance group than those infants who tolerated enteral feeds (70.4 ± 52.3 vs 47.4 ± 40.1 g; p = 0.04). Infants exposed to more than 80 g of maternal magnesium sulfate therapy were more likely to develop enteral feeding intolerance (44% vs 22%; p = 0.04). Multivariate logistic regression indicated that prematurity and cumulative maternal magnesium sulfate dose were the strongest predictors of neonatal enteral feeding intolerance. Infants of mothers who received more than 80 g of intravenous magnesium sulfate prior to delivery were more likely to develop feeding intolerance. Prematurity also was a significant predictor of intolerance.

  3. Feeding Practices and NEC

    PubMed Central

    Ramani, Manimaran

    2012-01-01

    Synopsis Necrotizing enterocolitis (NEC) is a multifactorial disorder that primarily affects premature infants. Human milk as compared to formula reduces the incidence of NEC. Feeding practices such as minimal enteral nutrition (versus complete fasting) before progressive advancement of feeds, early introduction of feeds (before day 4 of life as compared to later), and a more rapid advancement of feeds (30–35 ml/kg/day as compared to 15–20 ml/kg/day) do not increase the incidence of NEC in preterm infants. There is no evidence supporting continuous over intermittent tube feedings in preterm infants. In a feed-intolerant preterm infant without any other clinical and radiological evidence of NEC, minimal enteral nutrition rather than complete suspension of enteral feeding may be an alternative. Human milk-based fortifier as compared to bovine-based fortifier may reduce the incidence of NEC but additional studies are required. PMID:23415260

  4. Gluten intolerance and skin diseases.

    PubMed

    Humbert, Philippe; Pelletier, Fabien; Dreno, Brigitte; Puzenat, Eve; Aubin, François

    2006-01-01

    Gluten sensitivity with or without coeliac disease (CD) symptoms and intestinal pathology has been suggested as a potentially treatable cause of various diseases. CD is a chronic disease which improves on withdrawal of wheat gliadins and barley, rye and oat prolamins from the diet. There have been numerous reports linking CD with several skin conditions. A body of evidence shows that dermatitis herpetiformis is actually a cutaneous manifestation of CD. Autoimmune diseases, allergic diseases, psoriasis and miscellaneous diseases have also been described with gluten intolerance. Dermatologists should be familiar with the appraisal of gluten sensitive enteropathy and should be able to search for an underlying gluten intolerance (GI). Serological screening by means of antigliadin, antiendomysial and transglutaminase antibodies should be performed. HLA typing is often useful in association with serologic tests. Intestinal biopsy is usually needed to establish the diagnosis of CD or GI. Thus, gluten intolerance gives rise to a variety of dermatological manifestations which may benefit from a gluten-free diet.

  5. Sensory Intolerance: Latent Structure and Psychopathologic Correlates

    PubMed Central

    Taylor, Steven; Conelea, Christine A.; McKay, Dean; Crowe, Katherine B.; Abramowitz, Jonathan S.

    2014-01-01

    Background Sensory intolerance refers to high levels of distress evoked by everyday sounds (e.g., sounds of people chewing) or commonplace tactile sensations (e.g., sticky or greasy substances). Sensory intolerance may be associated with obsessive-compulsive (OC) symptoms, OC-related phenomena, and other forms of psychopathology. Sensory intolerance is not included as a syndrome in current diagnostic systems, although preliminary research suggests that it might be a distinct syndrome. Objectives First, to investigate the latent structure of sensory intolerance in adults; that is, to investigate whether it is syndrome-like in nature, in which auditory and tactile sensory intolerance co-occur and are associated with impaired functioning. Second, to investigate the psychopathologic correlates of sensory intolerance. In particular, to investigate whether sensory intolerance is associated with OC-related phenomena, as suggested by previous research. Method A sample of 534 community-based participants were recruited via Amazon.com’s Mechanical Turk program. Participants completed measures of sensory intolerance, OC-related phenomena, and general psychopathology. Results Latent class analysis revealed two classes of individuals: Those who were intolerant of both auditory and tactile stimuli (n = 150), and those who were relatively undisturbed by auditory or tactile stimuli (n = 384). Sensory intolerant individuals, compared to those who were comparatively sensory tolerant, had greater scores on indices of general psychopathology, more severe OC symptoms, a higher likelihood of meeting caseness criteria for OC disorder, elevated scores on measures of OC-related dysfunctional beliefs, a greater tendency to report OC-related phenomena (e.g., a greater frequency of tics), and more impairment on indices of social and occupational functioning. Sensory intolerant individuals had significantly higher scores on OC symptoms even after controlling for general psychopathology

  6. Determination of paralytic shellfish toxins in Portuguese shellfish by automated pre-column oxidation.

    PubMed

    Vale, P; de M Sampayo, M A

    2001-04-01

    Automated pre-column oxidation (the method of Lawrence) was implemented on a routine basis since the end of 1996 to study paralytic shellfish poisoning (PSP) toxins in Portuguese shellfish. Liquid chromatography confirmed the presence of PSP toxins when the known toxic algae were present: Gymnodinium catenatum and/or Alexandrium cf. lusitanicum. On the other side, it has eliminated PSP toxins as a possible recurrent contaminant in oysters from Sado estuary. These oysters were already known to contain high levels of some metals (mainly zinc, copper and cadmium) due to their location in a contaminated area and their particular physiology prone to accumulate metals. The presence of PSP toxins in Scrobicularia plana from Mondego estuary and Tellina crassa from the northern coast, during the absence of the above toxic microalgae in the water column, was confirmed. Unlike other shellfish, these two genera have the feeding habit of aspirating more sediment than organisms in suspension, and probably ingest from the sediment resting cysts of PSP producing microalgae. This is another route of contamination that may help to explain why after a bloom certain shellfish species maintain toxicity for long periods. The method revealed to have a fast implementation on a daily basis, short analysis time (around 20 min between samples), high sensitivity and robustness, and therefore, it is one of the best HPLC methods for screening a large number of shellfish samples for monitoring purposes.

  7. Lactose intolerance and other disaccharidase deficiency.

    PubMed

    Tomar, Balvir S

    2014-09-01

    Intolerance to foods which contain lactose can cause a range of intestinal and systemic symptoms. These symptoms are caused by Lactase deficiency which is encoded by a single gene (LCT) of ≈ 50 kb located on chromosome 2q21. In some food items, lactose has been missed because of "hidden" lactose due to inadequately labeled, confusing diagnosis of lactose intolerance based on dietary restriction of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. The key in the management of lactose intolerance is the dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labeled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the types, symptoms and management of lactose intolerance and also highlights differences from milk allergy which closely mimics the symptoms of lactose intolerance.

  8. Statin intolerance: more questions than answers.

    PubMed

    Guyton, John R; Campbell, Kristen B; Lakey, Wanda C

    2014-01-01

    The dramatic effectiveness of statins in improving the course of atherosclerotic cardiovascular disease tends to overshadow questions of statin intolerance. Thus after more than 25 years of clinical statin use, intolerance remains a poorly understood, frustrating issue for patients and providers. It has been extraordinarily difficult to define statin intolerance and its implications for clinical practice. Here, we briefly summarize current knowledge and raise questions that need to be addressed.

  9. Commentary on AOAC method for paralytic shellfish poisoning.

    PubMed

    Adams, W N; Miescier, J J

    1980-11-01

    Paralytic shellfish poisoning (PSP) is caused by ingesting bivalve molluscan shellfish which have fed on the toxigenic marine dinoflagellates Gonyaulax catanella or G. tamarensis. The toxins from these organisms are neurotoxic alkaloids which interfere with nerve conduction and block muscle-action potential. The U.S. Food and Drug Administration cooperates with state shellfish control officials in the National Shellfish Sanitation Program to prevent marketing of toxin-contaminated shellfish. The toxins are quantitated by the standard mouse bioassay method, as found in Official Methods of Analysis of the AOAC. This paper discusses the procedure followed in the standard bioassay method in an attempt to clarify for the PSP analyst the rather complex official methodology, and, thus, promote more uniform results among laboratories.

  10. Gold weight implants in the management of paralytic lagophthalmos.

    PubMed

    Baheerathan, N; Ethunandan, M; Ilankovan, V

    2009-06-01

    Lagophthalmos secondary to facial nerve damage can lead to corneal exposure and eventually blindness. Appropriate management depends on the severity and likely duration of recovery. Upper eyelid gold implants play an important role in the medium and long term management of this condition. The authors report their experience with 16 consecutive patients who underwent gold weight implantation of the upper eyelids for correction of paralytic lagophthalmos and describe their surgical technique. The mean age of the patients was 70 years with a male predominance (M:F=3.2:1). Radical parotidectomy (69%) was the most common reason for the intervention. The mean weight of the implant was 0.95 g. There were no intraoperative or immediate postoperative complications. One implant (6%) was extruded and one patient (6%) had residual lagophthalmos and required a heavier implant. 15 of the 16 patients were satisfied with the outcome and all had adequate lid closure at last follow up.

  11. Food intolerances and eosinophilic esophagitis in childhood.

    PubMed

    Ozdemir, Oner; Mete, Emin; Catal, Ferhat; Ozol, Duygu

    2009-01-01

    Food intolerance is an adverse reaction to a particular food or ingredient that may or may not be related to the immune system. A deficiency in digestive enzymes can also cause some types of food intolerances like lactose and gluten intolerance. Food intolerances may cause unpleasant symptoms, including nausea, bloating, abdominal pain, and diarrhea, which usually begin about half an hour after eating or drinking the food in question, but sometimes symptoms may delayed up to 48 h. There is also a strong genetic pattern to food intolerances. Intolerance reactions to food chemicals are mostly dose-related, but also some people are more sensitive than others. Diagnosis can include elimination and challenge testing. Food intolerance can be managed simply by avoiding the particular food from entering the diet. Babies or younger children with lactose intolerance can be given soy milk or hypoallergenic milk formula instead of cow's milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment. Eosinophilic esophagitis (EE) is defined as isolated eosinophilic infiltration in patients with reflux-like symptoms and normal pH studies and whose symptoms are refractory to acid-inhibition therapy. Food allergy, abnormal immunologic response, and autoimmune mechanisms are suggested as possible etiological factors for EE. This article is intended to review the current literature and to present a practical approach for managing food intolerances and EE in childhood.

  12. Upper eyelid postseptal weight placement for treatment of paralytic lagophthalmos.

    PubMed

    Rozen, Shai; Lehrman, Craig

    2013-06-01

    Left untreated, paralytic lagophthalmos may result in corneal dryness, ulcerations, and subsequent blindness. The most common nondynamic surgical solution is upper eyelid weight placement in a superficial, pretarsal pocket, carrying the risk of visibility, extrusion, and entropion. The authors present a technique useful in patients presenting with either primary symptoms of corneal exposure or complications of previous implants that is equally efficacious, with a potentially decreased risk of complications, in which the weight is inserted into a deeper, postseptal position but requires use of a heavier weight. Nineteen patients, 15 primary and four secondary, treated between the years 2008 and 2012 with the postseptal approach, were evaluated for demographics, cause, resolution of primary symptoms, and complications. The average weight difference between that measured in the clinic versus weight used in surgery in the primary group and the average weight difference between that inserted in previous surgery versus weight placed in corrective surgery were calculated. The average weight difference was 0.213 g (range, 0 to 0.4 g) in the primary group and 0.2 g (range, 0 to 0.4 g) in the revision group. Symptoms resolved in all but one patient, neither revisions nor complications were noted, and the longest follow-up was 4 years. The retroseptal technique has proven to be safe, reproducible, and very useful in both primary and secondary upper eyelid surgery for paralytic lagophthalmos. It successfully addresses several common problems encountered with more superficial weight placement, including visibility, exposure, and entropion, but often necessitates use of a heavier weight. Therapeutic, IV.

  13. Paralytic poliomyelitis in England and Wales, 1985-91.

    PubMed Central

    Joce, R.; Wood, D.; Brown, D.; Begg, N.

    1992-01-01

    OBJECTIVES--To ascertain all cases of paralytic poliomyelitis in England and Wales during 1985-91 and to determine the source of infection in each case. DESIGN--Descriptive study of cases reported between 1985 and 1991. SETTING--All health districts in England and Wales. SUBJECTS--Patients normally resident in England and Wales whose clinical features were consistent with paralytic poliomyelitis or with laboratory evidence of recent poliovirus infection and compatible symptoms. MAIN OUTCOME MEASURES--Clinical, epidemiological, and laboratory features in identified cases. RESULTS--Of 54 suspected cases of poliomyelitis, 33 were excluded, leaving 21 cases, of which 13 were vaccine associated (nine recipient and four contact) cases, five were imported cases, and three were cases whose source of infection was unknown. No cases due to indigenous wild polioviruses were identified; two were imported cases due to wild viruses. One patient died during the acute phase of the illness, and two children with previously unrecognised severe congenital immune deficiency died between one and two months after the onset of paralysis after the first or second dose of oral polio vaccine. The estimated risk of vaccine associated paralysis is 1.46 per million for the first dose, 0.49 for the second, zero for the third and fourth doses, and 0.33 for the fifth. CONCLUSIONS--Indigenous wild poliovirus seems to have been eradicated, although wild virus may be imported; improved surveillance of suspected cases including immediate notification and characterisation of the virus to ensure that eradication is maintained is essential. PMID:1322218

  14. [Food allergy or food intolerance?].

    PubMed

    Maître, S; Maniu, C-M; Buss, G; Maillard, M H; Spertini, F; Ribi, C

    2014-04-16

    Adverse food reactions can be classified into two main categories depending on wether an immune mechanism is involved or not. The first category includes immune mediated reactions like IgE mediated food allergy, eosinophilic oesophagitis, food protein-induced enterocolitis syndrome and celiac disease. The second category implies non-immune mediated adverse food reactions, also called food intolerances. Intoxications, pharmacologic reactions, metabolic reactions, physiologic, psychologic or reactions with an unknown mechanism belong to this category. We present a classification of adverse food reactions based on the pathophysiologic mechanism that can be useful for both diagnostic approach and management.

  15. Aspirin intolerance--a review.

    PubMed

    Abrishami, M A; Thomas, J

    1977-07-01

    1. Association of bronchial asthma, nasal pathology and intolerance to aspirin is a unique syndrome. Aspirin-induced prolongation of bleeding time, and a tendency for diabetes, may exist with it. 2. The syndrome occurs most often in the middle-aged female. 3. Progression of asthma and nasal polyposis is not prevented by avoidance of aspirin. 4. Salicylates other than aspirin are well tolerated but cross-reactivity with other analgesics, and with tartrazine, may occur. 5. The underlying mechanism is unknown. An immunologic basic is most unlikely.

  16. Lactose malabsorption and lactose intolerance: implications for general milk consumption.

    PubMed

    Torún, B; Solomons, N W; Viteri, F E

    1979-12-01

    A total of 194 publications related to lactose malabsorption or intolerance were reviewed. The poor correlation between lactose malabsorption and intolerance to the amounts of milk ordinarily ingested in a meal, indicates that the assumption of milk tolerance by many populations is exaggerated. The methods for the diagnosis of these conditions were critically evaluated and it is suggested that, a) "physiological" doses of lactose be used; b) milk is the vehicle of choice; c) tests of intolerance be double-blind, and d) analysis of breath hydrogen be used for malabsorption. Most of the evidence indicates that milk consumption allows adequate growth of children, even when they are malnourished and have diarrhea. Nevertheless, it is recommended to substitute temporarily non-human milk by other good sources of dietary protein and energy during episodes of severe diarrhea, and to reintroduce milk to the diet gradually during convalescence. Breast feeding, however, should not be interrupted. These is not enough scientific nor epidemiological support to justify discouraging the use of milk in food supplementation programs, but several aspects that must be considered in such programs are outlined.

  17. Histamine, histamine intoxication and intolerance.

    PubMed

    Kovacova-Hanuskova, E; Buday, T; Gavliakova, S; Plevkova, J

    2015-01-01

    Excessive accumulation of histamine in the body leads to miscellaneous symptoms mediated by its bond to corresponding receptors (H1-H4). Increased concentration of histamine in blood can occur in healthy individuals after ingestion of foods with high contents of histamine, leading to histamine intoxication. In individuals with histamine intolerance (HIT) ingestion of food with normal contents of histamine causes histamine-mediated symptoms. HIT is a pathological process, in which the enzymatic activity of histamine-degrading enzymes is decreased or inhibited and they are insufficient to inactivate histamine from food and to prevent its passage to blood-stream. Diagnosis of HIT is difficult. Multi-faced, non-specific clinical symptoms provoked by certain kinds of foods, beverages and drugs are often attributed to different diseases, such as allergy and food intolerance, mastocytosis, psychosomatic diseases, anorexia nervosa or adverse drug reactions. Correct diagnosis of HIT followed by therapy based on histamine-free diet and supplementation of diamine oxidase can improve patient's quality of life.

  18. Children with paralytic poliomyelitis: utilization of physiotherapy services in Zamfara State, Nigeria.

    PubMed

    Ogwumike, Omoyemi O; Kaka, Bashir; Adeniyi, Ade F

    2013-02-01

    Physiotherapy is usually indicated for health promotion and the rehabilitation of individuals with paralytic poliomyelitis. The endemic nature of this condition in children in Zamfara State, Nigeria necessitated investigation into the utilization of physiotherapy services by parents or primary caregivers of children affected with polio in this sub-region. Parents and primary caregivers of children with paralytic poliomyelitis were recruited using a purposive multi-stage sampling procedure in a cross-sectional survey. Factors associated with the utilization of physiotherapy services were assessed based on questions extracted from a 4-part, 52-item structured questionnaire originally designed for a study which investigated knowledge, attitude, and beliefs of parents of children with paralytic poliomyelitis. A total of 217 participants were included in this study. The mean age was 32.29 ± 9.89 years and the mean knowledge of polio score was 62.0 ± 17.3%. The mean age of the children with paralytic poliomyelitis was 6.41 ± 2.50 years. Only 27.2% of the parents or primary caregivers had utilized physiotherapy service for their children at some point. No association existed between utilization of physiotherapy service and 'knowledge of paralytic poliomyelitis', 'employment status', and 'family income' of respondents. Explanations for low utilization of physiotherapy services for children with paralytic poliomyelitis by parents or primary caregivers are discussed.

  19. Dogs that develop rabies post-vaccination usually manifest the paralytic subtype.

    PubMed

    Tepsumethanon, Veera; Likitsuntonwong, Wanlop; Thorner, Paul Scott; Shuangshoti, Shanop

    2016-09-01

    Rabies infection can manifest as either encephalitic (furious) or paralytic (dumb) types, with a ratio of approximately 2:1 in dogs. The clinical type of rabies that develops post-vaccination has only been reported in studies from one country, all with similar findings. We report a study of 36 rabid dogs with obtainable vaccination history, presenting to The Queen Saovabha Memorial Institute, Bangkok, Thailand during 2002-2008. Dogs were classified into encephalitic or paralytic types. Of 22 non-vaccinated dogs, 16 (73%) had the encephalitic type. In contrast, of the 14 vaccinated dogs, 10 (71%) had the paralytic type, a difference that was significant (p=0.016). Recent studies on canine brains have shown that lymphocyte response is more pronounced in paralytic rabies at the brainstem level, whereas viral burden is greater in the encephalitic form. We postulate partial immune response in the vaccinated dogs might influence rabies to manifest as the paralytic type. These results can serve as a natural experiment that can help explain the basis for the differences between the paralytic and encephalitic forms of canine rabies.

  20. Worry, Intolerance of Uncertainty, and Statistics Anxiety

    ERIC Educational Resources Information Center

    Williams, Amanda S.

    2013-01-01

    Statistics anxiety is a problem for most graduate students. This study investigates the relationship between intolerance of uncertainty, worry, and statistics anxiety. Intolerance of uncertainty was significantly related to worry, and worry was significantly related to three types of statistics anxiety. Six types of statistics anxiety were…

  1. Two cases of hereditary fructose intolerance.

    PubMed

    Ananth, N; Praveenkumar, G S; Rao, K Aravind; Vasanthi; Kakkilaya, Srinivas

    2003-07-01

    Hereditary fructose intolerance is a rare cause of hepatic cirrhosis in the young. The disorder has a reported frequency of 1 in 20000 live births and no case has been reported from India so far. We report two cases of hereditary fructose intolerance, both with bilateral cataracts and one with cirrhosis of the liver.

  2. Worry, Intolerance of Uncertainty, and Statistics Anxiety

    ERIC Educational Resources Information Center

    Williams, Amanda S.

    2013-01-01

    Statistics anxiety is a problem for most graduate students. This study investigates the relationship between intolerance of uncertainty, worry, and statistics anxiety. Intolerance of uncertainty was significantly related to worry, and worry was significantly related to three types of statistics anxiety. Six types of statistics anxiety were…

  3. Metabolic causes of equine exercise intolerance.

    PubMed

    Foreman, J H

    1996-12-01

    Metabolic causes of exercise intolerance can be subtle and difficult to document in horses. Because of increased metabolic rate in exercising muscle, most metabolic causes of exercise intolerance are clinically manifested by muscle abnormalities such as ER. Newer causes of ER are being documented by current research and are summarized in the article on muscular causes of equine exercise intolerance. Endocrine causes of exercise intolerance have been poorly documented, but recent work has shown the detrimental effects of hypothyroidism on exercise tolerance in horses. Many metabolic manifestations of exercise intolerance are cumulative in heat exhaustion; prevention by veterinary monitoring is the best treatment, followed by cold water bathing and oral or intravenous fluid and electrolyte replacement. Several ergogenic aids have been proposed and marketed for use in horses, but each has its own problems and few have been shown clearly to have positive effects on performance.

  4. A feasibility study into the production of a freeze-dried oyster reference material for paralytic shellfish poisoning toxins.

    PubMed

    Turner, Andrew D; Lewis, Adam M; Hatfield, Robert G; Higman, Wendy A; Burrell, Stephen

    2013-10-01

    Matrix reference materials are an essential component for the validation and quality control of analytical methodologies for the quantitation of marine biotoxins in shellfish. Given the potential advantages of reference materials in powder form, a study was conducted to assess the feasibility for the production of a freeze-dried oyster tissue reference material containing a range of important paralytic shellfish poisoning toxins. One bulk sample of a wet oyster tissue homogenate was generated following mass culturing of toxic Alexandrium and oyster feeding experiments. The bulk tissue was used to prepare untreated wet frozen aliquots with the remainder being freeze-dried and processed into appropriately-sized powder samples. A pre-column oxidation LC-FLD analysis was used to confirm the absence of any chromatographic artefacts resulting from the processing and to confirm acceptable homogeneity of the tissues. Excellent stability over both the short-term (1 month) and long-term (1 year) of the freeze-dried material was demonstrated as compared with the stability of the untreated wet tissue. A post-column oxidation LC-FLD method was used to confirm the absence of toxin epimerisation in freeze-dried tissues which were observed in the wet tissues. Overall the work showed the feasibility of an approach to produce a homogenous freeze-dried oyster matrix material with enhanced stability in comparison to the untreated wet tissue. The potential for use of the process for preparation of large scale production batches of a freeze-dried CRM for paralytic shellfish poisoning toxins has therefore been demonstrated.

  5. Space Flight Orthostatic Intolerance Protection

    NASA Technical Reports Server (NTRS)

    Luty, Wei

    2009-01-01

    This paper summarizes investigations conducted on different orthostatic intolerance protection garments. This paper emphasizes on the engineering and operational aspects of the project. The current Shuttle pneumatic Anti-G Suit or AGS at 25 mmHg (0.5 psi) and customized medical mechanical compressive garments (20-30 mmHg) were tested on human subjects. The test process is presented. The preliminary results conclude that mechanical compressive garments can ameliorate orthostatic hypotension in hypovolemic subjects. A mechanical compressive garment is light, small and works without external pressure gas source; however the current garment design does not provide an adjustment to compensate for the loss of mass and size in the lower torso during long term space missions. It is also difficult to don. Compression garments that do not include an abdominal component are less effective countermeasures than garments which do. An early investigation conducted by the Human Adaptation and Countermeasures Division at Johnson Space Center (JSC) has shown there is no significant difference between the protection function of the AGS (at 77 mmHg or 1.5 psi) and the Russian anti-g suit, Kentavr (at 25 mmHg or 0.5 psi). Although both garments successfully countered hypovolemia-induced orthostatic intolerance, the Kentavr provided protection by using lower levels of compression pressure. This more recent study with a lower AGS pressure shows that pressures at 20-30 mmHg is acceptable but protection function is not as effective as higher pressure. In addition, a questionnaire survey with flight crewmembers who used both AGS and Kentavr during different missions was also performed.

  6. Space Flight Orthostatic Intolerance Protection

    NASA Technical Reports Server (NTRS)

    Luty, Wei

    2009-01-01

    This paper summarizes investigations conducted on different orthostatic intolerance protection garments. This paper emphasizes on the engineering and operational aspects of the project. The current Shuttle pneumatic Anti-G Suit or AGS at 25 mmHg (0.5 psi) and customized medical mechanical compressive garments (20-30 mmHg) were tested on human subjects. The test process is presented. The preliminary results conclude that mechanical compressive garments can ameliorate orthostatic hypotension in hypovolemic subjects. A mechanical compressive garment is light, small and works without external pressure gas source; however the current garment design does not provide an adjustment to compensate for the loss of mass and size in the lower torso during long term space missions. It is also difficult to don. Compression garments that do not include an abdominal component are less effective countermeasures than garments which do. An early investigation conducted by the Human Adaptation and Countermeasures Division at Johnson Space Center (JSC) has shown there is no significant difference between the protection function of the AGS (at 77 mmHg or 1.5 psi) and the Russian anti-g suit, Kentavr (at 25 mmHg or 0.5 psi). Although both garments successfully countered hypovolemia-induced orthostatic intolerance, the Kentavr provided protection by using lower levels of compression pressure. This more recent study with a lower AGS pressure shows that pressures at 20-30 mmHg is acceptable but protection function is not as effective as higher pressure. In addition, a questionnaire survey with flight crewmembers who used both AGS and Kentavr during different missions was also performed.

  7. Orthostatic intolerance: potential pathophysiology and therapy.

    PubMed

    Lu, Chih-Cherng; Tseng, Ching-Jiunn; Tang, Hung-Shang; Tung, Che-Se

    2004-09-30

    Orthostatic intolerance affects an estimated 1 in 500 persons and causes a wide range of disabilities. After essential hypertension, it is the most frequently encountered dysautonomia, accounting for the majority of patients referred to centers specializing in autonomic disorders. Patients are typically young females with symptoms such as dizziness, visual changes, head and neck discomfort, poor concentration, fatigue, palpitations, tremulousness, anxiety, and, in some cases, syncope. Syncope is the most hazardous symptom of orthostatic intolerance, presumably occurring because of impaired cerebral perfusion and in part to compensatory autonomic mechanisms. The etiology of this syndrome is still unclear but is heterogeneous. Orthostatic intolerance used to be characterized by an overall enhancement of noradrenergic tone at rest in some patients and by a patchy dysautonomia of postganglionic sympathetic fibers with a compensatory cardiac sympathetic activation in others. However, recent advances in molecular genetics are improving our understanding of orthostatic intolerance, such as several genetic diseases (such as Ehler-Danlos syndrome and norepinephrine transporter deficiency) presenting with symptoms typical of orthostatic intolerance. Future work will include investigation of genetic functional mutations underlying interindividual differences in autonomic cardiovascular control, body fluid regulation, and vascular regulation in orthostatic intolerance patients. The goal of this review article is to describe recent advances in understanding the pathophysiological mechanisms of orthostatic intolerance and their clinical significance.

  8. Statin intolerance - a question of definition.

    PubMed

    Algharably, Engi Abdel-Hady; Filler, Iris; Rosenfeld, Stephanie; Grabowski, Katja; Kreutz, Reinhold

    2017-01-01

    Statin therapy is the backbone of pharmacologic therapy for low-density lipoproteins cholesterol lowering and plays a pivotal role in cardiovascular disease prevention. Statin intolerance is understood as the inability to continue using a statin to reduce individual cardiovascular risk sufficiently, due to the development of symptoms or laboratory abnormalities attributable to the initiation or dose escalation of a statin. Muscle symptoms are the most common side effects observed. Areas covered: The main aim of this article is to present a review on published definitions of statin intolerance. In addition, a brief review on clinical aspects and risk factors of statin intolerance is provided and features for a common definition for statin intolerance are suggested. Expert opinion: A definition of statin intolerance by major drug regulatory agencies is not available. In clinical studies, different definitions are chosen and results are not comparable; different medical associations do not agree on one common definition. There is an unmet need to establish a common definition of statin intolerance to ensure an appropriate clinical use of this important drug class. Further work is required to develop a consensus definition on statin intolerance that could have significant positive impact on both research and clinical management.

  9. [Analysis of paralytic shellfish poison of bivalves in seafood market in Guangzhou].

    PubMed

    Nie, Li-Hua; Jiang, Tian-Jiu; Yang, Wei-Dong; Liu, Jie-Sheng

    2005-01-01

    The investigations of the paralytic shellfish poisoning (PSP) from Huangsha seafood market of Guangzhou was performed to assess the risk of PSP in bivalves. The concentration and profiles of PSP toxins in bivalves were determined by mouse bioassay of AOAC and high-performance liquid chromatography (HPLC). The risk assessment of PSP in bivalves was conducted with FAO and Chinese Administration Organization of Fish Culture and Seaport. The content of PSP detected was lower than the safe standard (4 MU/g meat) in all of the 84 samples, one of which had the highest toxicity with 1.84 MU/g muscle. These results suggested that the bivalves in seafood market was safe to feed. It was 9 samples' gland in 2 species that be detected to have PSP in the bivalves being researched, the muscles had few PSP. The concentration of PSP in one sample's gland exceeded the threshold of FAO (4 MU/g) with 14.52 MU/g meat, and the profiles of PSP in the gland were B1, GTX2/3, GTX1/4 and C according to HPLC. These results suggested that both of the concentration and detection rate of PSP of bivalves in seafood market in Guangzhou were low as a whole, but the content and discovery rate of PSP were far higher in glands than in the muscles, and the PSP content in one gland exceeded the threshold of Standard. The levels of PSP contamination in shellfish was characteristic of season. The toxins level in shellfish were the maximum in spring, but the frequency of toxins detected in shellfish was higher in summer and autumn, so the detection and risk assessment of PSP in bivalves from seafood market was essential in the future.

  10. Case Report: Paralytic Shellfish Poisoning in Sabah, Malaysia.

    PubMed

    Suleiman, Maria; Jelip, Jenarun; Rundi, Christina; Chua, Tock H

    2017-10-09

    During the months of January-February and May-June 2013 coinciding with the red tide occurrence in Kota Kinabalu, Sabah, Malaysia, six episodes involving 58 cases of paralytic shellfish poisoning (PSP) or saxitoxin (STX) poisoning and resulting in four deaths were reported. Many of them were intoxicated from consuming shellfish purchased from the markets, whereas others were intoxicated from eating shellfish collected from the beach. Levels of STX in shellfish collected from the affected areas were high (mean 2,920 ± 780 and 360 ± 140 µg STX equivalents/100 g shellfish meat respectively for the two periods). The count of toxic dinoflagellates (Pyrodinium bahamense var compressum) of the sea water sampled around the coast was also high (mean 34,200 ± 10,300 cells/L). Species of shellfish containing high levels of STX were Atrina fragilis, Perna viridis, and Crassostrea belcheri. The age of victims varied from 9 to 67 years. Symptoms presented were typical of PSP, such as dizziness, numbness, vomiting, and difficulty in breathing. Recommended steps to prevent or reduce PSP in future red tide season include better monitoring of red tide occurrence, regular sampling of shellfish for determination of STX level, wider dissemination of information on the danger of eating contaminated shellfish among the communities, fishermen, and fishmongers.

  11. Total hip arthroplasty in paralytic dislocation from poliomyelitis.

    PubMed

    Laguna, Rafael; Barrientos, Jesús

    2008-02-01

    This article presents a case of a patient with degenerative hip disease in paralytic dislocation by poliomyelitis. Poliomyelitis is an acute infection disease caused by a group of neurotrophic viruses, which has a special affinity by the anterior horns cells of the spinal cord and for certain motor nuclei of the brain stem. Paralysis is a flaccid type and characteristically paralysis is asymmetrical. It is said that the joints of the affected limb by poliomyelitis are protected from the development of osteoarthritis. Hip dislocation in poliomyelitis is an acquired deformity caused by flaccid paralysis and the resulting muscular imbalance. In young children, when the gluteus maximus and medius muscles are paralyzed and the hip flexors and adductors are of normal strength, eventual luxation of the hip is almost inevitable. Hip osteoarthritis in a limb with poliomyelitis is an unusual entity because these limbs do not support excessive loads. In patients who present with the residual effects of poliomyelitis including degenerative disease and hip dysplastic, surgery is one of the most difficult challenges faced by reconstructive surgeons. In such cases, surgeons should attempt to optimize the component position and choice, surgical approach, and soft tissue tensioning because stability of the prosthesis can be problematic.

  12. Customized gold weight eyelid implantation in paralytic lagophthalmos.

    PubMed

    Jayashankar, N; Morwani, K P; Shaan, M J; Bhatia, S R; Patil, K T

    2008-10-01

    Gold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import. We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure. A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question. Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases. Customized gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.

  13. [Progress on the research of lactose intolerance].

    PubMed

    Chen, J; Sai, X Y

    2016-02-01

    Our group generalized the research development of lactose intolerance, both internationally and nationally. We systematically reviewed the pathogenesis, genetic polymorphisms of lactase deficiency, relevant progress of diagnostic methods and treatment. Through this systematic review, we undedrstood that there were insufficient research efforts made on understanding the epidemiological feature of lactose intolerance in this country. Relevant genetic mutations of people were also not clear, neither the development of simple and effective diagnosis method made. We should continue to extensively and deeply carry out the study regarding methods for early prevention and intervention on lactose intolerance.

  14. Molecular Chaperone Calnexin Regulates the Function of Drosophila Sodium Channel Paralytic

    PubMed Central

    Xiao, Xi; Chen, Changyan; Yu, Tian-Ming; Ou, Jiayao; Rui, Menglong; Zhai, Yuanfen; He, Yijing; Xue, Lei; Ho, Margaret S.

    2017-01-01

    Neuronal activity mediated by voltage-gated channels provides the basis for higher-order behavioral tasks that orchestrate life. Chaperone-mediated regulation, one of the major means to control protein quality and function, is an essential route for controlling channel activity. Here we present evidence that Drosophila ER chaperone Calnexin colocalizes and interacts with the α subunit of sodium channel Paralytic. Co-immunoprecipitation analysis indicates that Calnexin interacts with Paralytic protein variants that contain glycosylation sites Asn313, 325, 343, 1463, and 1482. Downregulation of Calnexin expression results in a decrease in Paralytic protein levels, whereas overexpression of the Calnexin C-terminal calcium-binding domain triggers an increase reversely. Genetic analysis using adult climbing, seizure-induced paralysis, and neuromuscular junction indicates that lack of Calnexin expression enhances Paralytic-mediated locomotor deficits, suppresses Paralytic-mediated ghost bouton formation, and regulates minature excitatory junction potentials (mEJP) frequency and latency time. Taken together, our findings demonstrate a need for chaperone-mediated regulation on channel activity during locomotor control, providing the molecular basis for channlopathies such as epilepsy. PMID:28326013

  15. Mechanisms of post-flight orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Blomqvist, C. G.; Buckey, J. C.; Gaffney, F. A.; Lane, L. D.; Levine, B. D.; Watenpaugh, D. E.

    1994-01-01

    Post-flight orthostatic intolerance is a dramatic physiological consequence of human adaptation to microgravity made inappropriate by a sudden return to 1-G. The immediate mechanism is almost always a failure to maintain adequate tissue perfusion, specifically perfusion of the central nervous system, but vestibular dysfunction may occasionally be the primary cause. Orthostatic intolerance is present in a wide range of clinical disorders of the nervous and cardiovascular systems. The intolerance that is produced by spaceflight and 1-G analogs (bed rest, head-down tilt at a moderate angle, water immersion) is different from its clinical counterparts by being only transiently present in subjects who otherwise have normal cardiovascular and regulatory systems. However, the same set of basic pathophysiological elements should be considered in the analysis of any form of orthostatic intolerance.

  16. Mechanisms of post-flight orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Blomqvist, C. G.; Buckey, J. C.; Gaffney, F. A.; Lane, L. D.; Levine, B. D.; Watenpaugh, D. E.

    1994-01-01

    Post-flight orthostatic intolerance is a dramatic physiological consequence of human adaptation to microgravity made inappropriate by a sudden return to 1-G. The immediate mechanism is almost always a failure to maintain adequate tissue perfusion, specifically perfusion of the central nervous system, but vestibular dysfunction may occasionally be the primary cause. Orthostatic intolerance is present in a wide range of clinical disorders of the nervous and cardiovascular systems. The intolerance that is produced by spaceflight and 1-G analogs (bed rest, head-down tilt at a moderate angle, water immersion) is different from its clinical counterparts by being only transiently present in subjects who otherwise have normal cardiovascular and regulatory systems. However, the same set of basic pathophysiological elements should be considered in the analysis of any form of orthostatic intolerance.

  17. [Congenital fructose intolerance. New molecular aspects].

    PubMed

    Larsen, K; Adnanes, O; Aarskog, N K; Runde, I; Ogreid, D

    1994-11-20

    Hereditary fructose intolerance is a human autosomal recessive disease caused by a deficiency of aldolase B that results in an inability to metabolize fructose and related sugars. Molecular analyses have shown that most defects are caused by point mutations in critical regions of the aldolase B gene. We have performed PCR-based DNA analysis of members of two Norwegian families with hereditary fructose intolerance. The affected individuals from both families contained a point mutation (A149P) in exon 5 of the aldolase B gene. Molecular diagnosis of fructose intolerance is rapid and specific, and causes no inconvenience to the patient. It should be preferred to conventional fructose intolerance tests and visceral biopsy analyses.

  18. Lactose intolerance: from diagnosis to correct management.

    PubMed

    Di Rienzo, T; D'Angelo, G; D'Aversa, F; Campanale, M C; Cesario, V; Montalto, M; Gasbarrini, A; Ojetti, V

    2013-01-01

    This review discusses one of the most relevant problems in gastrointestinal clinical practice: lactose intolerance. The role of lactase-persistence alleles the diagnosis of lactose malabsorption the development of lactose intolerance symptoms and its management. Most people are born with the ability to digest lactose, the major carbohydrate in milk and the main source of nutrition until weaning. Approximately, 75% of the world's population loses this ability at some point, while others can digest lactose into adulthood. Symptoms of lactose intolerance include abdominal pain, bloating, flatulence and diarrhea with a considerable intraindividual and interindividual variability in the severity. Diagnosis is most commonly performed by the non invasive lactose hydrogen breath test. Management of lactose intolerance consists of two possible clinical choice not mutually exclusive: alimentary restriction and drug therapy.

  19. Paralytic shellfish toxins in clinical matrices: Extension of AOAC official method 2005.06 to human urine and serum and application to a 2007 case study in Maine

    NASA Astrophysics Data System (ADS)

    DeGrasse, Stacey; Rivera, Victor; Roach, John; White, Kevin; Callahan, John; Couture, Darcie; Simone, Karen; Peredy, Tamas; Poli, Mark

    2014-05-01

    Paralytic shellfish poisoning (PSP), a potentially fatal foodborne illness, is often diagnosed anecdotally based on symptoms and dietary history. The neurotoxins responsible for PSP, collectively referred to as the saxitoxins or paralytic shellfish toxins (PSTs), are natural toxins, produced by certain dinoflagellates, that may accumulate in seafood, particularly filter-feeding bivalves. Illnesses are rare because of effective monitoring programs, yet occasional poisonings occur. Rarely are contaminated food and human clinical samples (e.g., urine and serum) available for testing. There are currently few methods, none of which are validated, for determining PSTs in clinical matrices. This study evaluated AOAC (Association of Analytical Communities) Official Method of Analysis (OMA) 2005.06. [AOAC Official Method 2005.06 Paralytic Shellfish Poisoning Toxins in Shellfish: Prechormatographic Oxidation and Liquid Chromatography with Fluorescence Detection. In Official Methods of Analysis of AOAC International ], validated only for shellfish extracts, for its extension to human urine and serum samples. Initial assessment of control urine and serum matrices resulted in a sample cleanup modification when working with urine to remove hippuric acid, a natural urinary compound of environmental/dietary origin, which co-eluted with saxitoxin. Commercially available urine and serum matrices were then quantitatively spiked with PSTs that were available as certified reference materials (STX, dcSTX, B1, GTX2/3, C1/2, NEO, and GTX1/4) to assess method performance characteristics. The method was subsequently applied successfully to a PSP case study that occurred in July 2007 in Maine. Not only were PSTs identified in the patient urine and serum samples, the measured time series also led to the first report of human PST-specific urinary elimination rates. The LC-FD data generated from this case study compared remarkably well to results obtained using AOAC

  20. Evidence of paralytic shellfish poisoning toxin in milkfish in South Taiwan.

    PubMed

    Chou, H-N; Chung, Y-C; Cho, W-C; Chen, C-Y

    2003-06-01

    Natural phytoplankton blooms of the dinoflagellate Alexandrium minutum, milkfish (Chanos chanos) exposed to natural blooms, sediment and mangrove crab (Scylla serrata) were analysed for paralytic shellfish poisoning toxins by high-performance liquid chromatography. The toxin profiles of milkfish and mangrove crab were similar to that of A. minutum collected from blooming fishponds. In a laboratory A. minutum-blooming environment, the stomach and intestine of milkfish accumulated paralytic shellfish poisoning toxins during the exposure period. The non-visceral tissues were non-toxic. However, milkfish lost their entire body burden of toxin on the first day of transferring to a toxic algae-free environment. The result shows that milkfish concentrate paralytic shellfish poisoning toxins in digestive organs and did not retain toxins.

  1. Paralytic shellfish poisons produced by the freshwater cyanobacterium Aphanizomenon flos-aquae NH-5.

    PubMed

    Mahmood, N A; Carmichael, W W

    1986-01-01

    A single filament clonal isolate of Aphanizomenon flos-aquae was made from a water bloom sample taken at a small pond near Durham, New Hampshire, in 1980. When batch cultured the strain was toxic to mice and had an i.p. LD50 of about 5.0 mg/kg. Using an extraction procedure originally designed for paralytic shellfish poisons and other neurotoxins of freshwater cyanobacteria, a purification method was developed. The procedure involved acidified water/ethanol extraction of the cells followed by ultrafiltration, gel filtration, use of C18 cartridges to remove pigments, ion-exchange and high performance liquid chromatography using u.v. detection at 220 or 240 nm. Thin-layer chromatography and high performance liquid chromatography results indicate that Aphanizomenon flos-aquae NH-5 may produce paralytic shellfish poisons, mainly neo-saxitoxin and saxitoxin. Three labile toxins were also detected which were not similar to any of the known paralytic shellfish poisons.

  2. A developing country perspective on vaccine-associated paralytic poliomyelitis.

    PubMed Central

    John, T. Jacob

    2004-01-01

    When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV). Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP). Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP. Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio. To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV. Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV. Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking. Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin. PMID:15106301

  3. [Non-paralytic pontine exotropia with alternating exotropia].

    PubMed

    Deguchi, K; Takeuchi, H; Touge, T; Tsukaguchi, M; Sasaki, I; Ishibashi, T; Nishioka, M

    1996-02-01

    We report a patient with pontine infarction who showed non-paralytic pontine exotropia (NPPE) with alternating exotropia. An 81-year old woman developed diplopia and gait disturbance. On the fourth day, she was admitted to our hospital. Oculomotor findings on admission showed that the ocular position of the left eye on forward gaze was fixed at the midline, while the right eye was abducted. When she was instructed to use the right eye for forward gaze, the left eye deviated outward. On right gaze, the left eye was not abducted and monocular nystagmus was noted in the abducted right eye. Upper gaze was limited in the right eye and convergence was not possible. The remaining ocular movements were intact. On cranial CT performed on eye closure, the left eye was abducted and the right eye was fixed at the midline. Brain MRI showed cerebral infarction located in the left paramedian portion of the middle pontine tegmentum with involvement of the medial longitudinum fasciculus (MLF) and in the ventral site of the upper pons. On the 16th day, right exotropia disappeared on eye opening without forward gaze, but forward gaze easily induced outward deviation of the right eye. On the 39th day, right exotropia on forward gaze had almost disappeared. However, left MLF syndrome and abnormal convergence were persistent when she discharged on the 76th day. In conjunction with oculomotor and neuroradiological findings, the NPPE with alternating exotropia in our patient may be due to severe MLF damage and secondary hyperactivity of the contralateral paramedian pontine reticular formation.

  4. Frequency of methotrexate intolerance in rheumatoid arthritis patients using methotrexate intolerance severity score (MISS questionnaire).

    PubMed

    Fatimah, Nibah; Salim, Babur; Nasim, Amjad; Hussain, Kamran; Gul, Harris; Niazi, Sarah

    2016-05-01

    The objective of the study was to determine the frequency of methotrexate intolerance in rheumatoid arthritis (RA) patients by applying the methotrexate intolerance severity score (MISS) questionnaire and to see the effect of dose and concomitant use of other disease-modifying antirheumatic drugs (DMARDS) on methotrexate (MTX) intolerance. For the descriptive study, non-probability sampling was carried out in the Female Rheumatology Department of Fauji Foundation Hospital (FFH), Rawalpindi, Pakistan. One hundred and fifty diagnosed cases of RA using oral MTX were selected. The MISS questionnaire embodies five elements: abdominal pain, nausea, vomiting, fatigue and behavioural symptoms. The amplitude of each element was ranked from 0 to 3 being no complaint (0 points), mild (1 point), moderate (2 points) and severe (3 points). A cut-off score of 6 and above ascertained intolerance by the physicians. A total of 33.3 % of the subjects exhibited MTX intolerance according to the MISS questionnaire. Out of which, the most recurring symptom of all was behavioural with a value of 44 % whereas vomiting was least noticeable with a figure of 11 %. About 6.6 % of the women with intolerance were consuming DMARDs in conjunction with MTX. Those using the highest weekly dose of MTX (20 mg) had supreme intolerance with prevalence in 46.2 % of the patients. The frequency of intolerance decreased with a decrease in weekly dose to a minimum of 20 % with 7.5 mg of MTX. MTX intolerance has moderate prevalence in RA patients and if left undetected, the compliance to use of MTX as a first-line therapy will decrease. Methotrexate intolerance is directly proportional to the dose of MTX taken. Also, there is no upstroke seen in intolerance with the use of other disease-modifying agents.

  5. Paralytic ileus in a fetus-neonate after maternal intake of benzodiazepine.

    PubMed

    Haeusler, M C; Hoellwarth, M E; Holzer, P

    1995-12-01

    Paralytic ileus of the small bowel was diagnosed in a fetus at 32 weeks' gestation after referral because of polyhydramnios. The mother had taken clonazepam, a benzodiazepine, and carbamazepine during the entire pregnancy for epilepsy. All known causes for the ileus were ruled out and at 20 months the boy has developed normally. We conclude that maternal anticonvulsant drug intake was very likely the cause of the paralytic ileus. This side-effect is known in experimental and clinical pharmacology but has not yet been described in human fetuses.

  6. Lactose intolerance in Indonesian children.

    PubMed

    Hegar, Badriul; Widodo, Ariani

    2015-01-01

    "Lactose intolerance (LI)" is considered a common problem in Asians, and in many parts of the world. Its prevalence and age of manifestation varies between by Asian country, for possible genetic or cultural reasons. Studies in Indonesian children 3-15 years old (y) are available within the past two decades, using a pure lactose tolerance test. The prevalences of lactose malabsorption (LM) in pre-elementary (3-5 y), elementary (6-11 y), and junior high (12-14 y) school-children were 21.3%, 57.8%, and 73%, respectively. An increasing trend for LM prevalence was seen within the pre-elementary group, from 9.1% at 3 y to 28.6% at 5 y. The most frequent symptoms of LI in junior high school (JHS) group were abdominal pain (64.1%), abdominal distention (22.6%), nausea (15.1%), flatulence (5.7%), and diarrhea (1.9%), mostly within one hour of lactose ingestion. In children with regular and irregular milk drinking, LM occurred in 81.2% and 69.6%; LI was found in 56.2% and 52.1%, respectively. Most JHS children with dairy-associated recurrent abdominal pain (RAP) symptoms proved to be malabsorbers. Dairy products most related to RAP were milk and yogurt. LI was found in 81% of RAP children with abdominal pain most frequently, followed by nausea, bloating, diarrhea, borborygmi, and flatulence. Symp-tom onset occurred 30 minutes after lactose ingestion, especially nausea, bloating, and abdominal pain. In RAP children LI symptoms mostly found in breath hydrogen concentration>20 ppm. More LI symptoms were found in lactose malabsorbers, but symptoms were mild and generally disappeared in 7 hours, and in most by 15 hours.

  7. Hypoxia causes glucose intolerance in humans.

    PubMed

    Oltmanns, Kerstin M; Gehring, Hartmut; Rudolf, Sebastian; Schultes, Bernd; Rook, Stefanie; Schweiger, Ulrich; Born, Jan; Fehm, Horst L; Peters, Achim

    2004-06-01

    Hypoxic respiratory diseases are frequently accompanied by glucose intolerance. We examined whether hypoxia is a cause of glucose intolerance in healthy subjects. In a double-blind within-subject crossover design, hypoxic versus normoxic conditions were induced in 14 healthy men for 30 minutes by decreasing oxygen saturation to 75% (versus 96% in control subjects) under the conditions of a euglycemic clamp. The rate of dextrose infusion needed to maintain stable blood glucose levels was monitored. Neurohormonal stress response was evaluated by measuring catecholamine and cortisol concentrations as well as cardiovascular parameters, and symptoms of anxiety. To differentiate between the effects of stress hormonal response, and hypoxia itself, on glucose intolerance, we performed hypoglycemic clamps as a nonspecific control. We found a significant decrease in dextrose infusion rate over a period of 150 minutes after the start of hypoxia (p < 0.01). Hypoxia also increased plasma epinephrine concentration (p < 0.01), heart rate (p < 0.01), and symptoms of anxiety (p < 0.05), whereas the other parameters remained unaffected. Glucose intolerance was closely comparable between hypoxic and hypoglycemic conditions (p < 0.9) despite clear differences in stress hormonal responses. Hypoxia acutely causes glucose intolerance. One of the factors mediating this effect could be an elevated release of epinephrine.

  8. The molecular basis of lactose intolerance.

    PubMed

    Campbell, Anthony K; Waud, Jonathan P; Matthews, Stephanie B

    2005-01-01

    A staggering 4000 million people cannot digest lactose, the sugar in milk, properly. All mammals, apart from white Northern Europeans and few tribes in Africa and Asia, lose most of their lactase, the enzyme that cleaves lactose into galactose and glucose, after weaning. Lactose intolerance causes gut and a range of systemic symptoms, though the threshold to lactose varies considerably between ethnic groups and individuals within a group. The molecular basis of inherited hypolactasia has yet to be identified, though two polymorphisms in the introns of a helicase upstream from the lactase gene correlate closely with hypolactasia, and thus lactose intolerance. The symptoms of lactose intolerance are caused by gases and toxins produced by anaerobic bacteria in the large intestine. Bacterial toxins may play a key role in several other diseases, such as diabetes, rheumatoid arthritis, multiple sclerosis and some cancers. The problem of lactose intolerance has been exacerbated because of the addition of products containing lactose to various foods and drinks without being on the label. Lactose intolerance fits exactly the illness that Charles Darwin suffered from for over 40 years, and yet was never diagnosed. Darwin missed something else--the key to our own evolution--the Rubicon some 300 million years ago that produced lactose and lactase in sufficient amounts to be susceptible to natural selection.

  9. [Lactose intolerance: past and present. Part 1].

    PubMed

    Buzás, György Miklós

    2015-09-20

    Lactose intolerance is the most prevalent intestinal malabsorption disorder. After presentation of its history, the author describes the emergence of lactose intolerance during the evolution of species, and the biochemistry of lactose as well as features of human and bacterial lactase enzymes are then described. The unequal distribution of lactose intolerance in different continents and population is discussed, followed by presentation of past and present prevalence data in Hungary. Adult-type hypolactasia is caused by a polymorphism of the MCM6 gene located upstream from the lactase gene on the long arm of the chromosome 2. It can be determined with the polymerase chain reaction. The intestinal symptoms of lactose intolerance are well known, but its extra-intestinal manifestations are less recognised. Invasive diagnostic methods (determination of lactase activity from small intestinal biopsies, lactose tolerance test), are accurate, but have been replaced by the non-invasive methods; their gold standard is the H2 breath test. Genetic testing is being used more and more frequently in Hungary too, and, presumably, the methane breath test will be also available in the near future. Lactose intolerance can be accompanied by inflammatory bowel diseases, coeliac disease and irritable bowel syndrome; it could be established whether this association is causal or not in order to start a correct diet and therapy.

  10. The molecular basis of lactose intolerance.

    PubMed

    Campbell, Anthony K; Waud, Jonathan P; Matthews, Stephanie B

    2009-01-01

    A staggering 4000 million people cannot digest lactose, the sugar in milk, properly. All mammals, apart from white Northern Europeans and few tribes in Africa and Asia, lose most of their lactase, the enzyme that cleaves lactose into galactose and glucose, after weaning. Lactose intolerance causes gut and a range of systemic symptoms, though the threshold to lactose varies considerably between ethnic groups and individuals within a group. The molecular basis of inherited hypolactasia has yet to be identified, though two polymorphisms in the introns of a helicase upstream from the lactase gene correlate closely with hypolactasia, and thus lactose intolerance. The symptoms of lactose intolerance are caused by gases and toxins produced by anaerobic bacteria in the large intestine. Bacterial toxins may play a key role in several other diseases, such as diabetes, rheumatoid arthritis, multiple sclerosis and some cancers. The problem of lactose intolerance has been exacerbated because of the addition of products containing lactose to various foods and drinks without being on the label. Lactose intolerance fits exactly the illness that Charles Darwin suffered from for over 40 years, and yet was never diagnosed. Darwin missed something else--the key to our own evolution--the Rubicon some 300 million years ago that produced lactose and lactase in sufficient amounts to be susceptible to natural selection.

  11. Accumulation and depuration of cyanobacterial paralytic shellfish toxins by the freshwater mussel Anodonta cygnea.

    PubMed

    Pereira, Paulo; Dias, Elsa; Franca, Susana; Pereira, Elisa; Carolino, Manuela; Vasconcelos, Vitor

    2004-07-14

    The increasing frequency by which the production of paralytic shellfish toxins (PST) by freshwater bloom-forming cyanobacteria is being noticed world-wide raises the possibility of PST bioaccumulation by freshwater mussels. This study evaluates PST accumulation and depuration by the freshwater mussel Anodonta cygnea exposed over a 14-day period to high densities (mean = 1.4 x 10(9) cells1(-1), S.D. = 0.29 x 10(9) cellsl(-1)) of the toxic cyanobacterium Aphanizomenon issatschenkoi (corresponding to a mean toxin concentration of 25.5 nmol PSTl(-1), S.D. = 9.9 nmol PSTl(-1)). Mussels were subsequently detoxified either by starvation or by feeding on the non-toxic green-algae Ankistodesmus falcatus. Filter feeding activity and toxin uptake by the mussels were followed by cell counting and toxin analysis in water samples taken before and after each daily water renewal. The accumulation and depuration of PST as well as the anatomical distribution of toxins were monitored throughout the experiment by HPLC analysis of mussel extracts. Mussels fed the toxic cyanobacterium removed on average 65.3% of cells and 40.36% of total PST daily provided. Daily rates of cell clearance (% of initial) were negatively correlated with the amounts of PST daily provided (but not with the amount of cells). This suggests a negative effect of toxins on the feeding behaviour of mussels. Small amounts of toxins could be detected in the mussels after the second day of exposure, reaching a maximum of 26 microg PST100 g(-1) by day 7. The viscera contained the greatest proportion of toxins (78%) at the start of the toxification. However, increasing amounts of PST were found in the remaining tissues (gills, mantle and foot) over time. Toxins detected in the mussel extracts were the same provided in the dietary A. issatschenkoi. Nevertheless, mussels showed a higher proportion of saxitoxin and decarbomoylsaxitoxin and a lower proportion of gonyautoxin-5 than the fed cyanobacterium. Similar depuration

  12. Vaccine-associated Paralytic Poliomyelitis in Immunodeficient Children, Iran, 1995–2008

    PubMed Central

    Shahmahmoodi, Shohreh; Mamishi, Setareh; Aghamohammadi, Asghar; Aghazadeh, Nessa; Tabatabaie, Hamideh; Gooya, Mohammad Mehdi; Zahraei, Seyed Mohsen; Mousavi, Taha; Yousefi, Maryam; Farrokhi, Kobra; Mohammadpour, Masoud; Ashrafi, Mahmoud Reza; Nategh, Rakhshandeh

    2010-01-01

    To determine the prevalence of vaccine-associated paralytic poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection. PMID:20587188

  13. TOXICITY ASSESSMENT OF PARALYTIC SHELLFISH POISONS (PSPS) USING QUANTITATIVE STRUCTURE-ACTIVITY RELATIONSHIPS

    EPA Science Inventory

    The most significant harmful algal bloom (HAB) toxin in terms of public health is commonly known as paralytic shellfish poisons (PSPs, "red tides" toxins). PSPs are neurotoxins produced by marine dinoflagellates and some cyanobacteria. PSPs comprise of over 21 natural toxins wi...

  14. TOXICITY ASSESSMENT OF PARALYTIC SHELLFISH POISONS (PSPS) USING QUANTITATIVE STRUCTURE-ACTIVITY RELATIONSHIPS

    EPA Science Inventory

    The most significant harmful algal bloom (HAB) toxin in terms of public health is commonly known as paralytic shellfish poisons (PSPs, "red tides" toxins). PSPs are neurotoxins produced by marine dinoflagellates and some cyanobacteria. PSPs comprise of over 21 natural toxins wi...

  15. Lactose intolerance in infants, children, and adolescents.

    PubMed

    Heyman, Melvin B

    2006-09-01

    The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided.

  16. High liver glycogen in hereditary fructose intolerance.

    PubMed

    Cain, A R; Ryman, B E

    1971-11-01

    A case of hereditary fructose intolerance is reported in a girl aged 2 years at the time of her death. She had apparently progressed normally until the age of 14 months. At 19 months she was admitted to hospital with failure to thrive, hepatomegaly, and superficial infections. Investigations revealed hypoglycaemia, persistent acidosis, aminoaciduria, and a high liver glycogen level which suggested that she had glycogen storage disease. There was also some evidence of malabsorption. At necropsy the liver enzyme estimations showed that fructose 1-phosphate aldolase activity was absent and that fructose 1,6-diphosphate aldolase activity was reduced. Hereditary fructose intolerance and glycogen storage disease have been confused in the past on clinical grounds, but a high liver glycogen level has not previously been reported in hereditary fructose intolerance.

  17. Proposed Biotransformation Pathways for New Metabolites of Paralytic Shellfish Toxins Based on Field and Experimental Mussel Samples.

    PubMed

    Ding, Ling; Qiu, Jiangbing; Li, Aifeng

    2017-07-12

    A seafood poisoning event occurred in Qinhuangdao, China, in April 2016. Subsequently, the causative mussels (Mytilus galloprovincialis) were harvested and analyzed to reveal a high concentration [∼10 758 μg of saxitoxin (STX) equiv kg(-1)] of paralytic shellfish toxins (PSTs), including gonyautoxin (GTX)1/4 and GTX2/3, as well as new metabolites 11-hydroxy-STX (M2), 11,11-dihydroxy-STX (M4), open-ring 11,11-dihydroxy-STX (M6), 11-hydroxy-neosaxitoxin (NEO) (M8), and 11,11-dihydroxy-NEO (M10). To understand the origin and biotransformation pathways of these new metabolites, uncontaminated mussels (M. galloprovincialis) were fed with either of two Alexandrium tamarense strains (ATHK and TIO108) under laboratory conditions. Similar PST metabolites were also detected in mussels from both feeding experiments. Results supposed that 11-hydroxy-C2 toxin (M1) and 11,11-dihydroxy-C2 (M3) are transformed from C2, while 11-hydroxy-C4 toxin (M7) and 11,11-dihydroxy-C4 (M9) are converted from C4. In addition, the metabolites M2, M4, and M6 appear to be products of GTX2/3, and the metabolites M8 and M10 are likely derived from GTX1/4.

  18. Exposure to the Paralytic Shellfish Toxin Producer Alexandrium catenella Increases the Susceptibility of the Oyster Crassostrea gigas to Pathogenic Vibrios

    PubMed Central

    Abi-Khalil, Celina; Lopez-Joven, Carmen; Abadie, Eric; Savar, Veronique; Amzil, Zouher; Laabir, Mohamed; Rolland, Jean-Luc

    2016-01-01

    The multifactorial etiology of massive Crassostrea gigas summer mortalities results from complex interactions between oysters, opportunistic pathogens and environmental factors. In a field survey conducted in 2014 in the Mediterranean Thau Lagoon (France), we evidenced that the development of the toxic dinoflagellate Alexandrium catenella, which produces paralytic shellfish toxins (PSTs), was concomitant with the accumulation of PSTs in oyster flesh and the occurrence of C. gigas mortalities. In order to investigate the possible role of toxic algae in this complex disease, we experimentally infected C. gigas oyster juveniles with Vibrio tasmaniensis strain LGP32, a strain associated with oyster summer mortalities, after oysters were exposed to Alexandrium catenella. Exposure of oysters to A. catenella significantly increased the susceptibility of oysters to V. tasmaniensis LGP32. On the contrary, exposure to the non-toxic dinoflagellate Alexandrium tamarense or to the haptophyte Tisochrysis lutea used as a foraging alga did not increase susceptibility to V. tasmaniensis LGP32. This study shows for the first time that A. catenella increases the susceptibility of Crassostrea gigas to pathogenic vibrios. Therefore, in addition to complex environmental factors explaining the mass mortalities of bivalve mollusks, feeding on neurotoxic dinoflagellates should now be considered as an environmental factor that potentially increases the severity of oyster mortality events. PMID:26784228

  19. Dairy intake, dietary adequacy, and lactose intolerance.

    PubMed

    Heaney, Robert P

    2013-03-01

    Despite repeated emphasis in the Dietary Guidelines for Americans on the importance of calcium in the adult American diet and the recommendation to consume 3 dairy servings a day, dairy intake remains well below recommendations. Insufficient health professional awareness of the benefits of calcium and concern for lactose intolerance are among several possible reasons, This mini-review highlights both the role of calcium (and of dairy, its principal source in modern diets) in health maintenance and reviews the means for overcoming lactose intolerance (real or perceived).

  20. Pathogenic Events in a Nonhuman Primate Model of Oral Poliovirus Infection Leading to Paralytic Poliomyelitis.

    PubMed

    Shen, Ling; Chen, Crystal Y; Huang, Dan; Wang, Richard; Zhang, Meihong; Qian, Lixia; Zhu, Yanfen; Zhang, Alvin Zhuoran; Yang, Enzhuo; Qaqish, Arwa; Chumakov, Konstantin; Kouiavskaia, Diana; Vignuzzi, Marco; Nathanson, Neal; Macadam, Andrew J; Andino, Raul; Kew, Olen; Xu, Junfa; Chen, Zheng W

    2017-07-15

    Despite a great deal of prior research, the early pathogenic events in natural oral poliovirus infection remain poorly defined. To establish a model for study, we infected 39 macaques by feeding them single high doses of the virulent Mahoney strain of wild type 1 poliovirus. Doses ranging from 10(7) to 10(9) 50% tissue culture infective doses (TCID50) consistently infected all the animals, and many monkeys receiving 10(8) or 10(9) TCID50 developed paralysis. There was no apparent difference in the susceptibilities of the three macaque species (rhesus, cynomolgus, and bonnet) used. Virus excretion in stool and nasopharynges was consistently observed, with occasional viremia, and virus was isolated from tonsils, gut mucosa, and draining lymph nodes. Viral replication proteins were detected in both epithelial and lymphoid cell populations expressing CD155 in the tonsil and intestine, as well as in spinal cord neurons. Necrosis was observed in these three cell types, and viral replication in the tonsil/gut was associated with histopathologic destruction and inflammation. The sustained response of neutralizing antibody correlated temporally with resolution of viremia and termination of virus shedding in oropharynges and feces. For the first time, this model demonstrates that early in the infectious process, poliovirus replication occurs in both epithelial cells (explaining virus shedding in the gastrointestinal tract) and lymphoid/monocytic cells in tonsils and Peyer's patches (explaining viremia), extending previous studies of poliovirus pathogenesis in humans. Because the model recapitulates human poliovirus infection and poliomyelitis, it can be used to study polio pathogenesis and to assess the efficacy of candidate antiviral drugs and new vaccines.IMPORTANCE Early pathogenic events of poliovirus infection remain largely undefined, and there is a lack of animal models mimicking natural oral human infection leading to paralytic poliomyelitis. All 39 macaques fed with

  1. Food and feed enzymes.

    PubMed

    Fraatz, Marco Alexander; Rühl, Martin; Zorn, Holger

    2014-01-01

    Humans have benefited from the unique catalytic properties of enzymes, in particular for food production, for thousands of years. Prominent examples include the production of fermented alcoholic beverages, such as beer and wine, as well as bakery and dairy products. The chapter reviews the historic background of the development of modern enzyme technology and provides an overview of the industrial food and feed enzymes currently available on the world market. The chapter highlights enzyme applications for the improvement of resource efficiency, the biopreservation of food, and the treatment of food intolerances. Further topics address the improvement of food safety and food quality.

  2. Adverse reactions to food: allergies and intolerances.

    PubMed

    Montalto, Massimo; Santoro, Luca; D'Onofrio, Ferruccio; Curigliano, Valentina; Gallo, Antonella; Visca, Dina; Cammarota, Giovanni; Gasbarrini, Antonio; Gasbarrini, Giovanni

    2008-01-01

    All the anomalous reactions secondary to food ingestion are defined as 'adverse reactions to food'. In 1995 the European Academy of Allergology and Clinical Immunology suggested a classification on the basis of the responsible pathogenetic mechanism; according to this classification, non-toxic reactions can be divided into 'food allergies' when they recognize immunological mechanisms, and 'food intolerances' when there are no immunological implications. The diagnostic approach to adverse reactions to food is based on accurate clinical history and objective examination, and further execution of specific tests when allergy or intolerance is suspected. The therapy for food allergies is the elimination of the food to which hypersensibility has been found; this strategy can lead, especially in pediatric age, to tolerance. If elimination diets cannot be completely performed, or if it is not possible to identify the food to eliminate, some drugs (e.g. antihistaminics, steroids, etc.) can be administered. Specific allergen immunotherapy has been recently introduced. Fundamental is food allergy prevention, especially in high-risk subjects. The therapeutic approach to secondary food intolerances is based principally on primitive disease resolution; on the other hand, some specific treatments (e.g. beta-galactosidases in lactose malabsorption) are available in case of primary intolerance. 2008 S. Karger AG, Basel.

  3. Understanding and overcoming metformin gastrointestinal intolerance.

    PubMed

    Bonnet, Fabrice; Scheen, André

    2017-04-01

    Metformin is the most widely prescribed drug for patients with type 2 diabetes mellitus and the first-line pharmacological option as supported by multiple international guidelines, yet a rather large proportion of patients cannot tolerate metformin in adequate amounts because of its associated gastrointestinal (GI) adverse events (AEs). GI AEs typically encountered with metformin therapy include diarrhoea, nausea, flatulence, indigestion, vomiting and abdominal discomfort, with diarrhoea and nausea being the most common. Although starting at a low dose and titrating slowly may help prevent some GI AEs associated with metformin, some patients are unable to tolerate metformin at all and it may also be difficult to convince patients to start metformin again after a bout of GI AEs. Despite this clinical importance, the underlying mechanisms of the GI intolerance associated with metformin are poorly known. In the present review, we discuss: the epidemiology of metformin-associated GI intolerance and its underlying mechanisms; genotype variability and associated factors affecting metformin GI intolerance, such as comorbidities, co-medications and bariatric surgery; clinical consequences and therapeutic strategies to overcome metformin GI intolerance. These strategies include appropriate titration of immediate-release metformin, use of extended-release metformin, the promise of delayed-release metformin and gut microbiome modulators, as well as alternative pharmacological therapies when metformin cannot be tolerated at all. Given the available data, all efforts should be made to maintain metformin before considering a shift to another drug therapy.

  4. Tolerance and Intolerance in Multicultural Education.

    ERIC Educational Resources Information Center

    Heslep, Robert D.

    This essay argues that some proponents of multicultural education (ME) appear to teach intolerance of certain kinds of speech. The essay argues, in support, the down-playing of tolerance in ME as cultural respect, accommodation, and harmony are stronger candidates as virtues. The essay goes on to point out that ME does not teach cultural…

  5. [Food allergy, food intolerance or functional disorder?].

    PubMed

    Wüthrich, B

    2009-04-01

    The term "food allergy" is widely misused for all sorts of symptoms and diseases caused by food. Food allergy (FA) is an adverse reaction to food (food hypersensitivity) occurring in susceptible individuals, which is mediated by a classical immune mechanism specific for the food itself. The best established mechanism in FA is due to the presence of IgE antibodies against the offending food. Food intolerance (FI) are all non-immune-mediated adverse reactions to food. The subgroups of FI are enzymatic (e.g. lactose intolerance due to lactase deficiency), pharmacological (reactions against biogenic amines, histamine intolerance), and undefined food intolerance (e.g. against some food additives). The diagnosis of an IgE-mediated FA is made by a carefully taken case history, supported by the demonstration of an IgE sensitization either by skin prick tests or by in vitro tests, and confirmed by positive oral provocation. For scientific purposes the only accepted test for the confirmation of FA/FI is a properly performed double-blind, placebo-controlled food challenge (DBPCFC). A panel of recombinant allergens, produced as single allergenic molecules, may in future improve the diagnosis of IgE-mediated FA. Due to a lack of causal treatment possibilities, the elimination of the culprit "food allergen" from the diet is the only therapeutic option for patients with real food allergy.

  6. Milk Intolerance, Beta-Casein and Lactose

    PubMed Central

    Pal, Sebely; Woodford, Keith; Kukuljan, Sonja; Ho, Suleen

    2015-01-01

    True lactose intolerance (symptoms stemming from lactose malabsorption) is less common than is widely perceived, and should be viewed as just one potential cause of cows’ milk intolerance. There is increasing evidence that A1 beta-casein, a protein produced by a major proportion of European-origin cattle but not purebred Asian or African cattle, is also associated with cows’ milk intolerance. In humans, digestion of bovine A1 beta-casein, but not the alternative A2 beta-casein, releases beta-casomorphin-7, which activates μ-opioid receptors expressed throughout the gastrointestinal tract and body. Studies in rodents show that milk containing A1 beta-casein significantly increases gastrointestinal transit time, production of dipeptidyl peptidase-4 and the inflammatory marker myeloperoxidase compared with milk containing A2 beta-casein. Co-administration of the opioid receptor antagonist naloxone blocks the myeloperoxidase and gastrointestinal motility effects, indicating opioid signaling pathway involvement. In humans, a double-blind, randomized cross-over study showed that participants consuming A1 beta-casein type cows’ milk experienced statistically significantly higher Bristol stool values compared with those receiving A2 beta-casein milk. Additionally, a statistically significant positive association between abdominal pain and stool consistency was observed when participants consumed the A1 but not the A2 diet. Further studies of the role of A1 beta-casein in milk intolerance are needed. PMID:26404362

  7. Milk Intolerance and the American Indian

    ERIC Educational Resources Information Center

    Indian Historian, 1973

    1973-01-01

    The intolerance of milk by American Indians and other groups (Thais, Chinese, Filipinos, Melonesians of New Guinea, Australian Aborigines, Black groups of Africa, American Blacks, and Eskimos) due to the lack of the lactose enzyme is discussed in this article. (FF)

  8. [Lactose intolerance: past and present. Part II].

    PubMed

    Buzás, György Miklós

    2015-10-25

    The author summarises the interrelations between lactose intolerance, calcium and vitamin D metabolism and osteoporosis. Lactose intolerance enhances the risk of forearm and hip fractures in some patients. Lactase gene genotype and fracture risk are related in some populations. Calcium and vitamin D supplementation increase bone mineral content and they are justified in children, during pregnancy and lactation, and in postmenopausal women. The intake of milk and milk products could increase the risk of ovarian carcinoma. CC genotype of the lactase gene increased the risk of colorectal carcinoma in Finns; no such effect was observed in British, Spanish and Italian patients. Even small quantities of lactose in drugs (10-750 mg) could elicit intolerance symptoms due to individual susceptibility. In spite of public knowledge and advertising, controlled studies did not prove the beneficial effect of either a lactose-free diet, enzyme supplementation or probiotics in an evidence-based manner. While accepted guidelines are lacking, a personalised therapy is mandatory. In spite of increasing public interest in lactose intolerance, many unknown factors must still be studied.

  9. Milk Intolerance, Beta-Casein and Lactose.

    PubMed

    Pal, Sebely; Woodford, Keith; Kukuljan, Sonja; Ho, Suleen

    2015-08-31

    True lactose intolerance (symptoms stemming from lactose malabsorption) is less common than is widely perceived, and should be viewed as just one potential cause of cows' milk intolerance. There is increasing evidence that A1 beta-casein, a protein produced by a major proportion of European-origin cattle but not purebred Asian or African cattle, is also associated with cows' milk intolerance. In humans, digestion of bovine A1 beta-casein, but not the alternative A2 beta-casein, releases beta-casomorphin-7, which activates μ-opioid receptors expressed throughout the gastrointestinal tract and body. Studies in rodents show that milk containing A1 beta-casein significantly increases gastrointestinal transit time, production of dipeptidyl peptidase-4 and the inflammatory marker myeloperoxidase compared with milk containing A2 beta-casein. Co-administration of the opioid receptor antagonist naloxone blocks the myeloperoxidase and gastrointestinal motility effects, indicating opioid signaling pathway involvement. In humans, a double-blind, randomized cross-over study showed that participants consuming A1 beta-casein type cows' milk experienced statistically significantly higher Bristol stool values compared with those receiving A2 beta-casein milk. Additionally, a statistically significant positive association between abdominal pain and stool consistency was observed when participants consumed the A1 but not the A2 diet. Further studies of the role of A1 beta-casein in milk intolerance are needed.

  10. Severe lactose intolerance with lactosuria and vomiting.

    PubMed Central

    Hosková, A; Sabacký, J; Mrskos, A; Pospísil, R

    1980-01-01

    An infant with lactose intolerance is described. A breast-fed infant developed vomiting at 3 weeks, and became dehydrated. Lactosuria, aminoaciduria, and liver damage were preesent. A milk-free diet led to rapid recovery. At 6 months a normal diet was well tolerated. PMID:7416780

  11. Fear of heights and visual height intolerance.

    PubMed

    Brandt, Thomas; Huppert, Doreen

    2014-02-01

    The aim of this review is, first, to cover the different aspects of visual height intolerance such as historical descriptions, definition of terms, phenomenology of the condition, neurophysiological control of gaze, stance and locomotion, and therapy, and, second, to identify warranted epidemiological and experimental studies. Vivid descriptions of fear of heights can be found in ancient texts from the Greek, Roman, and Chinese classics. The life-time prevalence of visual height intolerance is as high as 28% in the general population, and about 50% of those who are susceptible report an impact on quality of life. When exposed to heights, visual exploration by eye and head movements is restricted, and the velocity of locomotion is reduced. Therapy for fear of heights is dominated by the behavioral techniques applied during real or virtual reality exposure. Their efficacy might be facilitated by the administration of D-cycloserine or glucocorticoids. Visual height intolerance has a considerable impact on daily life and interpersonal interactions. It is much more frequent than fear of heights, which is defined as an environmental subtype of a specific phobia. There is certainly a continuum stretching from acrophobia to a less-pronounced visual height intolerance, to which the categorical distinction of a specific phobia does not apply.

  12. Children with paralytic poliomyelitis: a cross-sectional study of knowledge, attitudes and beliefs of parents in Zamfara state, Nigeria

    PubMed Central

    2012-01-01

    Background Nigeria is one of the major African countries in which incidences of polio infection persist in spite of several eradication efforts. The preponderance of paralytic poliomyelitis particularly in the northern part of Nigeria raises the question as to whether parents of children affected with polio know how polio is contracted and spread, whether having a disabled child affects the parents’ attitude towards these children, and what they believe about poliomyelitis in view of their socio-cultural and belief system in the sub-region. Zamfara State, in the north-west of Nigeria is one of the endemic areas where resistance to the global campaign on polio eradication was very high. Therefore this study was conducted to investigate the knowledge, attitudes and beliefs of parents/primary caregivers of children affected with paralytic poliomyelitis in Zamfara State. Methods This study is a cross-sectional survey in which the multistage probability sampling technique was used to randomly select two local government areas in Zamfara State where consenting parents/primary caregivers of children with paralytic poliomyelitis were purposively selected. The knowledge, attitudes and beliefs of parents were assessed with the aid of a 4-part 52-item structured researcher administered questionnaire and the data obtained were analyzed. Results Two hundred and seventeen parents/primary caregivers participated in the study. One hundred and forty-two, (65.4%) reported good, 51 (23.8%) reported fair, while 24 (11%) of participants reported poor knowledge of paralytic poliomyelitis. More respondents 120 (55.3%) showed a positive attitude towards children with paralytic poliomyelitis. Younger age (P=0.016) and paid employment (P=0.020) were positively associated with good knowledge of paralytic poliomyelitis. Female gender (P=0.020), higher educational level (P=0.015), being employed (P=0.010) and having from middle to high household income (P=0.016) were positively associated

  13. Children with paralytic poliomyelitis: a cross-sectional study of knowledge, attitudes and beliefs of parents in Zamfara state, Nigeria.

    PubMed

    Ogwumike, Omoyemi O; Kaka, Bashir; Adeniyi, Ade F

    2012-10-22

    Nigeria is one of the major African countries in which incidences of polio infection persist in spite of several eradication efforts. The preponderance of paralytic poliomyelitis particularly in the northern part of Nigeria raises the question as to whether parents of children affected with polio know how polio is contracted and spread, whether having a disabled child affects the parents' attitude towards these children, and what they believe about poliomyelitis in view of their socio-cultural and belief system in the sub-region. Zamfara State, in the north-west of Nigeria is one of the endemic areas where resistance to the global campaign on polio eradication was very high. Therefore this study was conducted to investigate the knowledge, attitudes and beliefs of parents/primary caregivers of children affected with paralytic poliomyelitis in Zamfara State. This study is a cross-sectional survey in which the multistage probability sampling technique was used to randomly select two local government areas in Zamfara State where consenting parents/primary caregivers of children with paralytic poliomyelitis were purposively selected. The knowledge, attitudes and beliefs of parents were assessed with the aid of a 4-part 52-item structured researcher administered questionnaire and the data obtained were analyzed. Two hundred and seventeen parents/primary caregivers participated in the study. One hundred and forty-two, (65.4%) reported good, 51 (23.8%) reported fair, while 24 (11%) of participants reported poor knowledge of paralytic poliomyelitis. More respondents 120 (55.3%) showed a positive attitude towards children with paralytic poliomyelitis. Younger age (P=0.016) and paid employment (P=0.020) were positively associated with good knowledge of paralytic poliomyelitis. Female gender (P=0.020), higher educational level (P=0.015), being employed (P=0.010) and having from middle to high household income (P=0.016) were positively associated with a positive attitude toward

  14. [Lactose intolerance: pathophysiology, clinical symptoms, diagnosis and treatment].

    PubMed

    Hutyra, Tomasz; Iwańczak, Barbara

    2009-02-01

    Lactose malabsorption and milk products intolerance symptoms are the most common alimentary tract disorders. Lactose intolerance is a result of lactase deficiency or lack of lactase and lactose malabsorption. Three types of lactase deficiency were distinguished: congenital, late-onset lactase deficiency and secondary lactase deficiency. Lactose intolerance means the appearance of clinical gastrointestinal symptoms after ingestion of lactose. To the clinical symptoms of lactose intolerance belongs: nausea, vomiting, abdominal distension, cramps, flatulence, flatus, diarrhea and abdominal pain. The diagnosis of lactose intolerance is based on the breath hydrogen test and analysis of lactase activity in the small intestine mucosa. Dietary treatment eliminates clinical symptoms.

  15. Distress intolerance and clinical functioning in persons with schizophrenia

    PubMed Central

    Nugent, Katie L.; Chiappelli, Joshua; Rowland, Laura M.; Daughters, Stacey B.; Hong, L. Elliot

    2014-01-01

    Impaired tolerance to distress may help explain part of the cognitive and functional impairments in schizophrenia. This project investigated distress intolerance in schizophrenia patients (SZ) as compared to controls, and whether distress intolerance represented an independent domain in relationship to symptoms, cognition, and functional capacity. Healthy controls (n=43) and SZ (n=65) completed a psychological distress challenge experiment and their levels of intolerance to distress were estimated. SZ showed increased distress intolerance such that they were significantly more likely to terminate the distress challenge session early compared to controls. Greater distress intolerance was associated with reduced functional capacity and worse cognitive performance in SZ. Mediation analyses suggested that distress intolerance had an independent effect on functional capacity, while some of this effect was mediated by cognitive performance. Our results suggest that distress intolerance is a promising domain for treatment research, and functional capacity may be improved by targeting treatments towards SZ patient’s ability to tolerate distress. PMID:25107316

  16. Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis.

    PubMed

    Lessa, Sergio; Nanci, Marcelo; Sebastiá, Roberto; Flores, Eduardo

    2009-01-01

    To describe a technique to treat paralytic lagophthalmos and exposure keratitis with gold weight implants covered by levator aponeurosis. The authors studied a case series of 29 patients who underwent surgical treatment for paralytic lagophthalmos using the technique of gold weight implantation covered by the aponeurosis of the levator palpebrae superioris muscle between June 1997 and December 2006. None had undergone previous surgical treatment. All patients sustained their implants; there were no cases of extrusion, dislocation, or infection. Patients had significant improvement of symptoms, especially exposure keratopathy, with lagophthalmos dimensions decreased from 4 to 5 mm preoperatively to 0.5 mm after surgery. Excellent results were obtained by recessing the levator palpebrae superioris muscle aponeurosis with relaxing incisions and advancing it to overly the gold weight implant completely. Visibility of the implant in the pretarsal upper eyelid surface was minimized, extrusion was avoided, and good eyelid position was obtained.

  17. Synthesis of the Paralytic Shellfish Poisons (+)-Gonyautoxin 2, (+)-Gonyautoxin 3, and (+)-11,11-Dihydroxysaxitoxin.

    PubMed

    Mulcahy, John V; Walker, James R; Merit, Jeffrey E; Whitehead, Alan; Du Bois, J

    2016-05-11

    The paralytic shellfish poisons are a collection of guanidine-containing natural products that are biosynthesized by prokaryote and eukaryote marine organisms. These compounds bind and inhibit isoforms of the mammalian voltage-gated Na(+) ion channel at concentrations ranging from 10(-11) to 10(-5) M. Here, we describe the de novo synthesis of three paralytic shellfish poisons, gonyautoxin 2, gonyautoxin 3, and 11,11-dihydroxysaxitoxin. Key steps include a diastereoselective Pictet-Spengler reaction and an intramolecular amination of an N-guanidyl pyrrole by a sulfonyl guanidine. The IC50's of GTX 2, GTX 3, and 11,11-dhSTX have been measured against rat NaV1.4, and are found to be 22 nM, 15 nM, and 2.2 μM, respectively.

  18. Paralytic toxins in three new gastropod (Olividae) species implicated in food poisoning in southern Taiwan.

    PubMed

    Hwang, Pai-An; Tsai, Yung-Hsiang; Lu, Ya-Hui; Hwang, Deng-Fwu

    2003-03-01

    The toxins in the new gastropods Oliva miniacea, O. mustelina and O. nirasei implicated in a food paralytic poisoning incident in South Taiwan in February 2002 were studied. It was found that the three species of gastropods contained moderate amounts of toxin in edible portion only, and the highest toxicity score was 18 MU/g for O. miniacea, 10 MU/g for O. mustelina, and 27 MU/g for O. nirasei. The toxin was partially purified from the toxic specimens of each species by ultrafiltration using a YM-1 membrane, followed by chromatography on Bio-Gel P-2 column. Analyses by HPLC, GC-MS and LC-MS showed that the toxin from O. miniacea, O. nirasei and O. mustelina contained TTX, and related compounds 4-epi TTX and anhydro-TTX. The paralytic shellfish poisons were not found.

  19. Warm temperature acclimation impacts metabolism of paralytic shellfish toxins from Alexandrium minutum in commercial oysters.

    PubMed

    Farrell, Hazel; Seebacher, Frank; O'Connor, Wayne; Zammit, Anthony; Harwood, D Tim; Murray, Shauna

    2015-09-01

    Species of Alexandrium produce potent neurotoxins termed paralytic shellfish toxins and are expanding their ranges worldwide, concurrent with increases in sea surface temperature. The metabolism of molluscs is temperature dependent, and increases in ocean temperature may influence both the abundance and distribution of Alexandrium and the dynamics of toxin uptake and depuration in shellfish. Here, we conducted a large-scale study of the effect of temperature on the uptake and depuration of paralytic shellfish toxins in three commercial oysters (Saccostrea glomerata and diploid and triploid Crassostrea gigas, n = 252 per species/ploidy level). Oysters were acclimated to two constant temperatures, reflecting current and predicted climate scenarios (22 and 27 °C), and fed a diet including the paralytic shellfish toxin-producing species Alexandrium minutum. While the oysters fed on A. minutum in similar quantities, concentrations of the toxin analogue GTX1,4 were significantly lower in warm-acclimated S. glomerata and diploid C. gigas after 12 days. Following exposure to A. minutum, toxicity of triploid C. gigas was not affected by temperature. Generally, detoxification rates were reduced in warm-acclimated oysters. The routine metabolism of the oysters was not affected by the toxins, but a significant effect was found at a cellular level in diploid C. gigas. The increasing incidences of Alexandrium blooms worldwide are a challenge for shellfish food safety regulation. Our findings indicate that rising ocean temperatures may reduce paralytic shellfish toxin accumulation in two of the three oyster types; however, they may persist for longer periods in oyster tissue. © 2015 John Wiley & Sons Ltd.

  20. Paralytic poliomyelitis during the pre-, peri- and post-suspension periods of a polio immunization campaign.

    PubMed

    Lamina, S; Hanif, S

    2008-07-01

    A total of 744 paralytic poliomyelitis patients (0-59 months old) were reviewed and results showed a critical and perpetual surge during 2003 (20.2%), 2004 (27.4%) and 2005 (41%). A slight male predominance (56%) was reported and a high incidence was reported in the low socioeconomic (68.3%) and urban setting (60.3%) groups. It was concluded that the polio eradication campaigning programmes in Nigeria had not been successful and that legislation on poliomyelitis was required.

  1. Preoperative evaluation of activity and function in patients with paralytic scoliosis.

    PubMed

    Larsson, E L; Aaro, S; Ahlinder, P; Oberg, B

    1998-01-01

    Preoperative evaluation of patients with paralytic scoliosis should take into account the consequences of surgery on the every day life of the patient. However, the parameters that are customarily used in these operations relate only to very narrow measures such as the angle of scoliosis or kyphosis. The aim of this study was to introduce a set of instruments appropriate for measuring both function and activities in paralytic scoliosis patients. The study took as its starting point the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH), in which an activity is described at the level of the individual and function at the level of the organ. A consecutive series of 100 paralytic scoliosis patients with 18 different diagnoses were evaluated preoperatively with a set of instruments that had been specially developed at Linköping hospital, in which the variables are classified according to the system used in the ICIDH. The set of instruments included general information and evaluation of activities and function--sitting, balance, weight distribution to sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Barthel and ADL Klein and Bell, care given, time spent resting, and seating supports). The results showed that patients with paralytic scoliosis constitute a heterogeneous group in activities and function. Even when the patients were grouped into four subgroups according to the Scoliosis Research Society Classification, they remained very heterogeneous. However, reaching, Klein and Bell Activities of Daily Living and pain could only evaluate patients who could understand verbal instructions. In those who could not, assessment relied more heavily on measures of function and level of dependence. It was concluded that the choice of assessment must be guided by the patient's ability to understand verbal instructions irrespective of his/her disorder. It is important to use the three levels

  2. Reevaluation of Production of Paralytic Shellfish Toxin by Bacteria Associated with Dinoflagellates of the Portuguese Coast

    PubMed Central

    Martins, Claudia A.; Alvito, Paula; Tavares, Maria João; Pereira, Paulo; Doucette, Gregory; Franca, Susana

    2003-01-01

    Paralytic shellfish toxins (PSTs) are potent neurotoxins produced by certain dinoflagellate and cyanobacterial species. The autonomous production of PSTs by bacteria remains controversial. In this study, PST production by two bacterial strains, isolated previously from toxic dinoflagellates, was evaluated using biological and analytical methods. Analyses were performed under conditions determined previously to be optimal for toxin production and detection. Our data are inconsistent with autonomous bacterial PST production under these conditions, thereby challenging previous findings for the same strains. PMID:12957964

  3. Electrodiagnostic features of acute paralytic poliomyelitis associated with West Nile virus infection.

    PubMed

    Al-Shekhlee, Amer; Katirji, Bashar

    2004-03-01

    West Nile virus (WNV) infection is a potentially fatal disease, with meningoencephalitis being its most common neurological manifestation. Guillain-Barré syndrome (GBS) has also been described, but acute paralytic poliomyelitis has only recently been recognized. We report the clinical and electrodiagnostic findings of five patients with WNV infection, who presented with acute paralytic poliomyelitis. Three patients manifested focal asymmetrical weakness, and two had rapid ascending quadriplegia mimicking GBS. Electrodiagnostic studies during the acute illness showed normal sensory nerve action potentials, compound motor action potentials of normal or reduced amplitude, and no slowing of nerve conduction velocities. Depending on the timing of the examination, fibrillation potentials were widespread, including in those with focal weakness. Cervical magnetic resonance imaging in one patient showed abnormal T2-weighted signals in the spinal cord gray matter. On follow-up, signs of clinical improvement were seen in one patient, whereas two remained quadriplegic and ventilator-dependent 5 months after the onset. This report highlights the value of the electrodiagnostic studies in the diagnosis and prognosis of focal or generalized weakness due to acute paralytic poliomyelitis associated with WNV infection.

  4. Three cases of paralytic poliomyelitis associated with type 3 vaccine poliovirus strains in Bulgaria.

    PubMed

    Korsun, Neli; Kojouharova, Mira; Vladimirova, Nadezhda; Fiore, Lucia; Litvinenko, Ivan; Buttinelli, Gabriele; Fiore, Stefano; Voynova-Georgieva, Violeta; Mladenova, Zornitsa; Georgieva, Daniela

    2009-09-01

    Oral poliovirus vaccine (OPV) can cause, in extremely rare cases vaccine-associated paralytic poliomyelitis in recipients, or contacts of vaccinees. Three cases of vaccine-associated paralytic poliomyelitis (two contacts and one recipient) occurred in the Bourgas region of Bulgaria in the spring of 2006. The first two cases, notified as acute flaccid paralysis, were 55 days old unvaccinated twin brothers, having been in contact with vaccinees. The third case concerned a 4-month-old infant who had received the first OPV dose 37 days prior to the onset of illness. Complete clinical, epidemiological, virological, serological and molecular investigations of the children with paralysis and their contacts were undertaken. In all the three cases type 3 polioviruses were isolated from fecal samples and characterized as Sabin-like poliovirus strains. Type 3 polioviruses isolated from the twin brothers demonstrated by sequence analysis U-to-C back mutation at nt 472 of the 5' UTR, known to correlate with neurovirulence, and mutation in the VP1 region. Type 3 poliovirus isolated from the third child demonstrated in the 3D sequenced region a recombination with Sabin type 1 poliovirus. In the latter region, three silent mutations and one, resulting in amino acid substitution, were also observed. The clinical, epidemiological and virological data and the neurological sequelae observed 60 days following the onset of paralysis, confirmed the diagnosis of vaccine-associated paralytic poliomyelitis in all the three patients.

  5. Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos.

    PubMed

    Miyamoto, Shimpei; Takushima, Akihiko; Okazaki, Mutsumi; Momosawa, Akira; Asato, Hirotaka; Harii, Kiyonori

    2009-09-01

    Temporalis muscle transfer for paralytic lagophthalmos, which was first proposed by Gillies and later developed by Andersen, has been one of the most common treatment modalities for paralytic lagophthalmos. However, there have been no scientific reports statistically analysing the efficacy of temporalis muscle transfer. We, therefore, retrospectively analysed the functional and aesthetic results of temporalis muscle transfer. Between 1994 and 2006, we carried out temporalis muscle transfer (the so-called Gillies-Andersen method) on 95 established facial paralysis patients. We sent a postal questionnaire to these patients and 47 of them responded. The functional and aesthetic results were analysed based on the patients' replies together with clinical records and photographs, and unfavourable factors of this procedure were investigated. After surgery, most ocular symptoms (mechanical irritation, dry eye, soreness, and discharge) improved significantly. Achievement rate of complete eye closure was 78.7%. A morphometric study revealed that possible unfavourable factors (old age, intracranial disease, use of dentures, etc.) did not affect the achievement rates of complete eye closure. Deformity of eyelid fissure due to undue tension of the temporal fascia fixation was found in nine patients (19.1%) and six of these patients underwent secondary revision. Unlike lid loading with a gold implant, the results of temporalis muscle transfer depend greatly on the surgeon's skill. However, if this procedure is performed properly, strong eye closure can be obtained. We, therefore, recommend temporalis muscle transfer as the preferred option for reconstruction of paralytic lagophthalmos.

  6. Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy.

    PubMed

    Friedhofer, Henri; Coltro, Pedro Soler; Vassiliadis, Aneta Hionia; Nigro, Marcelus Vinícius; Saito, Fábio Lopes; Moura, Tatiana; Faria, José Carlos; Ferreira, Marcus Castro

    2013-08-01

    This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases. We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim. All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos. The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.

  7. Intolerance to food additives - does it exist?

    PubMed

    Turner, Paul J; Kemp, Andrew S

    2012-02-01

    'Food intolerance' is often confused with a range of adverse symptoms which may be coincidental to ingestion of food. 'Food intolerance' is defined as a reaction in which symptoms must be objectively reproducible and not known to involve an immunological mechanism. A more precise term is non-allergic food hypersensitivity, which contrasts with food allergies which are due to an immunological mechanism. Some children will experience food reactions to food additives. Reported symptoms range from urticaria/angioedema to hyperactive behaviours. While parents/carers report that over one fifth of children experience of food reaction, only 1 in 20 of these are confirmed to have a non-allergic food hypersensitivity on testing.

  8. Orthostatic intolerance: a disorder of young women

    NASA Technical Reports Server (NTRS)

    Ali, Y. S.; Daamen, N.; Jacob, G.; Jordan, J.; Shannon, J. R.; Biaggioni, I.; Robertson, D.

    2000-01-01

    Orthostatic intolerance (OI) is a cause of significant disability in otherwise healthy women seen by gynecologists. Orthostatic tachycardia is often the most obvious hemodynamic abnormality found in OI patients, but symptoms may include dizziness, visual changes, discomfort in the head or neck, poor concentration, fatigue, palpitations, tremulousness, anxiety, and, in some cases, fainting (syncope). It is the most common disorder of blood pressure regulation after essential hypertension, and patients with OI are traditionally women of childbearing age. Estimates suggest that at least 500,000 Americans suffer from some form of OI, and such patients comprise the largest group referred to centers specialized in autonomic disorders. This article reviews recent advances made in the understanding of this condition, potential pathophysiological mechanisms contributing to orthostatic intolerance, and therapeutic alternatives currently available for the management of these patients.

  9. The biochemical basis of hereditary fructose intolerance.

    PubMed

    Bouteldja, Nadia; Timson, David J

    2010-04-01

    Hereditary fructose intolerance is a rare, but potentially lethal, inherited disorder of fructose metabolism, caused by mutation of the aldolase B gene. Treatment currently relies solely on dietary restriction of problematic sugars. Biochemical study of defective aldolase B enzymes is key to revealing the molecular basis of the disease and providing a stronger basis for improved treatment and diagnosis. Such studies have revealed changes in enzyme activity, stability and oligomerisation. However, linking these changes to disease phenotypes has not always been straightforward. This review gives a general overview of the features of hereditary fructose intolerance, then concentrates on the biochemistry of the AP variant (Ala149Pro variant of aldolase B) and molecular pathological consequences of mutation of the aldolase B gene.

  10. Orthostatic intolerance: a disorder of young women

    NASA Technical Reports Server (NTRS)

    Ali, Y. S.; Daamen, N.; Jacob, G.; Jordan, J.; Shannon, J. R.; Biaggioni, I.; Robertson, D.

    2000-01-01

    Orthostatic intolerance (OI) is a cause of significant disability in otherwise healthy women seen by gynecologists. Orthostatic tachycardia is often the most obvious hemodynamic abnormality found in OI patients, but symptoms may include dizziness, visual changes, discomfort in the head or neck, poor concentration, fatigue, palpitations, tremulousness, anxiety, and, in some cases, fainting (syncope). It is the most common disorder of blood pressure regulation after essential hypertension, and patients with OI are traditionally women of childbearing age. Estimates suggest that at least 500,000 Americans suffer from some form of OI, and such patients comprise the largest group referred to centers specialized in autonomic disorders. This article reviews recent advances made in the understanding of this condition, potential pathophysiological mechanisms contributing to orthostatic intolerance, and therapeutic alternatives currently available for the management of these patients.

  11. A model of type 2 diabetes in the guinea pig using sequential diet-induced glucose intolerance and streptozotocin treatment

    PubMed Central

    Ackart, David F.; Richardson, Michael A.; DiLisio, James E.; Pulford, Bruce; Basaraba, Randall J.

    2017-01-01

    ABSTRACT Type 2 diabetes is a leading cause of morbidity and mortality among noncommunicable diseases, and additional animal models that more closely replicate the pathogenesis of human type 2 diabetes are needed. The goal of this study was to develop a model of type 2 diabetes in guinea pigs, in which diet-induced glucose intolerance precedes β-cell cytotoxicity, two processes that are crucial to the development of human type 2 diabetes. Guinea pigs developed impaired glucose tolerance after 8 weeks of feeding on a high-fat, high-carbohydrate diet, as determined by oral glucose challenge. Diet-induced glucose intolerance was accompanied by β-cell hyperplasia, compensatory hyperinsulinemia, and dyslipidemia with hepatocellular steatosis. Streptozotocin (STZ) treatment alone was ineffective at inducing diabetic hyperglycemia in guinea pigs, which failed to develop sustained glucose intolerance or fasting hyperglycemia and returned to euglycemia within 21 days after treatment. However, when high-fat, high-carbohydrate diet-fed guinea pigs were treated with STZ, glucose intolerance and fasting hyperglycemia persisted beyond 21 days post-STZ treatment. Guinea pigs with diet-induced glucose intolerance subsequently treated with STZ demonstrated an insulin-secretory capacity consistent with insulin-independent diabetes. This insulin-independent state was confirmed by response to oral antihyperglycemic drugs, metformin and glipizide, which resolved glucose intolerance and extended survival compared with guinea pigs with uncontrolled diabetes. In this study, we have developed a model of sequential glucose intolerance and β-cell loss, through high-fat, high-carbohydrate diet and extensive optimization of STZ treatment in the guinea pig, which closely resembles human type 2 diabetes. This model will prove useful in the study of insulin-independent diabetes pathogenesis with or without comorbidities, where the guinea pig serves as a relevant model species. PMID:28093504

  12. The diagnosis and management of cow milk protein intolerance in the primary care setting.

    PubMed

    Ewing, Whitney Merrill; Allen, Patricia Jackson

    2005-01-01

    Cow milk protein intolerance (CMPI) affects 3% of infants under the age of 12 months and is often misdiagnosed as GERD or colic, risking dangerous exposure to antigens. Most infants out grow CMPI by 12 months; however, those with IgE-mediated reactions usually continue to be intolerant to cow's milk proteins and also develop other allergens including environmental allergens that cause asthmatic symptoms. Clinical manifestations of CMPI include diarrhea, bloody stools, vomiting, feeding refusal, eczema, atopic dermatitis, urticaria, angioedema, allergic rhinitis, coughing, wheezing, failure to thrive, and anaphylaxis. The research and literature showed that CMPI is easily missed in the primary care setting and needs to be considered as a cause of infant distress and clinical symptoms. This article focuses on correctly diagnosing CMPI and managing it in the primary care setting.

  13. Acute rigid gas permeable contact lens intolerance.

    PubMed

    Jackson, A J; Wolsley, C; Briggs, J L; Frazer, D G

    2001-01-01

    Rigid gas permeable (RGP) and polymethylmethacrylate (PMMA) lens wearers occasionally report episodes of acute intolerance which is experienced upon lens insertion. In this paper, we report two cases of such intolerance in which the probable cause was contact lens inversion. We also present the results of a study in which a custom-built calibrated strain gauge was used to measure the force in Newtons (N), required to invert RGP lenses [oxygen permeability, or Dk, values between 30 and 90 x 10(-11) (cm2/s) (mlO2/ml x mmHg)] and PMMA lenses of different spherical back vertex powers (+/-3.00 D, 9.00 D). Significantly, less force was required to invert minus powered lenses (17.5 +/- 4.8 N) than plus powered lenses (31.7 +/- 7 .4 N), irrespective of the material. PMMA lenses required more force to induce inversion than that required to invert RGP lenses. Lenses with a Dk of 90 required only two thirds of the force (20.0 +/- 5.8 N) required to cause inversion compared to PMMA lenses (32.9 +/- 11.0 N). High powered PMMA lenses were found to be more likely to fracture on inversion than any other lenses tested. The force required to return negatively powered lenses to their original shape, once inverted, was less than 25% of that initially required to induce inversion. Plus powered lenses either reverted to their original form spontaneously, or required less than 3% of the original inversion force to do so. It was concluded that practitioners should consider inversion as a possible reason for otherwise unexplained, acute RGP contact lens intolerance experienced upon lens insertion. The reason why inversion has eluded so many, as a possible cause of intolerance, is likely to be because minimal force is required to return those lenses, which do not crack or fracture, to their original shape.

  14. Pyridostigmine in the treatment of orthostatic intolerance.

    PubMed

    Gales, Barry J; Gales, Mark A

    2007-02-01

    To review the efficacy of pyridostigmine bromide for the treatment of orthostatic intolerance. MEDLINE and International Pharmaceutical Abstracts were searched (1966-December 2006) using the terms pyridostigmine, acetylcholinesterase inhibitor, orthostatic intolerance, orthostatic hypotension, neurogenic orthostatic hypotension, postural tachycardia syndrome, tachycardia, and orthostatic tachycardia. Pertinent English-language human clinical trials, case reports, and background material were evaluated for safety and efficacy data. The references of reviewed articles were reviewed and used to identify additional sources. Pyridostigmine bromide has been associated with improved baroreceptor sensitivity and presents a novel approach to treatment of orthostatic intolerance. Four single-dose trials and a follow-up survey encompassing a total of 106 patients were identified. One open-label and one placebo-controlled single-dose trial in patients with neurogenic orthostatic hypotension (NOH) found statistically significant improvement in standing diastolic blood pressures (DBP). Absolute improvements in standing DBP were 3.7 and 6.4 mm Hg in the open-label and controlled trials, respectively. Long-term data consist of a single survey of patients receiving open-label pyridostigmine bromide. Twenty-nine percent of patients who initiated maintenance pyridostigmine bromide discontinued therapy. Concomitant NOH medications were taken by 75% of patients, and 85% of patients reported receiving benefit from pyridostigmine bromide. When evaluated for postural tachycardia syndrome, pyridostigmine bromide significantly reduced standing heart rate (10%). Pyridostigmine bromide significantly reduced symptom scores when compared with baseline but not placebo. The majority of patients included in these trials did not have supine hypertension. Single doses of pyridostigmine bromide produced modest but statistically significant improvements in hemodynamic measurements. At this time, long

  15. Lactase Non-persistence and Lactose Intolerance.

    PubMed

    Bayless, Theodore M; Brown, Elizabeth; Paige, David M

    2017-05-01

    To evaluate the clinical and nutritional significance of genetically determined lactase non-persistence and potential lactose and milk intolerance in 65-70% of the world's adult population. Milk consumption is decreasing in the USA and is the lowest in countries with a high prevalence of lactase non-persistence. The dairy industry and Minnesota investigators have made efforts to minimize the influence of lactose intolerance on milk consumption. Some lactose intolerant individuals, without co-existent irritable bowel syndrome, are able to consume a glass of milk with a meal with no or minor symptoms. The high frequency of lactase persistence in offspring of Northern European countries and in some nomadic African tribes is due to mutations in the promoter of the lactase gene in association with survival advantage of milk drinking. Educational and commercial efforts to improve calcium and Vitamin D intake have focused on urging consumption of tolerable amounts of milk with a meal, use of lowered lactose-content foods including hard cheeses, yogurt, and lactose-hydrolyzed milk products.

  16. Idiopathic orthostatic intolerance and postural tachycardia syndromes

    NASA Technical Reports Server (NTRS)

    Jacob, G.; Biaggioni, I.; Robertson, D. (Principal Investigator)

    1999-01-01

    Upright posture imposes a substantial gravitational stress on the body, for which we are able to compensate, in large part because of the autonomic nervous system. Alteration in autonomic function, therefore, may lead to orthostatic intolerance. On one extreme, patients with autonomic failure caused by degenerative loss of autonomic function are severely disabled by orthostatic hypotension and may faint whenever they stand up. Fortunately, such patients are relatively rare. On the other hand, disabling orthostatic intolerance can develop in otherwise normal young people. These patients can be severely impaired by symptoms of fatigue, tachycardia, and shortness of breath when they stand up. The actual incidence of this disorder is unknown, but these patients make up the largest group of patients referred to centers that specialize in autonomic disorders. We will review recent advances made in the understanding of this condition, potential pathophysiological mechanisms that contribute to orthostatic intolerance, therapeutic alternatives currently available for the management of these patients, and areas in which more research is needed.

  17. Seafood Allergy, Toxicity, and Intolerance: A Review.

    PubMed

    Prester, Ljerka

    2016-01-01

    Seafood allergies have been increasing their presence in the last 2 decades. Allergic reactions to seafood can range from mild urticarial and oral allergy syndrome to life-threatening anaphylactic reactions. Ingestion of seafood infested with Anisakis larvae can cause a disease known as anisakiasis with symptoms similar to true seafood allergy. Furthermore, some adverse reactions to seafood including histamine fish poisoning (HFP), and intolerance to histamine can trigger clinical symptoms, which, although nonallergic in origin, are similar to true immunoglobulin E (IgE)-mediated allergic reactions. Because seafood allergy usually remains a lifelong food allergy, this review focuses on the current knowledge on fish and shellfish allergens and emphasizes the importance of differentiating seafood allergy from other allergy-like reactions (anisakiasis, HFP, and intolerance to histamine). Key teaching points: • Fish and shellfish are potent allergens that can provoke serious IgE antibody-mediated adverse reactions in sensitive individuals. • Sensitization to seafood allergens can be achieved by ingestion, inhalation, or skin contact. • Shellfish major allergen, tropomyosin, shares significant homology to arthropods (dust mites and cockroaches). • Accidental exposures to seafood products cross-contaminated with fish or shellfish allergens (hidden allergens) during processing may present a health risk for sensitive individuals. • Allergens of fish parasite A. simplex present common hidden allergens in seafood, particularly in raw and undercooked home-made fish dishes. • Symptoms caused by HFP, histamine intolerance, and anisakiasis are similar to true seafood allergy.

  18. Lactose intolerance and lactase deficiency in children.

    PubMed

    Rings, E H; Grand, R J; Büller, H A

    1994-10-01

    The term lactase deficiency is widely used to indicate a low or absent level of lactase enzyme in the small intestine, leading to lactose intolerance. This term is correctly used when the intestinal mucosa is damaged and results in secondary lactase deficiency. In the case of the genetically determined decrease of lactase activity during childhood, however, low lactase levels suggest that the majority of the world's population is "abnormal," whereas individuals from caucasian extraction with high levels of lactase enzyme throughout life are then considered "normal." It would be better to ascribe racial and ethnic lactose malabsorption as the result of genetically determined reduction of lactase activity, rather then implying an "abnormality" by the term, "deficiency." Recent studies reveal that this genetic control is at the transcriptional level. The symptomatology of lactose intolerance varies widely, and the diagnostic method of choice is the lactose breath hydrogen test in combination with clinical findings, although small intestinal biopsies should be performed when mucosal diseases are suspected. Treatment of lactose intolerance depends on the age of the child. In young infants complete restriction of lactose containing foods is rarely necessary.

  19. High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score.

    PubMed

    Bulatović, Maja; Heijstek, Marloes W; Verkaaik, Marleen; van Dijkhuizen, E H Pieter; Armbrust, Wineke; Hoppenreijs, Esther P A; Kamphuis, Sylvia; Kuis, Wietse; Egberts, Toine C G; Sinnema, Gerben; Rademaker, Carin M A; Wulffraat, Nico M

    2011-07-01

    To design and validate a new questionnaire for identifying patients with methotrexate (MTX) intolerance, and to determine the prevalence of MTX intolerance in patients with juvenile idiopathic arthritis (JIA) using this questionnaire. The MTX Intolerance Severity Score (MISS) questionnaire was constructed, consisting of 5 domains: stomach ache, nausea, vomiting, sore mouth, and behavioral symptoms. The domains each consisted of 3 questions pertaining to the presence of a symptom upon, prior to (anticipatory), and when thinking of (associative) MTX intake. The MISS questionnaire was validated in 86 patients by determining its discriminative power between patients with and those without MTX intolerance, identified as such by a gold standard (physician's opinion). Using the MISS questionnaire, the prevalence of MTX intolerance was determined in 297 JIA patients. The MISS questionnaire discriminated well between MTX-intolerant and MTX-tolerant patients. A cutoff score of 6 yielded the best sensitivity (88%) and specificity (80%). MTX intolerance was found in 150 (50.5%) of 297 patients. Of 220 patients receiving oral MTX, 98 (44.5%) experienced MTX intolerance, whereas 67.5% of 77 patients receiving parenteral MTX experienced intolerance to the drug (P = 0.001). Our findings indicate that the MISS questionnaire is a highly sensitive and specific tool for the diagnosis of MTX intolerance, and that there is a high prevalence of MTX intolerance among JIA patients. The prevalence of intolerance in patients receiving parenteral MTX exceeds that in patients receiving oral MTX. The frequent occurrence of anticipatory and associative symptoms suggests that classic conditioning plays an important role in MTX intolerance. Copyright © 2011 by the American College of Rheumatology.

  20. Non responsive celiac disease due to coexisting hereditary fructose intolerance.

    PubMed

    Bharadia, Lalit; Shivpuri, Deepak

    2012-04-01

    Celiac disease is associated with several genetic disorders, but its association with hereditary fructose intolerance is rare. Hereditary fructose intolerance is a rare autosomal recessive disease of fructose metabolism presenting as vomiting after intake of fructose. An association between these two distinct genetic gastrointestinal disorders is important as treatment failure of celiac disease calls for careful evaluation for hereditary fructose intolerance. We report a patient with an association of these two disorders.

  1. An assessment by the Statin Intolerance Panel: 2014 update.

    PubMed

    Guyton, John R; Bays, Harold E; Grundy, Scott M; Jacobson, Terry A; The National Lipid Association Statin Intolerance Panel

    2014-01-01

    This article from the National Lipid Association Statin Intolerance Panel provides a framework for understanding statin intolerance and makes general recommendations for health professionals. For specific guidance on adverse events related to muscle, liver, cognition, and glucose metabolism, one should refer to the other reports of the Statin Safety Task Force for those topics. Although statin adverse effects rarely lead to permanent sequelae, symptomatic intolerance frequently hinders cardiovascular risk reduction by statins. We emphasize here the advisory role of the clinician helping each patient to make personal decisions on statin tolerability. We identify a pressing need for further research on statin intolerance and make suggestions for research design.

  2. Upper respiratory causes of exercise intolerance.

    PubMed

    Beard, W

    1996-12-01

    The respiratory system is a frequent cause of exercise intolerance in performance horses. Labored breathing, fatigue during performance, and prolonged recovery after exercise are common complaints. Inadequate fitness level and diseases of the cardiovascular system are differential diagnoses that share these complaints and should be ruled out. Generation of increased airway noise is a clinical sign that implicates the upper respiratory system. A careful history from the owner and endoscopy of the upper airway are the most useful diagnostic tools. Endoscopy during exercise on a treadmill is indicated when the airway lesion is not apparent with endoscopy at rest. Treatment of the respiratory obstruction may differ with the level of performance required.

  3. Control of salicylate intolerance with fish oils.

    PubMed

    Healy, E; Newell, L; Howarth, P; Friedmann, P S

    2008-12-01

    We report three patients with disabling salicylate-induced intolerance who experienced abrogation of symptoms following dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs). All three patients experienced severe urticaria, asthma requiring systemic steroid therapy and anaphylactic reactions. After dietary supplementation with 10 g daily of fish oils rich in omega-3 PUFAs for 6-8 weeks all three experienced complete or virtually complete resolution of symptoms allowing discontinuation of systemic corticosteroid therapy. Symptoms relapsed after dose reduction. Fish oil appears a safe and effective treatment for this difficult and often serious condition.

  4. [Hereditary intolerance to fructose in infants. Presentation of a clinical case].

    PubMed

    Livolsi, P

    1988-01-01

    One case of hereditary fructose intolerance is examined: the disease was known exceptionally early when the baby was about two months old. The case is classified and described with the metabolic alterations typical of the syndrome and then it is examined stressing the difficulty in diagnosing it at such an early stage of the baby's life and the possibility of worsening the symptoms with unsuitable treatments (i.e. use of solutions fructose-containing). The author concludes advising to use the utmost care in feeding the baby since its birth in order to avoid an early administration of potentially dangerous carbohydrates.

  5. Paralytic shellfish toxins in the freshwater cyanobacterium Aphanizomenon flos-aquae, isolated from Montargil reservoir, Portugal.

    PubMed

    Pereira, P; Onodera, H; Andrinolo, D; Franca, S; Araújo, F; Lagos, N; Oshima, Y

    2000-12-01

    Montargil reservoir, located in a dry flat area in the centre of Portugal, was filled in 1958 to fulfil agricultural, electric and industrial requirements. In May 1996, an intensive bloom of phytoplankton was detected. The algal community was strongly dominated by cyanobacteria with predominance of Aphanizomenon flos-aquae from May to June and Microcystis aeruginosa from July to August. Extracts of samples collected during the bloom period showed high toxicity by mouse bioassay. During the M. aeruginosa predominance period, the toxicity was ascribed to the presence of hepatotoxins, but clear symptoms of paralytic shellfish poison were observed when A. flos-aquae was the dominant species. In order to confirm the production of neurotoxins a strain of A. flos-aquae was isolated and established in culture. In this manuscript, we show the morphological characteristics and confirm paralytic shellfish toxins production by the strain isolated and maintained in culture. Identification of the saxitoxin analogs was achieved using high performance liquid chromatography with postcolumn fluorescence derivatization (HPLC-FLD) and liquid chromatographic mass spectrometry technique (LC-MS). The toxins found in the culture extract were GTX5 (64.5 mol%), neoSTX (23.0 mol%), dcSTX (6.1 mol%), STX (5.4 mol%) and GTX6 (1.1 mol%). This is, to our knowledge, the first report of unambiguous evidence of paralytic shellfish toxins produced by freshwater cyanobacteria in Portugal. The toxin profile is rather different from the previously reported PSP producing A. flos-aquae and demonstrates its diversity in terms of toxin production.

  6. [A case of hemi-hyperhidrosis and non-paralytic pontine exotropia due to brainstem infarction].

    PubMed

    Mon, Y; Mizotani, M

    1992-07-01

    A case of hemihyperhidrosis and non-paralytic pontine exotropia due to brainstem infarction is reported. A 55-year-old hypertensive man developed right hemiparesis with slight dysarthria and nausea upon awaking. The right side of his face and right upper limb and trunk to the level of the Th8-9 territory showed hyperhidrosis, which disappeared in a week. Ocular motor examination revealed that during forward gaze with the left eye fixing, the right eye deviated outward. The patient was able to adduct the right eye to midposition with the right eye fixing. Rightward gaze elicited full abduction and right-beating nystagmus of the right eye, but the left eye did not adduct. When he attempted to gaze leftward, both eyes made the full excursion, but saccades were slow in that direction. Convergence was intact. Vertical gaze was full, and he did not show Horner's sign. This ocular sign, non-paralytic pontine exotropia, disappeared three days later. T2-weighted spin echo magnetic resonance imaging disclosed a small lesion with high intensity in the inner side of the left middle pons. This hyperhidrosis was thought to be caused by destruction of inhibitory fibers thermoregulating sweating. These findings suggest that at the level of the middle pons inhibitory fibers descend along the inner side of facilitatory fibers thermoregulating sweating, which are speculated to descend the dorso-lateral part of the pontine tegmentum. These findings also suggest that lesions of non-paralytic pontine exotropia may be located in the paramedian pontine reticular formation rostral to the abducens nucleus with ipsilateral medial longitudinal fasciculus lesion, but further investigation is necessary.

  7. An epidemic of paralytic poliomyelitis characterized by dual infections with poliomyelitis and Coxsackie viruses.

    PubMed

    MELNICK, J L; KAPLAN, A S; ZABIN, E; CONTRERAS, G; LARKUM, N W

    1951-12-01

    The first known epidemic of poliomyelitis in Easton, Pennsylvania, occurred in 1949, and was unusual in the high proportion of paralytic to non-paralytic cases. Both poliomyelitis and Cosxackie, or C, viruses were isolated from more than half the patients studied during the acute stage of the disease. One month later C virus was only occasionally recovered. Classification of the 28 strains of C virus which were isolated revealed that 24 belonged to one antigenic type, Easton-2 (related to Albany type 1 virus). Patients from whom C virus was isolated showed a rise during convalescence to the Easton-2 or homologous type antibody. Two patients with paralytic poliomyelitis were studied for the quantitative development of antibodies to the poliomyelitis virus and to the C virus found in their stools. Using the neutralization test in monkeys and in newborn mice, respectively, a simultaneous rise in antibodies to both agents was observed. The situation at present can be summarized as follows:-Poliomyelitis virus or C virus may produce infection in man, with a specific antibody response. Both agents may be carried, particularly in the intestines, without causing any serious illness and healthy carrier states have been observed for each. Both viruses can be found in nature in flies and in sewage. However there has been no evidence to suggest that these two viruses bear a relationship to each other, even when isolated from the same patient. Thus, when both viruses are found in a patient with paralysis, it is not yet possible to say with any degree of accuracy to what extent each is responsible in the over-all pattern of the disease. How frequently dual infections of this nature may occur remains for future investigations to determine. Certainly all cases of poliomyelitis are not complicated by a superimposed infection with a C virus. However, this will have to be one more item to consider in epidemic poliomyelitis.

  8. [Breath tests in children with suspected lactose intolerance].

    PubMed

    Parra, P Ángela; Furió, C Simone; Arancibia, A Gabriel

    2015-01-01

    Up to 70% of the world population is lactose intolerance. However, there are no epidemiological studies among Chilean pediatric population affected by this condition. Clinical characterization of a series of children who underwent the lactose intolerance breath test for lactose intolerance study, establishing intolerance and malabsorption frequencies, the most frequent symptoms, and test performance depending on the origin. Patients under 18 years old who took the lactose intolerance breath test in the Gastroenterology Laboratory of the Catholic University of Chile, and who were admitted due to clinically suspected lactose intolerance. Malabsorption was considered when there was as an increase of ≥20ppm above the baseline (H2) or ≥34ppm of H2 and methane (CH4) combined. Intolerance was considered when the above was associated with a symptom intensity score ≥7 during registration. The analysis included194 patients aged 1 to17 years of age. Of these, 102 (53%) presented with malabsorption, and 53 (27%) were intolerant. The frequency of lactose intolerance varied from 7.1 to 45.4%, and it occurred more frequently at older ages. The most common reported symptoms were abdominal pain, bloating and rumbling. Lactose malabsorption and intolerance can be investigated from the first years of life using the lactose breath test plus a symptom questionnaire. An increase in the frequency of intolerance with age, and a greater number of positive tests, if they were requested by a gastroenterologist, were observed. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Algorithms to Identify Statin Intolerance in Medicare Administrative Claim Data.

    PubMed

    Colantonio, Lisandro D; Kent, Shia T; Huang, Lei; Chen, Ligong; Monda, Keri L; Serban, Maria-Corina; Manthripragada, Angelika; Kilgore, Meredith L; Rosenson, Robert S; Muntner, Paul

    2016-10-01

    To compare characteristics of patients with possible statin intolerance identified using different claims-based algorithms versus patients with high adherence to statins. We analyzed 134,863 Medicare beneficiaries initiating statins between 2007 and 2011. Statin intolerance and discontinuation, and high adherence to statins, defined by proportion of days covered ≥80 %, were assessed during the 365 days following statin initiation. Definition 1 of statin intolerance included statin down-titration or discontinuation with ezetimibe initiation, having a claim for a rhabdomyolysis or antihyperlipidemic event followed by statin down-titration or discontinuation, or switching between ≥3 types of statins. Definition 2 included beneficiaries who met Definition 1 and those who down-titrated statin intensity. We also analyzed beneficiaries who met Definition 2 of statin intolerance or discontinued statins. The prevalence of statin intolerance was 1.0 % (n = 1320) and 5.2 % (n = 6985) using Definitions 1 and 2, respectively. Overall, 45,266 (33.6 %) beneficiaries had statin intolerance by Definition 2 or discontinued statins and 55,990 (41.5 %) beneficiaries had high adherence to statins. Compared with beneficiaries with high adherence to statins, those with statin intolerance and who had statin intolerance or discontinued statins were more likely to be female versus male, and black, Hispanic or Asian versus white. The multivariable adjusted odds ratio for statin intolerance by Definitions 1 and 2 comparing patients initiating high versus low/moderate intensity statins were 2.82 (95%CI: 2.42-3.29), and 8.58 (8.07-9.12), respectively, and for statin intolerance or statin discontinuation was 2.35 (2.25-2.45). Definitions of statin intolerance presented herein can be applied to analyses using administrative claims data.

  10. Feasibility studies into the production of gamma-irradiated oyster tissue reference materials for paralytic shellfish poisoning toxins.

    PubMed

    Turner, Andrew D; Lewis, Adam M; Hatfield, Robert G; Powell, Andy L; Higman, Wendy A

    2013-09-01

    A study was conducted to assess the feasibility for the production of sterile, stable and homogenous shellfish reference materials containing known concentrations of paralytic shellfish poisoning (PSP) toxins. Pacific oysters were contaminated with toxins following mass culturing of toxic algae and shellfish feeding experiments. Live oysters were shucked and tissues homogenised, before measuring into multiple aliquots, with one batch subjected to gamma irradiation treatment and the other remaining untreated. The homogeneity of both batches of samples was assessed using a pre-column oxidation liquid chromatography with fluorescence detection (Pre-COX LC-FLD) method and shown to be within the limits of normal within-batch repeatability. A twelve-month stability experiment was conducted for both untreated and gamma irradiated batches, specifically examining the effects of long term storage at -20 °C, +4 °C and +40 °C. Results indicated mostly good stability of PSP toxins in both materials when stored frozen at -20 °C, but with the instability of GTX2&3 concentrations in the untreated tissues eliminated in the irradiated tissues. Analysis using a post-column oxidation (PCOX) LC-FLD method also showed epimerisation in both GTX1&4 and GTX2&3 epimeric pairs in untreated samples after only 6 months frozen storage. This issue was not present in the tissues irradiated before long term storage. Biological activity testing confirmed the absence of bacteria in the irradiated samples throughout the 12 month study period. With such results there was clear evidence for the potential of increasing the scale of the mass culturing and shellfish feeding for the production of large batches of tissue suitable for the preparation of a certified matrix reference material. Overall results demonstrated the feasibility for production of oyster reference materials for PSTs, with evidence for prolonged stability following gamma irradiation treatment and storage at -20 °C. Crown

  11. Mechanisms of orthostatic intolerance during heat stress.

    PubMed

    Schlader, Zachary J; Wilson, Thad E; Crandall, Craig G

    2016-04-01

    Heat stress profoundly and unanimously reduces orthostatic tolerance. This review aims to provide an overview of the numerous and multifactorial mechanisms by which this occurs in humans. Potential causal factors include changes in arterial and venous vascular resistance and blood distribution, and the modulation of cardiac output, all of which contribute to the inability to maintain cerebral perfusion during heat and orthostatic stress. A number of countermeasures have been established to improve orthostatic tolerance during heat stress, which alleviate heat stress induced central hypovolemia (e.g., volume expansion) and/or increase peripheral vascular resistance (e.g., skin cooling). Unfortunately, these countermeasures can often be cumbersome to use with populations prone to syncopal episodes. Identifying the mechanisms of inter-individual differences in orthostatic intolerance during heat stress has proven elusive, but could provide greater insights into the development of novel and personalized countermeasures for maintaining or improving orthostatic tolerance during heat stress. This development will be especially impactful in occuational settings and clinical situations that present with orthostatic intolerance and/or central hypovolemia. Such investigations should be considered of vital importance given the impending increased incidence of heat events, and associated cardiovascular challenges that are predicted to occur with the ensuing changes in climate. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Mechanisms of orthostatic intolerance during heat stress

    PubMed Central

    Schlader, Zachary J.; Wilson, Thad E.; Crandall, Craig G.

    2017-01-01

    Heat stress profoundly and unanimously reduces orthostatic tolerance. This review aims to provide an overview of the numerous and multifactorial mechanisms by which this occurs in humans. Potential causal factors include changes in arterial and venous vascular resistance and blood distribution, and the modulation of cardiac output, all of which contribute to the inability to maintain cerebral perfusion during heat and orthostatic stress. A number of countermeasures have been established to improve orthostatic tolerance during heat stress, which alleviate heat stress induced central hypovolemia (e.g., volume expansion) and/or increase peripheral vascular resistance (e.g., skin cooling). Unfortunately, these countermeasures can often be cumbersome to use with populations prone to syncopal episodes. Identifying the mechanisms of inter-individual differences in orthostatic intolerance during heat stress has proven elusive, but could provide greater insights into the development of novel and personalized countermeasures for maintaining or improving orthostatic tolerance during heat stress. This development will be especially impactful in occuational settings and clinical situations that present with orthostatic intolerance and/or central hypovolemia. Such investigations should be considered of vital importance given the impending increased incidence of heat events, and associated cardiovascular challenges that are predicted to occur with the ensuing changes in climate. PMID:26723547

  13. [Intolerance to food additives: an update].

    PubMed

    Cardinale, F; Mangini, F; Berardi, M; Sterpeta Loffredo, M; Chinellato, I; Dellino, A; Cristofori, F; Di Domenico, F; Mastrototaro, M F; Cappiello, A; Centoducati, T; Carella, F; Armenio, L

    2008-12-01

    Contrary to common believing, the prevalence of the intolerance to food additives in the general population is rather low. Nowadays many doubts persist with regard both to the pathogenetic mechanisms and to the clinical and diagnostic aspects in this field. Symptoms due to, or exacerbated from, food additives usually involve non-IgE-mediate mechanisms (pseudo-allergic reactions, PAR) and are usually less severe of those induced by food allergy. The most frequent clinical feature of the intolerance to food additives still remains the urticaria-angioedema syndrome, although these substances are really involved only in a minority of patients. Other possible clinical features include anaphylaxis, atopic eczema, behaviour disturbances, asthma and non-allergic rhinitis. The diagnostic approach consists in diary cards, reporting symptoms and food habits, elimination diet and double blinded placebo-controlled oral challenge with suspected additives. However, such procedure still remains poorly standardized and numerous uncertainties persist with regard to optimal conditions for performing and interpret the challenge results. The therapeutic approach consists in the exclusion of foods and products containing the additive involved, and, in patients not compliant to the diet, in treatment with symptomatic drugs.

  14. Idiopathic environmental intolerances (IEI): myth and reality.

    PubMed

    Staudenmayer, H

    2001-03-31

    The psychogenic theory presupposes that idiopathic environmental intolerance (IEI) is an overvalued idea explained by psychological and psychosocial processes. The polysomatic symptoms are amplifications of complaints common to the general population, psychophysiological manifestations of stress and the stress-response, or symptoms of psychiatric clinical syndromes. The psychogenic theory is supported by provocation challenge studies which demonstrate that appraisals of 'reactions' are unreliable and cognitively mediated. Clinical studies of IEI cases consistently identify greater incidence of current and premorbid lifetime psychiatric disorders and co-morbidity with functional somatic syndromes that are fashionable 'diagnoses'. The toxicogenic theory presupposes low-level chemical sensitivity or intolerance without objective signs to a plethora of diverse chemical agents. Symptoms are synonymous with disease and attributions are synonymous with cause. Hypotheses about physiological processes and mechanisms are implausible and unsupported by evidence. Advocates claim this phenomenon is so ephemeral that the principles and methods of toxicology do not apply and that a scientific paradigm shift is in order.

  15. Lactose intolerance in systemic nickel allergy syndrome.

    PubMed

    Cazzato, I A; Vadrucci, E; Cammarota, G; Minelli, M; Gasbarrini, A

    2011-01-01

    Some patients affected by nickel-contact allergy present digestive symptoms in addition to systemic cutaneous manifestations, falling under the condition known as systemic nickel allergy syndrome (SNAS). A nickel-related pro-inflammatory status has been documented at intestinal mucosal level. The aim of the present study is to evaluate the prevalence of lactose intolerance in patients affected by SNAS compared to a healthy population. Consecutive patients affected by SNAS referring to our departments were enrolled. The control population consisted of healthy subjects without gastrointestinal symptoms. All subjects enrolled underwent lactose breath test under standard conditions. One hundred and seventy-eight SNAS patients and 60 healthy controls were enrolled. Positivity of lactose breath test occurred in 74.7% of the SNAS group compared to 6.6% of the control group. Lactose intolerance is highly prevalent in our series of patients affected by SNAS. Based on our preliminary results, we can hypothesize that in SNAS patients, the nickel-induced pro-inflammatory status could temporarily impair the brush border enzymatic functions, resulting in hypolactasia. Further trials evaluating the effect of a nickel-low diet regimen on lactase activity, histological features and immunological pattern are needed.

  16. Route of metabolization and detoxication of paralytic shellfish toxins in humans.

    PubMed

    García, Carlos; Barriga, Andrés; Díaz, Juan Carlos; Lagos, Marcelo; Lagos, Néstor

    2010-01-01

    Paralytic shellfish toxins (PST) are a collection of over 26 structurally related imidazoline guanidinium derivatives produced by marine dinoflagellates and freshwater cyanobacteria. Glucuronidation of drugs by UDP-glucuronosyltransferase (UGT) is the major phase II conjugation reaction in mammalian liver. In this study, using human liver microsomes, the in vitro paralytic shellfish toxins oxidation and sequential glucuronidation are achieved. Neosaxitoxin (neoSTX), Gonyautoxin 3/2 epimers (GTX3/GTX2) and Saxitoxin (STX) are used as starting enzymatic substrates. The enzymatic reaction final product metabolites are identified by using HPLC-FLD and HPLC/ESI-IT/MS. Four metabolites from GTX3/GTX2 epimers precursors, three of neoSTX and two of STX are clearly identified after incubating with UDPGA/NADPH and fresh liver microsomes. The glucuronic-Paralytic Shellfish Toxins were completely hydrolysed by treatment with beta-glucuronidase. All toxin analogs were identified comparing their HPLC retention time with those of analytical standard reference samples and further confirmed by HPLC/ESI-IT/MS. Paralytic Shellfish Toxins (PST) were widely metabolized by human microsomes and less than 15% of the original PST, incubated as substrate, stayed behind at the end of the incubation. The apparent V(max) and Km formation values for the respective glucuronides of neoSTX, GTX3/GTX2 epimers and STX were determined. The V(max) formation values for Glucuronic-GTX3 and Glucuronic-GTX2 were lower than Glucuronic-neoSTX and Glucuronic-STX (6.8+/-1.9x10(-3); 8.3+/-2.8x10(-3) and 9.7+/-2.8x10(-3)pmol/min/mg protein respectively). Km of the glucuronidation reaction for GTX3/GTX2 epimers was less than that of glucuronidation of neoSTX and STX (20.2+/-0.12; 27.06+/-0.23 and 32.02+/-0.64microM respectively). In conclusion, these data show for the first time, direct evidence for the sequential oxidation and glucuronidation of PST in vitro, both being the initial detoxication reactions for

  17. Paralytic shellfish toxin biosynthesis in cyanobacteria and dinoflagellates: A molecular overview.

    PubMed

    Wang, Da-Zhi; Zhang, Shu-Fei; Zhang, Yong; Lin, Lin

    2016-03-01

    Paralytic shellfish toxins (PSTs) are a group of water soluble neurotoxic alkaloids produced by two different kingdoms of life, prokaryotic cyanobacteria and eukaryotic dinoflagellates. Owing to the wide distribution of these organisms, these toxic secondary metabolites account for paralytic shellfish poisonings around the world. On the other hand, their specific binding to voltage-gated sodium channels makes these toxins potentially useful in pharmacological and toxicological applications. Much effort has been devoted to the biosynthetic mechanism of PSTs, and gene clusters encoding 26 proteins involved in PST biosynthesis have been unveiled in several cyanobacterial species. Functional analysis of toxin genes indicates that PST biosynthesis in cyanobacteria is a complex process including biosynthesis, regulation, modification and export. However, less is known about the toxin biosynthesis in dinoflagellates owing to our poor understanding of the massive genome and unique chromosomal characteristics [1]. So far, few genes involved in PST biosynthesis have been identified from dinoflagellates. Moreover, the proteins involved in PST production are far from being totally explored. Thus, the origin and evolution of PST biosynthesis in these two kingdoms are still controversial. In this review, we summarize the recent progress on the characterization of genes and proteins involved in PST biosynthesis in cyanobacteria and dinoflagellates, and discuss the standing evolutionary hypotheses concerning the origin of toxin biosynthesis as well as future perspectives in PST biosynthesis. Paralytic shellfish toxins (PSTs) are a group of potent neurotoxins which specifically block voltage-gated sodium channels in excitable cells and result in paralytic shellfish poisonings (PSPs) around the world. Two different kingdoms of life, cyanobacteria and dinoflagellates are able to produce PSTs. However, in contrast with cyanobacteria, our understanding of PST biosynthesis in

  18. [The first experience of using an implant for upper eyelid loading in paralytic lagophthalmos].

    PubMed

    Grusha, Ia O; Novikov, I A; Agafonova, E I

    2012-01-01

    The results of using an implant (weight) for upper eyelid loading to correct paralytic lagophthalmos in patients with chronic facial palsy are presented 7 patients (7 eyes) were included into the study. The weight was implanted into the upper eyelid and fixed to the tarsal plate. No intra- and postoperative complications caused by weight implantation into the upper eyelid were observed during 12 months of follow-up. The first experience of using of this method indicates an opportunity of effective lagophthalmos correction and significant corneal improvement.

  19. Canning process that diminishes paralytic shellfish poison in naturally contaminated mussels (Mytilus galloprovincialis).

    PubMed

    Vieites, J M; Botana, L M; Vieytes, M R; Leira, F J

    1999-05-01

    Changes in toxin profile and total toxicity levels of paralytic shellfish poison (PSP)-containing mussels were monitored during the standard canning process of pickled mussels and mussels in brine using mouse bioassays and high-performance liquid chromatography. Detoxification percentages for canned mussel meat exceeded 50% of initial toxicity. Total toxicity reduction did not fully correspond to toxin destruction, which was due to the loss of PSP to cooking water and packing media of the canned product. Significant differences in detoxification percentages were due to changes in toxin profile during heat treatment in packing media. Toxin conversion phenomena should be determined to validate detoxification procedures in the canning industry.

  20. Perivertebral B-cell lymphoma in a Queensland koala (Phascolarctos cinereus adustus) with paralytic symptoms in the hind limbs.

    PubMed

    Kido, Nobuhide; Edamura, Kazuya; Inoue, Naomi; Shibuya, Hisashi; Sato, Tsuneo; Kondo, Masako; Shindo, Izumi

    2012-08-01

    A male Queensland koala (Phascolarctos cinereus adustus) at Kanazawa Zoological Gardens (Kanagawa, Japan) exhibited paralytic symptoms in the hind limbs. Computed tomography and magnetic resonance imaging revealed a mass on the left ventral side of the 11th to 13th thoracic vertebrae, and the presence of myelitis or edema in the spinal cord. The koala was under anesthesia during the examination and suddenly developed ventricular fibrillation and died. Necropsy revealed a firm flat ovoid hemorrhagic mass on the vertebrae. Following a microscopic examination including immunohistochemistry, the perivertebral mass was diagnosed as B cell lymphoma. Therefore, neoplastic cell infiltration into the spinal cord may cause paralytic symptoms in the hind limbs.

  1. Chronic rhinitis with nasal polyposis associated with sodium glutamate intolerance.

    PubMed

    Asero, Riccardo; Bottazzi, Gianna

    2007-01-01

    The study reports a case of perennial rhinitis with bilateral polyposis. A careful diagnostic workup revealed that the disorder was caused by sodium glutamate intolerance. This is the first study showing an association between intolerance to food additives and nasal polyposis. 2007 S. Karger AG, Basel

  2. Intolerance of Uncertainty, Fear of Anxiety, and Adolescent Worry

    ERIC Educational Resources Information Center

    Dugas, Michel J.; Laugesen, Nina; Bukowski, William M.

    2012-01-01

    A 5 year, ten wave longitudinal study of 338 adolescents assessed the association between two forms of cognitive vulnerability (intolerance of uncertainty and fear of anxiety) and worry. Multilevel mediational analyses revealed a bidirectional and reciprocal relation between intolerance of uncertainty and worry in which change in one variable…

  3. Intolerance of Uncertainty, Fear of Anxiety, and Adolescent Worry

    ERIC Educational Resources Information Center

    Dugas, Michel J.; Laugesen, Nina; Bukowski, William M.

    2012-01-01

    A 5 year, ten wave longitudinal study of 338 adolescents assessed the association between two forms of cognitive vulnerability (intolerance of uncertainty and fear of anxiety) and worry. Multilevel mediational analyses revealed a bidirectional and reciprocal relation between intolerance of uncertainty and worry in which change in one variable…

  4. The Intolerance of Uncertainty Scale for Children: A Psychometric Evaluation

    ERIC Educational Resources Information Center

    Comer, Jonathan S.; Roy, Amy K.; Furr, Jami M.; Gotimer, Kristin; Beidas, Rinad S.; Dugas, Michel J.; Kendall, Philip C.

    2009-01-01

    Intolerance of uncertainty (IU) has contributed to our understanding of excessive worry and adult anxiety disorders, but there is a paucity of research on IU in child samples. This gap is due to the absence of a psychometrically sound measure of IU in youth. The present study adapted parallel child- and parent-report forms of the Intolerance of…

  5. Competing Claims: Religious Affiliation and African Americans' Intolerance of Homosexuals.

    PubMed

    Ledet, Richard

    2016-09-15

    Literature on religion and political intolerance indicates competing expectations about how Black Protestant church affiliation affects African Americans' attitudes about civil liberties. On the one hand, Black Protestant theology emphasizes personal freedom and social justice, factors generally linked to more tolerant attitudes. On the other hand, Black Protestants tend to be conservative on family and social issues, factors often linked to intolerance of gays and lesbians. Data from the General Social Survey are used to examine the influence of religious group identification, as well as other relevant aspects of religiosity, on political intolerance among African Americans. Results indicate that although other aspects of religion (beliefs and behaviors) help explain variation in political intolerance, Black Protestant church affiliation has no relationship with attitudes about the civil liberties of homosexuals. However, additional tests show that Black Protestant church affiliation significantly predicts intolerance of other target groups (atheists and racists).

  6. [Calcium supplementation uncovering lactose intolerance - a case report].

    PubMed

    Trifina, Eva; Geissler, Dietmar; Zwettler, Elisabeth; Klaushofer, Klaus; Mikosch, Peter

    2012-03-01

    A 44 yr-old female with osteoporosis had no relevant gastrointestinal symptoms and did not avoid any specific food. However, after prescription of a lactose-rich calcium supplementation, clinical symptoms suspicious for lactose intolerance occurred, which were thereafter confirmed by a lactose tolerance test. Lactose intolerance may present with only slight or subtle symptoms. Drugs containing lactose may induce or increase gastrointestinal symptoms in patients with lactose intolerance. In case of gastrointestinal symptoms occurring after the initiation of drugs containing lactose, the possibility of lactose intolerance should be considered and tested by lactose tolerance test or genetic testing for the LCT (-13910) polymorphism. Due to the prevalence of about 15-25% lactose intolerance in the Austrian population, lactose free drugs should be prescribed as widely as possible.

  7. Lactose intolerance: an unnecessary risk for low bone density.

    PubMed

    Savaiano, Dennis

    2011-01-01

    The potential for lactose intolerance causes 25-50 million Americans and an unknown number of people around the world to avoid milk. Milk avoidance is a significant risk factor for low bone density. Individuals who avoid milk, due to intolerance or learned aversion, consume significantly less calcium and have poorer bone health and probable higher risk of osteoporosis. Lactose intolerance is easily managed by: (1) regular consumption of milk that adapts the colon bacteria and facilitates digestion of lactose; (2) consumption of yogurts and cheeses and other dairy foods low in lactose; consumption of dairy foods with meals to slow transit and maximize digestion, and use of lactose-digestive aids. As dairying spreads around the world to new markets and dairy foods become the dominant source of calcium in these markets, the potential for lactose intolerance will grow. Management of lactose intolerance globally will require both education and product development.

  8. Pathogenesis of glucose intolerance in uremia.

    PubMed

    DeFronzo, R A

    1978-12-01

    The pathogenesis of glucose intolerance in uremia was examined with the glucose clamp technique. Hyperglycemic clamp (n = 8): The plasma glucose concentration is acutely raised and maintained at 125 mg/dl above basal levels. Under these steady state conditions the glucose infusion rate, M, equals the amount of glucose metabolized: Predialysis M averaged 4.23 +/- 0.36 mg/kg/min and increased to 7.71 +/- 0.43 postdialysis (p less than 0.001). The plasma insulin response predialysis was 90 +/- 20 microU/ml and decreased to 80 +/- 23 microU/ml following dialysis. Consequently the M/l ratio, a measure of tissue sensitivity to insulin, increased by 80% +/- 25% (p less than 0.001) but still remained less than controls (p less than 0.01). Euglycemic insulin clamp (n = 10): The plasma insulin concentration is acutely raised by 100 microU/ml and the plasma glucose concentration is held constant at the basal level. Predialysis both M (3.37 +/- 0.36 mg/kg/min) and M/l (3.56 +/- 0.33 mg/kg/min per microU/ml X 100) were significantly less than controls (p less than 0.01). Postdialysis both M and M/l increased significantly (p less than 0.01) to a mean that was not significantly different from controls. Basal hepatic glucose production (n = 6), 2.15 +/- 0.09 mg/kg/min, was similar to controls and fell (87% +/- 4%) normally during the insulin clamp. In five uremic subjects in wom insulin binding to monocytes was measured, there was no correlation with tissue sensitivity to insulin (M/l). Significant abnormalities in both growth hormone and glucagon physiology were present in uremic individuals, but no correlation with either the presence or degree of glucose intolerance was demonstrable. In conclusion, glucose intolerance is universally present in uremic subjects and results primarily from peripheral tissue insensitivity to insulin. Insulin secretion is usually enhanced in an attempt to compensate for this insulin resistance but in occasional subjects uremia also inhibits beta

  9. Sediment Burial Intolerance of Marine Macroinvertebrates

    PubMed Central

    Hendrick, Vicki J.; Hutchison, Zoë L.; Last, Kim S.

    2016-01-01

    The marine environment contains suspended particulate matter which originates from natural and anthropogenic sources. Settlement of this material can leave benthic organisms susceptible to smothering, especially if burial is sudden i.e. following storms or activities such as dredging. Their survival will depend on their tolerance to, and their ability to escape from burial. Here we present data from a multi-factorial experiment measuring burial responses incorporating duration, sediment fraction and depth. Six macroinvertebrates commonly found in sediment rich environments were selected for their commercial and/or conservation importance. Assessments revealed that the brittle star (Ophiura ophiura), the queen scallop (Aequipecten opercularis) and the sea squirt (Ciona intestinalis) were all highly intolerant to burial whilst the green urchin (Psammichinus miliaris) and the anemone (Sagartiogeton laceratus), showed intermediate and low intolerance respectively, to burial. The least intolerant, with very high survival was the Ross worm (Sabellaria spinulosa). With the exception of C. intestinalis, increasing duration and depth of burial with finer sediment fractions resulted in increased mortality for all species assessed. For C. intestinalis depth of burial and sediment fraction were found to be inconsequential since there was complete mortality of all specimens buried for more than one day. When burial emergence was assessed O. ophiura emerged most frequently, followed by P. miliaris. The former emerged most frequently from the medium and fine sediments whereas P. miliaris emerged more frequently from coarse sediment. Both A. opercularis and S. laceratus showed similar emergence responses over time, with A. opercularis emerging more frequently under coarse sediments. The frequency of emergence of S. laceratus increased with progressively finer sediment and C. intestinalis did not emerge from burial irrespective of sediment fraction or depth. Finally, and perhaps

  10. Sediment Burial Intolerance of Marine Macroinvertebrates.

    PubMed

    Hendrick, Vicki J; Hutchison, Zoë L; Last, Kim S

    2016-01-01

    The marine environment contains suspended particulate matter which originates from natural and anthropogenic sources. Settlement of this material can leave benthic organisms susceptible to smothering, especially if burial is sudden i.e. following storms or activities such as dredging. Their survival will depend on their tolerance to, and their ability to escape from burial. Here we present data from a multi-factorial experiment measuring burial responses incorporating duration, sediment fraction and depth. Six macroinvertebrates commonly found in sediment rich environments were selected for their commercial and/or conservation importance. Assessments revealed that the brittle star (Ophiura ophiura), the queen scallop (Aequipecten opercularis) and the sea squirt (Ciona intestinalis) were all highly intolerant to burial whilst the green urchin (Psammichinus miliaris) and the anemone (Sagartiogeton laceratus), showed intermediate and low intolerance respectively, to burial. The least intolerant, with very high survival was the Ross worm (Sabellaria spinulosa). With the exception of C. intestinalis, increasing duration and depth of burial with finer sediment fractions resulted in increased mortality for all species assessed. For C. intestinalis depth of burial and sediment fraction were found to be inconsequential since there was complete mortality of all specimens buried for more than one day. When burial emergence was assessed O. ophiura emerged most frequently, followed by P. miliaris. The former emerged most frequently from the medium and fine sediments whereas P. miliaris emerged more frequently from coarse sediment. Both A. opercularis and S. laceratus showed similar emergence responses over time, with A. opercularis emerging more frequently under coarse sediments. The frequency of emergence of S. laceratus increased with progressively finer sediment and C. intestinalis did not emerge from burial irrespective of sediment fraction or depth. Finally, and perhaps

  11. A fresh look at paralytics in the critically ill: real promise and real concern.

    PubMed

    Price, David; Kenyon, Nicholas J; Stollenwerk, Nicholas

    2012-10-12

    Neuromuscular blocking agents (NMBAs), or "paralytics," often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies.

  12. Paralytic and lethal effects of Trichosanthes dioica root extracts in experimental worms.

    PubMed

    Bhattacharya, Sanjib; Haldar, Pallab Kanti; Ghosh, Ashoke Kumar

    2010-09-01

    Trichosanthes dioica Roxb. (Cucurbitaceae), called pointed gourd in English, is a dioecious climber and its roots are traditionally used in India as a hydrogouge cathartic, tonic, and febrifuge, and in the treatment of jaundice, anasarca, and ascites. To evaluate the in vitro effects of different solvent extracts of T. dioica root in experimental worms, viz. annelids and nematodes. The in vitro paralytic and lethal effects of defatted dichloromethane (DCTD), methanol (METD), and aqueous (AQTD) extracts of T. dioica root were evaluated against Pheretima posthuma (Annelida) and Ascaridia galli (Nematoda) by keeping the worms in different concentrations of each test extract under specific experimental conditions followed by determination of mean paralysis and lethal times. Albendazole was used as the reference drug. All the extracts demonstrated concentration-dependent paralytic and lethal effects on P. posthuma and lethal effects on A. galli. The DCTD was found to be the most potent followed by the METD and AQTD. A. galli was found to be more sensitive than P. posthuma against all extracts, indicating T. dioica root as an effective nematocide. The present study establishes the in vitro wormicidal property of T. dioica root extracts against the experimental worms, showing promising nematocidal (and hence anthelmintic) potential.

  13. Results in the treatment of paralytic calcaneus-valgus feet with the Westin technique

    PubMed Central

    Svartman, Celso; Santili, Cláudio; De Assumpção, Rodrigo MontezumaC.; de Almeida Leite, Leonardo Felicissimo; Quialheiro, Leonardo Silva; de Carvalho Fabricio, Sidney

    2006-01-01

    Between 1988 and 2003, 23 patients with paralytic calcaneus-valgus feet were submitted to the Westin procedure and 17 patients (25 feet) were re-evaluated. Nine patients were male and eight were female. The mean age at the surgical procedure was 8±5 years. The aetiology of paralysis was sequelae of poliomyelitis in 6 patients (8 feet) and of myelomeningocele in 11 patients (17 feet). The mean follow-up period was 6±6 years. The results were analysed clinically and radiographically considering the decrease of the retropulsion, the patient’s satisfaction, and the increase of the lateral tibiocalcaneal angle. Results were considered satisfactory when the patients showed a decrease of the retropulsion during gait, improvement of the gait pattern, and an increase of the tibiocalcaneal angle. As an overall result, 16 patients (94.2%) were satisfied and 1 patient (two feet) dissatisfied with the outcome. The increase of the tibiocalcaneal angle was significant for the myelomeningocele patients (P=0.001), but not for poliomyelitis (P=0.053). No statistical relation between the follow-up period and the increase of the tibiocalcaneal angle was found (r=0.04). The authors concluded that the Westin procedure is a good technique for the treatment of paralytic calcaneus valgus feet with myelomeningocele. PMID:16933136

  14. Recession and Extirpation of the Lower Eyelid Retractors for Paralytic Lagophthalmos.

    PubMed

    Compton, Christopher J; Clark, Jeremy D; Nunery, William R; Lee, H B Harold

    2015-01-01

    To describe a technique to correct lower eyelid malposition and lagophthalmos due to facial nerve palsy. Chart review was performed and identified 13 patients with facial nerve palsy, who presented with paralytic eyelid malposition and were treated with recession and extirpation of the lower eyelid retractors between September 2012 and March 2014 by 1 surgeon (HBL). A total of 12 eyelids in 11 patients met inclusion criteria. Mean preoperative MRD2 was 10 mm (range, 9.0-12.0 mm) and the mean postoperative MRD2 was 7 mm (range, 5.0-9.0 mm). The MRD2 improved an average of 3.0 mm in each patient (range, 2.0-4.0 mm). Patients had an average of 6.9 mm (range, 4.0-10.0 mm) of lagophthalmos preoperatively, which improved to 2.1 mm (range, 0.0-4 mm). The amount of lagophthalmos improved an average of 4.8 mm in the patients. There were no complications encountered in the patients. All patients had a subjective improvement in ocular comfort. The authors' surgical technique is effective in addressing lower eyelid malposition and ocular surface disease in paralytic lagophthalmos.

  15. Framework for evaluating the risks of paralytic poliomyelitis after global interruption of wild poliovirus transmission.

    PubMed Central

    Aylward, R. Bruce; Cochi, Stephen L.

    2004-01-01

    With the interruption of wild poliovirus transmission globally, the need for new policies to deal with the post-certification era will rapidly arise. New policies will be required in four areas: detection and notification of circulating polioviruses; biocontainment of wild, vaccine-derived and attenuated strains of poliovirus; vaccine stockpiles and response mechanisms; and routine immunization against polioviruses. A common understanding of the potential risks of paralytic poliomyelitis in the post-certification period is essential to the development of these policies. Since 2000, there has been increasing international consensus that the risks of paralytic poliomyelitis in the post-certification era fall into two categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses. The specific risks within both categories have now been defined, and an understanding of the frequency and potential burden of disease associated with each is rapidly improving. This knowledge and clarity have provided a framework that is already proving valuable for identifying research priorities and discussing potential policy options with national authorities. However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available through further scientific research, programmatic work, and policy decisions. PMID:15106299

  16. Risks of paralytic disease due to wild or vaccine-derived poliovirus after eradication.

    PubMed

    Tebbens, Radboud J Duintjer; Pallansch, Mark A; Kew, Olen M; Cáceres, Victor M; Jafari, Hamid; Cochi, Stephen L; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

    2006-12-01

    After the global eradication of wild polioviruses, the risk of paralytic poliomyelitis from polioviruses will still exist and require active management. Possible reintroductions of poliovirus that can spread rapidly in unprotected populations present challenges to policymakers. For example, at least one outbreak will likely occur due to circulation of a neurovirulent vaccine-derived poliovirus after discontinuation of oral poliovirus vaccine and also could possibly result from the escape of poliovirus from a laboratory or vaccine production facility or from an intentional act. In addition, continued vaccination with oral poliovirus vaccines would result in the continued occurrence of vaccine-associated paralytic poliomyelitis. The likelihood and impacts of reintroductions in the form of poliomyelitis outbreaks depend on the policy decisions and on the size and characteristics of the vulnerable population, which change over time. A plan for managing these risks must begin with an attempt to characterize and quantify them as a function of time. This article attempts to comprehensively characterize the risks, synthesize the existing data available for modeling them, and present quantitative risk estimates that can provide a starting point for informing policy decisions.

  17. Results in the treatment of paralytic calcaneus-valgus feet with the Westin technique.

    PubMed

    Fucs, Patrícia M de Moraes Barros; Svartman, Celso; Santili, Cláudio; De Assumpção, Rodrigo Montezuma C; de Almeida Leite, Leonardo Felicissimo; Quialheiro, Leonardo Silva; de Carvalho Fabricio, Sidney

    2007-08-01

    Between 1988 and 2003, 23 patients with paralytic calcaneus-valgus feet were submitted to the Westin procedure and 17 patients (25 feet) were re-evaluated. Nine patients were male and eight were female. The mean age at the surgical procedure was 8+/-5 years. The aetiology of paralysis was sequelae of poliomyelitis in 6 patients (8 feet) and of myelomeningocele in 11 patients (17 feet). The mean follow-up period was 6+/-6 years. The results were analysed clinically and radiographically considering the decrease of the retropulsion, the patient's satisfaction, and the increase of the lateral tibiocalcaneal angle. Results were considered satisfactory when the patients showed a decrease of the retropulsion during gait, improvement of the gait pattern, and an increase of the tibiocalcaneal angle. As an overall result, 16 patients (94.2%) were satisfied and 1 patient (two feet) dissatisfied with the outcome. The increase of the tibiocalcaneal angle was significant for the myelomeningocele patients (P=0.001), but not for poliomyelitis (P=0.053). No statistical relation between the follow-up period and the increase of the tibiocalcaneal angle was found (r=0.04). The authors concluded that the Westin procedure is a good technique for the treatment of paralytic calcaneus valgus feet with myelomeningocele.

  18. [A study of eight patients with non-paralytic pontine exotropia].

    PubMed

    Takamatsu, K; Ohta, T

    1995-10-01

    We reported 8 patients with non-paralytic pontine exotropia (NPPE): 7 men and 1 woman aged from 56 to 79 years (mean: 67.8 years). From 1991 to 1994, 402 patients with acute infratentrial cerebrovascular diseases other than subarachnoid hemorrhage were admitted to our hospital within 7 days after the ouset of their stroke. NPPE was observed in 2% of these patients. NPPE was noted on admission in 6 of them, while it developed during the hospital stay in 2 others with paralytic pontine exotropia and bilateral median longitudinal fasciculus (MLF) syndrome, respectively. Abnormal convergence and alternating exotropia were noted in 6 and 2 patients respectively. The duration of NPPE was 0.5 to 4 days (mean; 2 days), and the ocular movement disorder was transient in all patients. When MRI was performed to detect the causative lesion, a small infarct was found in the upper, middle, and lower pons in 1, 3, and 4 patients, respectively. NPPE is generally considered to develop when the MLF and the paramedian pontine reticular formation (PPRF) are completely and incompletely destroyed respectively. In the present study, however, the pathophysiological features of the NPPE patients with alternating exotropia could not be explained by this mechanism, and severe MLF damage was considered to be a contributory factor.

  19. [Lactose and gluten intolerance: which to suscept?].

    PubMed

    Van Gossum, M; Mascart, F; Rickaert, F; Codden, T; Colonius, V

    2000-09-01

    Lactose intolerance affects millions of people world-wide and should be suspected specially when evaluating gastrointestinal symptoms in ethnic populations in which it is prevalent. Fortunately, once a diagnosis is made, management is fairly straightforward. The authors discuss symptoms and methods of detection and offer their recommendations for helping patients with this common disorder. Coeliac disease is the end result of 3 processes that culminate in intestinal damage: genetic predisposition, environmental factors, and immunological based inflammation. Epidemiological studies based on serologic tests suggest that the prevalence of coeliac disease has been significantly underestimated. The classic sprue syndrome of steatorrhea and malnutrition may be less common than more subtle and often monosymptomatic presentations of the disease. The authors discuss the diagnostic criteria and the clinical utility of serologic tests.

  20. Chemical intolerance among hairdressers in Denmark.

    PubMed

    Tran, Marie Thi Dao; Elberling, Jesper; Skovbjerg, Sine; Berg, Nikolaj Drimer; Søsted, Heidi; Johansen, Jeanne Duus; Lysdal, Susan Hovmand

    2013-01-01

    To investigate the prevalence and the severity of fragrance-related symptoms among hairdressers in Denmark compared with the Danish general population. Further, to characterize former hairdressers who are severely chemically intolerant to fragranced products in relation to sex, age and health- and work-related reasons for leaving the hairdressing profession. The study population consisted of all hairdressers who graduated from the public vocational schools in Denmark during 1985 and 2007 (n = 7840) and a random sample of individuals from the Danish general population (n = 6000). Both populations received a postal questionnaire on symptoms from inhalation of fragranced products and the resultant behavioural consequences. All former hairdressers also answered additional questions on health- and work-related reasons for leaving the profession. No differences were found in the prevalence (OR = 1.0, CI = 0.89-1.14) or the severity (OR = 1.1, CI = 0.80-1.51) of symptoms from inhalation of fragranced products in hairdressers compared with the general population. Among hairdressers, however, experience of fragrance-related symptoms (OR = 1.2, CI = 1.01-1.31) and adjustments of social (OR = 1.8, CI = 1.12-2.80) and occupational conditions (OR = 2.8, CI = 1.84-4.25) were reported significantly more often by former hairdressers than current hairdressers. The prevalence and the severity of fragrance-related symptoms were similar in hairdressers and the general population. Former hairdressers were more affected by fragranced products than current hairdressers were. Although fragrance-related symptoms did not seem to be more frequent among hairdressers, the hairdressing profession might pose a problem for those who are chemically intolerant.

  1. Chemical Intolerance among Hairdressers in Denmark

    PubMed Central

    Tran, Marie Thi Dao; Elberling, Jesper; Skovbjerg, Sine; Berg, Nikolaj Drimer; Søsted, Heidi; Johansen, Jeanne Duus; Lysdal, Susan Hovmand

    2013-01-01

    Objectives To investigate the prevalence and the severity of fragrance-related symptoms among hairdressers in Denmark compared with the Danish general population. Further, to characterize former hairdressers who are severely chemically intolerant to fragranced products in relation to sex, age and health- and work-related reasons for leaving the hairdressing profession. Methods The study population consisted of all hairdressers who graduated from the public vocational schools in Denmark during 1985 and 2007 (n = 7840) and a random sample of individuals from the Danish general population (n = 6000). Both populations received a postal questionnaire on symptoms from inhalation of fragranced products and the resultant behavioural consequences. All former hairdressers also answered additional questions on health- and work-related reasons for leaving the profession. Results No differences were found in the prevalence (OR = 1.0, CI = 0.89–1.14) or the severity (OR = 1.1, CI = 0.80–1.51) of symptoms from inhalation of fragranced products in hairdressers compared with the general population. Among hairdressers, however, experience of fragrance-related symptoms (OR = 1.2, CI = 1.01–1.31) and adjustments of social (OR = 1.8, CI = 1.12–2.80) and occupational conditions (OR = 2.8, CI = 1.84–4.25) were reported significantly more often by former hairdressers than current hairdressers. Conclusions The prevalence and the severity of fragrance-related symptoms were similar in hairdressers and the general population. Former hairdressers were more affected by fragranced products than current hairdressers were. Although fragrance-related symptoms did not seem to be more frequent among hairdressers, the hairdressing profession might pose a problem for those who are chemically intolerant. PMID:23951117

  2. From 'lactose intolerance' to 'lactose nutrition'.

    PubMed

    Lukito, Widjaja; Malik, Safarina G; Surono, Ingrid S; Wahlqvist, Mark L

    2015-01-01

    The concept of lactose intolerance has become embedded in Western medicine and developing economy medicine. It is based on evidence that intestinal lactase activity persists into later childhood and throughout life in only a minority of the world's population, notably northern European-derived populations. These people have the T single nucleotide polymorphism (SNP) of the rs49882359 allele (C/T), also known as C/T-13910, the MCM6 gene which positively influences the lactase LCT gene. Other lactase persistent (LP) populations are found in Africa and the Middle East with different genetic variants. These SNPs represent co-evolution with dairying since the agricultural revolution and nutrient-dependent ecological adaptation. That said, gastrointestinal symptoms considered due to small intestinal lactose malabsorption are poorly correlated with lactase non-persistence (LNP), the situation for most people. With LNP, colonic microbiome lactase enables lactose fermentation to occur so that none is found in faeces. Whether the short chain fatty acids (SCFAs) and gases (hydrogen, carbon dioxide and methane) produced cause symptoms is dose-dependent. Up to 25 g of lactose at any one time can usually be consumed by a LNP person, but its food and meal pattern context, the microbiomic characteristics, age and other factors may alter tolerance. Thus, the notion that lactose intolerance is a disorder or disease of LNP people is misplaced and has been one of cultural perspective. What actually matters is whether a particular dairy product as normally consumed give rise to symptoms. It is, therefore, proposed that lactose tolerance tests be replaced with dairy food tolerance tests.

  3. [Food intolerances caused by enzyme defects and carbohydrate malassimiliations : Lactose intolerance and Co].

    PubMed

    Schäfer, Christiane

    2016-06-01

    Apart from allergic conditions, carbohydrate malassimiliations (sugar metabolism disorders) are classified within the group of food intolerances. These dose-dependent, yet non-immunological reactions require gastroenterological or internal diagnosis following nutritional therapy. Intolerances to carbohydrates such as lactose (milk sugar) and fructose (fruit sugar) in addition to sugar alcohols (sorbitol, mannitol, lactitol etc.) have been gaining increasing attention in recent decades as they are the cause of a wide range of gastrointestinal symptoms. There are currently various options for both diagnosis and therapy that differ notably in terms of effort, costs, and efficiency. Nutritional change and patient education are the bases of therapy. Non-observance of the trigger will result in increasing complaints and possibly even more infections, e.g., diverticula, rectal disorders, bacterial miscolonization, bile acid malabsorption). For an optimal therapy, the following sugar metabolism disorders have to be differentiated: hypolactasia versus lactose maldigestion, fructose malabsorption versus fructose overload, combined lactose and fructose intolerance, and isolated adverse reactions against sorbitol.For the medical conditions listed above, a three- or four-stage treatment regimen is recommended. Extensive dietary restrictions with regard to the relevant sugar, except for lactose, should not be maintained over a longer period of time.

  4. Recent trends in paralytic shellfish toxins in Puget Sound, relationships to climate, and capacity for prediction of toxic events

    Treesearch

    Stephanie K. Moore; Nathan J. Mantua; Barbara M. Hickey; Vera L. Trainer

    2009-01-01

    Temporal and spatial trends in paralytic shellfish toxins (PSTs) in Puget Sound shellfish and their relationships with climate are investigated using long-term monitoring data since 1957. Data are selected for trend analyses based on the sensitivity of shellfish species to PSTs and their depuration rates, and the frequency of sample collection at individual sites....

  5. [The discussion on relationship between adenoids hypertrophy and food intolerance].

    PubMed

    Li, Yaqiong; Sun, Jie; Zhang, Hua

    2013-06-01

    To explore the relationship between food intolerance and adenoidal hypertrophy and accordingly to provide evidence for intolerance and adenoidal hypertrophy. Adenoidal hypertrophy in patients with a total of 111 cases as the experiment group, 30 cases of children with no history of allergies and allergy-related diseases and adenoidal hypertrophy symptoms as the control group, and compared the result of food intolerance between two groups. 1) Food intolerance detected positive rate of adenoidal hypertrophy group was higher than the control group. 2) The distribution of the two groups of children in the extent of food intolerance is different. 3) Adenoid hypertrophy and how many types of the food, which is high, moderate intolerance, are unrelated. 4) The daily consumption of 14 kinds of food, the top three foods of adenoidal hypertrophy group and control group are eggs, milk, cod. Food intolerance is the possible cause of adenoidal hypertrophy. The detection of specific IgG antibodies of food have positive significance in the prevention of adenoidal hypertrophy.

  6. Intracellular Spread of Rabies Virus Is Reduced in the Paralytic Form of Canine Rabies Compared to the Furious Form.

    PubMed

    Shuangshoti, Shanop; Thorner, Paul Scott; Teerapakpinyo, Chinachote; Thepa, Nisachol; Phukpattaranont, Pornchai; Intarut, Nirun; Lumlertdacha, Boonlert; Tepsumethanon, Veera; Hemachudha, Thiravat

    2016-06-01

    Studies of the furious and paralytic forms of canine rabies at the early stage of disease have shown a more rapid viral colonization of the cerebral hemispheres in the furious form, as measured by viral antigen within neuronal cell bodies and viral RNA levels. Measurement of cellular processes separate from neuronal cell body provides a visual record of the spread of rabies virus which occurs across synapses. In this study, the amount of rabies viral antigen within cell processes was quantitatively assessed by image analysis in a cohort of naturally rabies infected non-vaccinated dogs (5 furious and 5 paralytic) that were sacrificed shortly after developing illness. Measurements were taken at different levels of the spinal cord, brain stem, and cerebrum. Results were compared to the amount of rabies viral antigen in neuronal cell bodies. Generally, the amount of rabies viral antigen in cell processes decreased in a rostral direction, following the pattern for the amount of rabies viral antigen in neuronal cell bodies and the percentage of involved cell bodies. However, there was a delay in cell process involvement following cell body involvement, consistent with replication occurring in the cell body region and subsequent transport out to cell processes. Greater amounts of antigen were seen in cell processes in dogs with the furious compared to paralytic form, at all anatomic levels examined. This difference was even evident when comparing (1) neurons with similar amounts of antigen, (2) similar percentages of involved neurons, and (3) anatomic levels that showed 100% positive neurons. These findings suggest that intracellular transport of the virus may be slower in the paralytic form, resulting in slower viral propagation. Possible mechanisms might involve host-specific differences in intracellular virus transport. The latter could be cytokine-mediated, since previous studies have documented greater inflammation in the paralytic form.

  7. Intracellular Spread of Rabies Virus Is Reduced in the Paralytic Form of Canine Rabies Compared to the Furious Form

    PubMed Central

    Shuangshoti, Shanop; Thorner, Paul Scott; Teerapakpinyo, Chinachote; Thepa, Nisachol; Phukpattaranont, Pornchai; Intarut, Nirun; Lumlertdacha, Boonlert; Tepsumethanon, Veera; Hemachudha, Thiravat

    2016-01-01

    Studies of the furious and paralytic forms of canine rabies at the early stage of disease have shown a more rapid viral colonization of the cerebral hemispheres in the furious form, as measured by viral antigen within neuronal cell bodies and viral RNA levels. Measurement of cellular processes separate from neuronal cell body provides a visual record of the spread of rabies virus which occurs across synapses. In this study, the amount of rabies viral antigen within cell processes was quantitatively assessed by image analysis in a cohort of naturally rabies infected non-vaccinated dogs (5 furious and 5 paralytic) that were sacrificed shortly after developing illness. Measurements were taken at different levels of the spinal cord, brain stem, and cerebrum. Results were compared to the amount of rabies viral antigen in neuronal cell bodies. Generally, the amount of rabies viral antigen in cell processes decreased in a rostral direction, following the pattern for the amount of rabies viral antigen in neuronal cell bodies and the percentage of involved cell bodies. However, there was a delay in cell process involvement following cell body involvement, consistent with replication occurring in the cell body region and subsequent transport out to cell processes. Greater amounts of antigen were seen in cell processes in dogs with the furious compared to paralytic form, at all anatomic levels examined. This difference was even evident when comparing (1) neurons with similar amounts of antigen, (2) similar percentages of involved neurons, and (3) anatomic levels that showed 100% positive neurons. These findings suggest that intracellular transport of the virus may be slower in the paralytic form, resulting in slower viral propagation. Possible mechanisms might involve host-specific differences in intracellular virus transport. The latter could be cytokine-mediated, since previous studies have documented greater inflammation in the paralytic form. PMID:27253394

  8. Diagnosing and Treating Intolerance to Carbohydrates in Children

    PubMed Central

    Berni Canani, Roberto; Pezzella, Vincenza; Amoroso, Antonio; Cozzolino, Tommaso; Di Scala, Carmen; Passariello, Annalisa

    2016-01-01

    Intolerance to carbohydrates is relatively common in childhood, but still poorly recognized and managed. Over recent years it has come to the forefront because of progresses in our knowledge on the mechanisms and treatment of these conditions. Children with intolerance to carbohydrates often present with unexplained signs and symptoms. Here, we examine the most up-to-date research on these intolerances, discuss controversies relating to the diagnostic approach, including the role of molecular analysis, and provide new insights into modern management in the pediatric age, including the most recent evidence for correct dietary treatment. PMID:26978392

  9. Intolerance of uncertainty, fear of anxiety, and adolescent worry.

    PubMed

    Dugas, Michel J; Laugesen, Nina; Bukowski, William M

    2012-08-01

    A 5 year, ten wave longitudinal study of 338 adolescents assessed the association between two forms of cognitive vulnerability (intolerance of uncertainty and fear of anxiety) and worry. Multilevel mediational analyses revealed a bidirectional and reciprocal relation between intolerance of uncertainty and worry in which change in one variable partially explained change in the other. Fear of anxiety and worry also showed evidence of a bidirectional relation, although change in fear of anxiety had a much weaker mediational effect on change in worry than vice versa. The findings show that relative to fear of anxiety, intolerance of uncertainty may play a greater role in the etiology of worry in adolescents.

  10. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Novak, V.; Spies, J. M.; Novak, P.; McPhee, B. R.; Rummans, T. A.; Low, P. A.

    1998-01-01

    BACKGROUND AND PURPOSE: Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI). METHODS: Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions. RESULTS: The OI group had higher supine heart rates (P<0.001) and cardiac outputs (P<0.01) than the control group. In response to HUT, OI patients underwent a greater heart rate increment (P<0.001) and greater reductions in pulse pressure (P<0.01) and CO2 (P<0.001), but total systemic resistance failed to show an increment. Among the cerebrovascular indices, all BFVs (systolic, diastolic, and mean) decreased significantly more, and cerebrovascular resistance (CVR) was increased in OI patients (P<0.01) compared with control subjects. In both groups, hyperventilation induced mild tachycardia (P<0.001), a significant reduction of BFV, and a significant increase of CVR associated with a fall in CO2. Hyperventilation during HUT reproduced hypocapnia, BFV reduction, and tachycardia and worsened symptoms of OI; these symptoms and indices were improved within 2 minutes of CO2 rebreathing. The relationships between CO2 and BFV and heart rate were well described by

  11. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Novak, V.; Spies, J. M.; Novak, P.; McPhee, B. R.; Rummans, T. A.; Low, P. A.

    1998-01-01

    BACKGROUND AND PURPOSE: Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI). METHODS: Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions. RESULTS: The OI group had higher supine heart rates (P<0.001) and cardiac outputs (P<0.01) than the control group. In response to HUT, OI patients underwent a greater heart rate increment (P<0.001) and greater reductions in pulse pressure (P<0.01) and CO2 (P<0.001), but total systemic resistance failed to show an increment. Among the cerebrovascular indices, all BFVs (systolic, diastolic, and mean) decreased significantly more, and cerebrovascular resistance (CVR) was increased in OI patients (P<0.01) compared with control subjects. In both groups, hyperventilation induced mild tachycardia (P<0.001), a significant reduction of BFV, and a significant increase of CVR associated with a fall in CO2. Hyperventilation during HUT reproduced hypocapnia, BFV reduction, and tachycardia and worsened symptoms of OI; these symptoms and indices were improved within 2 minutes of CO2 rebreathing. The relationships between CO2 and BFV and heart rate were well described by

  12. Evaluation of mouse bioassay results in an inter-laboratory comparison for paralytic shellfish poisoning toxins

    NASA Astrophysics Data System (ADS)

    Cao, Jijuan; Zheng, Jiang; Yu, Bing; Wang, Qiuyan; Xu, Junyi; Li, Aifeng

    2011-07-01

    An inter-laboratory comparison of the AOAC mouse bioassay for paralytic shellfish poisoning (PSP) toxicity in shellfish was carried out among 25 Chinese laboratories to examine the overall performance for PSP testing in China, and to analyze the main factors affecting the performance of this method. The toxic scallop Patinopecten yessoensis collected from coast of Bohai Sea, China, was used as a test sample in the comparison study. The results were reported and evaluated using robust statistical methods. The z scores showed that 80%, 8%, and 12% of laboratories reported satisfactory results, unsatisfactory results, and questionable results, respectively. This evaluation demonstrates that the PSP mouse bioassay is an appropriate method for screening and testing PSP toxicity in shellfish. However, it was found that the experience and skill of technicians, as well as the body weight and health status of mice being used significantly affected the accuracy of the method.

  13. Chronic partial denervation is more widespread than is suspected clinically in paralytic poliomyelitis. Electrophysiological study.

    PubMed

    Cruz Martínez, A; Pérez Conde, M C; Ferrer, M T

    1983-01-01

    Clinical evaluation, quantitative analysis of the EMG, and motor unit fiber density were carried out on 34 selected patients that suffered paralytic poliomyelitis. 50% of the subjects developed a late and slowly progressive weakness. Automatic analysis of the electromyogram showed a great increase in mean amplitude in weak muscles but also in hypertrophic ones, and in other muscles that had normal strength. Increase in mean amplitude and in motor unit fiber density was greater in the weaker muscles. The increased amplitude ad motor unit fiber density found in clinically unaffected muscles confirms that neurogenic atrophy is more widespread than is suspected clinically. Thus, the late deterioration of function developed in some of the patients always takes place in muscles which are previously damaged and partially depleted in motor units. Widespread neurogenic involvement of the muscles can play an important role in the late deterioration of these patients.

  14. Paralytic shellfish poisoning toxin profile of mussels Perna perna from southern Atlantic coasts of Morocco.

    PubMed

    Abouabdellah, Rachid; Taleb, Hamid; Bennouna, Asmae; Erler, Katrin; Chafik, Abdeghani; Moukrim, Abdelatif

    2008-04-01

    During the monitoring programme of harmful algal blooms established along the south Atlantic coast of Morocco, a bimonthly determination of harmful algae and phycotoxins analysis in Perna perna was carried out from May 2003 to December 2004. Results of mouse bioassay (in organs and whole flesh) showed a seasonal evolution of paralytic shellfish poisoning (PSP) toxin. The mussel's contamination was associated with the occurrence in water of Alexandrium minutum. The PSP toxin profile obtained with high-performance liquid chromatography (HPLC/FD) revealed the dominance of gonyautoxins GTX2 and GTX3 and a minority of GTX1, GTX4 and saxitoxin (STX). This profile explains that the toxicity was mainly associated with A. minutum.

  15. Vaccine-associated paralytic poliomyelitis: a case report of flaccid monoparesis after oral polio vaccine.

    PubMed

    Kim, Sun Jun; Kim, Sung Han; Jee, Young Mee; Kim, Jung Soo

    2007-04-01

    This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the left lower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.

  16. Conduction in the giant nerve fiber pathway in temperature-sensitive paralytic mutants of Drosophila.

    PubMed

    Elkins, T; Ganetzky, B

    1990-08-01

    To study electrogenic conduction in neurons of the cervical giant nerve fiber (CGF) pathway in Drosophila adults carrying temperature-sensitive paralytic mutations that affect sodium channels, we recorded dorsal longitudinal muscle (DLM) responses evoked by electrical stimulation of the brain. In the mutants tipE, napts and parats, conduction in certain neurons presynaptic to the CGF failed at about the same temperature at which paralysis occurred in each mutant. Conduction in the CGF and neurons postsynaptic to it remained active in all mutants even at very elevated temperatures. In contrast, analysis of sei mutants showed enhanced spontaneous activity at elevated temperatures in at least some neurons of the CGF pathway. The implications of these results with respect to the normal in vivo functions of these genes in neuronal signalling are considered.

  17. Fatal paralytic shellfish poisoning in Kittlitz's Murrelet (Brachyramphus brevirostris) nestlings, Alaska, USA

    USGS Publications Warehouse

    Shearn-Bochsler, Valerie I.; Lance, Ellen W.; Corcoran, Robin; Piatt, John; Bodenstein, Barbara; Frame, Elizabeth; Lawonn, James

    2014-01-01

    Paralytic shellfish poisoning (PSP) is an acute toxic illness in humans resulting from ingestion of shellfish contaminated with a suite of neurotoxins (saxitoxins) produced by marine dinoflagellates, most commonly in the genus Alexandrium. Poisoning also has been sporadically suspected and, less often, documented in marine wildlife, often in association with an outbreak in humans. Kittlitz's Murrelet (Brachyramphus brevirostris) is a small, rare seabird of the Northern Pacific with a declining population. From 2008 to 2012, as part of a breeding ecology study, multiple Kittlitz's Murrelet nests on Kodiak Island, Alaska, were monitored by remote cameras. During the 2011 and 2012 breeding seasons, nestlings from several sites died during mild weather conditions. Remote camera observations revealed that the nestlings died shortly after consuming sand lance (Ammodytes hexapterus), a fish species known to biomagnify saxitoxin. High levels of saxitoxin were subsequently documented in crop content in 87% of nestling carcasses. Marine bird deaths from PSP may be underreported.

  18. Effects of “paralytic shellfish poison” on frog nerve and muscle

    PubMed Central

    Evans, M. H.

    1964-01-01

    A purified extract of toxic lamellibranchs, Saxidomus giganteus (Deshayes), containing “paralytic shellfish poison,” has been tested for its effects on conduction and contraction in frog nerve and muscle. The poison was very toxic and concentrations within the range 0.025 to 0.1 μg/ml. paralysed isolated muscle preparations, with abolition of the muscle action potential. The poison did not readily penetrate the perineurium, but in desheathed sciatic nerves the conduction of nerve impulses was rapidly blocked by concentrations of 0.05 to 0.1 μg/ml. There was no evidence that the poison had any specific curarizing action at the neuromuscular junction, and the paralysis was not accompanied by any appreciable depolarization of the muscle membrane. PMID:14211678

  19. [A case of non-paralytic pontine exotropia due to brainstem infarction].

    PubMed

    Kuroki, K; Taguchi, H; Sumida, M

    1998-12-01

    A case with non-paralytic pontine exotropia due to brainstem infarction is reported. A 58-year-old male developed sudden onset diplopia. Ocular motor findings were as follows; in forward gaze, the left eye was in abduction position. Leftward gaze, the right eye did not adduct with left beating nystagmus of left eye. Rightward gaze, both eyes could make full excursion and upward, downward gaze were possible. These findings was noted at only acute phase, 7 days later NPPE was disappeared. MRI revealed spotty lesion in the paramedian portion of the mid pontine tegmentum. It is important to observe ocular movement at acute phase because NPPE is very important sign in diagnosis of brainstem disorders.

  20. The problem of paralytic poliomyelitis in the urban and rural population around Lucknow, India.

    PubMed Central

    Chaturvedi, U. C.; Mathur, A.; Singh, U. K.; Kushwaha, M. R.; Mehrotra, R. M.; Kapoor, A. K.; Rai, S.; Gurha, R. G.

    1978-01-01

    A house to house survey was done from October 1972 to March 1974, covering 528952 individuals of urban population at Lucknow and 50,156 individuals of rural population of Unnao district, to find out the incidence of polio-like paralysis in our population. Among 12874 urban children up to 8 years old 8.2/1000 had polio-like paralysis while 4.6/1000 children of the rural population of 13554 children were affected. The incidence was significantly higher in the urban population. In the preschool age group almost 1 out of every 100 children was affected. A higher number of children were affected during 1968-9 and 1971-2, though it did not reach epidemic proportion. The findings show that paralytic polio is a serious problem in our country where poliomyelitis is endemic: this is contrary to the views generally held so far. PMID:701784

  1. A new simple screening method for the detection of paralytic shellfish poisoning toxins

    NASA Astrophysics Data System (ADS)

    Cheng, Jinping; Pi, Shuaishuai; Ye, Shufeng; Gao, Haomin; Yao, Lei; Jiang, Zhenyi; Song, Yuling; Xi, Lei

    2012-09-01

    The current testing for paralytic shellfish poisoning (PSP) in shellfish is based on the mouse bioassay (MBA). To alleviate animal welfare concerns, we evaluated the utility of using sublethal indicators of toxicity as an alternative to measuring time to death. Live mice were injected with a PSP congener and the changes in neurotransmitter levels were measured 60, 90, and 120 min after injection. Acetylcholine (ACh) was the most sensitive marker for PSP toxicity. The changes in neurotransmitter levels were most pronounced in the blood. Thus, measurement of Ach levels in the blood may serve as a sensitive predictor for PSP that would not require sacrifice of the mice. This method was relatively simple, sensitive (less than 1 μg/kg weight, equivalent to 20 ng/mL), low maintenance, and rapid (less than 60 min).

  2. What People with Lactose Intolerance Need to Know about Osteoporosis

    MedlinePlus

    ... People With Lactose Intolerance Need to Know About Osteoporosis Publication available in: PDF (88 KB) Chinese ( 繁體中文 ) ... Health Strategies Resources For Your Information What Is Osteoporosis? Osteoporosis is a condition in which bones become ...

  3. Systemic lactose intolerance: a new perspective on an old problem

    PubMed Central

    Matthews, S; Waud, J; Roberts, A; Campbell, A

    2005-01-01

    Intolerance to certain foods can cause a range of gut and systemic symptoms. The possibility that these can be caused by lactose has been missed because of "hidden" lactose added to many foods and drinks inadequately labelled, confusing diagnosis based on dietary removal of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance. The key is the prolonged effect of dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labelled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the wide range of systemic symptoms caused by lactose intolerance. This has important implications for the management of irritable bowel syndrome, and for doctors of many specialties. PMID:15749792

  4. The role of colonic metabolism in lactose intolerance.

    PubMed

    He, T; Venema, K; Priebe, M G; Welling, G W; Brummer, R-J M; Vonk, R J

    2008-08-01

    Lactose maldigestion and intolerance affect a large part of the world population. The underlying factors of lactose intolerance are not fully understood. In this review, the role of colonic metabolism is discussed, i.e. fermentation of lactose by the colonic microbiota, colonic processing of the fermentation metabolites and how these processes would play a role in the pathophysiology of lactose intolerance. We suggest that the balance between the removal and production rate of osmotic-active components (lactose, and intermediate metabolites, e.g. lactate, succinate, etc.) in the colon is a key factor in the development of symptoms. The involvement of the colon may provide the basis for designing new targeted strategies for dietary and clinical management of lactose intolerance.

  5. Paralytic poliomyelitis associated with Sabin monovalent and bivalent oral polio vaccines in Hungary.

    PubMed

    Estívariz, Concepción F; Molnár, Zsuzsanna; Venczel, Linda; Kapusinszky, Beatrix; Zingeser, James A; Lipskaya, Galina Y; Kew, Olen M; Berencsi, György; Csohán, Agnes

    2011-08-01

    Historical records of patients with vaccine-associated paralytic poliomyelitis (VAPP) in Hungary during 1961-1981 were reviewed to assess the risk of VAPP after oral polio vaccine (OPV) administration. A confirmed VAPP case was defined as a diagnosis of paralytic poliomyelitis and residual paralysis at 60 days in a patient with an epidemiologic link to the vaccine. Archived poliovirus isolates were retested using polymerase chain reaction and sequencing of the viral protein 1 capsid region. This review confirmed 46 of 47 cases previously reported as VAPP. Three cases originally linked to monovalent OPV (mOPV) 3 and one case linked to mOPV1 presented after administration of bivalent OPV 1 + 3 (bOPV). The adjusted VAPP risk per million doses administered was 0.18 for mOPV1 (2 cases/11.13 million doses), 2.96 for mOPV3 (32 cases/10.81 million doses), and 12.82 for bOPV (5 cases/390,000 doses). Absence of protection from immunization with inactivated poliovirus vaccine or exposure to OPV virus from routine immunization and recent injections could explain the higher relative risk of VAPP in Hungarian children. In polio-endemic areas in which mOPV3 and bOPV are needed to achieve eradication, the higher risk of VAPP would be offset by the high risk of paralysis due to wild poliovirus and higher per-dose efficacy of mOPV3 and bOPV compared with trivalent OPV.

  6. Case diagnosis and characterization of suspected paralytic shellfish poisoning in Alaska.

    PubMed

    Knaack, Jennifer S; Porter, Kimberly A; Jacob, Justin T; Sullivan, Kate; Forester, Matthew; Wang, Richard Y; Trainer, Vera L; Morton, Steve; Eckert, Ginny; McGahee, Ernest; Thomas, Jerry; McLaughlin, Joseph; Johnson, Rudolph C

    2016-07-01

    Clinical cases of paralytic shellfish poisoning (PSP) are common in Alaska, and result from human consumption of shellfish contaminated with saxitoxin (STX) and its analogues. Diagnosis of PSP is presumptive and based on recent ingestion of shellfish and presence of manifestations consistent with symptoms of PSP; diagnosis is confirmed by detection of paralytic shellfish toxins in a clinical specimen or food sample. A clinical diagnostic analytical method using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to evaluate the diagnosis of saxitoxin-induced PSP (STX-PSP) in 11 Alaskan patients using urine specimens collected between June 2010 and November 2011. Concentrations of urinary STX were corrected for creatinine concentrations to account for dilution or concentration of urine from water intake or restriction, respectively. Of the 11 patients with suspected PSP, four patients were confirmed to have STX-PSP by urine testing (24-364ng STX/g creatinine). Five patients had clinical manifestations of PSP though no STX was detected in their urine. Two patients were ruled out for STX-PSP based on non-detected urinary STX and the absence of clinical findings. Results revealed that dysphagia and dysarthria may be stronger indicators of PSP than paresthesia and nausea, which are commonly used to clinically diagnose patients with PSP. PSP can also occur from exposure to a number of STX congeners, such as gonyautoxins, however their presence in urine was not assessed in this investigation. In addition, meal remnants obtained from six presumptive PSP cases were analyzed using the Association of Official Analytical Chemists' mouse bioassay. All six samples tested positive for PSP toxins. In the future, the clinical diagnostic method can be used in conjunction with the mouse bioassay or HPLC-MS/MS to assess the extent of STX-PSP in Alaska where it has been suggested that PSP is underreported. Published by Elsevier B.V.

  7. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance

    PubMed Central

    Garland, Emily M; Celedonio, Jorge E; Raj, Satish R

    2015-01-01

    Postural Tachycardia Syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. The orthostatic tachycardia occurs in the absence of orthostatic hypotension and is associated with a >6-month history of symptoms that are relieved by recumbence. The heart rate abnormality and orthostatic symptoms should not be caused by medications that impair autonomic regulation or by debilitating disorders that can cause tachycardia. POTS is a “final common pathway” for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. Not only may patients be affected by more than one of these pathophysiologies, but also the phenotype of POTS has similarities to a number of other disorders, e.g., chronic fatigue syndrome, Ehlers-Danlos Syndrome, vasovagal syncope, and inappropriate sinus tachycardia. POTS can be treated with a combination of non-pharmacological approaches, a structured exercise training program, and often some pharmacological support. PMID:26198889

  8. Endogenous circulating sympatholytic factor in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Shapiro, R. E.; Winters, B.; Hales, M.; Barnett, T.; Schwinn, D. A.; Flavahan, N.; Berkowitz, D. E.

    2000-01-01

    Sympathotonic orthostatic hypotension (SOH) is an idiopathic syndrome characterized by tachycardia, hypotension, elevated plasma norepinephrine, and symptoms of orthostatic intolerance provoked by assumption of an upright posture. We studied a woman with severe progressive SOH with blood pressure unresponsive to the pressor effects of alpha(1)-adrenergic receptor (AR) agonists. We tested the hypothesis that a circulating factor in this patient interferes with vascular adrenergic neurotransmission. Preincubation of porcine pulmonary artery vessel rings with patient plasma produced a dose-dependent inhibition of vasoconstriction to phenylephrine in vitro, abolished vasoconstriction to direct electrical stimulation, and had no effect on nonadrenergic vasoconstrictive stimuli (endothelin-1), PGF-2alpha (or KCl). Preincubation of vessels with control plasma was devoid of these effects. SOH plasma inhibited the binding of an alpha(1)-selective antagonist radioligand ([(125)I]HEAT) to membrane fractions derived from porcine pulmonary artery vessel rings, rat liver, and cell lines selectively overexpressing human ARs of the alpha(1B) subtype but not other AR subtypes (alpha(1A) and alpha(1D)). We conclude that a factor in SOH plasma can selectively and irreversibly inhibit adrenergic ligand binding to alpha(1B) ARs. We propose that this factor contributes to a novel pathogenesis for SOH in this patient. This patient's syndrome represents a new disease entity, and her plasma may provide a unique tool for probing the selective functions of alpha(1)-ARs.

  9. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance.

    PubMed

    Garland, Emily M; Celedonio, Jorge E; Raj, Satish R

    2015-09-01

    Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. The orthostatic tachycardia occurs in the absence of orthostatic hypotension and is associated with a >6-month history of symptoms that are relieved by recumbence. The heart rate abnormality and orthostatic symptoms should not be caused by medications that impair autonomic regulation or by debilitating disorders that can cause tachycardia. POTS is a "final common pathway" for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. Not only may patients be affected by more than one of these pathophysiologies but also the phenotype of POTS has similarities to a number of other disorders, e.g., chronic fatigue syndrome, Ehlers-Danlos syndrome, vasovagal syncope, and inappropriate sinus tachycardia. POTS can be treated with a combination of non-pharmacological approaches, a structured exercise training program, and often some pharmacological support.

  10. Differentiating food allergies from food intolerances.

    PubMed

    Guandalini, Stefano; Newland, Catherine

    2011-10-01

    Adverse reactions to foods are extremely common, and generally they are attributed to allergy. However, clinical manifestations of various degrees of severity related to ingestion of foods can arise as a result of a number of disorders, only some of which can be defined as allergic, implying an immune mechanism. Recent epidemiological data in North America showed that the prevalence of food allergy in children has increased. The most common food allergens in the United States include egg, milk, peanut, tree nuts, wheat, crustacean shellfish, and soy. This review examines the various forms of food intolerances (immunoglobulin E [IgE] and non-IgE mediated), including celiac disease and gluten sensitivity. Immune mediated reactions can be either IgE mediated or non-IgE mediated. Among the first group, Immediate GI hypersensitivity and oral allergy syndrome are the best described. Often, but not always, IgE-mediated food allergies are entities such as eosinophilic esophagitis and eosinophilic gastroenteropathy. Non IgE-mediated immune mediated food reactions include celiac disease and gluten sensitivity, two increasingly recognized disorders. Finally, non-immune mediated reactions encompass different categories such as disorders of digestion and absorption, inborn errors of metabolism, as well as pharmacological and toxic reactions.

  11. Endogenous circulating sympatholytic factor in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Shapiro, R. E.; Winters, B.; Hales, M.; Barnett, T.; Schwinn, D. A.; Flavahan, N.; Berkowitz, D. E.

    2000-01-01

    Sympathotonic orthostatic hypotension (SOH) is an idiopathic syndrome characterized by tachycardia, hypotension, elevated plasma norepinephrine, and symptoms of orthostatic intolerance provoked by assumption of an upright posture. We studied a woman with severe progressive SOH with blood pressure unresponsive to the pressor effects of alpha(1)-adrenergic receptor (AR) agonists. We tested the hypothesis that a circulating factor in this patient interferes with vascular adrenergic neurotransmission. Preincubation of porcine pulmonary artery vessel rings with patient plasma produced a dose-dependent inhibition of vasoconstriction to phenylephrine in vitro, abolished vasoconstriction to direct electrical stimulation, and had no effect on nonadrenergic vasoconstrictive stimuli (endothelin-1), PGF-2alpha (or KCl). Preincubation of vessels with control plasma was devoid of these effects. SOH plasma inhibited the binding of an alpha(1)-selective antagonist radioligand ([(125)I]HEAT) to membrane fractions derived from porcine pulmonary artery vessel rings, rat liver, and cell lines selectively overexpressing human ARs of the alpha(1B) subtype but not other AR subtypes (alpha(1A) and alpha(1D)). We conclude that a factor in SOH plasma can selectively and irreversibly inhibit adrenergic ligand binding to alpha(1B) ARs. We propose that this factor contributes to a novel pathogenesis for SOH in this patient. This patient's syndrome represents a new disease entity, and her plasma may provide a unique tool for probing the selective functions of alpha(1)-ARs.

  12. [Hyponatremia : The water-intolerant patient].

    PubMed

    Hensen, J

    2012-09-01

    Hyponatremia due to intolerance to water is a frequent clinical condition and associated with increased mortality. Besides the well known neurological symptoms, gait disturbances, falls, fractures and osteoporosis have also been described recently in patients with chronic hyponatremia. Acute hyponatremia is a more dramatic situation and needs rapid action when severe neurological symptoms are present. Hypertonic saline is recommended to treat this condition until relief of severe symptoms. The causes of hyponatremia have to be carefully examined. Especially diuretics, antidepressants and endocrine causes, e.g. hypothyroidism, hypocortisolism and hypoaldosteronism should be excluded by examination of the patient history, clinical examination and by laboratory tests. Patients should be classified as being euvolemic, hypovolemic or hypervolemic. Whereas acute hyponatremia with severe symptom should be treated with hypertonic saline, euvolemic hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild and moderate symptoms can now be treated with tolvaptan, a selective V(2)-vasopressin antagonist. Oral tolvaptan has been shown to be an effective and potent aquaretic to treat hyponatremia caused by SIADH as evidenced by a simultaneous increase in serum sodium and a decrease in urine osmolality. The condition of patients with mild or moderate hyponatremia is also improved. Side effects associated with tolvaptan include increased thirst, dry mouth, polyuria and hypernatremia. Rapid increases in serum sodium should be avoided by close monitoring in a hospital setting.

  13. Clinical picture of hypolactasia and lactose intolerance.

    PubMed

    Villako, K; Maaroos, H

    1994-01-01

    Selective adult-type hypolactasia, the main cause of primary malabsorption of lactose, shows considerable variation in terms of its symptoms, which mainly depend on the amount of milk consumption. The article discusses congenital lactase deficiency and familial lactose intolerance. Links between hypolactasia and non-specific abdominal complaints, coronary heart disease and cataract are presented. The decrease in lactase activity in the brush border of jejunal mucosa, associated with diseases of the mucosa or any other condition which damages the enterocytes, is discussed as a cause of secondary hypolactasia. It is shown that adult-type primary hypolactasia and selective lactose malabsorption represent a major problem in the everyday work of general practitioners, particularly in populations where hypolactasia is common. Therefore, the examination and treatment of non-selected patients with vague abdominal complaints is important in primary health care. As the need for calcium in humans is largely met by the intake of milk, the consumption of milk has to be in amounts that are tolerable for the individual.

  14. Pathogenesis of acidosis in hereditary fructose intolerance.

    PubMed

    Richardson, R M; Little, J A; Patten, R L; Goldstein, M B; Halperin, M L

    1979-11-01

    An 18-yr-old man with a classical history of hereditary fructose intolerance (HFI) developed typical biochemical changes following an oral fructose load: fructosemia, hypoglycemia, hypophosphatemia, hyperuricemia, and metabolic acidosis. Hypokalemia (3.1 meq/liter) was also noted. Three aspects of this case expand the published literature on this syndrome: (1) Metabolic acidosis was found to be due to both lactic acidosis and proximal renal tubular acidosis (RTA). We could quantitate the relative contribution of each, and found that urinary bicarbonate loss due to proximal RTA accounted for less than 10% of the fall in serum bicarbonate. The major cause of the metabolic acidosis was lactic acidosis. (2) Hypokalemia was found to be due to movement of potassium out of the extracellular space rather than to urinary loss. Potassium may have entered cells with phosphate or may have been sequestered in the gastrointestinal tract. (3) The coexistence of proximal RTA and acidemia made it possible to study the effect of acidemia on the urine-blood partial pressure of carbon dioxide (PCO2) gradient in alkaline urine (U-B PCO2). The U-B PCO2 measured during acidemia was much higher at the same urine bicarbonate concentration than in normal controls during alkalemia, providing evidence in humans that acidemia stimulates distal nephron hydrogen-ion secretion.

  15. Perceived lactose intolerance in adult Canadians: a national survey.

    PubMed

    Barr, Susan I

    2013-08-01

    Although double-blind studies show that lactose-intolerant individuals can consume moderate quantities of milk products without perceptible symptoms, many who perceive that they are lactose intolerant limit or avoid milk products, potentially compromising calcium and vitamin D intakes. Adult Canadians are at risk of inadequate intakes of these nutrients, but no data exist on the prevalence, correlates, and potential impact of perceived lactose intolerance among Canadians. To address this, a Web-based survey of a population-representative sample of 2251 Canadians aged ≥19 years was conducted. Overall, 16% self-reported lactose intolerance. This was more common in women (odds ratio (OR), 1.84; 95% CI, 1.46-2.33) and in nonwhites (OR, 1.79; 95% CI, 1.24-2.58) and less common in those >50 years of age (OR, 0.71; 95% CI, 0.56-0.90) and in those completing the survey in French (OR, 0.74; 95% CI, 0.56-0.99). Those with self-reported lactose intolerance had lower covariate-adjusted milk product and alternative intakes (mean ± SE; 1.40 ± 0.08 servings·day(-1) vs. 2.33 ± 0.03 servings·day(-1), p < 0.001). A greater proportion used supplements containing calcium (52% vs. 37%, p < 0.001) and vitamin D (58% vs. 46%, p < 0.001), but calcium intakes from the combination of milk products, alternatives, and supplements were lower (739 ± 30 mg·day(-1) vs. 893 ± 13 mg·day(-1), p < 0.0001). Variation in self-reported lactose intolerance by sex, age, and language preference was unexpected and suggests that some groups may be more vulnerable to the perception that they are lactose intolerant. Regardless of whether lactose intolerance is physiologically based or perceptual, education is required to ensure that calcium intakes are not compromised.

  16. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management

    PubMed Central

    Deng, Yanyong; Misselwitz, Benjamin; Dai, Ning; Fox, Mark

    2015-01-01

    Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance. PMID:26393648

  17. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management.

    PubMed

    Deng, Yanyong; Misselwitz, Benjamin; Dai, Ning; Fox, Mark

    2015-09-18

    Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance.

  18. Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment.

    PubMed

    Misselwitz, Benjamin; Pohl, Daniel; Frühauf, Heiko; Fried, Michael; Vavricka, Stephan R; Fox, Mark

    2013-06-01

    Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and intolerance.

  19. Feeding Tubes

    MedlinePlus

    ... Feeding Tubes Health Information Sheet Q & A with Experts Patient Stories Social Security Disability Application Process For Kids ... Feeding Tubes Health Information Sheet Q & A with Experts Patient Stories Social Security Disability Application Process For Kids ...

  20. Statin intolerance in a referral lipid clinic.

    PubMed

    Lakey, Wanda C; Greyshock, Nicole G; Kelley, Carly E; Siddiqui, Mohammad A; Ahmad, Umar; Lokhnygina, Yuliya V; Guyton, John R

    2016-01-01

    Statins effectively prevent atherosclerotic cardiovascular disease, but rates of statin discontinuation after adverse events are high. Describe the range and relative frequencies of adverse events potentially attributable to statins in lipid referral practice and assess statin rechallenge outcomes. Retrospective cohort study of 642 patients with statin-associated adverse events evaluated in a referral lipid clinic between January 1, 2004 and January 27, 2011. Patients experiencing adverse events by organ system included 92% with musculoskeletal, 8% central nervous system, 10% liver, 8% gastrointestinal, 5% peripheral nervous system, 5% skin, and 3% other events. Overlap of organ system involvement occurred in 22.5%. At least 1 follow-up visit was made by 557 patients, among whom overall median follow-up was 25 months. Among patients treated with a statin in the clinic, 71% remained on a statin at the last follow-up visit. Patients with hepatic transaminase increases by history were numerically more likely than the overall group to resume or remain on statin treatment, whereas those reporting central nervous system or gastrointestinal symptoms trended lower for statin maintenance. Among patients who experienced an adverse event after statin rechallenge, the majority (64%) were being treated with intermittent, nondaily dosing at the time of the adverse event. Although musculoskeletal symptoms are reported by 90% of patients with statin intolerance, symptoms involving other organ systems may be more frequent than previously supposed. Understanding the range of symptoms, time course, and impact on daily activities informs counseling in patient-centered practice, but assessment of causation by statins remains challenging. Published by Elsevier Inc.

  1. Bortezomib-induced paralytic ileus is a potential gastrointestinal side effect of this first-in-class anticancer proteasome inhibitor.

    PubMed

    Perfetti, Vittorio; Palladini, Giovanni; Brunetti, Laura; Sgarella, Adele; Brugnatelli, Silvia; Gobbi, Paolo G; Corazza, Gino Roberto

    2007-07-01

    Bortezomib is the first anticancer proteasome inhibitor introduced into clinical practice. It has been recently approved for the treatment of multiple myeloma, an incurable plasma cell tumour that accounts for 10-15% of all haematologic malignancies and for approximately 20% of deaths. Gastrointestinal toxicity associated with the use of this drug is common but generally mild to moderate. Paralytic ileus in patients undergoing bortezomib treatment has been reported, although a definite attribution to bortezomib administration has not been established. We report a myeloma patient who developed severe paralytic ileus during bortezomib therapy, which presented in the context of progressive constipation without other known causes and which regressed promptly with medical management after drug cessation, suggesting a direct causal relationship. Awareness of the various potential gastrointestinal toxic effects of bortezomib is of relevance given the growing number of patients undergoing treatment with this important and effective new cancer drug.

  2. [Pontine infarction presenting non-paralytic pontine exotropia--evaluation of its clinical course and its MRI findings].

    PubMed

    Takamatsu, K; Takizawa, T; Sato, S; Sano, A; Takahashi, K; Murakami, Y; Yoshihisa, K; Sato, M; Ota, K; Miyamoto, T

    1992-07-01

    We report two patients with brainstem infarction who presented non-paralytic pontine exotropia (NPPE) in acute phase. Case 1 was a 76-year-old woman. NPPE observed 3 hours after the onset disappeared two days later. Case 2 was a 60-year-old man. Paralytic pontine exotropia was observed 4 hours after the onset of his stroke. NPPE was noted on the next day and left medial longitudinal fasciculus (MLF) syndrome was still present on the third day. Seven days later, the disturbances of ocular movement was disappeared. T2-weighted cranial MRI showed high signal intensity lesions in the paramedian portion of the mid-pontine tegmentum beneath the fourth ventricle in both cases. Although it has been thought that NPPE is a rare clinical symptom, we think that NPPE is by no means a rare symptom in the acute stage of brainstem infarction.

  3. Potential use of gamma irradiation in the production of mussel and oyster reference materials for paralytic shellfish poisoning toxins.

    PubMed

    Turner, Andrew D; Hatfield, Robert G; Powell, Andy L; Higman, Wendy

    2010-05-01

    Bivalve shellfish samples containing paralytic shellfish poisoning toxins were subjected to gamma irradiation dosage trials in order to assess the potential suitability of the technique in the production of toxin reference materials. Two candidate reference materials of tissue homogenates, mussels (Mytilus sp.) and native oysters (Ostrea edulis), were prepared in-house. Both were subjected to gamma irradiation at four different dose levels, 3.0, 6.0, 13.0 and 18.1 kGy. Bacterial levels were shown to be eliminated in the mussels and significantly reduced in the oysters following irradiation at all four dose levels. Paralytic shellfish poisoning (PSP) toxin concentrations were not significantly reduced in any of the samples indicating the treatment had no adverse affect on the initial stability of any of the PSP toxins monitored. Chromatographic results showed near-identical profiles for treated and non-treated samples inferring that no fluorescent toxin degradation products or matrix interferences were produced during the irradiation process. Results therefore proved that gamma irradiation treatment reduced bacterial levels within paralytic shellfish poisoning reference materials without compromising analyte content, with the subsequent potential to enhance the stability of future candidate reference materials treated in this manner.

  4. Ringer's lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial.

    PubMed

    Li, Yuhong; He, Rui; Ying, Xiaojiang; Hahn, Robert G

    2015-05-06

    The infusion of large amounts of Ringer's lactate prolongs the functional gastrointestinal recovery time and increases the number of complications after open abdominal surgery. We performed an open-labelled clinical trial to determine whether hydroxyethyl starch or Ringer's lactate exerts these adverse effects when the surgery is performed by laparoscopy. Eighty-eight patients scheduled for major abdominal cancer surgery (83% by laparoscopy) received a first-line fluid treatment with 9 ml/kg of either 6% hydroxyethyl starch 130/0.4 (Voluven) or Ringer's lactate, just after induction of anaesthesia; this was followed by a second-line infusion with 12 ml/kg of either starch or Ringer's lactate over 1 hour. Further therapy was managed at the discretion of the attending anaesthetist. Outcome data consisted of postoperative gastrointestinal recovery time, complications and length of hospital stay. The order of the infusions had no impact on the outcome. Both the administration of ≥ 2 L of Ringer's lactate and the development of a surgical complication were associated with a longer time period of paralytic ileus and food intolerance (two-way ANOVA, P < 0.02), but only surgical complications prolonged the length of hospital stay (P < 0.001). The independent effect of Ringer's lactate and complications of food intolerance time amounted to 2 days each. The infusion of ≥ 1 L of hydroxyethyl starch did not adversely affect gastrointestinal recovery. Ringer's lactate, but not hydroxyethyl starch, prolonged the gastrointestinal recovery time in patients undergoing laparoscopic cancer surgery. Surgical complications prolonged the hospital stay.

  5. Relation of blood volume and blood pressure in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Jacob, G.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.

    1998-01-01

    A complex but crucial relationship exists between blood volume and blood pressure in human subjects; it has been recognized that in essential hypertension, renovascular hypertension, and pheochromocytoma, the relationship between plasma volume and diastolic blood pressure is an inverse one. This phenomenon has not been studied in individuals with low normal and reduced blood pressures. Orthostatic intolerance is a commonly encountered abnormality in blood pressure regulation often associated with tachycardia in the standing position. Most of these patients have varying degrees of reduced blood volume. We tested the hypothesis that the relationship previously found between plasma volume and diastolic blood pressure in pressor states would also hold in orthostatic intolerance. We studied 16 patients with a history of symptomatic orthostatic intolerance associated with an elevation in plasma norepinephrine in the upright posture and hypovolemia in 9 patients and normovolemia in 7 patients. Our studies demonstrate an inverse relationship between plasma volume and diastolic blood pressure in patients with orthostatic intolerance. This finding also holds for the change in diastolic blood pressure in response to upright posture. In this relationship, patients with orthostatic intolerance with high plasma norepinephrine resemble those with essential hypertension, renovascular hypertension, and pheochromocytoma. We conclude that in a variety of conditions at both ends of the blood pressure spectrum, the seemingly paradoxical association of hypovolemia and diastolic blood pressure is preserved.

  6. Expert opinion: the therapeutic challenges faced by statin intolerance.

    PubMed

    Patel, Jaideep; Martin, Seth S; Banach, Maciej

    2016-08-01

    Statin intolerance is largely defined by muscle related symptoms, leading to intolerability and cessation. The nocebo effect coupled with the challenges of diagnosing statin myopathy undermines drug adherence that is critical for achieving the benefits of lipid-lowering and cardiovascular risk reduction. A temporal relationship should be made between the initiation of therapy and development of symptoms to aid in diagnosis. The mainstay of treatment is statin cessation or statin dose reduction and evaluation of alternative causes for muscle related symptoms. Most symptoms usually resolve within 2 weeks of discontinuing therapy. The patient can be re-challenged with the same statin at a lower dose or an alternative statin. Non-statin lipid lowering therapies offer an alternative to patients who cannot tolerate statins. We discuss current guideline-focused management of patients with statin intolerance. When initiating statin therapy, attention to risk factors for statin intolerance is strongly recommended. Most patients will tolerate some degree of statin therapy; thus statin re-challenge is advisable. If alternative dosing regimens are not tolerated, non-statin medications are acceptable alternatives. To limit errors in the diagnosis of statin intolerance, improvements in clinician-patient communication about the side effects and benefits of statins should be attempted.

  7. Relation of blood volume and blood pressure in orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Jacob, G.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.

    1998-01-01

    A complex but crucial relationship exists between blood volume and blood pressure in human subjects; it has been recognized that in essential hypertension, renovascular hypertension, and pheochromocytoma, the relationship between plasma volume and diastolic blood pressure is an inverse one. This phenomenon has not been studied in individuals with low normal and reduced blood pressures. Orthostatic intolerance is a commonly encountered abnormality in blood pressure regulation often associated with tachycardia in the standing position. Most of these patients have varying degrees of reduced blood volume. We tested the hypothesis that the relationship previously found between plasma volume and diastolic blood pressure in pressor states would also hold in orthostatic intolerance. We studied 16 patients with a history of symptomatic orthostatic intolerance associated with an elevation in plasma norepinephrine in the upright posture and hypovolemia in 9 patients and normovolemia in 7 patients. Our studies demonstrate an inverse relationship between plasma volume and diastolic blood pressure in patients with orthostatic intolerance. This finding also holds for the change in diastolic blood pressure in response to upright posture. In this relationship, patients with orthostatic intolerance with high plasma norepinephrine resemble those with essential hypertension, renovascular hypertension, and pheochromocytoma. We conclude that in a variety of conditions at both ends of the blood pressure spectrum, the seemingly paradoxical association of hypovolemia and diastolic blood pressure is preserved.

  8. The diagnosis of hereditary fructose intolerance.

    PubMed

    Steinmann, B; Gitzelmann, R

    1981-09-01

    Hereditary fructose intolerance (HFI) is a potentially life-threatening disorder and can be suspected from a detailed nutritional history. The usefulness of 2 diagnostic procedures, fructose tolerance test (FTT) and aldolase assay on biopsied liver, was studied. A standardized intravenous FTT with 200 mg/kg b.w. was done on 11 children with HFI, 17 age-matched contrast children, 6 adults with HFI and 6 adult controls. Blood glucose, phosphorus, urate, magnesium and fructose were followed for 2 hours. By the FTT, each HFI individual was reliably distinguished from controls and contrasts and even from those with acute liver disease other than HFI. Both children with non-HFI hepatopathy examined by both procedures had a normal FTT in spite of reduced liver fructaldolase activity. HFI children responded to the FTT by earlier and more pronounced hypoglycemia than adults, and one girl converted to an adult type response between the ages 12 and 181/2 years. Responses of two HFI sibling pairs and of one set of monozygotic twins were typical for age, but resemblance was no greater than within the unrelated HFI probands. The intravenous FTT is judged a reliable diagnostic tool, simple and harmless if done in hospital. Essential fructosuria is readily diagnosed by the FTT, but fructose-1,6-diphosphatase deficiency and HFI are not differentiated with certainty. Liver biopsies were obtained from 35 children with HFI, 14 contrast persons and 10 controls (of which 9 organ donors) and examined enzymatically. Deficiency of fructaldolase was observed in all HFI children but also in some contrast children suffering from acute liver disease other than HFI. In these, HFI could only be excluded when the reduced activity of reference enzymes such as fructose-1,6-diphosphatase and glucose-6-phosphatase and liver histology were included in the evaluation. In one deceased HFI infant, fructaldolase was deficient in both, liver and kidney cortex. Extent of antibody activation and of heat

  9. A Cluster of Paralytic Poliomyelitis Cases Due to Transmission of Slightly Diverged Sabin 2 Vaccine Poliovirus.

    PubMed

    Korotkova, Ekaterina A; Gmyl, Anatoly P; Yakovenko, Maria L; Ivanova, Olga E; Eremeeva, Tatyana P; Kozlovskaya, Liubov I; Shakaryan, Armen K; Lipskaya, Galina Y; Parshina, Irina L; Loginovskikh, Nataliya V; Morozova, Nadezhda S; Agol, Vadim I

    2016-07-01

    Four cases of acute flaccid paralysis caused by slightly evolved (Sabin-like) vaccine polioviruses of serotype 2 were registered in July to August 2010 in an orphanage of Biysk (Altai Region, Russia). The Biysk cluster of vaccine-associated paralytic poliomyelitis (VAPP) had several uncommon, if not unique, features. (i) Until this outbreak, Sabin-like viruses (in distinction to more markedly evolved vaccine-derived polioviruses [VDPVs]) were reported to cause only sporadic cases of VAPP. Consequently, VAPP cases were not considered to require outbreak-type responses. However, the Biysk outbreak completely blurred the borderline between Sabin-like viruses and VDPVs in epidemiological terms. (ii) The outbreak demonstrated a very high disease/infection ratio, apparently exceeding even that reported for wild polioviruses. The viral genome structures did not provide any substantial hints as to the underlying reason(s) for such pathogenicity. (iii) The replacement of intestinal poliovirus lineages by other Sabin-like lineages during short intervals after the disease onsets was observed in two patients. Again, the sequences of the respective genomes provided no clues to explain these events. (iv) The polioviruses isolated from the patients and their contacts demonstrated a striking heterogeneity as well as rapid and uneven evolution of the whole genomes and their parts, apparently due to extensive interpersonal contacts in a relatively small closed community, multiple bottlenecking, and recombination. Altogether, the results demonstrate several new aspects of pathogenicity, epidemiology, and evolution of vaccine-related polioviruses and underscore several serious gaps in understanding these problems. The oral poliovirus vaccine largely contributed to the nearly complete disappearance of poliovirus-caused poliomyelitis. Being generally safe, it can, in some cases, result in a paralytic disease. Two types of such outcomes are distinguished: those caused by slightly

  10. [Long-term results of two temporalis muscle transfer procedures in correction of paralytic lagophthalmos].

    PubMed

    Qian, Jiange; Yan, Liangbin; Zhang, Guocheng

    2004-11-01

    To compare the long-term results and possible complications of a modified temporalis muscle transfer (TMT) with the Johnson's procedure in correction of paralytic lagophthalmos. From September 1997 to March 2000, paralytic lagophthalmos due to leprosy in 92 patients were corrected with TMT. The 89 cases (127 to eyes including 51 unilateral and 38 bilateral) followed up 3 years after operation were analyzed. There were 69 males and 20 females with ages ranging from 18 to 65 years (52 years on average). The duration of lagophthalmos was 1-22 years with an average of 8.2 years. And 36 eyes were complicated with lower eyelid ectropion. Sixty-five eyes were corrected with Johnson's procedure (Johnson's TMT group), 62 with the modified TMT procedure (modified TMT group). The modifications were as follows: (1) omitting the fascial strip in the lower eyelid to avoid postoperative ectropion. (2) fixing the fascial strip of the upper eyelid to the middle or inner margin of the tarsal palate depending on the degree of the lagophthalmos to avoid possible ptosis of the upper eyelid. In Johnson's TMT group, the mean lid gap on light closure was reduced to 3.1 mm postoperatively from 7.7 mm preoperatively; and the mean lid gap on tight closure was reduced to 0.5 mm postoperatively from 6.1 mm preoperatively. The symptoms of redness (73.7%) and tearing (63.7%) disappeared or were improved postoperatively. However, ectropion and ptosis occurred in 24 eyes and 9 eyes respectively. The overall excellent and good rate was 58.5%. In the modified TMT group, the mean lid gap on light closure was reduced to 3.3 mm postoperatively from 7.5 mm preoperatively; and the mean lid gap on tight closure was reduced to 0. 6 mm postoperatively from 6. 3 mm preoperatively. The symptoms of redness (90.9%) and tearing (71.0%) disappeared or were improved postoperatively, and no ectropion or ptosis was found except one ectropion. The overall excellent and good rate was 87.1%, which was significantly

  11. A Cluster of Paralytic Poliomyelitis Cases Due to Transmission of Slightly Diverged Sabin 2 Vaccine Poliovirus

    PubMed Central

    Korotkova, Ekaterina A.; Gmyl, Anatoly P.; Yakovenko, Maria L.; Ivanova, Olga E.; Eremeeva, Tatyana P.; Kozlovskaya, Liubov I.; Shakaryan, Armen K.; Lipskaya, Galina Y.; Parshina, Irina L.; Loginovskikh, Nataliya V.; Morozova, Nadezhda S.

    2016-01-01

    ABSTRACT Four cases of acute flaccid paralysis caused by slightly evolved (Sabin-like) vaccine polioviruses of serotype 2 were registered in July to August 2010 in an orphanage of Biysk (Altai Region, Russia). The Biysk cluster of vaccine-associated paralytic poliomyelitis (VAPP) had several uncommon, if not unique, features. (i) Until this outbreak, Sabin-like viruses (in distinction to more markedly evolved vaccine-derived polioviruses [VDPVs]) were reported to cause only sporadic cases of VAPP. Consequently, VAPP cases were not considered to require outbreak-type responses. However, the Biysk outbreak completely blurred the borderline between Sabin-like viruses and VDPVs in epidemiological terms. (ii) The outbreak demonstrated a very high disease/infection ratio, apparently exceeding even that reported for wild polioviruses. The viral genome structures did not provide any substantial hints as to the underlying reason(s) for such pathogenicity. (iii) The replacement of intestinal poliovirus lineages by other Sabin-like lineages during short intervals after the disease onsets was observed in two patients. Again, the sequences of the respective genomes provided no clues to explain these events. (iv) The polioviruses isolated from the patients and their contacts demonstrated a striking heterogeneity as well as rapid and uneven evolution of the whole genomes and their parts, apparently due to extensive interpersonal contacts in a relatively small closed community, multiple bottlenecking, and recombination. Altogether, the results demonstrate several new aspects of pathogenicity, epidemiology, and evolution of vaccine-related polioviruses and underscore several serious gaps in understanding these problems. IMPORTANCE The oral poliovirus vaccine largely contributed to the nearly complete disappearance of poliovirus-caused poliomyelitis. Being generally safe, it can, in some cases, result in a paralytic disease. Two types of such outcomes are distinguished: those caused

  12. Ultrasonic Monitoring of Enzyme Catalysis; Enzyme Activity in Formulations for Lactose-Intolerant Infants.

    PubMed

    Altas, Margarida C; Kudryashov, Evgeny; Buckin, Vitaly

    2016-05-03

    The paper introduces ultrasonic technology for real-time, nondestructive, precision monitoring of enzyme-catalyzed reactions in solutions and in complex opaque media. The capabilities of the technology are examined in a comprehensive analysis of the effects of a variety of diverse factors on the performance of enzyme β-galactosidase in formulations for reduction of levels of lactose in infant milks. These formulations are added to infant's milk bottles prior to feeding to overcome the frequently observed intolerance to lactose (a milk sugar), a serious issue in healthy development of infants. The results highlight important impediments in the development of these formulations and also illustrate the capability of the described ultrasonic tools in the assessment of the performance of enzymes in complex reaction media and in various environmental conditions.

  13. Use of hyaluronic Acid gel in the management of paralytic lagophthalmos: the hyaluronic Acid gel "gold weight".

    PubMed

    Mancini, Ronald; Taban, Mehryar; Lowinger, Alan; Nakra, Tanuj; Tsirbas, Angelo; Douglas, Raymond S; Shorr, Norman; Goldberg, Robert A

    2009-01-01

    To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic lagophthalmos. This is a retrospective study of 9 patients (10 eyelids) with paralytic lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31-90 years) with paralytic lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2-1.2 ml). All patients demonstrated significant improvement in lagophthalmos and exposure keratopathy. The mean improvement in lagophthalmos was 4.8 mm (range, 0.9-11.9 mm; p = 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2-5 months). Of these, 2 had no change in lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in lagophthalmos (4.8-4.6 mm at 2 months), one had a slight increase in lagophthalmos (0.3-0.5 mm at 2 months), and one had a more significant increase in lagophthalmos (1.9-4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic lagophthalmos. This

  14. Non coeliac gluten sensitivity - A new disease with gluten intolerance.

    PubMed

    Czaja-Bulsa, Grażyna

    2015-04-01

    Until recently gluten intolerance has been believed to be typical of celiac disease (CD) and wheat allergy (WA). In the last few years, however, several study results have been published that have proved that gluten intolerance can also affect people who do not suffer from any of the above mentioned diseases. The new syndrome has been named non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS). It has been included in the new list of gluten-related disorders published in 2012. Researchers believe that NCGS is the most common syndrome of gluten intolerance. This review discusses many aspects of NCGS epidemiology, pathophysiology, clinical spectrum, and treatment and current tools to identify patients suffering from CD, WA, and NCGS.

  15. Associations of excessive irritability with common illnesses and food intolerance.

    PubMed

    Price, C E; Rona, R J; Chinn, S

    1990-04-01

    In a national study of almost 7000 primary school children, parents' perceptions were used to test the hypothesis that the child's irritability was associated with food intolerance independently of other symptoms. After adjustment in a multiple regression analysis for asthma or wheeze, cough, eczema, hives, diarrhoea and vomiting, rhinitis, hay fever and headache, and the social factors of father's social class, maternal education and maternal age, a highly significant association between perception of food intolerance and irritability (P less than 0.001) remained. Though we cannot rule out that irritable children's parents could be biased towards diagnosing food intolerance the possibility that some children do have behavioural disturbance associated with reactions to food needs to be explored further, preferably with a double blind challenge assessment.

  16. Intolerance for approach of ambiguity in social anxiety disorder.

    PubMed

    Kuckertz, Jennie M; Strege, Marlene V; Amir, Nader

    2017-06-01

    Previous research has utilised the approach-avoidance task (AAT) to measure approach and avoidance action tendencies in socially anxious individuals. "Neutral" social stimuli may be perceived as ambiguous and hence threatening to socially anxious individuals, however it is unclear whether this results in difficulty approaching ambiguous ("neutral") versus unambiguous threat (e.g. disgust) faces (i.e. intolerance of ambiguity). Thirty participants with social anxiety disorder (SADs) and 29 non-anxious controls completed an implicit AAT in which they were instructed to approach or avoid neutral and disgust faces (i.e. pull or push a joystick) based on colour of the picture border. Results indicated that SADs demonstrated greater difficulty approaching neutral relative to disgust faces. Moreover, intolerance for approach of ambiguity predicted social anxiety severity while controlling for the effects of trait anxiety and depression. Our results provide further support for the role of intolerance of ambiguity in SAD.

  17. Desensitization with oxaliplatin in patients intolerant of carboplatin desensitization.

    PubMed

    Rose, Peter G; Metz, Carol; Link, Nicolas

    2014-11-01

    The tolerance and efficacy of oxaliplatin desensitization in patients who were intolerant of carboplatin desensitization were determined. We retrospectively reviewed the Gynecologic Oncology patients who received carboplatin or oxaliplatin from December 2007 until August 2014. The number of treatments and number of patients of carboplatin standard infusions, carboplatin desensitizations, and oxaliplatin desensitizations were determined. Carboplatin infusions (2294) were administered to 281 patients. Twenty-eight (10%) of these patients developed carboplatin hypersensitivity and were treated with 205 carboplatin desensitizations. Nine (29%) patients were subsequently treated with 61 oxaliplatin desensitizations due to intolerance of carboplatin desensitization. Nine of the 10 patients tolerated this infusion well. Four of 9 evaluable patients had an objective response, 2 complete and 2 partial. Oxaliplatin desensitization seems well tolerated and effective in most patients who are intolerant of carboplatin desensitization.

  18. [Lactose intolerance: changing paradigms due to molecular biology].

    PubMed

    Mattar, Rejane; Mazo, Daniel Ferraz de Campos

    2010-01-01

    In most mammals, lactase activity declines on the intestinal wall after weaning, characterizing primary hypolactasia that provokes symptoms of lactose intolerance. The intensity of symptoms of distention, flatulence, abdominal pain and diarrhea varies, according to the amount of ingested lactose, and increases with age. Hypolactasia is genetically determined; nonetheless, a mutation occurred that had made a part of mankind tolerate milk in adulthood. Diagnosis is made by a tolerance test, using the lactose challenge. With the discovery made by the Finns of polymorphism associated with lactase persistence, mainly, in Northern Europe, the genetic test was incorporated as a more comfortable diagnostic tool for the intolerant. In Brazil, 43% of Caucasian and Mulatto groups have lactase persistence allele, with hipolactasia more frequently found among Blacks and Japanese. However, in clinical practice people with hypolactasia may be advised to consume certain dairy products and food containing lactose without developing intolerance symptoms, whereas others will need a lactose restriction diet.

  19. Food allergy and food intolerance: towards a sociological agenda.

    PubMed

    Nettleton, Sarah; Woods, Brian; Burrows, Roger; Kerr, Anne

    2009-11-01

    This article asks what sociological insights an analysis of food allergy and food intolerance might afford. We outline the parameters of debates around food allergy and food intolerance in the immunological, clinical and epidemiological literatures in order to identify analytic strands which might illuminate our sociological understanding of the supposed increase in both. Food allergy and food intolerance are contested and contingent terms and it is salient that the term true food allergy is replete throughout medico-scientific, epidemiological and popular discourses in order to rebuff spurious or 'nonallergic' claims of food-related symptoms. Complexity theory is introduced as a means of gaining analytic purchase on the food allergy debate. The article concludes that the use of this perspective provides a contemporary example of the 'double hermeneutic', in that the meanings and interpretations of contemporary explanations of food allergy are both permeated by, and can be made sense of, through recourse to complexity thinking.

  20. Coping strategies, social support and responsibility in chemical intolerance.

    PubMed

    Nordin, Maria; Andersson, Linus; Nordin, Steven

    2010-08-01

    To study coping strategies, social support and responsibility for improvement in chemical intolerance (CI). Limited knowledge of CI among health professionals and lay persons places demands on the chemically intolerant individual's coping strategies and perception of social support and ability to take responsibility for improvement. However, there is sparse literature on these issues in CI. A cross-sectional, questionnaire-based, quasi-experimental study. Fifty-nine persons with mild, 92 with moderate and 31 with severe CI participated by rating (i) usage and effectiveness of six problem- and six emotion-focused coping strategies, (ii) emotional, instrumental and informative support provided by various sources and (iii) society's and the inflicted individual's responsibility for improvement. The participants reported that the most commonly used and effective coping strategies were avoiding odorous/pungent environments and asking persons to limit their use of odorous/pungent substances (problem-focused strategies) as well as accepting the situation and reprioritising (emotion-focused strategies). High intolerance severity was associated with problem-focused coping strategies and relatively low intolerance with emotion-focused strategies. More emotional than instrumental and informative support was perceived, predominantly from the partner and other family members. Responsibility attributed to society was also found to increase from mild to moderate/severe intolerance. Certain coping strategies are more commonly used and perceived as more effective than others in CI. However, intolerance severity plays a role regarding both coping strategies and responsibility. Emotional support appears to be the most available type of support. For improved care, certain coping strategies may be suggested by nurses, the healthcare system needs to provide better social support to these patients and the issue of responsibility for improvement may be discussed with the patient.

  1. Dizziness and Orthostatic Intolerance In Pediatric Headache Patients.

    PubMed

    Qubty, William; Kedia, Sita

    2016-02-01

    Children and adolescents with headaches commonly complain of dizziness that creates significant distress among the patients and their families. Dizziness is largely due to either orthostatic intolerance or vertigo; this distinction is the initial step in the evaluation of a child with co-occurrence of headaches and dizziness. Vertiginous symptoms are most commonly due to vestibular migraine or benign positional vertigo. This review would focus its attention on the diagnosis, evaluation, and management of orthostatic intolerance, specifically postural orthostatic tachycardia syndrome. Copyright © 2016. Published by Elsevier Inc.

  2. Recommendations for the management of beta-lactam intolerance.

    PubMed

    Macy, Eric; Ngor, Eunis

    2014-08-01

    Beta-lactam intolerance, most of which is not IgE or even immunologically mediated even though it is commonly called an "allergy," can be safely managed using the following seven steps: 1. Avoid testing, re-challenging, or desensitizing individuals with histories of beta-lactam associated toxic epidermal necrolysis, Stevens-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms syndrome, severe hepatitis, interstitial nephritis, or hemolytic anemia. 2. Avoid unnecessary antibiotic use, especially in the setting of viral infections. 3. Expect new intolerances to be reported after 0.5 to 4% of all antibiotic utilizations, dependent on gender and the specific antibiotic used. 4. Expect a higher incidence of new intolerances in individuals with three or more medication intolerances already noted in their medical records. 5. For individuals with an appropriate penicillin class antibiotic intolerance based on a history of anaphylaxis, urticaria, macular papular rashes, unknown symptoms, or symptoms not excluded in step one, proceed with penicillin skin testing. Skin test with penicilloyl-poly-lysine and native penicillin. If skin test is negative, proceed with an oral amoxicillin challenge. If skin test and oral challenge are negative, penicillin class antibiotics may be used. If skin test or oral challenge is positive, avoid penicillin class antibiotics. If skin test or oral challenge is positive, non-penicillin-beta-lactams may be used, unless there is a history of intolerance to a specific non-penicillin-beta-lactam, then avoid that specific non-penicillin-beta-lactam. If there is life-threatening infection that can only be treated with a penicillin class antibiotic, proceed with oral penicillin desensitization prior to any oral or parenteral penicillin use. 6. For individuals with an appropriate non-penicillin-beta-lactam intolerance, avoid re-exposure to the beta-lactam implicated. An alternative beta-lactam may be used, ideally with different side

  3. Dairy Intake, Dietary Adequacy, and Lactose Intolerance12

    PubMed Central

    Heaney, Robert P.

    2013-01-01

    Despite repeated emphasis in the Dietary Guidelines for Americans on the importance of calcium in the adult American diet and the recommendation to consume 3 dairy servings a day, dairy intake remains well below recommendations. Insufficient health professional awareness of the benefits of calcium and concern for lactose intolerance are among several possible reasons, This mini-review highlights both the role of calcium (and of dairy, its principal source in modern diets) in health maintenance and reviews the means for overcoming lactose intolerance (real or perceived). PMID:23493531

  4. The pathomechanism of acetylsalicylic acid intolerance. A hypothesis.

    PubMed

    Kallós, P; Schlumberger, H D

    1980-05-01

    In a number of individuals suffering from chronic asthma or chronic urticaria, acetylsalicylic acid and structurally unrelated non-steroidal anti-inflammatory agents and other compounds, e.g. tartrazine, elicit an intolerance syndrome that mimics the signs and symptoms of an immediate-type allergic (anaphylactic) reaction. An immunological basis for this reaction could be excluded. It is assumed that the eliciting agents activate complement and that the intolerant individuals lack plasma carboxypeptidase B, that normally inactivates C3a and C5a in statu nascendi. The anaphylatoxins, if not immediately inactivated, release the endogenous mediators of the anaphylactic reaction from the tissue mast cells.

  5. [Glycoprotein hexoses in feces of infants with lactose intolerance].

    PubMed

    Filippvskiĭ, G K; Klimov, L Ia

    1995-01-01

    A modified method for estimation of total glycoprotein hexoses in feces, based on their measurements in the blood serum, is presented. Sixty-six nursing children with lactose intolerance, breastfed or formula fed, were examined; formula fed babies were kept on mixtures with high and low lactose content. Glycoprotein hexose parameters were as follows (X +/- m): 13.51 +/- 1.93, 12.05 +/- 2.20, and 3.69 +/- 0.47 g/l feces. In control children without lactose intolerance (n = 33) this value was 3.6 +/- 0.79 g/l. Increased glycoprotein excretion is connected with glycocalix and small intestinal enterocyte alteration.

  6. The molecular basis of hereditary fructose intolerance in Italian children.

    PubMed

    Santamaria, R; Scarano, M I; Esposito, G; Chiandetti, L; Izzo, P; Salvatore, F

    1993-10-01

    We investigated the molecular defects of the aldolase B gene in five unrelated patients affected by hereditary fructose intolerance. The techniques used were DNA amplification, direct sequencing and allele-specific oligonucleotide (ASO) hybridization. The most frequent substitutions found in the hereditary fructose intolerance alleles analysed were the A174D and the A149P mutations, which account for 50% and 30% of the alleles, respectively. In two unrelated families, we found a rare mutation, the MD delta 4 previously described only in one British family, which may be an important cause of the disease in Italy.

  7. Fifteen-minute consultation on the healthy child: breast feeding.

    PubMed

    Cleugh, F; Langseth, A

    2017-02-01

    Despite extensive evidence about the benefits of breast feeding for both infants and mothers, breastfeeding rates in the UK remain low. Most infants presenting with feeding issues are otherwise well but are often over diagnosed with clinical conditions such as maternal milk insufficiency, cow's milk intolerance or reflux. With simple advice and troubleshooting common problems, all child health professionals can support mothers to establish and continue breast feeding exclusively for longer. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Contrasting physiological responses of two populations of the razor clam Tagelus dombeii with different histories of exposure to paralytic shellfish poisoning (PSP).

    PubMed

    Navarro, Jorge M; González, Katerina; Cisternas, Barbara; López, Jorge A; Chaparro, Oscar R; Segura, Cristian J; Córdova, Marco; Suárez-Isla, Benjamín; Fernandez-Reiriz, María J; Labarta, Uxio

    2014-01-01

    This study describes the physiological performance of two populations of the razor clam Tagelus dombeii from two geographic areas with different histories of exposure to paralytic shellfish poisoning (PSP) linked to the toxic dinoflagellate Alexandrium catenella. Clams from Melinka-Aysén, which are frequently exposed to PSP, were not affected by the presence of toxins in the diet. However, clams from Corral-Valdivia, which have never been exposed to PSP, exhibited significantly reduced filtration activity and absorption, affecting the energy allocated to scope for growth (SFG). Ammonia excretion and oxygen uptake were not affected significantly by the presence of A. catenella in the diet. Measurements of energy acquisition and expenditure were performed during a 12-day intoxication period. According to three-way repeated measure ANOVAs, the origin of the clams had a highly significant effect on all physiological variables, and the interaction between diet and origin was significant for the clearance and absorption rates and for the scope for growth. The scope for growth index showed similar positive values for both the toxic and non-toxic individuals from the Melinka-Aysén population. However, it was significantly reduced in individuals from Corral-Valdivia when exposed to the diet containing A. catenella. The absence of differences between the physiological response of the toxic and non-toxic clams from Melinka-Aysén may be related to the frequent presence of A. catenella in the environment, indicating that this bivalve does not suffer negative consequences from PSP. By contrast, A. catenella has a negative effect on the physiological performance, primarily on the energy gained from the environment, on T. dombeii from Corral-Valdivia. This study supports the hypothesis that the history of PSP exposure plays an important role in the physiological performance and fitness of filter feeding bivalves.

  9. Contrasting Physiological Responses of Two Populations of the Razor Clam Tagelus dombeii with Different Histories of Exposure to Paralytic Shellfish Poisoning (PSP)

    PubMed Central

    Navarro, Jorge M.; González, Katerina; Cisternas, Barbara; López, Jorge A.; Chaparro, Oscar R.; Segura, Cristian J.; Córdova, Marco; Suárez-Isla, Benjamín; Fernandez-Reiriz, María J.; Labarta, Uxio

    2014-01-01

    This study describes the physiological performance of two populations of the razor clam Tagelus dombeii from two geographic areas with different histories of exposure to paralytic shellfish poisoning (PSP) linked to the toxic dinoflagellate Alexandrium catenella. Clams from Melinka-Aysén, which are frequently exposed to PSP, were not affected by the presence of toxins in the diet. However, clams from Corral-Valdivia, which have never been exposed to PSP, exhibited significantly reduced filtration activity and absorption, affecting the energy allocated to scope for growth (SFG). Ammonia excretion and oxygen uptake were not affected significantly by the presence of A. catenella in the diet. Measurements of energy acquisition and expenditure were performed during a 12-day intoxication period. According to three-way repeated measure ANOVAs, the origin of the clams had a highly significant effect on all physiological variables, and the interaction between diet and origin was significant for the clearance and absorption rates and for the scope for growth. The scope for growth index showed similar positive values for both the toxic and non-toxic individuals from the Melinka-Aysén population. However, it was significantly reduced in individuals from Corral-Valdivia when exposed to the diet containing A. catenella. The absence of differences between the physiological response of the toxic and non-toxic clams from Melinka-Aysén may be related to the frequent presence of A. catenella in the environment, indicating that this bivalve does not suffer negative consequences from PSP. By contrast, A. catenella has a negative effect on the physiological performance, primarily on the energy gained from the environment, on T. dombeii from Corral-Valdivia. This study supports the hypothesis that the history of PSP exposure plays an important role in the physiological performance and fitness of filter feeding bivalves. PMID:25153329

  10. Lethal paralytic shellfish poisoning from consumption of green mussel broth, Western Samar, Philippines, August 2013.

    PubMed

    Ching, Paola Katrina; Ramos, Ruth Alma; de los Reyes, Vikki Carr; Sucaldito, Ma Nemia; Tayag, Enrique

    2015-01-01

    In July 2013, the Philippines' Event-Based Surveillance & Response Unit received a paralytic shellfish poisoning (PSP) report from Tarangnan, Western Samar. A team from the Department of Health conducted an outbreak investigation to identify the implicated source and risk factors in coastal villages known for green mussel production and exportation. A case was defined as a previously well individual from Tarangan, Western Samar who developed gastrointestinal symptoms and any motor and/or sensory symptoms after consumption of shellfish from 29 June to 4 July 2013 in the absence of any known cause. The team reviewed medical records, conducted active case finding and a case-control study. Relatives of cases who died were interviewed. Sera and urine specimens, green mussel and seawater samples were tested for saxitoxin levels using high performance liquid chromatography. Thirty-one cases and two deaths were identified. Consumption of > 1 cup of green mussel broth was associated with being a case. Seawater sample was positive for Pyrodinium bahamense var. compressum and green mussel samples were positive for saxitoxin. Inspection revealed villagers practice open defecation and improper garbage disposal. This PSP outbreak was caused by the consumption of the green mussel broth contaminated by saxitoxin. As a result of this outbreak, dinoflagellate and saxitoxin surveillance was established, and since the outbreak, there have been no harmful algal blooms event or PSP case reported since. A "Save Cambatutay Bay" movement, focusing on proper waste disposal practice and clean-up drives has been mobilized.

  11. Predator lipids induce paralytic shellfish toxins in bloom-forming algae.

    PubMed

    Selander, Erik; Kubanek, Julia; Hamberg, Mats; Andersson, Mats X; Cervin, Gunnar; Pavia, Henrik

    2015-05-19

    Interactions among microscopic planktonic organisms underpin the functioning of open ocean ecosystems. With few exceptions, these organisms lack advanced eyes and thus rely largely on chemical sensing to perceive their surroundings. However, few of the signaling molecules involved in interactions among marine plankton have been identified. We report a group of eight small molecules released by copepods, the most abundant zooplankton in the sea, which play a central role in food webs and biogeochemical cycles. The compounds, named copepodamides, are polar lipids connecting taurine via an amide to isoprenoid fatty acid conjugate of varying composition. The bloom-forming dinoflagellate Alexandrium minutum responds to pico- to nanomolar concentrations of copepodamides with up to a 20-fold increase in production of paralytic shellfish toxins. Different copepod species exude distinct copepodamide blends that contribute to the species-specific defensive responses observed in phytoplankton. The signaling system described here has far reaching implications for marine ecosystems by redirecting grazing pressure and facilitating the formation of large scale harmful algal blooms.

  12. [Paralytic shellfish poisoning by Spondylus calcifer contaminated with Pyrodinium bahamense, Costa Rica, 1989-1990].

    PubMed

    Mata, L; Abarca, G; Marranghello, L; Víquez, R

    1990-06-01

    This paper describes an outbreak of paralytic shellfish poisoning (PSP), affecting human populations on the Pacific Coast of Costa Rica in October 1989. Numbness in arms, face and legs occurred 30 to 45 minutes after ingestion of the large clam Spondylus calcifer. Paralysis of legs and respiratory symptoms followed, often persisting for one week. Large amounts of the dinoflagellate Pyrodinium bahamense were found in the intestine of the mollusk. A toxin was detected in crude or filtered and heated macerates of intestine, muscle, mantle and hepatopancreas of S. calcifer, and to a lesser extent Tagelus sp., by injection of its crude or diluted extracts in white mice. The effects in mice consisted in paralysis and asphyxia generally leading to death in less than 5 minutes, compatible with saxitoxin. Mice were killed by the toxin in macerates diluted 1:100 to 1:1000. No toxin was detected in Anadara tuberculosa (Bivalvia) or in peneids. Prevention rests on intersectoral actions between state and private sectors in charge of fishing, distribution and marketing of shellfish, as well as on education of the population at large.

  13. Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome.

    PubMed

    Viana, Celiana Figueiredo; Pradella-Hallinan, Márcia; Quadros, Abrahão Augusto Juviniano; Marin, Luis Fabiano; Oliveira, Acary Souza Bulle

    2013-07-01

    It was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle. Thirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years). Our study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography. Fatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS.

  14. Paralytic effect of alcoholic extract of Allium sativum and Piper longum on liver amphistome, Gigantocotyle explanatum

    PubMed Central

    Singh, T.U.; Kumar, D.; Tandan, S.K.

    2008-01-01

    Objective: To investigate the effects of alcoholic extract of Allium sativum and Piper longum on the muscular activity of a parasitic amphistome, Gigantocotyle explanatum. Materials and Methods: Amphistomes were isometrically mounted to record the spontaneous muscular activity by using Chart 4 software program (Power Lab, AD Instruments, Australia) and to examine the effects of cumulative doses (100, 300, 1000, and 3000 μg/ml) of the plant extracts on the amplitude (g), frequency (per 10 min), and baseline tension (g) of the spontaneous muscular activity of the amphistome. Results: Alcoholic extract of A. sativum produced significant reduction in the frequency and amplitude of contractile activity of the amphistome at 1000 and 3000 μg/ml bath concentrations. Complete paralysis of the amphistome was observed after 15 min of addition of 3000 μg/ml concentration. Alcoholic extract of P. longum also caused paralysis following 15-20 min exposure of the amphistome to 3000 μg/ml concentration. In both the cases the amphistomes did not recover from paralysis following 2-3 washes. Conclusion: The observations demonstrate the paralytic effect of alcoholic extract of A. sativum and P. longum on G. explanatum. PMID:21279168

  15. A prospective study of Japas' osteotomy in paralytic pes cavus deformity in adolescent feet

    PubMed Central

    Chatterjee, Protyush; Sahu, M K

    2009-01-01

    Background: Pes cavus is a progressive and ugly deformity of the foot. Although initially the deformity is painless, with time, painful callosities develop under metatarsal heads and arthritis supervenes later in feet. Mild deformities can be treated with corrective shoes, or foot exercises. However, in others, operative treatment is imperative. Soft tissue operations are largely unsatisfactory and temporary. Bony operations give permanent correction. We present our series of 18 patients of pes cavus in the adolescent age group, treated by Japas' V-osteotomy of the tarsus. Materials and Methods: 18 patients of paralytic pes cavus deformity were treated by Japas osteotomy, between March 1995 and 2005, at our institute. The age of the patients ranged from 8.6 to 15 years (mean 11.3); 10 were boys and 8 girls. All cases had unilateral involvement, and all, but one, were post-polio cases. Result: The mean follow-up is 5.4 years. Of the 18 patients, 14 had excellent or good corrections; 4 had poor correction/complications. However, those patients could be salvaged by triple arthordesis or Dwyer's calcaneal osteotomy. Conclusion: Japas' osteotomy is a satisfactory option for correction of pes cavus deformity in adolescents. In patients who have rigid hind foot equinus or varus, however, the results are compromised. PMID:19838351

  16. Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses.

    PubMed

    Higashigawa, Masamune; Maegawa, Kayoka; Honma, Hitoshi; Yoshino, Ayako; Onozato, Kaori; Nashida, Yuji; Fujiwara, Takashi; Inoue, Masakazu

    2010-10-01

    We describe a case of vaccine-associated paralytic poliomyelitis (VAPP) in a 7-month-old infant with perianal abscesses. The infant had suffered from perianal abscesses from 3 weeks after birth. The abscesses repeatedly developed and spontaneously drained through the orifice. Twenty-seven days before admission, a live attenuated oral poliovirus vaccine (OPV) was given to the infant for the first time for routine immunization. His body temperature rose to 38°C 19 days after receiving the OPV and fell 4 days later. Flaccid paralysis of the right leg appeared 26 days after receipt of the OPV. A Sabin type 3 poliovirus was isolated from a stool obtained at admission. The DNA sequences of the VP1 region of the isolated virus were more than 99% identical with those of the vaccine strain. Mild muscle atrophy with moderate motor impairment in the right leg persisted at 18 months of age. One VAPP case provoked by a perianal abscess has been reported from the United Kingdom. Database search revealed that one of nine VAPP cases reported during 2003-2008 in Japan had a perianal abscess. Taken together, these reports and our case imply that we should give OPV with caution to infants with a perianal abscess.

  17. Quantitative determination of paralytic shellfish toxins in cultured toxic algae by LC-MS/MS.

    PubMed

    Watanabe, Ryuichi; Matsushima, Ryoji; Harada, Tomoko; Oikawa, Hiroshi; Murata, Masakazu; Suzuki, Toshiyuki

    2013-01-01

    We developed a sample preparation and LC-MS/MS method for the determination of saxitoxins in toxic algae. Paralytic shellfish toxins (PSTs) were successfully separated by gradient elution on an amide column with the hydrophilic interaction mode and quantified with multiple reaction monitoring (MRM) detection in the positive ion mode. This method showed good performance in the summed LODs and LOQs for all 12 toxins, 25 and 84 nM, respectively. Next, extracts of cultured strains of a toxic dinoflagellate Alexandrium tamarense and a freshwater cyanobacteria Anabaena circinalis were treated in a short column of basic alumina and the toxic fractions were analysed by our LC-MS/MS method and by HPLC with fluorescence detection. Comparison of the results obtained by the two methods demonstrated that approximately equivalent results were obtained for both the dinoflagellate and the cyanobacteria. In addition, the retention time of the toxins showed acceptable shifts. Therefore, the clean-up of the toxic algal extracts by using the basic alumina column controlled unwanted chromatographic behaviour and variable ionisation efficiency during MS detection. LC-MS/MS for saxitoxins has great potential as a rapid analytical method for determining all primary saxitoxins in cultured algae.

  18. Apparent bioaccumulation of cylindrospermopsin and paralytic shellfish toxins by finfish in Lake Catemaco (Veracruz, Mexico).

    PubMed

    Berry, J P; Jaja-Chimedza, A; Dávalos-Lind, L; Lind, O

    2012-01-01

    Compared to the well-characterized health threats associated with contamination of fish and shellfish by algal toxins in marine fisheries, the toxicological relevance of the bioaccumulation of toxins from cyanobacteria (blue-green algae), as the primary toxigenic algae in freshwater systems, remains relatively unknown. Lake Catemaco (Veracruz, Mexico) is a small, tropical lake system specifically characterized by a year-round dominance of the known toxigenic cyanobacterial genus, Cylindrospermopsis, and by low, but detectable, levels of both a cyanobacterial hepatotoxin, cylindrospermopsin (CYN), and paralytic shellfish toxins (PSTs). In the present study, we evaluated, using enzyme-linked immunoassay (ELISA), levels of both toxins in several species of finfish caught and consumed locally in the region to investigate the bioaccumulation of, and possible health threats associated with, these toxins as potential foodborne contaminants. ELISA detected levels of both CYN and PSTs in fish tissues from the lake. Levels were generally low (≤ 1 ng g(-1) tissue); however, calculated bioaccumulation factors (BAFs) indicate that toxin levels exceed the rather low levels in the water column and, consequently, indicated bioaccumulation (BAF >1). A reasonable correlation was observed between measured bioaccumulation of CYN and PSTs, possibly indicating a mutual source of both toxins, and most likely cells of Cylindrospermopsis, the dominant cyanobacteria in the lake, and a known producer of both metabolites. The potential roles of trophic transport in the system, as well as possible implications for human health with regards to bioaccumulation, are discussed.

  19. Label-free quantitative phosphoproteomic profiling of cellular response induced by an insect cytokine paralytic peptide.

    PubMed

    Song, Liang; Wang, Fei; Dong, Zhaoming; Hua, Xiaoting; Xia, Qingyou

    2017-02-10

    Paralytic peptide (PP) participates in diverse physiological processes as an insect cytokine, such as immunity control, paralysis induction, regulation of cell morphology and proliferation. To investigate the molecular mechanism underlying those physiological activities, we systematically investigated the global phosphorylation events in fat body of silkworm larvae induced by PP through label-free quantitative phosphoproteomics. 2534 phosphosites were finally identified, of which the phosphorylation level of 620 phosphosites on 244 proteins was significantly up-regulated and 67 phosphosites on 43 proteins was down-regulated. Among those proteins, 13 were protein kinases (PKs), 13 were transcription factors (TFs) across 10 families and 17 were metabolism related enzymes. Meanwhile, Motif-X analysis of the phosphorylation sites showed that 16 motifs are significantly enriched, including 8 novel phosphorylation motifs. In addition, KEGG and functional interacting network analysis revealed that phosphorylation cascades play the crucial regulation roles in PP-dependent signaling pathways, and highlighted the potential central position of the mitogen-activated protein kinases (MAPKs) in them. These analyses provide direct insights into the molecule mechanisms of cellular response induced by PP.

  20. Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden.

    PubMed

    Platt, Lauren R; Estívariz, Concepción F; Sutter, Roland W

    2014-11-01

    Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate. A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates. Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490). Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Paralytic shellfish toxins, including deoxydecarbamoyl-STX, in wild-caught Tasmanian abalone (Haliotis rubra).

    PubMed

    Harwood, D Tim; Selwood, Andrew I; van Ginkel, Roel; Waugh, Craig; McNabb, Paul S; Munday, Rex; Hay, Brenda; Thomas, Krista; Quilliam, Michael A; Malhi, Navreet; Dowsett, Natalie; McLeod, Catherine

    2014-11-01

    For the first time wild-caught Tasmanian abalone, Haliotis rubra, have been reported to contain paralytic shellfish toxins (PSTs). This observation followed blooms of the toxic dinoflagellate Gymnodinium catenatum. No illnesses were reported, but harvesting restrictions were enforced in commercial areas. Abalone were assayed using HPLC-FLD methodology based on AOAC official method 2005.06. An uncommon congener, deoxydecarbamoyl-STX (doSTX), was observed in addition to regulated PSTs as unassigned chromatographic peaks. A quantitative reference material was prepared from contaminated Tasmanian abalone viscera and ampouled at 54.2 μmol/L. The LD50 of doSTX via intraperitoneal injection was 1069 nmol/kg (95% confidence limits 983-1100 nmol/kg), indicating it is nearly 40 times less toxic than STX. A toxicity equivalence factor of 0.042 was generated using the mouse bioassay. Levels of PSTs varied among individuals from the same site, although the toxin profile remained relatively consistent. In the foot tissue, STX, decarbamoyl-STX and doSTX were identified. On a molar basis doSTX was the dominant congener in both foot and viscera samples. The viscera toxin profile was more complex, with other less toxic PST congeners observed and was similar to mussels from the same site. This finding implicates localised dinoflagellate blooms as the PST source in Tasmanian abalone. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Predator lipids induce paralytic shellfish toxins in bloom-forming algae

    PubMed Central

    Selander, Erik; Kubanek, Julia; Hamberg, Mats; Andersson, Mats X.; Cervin, Gunnar; Pavia, Henrik

    2015-01-01

    Interactions among microscopic planktonic organisms underpin the functioning of open ocean ecosystems. With few exceptions, these organisms lack advanced eyes and thus rely largely on chemical sensing to perceive their surroundings. However, few of the signaling molecules involved in interactions among marine plankton have been identified. We report a group of eight small molecules released by copepods, the most abundant zooplankton in the sea, which play a central role in food webs and biogeochemical cycles. The compounds, named copepodamides, are polar lipids connecting taurine via an amide to isoprenoid fatty acid conjugate of varying composition. The bloom-forming dinoflagellate Alexandrium minutum responds to pico- to nanomolar concentrations of copepodamides with up to a 20-fold increase in production of paralytic shellfish toxins. Different copepod species exude distinct copepodamide blends that contribute to the species-specific defensive responses observed in phytoplankton. The signaling system described here has far reaching implications for marine ecosystems by redirecting grazing pressure and facilitating the formation of large scale harmful algal blooms. PMID:25918403

  3. Gold weight implantation as a treatment measure for correction of paralytic lagophthalmos.

    PubMed

    Manodh, P; Devadoss, Pradeep; Kumar, Nishant

    2011-01-01

    Ocular complications from facial nerve paralysis can be quite devastating. Facial nerve paralysis results in cosmetic as well as functional problems. Paralysis of the upper eyelids leads to lagophthalmos, which results in incomplete closure of the lid over the cornea, leading to potential complication of corneal ulceration. The management of the affected eye in patients with facial palsy has been improved. Previously, ointment, eye drops, taping, partial or complete tarsorrhaphy was the primary treatment for inability to close the eyelid. Other mechanical techniques for reanimating lid closure are palpebral springs, encircling the upper and lower eyelids with silicone or fascia lata and temporalis muscle transfer. The most popular and widely used static procedure in facial nerve palsy is the upper eyelid gold weight implant. Gold eyelid implants are designed for the gravity assisted treatment of the functional defect of lagophthalmos resulting from facial paralysis. We report a case of a patient with facial paralysis who underwent gold weight implantation of the upper eyelid for correction of paralytic lagophthalmos.

  4. Neutralizing effect of hemolymph from the shore crab, Thalamita crenata, on paralytic shellfish toxins.

    PubMed

    Lin, Huajuan; Zhang, Chaohua; Liao, Jianmeng; Yang, Feng; Zhong, Saiyi; Jiang, Peihong; Chen, Xiao; Nagashima, Yuji

    2015-06-01

    Several species of crabs are resistant to paralytic shellfish toxins (PSTs) and/or pufferfish toxin, tetrodotoxin, regardless of toxification by the toxins. The shore crab Thalamita crenata, which inhabits Leizhou Peninsula, China, is tolerant to PST toxicity, and the hemolymph has neutralizing effects against the lethal activity of PST. In the present study, we investigated the PST neutralizing factors in the hemolymph from T. crenata and successfully separated PST-binding proteins by PST-ligand affinity chromatography. The neutralization factors, obtained in the fraction with a molecular weight over 10 kDa by ultrafiltration, were susceptible to proteases such as alcalase, animal complex proteases, pancreatin, and papain. The PST-binding protein had high dose-dependent neutralization effects on PST toxicity. The PST-binding activity of the protein was stable at 25 °C and then decreased with an increase in temperature; heating at 65 °C for 60 min eliminated the initial activity by two-thirds. The PST-binding activity was strongly inhibited in the presence of Mg(2+) and Ca(2+), but not Na(+) and K(+). The PST-binding capability of the protein differed among PST components in descending order of neosaxitoxin, gonyautoxins 1 and 4, saxitoxin, and gonyautoxins 2 and 3, suggesting a structure-activity relationship in PST binding. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Toxicity of Alexandrium lusitanicum to gastropod larvae is not caused by paralytic-shellfish-poisoning toxins

    PubMed Central

    Juhl, A. R.; Martins, C. A.; Anderson, D. M.

    2017-01-01

    Laboratory grazing experiments compared ingestion of two subclones of the dinoflagellate Alexandrium lusitanicum by gastropod veliger larvae (Nassarius sp.). While the two prey subclones originated from the same monoclonal isolate of A. lusitanicum, one possessed the ability to produce paralytic-shellfish-poisoning toxins (PSTs), while the other did not. Ingestion rates on the two Alexandrium subclones were not significantly different over a range of prey concentrations (approximately 100 – 660 cells ml-1), indicating that PSTs did not serve as a grazing deterrent for these larvae. However, ingestion rates on both subclones were low at the higher prey concentrations tested. Mortality of the predators also increased linearly with concentration of either subclone. These observations indicated that both A. lusitanicum subclones produced an unknown substance that inhibited and killed the grazers. Veliger mortality was not induced by culture filtrates or lysates, suggesting either that the substance was either highly labile or that contact with intact cells was required. Because toxic algae can produce multiple bioactive substances, experimental demonstrations of alleopathic effects of toxic species should not be assigned to known toxins without supporting evidence. In addition, the results show that the effectiveness of algal grazing deterrents can increase with cell concentration, which may have implications for bloom dynamics. PMID:28729816

  6. [A case of non-paralytic pontine exotropia with vertical dissociated nystagmus in the contralateral eye].

    PubMed

    Nakaso, Kazuhiro; Yoshimoto, Yuko; Ueda, Keigo; Sasaki, Kiyohiro

    2002-02-01

    We report a 74-year-old woman presenting non-paralytic pontine exotropia (NPPE) with vertical monocular nystagmus in her contralateral eye, due to a small infarction in the upper pons. On forward gaze, the ocular position of the right eye was fixed at the midline, while the left eye was abducted. On the leftward gaze, the left eye was abducted and monocular nystagmus was noted, but the right eye was not able to pass midline, which indicated NPPE. Neither a skew deviation nor an alternating exotropia was observed. In the acute phase of this case, disturbances in the vertical eye movement of her right eye and the monocular upper gaze-evoked nystagmus of her left eye were observed. On the 7th hospital day, the monocular nystagmus disappeared simultaneously with an improvement of vertical eye movement. This finding suggests that the patient's vertical monocular nystagmus occurred due to an adaptive increase in the innervation to the left eye according to Hering's law of equal innervation, which indicates either horizontal dissociated nystagmus in MLF syndrome or NPPE.

  7. Receptor binding assay for paralytic shellfish poisoning toxins: optimization and interlaboratory comparison.

    PubMed

    Ruberu, Shryamalie R; Liu, Yun-Gang; Wong, Carolyn T; Perera, S Kusum; Langlois, Gregg W; Doucette, Gregory J; Powell, Christine L

    2003-01-01

    A receptor binding assay (RBA) for detection of paralytic shellfish poisoning (PSP) toxins was formatted for use in a high throughput detection system using microplate scintillation counting. The RBA technology was transferred from the National Ocean Service, which uses a Wallac TriLux 1450 MicroBeta microplate scintillation counter, to the California Department of Health Services, which uses a Packard TopCount scintillation counter. Due to differences in the detector arrangement between these 2 counters, markedly different counting efficiencies were exhibited, requiring optimization of the RBA protocol for the TopCount instrument. Precision, accuracy, and sensitivity [limit of detection = 0.2 microg saxitoxin (STX) equiv/100 g shellfish tissue] of the modified protocol were equivalent to those of the original protocol. The RBA robustness and adaptability were demonstrated by an interlaboratory study, in which STX concentrations in shellfish generated by the TopCount were consistent with MicroBeta-derived values. Comparison of STX reference standards obtained from the U.S. Food and Drug Administration and the National Research Council, Canada, showed no observable differences. This study confirms the RBA's value as a rapid, high throughput screen prior to testing by the conventional mouse bioassay (MBA) and its suitability for providing an early warning of increasing PSP toxicity when toxin levels are below the MBA limit of detection.

  8. Comparison of analytical tools and biological assays for detection of paralytic shellfish poisoning toxins.

    PubMed

    Humpage, A R; Magalhaes, V F; Froscio, S M

    2010-07-01

    The paralytic shellfish poisoning toxins (PSTs) were, as their name suggests, discovered as a result of human poisoning after consumption of contaminated shellfish. More recently, however, the same toxins have been found to be produced by freshwater cyanobacteria. These organisms have worldwide distribution and are common in our sources of drinking water, thus presenting another route of potential human exposure. However, the regulatory limits for PSTs in drinking water are considerably lower than in shellfish. This has increased the need to find alternatives to the mouse bioassay, which, apart from being ethically questionable, does not have a limit of detection capable of detecting the PSTs in water at the regulated concentrations. Additionally, the number of naturally occurring PSTs has grown substantially since saxitoxin was first characterised, markedly increasing the analytical challenge of this group of compounds. This paper summarises the development of chromatographic, toxicity, and molecular sensor binding methodologies for detection of the PSTs in shellfish, cyanobacteria, and water contaminated by these toxins. It then summarises the advantages and disadvantages of their use for particular applications. Finally it recommends some future requirements that will contribute to their improvement for these applications.

  9. Orthostatic Intolerance and Motion Sickness After Parabolic Flight

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Brown, Troy E.; Wood, Scott J.; Benavides, Edgar W.; Bondar, Roberta L.; Stein, Flo; Moradshahi, Peyman; Harm, Deborah L.; Low, Phillip A.

    1999-01-01

    Orthostatic intolerance is common in astronauts after prolonged space flight. However, the "push-pull effect" in military aviators suggests that brief exposures to transitions between hypo- and hypergravity are sufficient to induce untoward autonomic cardiovascular physiology in susceptible individuals. We therefore investigated orthostatic tolerance and autonomic cardiovascular function in 16 healthy test subjects before and after a seated 2-hr parabolic flight. At the same time, we also investigated relationships between parabolic flight-induced vomiting and changes in orthostatic and autonomic cardiovascular function. After parabolic flight, 8 of 16 subjects could not tolerate a 30-min upright tilt test, compared to 2 of 16 before flight. Whereas new intolerance in non-Vomiters resembled the clinical postural tachycardia syndrome (POTS), new intolerance in Vomiters was characterized by comparatively isolated upright hypocapnia and cerebral vasoconstriction. As a group, Vomiters also had evidence for increased postflight fluctuations in efferent vagal-cardiac nerve traffic occurring independently of any superimposed change in respiration. Results suggest that syndromes of orthostatic intolerance resembling those occurring after space flight can occur after a brief (i.e., 2-hr) parabolic flight.

  10. Preliminary Investigation of Intolerance of Uncertainty Treatment for Anxiety Disorders

    ERIC Educational Resources Information Center

    Hewitt, Sarah N.; Egan, Sarah; Rees, Clare

    2009-01-01

    Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations or events, and it has been found to be an important maintaining factor in a number of different anxiety disorders. It is often included as a part of cognitive behavioural interventions for anxiety disorders but its specific contribution to treatment outcome…

  11. Tolerance of Intolerance: Values and Virtues at Stake in Education

    ERIC Educational Resources Information Center

    Orlenius, Kennert

    2008-01-01

    The article addresses the issue of the tolerance of intolerance in an educational context. It concerns a real case in a Swedish upper secondary school some years ago, when a student was suspended from school owing to his sympathies with Nazi ideas. One hundred and twenty student teachers' responses to this decision were analysed in respect of the…

  12. Preliminary Investigation of Intolerance of Uncertainty Treatment for Anxiety Disorders

    ERIC Educational Resources Information Center

    Hewitt, Sarah N.; Egan, Sarah; Rees, Clare

    2009-01-01

    Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations or events, and it has been found to be an important maintaining factor in a number of different anxiety disorders. It is often included as a part of cognitive behavioural interventions for anxiety disorders but its specific contribution to treatment outcome…

  13. The Black Vote: Racial Intolerance or the Politics of Perception.

    ERIC Educational Resources Information Center

    Scott, Richard R.

    Voting behavior of blacks is examined with specific regard to racial intolerance. Factors studied include racial identification, amount of interracial contact, and the black candidate's job performance. In 1969, interviewers collected data on 400 black respondents' attitudes about Carl Stokes (the black incumbent mayoralty candidate), the other…

  14. Intolerance of Ambiguity and Political Orientation among Israeli University Students.

    ERIC Educational Resources Information Center

    Fibert, Zigi; Ressler, William Harris

    1998-01-01

    Explores relations between political orientation and cognitive style among Israeli university students. Finds that intolerance of ambiguity contributed significantly to political orientation and that the political Left showed more complex cognitive styles than the Right. Notes implications for testing competing hypotheses about cognitive style and…

  15. Fructose-induced breath hydrogen in patients with fruit intolerance.

    PubMed

    Mann, Nirmal S; Cheung, Eddie C

    2008-02-01

    To measure bloating score, flatus passage, and hydrogen production after oral fructose in patients with history of fruit intolerance and compare these parameters with those in normal controls. Some patients complain of abdominal distention and excessive flatus after ingesting certain fruits such as mango, persimmon, and grapes but not after eating apricots and melon. We recorded breath hydrogen, flatus passage and bloating after 20 g fructose in 8 patients with history of fruit intolerance and 4 healthy controls. Breath hydrogen was measured every 15 minutes for 480 minutes using EC-60 gastrolyzer. Number of passage of flatus was recorded over 8 hours. Severity of abdominal distention on a scale of 1 to 10 was noted. The patients with fruit intolerance produced breath hydrogen 1745.2+/-7.8 parts per million, passed flatus 13.8+/-0.3 times, and had bloating score of 5.7+/-0.1. The healthy controls produced breath hydrogen 712.5+/-5.8 parts per million in 8 hours, passed flatus 7.2+/-0.5 time, and had bloating score of 2.7+/-0.2. After 20 g fructose, patients with history of fruit intolerance produce more breath hydrogen, pass flatus more frequently, and have a higher bloating score compared with healthy controls.

  16. A case of galactosemia misdiagnosed as cow's milk intolerance.

    PubMed

    Della Casa, Roberto; Ungaro, Carla; Acampora, Emma; Pignata, Claudio; Vajro, Pietro; Salerno, Mariacarolina; Santamaria, Francesca; Parenti, Giancarlo

    2012-09-19

    We report on a female patient affected by galactosemia in whom the diagnosis was obscured by the concomitant presence of manifestations suggesting a cow's milk intolerance. This case exemplifies the problems in reaching a correct diagnosis in patients with metabolic diseases.

  17. Hereditary fructose intolerance and alpha(1) antitrypsin deficiency.

    PubMed

    Hillebrand, G; Schneppenheim, R; Oldigs, H D; Santer, R

    2000-07-01

    A patient with coexisting hereditary fructose intolerance (HFI) and alpha(1) antitrypsin deficiency (alpha(1)ATD) is described. Protease inhibitor typing was not conclusive, presumably because of impaired N-glycosylation secondary to HFI. The case underlines the diagnostic role of molecular genetic techniques in inborn errors of metabolism.

  18. Rainbow Visibility: How One Catholic University Responded to Intolerance.

    ERIC Educational Resources Information Center

    Getz, Cheryl; Kirkley, Evelyn A.

    2002-01-01

    When intolerance of gays and lesbians at the University of San Diego became a problem, a group of students, staff, and faculty decided to do something about it. The result was a project called Rainbow Visibility that works on many forms to educate the campus community. (Author)

  19. Are ambiguity aversion and ambiguity intolerance identical? A neuroeconomics investigation.

    PubMed

    Tanaka, Yusuke; Fujino, Junya; Ideno, Takashi; Okubo, Shigetaka; Takemura, Kazuhisa; Miyata, Jun; Kawada, Ryosaku; Fujimoto, Shinsuke; Kubota, Manabu; Sasamoto, Akihiko; Hirose, Kimito; Takeuchi, Hideaki; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2014-01-01

    In recent years, there has been growing interest in understanding a person's reaction to ambiguous situations, and two similar constructs related to ambiguity, "ambiguity aversion" and "ambiguity intolerance," are defined in different disciplines. In the field of economic decision-making research, "ambiguity aversion" represents a preference for known risks relative to unknown risks. On the other hand, in clinical psychology, "ambiguity intolerance" describes the tendency to perceive ambiguous situations as undesirable. However, it remains unclear whether these two notions derived from different disciplines are identical or not. To clarify this issue, we combined an economic task, psychological questionnaires, and voxel-based morphometry (VBM) of structural brain magnetic resonance imaging (MRI) in a sample of healthy volunteers. The individual ambiguity aversion tendency parameter, as measured by our economic task, was negatively correlated with agreeableness scores on the self-reported version of the Revised NEO Personality Inventory. However, it was not correlated with scores of discomfort with ambiguity, one of the subscales of the Need for Closure Scale. Furthermore, the ambiguity aversion tendency parameter was negatively correlated with gray matter (GM) volume of areas in the lateral prefrontal cortex and parietal cortex, whereas ambiguity intolerance was not correlated with GM volume in any region. Our results suggest that ambiguity aversion, described in decision theory, may not necessarily be identical to ambiguity intolerance, referred to in clinical psychology. Cautious applications of decision theory to clinical neuropsychiatry are recommended.

  20. Rainbow Visibility: How One Catholic University Responded to Intolerance.

    ERIC Educational Resources Information Center

    Getz, Cheryl; Kirkley, Evelyn A.

    2002-01-01

    When intolerance of gays and lesbians at the University of San Diego became a problem, a group of students, staff, and faculty decided to do something about it. The result was a project called Rainbow Visibility that works on many forms to educate the campus community. (Author)

  1. Tolerance of Intolerance: Values and Virtues at Stake in Education

    ERIC Educational Resources Information Center

    Orlenius, Kennert

    2008-01-01

    The article addresses the issue of the tolerance of intolerance in an educational context. It concerns a real case in a Swedish upper secondary school some years ago, when a student was suspended from school owing to his sympathies with Nazi ideas. One hundred and twenty student teachers' responses to this decision were analysed in respect of the…

  2. NIH consensus development conference statement: Lactose intolerance and health.

    PubMed

    Suchy, Frederick J; Brannon, Patsy M; Carpenter, Thomas O; Fernandez, Jose R; Gilsanz, Vicente; Gould, Jeffrey B; Hall, Karen; Hui, Siu L; Lupton, Joanne; Mennella, Julie; Miller, Natalie J; Osganian, Stavroula Kalis; Sellmeyer, Deborah E; Wolf, Marshall A

    2010-02-24

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on lactose intolerance and health. A non-DHHS, nonadvocate 14-member panel representing the fields of internal medicine, pediatrics, pediatric and adult endocrinology, gastroenterology, hepatology, neonatology and perinatology, geriatrics, racial/ethnic disparities, radiology, maternal and fetal nutrition, vitamin and mineral metabolism, nutritional sciences, bone health, preventive medicine, biopsychology, biostatistics, statistical genetics, epidemiology, and a public representative. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. Presentations by experts and a systematic review of the literature prepared by the University of Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. • Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known. • The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers. • Many individuals with real or perceived lactose intolerance avoid dairy and ingest inadequate amounts of calcium and vitamin D, which may predispose them to decreased bone accrual, osteoporosis, and other adverse health outcomes. In most cases, individuals do not need to eliminate dairy

  3. Pneumatosis Intestinalis in Patients Receiving Tube Feeds.

    PubMed

    Cavalea, Alexander C; Heidel, Robert E; Daley, Brian J; Lawson, Christy M; Benton, Darrell A; McLoughlin, James M

    2017-08-01

    Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. We retrospectively reviewed patients from a single institution from 2008 to 2016 with CT findings of PI and an enteric feeding tube. Patients who had not received tube feeds within one week of the CT were excluded. We analyzed clinical, operative, and outcome data to differentiate benign from pathologic outcomes. P values < 0.05 were set as significant. Forty patients were identified. We classified 24 as benign (no intervention) and 16 as pathologic (requiring intervention). A pathologic outcome was demonstrated for free fluid on CT [odds ratio (OR) = 5.00, confidence interval (CI) 1.23-20.30, P = 0.03)], blood urea nitrogen (BUN) elevation (OR = 8.27, CI 1.53-44.62, P = 0.01), creatinine (Cr) elevation (OR = 5.00, CI 1.27-19.62, P = 0.02), BUN/Cr ratio >30 (OR = 8.57, CI 1.79-40.98, P = 0.006), and vomiting/feeding intolerance (OR = 9.38, CI 1.64-53.62, P = 0.01). Bowel function within 24 hours of the CT, bowel dilatation (small ≥ 3 cm; large ≥6 cm), and lactic acidemia were not significant. Peritonitis was only seen in pathologic states, but this did not reach statistical significance (P = 0.06). This represents the largest single-center retrospective analysis of tube feeding-induced PI to date. The presence of free fluid on CT, BUN and Cr elevation, BUN/Cr >30, vomiting/feeding intolerance and peritonitis were predictive of a pathologic etiology of PI.

  4. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization.

    PubMed

    Bundgaard-Nielsen, M; Jørgensen, C C; Jørgensen, T B; Ruhnau, B; Secher, N H; Kehlet, H

    2009-06-01

    A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat, or blurred vision. We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy. Orthostatic tolerance and the cardiovascular response to sitting and standing were evaluated on the day before surgery and 6 and 22 h after operation in 16 patients. Non-invasive systolic (SAP) and diastolic arterial pressure (DAP) (Finometer), heart rate, cardiac output (CO, Modelflow), total peripheral resistance (TPR), and central venous oxygen saturation (Scv(O2)) were monitored. Before surgery, no patients had symptoms of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and approximately 22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P<0.05), whereas CO did not change (P>0.05) and Scv(O2) decreased (P<0.05) upon mobilization. At 6 h after operation, SAP and DAP declined with mobilization (P<0.05) and the arterial pressure response differed from the preoperative response both upon sitting (P<0.05) and standing (P<0.05) due to both impaired TPR and CO. At approximately 22 h, the SAP and DAP responses to mobilization did not differ from the preoperative evaluation (P>0.05). The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses.

  5. Current treatment of dyslipidaemia: PCSK9 inhibitors and statin intolerance.

    PubMed

    Koskinas, Konstantinos; Wilhelm, Matthias; Windecker, Stephan

    2016-01-01

    Statins are the cornerstone of the management of dyslipidaemias and prevention of cardiovascular disease. Although statins are, overall, safe and well tolerated, adverse events can occur and constitute an important barrier to maintaining long-term adherence to statin treatment. In patients who cannot tolerate statins, alternative treatments include switch to another statin, intermittent-dosage regimens and non-statin lipid-lowering medications. Nonetheless, a high proportion of statin-intolerant patients are unable to achieve recommended low-density lipoprotein (LDL) cholesterol goals, thereby resulting in substantial residual cardiovascular risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protease implicated in LDL receptor degradation and plays a central role in cholesterol metabolism. In recent studies, PCSK9 inhibition by means of monoclonal antibodies achieved LDL cholesterol reductions of 50% to 70% across various patient populations and background lipid-lowering therapies, while maintaining a favourable safety profile. The efficacy and safety of the monoclonal antibodies alirocumab and evolocumab were confirmed in statin-intolerant patients, indicating that PCSK9 inhibitors represent an attractive treatment option in this challenging clinical setting. PCSK9 inhibitors recently received regulatory approval for clinical use and may be considered in properly selected patients according to current consensus documents, including patients with statin intolerance. In this review we summarise current evidence regarding diagnostic evaluation of statin-related adverse events, particularly statin-associated muscle symptoms, and we discuss current recommendations on the management of statin-intolerant patients. In view of emerging evidence of the efficacy and safety of PCSK9 inhibitors, we further discuss the role of monoclonal PCSK9 antibodies in the management of statin-intolerant hypercholesterolaemic patients.

  6. Exogenous thyroxine improves glucose intolerance in insulin-resistant rats.

    PubMed

    Vazquez-Anaya, Guillermo; Martinez, Bridget; Soñanez-Organis, José G; Nakano, Daisuke; Nishiyama, Akira; Ortiz, Rudy M

    2017-03-01

    Both hypothyroidism and hyperthyroidism are associated with glucose intolerance, calling into question the contribution of thyroid hormones (TH) on glucose regulation. TH analogues and derivatives may be effective treatment options for glucose intolerance and insulin resistance (IR), but their potential glucoregulatory effects during conditions of impaired metabolism are not well described. To assess the effects of thyroxine (T4) on glucose intolerance in a model of insulin resistance, an oral glucose tolerance test (oGTT) was performed on three groups of rats (n = 8): (1) lean, Long Evans Tokushima Otsuka (LETO), (2) obese, Otsuka Long Evans Tokushima Fatty (OLETF) and (3) OLETF + T4 (8.0 µg/100 g BM/day × 5 weeks). T4 attenuated glucose intolerance by 15% and decreased IR index (IRI) by 34% in T4-treated OLETF compared to untreated OLETF despite a 31% decrease in muscle Glut4 mRNA expression. T4 increased the mRNA expressions of muscle monocarboxylate transporter 10 (Mct10), deiodinase type 2 (Di2), sirtuin 1 (Sirt1) and uncoupling protein 2 (Ucp2) by 1.8-, 2.2-, 2.7- and 1.4-fold, respectively, compared to OLETF. Activation of AMP-activated protein kinase (AMPK) and insulin receptor were not significantly altered suggesting that the improvements in glucose intolerance and IR were independent of enhanced insulin-mediated signaling. The results suggest that T4 treatment increased the influx of T4 in skeletal muscle and, with an increase of DI2, increased the availability of the biologically active T3 to upregulate key factors such SIRT1 and UCP2 involved in cellular metabolism and glucose homeostasis.

  7. Rapid resolution of milk protein intolerance in infancy.

    PubMed

    Lazare, Farrah B; Brand, Donald A; Marciano, Tuvia A; Daum, Fredric

    2014-08-01

    Infants with milk protein intolerance are usually switched to a casein hydrolysate or amino acid-based formula, which they continue to receive until 1 year of age, when they are rechallenged with a cow's-milk or soy protein formula. To investigate whether some of these infants actually become tolerant sooner, this study gathered preliminary data for establishing an empirical timetable for the resolution of milk protein intolerance. This prospective, longitudinal cohort study enrolled infants <4 months of age receiving either breast milk or a cow's-milk or casein hydrolysate formula who presented to a pediatric subspecialty practice during an 18-month period and had a positive stool guaiac test. After having been successfully switched to a casein hydrolysate or amino acid formula, infants who had guaiac-negative stools for at least 2 consecutive months were rechallenged with the formula that had necessitated the most recent switch. Of the 25 patients enrolled in the study, 16 completed the food challenge and data collection protocol. Negative stool guaiac tests following rechallenge indicated resolution of milk protein intolerance by the time subjects reached an average age of 6.7 ± 1.0 months (mean ± standard deviation). By the age of 7 months, milk protein intolerance was resolved in 12 of the 16 infants, the remainder having resolved by 10 months. It may be reasonable to treat infants with milk protein intolerance for 2 to 3 months with a hypoallergenic formula, then rechallenge them at 6 months of age, usually without causing recurrence of the hematochezia. Rechallenging before 12 months old could result in cost savings to families and insurers.

  8. Risks associated with the use of live-attenuated vaccine poliovirus strains and the strategies for control and eradication of paralytic poliomyelitis.

    PubMed

    Pliaka, Vaia; Kyriakopoulou, Zaharoula; Markoulatos, Panayotis

    2012-05-01

    The Global Polio Eradication Initiative was launched in 1988 with the aim to eliminate paralytic poliomyelitis. Two effective vaccines are available: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Since 1964, OPV has been used instead of IPV in most countries due to several economic and biological advantages. However, in rare cases, the live-attenuated Sabin strains of OPV revert to neurovirulence and cause vaccine-associated paralytic poliomyelitis in vaccinees or lead to emergence of vaccine-derived poliovirus strains. Attenuating mutations and recombination events have been associated with the reversion of vaccine strains to neurovirulence. The substitution of OPV with an improved new-generation IPV and the availability of new specific drugs against polioviruses are considered as future strategies for outbreak control and the eradication of paralytic poliomyelitis worldwide.

  9. A viral agent isolated from a case of "non-paralytic poliomyelitis" and pathogenic for suckling mice: its possible relation to the coxsackie group of viruses.

    PubMed

    CHEEVER, F S; DANIELS, J B; HERSEY, E F

    1950-08-01

    1. A viral agent, Powers, causing myocarditis, adipositis, pancreatitis, hepatitis, and encephalomyelitis but not myositis in suckling mice 1 to 2 days old has been isolated from the stool of a patient in whom the clinical diagnosis was "non-paralytic poliomyelitis." 2. Serological evidence linking the virus to the clinical disease observed was clear only in the case of "non-paralytic poliomyelitis" from which it was isolated. 3. The possible relation of this agent to the Coxsackie group of viruses is discussed. No serological relationship with the Connecticut 5, Ohio R, and High Point strains was demonstrated. 4. A second virus, Matulaitis, has been isolated from a concurrent case of "non-paralytic poliomyelitis" in the same area. Lesions produced in infant mice by the two agents show certain differences.

  10. Characterisation of the paralytic shellfish toxin biosynthesis gene clusters in Anabaena circinalis AWQC131C and Aphanizomenon sp. NH-5

    PubMed Central

    Mihali, Troco K; Kellmann, Ralf; Neilan, Brett A

    2009-01-01

    Background Saxitoxin and its analogues collectively known as the paralytic shellfish toxins (PSTs) are neurotoxic alkaloids and are the cause of the syndrome named paralytic shellfish poisoning. PSTs are produced by a unique biosynthetic pathway, which involves reactions that are rare in microbial metabolic pathways. Nevertheless, distantly related organisms such as dinoflagellates and cyanobacteria appear to produce these toxins using the same pathway. Hypothesised explanations for such an unusual phylogenetic distribution of this shared uncommon metabolic pathway, include a polyphyletic origin, an involvement of symbiotic bacteria, and horizontal gene transfer. Results We describe the identification, annotation and bioinformatic characterisation of the putative paralytic shellfish toxin biosynthesis clusters in an Australian isolate of Anabaena circinalis and an American isolate of Aphanizomenon sp., both members of the Nostocales. These putative PST gene clusters span approximately 28 kb and contain genes coding for the biosynthesis and export of the toxin. A putative insertion/excision site in the Australian Anabaena circinalis AWQC131C was identified, and the organization and evolution of the gene clusters are discussed. A biosynthetic pathway leading to the formation of saxitoxin and its analogues in these organisms is proposed. Conclusion The PST biosynthesis gene cluster presents a mosaic structure, whereby genes have apparently transposed in segments of varying size, resulting in different gene arrangements in all three sxt clusters sequenced so far. The gene cluster organizational structure and sequence similarity seems to reflect the phylogeny of the producer organisms, indicating that the gene clusters have an ancient origin, or that their lateral transfer was also an ancient event. The knowledge we gain from the characterisation of the PST biosynthesis gene clusters, including the identity and sequence of the genes involved in the biosynthesis, may

  11. Uptake, transfer and elimination kinetics of paralytic shellfish toxins in common octopus (Octopus vulgaris).

    PubMed

    Lopes, Vanessa M; Baptista, Miguel; Repolho, Tiago; Rosa, Rui; Costa, Pedro Reis

    2014-01-01

    Marine phycotoxins derived from harmful algal blooms are known to be associated with mass mortalities in the higher trophic levels of marine food webs. Bivalve mollusks and planktivorous fish are the most studied vectors of marine phycotoxins. However, field surveys recently showed that cephalopod mollusks also constitute potential vectors of toxins. Thus, here we determine, for the first time, the time course of accumulation and depuration of paralytic shellfish toxins (PSTs) in the common octopus (Octopus vulgaris). Concomitantly, the underlying kinetics of toxin transfer between tissue compartments was also calculated. Naturally contaminated clams were used to orally expose the octopus to PSTs during 6 days. Afterwards, octopus specimens were fed with non-contaminated shellfish during 10 days of depuration period. Toxins reached the highest concentrations in the digestive gland surpassing the levels in the kidney by three orders of magnitude. PSTs were not detected in any other tissue analyzed. Net accumulation efficiencies of 42% for GTX5, 36% for dcSTX and 23% for C1+2 were calculated for the digestive gland. These compounds were the most abundant toxins in both digestive gland and the contaminated shellfish diet. The small differences in relative abundance of each toxin observed between the prey and the cephalopod predator indicates low conversion rates of these toxins. The depuration period was better described using an exponential decay model comprising a single compartment - the entire viscera. It is worth noting that since octopuses' excretion and depuration rates are low, the digestive gland is able to accumulate very high toxin concentrations for long periods of time. Therefore, the present study clearly shows that O. vulgaris is a high-potential vector of PSTs during and even after the occurrence of these toxic algal blooms.

  12. Kinetics of accumulation and transformation of paralytic shellfish toxins in the blue mussel Mytilus galloprovincialis.

    PubMed

    Blanco, Juan; Reyero, Ma Isabel; Franco, José

    2003-12-01

    Mussels (Mytilus galloprovincialis) were fed cultures of the Paralytic Shellfish Poisoning agent Alexandrium minutum (Strain AL1V) for a 15-day period and, for the next 12 days, they were fed the non-toxic species Tetraselmis suecica, in order to monitor the intoxication/detoxification process. The toxin content in the bivalve was checked daily throughout the experiment. During the time-course of the experiment, the toxin profile of the bivalves changed substantially, showing increasingly greater differences from the proportions found in the toxigenic dinoflagellate used as food. The main processes involved in the accumulation of toxins and in the variation of the toxic profiles were implemented in a series of numerical models and the usefulness of those models to describe the actual intoxication/detoxification kinetics was assessed. Models that did not include transformations between toxins were unable to describe the kinetics, even when different detoxification rates were allowed for the toxins involved. The models including epimerization and reduction provided a good description of the kinetics whether or not differential detoxification was allowed for the different toxins, suggesting that the differences in detoxification rates between the toxins are not an important factor in regulating the change of the toxic profile. The implementation of Michaelis-Menten kinetics to describe the two reductive transformations produced a model that had a poorer fit to the data observed than the model that included only a first order kinetics. This suggests that, it is very unlikely that any enzymatic reaction is involved in the reduction of the hydroxycarbamate (OH-GTXs) to carbamate (H-GTXs) gonyautoxins.

  13. Long-Term Circulation of Vaccine-Derived Poliovirus That Causes Paralytic Disease

    PubMed Central

    Cherkasova, Elena A.; Korotkova, Ekaterina A.; Yakovenko, Maria L.; Ivanova, Olga E.; Eremeeva, Tatyana P.; Chumakov, Konstantin M.; Agol, Vadim I.

    2002-01-01

    Successful implementation of the global poliomyelitis eradication program raises the problem of vaccination against poliomyelitis in the posteradication era. One of the options under consideration envisions completely stopping worldwide the use of the Sabin vaccine. This strategy is based on the assumption that the natural circulation of attenuated strains and their derivatives is strictly limited. Here, we report the characterization of a highly evolved derivative of the Sabin vaccine strain isolated in a case of paralytic poliomyelitis from a 7-month-old immunocompetent baby in an apparently adequately immunized population. Analysis of the genome of this isolate showed that it is a double (type 1-type 2-type 1) vaccine-derived recombinant. The number of mutations accumulated in both the type 1-derived and type 2-derived portions of the recombinant genome suggests that both had diverged from their vaccine predecessors ∼2 years before the onset of the illness. This fact, along with other recent observations, points to the possibility of long-term circulation of Sabin vaccine strain derivatives associated with an increase in their neurovirulence. Comparison of genomic sequences of this and other evolved vaccine-derived isolates reveals some general features of natural poliovirus evolution. They include a very high preponderance and nonrandom distribution of synonymous substitutions, conservation of secondary structures of important cis-acting elements of the genome, and an apparently adaptive character of most of the amino acid mutations, with only a few of them occurring in the antigenic determinants. Another interesting feature is a frequent occurrence of tripartite intertypic recombinants with either type 1 or type 3 homotypic genomic ends. PMID:12050392

  14. Lethal paralytic shellfish poisoning from consumption of green mussel broth, Western Samar, Philippines, August 2013

    PubMed Central

    Ramos, Ruth Alma; de los Reyes, Vikki Carr; Sucaldito, Ma Nemia; Tayag, Enrique

    2015-01-01

    Background In July 2013, the Philippines’ Event-Based Surveillance & Response Unit received a paralytic shellfish poisoning (PSP) report from Tarangnan, Western Samar. A team from the Department of Health conducted an outbreak investigation to identify the implicated source and risk factors in coastal villages known for green mussel production and exportation. Methods A case was defined as a previously well individual from Tarangan, Western Samar who developed gastrointestinal symptoms and any motor and/or sensory symptoms after consumption of shellfish from 29 June to 4 July 2013 in the absence of any known cause. The team reviewed medical records, conducted active case finding and a case-control study. Relatives of cases who died were interviewed. Sera and urine specimens, green mussel and seawater samples were tested for saxitoxin levels using high performance liquid chromatography. Results Thirty-one cases and two deaths were identified. Consumption of > 1 cup of green mussel broth was associated with being a case. Seawater sample was positive for Pyrodinium bahamense var. compressum and green mussel samples were positive for saxitoxin. Inspection revealed villagers practice open defecation and improper garbage disposal. Conclusion This PSP outbreak was caused by the consumption of the green mussel broth contaminated by saxitoxin. As a result of this outbreak, dinoflagellate and saxitoxin surveillance was established, and since the outbreak, there have been no harmful algal blooms event or PSP case reported since. A “Save Cambatutay Bay” movement, focusing on proper waste disposal practice and clean-up drives has been mobilized. PMID:26306212

  15. Treating the Golden Implant Visibility on a Paralytic Eye by Using the Capsule Shield Technique.

    PubMed

    Akcal, Arzu; Savas, Seckin Aydin; Ozkan, Ozlenen; Ogan, Onur; Ozkan, Omer

    2016-01-01

    Static upper eyelid weight loading is a well known treatment option for patients who suffer from paralytic lagophtalmus. Golden implants may cause some complications such as extrusion, postoperative ptosis, visibility of the implant from the skin, infection, or dislocation. Our patients applied to our clinic with discomfort of the implant's easily noticeable visibility in their daily life. They were scheduled the operation programme for reducing visibility of implant.In operation, capsule formation has seen and dissection begun preserving the capsule formation. The capsule has opened on its cranial edge and implant has been removed. By this maneuver, 2 layers of capsule were dissected from surrounding tissues without separating its caudal edges from the upper tarsal fold. These 2 layers were sutured to each other providing strong fibrous shield with the aim of preventing implant visibility. A new pocket has been created under this fibrous shield.Capsule shield technique is provided to replace the implant and prevent revisibilation by using forceful fibrous and highly vascular 2 layers of capsule. This technique seems 1 step ahead than autogenous grafts that require secondary surgical area and bring donor site complications with itself. It does not contain any risk of developing foreign body response and graft infection, unlikely nonautogenous/autogenous graft materials. Also, in the capsule shield technique, operation duration will be shorter and hospitalization period will be shorter compared with techniques using barrier materials because it does not require any additional surgical intervention in donor area. In addition, the authors keep the apeuneurosis in anatomical position and no other new incisions are required. Since no biomaterials are required, this technique also avoids donor site morbidity.

  16. A mouse model of paralytic myelitis caused by enterovirus D68

    PubMed Central

    Yu, Guixia; Leser, J. Smith; Yagi, Shigeo; Tyler, Kenneth L.

    2017-01-01

    In 2014, the United States experienced an epidemic of acute flaccid myelitis (AFM) cases in children coincident with a nationwide outbreak of enterovirus D68 (EV-D68) respiratory disease. Up to half of the 2014 AFM patients had EV-D68 RNA detected by RT-PCR in their respiratory secretions, although EV-D68 was only detected in cerebrospinal fluid (CSF) from one 2014 AFM patient. Given previously described molecular and epidemiologic associations between EV-D68 and AFM, we sought to develop an animal model by screening seven EV-D68 strains for the ability to induce neurological disease in neonatal mice. We found that four EV-D68 strains from the 2014 outbreak (out of five tested) produced a paralytic disease in mice resembling human AFM. The remaining 2014 strain, as well as 1962 prototype EV-D68 strains Fermon and Rhyne, did not produce, or rarely produced, paralysis in mice. In-depth examination of the paralysis caused by a representative 2014 strain, MO/14-18947, revealed infectious virus, virion particles, and viral genome in the spinal cords of paralyzed mice. Paralysis was elicited in mice following intramuscular, intracerebral, intraperitoneal, and intranasal infection, in descending frequency, and was associated with infection and loss of motor neurons in the anterior horns of spinal cord segments corresponding to paralyzed limbs. Virus isolated from spinal cords of infected mice transmitted disease when injected into naïve mice, fulfilling Koch’s postulates in this model. Finally, we found that EV-D68 immune sera, but not normal mouse sera, protected mice from development of paralysis and death when administered prior to viral challenge. These studies establish an experimental model to study EV-D68-induced myelitis and to better understand disease pathogenesis and develop potential therapies. PMID:28231269

  17. Experience with the gold weight and palpebral spring in the management of paralytic lagophthalmos.

    PubMed

    Terzis, Julia K; Kyere, Sampson A

    2008-03-01

    The loss of the blink reflex and the ability to close the eye actively are disabling functional and aesthetic impairments common to patients with facial paralysis. Nonphysiologic (static) management techniques involve implantation of devices in the upper eyelid that mechanically aid eye closure. The most popular devices are the gold weight and the palpebral spring. The authors' experience with these devices is presented. Thirty-nine patients treated for paralytic lagophthalmos by the senior author (J.K.T.) between 1987 and 2002 met the inclusion criteria. Eighteen patients received the gold weight and 21 received the palpebral spring. From standardized video records, preoperative and postoperative blink scores were calculated. Fifty-nine percent of the patients (23 of 39) were female, and the most common cause for facial paralysis [35.9 percent (14 of 39)] was extirpation of acoustic neuroma and other cerebellopontine lesions. Fifty percent of the gold weight cohort was younger than 20 years at the time of surgery, with almost 40 percent (seven of 18) younger than 10 years. In the palpebral spring group, 14.3 percent (three of 21) were younger than 20 years, with 4.8 percent (one of 21) younger than 10 years. The palpebral spring group obtained a larger postoperative mean blink score of 34.0 +/- 12.4 percent compared with the gain of 21.4 +/- 14.6 percent (p = 0.025) by the gold weight group. The gold weight and palpebral spring are both effective in restoring motion to the paretic upper eyelid, but the palpebral spring is more so despite the frequent need for revisions.

  18. Hyaluronic acid gel weight: a nonsurgical option for the management of paralytic lagophthalmos.

    PubMed

    Martín-Oviedo, Carlos; García, Irene; Lowy, Alex; Scola, Esteban; Aristegui, Miguel; Scola, Bartolome

    2013-12-01

    Management of lagophthalmos should be a priority in the treatment of patients with facial palsy. The aim of the study was to evaluate the safety and efficacy of injecting hyaluronic acid gel into the upper eyelid as a nonsurgical alternative for patients with temporary facial palsy. Retrospective study of 26 patients treated with hyaluronic acid gel injected into the pretarsal region of the upper eyelid. Measurements taken before and after treatment were standardized and compared using digitized photographs. Patients were followed up for 1 year, and overall outcomes were assessed. All patients initially demonstrated improvement in lagophthalmos, which decreased to 0.0 mm. After 1 month, a significant increase in lagophthalmos was observed in two patients (initial fissure of 8 and 9 mm), and a platinum weight was implanted to control keratopathy. The remaining patients (initial lagophthalmos below 6.5 mm) maintained the improvement until facial restoration. Only three patients had recurrent lagophthalmos (2 mm) due to resorption, which was resolved by injecting an additional 0.3 cc. The mean improvement in lagophthalmos was 4.6 mm (range, 3.5-6.5 mm). Complications included transient ecchymosis and minimal blepharoptosis due to nonreabsorption in five patients. These patients were successfully treated with hyaluronidase. Hyaluronic acid gel has proven effective in reducing paralytic lagophthalmos and controlling keratopathy in patients with temporary facial palsy, especially those with palpebral fissure with attempted closure no greater than 6.5 mm. Injection of hyaluronic acid gel is safe, quick, and easily performed. In addition, it is more cost-effective than surgery. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Levator lengthening technique using cartilage or fascia graft for paralytic lagophthalmos in facial paralysis.

    PubMed

    Hayashi, Ayato; Yoshizawa, Hidekazu; Natori, Yuhei; Senda, Daiki; Tanaka, Rica; Mizuno, Hiroshi

    2016-05-01

    Lid loading using gold weights has been commonly used to treat paralytic lagophthalmos (PL); however, the procedure has a relatively high complication rate and the availability of these plates varies among social circumstances. We used a levator lengthening (LL) technique, which originally elongated the levator aponeurosis by inserting a fascia graft between the edge of the levator aponeurosis and the tarsal plate. However, because this procedure tends to result in a wide residual lagophthalmos, we changed the graft material from fascia to conchal cartilage. In this study, we describe in detail our experience with LL using the cartilage graft. LL was performed in 18 patients with PL. Fascia grafts were used in seven patients and cartilage grafts in 11. Static reconstructions of the lower eyelid and eyebrow were also performed in most patients. Efficacy was evaluated from patient reports of ocular symptoms and by measuring the palpebral fissure width at opening and closing for both eyes. All patients experienced improved ophthalmological symptoms, which were more apparent in cartilage cases. The average palpebral fissure at eyelid closure was 1.8 mm in cartilage cases and 4.0 mm in fascia cases. In cases where an eyebrow lift was concurrently performed, the residual lagophthalmos became wider in fascia grafting but remained acceptable in cartilage grafting. LL is a simple and useful procedure for treating PL with higher efficacy when a cartilage graft is used. However, the level of the upper eyelid can be easily adjusted by changing the fixation position of the cartilage. Additional experience is required to obtain more consistent outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Paralytic Shellfish Poisoning Toxin-Producing Cyanobacterium Aphanizomenon gracile in Northeast Germany▿ †

    PubMed Central

    Ballot, Andreas; Fastner, Jutta; Wiedner, Claudia

    2010-01-01

    Neurotoxic paralytic shellfish poisoning (PSP) toxins, anatoxin-a (ATX), and hepatotoxic cylindrospermopsin (CYN) have been detected in several lakes in northeast Germany during the last 2 decades. They are produced worldwide by members of the nostocalean genera Anabaena, Cylindrospermopsis, and Aphanizomenon. Although no additional sources of PSP toxins and ATX have been identified in German water bodies to date, the observed CYN concentrations cannot be produced solely by Aphanizomenon flos-aquae, the only known CYN producer in Germany. Therefore, we attempted to identify PSP toxin, ATX, and CYN producers by isolating and characterizing 92 Anabaena, Aphanizomenon, and Anabaenopsis strains from five lakes in northeast Germany. In a polyphasic approach, all strains were morphologically and phylogenetically classified and then tested for PSP toxins, ATX, and CYN by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA) and screened for the presence of PSP toxin- and CYN-encoding gene fragments. As demonstrated by ELISA and LC-MS, 14 Aphanizomenon gracile strains from Lakes Melang and Scharmützel produced four PSP toxin variants (gonyautoxin 5 [GTX5], decarbamoylsaxitoxin [dcSTX], saxitoxin [STX], and neosaxitoxin [NEO]). GTX5 was the most prevalent PSP toxin variant among the seven strains from Lake Scharmützel, and NEO was the most prevalent among the seven strains from Lake Melang. The sxtA gene, which is part of the saxitoxin gene cluster, was found in the 14 PSP toxin-producing A. gracile strains and in 11 non-PSP toxin-producing Aphanizomenon issatschenkoi, A. flos-aquae, Anabaena planktonica, and Anabaenopsis elenkinii strains. ATX and CYN were not detected in any of the isolated strains. This study is the first confirming the role of A. gracile as a PSP toxin producer in German water bodies. PMID:20048055

  1. Paralytic shellfish poisoning toxin-producing cyanobacterium Aphanizomenon gracile in northeast Germany.

    PubMed

    Ballot, Andreas; Fastner, Jutta; Wiedner, Claudia

    2010-02-01

    Neurotoxic paralytic shellfish poisoning (PSP) toxins, anatoxin-a (ATX), and hepatotoxic cylindrospermopsin (CYN) have been detected in several lakes in northeast Germany during the last 2 decades. They are produced worldwide by members of the nostocalean genera Anabaena, Cylindrospermopsis, and Aphanizomenon. Although no additional sources of PSP toxins and ATX have been identified in German water bodies to date, the observed CYN concentrations cannot be produced solely by Aphanizomenon flos-aquae, the only known CYN producer in Germany. Therefore, we attempted to identify PSP toxin, ATX, and CYN producers by isolating and characterizing 92 Anabaena, Aphanizomenon, and Anabaenopsis strains from five lakes in northeast Germany. In a polyphasic approach, all strains were morphologically and phylogenetically classified and then tested for PSP toxins, ATX, and CYN by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA) and screened for the presence of PSP toxin- and CYN-encoding gene fragments. As demonstrated by ELISA and LC-MS, 14 Aphanizomenon gracile strains from Lakes Melang and Scharmützel produced four PSP toxin variants (gonyautoxin 5 [GTX5], decarbamoylsaxitoxin [dcSTX], saxitoxin [STX], and neosaxitoxin [NEO]). GTX5 was the most prevalent PSP toxin variant among the seven strains from Lake Scharmützel, and NEO was the most prevalent among the seven strains from Lake Melang. The sxtA gene, which is part of the saxitoxin gene cluster, was found in the 14 PSP toxin-producing A. gracile strains and in 11 non-PSP toxin-producing Aphanizomenon issatschenkoi, A. flos-aquae, Anabaena planktonica, and Anabaenopsis elenkinii strains. ATX and CYN were not detected in any of the isolated strains. This study is the first confirming the role of A. gracile as a PSP toxin producer in German water bodies.

  2. Phylogeography of Cylindrospermopsin and Paralytic Shellfish Toxin-Producing Nostocales Cyanobacteria from Mediterranean Europe (Spain)

    PubMed Central

    Cirés, Samuel; Wörmer, Lars; Ballot, Andreas; Agha, Ramsy; Wiedner, Claudia; Velázquez, David; Casero, María Cristina

    2014-01-01

    Planktonic Nostocales cyanobacteria represent a challenge for microbiological research because of the wide range of cyanotoxins that they synthesize and their invasive behavior, which is presumably enhanced by global warming. To gain insight into the phylogeography of potentially toxic Nostocales from Mediterranean Europe, 31 strains of Anabaena (Anabaena crassa, A. lemmermannii, A. mendotae, and A. planctonica), Aphanizomenon (Aphanizomenon gracile, A. ovalisporum), and Cylindrospermopsis raciborskii were isolated from 14 freshwater bodies in Spain and polyphasically analyzed for their phylogeography, cyanotoxin production, and the presence of cyanotoxin biosynthesis genes. The potent cytotoxin cylindrospermopsin (CYN) was produced by all 6 Aphanizomenon ovalisporum strains at high levels (5.7 to 9.1 μg CYN mg−1 [dry weight]) with low variation between strains (1.5 to 3.9-fold) and a marked extracellular release (19 to 41% dissolved CYN) during exponential growth. Paralytic shellfish poisoning (PSP) neurotoxins (saxitoxin, neosaxitoxin, and decarbamoylsaxitoxin) were detected in 2 Aphanizomenon gracile strains, both containing the sxtA gene. This gene was also amplified in non-PSP toxin-producing Aphanizomenon gracile and Aphanizomenon ovalisporum. Phylogenetic analyses supported the species identification and confirmed the high similarity of Spanish Anabaena and Aphanizomenon strains with other European strains. In contrast, Cylindrospermopsis raciborskii from Spain grouped together with American strains and was clearly separate from the rest of the European strains, raising questions about the current assumptions of the phylogeography and spreading routes of C. raciborskii. The present study confirms that the nostocalean genus Aphanizomenon is a major source of CYN and PSP toxins in Europe and demonstrates the presence of the sxtA gene in CYN-producing Aphanizomenon ovalisporum. PMID:24334673

  3. Phylogeography of cylindrospermopsin and paralytic shellfish toxin-producing nostocales cyanobacteria from mediterranean europe (Spain).

    PubMed

    Cirés, Samuel; Wörmer, Lars; Ballot, Andreas; Agha, Ramsy; Wiedner, Claudia; Velázquez, David; Casero, María Cristina; Quesada, Antonio

    2014-02-01

    Planktonic Nostocales cyanobacteria represent a challenge for microbiological research because of the wide range of cyanotoxins that they synthesize and their invasive behavior, which is presumably enhanced by global warming. To gain insight into the phylogeography of potentially toxic Nostocales from Mediterranean Europe, 31 strains of Anabaena (Anabaena crassa, A. lemmermannii, A. mendotae, and A. planctonica), Aphanizomenon (Aphanizomenon gracile, A. ovalisporum), and Cylindrospermopsis raciborskii were isolated from 14 freshwater bodies in Spain and polyphasically analyzed for their phylogeography, cyanotoxin production, and the presence of cyanotoxin biosynthesis genes. The potent cytotoxin cylindrospermopsin (CYN) was produced by all 6 Aphanizomenon ovalisporum strains at high levels (5.7 to 9.1 μg CYN mg(-1) [dry weight]) with low variation between strains (1.5 to 3.9-fold) and a marked extracellular release (19 to 41% dissolved CYN) during exponential growth. Paralytic shellfish poisoning (PSP) neurotoxins (saxitoxin, neosaxitoxin, and decarbamoylsaxitoxin) were detected in 2 Aphanizomenon gracile strains, both containing the sxtA gene. This gene was also amplified in non-PSP toxin-producing Aphanizomenon gracile and Aphanizomenon ovalisporum. Phylogenetic analyses supported the species identification and confirmed the high similarity of Spanish Anabaena and Aphanizomenon strains with other European strains. In contrast, Cylindrospermopsis raciborskii from Spain grouped together with American strains and was clearly separate from the rest of the European strains, raising questions about the current assumptions of the phylogeography and spreading routes of C. raciborskii. The present study confirms that the nostocalean genus Aphanizomenon is a major source of CYN and PSP toxins in Europe and demonstrates the presence of the sxtA gene in CYN-producing Aphanizomenon ovalisporum.

  4. Enteral feedings.

    PubMed

    Chernoff, R

    1980-01-01

    The benefits, equipment used, commercially available sources, and the indications and techniques for administration of enteral nutrients are reviewed. In many malabsorption states, enteral feeding is preferable and parenteral nutrients are seldom indicated. Transitional enteral nutrient support usually is indicated after parenteral nutrient therapy. Enteral tube-feeding formulas should be matched to the patient's needs; formulas using blenderized natural foods or intact isolated nutrients are appropriate for patients with intact gastrointestinal tracts. Patients should be monitored for glucosuria and hyperglycemia, bloating, nausea, dehydration, and renal, hepatic and hematologic status. Formula dilution, and a reduced flow rate or use of continuous-drip feeding, will reduce the incidence of osmotic diarrhea. The effectiveness, low cost and low potential for serious complications make enteral feeding preferable to parenteral nutrient therapy for many patients.

  5. Two Hundred Cases of Paralytic Foot Stabilization after the Method of Hoke

    PubMed Central

    2008-01-01

    It is the desire of the American Academy of Orthopaedic Surgeons to offer its wholehearted support to our Country in this serious emergency.” A telegram with the resolution was sent to the President of the United States. Miller had a lasting interest in foot surgery, undoubtedly influenced by Hoke. We reprint here Miller’s report of Hoke’s triple arthrodesis for paralytic feet [3]. Astonishingly, Miller states this was the only operation performed for paralytic feet in his clinic over a three-year period, yet he reported 200 cases in this short time; obviously the number of polio patients at the time was devastating. Among these 200 cases, 121 were of the “clubfoot type,” 62 had pes cavus (on which he wrote in 1927 [4]), and 17 pes calcaneus (on which he wrote in 1936 [5]). Miller reports eight cases of flail feet (although it is unclear whether these are additional cases, or fall within one of the three categories since the numbers of those categories add to 200). His focus is to describe the basic operations with indications for supplemental procedures including tendon transfers. As was often common practice in describing procedures at the time, he did not report the followup results and did not provide references [3]. Oscar Lee Miller, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983. References Heck CV. Commemorative Volume 1933–1983 Fifty Years of Progress. Chicago, IL: American Academy of Orthopaedic Surgeons; 1983. Heck CV. Fifty Years of Progress: In Recognition of the 50th Anniversary of the American Academy of Orthopaedic Surgeons. Chicago, IL: American Academy of Orthopaedic Surgeons; 1983. Miller O. Two hundred cases of paralytic foot stabilization after the method of Hoke. J Bone Joint Surg Am. 1925;7:85–97. Miller O. A plastic foot operation. J Bone Joint Surg Am. 1927;9:84–91. Miller O. Surgical management of pes calcaneus. J Bone Joint Surg Am. 1936;18:169

  6. Observations of sylvatic rabies in Northern Argentina during outbreaks of paralytic cattle rabies transmitted by vampire bats (Desmodus rotundus).

    PubMed

    Delpietro, H A; Lord, R D; Russo, R G; Gury-Dhomen, F

    2009-10-01

    During rabies outbreaks in cattle (paralytic rabies) in Argentina associated with the common vampire bat Desmodus rotundus, rabies was observed in marsh deer (Blastocerus dichotomus), red brocket deer (Mazama americana), capybara (Hydrochoerus hydrochaeris), savanna fox (Cerdocyon thous), and great fruit-eating bat (Artibeus lituratus). Rabies could constitute a threat to the survival of marsh deer in places where they live in small groups, and infection of both great fruit-eating bats and savanna fox represent a risk for humans; both species exhibit aggressiveness and fury when infected.

  7. Combined immunodeficiency presenting with vaccine-associated paralytic poliomyelitis: a case report and narrative review of literature.

    PubMed

    Shaghaghi, Mohammadreza; Parvaneh, Nima; Ostad-Rahimi, Pouya; Fathi, Seyed Mohammad; Shahmahmoodi, Shohreh; Abolhassani, Hassan; Aghamohammadi, Asghar

    2014-01-01

    Neurologic abnormalities compatible with vaccine-related poliovirus infection (VAPP) may be a first presentation of some primary immunodeficient patients. The risk of VAPP rises from 1 case per 750 000 in normal population to 1 per 7000 times higher, particularly for persons with agammaglobulinemia and hypogammaglobulinemia. However, there is no appropriate estimation for VAPP occurrence in patients with cellular immunity defects. Herein we report a case of combined immunodeficiency with paralytic complication due to oral polio vaccine and we present a literature review on this topic.

  8. Breast-Feeding Twins: Making Feedings Manageable

    MedlinePlus

    ... breast-feed more than one baby? Here's help breast-feeding twins or other multiples, from getting positioned and ensuring an adequate milk supply to combining breast-feeding and formula-feeding. By Mayo Clinic Staff If ...

  9. Lifelong obesity in a polygenic mouse model prevents age- and diet-induced glucose intolerance- obesity is no road to late-onset diabetes in mice.

    PubMed

    Renne, Ulla; Langhammer, Martina; Brenmoehl, Julia; Walz, Christina; Zeissler, Anja; Tuchscherer, Armin; Piechotta, Marion; Wiesner, Rudolf J; Bielohuby, Maximilian; Hoeflich, Andreas

    2013-01-01

    Visceral obesity holds a central position in the concept of the metabolic syndrome characterized by glucose intolerance in humans. However, until now it is unclear if obesity by itself is responsible for the development of glucose intolerance. We have used a novel polygenic mouse model characterized by genetically fixed obesity (DU6) and addressed age- and high fat diet-dependent glucose tolerance. Phenotype selection over 146 generations increased body weight by about 2.7-fold in male 12-week DU6 mice (P<0.0001) if compared to unselected controls (Fzt:DU). Absolute epididymal fat mass was particularly responsive to weight selection and increased by more than 5-fold (P<0.0001) in male DU6 mice. At an age of 6 weeks DU6 mice consumed about twice as much food if compared to unselected controls (P<0.001). Absolute food consumption was higher at all time points measured in DU6 mice than in Fzt:DU mice. Between 6 and 12 weeks of age, absolute food intake was reduced by 15% in DU6 mice (P<0.001) but not in Fzt:DU mice. In both mouse lines feeding of the high fat diet elevated body mass if compared to the control diet (P<0.05). In contrast to controls, DU6 mice did not display high fat diet-induced increases of epididymal and renal fat. Control mice progressively developed glucose intolerance with advancing age and even more in response to the high fat diet. In contrast, obese DU6 mice did neither develop a glucose intolerant phenotype with progressive age nor when challenged with a high fat diet. Our results from a polygenic mouse model demonstrate that genetically pre-determined and life-long obesity is no precondition of glucose intolerance later in life.

  10. Reflections on the Institute of Medicine's systemic exertion intolerance disease.

    PubMed

    Jason, Leonard A; Sunnquist, Madison; Brown, Abigail; McManimen, Stephanie; Furst, Jacob

    2015-01-01

    The Institute of Medicine (IOM) in the United States has recently proposed that the term systemic exertion intolerance disease (SEID) replace chronic fatigue syndrome. In addition, the IOM proposed a new case definition for SEID, which includes substantial reductions or impairments in the ability to engage in pre‑illness activities, unrefreshing sleep, postexertional malaise, and either cognitive impairment or orthostatic intolerance. Unfortunately, these recommendations for a name change were not vetted with patient and professional audiences, and the new criteria were not evaluated with data sets of patients and controls. A recent poll suggests that the majority of patients reject this new name. In addition, studies have found that prevalence rates will dramatically increase with the new criteria, particularly due to the ambiguity revolving around exclusionary illnesses. Findings suggest that the new criteria select more patients who have less impairment and fewer symptoms than several other criteria. The implications of these findings are discussed in the current review.

  11. Towards an Ontological Theory of Substance Intolerance and Hypersensitivity

    PubMed Central

    Hogan, William R.

    2010-01-01

    A proper ontological treatment of intolerance—including hypersensitivity—to various substances is critical to patient care and research. However, existing methods and standards for documenting these conditions have flaws that inhibit these goals, especially translational research that bridges the two activities. In response, I outline a realist approach to the ontology of substance intolerance, including hypersensitivity conditions. I defend a view of these conditions as a subtype of disease. Specifically, a substance intolerance is a disease whose pathological process(es) are realized upon exposure to a quantity of substance of a particular type, and this quantity would normally not cause the realization of the pathological process(es). To develop this theory, it was necessary to build pieces of a theory of pathological processes. Overall, however, the framework of the Ontology for General Medical Science (which uses Basic Formal Ontology as its uppermost level) was a more-than-adequate foundation on which to build the theory. PMID:20152933

  12. Artificial sweeteners induce glucose intolerance by altering the gut microbiota.

    PubMed

    Suez, Jotham; Korem, Tal; Zeevi, David; Zilberman-Schapira, Gili; Thaiss, Christoph A; Maza, Ori; Israeli, David; Zmora, Niv; Gilad, Shlomit; Weinberger, Adina; Kuperman, Yael; Harmelin, Alon; Kolodkin-Gal, Ilana; Shapiro, Hagit; Halpern, Zamir; Segal, Eran; Elinav, Eran

    2014-10-09

    Non-caloric artificial sweeteners (NAS) are among the most widely used food additives worldwide, regularly consumed by lean and obese individuals alike. NAS consumption is considered safe and beneficial owing to their low caloric content, yet supporting scientific data remain sparse and controversial. Here we demonstrate that consumption of commonly used NAS formulations drives the development of glucose intolerance through induction of compositional and functional alterations to the intestinal microbiota. These NAS-mediated deleterious metabolic effects are abrogated by antibiotic treatment, and are fully transferrable to germ-free mice upon faecal transplantation of microbiota configurations from NAS-consuming mice, or of microbiota anaerobically incubated in the presence of NAS. We identify NAS-altered microbial metabolic pathways that are linked to host susceptibility to metabolic disease, and demonstrate similar NAS-induced dysbiosis and glucose intolerance in healthy human subjects. Collectively, our results link NAS consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage.

  13. Anemia: a cause of intolerance to thyroxine sodium.

    PubMed

    Shakir, K M; Turton, D; Aprill, B S; Drake, A J; Eisold, J F

    2000-02-01

    Usual causes of intolerance to thyroxine sodium include coronary artery disease, advanced age, untreated adrenal insufficiency, and severe hypothyroidism. We describe 4 patients with iron deficiency anemia and primary hypothyroidism. After treatment with thyroxine sodium, these patients developed palpitations and feelings of restlessness, which necessitated discontinuation of the thyroid hormone. After the anemia was treated with ferrous sulfate for 4 to 7 weeks, they were able to tolerate thyroxine sodium therapy. Iron deficiency anemia coexisting with primary hypothyroidism results in a hyperadrenergic state. In such patients, we postulate that thyroid hormone administration causes palpitations, nervousness, and feelings of restlessness. Correction of any existing pronounced anemia in hypothyroid patients who are intolerant to thyroxine sodium therapy may result in tolerance to this agent.

  14. Genetic analysis of a synaptic calcium channel in Drosophila: intragenic modifiers of a temperature-sensitive paralytic mutant of cacophony.

    PubMed Central

    Brooks, I M; Felling, R; Kawasaki, F; Ordway, R W

    2003-01-01

    Our previous genetic analysis of synaptic mechanisms in Drosophila identified a temperature-sensitive paralytic mutant of the voltage-gated calcium channel alpha1 subunit gene, cacophony (cac). Electrophysiological studies in this mutant, designated cac(TS2), indicated cac encodes a primary calcium channel alpha1 subunit functioning in neurotransmitter release. To further examine the functions and interactions of cac-encoded calcium channels, a genetic screen was performed to isolate new mutations that modify the cac(TS2) paralytic phenotype. The screen recovered 10 mutations that enhance or suppress cac(TS2), including second-site mutations in cac (intragenic modifiers) as well as mutations mapping to other genes (extragenic modifiers). Here we report molecular characterization of three intragenic modifiers and examine the consequences of these mutations for temperature-sensitive behavior, synaptic function, and processing of cac pre-mRNAs. These mutations may further define the structural basis of calcium channel alpha1 subunit function in neurotransmitter release. PMID:12750329

  15. A Rapid Method for the Analysis of Paralytic Shellfish Toxins Utilizing Standard Pressure HPLC: Refinement of AOAC 2005.06.

    PubMed

    Hatfield, Robert G; Punn, Rubi; Algoet, Myriam; Turner, Andrew D

    2016-01-01

    Superficially porous column technologies have previously been shown to provide faster chromatographic analysis of toxin oxidation products when analyzing shellfish for paralytic shellfish toxins. While sub 3 μm fused core columns have facilitated enhanced method performance, including significantly lower analysis times and lower LOD, they were also found to last for only a few hundred injections before pressure increases rendered them unusable with standard HPLC. Recently 5 μm superficially porous columns have become commercially available. In this study, a 5 μm fused core column was used to develop a fast chromatographic method for the analysis of paralytic shellfish toxins, with performance characteristics and column lifetime being assessed. The 5 μm column was found to be able to perform approximately 3000 injections without significant increases in back pressure or reduction in performance. Data generated using the column were found to be equivalent to that determined using current HPLC column technologies for both screening and quantitation methods. Furthermore, an increase in sensitivity for all toxins tested under the routine monitoring program for British waters was observed and the overall run time of the analysis halved. Overall, the 5 μm fused core column provided a significant increase in sample throughput, a reduction in mobile phase consumption, and an increase in method sensitivity.

  16. Outbreak of paralytic poliomyelitis in Finland: widespread circulation of antigenically altered poliovirus type 3 in a vaccinated population.

    PubMed

    Hovi, T; Cantell, K; Huovilainen, A; Kinnunen, E; Kuronen, T; Lapinleimu, K; Pöyry, T; Roivainen, M; Salama, N; Stenvik, M

    1986-06-21

    An outbreak of 9 cases of paralytic poliomyelitis and 1 non-paralytic case occurred in Finland between August, 1984, and January, 1985, after two decades of freedom from the disease attributable to a successful immunisation programme. During the outbreak poliovirus type 3 was isolated from the patients, from about 15% of healthy persons tested, and from sewage water. At least 100 000 persons were estimated to have been infected. With 1.5 million extra doses of inactivated poliovirus vaccine to children under 18 years of age and an oral poliovirus vaccine campaign covering about 95% of the entire population in February-March, 1985, the outbreak was halted in February, 1985. Impaired herd immunity to the epidemic strain of poliovirus type 3, which differed from the type 3 vaccine strains in both immunological and molecular properties, was important in the emergence of this outbreak. The inactivated poliovaccine that had been used in the vaccination programme was relatively weakly immunogenic, especially as regards the type 3 component. Whether continuous antigenic variation of poliovirus type 3 has wider epidemiological implications is not known.

  17. Proteomic analysis in allergy and intolerance to wheat products.

    PubMed

    Mamone, Gianfranco; Picariello, Gianluca; Addeo, Francesco; Ferranti, Pasquale

    2011-02-01

    Owing to its extensive use in the human diet, wheat is among the most common causes of food-related allergies and intolerances. Allergies to wheat are provoked by ingestion, inhalation or contact with either the soluble or the insoluble gluten proteins in wheat. Gluten proteins, and particularly the gliadin fraction, are also the main factor triggering celiac disease, a common enteropathy induced by ingestion of wheat gluten proteins and related prolamins from oat, rye and barley in genetically susceptible individuals. The role of gliadin and of its derived peptides in eliciting the adverse reactions in celiac disease are still far from being completely explained. Owing to its unique pathogenesis, celiac disease is widely investigated as a model immunogenetic disorder. The structural characterization of the injuring agents, the gluten proteins, assumes a particular significance in order to deepen the understanding of the events that trigger this and similar diseases at the molecular level. Recent developments in proteomics have provided an important contribution to the understanding of several basic aspects of wheat protein-related diseases. These include: the identification of gluten fractions and derived peptides involved in wheat allergy and intolerance, including celiac disease, and the elucidation of their mechanism of toxicity; the development and validation of sensitive and specific methods for detecting trace amounts of gluten proteins in gluten-free foods for intolerant patients; and the formulation of completely new substitute foods and ingredients to replace the gluten-based ones. In this article, the main aspects of current and prospective applications of mass spectrometry and proteomic technologies to the structural characterization of gluten proteins and derived peptides are critically presented, with a focus on issues related to their detection, identification and quantification, which are relevant to the biochemical, immunological and toxicological

  18. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency

    NASA Technical Reports Server (NTRS)

    Shannon, J. R.; Flattem, N. L.; Jordan, J.; Jacob, G.; Black, B. K.; Biaggioni, I.; Blakely, R. D.; Robertson, D.

    2000-01-01

    BACKGROUND: Orthostatic intolerance is a syndrome characterized by lightheadedness, fatigue, altered mentation, and syncope and associated with postural tachycardia and plasma norepinephrine concentrations that are disproportionately high in relation to sympathetic outflow. We tested the hypothesis that impaired functioning of the norepinephrine transporter contributes to the pathophysiologic mechanism of orthostatic intolerance. METHODS: In a patient with orthostatic intolerance and her relatives, we measured postural blood pressure, heart rate, plasma catecholamines, and systemic norepinephrine spillover and clearance, and we sequenced the norepinephrine-transporter gene and evaluated its function. RESULTS: The patient had a high mean plasma norepinephrine concentration while standing, as compared with the mean (+/-SD) concentration in normal subjects (923 vs. 439+/-129 pg per milliliter [5.46 vs. 2.59+/-0.76 nmol per liter]), reduced systemic norepinephrine clearance (1.56 vs. 2.42+/-0.71 liters per minute), impairment in the increase in the plasma norepinephrine concentration after the administration of tyramine (12 vs. 56+/-63 pg per milliliter [0.07 vs. 0.33+/-0.37 pmol per liter]), and a disproportionate increase in the concentration of plasma norepinephrine relative to that of dihydroxyphenylglycol. Analysis of the norepinephrine-transporter gene revealed that the proband was heterozygous for a mutation in exon 9 (encoding a change from guanine to cytosine at position 237) that resulted in more than a 98 percent loss of function as compared with that of the wild-type gene. Impairment of synaptic norepinephrine clearance may result in a syndrome characterized by excessive sympathetic activation in response to physiologic stimuli. The mutant allele in the proband's family segregated with the postural heart rate and abnormal plasma catecholamine homeostasis. CONCLUSIONS: Genetic or acquired deficits in norepinephrine inactivation may underlie hyperadrenergic

  19. Fructose intolerance/malabsorption and recurrent abdominal pain in children.

    PubMed

    Escobar, Mauricio A; Lustig, Daniel; Pflugeisen, Bethann M; Amoroso, Paul J; Sherif, Dalia; Saeed, Rasha; Shamdeen, Shaza; Tuider, Judith; Abdullah, Bisher

    2014-04-01

    The purpose of the present study was to ascertain whether pediatric patients with chronic abdominal pain had concurrent fructose intolerance as determined by a standardized dose breath hydrogen test (BHT), and whether symptoms would improve with a low-fructose diet. The fructose BHT test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating, and/or diarrhea. The patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. Hydrogen and methane were measured at 8 time points. The test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were given a dietitian-prescribed low-fructose diet. A total of 222 patients were part of the study. Ages ranged from 2 to 19 years with a mean of 10.5. BHT for fructose was performed in all of the patients and it was positive for fructose intolerance in 121 of 222 patients (54.5%). A total of 101 of 222 (45.5%) patients had negative BHT for fructose intolerance. All BHT-positive patients had a nutrition consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, 93 of 121 patients (76.9%) reported resolution of symptoms on a low-fructose diet (P < 0.0001). Furthermore, 55 of 101 patients (54.4%) with negative BHT for fructose reported resolution of symptoms without a low-fructose diet (P = 0.37). Fructose intolerance/malabsorption is common in children with recurrent/functional abdominal pain and a low-fructose diet is an effective treatment.

  20. Renal fructose-metabolizing enzymes: significance in hereditary fructose intolerance.

    PubMed

    Kranhold, J F; Loh, D; Morris, R C

    1969-07-25

    In patients with hereditary fructose intolerance, which is characterized by deficient aldolase activity toward fructose-1-phosphate, fructose induces a renal tubular dysfunction that implicates only the proximal convoluted tubule. Because normal metabolism of fructose by way of fructose-1-phosphate requires fructokinase, aldolase "B," and triokinase, the exclusively cortical location of these enzymes indicates that the medulla is not involved in the metabolic abnormality presumably causal of the renal dysfunction.

  1. A possible case of transient hereditary fructose intolerance.

    PubMed

    Catto-Smith, A G; Adams, A

    1993-01-01

    A patient is described who presented with the signs and symptoms of hereditary fructose intolerance a few hours after her first fructose challenge. The diagnosis was confirmed by the demonstration of reduced activity of hepatic aldolase B towards fructose-1-phosphate. A second liver biopsy 10 months later had normal aldolase B activity towards fructose-1-phosphate and a fructose tolerance test was also normal. A possible explanation for these findings is proposed.

  2. [Lactose-containing tablets for patients with lactose intolerance?].

    PubMed

    Picksak, Gesine; Stichtenoth, Dirk O

    2009-01-01

    Lactose is often used as an excipient in tablets because of its ideal characteristics. Most patients with lactose intolerance tolerate small amounts of lactose. However, the nocebo effect must be considered. Thus, patients should be informed about the very small amounts of lactose in the medication. If the patient is still suffering from gastrointestinal symptoms and there is no lactose-free alternative, the enzyme lactase can be substituted individually.

  3. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency

    NASA Technical Reports Server (NTRS)

    Shannon, J. R.; Flattem, N. L.; Jordan, J.; Jacob, G.; Black, B. K.; Biaggioni, I.; Blakely, R. D.; Robertson, D.

    2000-01-01

    BACKGROUND: Orthostatic intolerance is a syndrome characterized by lightheadedness, fatigue, altered mentation, and syncope and associated with postural tachycardia and plasma norepinephrine concentrations that are disproportionately high in relation to sympathetic outflow. We tested the hypothesis that impaired functioning of the norepinephrine transporter contributes to the pathophysiologic mechanism of orthostatic intolerance. METHODS: In a patient with orthostatic intolerance and her relatives, we measured postural blood pressure, heart rate, plasma catecholamines, and systemic norepinephrine spillover and clearance, and we sequenced the norepinephrine-transporter gene and evaluated its function. RESULTS: The patient had a high mean plasma norepinephrine concentration while standing, as compared with the mean (+/-SD) concentration in normal subjects (923 vs. 439+/-129 pg per milliliter [5.46 vs. 2.59+/-0.76 nmol per liter]), reduced systemic norepinephrine clearance (1.56 vs. 2.42+/-0.71 liters per minute), impairment in the increase in the plasma norepinephrine concentration after the administration of tyramine (12 vs. 56+/-63 pg per milliliter [0.07 vs. 0.33+/-0.37 pmol per liter]), and a disproportionate increase in the concentration of plasma norepinephrine relative to that of dihydroxyphenylglycol. Analysis of the norepinephrine-transporter gene revealed that the proband was heterozygous for a mutation in exon 9 (encoding a change from guanine to cytosine at position 237) that resulted in more than a 98 percent loss of function as compared with that of the wild-type gene. Impairment of synaptic norepinephrine clearance may result in a syndrome characterized by excessive sympathetic activation in response to physiologic stimuli. The mutant allele in the proband's family segregated with the postural heart rate and abnormal plasma catecholamine homeostasis. CONCLUSIONS: Genetic or acquired deficits in norepinephrine inactivation may underlie hyperadrenergic

  4. Orthostatic intolerance in multifocal acquired demyelinating sensory and motor neuropathy.

    PubMed

    Tramontozzi, Louis A; Russell, James A

    2012-09-01

    We report a patient with orthostatic intolerance and syncope as a major clinical manifestation of an acquired multifocal neuropathy with the clinical, electrodiagnostic, and cerebrospinal fluid features of multifocal acquired demyelinating sensory and motor neuropathy or the Lewis-Sumner syndrome. Immunomodulatory therapy led to clinical remission of both somatic and autonomic signs and symptoms. We are unaware of a previous description of symptomatic dysautonomia in this disorder.

  5. Orthostatic intolerance and motion sickness after parabolic flight

    NASA Technical Reports Server (NTRS)

    Schlegel, T. T.; Brown, T. E.; Wood, S. J.; Benavides, E. W.; Bondar, R. L.; Stein, F.; Moradshahi, P.; Harm, D. L.; Fritsch-Yelle, J. M.; Low, P. A.

    2001-01-01

    Because it is not clear that the induction of orthostatic intolerance in returning astronauts always requires prolonged exposure to microgravity, we investigated orthostatic tolerance and autonomic cardiovascular function in 16 healthy subjects before and after the brief micro- and hypergravity of parabolic flight. Concomitantly, we investigated the effect of parabolic flight-induced vomiting on orthostatic tolerance, R-wave-R-wave interval and arterial pressure power spectra, and carotid-cardiac baroreflex and Valsalva responses. After parabolic flight 1) 8 of 16 subjects could not tolerate 30 min of upright tilt (compared to 2 of 16 before flight); 2) 6 of 16 subjects vomited; 3) new intolerance to upright tilt was associated with exaggerated falls in total peripheral resistance, whereas vomiting was associated with increased R-wave-R-wave interval variability and carotid-cardiac baroreflex responsiveness; and 4) the proximate mode of new orthostatic failure differed in subjects who did and did not vomit, with vomiters experiencing comparatively isolated upright hypocapnia and cerebral vasoconstriction and nonvomiters experiencing signs and symptoms reminiscent of the clinical postural tachycardia syndrome. Results suggest, first, that syndromes of orthostatic intolerance resembling those developing after space flight can develop after a brief (i.e., 2-h) parabolic flight and, second, that recent vomiting can influence the results of tests of autonomic cardiovascular function commonly utilized in returning astronauts.

  6. Midodrine prevents orthostatic intolerance associated with simulated spaceflight

    NASA Technical Reports Server (NTRS)

    Ramsdell, C. D.; Mullen, T. J.; Sundby, G. H.; Rostoft, S.; Sheynberg, N.; Aljuri, N.; Maa, M.; Mukkamala, R.; Sherman, D.; Toska, K.; hide

    2001-01-01

    Many astronauts after being weightless in space become hypotensive and presyncopal when they assume an upright position. This phenomenon, known as orthostatic intolerance, may interfere with astronaut function during reentry and after spaceflight and may limit the ability of an astronaut to exit a landed spacecraft unaided during an emergency. Orthostatic intolerance is more pronounced after long-term spaceflight and is a major concern with respect to the extended flights expected aboard the International Space Station and for interplanetary exploration class missions, such as a human mission to Mars. Fully effective countermeasures to this problem have not yet been developed. To test the hypothesis that alpha-adrenergic stimulation might provide an effective countermeasure, we conducted a 16-day head-down-tilt bed-rest study (an analog of weightlessness) using normal human volunteers and administered the alpha(1)-agonist drug midodrine at the end of the bed-rest period. Midodrine was found to significantly ameliorate excessive decreases in blood pressure and presyncope during a provocative tilt test. We conclude that midodrine may be an effective countermeasure for the prevention of orthostatic intolerance following spaceflight.

  7. [Food Allergy and Intolerance : Distinction, Definitions and Delimitation].

    PubMed

    Kleine-Tebbe, Jörg; Waßmann-Otto, Anja; Mönnikes, Hubert

    2016-06-01

    Immunologically mediated hypersensitivity to foods is defined as food allergy, mainly due to immunglobulins of class E (IgE) triggering immediate reactions (type I hypersensitivity) with possible involvement of mucosa, skin, airways, intestinal tract, and the vascular system. Primary food allergy is based on (early) IgE sensitization against animal (e. g., cow's milk, hen's eggs) or plant proteins (e. g. peanut, hazelnut or wheat). In the case of secondary food allergies, IgE against pollen proteins (e. g., birch) reacts to structurally related food proteins (with cross-reactions to stone and pit fruits). Non-immunological food intolerance reactions are mostly based on carbohydrate malassimilation (e. g., lactose intolerance, fructose malabsorption) and are rarely due to pseudo-allergies (e. g., flavors, dyes, preservatives) primarily in patients with chronic urticaria. Common intestinal symptoms are mainly due to functional disorders (e. g., irritable bowel disease), rarely because of inflammatory intestinal diseases (e. g., celiac disease). Histamine intolerance, gluten hypersensitivity, and so-called food type III hypersensitivities are controversial diagnoses. The aforementioned disease entities/models are of variable importance for the affected individuals, the public health system, and society in general.

  8. Orthostatic intolerance and motion sickness after parabolic flight

    NASA Technical Reports Server (NTRS)

    Schlegel, T. T.; Brown, T. E.; Wood, S. J.; Benavides, E. W.; Bondar, R. L.; Stein, F.; Moradshahi, P.; Harm, D. L.; Fritsch-Yelle, J. M.; Low, P. A.

    2001-01-01

    Because it is not clear that the induction of orthostatic intolerance in returning astronauts always requires prolonged exposure to microgravity, we investigated orthostatic tolerance and autonomic cardiovascular function in 16 healthy subjects before and after the brief micro- and hypergravity of parabolic flight. Concomitantly, we investigated the effect of parabolic flight-induced vomiting on orthostatic tolerance, R-wave-R-wave interval and arterial pressure power spectra, and carotid-cardiac baroreflex and Valsalva responses. After parabolic flight 1) 8 of 16 subjects could not tolerate 30 min of upright tilt (compared to 2 of 16 before flight); 2) 6 of 16 subjects vomited; 3) new intolerance to upright tilt was associated with exaggerated falls in total peripheral resistance, whereas vomiting was associated with increased R-wave-R-wave interval variability and carotid-cardiac baroreflex responsiveness; and 4) the proximate mode of new orthostatic failure differed in subjects who did and did not vomit, with vomiters experiencing comparatively isolated upright hypocapnia and cerebral vasoconstriction and nonvomiters experiencing signs and symptoms reminiscent of the clinical postural tachycardia syndrome. Results suggest, first, that syndromes of orthostatic intolerance resembling those developing after space flight can develop after a brief (i.e., 2-h) parabolic flight and, second, that recent vomiting can influence the results of tests of autonomic cardiovascular function commonly utilized in returning astronauts.

  9. Risk of Orthostatic Intolerance During Re-Exposure to Gravity

    NASA Technical Reports Server (NTRS)

    Platts, Steven; Stenger, Michael B.; Lee, Stuart M. C.; Westby, Christian M.; Phillips, Tiffany R.; Arzeno, Natalia M.; Johnston, Smith; Mulugeta, Lealem

    2015-01-01

    Post-spaceflight orthostatic intolerance remains a significant concern to NASA. In Space Shuttle missions, astronauts wore anti-gravity suits and liquid cooling garments to protect against orthostatic intolerance during re-entry and landing, but in-flight exercise and the end-of-mission fluid loading failed to protect approximately 30% of Shuttle astronauts when these garments were not worn. The severity of the problem appears to be increased after long-duration space flight. Five of six US astronauts could not complete a 10-minutes upright-posture tilt testing on landing day following 4-5 month stays aboard the Mir space station. The majority of these astronauts had experienced no problems of orthostatic intolerance following their shorter Shuttle flights. More recently, four of six US astronauts could not complete a tilt test on landing day following approximately 6 month stays on the International Space Station. Similar observations were made in the Soviet and Russian space programs, such that some cosmonauts wear the Russian compression garments (Kentavr) up to 4 days after landing. Future exploration missions, such as those to Mars or Near Earth Objects, will be long duration, and astronauts will be landing on planetary bodies with no ground-support teams. The occurrence of severe orthostatic hypotension could threaten the astronauts' health and safety and success of the mission.

  10. Midodrine prevents orthostatic intolerance associated with simulated spaceflight.

    PubMed

    Ramsdell, C D; Mullen, T J; Sundby, G H; Rostoft, S; Sheynberg, N; Aljuri, N; Maa, M; Mukkamala, R; Sherman, D; Toska, K; Yelle, J; Bloomfield, D; Williams, G H; Cohen, R J

    2001-06-01

    Many astronauts after being weightless in space become hypotensive and presyncopal when they assume an upright position. This phenomenon, known as orthostatic intolerance, may interfere with astronaut function during reentry and after spaceflight and may limit the ability of an astronaut to exit a landed spacecraft unaided during an emergency. Orthostatic intolerance is more pronounced after long-term spaceflight and is a major concern with respect to the extended flights expected aboard the International Space Station and for interplanetary exploration class missions, such as a human mission to Mars. Fully effective countermeasures to this problem have not yet been developed. To test the hypothesis that alpha-adrenergic stimulation might provide an effective countermeasure, we conducted a 16-day head-down-tilt bed-rest study (an analog of weightlessness) using normal human volunteers and administered the alpha(1)-agonist drug midodrine at the end of the bed-rest period. Midodrine was found to significantly ameliorate excessive decreases in blood pressure and presyncope during a provocative tilt test. We conclude that midodrine may be an effective countermeasure for the prevention of orthostatic intolerance following spaceflight.

  11. Are ambiguity aversion and ambiguity intolerance identical? A neuroeconomics investigation

    PubMed Central

    Tanaka, Yusuke; Fujino, Junya; Ideno, Takashi; Okubo, Shigetaka; Takemura, Kazuhisa; Miyata, Jun; Kawada, Ryosaku; Fujimoto, Shinsuke; Kubota, Manabu; Sasamoto, Akihiko; Hirose, Kimito; Takeuchi, Hideaki; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2015-01-01

    In recent years, there has been growing interest in understanding a person's reaction to ambiguous situations, and two similar constructs related to ambiguity, “ambiguity aversion” and “ambiguity intolerance,” are defined in different disciplines. In the field of economic decision-making research, “ambiguity aversion” represents a preference for known risks relative to unknown risks. On the other hand, in clinical psychology, “ambiguity intolerance” describes the tendency to perceive ambiguous situations as undesirable. However, it remains unclear whether these two notions derived from different disciplines are identical or not. To clarify this issue, we combined an economic task, psychological questionnaires, and voxel-based morphometry (VBM) of structural brain magnetic resonance imaging (MRI) in a sample of healthy volunteers. The individual ambiguity aversion tendency parameter, as measured by our economic task, was negatively correlated with agreeableness scores on the self-reported version of the Revised NEO Personality Inventory. However, it was not correlated with scores of discomfort with ambiguity, one of the subscales of the Need for Closure Scale. Furthermore, the ambiguity aversion tendency parameter was negatively correlated with gray matter (GM) volume of areas in the lateral prefrontal cortex and parietal cortex, whereas ambiguity intolerance was not correlated with GM volume in any region. Our results suggest that ambiguity aversion, described in decision theory, may not necessarily be identical to ambiguity intolerance, referred to in clinical psychology. Cautious applications of decision theory to clinical neuropsychiatry are recommended. PMID:25698984

  12. Drug effects on orthostatic intolerance induced by bedrest

    NASA Technical Reports Server (NTRS)

    Vernikos, J.; Dallman, M. F.; Van Loon, G.; Keil, L. C.

    1991-01-01

    Effective and practical preventive procedures for postflight orthostatic intolerance are highly desirable. The current practice of attempts to expand plasma volume by ingestion of salt and fluids before reentry has proven benefits. This study evaluated alternative options using fludrocortisone (F) to expand plasma volume (PV), dextroamphetamine (Dex) to enhance norepinephrine (NE) release, and atropine (A) to reduce the effects of vagal stimulation. Seven subjects with proven post-bedrest orthostatic intolerance returned for a 7-day 6-deg head-down bedrest study. F (0.2 mg) was given at 8:00 AM and 8:00 PM the day before and 8:00 AM the day the subjects got out of bed (2 hours before standing). PV was measured before and 1 hour after the last dose of F. Dex (5 mg) and A (0.8 mg) were then taken orally 1 hour before the stand test. F expanded PV by 16 percent and caused sodium retention. Four of the 7 subjects stood for 1 hour post-bedrest and heart rate, plasma NE and plasma renin responses to standing were greatly enhanced and sustained. Although there was a narrowing of pulse pressure, the ability to overcome orthostatic intolerance with these countermeasures was largely due to vasoconstriction and sustained high heart rate.

  13. Drug effects on orthostatic intolerance induced by bedrest

    NASA Technical Reports Server (NTRS)

    Vernikos, J.; Dallman, M. F.; Van Loon, G.; Keil, L. C.

    1991-01-01

    Effective and practical preventive procedures for postflight orthostatic intolerance are highly desirable. The current practice of attempts to expand plasma volume by ingestion of salt and fluids before reentry has proven benefits. This study evaluated alternative options using fludrocortisone (F) to expand plasma volume (PV), dextroamphetamine (Dex) to enhance norepinephrine (NE) release, and atropine (A) to reduce the effects of vagal stimulation. Seven subjects with proven post-bedrest orthostatic intolerance returned for a 7-day 6-deg head-down bedrest study. F (0.2 mg) was given at 8:00 AM and 8:00 PM the day before and 8:00 AM the day the subjects got out of bed (2 hours before standing). PV was measured before and 1 hour after the last dose of F. Dex (5 mg) and A (0.8 mg) were then taken orally 1 hour before the stand test. F expanded PV by 16 percent and caused sodium retention. Four of the 7 subjects stood for 1 hour post-bedrest and heart rate, plasma NE and plasma renin responses to standing were greatly enhanced and sustained. Although there was a narrowing of pulse pressure, the ability to overcome orthostatic intolerance with these countermeasures was largely due to vasoconstriction and sustained high heart rate.

  14. Midodrine prevents orthostatic intolerance associated with simulated spaceflight

    NASA Technical Reports Server (NTRS)

    Ramsdell, C. D.; Mullen, T. J.; Sundby, G. H.; Rostoft, S.; Sheynberg, N.; Aljuri, N.; Maa, M.; Mukkamala, R.; Sherman, D.; Toska, K.; Yelle, J.; Bloomfield, D.; Williams, G. H.; Cohen, R. J.

    2001-01-01

    Many astronauts after being weightless in space become hypotensive and presyncopal when they assume an upright position. This phenomenon, known as orthostatic intolerance, may interfere with astronaut function during reentry and after spaceflight and may limit the ability of an astronaut to exit a landed spacecraft unaided during an emergency. Orthostatic intolerance is more pronounced after long-term spaceflight and is a major concern with respect to the extended flights expected aboard the International Space Station and for interplanetary exploration class missions, such as a human mission to Mars. Fully effective countermeasures to this problem have not yet been developed. To test the hypothesis that alpha-adrenergic stimulation might provide an effective countermeasure, we conducted a 16-day head-down-tilt bed-rest study (an analog of weightlessness) using normal human volunteers and administered the alpha(1)-agonist drug midodrine at the end of the bed-rest period. Midodrine was found to significantly ameliorate excessive decreases in blood pressure and presyncope during a provocative tilt test. We conclude that midodrine may be an effective countermeasure for the prevention of orthostatic intolerance following spaceflight.

  15. In silico analysis of putative paralytic shellfish poisoning toxins export proteins in cyanobacteria.

    PubMed

    Soto-Liebe, Katia; López-Cortés, Xaviera A; Fuentes-Valdes, Juan José; Stucken, Karina; Gonzalez-Nilo, Fernando; Vásquez, Mónica

    2013-01-01

    Paralytic shellfish poisoning toxins (PSTs) are a family of more than 30 natural alkaloids synthesized by dinoflagellates and cyanobacteria whose toxicity in animals is mediated by voltage-gated Na(+) channel blocking. The export of PST analogues may be through SxtF and SxtM, two putative MATE (multidrug and toxic compound extrusion) family transporters encoded in PSTs biosynthetic gene cluster (sxt). sxtM is present in every sxt cluster analyzed; however, sxtF is only present in the Cylindrospermopsis-Raphidiopsis clade. These transporters are energetically coupled with an electrochemical gradient of proton (H(+)) or sodium (Na(+)) ions across membranes. Because the functional role of PSTs remains unknown and methods for genetic manipulation in PST-producing organisms have not yet been developed, protein structure analyses will allow us to understand their function. By analyzing the sxt cluster of eight PST-producing cyanobacteria, we found no correlation between the presence of sxtF or sxtM and a specific PSTs profile. Phylogenetic analyses of SxtF/M showed a high conservation of SxtF in the Cylindrospermopsis-Raphidiopsis clade, suggesting conserved substrate affinity. Two domains involved in Na(+) and drug recognition from NorM proteins (MATE family) of Vibrio parahaemolyticus and V. cholerae are present in SxtF/M. The Na(+) recognition domain was conserved in both SxtF/M, indicating that Na(+) can maintain the role as a cation anti-transporter. Consensus motifs for toxin binding differed between SxtF and SxtM implying differential substrate binding. Through protein modeling and docking analysis, we found that there is no marked affinity between the recognition domain and a specific PST analogue. This agrees with our previous results of PST export in R. brookii D9, where we observed that the response to Na(+) incubation was similar to different analogues. These results reassert the hypothesis regarding the involvement of Na(+) in toxin export, as well as the

  16. Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: a systematic review.

    PubMed

    Ramirez, Jorge A; McIntosh, Andrew G; Strehlow, Robert; Lawrence, Valerie A; Parekh, Dipen J; Svatek, Robert S

    2013-10-01

    Postoperative paralytic ileus (POI) has profound clinical consequences because it represents a substantial burden on both patients and health care resources. To determine the knowledge base regarding POI in the radical cystectomy (RC) population with an emphasis on preventive measures and risk factors. A systematic literature search of Medline (1966 to February 2011) and a study review were conducted. Eligible studies explicitly reported the incidence of POI and/or at least two quantitative measures of gastrointestinal recovery. The search identified 727 relevant articles; 77 met eligibility criteria, comprising 13 793 patients. Of these, 21 used explicit definitions of POI, and they varied widely. Across studies, the incidence of POI ranged from 1.58% to 23.5%. Possible risk factors for POI included increasing age and body mass index. Seventeen studies reported effects of an intervention on POI: 3 randomized controlled studies, 11 observational cohort studies with concurrent comparison, and 3 observational cohort studies with nonconcurrent comparison. Gum chewing was associated with shortened times to flatus (2.4 vs 2.9 d; p<0.0001) and bowel movement (BM) (3.2 vs 3.9 d; p<0.001) in one observational cohort study (n=102); omission of a postoperative nasogastric tube (NGT) was associated with shorter time to flatus (4.21 vs 5.33 d; p=0.0001) and shorter length of stay (14.4 vs 19.1 d; p=0.001) in one observational cohort study (n=430); and the routine use of bowel preparation was associated with an increased incidence of POI (5% vs 19%) in another series (n=86). Additionally, readaptation of the dorsolateral peritoneal layer was shown to shorten times to flatus (p=0.016) and times to BM (p=0.011) in one randomized controlled study (n=200). The incidence/definition of POI after RC is highly variable. An improved reporting strategy is needed to identify true incidence and risk factors, and to guide future research for both potential preventive and therapeutic

  17. Temperature effects on kinetics of paralytic shellfish toxin elimination in Atlantic surfclams, Spisula solidissima

    NASA Astrophysics Data System (ADS)

    Monica Bricelj, V.; Cembella, Allan D.; Laby, David

    2014-05-01

    Surfclams, Spisula solidissima, pose a particular health risk for human consumption as they are characterized by accumulation of extremely high levels of toxins associated with paralytic shellfish poisoning (PSP), slow toxin elimination and an extremely high post-ingestive capacity for toxin bioconversion. Surfclam populations experience a wide range of temperatures along the NW Atlantic continental shelf, and are undergoing range contraction that has been attributed to global warming. In this study the influence of temperature (5, 12 and 21 °C) on detoxification kinetics of individual PSP toxins in two tissue compartments of juvenile surfclams (∼35 mm shell length) was determined under controlled laboratory conditions, over prolonged (2.4 months) depuration. Clams were toxified with a representative regional Gulf of Maine isolate of the dinoflagellate Alexandrium fundyense of known toxin profile, allowing tracking of changes in toxin composition and calculated toxicity in surfclam tissues. The visceral mass detoxified at all temperatures, although toxin loss rate increased with increasing temperature. In contrast, total toxin content and calculated toxicities in other tissues remained constant or even increased during depuration, suggesting a physiological or biochemical toxin-retention mechanism in this tissue pool and temperature-independent detoxification. In vivo toxin compositional changes in surfclam tissues found in this study provide evidence of specific toxin conversion pathways, involving both reductive and decarbamoylation pathways. We conclude that such toxin biotransformations, especially in non-visceral tissues, may introduce a discrepancy in describing kinetics of total toxicity (in saxitoxin equivalents [STXeq]) of S. solidissima over prolonged detoxification. Nevertheless, use of total toxicity values generated by routine regulatory monitoring based upon mouse bioassays or calculated from chemical analytical determination of molar toxin

  18. HIV-related Social Intolerance and Risky Sexual Behavior in a High HIV Prevalence Environment

    PubMed Central

    Delavande, Adeline; Sampaio, Mafalda

    2014-01-01

    Although most countries state that fighting social intolerance against persons with HIV is part of their national HIV strategy, the impact of reducing intolerance on risky sexual behavior is largely unknown. In this paper, we estimate the effect of social intolerance against HIV+ persons on risky sexual behavior in rural Malawi using data from roughly 2,000 respondents from the 2004 and 2006 waves of the Malawi Longitudional Study of Families and Health (MLSFH). The effect of social intolerance on risky behavior is a priori ambiguous. On the one hand, higher social intolerance or stigma can lead people to disassociate from the stigmatized group and hence promote risky behavior. On the other hand, intolerance can be viewed as a social tax on being HIV+ and thus higher intolerance may reduce risky behavior. We find that a decrease in social intolerance is associated with a decrease in risky behavior, including fewer partners and a lower likelihood of having extra-marital relations. This effect is mainly driven by the impact of social intolerance on men. Overall the results suggests that reducing social intolerance might not only benefit the HIV positive but might also forestall the spread of HIV. PMID:24768779

  19. HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment.

    PubMed

    Delavande, Adeline; Sampaio, Mafalda; Sood, Neeraj

    2014-06-01

    Although most countries state that fighting social intolerance against persons with HIV is part of their national HIV strategy, the impact of reducing intolerance on risky sexual behavior is largely unknown. In this paper, we estimate the effect of social intolerance against HIV+ persons on risky sexual behavior in rural Malawi using data from roughly 2000 respondents from the 2004 and 2006 waves of the Malawi Longitudinal Study of Families and Health (MLSFH). The effect of social intolerance on risky behavior is a priori ambiguous. On the one hand, higher social intolerance or stigma can lead people to disassociate from the stigmatized group and hence promote risky behavior. On the other hand, intolerance can be viewed as a social tax on being HIV+ and thus higher intolerance may reduce risky behavior. We find that a decrease in social intolerance is associated with a decrease in risky behavior, including fewer partners and a lower likelihood of having extra-marital relations. This effect is mainly driven by the impact of social intolerance on men. Overall the results suggests that reducing social intolerance might not only benefit the HIV positive but might also forestall the spread of HIV.

  20. Ala67Thr mutation in the poliovirus receptor CD155 is a potential risk factor for vaccine and wild-type paralytic poliomyelitis.

    PubMed

    Kindberg, Elin; Ax, Cecilia; Fiore, Lucia; Svensson, Lennart

    2009-05-01

    Poliovirus infections can be asymptomatic or cause severe paralysis. Why some individuals develop paralytic poliomyelitis is unknown, but a role for host genetic factors has been suggested. To investigate if a polymorphism, Ala67Thr, in the poliovirus receptor, which has been found to facilitate increased resistance against poliovirus-induced cell lysis and apoptosis, is associated with increased risk of paralytic poliomyelitis, poliovirus receptor genotyping was undertaken among Italian subjects with vaccine-associated (n = 9), or with wild-type paralytic poliomyelitis (n = 6), and control subjects (n = 71), using RFLP-PCR and pyrosequencing. Heterozygous poliovirus receptor Ala67Thr genotype was found in 13.3% of the patients with paresis and in 8.5% of the controls (Odds Ratio = 1.667). The frequency of Ala67Thr among the controls is in agreement with earlier published data. It is concluded that the Ala67Thr mutation in the poliovirus receptor is a possible risk factor for the development of vaccine-associated or paralytic poliomyelitis associated with wild-type virus.

  1. Tube Feedings.

    ERIC Educational Resources Information Center

    Plummer, Nancy

    This module on tube feedings is intended for use in inservice or continuing education programs for persons who work in long-term care. Instructor information, including teaching suggestions and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then provided. A brief discussion follows…

  2. Breast Feeding.

    ERIC Educational Resources Information Center

    International Children's Centre, Paris (France).

    This set of documents consists of English, French, and Spanish translations of four pamphlets on breast-feeding. The pamphlets provide information designed for lay persons, academics and professionals, health personnel and educators, and policy-makers. The contents cover health-related differences between breast and bottle milk; patterns of…

  3. Tube Feedings.

    ERIC Educational Resources Information Center

    Plummer, Nancy

    This module on tube feedings is intended for use in inservice or continuing education programs for persons who work in long-term care. Instructor information, including teaching suggestions and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then provided. A brief discussion follows…

  4. Nasogastric tube feedings and gastric residual volume: a regional survey.

    PubMed

    Ahmad, Shoaib; Le, Vu; Kaitha, Sindhu; Morton, Jordan; Ali, Tauseef

    2012-08-01

    To maintain adequate nutrition for patients who are in need, enteral feeding via nasogastric tube (NGT) is necessary. Although the literature suggests the safety of continued NGT feeding at a gastric residual volume of <400 mL, inconsistencies in withholding tube feeding based on residual volume have been observed in clinical practice. We performed a regional survey to determine the range of current practice among nursing staff regarding the decision to withhold NGT feeding based on residual volume and the factors that influence the decision-making process. A questionnaire was designed to evaluate nursing practice patterns regarding the decision of withholding NGT feeding based on a certain residual volume, which was distributed to the nursing staff at all major hospitals in the Oklahoma City metropolitan area. Statistical analysis was done with the Fisher exact test. All of the statistical tests were carried out at α = 0.05. A total of 582 nurses completed the survey. Residual volumes (milliliters) resulting in the termination of NGT feeding occurred in 89% of nurses at volumes <300 mL and only 3% of nurses at volumes >400 mL. Three main reasons for nurses to withhold NGT feeding were risk of aspiration (90%), potential feeding intolerance (81%), and risk of regurgitation (67%). Other less common concerns were abdominal distension and abdominal discomfort. The decision of withholding NGT feeding varied among the nursing staff that were surveyed. A consensus is necessary for the standardization of withholding NGT feeding in clinical practice among nursing staff.

  5. Determination of paralytic shellfish toxins in shellfish by receptor binding assay: collaborative study.

    PubMed

    Van Dolah, Frances M; Fire, Spencer E; Leighfield, Tod A; Mikulski, Christina M; Doucette, Gregory J

    2012-01-01

    A collaborative study was conducted on a microplate format receptor binding assay (RBA) for paralytic e shellfish toxins (PST). The assay quantifies the composite PST toxicity in shellfish samples based on the ability of sample extracts to compete with (3)H saxitoxin (STX) diHCl for binding to voltage-gated sodium channels in a rat brain membrane preparation. Quantification of binding can be carried out using either a microplate or traditional scintillation counter; both end points were included in this study. Nine laboratories from six countries completed the study. One laboratory analyzed the samples using the precolumn oxidation HPLC method (AOAC Method 2005.06) to determine the STX congener composition. Three laboratories performed the mouse bioassay (AOAC Method 959.08). The study focused on the ability of the assay to measure the PST toxicity of samples below, near, or slightly above the regulatory limit of 800 (microg STX diHCl equiv./kg). A total of 21 shellfish homogenates were extracted in 0.1 M HCl, and the extracts were analyzed by RBA in three assays on separate days. Samples included naturally contaminated shellfish samples of different species collected from several geographic regions, which contained varying STX congener profiles due to their exposure to different PST-producing dinoflagellate species or differences in toxin metabolism: blue mussel (Mytilus edulis) from the U.S. east and west coasts, California mussel (Mytilus californianus) from the U.S. west coast, chorito mussel (Mytilus chiliensis) from Chile, green mussel (Perna canaliculus) from New Zealand, Atlantic surf clam (Spisula solidissima) from the U.S. east coast, butter clam (Saxidomus gigantea) from the west coast of the United States, almeja clam (Venus antiqua) from Chile, and Atlantic sea scallop (Plactopecten magellanicus) from the U.S. east coast. All samples were provided as whole animal homogenates, except Atlantic sea scallop and green mussel, from which only the

  6. 75 FR 2551 - NIH Consensus Development Conference: Lactose Intolerance and Health; Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ..., abdominal pain, and diarrhea. These symptoms of lactose intolerance are caused by intestinal bacteria's fermentation of undigested lactose and often cause individuals to avoid lactose-containing products....

  7. How Many People Are Affected or At Risk for Lactose Intolerance?

    MedlinePlus

    ... Nutrition. (2006). Lactose intolerance in infants, children, and adolescents. Pediatrics , 118(3), 1276–1286. PMID 16951027 [top] « What are common ... Home Contact Accessibility Web Policies ...

  8. The association between Internet addiction and belief of frustration intolerance: the gender difference.

    PubMed

    Ko, Chih-Hung; Yen, Ju-Yu; Yen, Cheng-Fang; Chen, Chung-Sheng; Wang, Shing-Yaw

    2008-06-01

    This study evaluated the association between Internet addiction and frustration intolerance, the gender difference of frustration intolerance, and the gender differences of the association between Internet addiction and frustration intolerance. Participants were 2,114 students (1,204 male and 910 female) who were recruited to complete the Chen Internet Addiction Scale and Frustration Discomfort scale. Females had higher scores on the subscale of entitlement and emotional intolerance and the total scale of the frustration intolerance. There was a significant gender difference on the association between Internet addiction and frustration intolerance. The association was higher in male adolescents. Regression analysis revealed male adolescents with Internet addiction had higher intolerance to frustration of entitlement and emotional discomfort, and female adolescents with it had higher intolerance to emotional discomfort and lower tolerance to frustration of achievement. Frustration intolerance should be evaluated for adolescents with Internet addiction, especially for males. Rational emotive behavior therapy focusing on different irrational beliefs should be provided to male and female adolescents with Internet addiction.

  9. Applying the Implicit Association Test to Measure Intolerance of Uncertainty.

    PubMed

    Mosca, Oriana; Dentale, Francesco; Lauriola, Marco; Leone, Luigi

    2016-08-01

    Intolerance of Uncertainty (IU) is a key trans-diagnostic personality construct strongly associated with anxiety symptoms. Traditionally, IU is measured through self-report measures that are prone to bias effects due to impression management concerns and introspective difficulties. Moreover, self-report scales are not able to intercept the automatic associations that are assumed to be main determinants of several spontaneous responses (e.g., emotional reactions). In order to overcome these limitations, the Implicit Association Test (IAT) was applied to measure IU, with a particular focus on reliability and criterion validity issues. The IU-IAT and the Intolerance of Uncertainty Inventory (IUI) were administered to an undergraduate student sample (54 females and 10 males) with a mean age of 23 years (SD = 1.7). Successively, participants were asked to provide an individually chosen uncertain event from their own lives that may occur in the future and were requested to identify a number of potential negative consequences of it. Participants' responses in terms of cognitive thoughts (i.e., cognitive appraisal) and worry reactions toward these events were assessed using the two subscales of the Worry and Intolerance of Uncertainty Beliefs Questionnaire. The IU-IAT showed an adequate level of internal consistency and a not significant correlation with the IUI. A path analysis model, accounting for 35% of event-related worry, revealed that IUI had a significant indirect effect on the dependent variable through event-related IU thoughts. By contrast, as expected, IU-IAT predicted event-related worry independently from IU thoughts. In accordance with dual models of social cognition, these findings suggest that IU can influence event-related worry through two different processing pathways (automatic vs. deliberative), supporting the criterion and construct validity of the IU-IAT. The potential role of the IU-IAT for clinical applications was discussed.

  10. Orthostatic intolerance without postural tachycardia: how much dysautonomia?

    PubMed Central

    Parsaik, Ajay K.; Singer, Wolfgang; Allison, Thomas G.; Sletten, David M.; Joyner, Michael J.; Benarroch, Eduardo E.; Low, Phillip A.

    2014-01-01

    Background Chronic symptoms of orthostatic intolerance occur in postural tachycardia syndrome (POTS) and patients with orthostatic intolerance (OI) without tachycardia. We recently reported that deconditioning is almost universal in both patient groups. In this study, we focussed on the question of how much dysautonomia, besides orthostatic tachycardia, is there in POTS vs. OI, and how the two groups compare in regards to clinical, autonomic, laboratory, and exercise variables. Methods We retrospectively studied all patients referred for orthostatic intolerance at Mayo Clinic between January 2006 and June 2011, who underwent standardized autonomic and exercise testing. Results Eighty-four POTS and 100 OI fulfilled inclusion criteria, 89 % were females. The mean age was 25 and 32 years, respectively. Clinical presentation, autonomic parameters, laboratory findings, and degree of deconditioning were overall similar between the two groups, except for the excessive orthostatic heart rate (HR) rise and mild vasomotor findings observed in POTS but not in OI (slightly larger Valsalva ratio and incomplete blood pressure recovery during Valsalva). Both groups responded poorly to various medications. Severely deconditioned patients were similar to non-deconditioned patients, except for 24 h urine volume (1,555 vs. 2,417 ml), sweat loss on thermoregulatory sweat test (1.5 vs. 0.5 %), and few respiratory parameters during exercise, which are likely clinically insignificant. Conclusion Though similar in clinical presentation, POTS and OI are different entities with greater, albeit still mild, dysautonomia in POTS. The clinical and pathophysiological relevance of minimal dysautonomia in the absence of orthostatic tachycardia as seen in OI remain uncertain. PMID:23729158

  11. Aspirin Intolerance: Experimental Models for Bed-to-Bench

    PubMed Central

    Yamashita, Masamichi

    2016-01-01

    Aspirin is the oldest non-steroidal anti-inflammatory drug (NSAID), and it sometimes causes asthma-like symptoms known as aspirin-exacerbated respiratory disease (AERD), which can be serious. Unwanted effects of aspirin (aspirin intolerance) are also observed in patients with food-dependent exercise-induced anaphylaxis, a type I allergy disease, and aspirin-induced urticaria (AIU). However the target and the mechanism of the aspirin intolerance are still unknown. There is no animal or cellular model of AERD, because its pathophysiological mechanism is still unknown, but it is thought that inhibition of cyclooxygenase by causative agents leads to an increase of free arachidonic acid, which is metabolized into cysteinyl leukotrienes (cysLTs) that provoke airway smooth muscle constriction and asthma symptoms. As the bed-to-bench approach, to confirm the clinical discussion in experimental cellular models, we have tried to develop a cellular model of AERD using activated RBL-2H3 cells, a rat mast cell like cell line. Indomethacin (another NSAID and also causes AERD), enhances in vitro cysLTs production by RBL-2H3 cells, while there is no induction of cysLTs production in the absence of inflammatory activation. Since this suggests that all inflammatory cells with activation of prostaglandin and cysLT metabolism should respond to NSAIDs, and then I have concluded that aspirin intolerance should be separated from subsequent bronchoconstriction. Evidence about the cellular mechanisms of NSAIDs may be employed for development of in vitro AERD models as the approach from bench-to-bed. PMID:27719658

  12. Perceived psychosocial stress and glucose intolerance among pregnant Hispanic women

    PubMed Central

    Silveira, M.L.; Whitcomb, B.W.; Pekow, P.; Braun, B.; Markenson, G.; Dole, N.; Manson, J.E.; Solomon, C.G.; Carbone, E.T.; Chasan-Taber, L.

    2016-01-01

    Aim Prior literature suggests a positive association between psychosocial stress and the risk of diabetes in non-pregnant populations, but studies during pregnancy are sparse. We evaluated the relationship between stress and glucose intolerance among 1115 Hispanic (predominantly Puerto Rican) prenatal care patients in Proyecto Buena Salud, a prospective cohort study in Western Massachusetts (2006–2011). Methods Cohen’s Perceived Stress Scale (PSS-14) was administered in early (mean = 12.3 weeks gestation; range 4.1–18 weeks) and mid-(mean = 21.3 weeks gestation; range 18.1–26 weeks) pregnancy. Participants were classified as having a pregnancy complicated by gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance, based on the degree of abnormality on glucose tolerance testing between 24 and 28 weeks of gestation. Results The prevalence of gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance was 4.1%, 7.2%, and 14.5%, respectively. Absolute levels of early or mid-pregnancy stress were not significantly associated with glucose intolerance. However, participants with an increase in stress from early to mid-pregnancy had a 2.6-fold increased odds of gestational diabetes mellitus (95% confidence intervals: 1.0–6.9) as compared to those with no change or a decrease in stress after adjusting for age and pre-pregnancy body mass index. In addition, every one-point increase in stress scores was associated with a 5.5 mg/dL increase in screening glucose level (β = 5.5; standard deviation = 2.8; P = 0.05), after adjusting for the same variables. Conclusion In this population of predominantly Puerto Rican women, stress patterns during pregnancy may influence the risk of glucose intolerance. PMID:24948416

  13. Down on heights? One in three has visual height intolerance.

    PubMed

    Huppert, Doreen; Grill, Eva; Brandt, Thomas

    2013-02-01

    The distressing phenomenon of visual height intolerance (vHI) occurs when a visual stimulus causes apprehension of losing control of balance and falling from some height. Epidemiological data of this condition in the general population are lacking. Assignment of prevalence, determinants, and compensation of vHI was performed in a cross-sectional epidemiological study of 3,517 individuals representing the German population. Life-time prevalence of vHI is 28 % (females 32 %). A higher prevalence is associated independently with a family history of vHI, anxiety disorders, migraine, or motion sickness susceptibility. Women aged 50-59 have a higher prevalence than younger women or men of all ages. Initial attacks occur most often (30 %) in the second decade; however, attacks can manifest throughout life. The main symptoms are fearfulness, inner agitation, a queasy-stomach feeling, subjective postural instability with to-and-fro vertigo, and weakness in the knees. Climbing a tower is the first most common precipitating stimulus; the spectrum of such stimuli widens with time in more than 50 % of afflicted individuals. The most frequent reaction to vHI is to avoid the triggering stimuli (>50 %); 11 % of susceptible individuals consult a doctor, most often a general practitioner, neurologist, ENT doctor, or psychiatrist. In brief, visual height intolerance affects one-third of the general population, considerably restricting the majority of these individuals in their daily activities. The data show that the two terms do not indicate a categorical distinction but rather a continuum from slight forms of visual height intolerance to the specific phobia of fear of heights.

  14. Comparison of Toxicity between Saxitoxin and Decarbamoyl Saxitoxin in the Mouse Bioassay for Paralytic Shellfish Poisoning Toxins

    PubMed Central

    SUZUKI, Hodaka; MACHII, Kenji

    2014-01-01

    ABSTRACT The mouse bioassay (MBA) for paralytic shellfish poisoning (PSP) toxins has been used in the AOAC Official Method and the official Japanese method. In the AOAC Official Method, the saxitoxin (STX) standard provided by the U.S. Food and Drug Administration (FDA) is used, but no standard is used in the official Japanese method. The objective of this study was to compare the toxicity of decarbamoyl STX (dcSTX), one of the derivatives of STX and a candidate standard for the MBA for PSP toxins in Japan, to that of FDA STX in the MBA platform. In this study, the toxicity of dcSTX was 918.0 ± 44.9 mouse units/µmol, and the relative toxicity ratio of dcSTX to FDA STX based on moles was 0.478. PMID:25213205

  15. A review of the factors causing paralysis in wild birds: Implications for the paralytic syndrome observed in the Baltic Sea.

    PubMed

    Sonne, Christian; Alstrup, Aage Kristian Olsen; Therkildsen, Ole Roland

    2012-02-01

    We reviewed paralysis in wild birds with a special focus on the Baltic Sea paralytic syndrome recently described by Balk et al. (2009) by assessing multiple causative factors. The review showed that paralysis may occur in various species and that the aetiology can be divided into biotoxins, nutritional deficiencies, environmental contaminants and infectious diseases. The review also showed that the symptoms are influenced by age, sex and species of the affected individual. It seemed that paralysis may be treated or relieved by e.g. thiamine injections or additives. Due to a lack of extensive diagnostic studies, the potentially negative effects of paralysis at the population level of wild birds remain unsolved. We recommend that when investigating paralysis in wild birds, a holistic study approach including multiple factors are undertaken in order to pinpoint cause-and-effect relationships as well as the potential impacts on wild bird populations including those in the Baltic Sea.

  16. Autogenic-feedback training: A countermeasure for orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Cowings, Patricia S.; Toscano, William B.; Kamiya, Joe; Miller, Neal E.; Pickering, Thomas G.

    1991-01-01

    NASA has identified cardiovascular deconditioning as a serious biomedical problem associated with long-duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder and the resulting orthostatic intolerance experienced by crewmembers upon their return to the 1g norm of Earth. The present study was designed to examine the feasibility of training human subjects to control their own cardiovascular responses to gravitational stimulation (i.e., a tilt table). Using an operant conditioning procedure, Autogenic-Feedback Training (AFT), we would determine if subjects could learn to increase their own blood pressure voluntarily.

  17. Intolerance of uncertainty in emotional disorders: What uncertainties remain?

    PubMed

    Shihata, Sarah; McEvoy, Peter M; Mullan, Barbara Ann; Carleton, R Nicholas

    2016-06-01

    The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.

  18. Mutation analysis in Turkish patients with hereditary fructose intolerance.

    PubMed

    Dursun, A; Kalkanoğlu, H S; Coşkun, T; Tokatli, A; Bittner, R; Koçak, N; Yüce, A; Ozalp, I; Boehme, H J

    2001-10-01

    Thirteen Turkish patients with hereditary fructose intolerance (HFI) were screened for the three common mutations, A149P, A174D and N334K, in the aldolase B gene that have been detected frequently in European population. We found that nine of the patients carry the A149P mutation in both alleles, which corresponds to a frequency of about 55%. Single-strand conformation analysis of all coding exons of the gene was also performed to detect unknown mutations in four patients not carrying the three common mutations. No aberrant migration patterns were observed in these patients.

  19. Development and validation of an ultrasensitive fluorescence planar waveguide biosensor for the detection of paralytic shellfish toxins in marine algae.

    PubMed

    Meneely, Julie P; Campbell, Katrina; Greef, Charles; Lochhead, Michael J; Elliott, Christopher T

    2013-03-15

    Marine dinoflagellates of the genera Alexandrium are well known producers of the potent neurotoxic paralytic shellfish toxins that can enter the food web and ultimately present a serious risk to public health in addition to causing huge economic losses. Direct coastal monitoring of Alexandrium spp. can provide early warning of potential shellfish contamination and risks to consumers and so a rapid, sensitive, portable and easy-to-use assay has been developed for this purpose using an innovative planar waveguide device. The disposable planar waveguide is comprised of a transparent substrate onto which an array of toxin-protein conjugates is deposited, assembled in a cartridge allowing the introduction of sample, and detection reagents. The competitive assay format uses a high affinity antibody to paralytic shellfish toxins with a detection signal generated via a fluorescently labelled secondary antibody. The waveguide cartridge is analysed by a simple reader device and results are displayed on a laptop computer. Assay speed has been optimised to enable measurement within 15 min. A rapid, portable sample preparation technique was developed for Alexandrium spp. in seawater to ensure analysis was completed within a short period of time. The assay was validated and the LOD and CCβ were determined as 12 pg/mL and 20 pg/mL respectively with an intra-assay CV of 11.3% at the CCβ and an average recovery of 106%. The highly innovative assay was proven to accurately detect toxin presence in algae sampled from the US and European waters at an unprecedented cell density of 10 cells/L. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Differential Mobility Spectrometry for Improved Selectivity in Hydrophilic Interaction Liquid Chromatography-Tandem Mass Spectrometry Analysis of Paralytic Shellfish Toxins

    NASA Astrophysics Data System (ADS)

    Beach, Daniel G.

    2017-08-01

    Paralytic shellfish toxins (PSTs) are neurotoxins produced by dinoflagellates and cyanobacteria that cause paralytic shellfish poisoning in humans. PST quantitation by LC-MS is challenging because of their high polarity, lability as gas-phase ions, and large number of potentially interfering analogues. Differential mobility spectrometry (DMS) has the potential to improve the performance of LC-MS methods for PSTs in terms of selectivity and limits of detection. This work describes a comprehensive investigation of the separation of 16 regulated PSTs by DMS and the development of highly selective LC-DMS-MS methods for PST quantitation. The effects of all DMS parameters on the separation of PSTs from one another were first investigated in detail. The labile nature of 11α-gonyautoxin epimers gave unique insight into fragmentation of labile analytes before, during, and after the DMS analyzer. Two sets of DMS parameters were identified that either optimized the resolution of PSTs from one another or transmitted them at a limited number of compensation voltage (CV) values corresponding to structural subclasses. These were used to develop multidimensional LC-DMS-MS/MS methods using existing HILIC-MS/MS parameters. In both cases, improved selectivity was observed when using DMS, and the quantitative capabilities of a rapid UPLC-DMS-MS/MS method were evaluated. Limits of detection of the developed method were similar to those without DMS, and differences were highly analyte-dependant. Analysis of shellfish matrix reference materials showed good agreement with established methods. The developed methods will be useful in cases where specific matrix interferences are encountered in the LC-MS/MS analysis of PSTs in complex biological samples.

  1. Genetic Ablation of CD38 Protects against Western Diet-Induced Exercise Intolerance and Metabolic Inflexibility

    PubMed Central

    Chiang, Shian-Huey; Harrington, W. Wallace; Luo, Guizhen; Milliken, Naphtali O.; Ulrich, John C.; Chen, Jing; Rajpal, Deepak K.; Qian, Ying; Carpenter, Tiffany; Murray, Rusty; Geske, Robert S.; Stimpson, Stephen A.; Kramer, Henning F.; Haffner, Curt D.; Becherer, J. David; Preugschat, Frank; Billin, Andrew N.

    2015-01-01

    Nicotinamide adenine dinucleotide (NAD+) is a key cofactor required for essential metabolic oxidation-reduction reactions. It also regulates various cellular activities, including gene expression, signaling, DNA repair and calcium homeostasis. Intracellular NAD+ levels are tightly regulated and often respond rapidly to nutritional and environmental changes. Numerous studies indicate that elevating NAD+ may be therapeutically beneficial in the context of numerous diseases. However, the role of NAD+ on skeletal muscle exercise performance is poorly understood. CD38, a multi-functional membrane receptor and enzyme, consumes NAD+ to generate products such as cyclic-ADP-ribose. CD38 knockout mice show elevated tissue and blood NAD+ level. Chronic feeding of high-fat, high-sucrose diet to wild type mice leads to exercise intolerance and reduced metabolic flexibility. Loss of CD38 by genetic mutation protects mice from diet-induced metabolic deficit. These animal model results suggest that elevation of tissue NAD+ through genetic ablation of CD38 can profoundly alter energy homeostasis in animals that are maintained on a calorically-excessive Western diet. PMID:26287487

  2. Impact of short-chain galactooligosaccharides on the gut microbiome of lactose-intolerant individuals

    PubMed Central

    Azcarate-Peril, M. Andrea; Ritter, Andrew J.; Savaiano, Dennis; Monteagudo-Mera, Andrea; Anderson, Carlton; Magness, Scott T.; Klaenhammer, Todd R.

    2017-01-01

    Directed modulation of the colonic bacteria to metabolize lactose effectively is a potentially useful approach to improve lactose digestion and tolerance. A randomized, double-blind, multisite placebo-controlled trial conducted in human subjects demonstrated that administration of a highly purified (>95%) short-chain galactooligosaccharide (GOS), designated “RP-G28,” significantly improved clinical outcomes for lactose digestion and tolerance. In these individuals, stool samples were collected pretreatment (day 0), after GOS treatment (day 36), and 30 d after GOS feeding stopped and consumption of dairy products was encouraged (day 66). In this study, changes in the fecal microbiome were investigated using 16S rRNA amplicon pyrosequencing and high-throughput quantitative PCR. At day 36, bifidobacterial populations were increased in 27 of 30 of GOS subjects (90%), demonstrating a bifidogenic response in vivo. Relative abundance of lactose-fermenting Bifidobacterium, Faecalibacterium, and Lactobacillus were significantly increased in response to GOS. When dairy was introduced into the diet, lactose-fermenting Roseburia species increased from day 36 to day 66. The results indicated a definitive change in the fecal microbiome of lactose-intolerant individuals, increasing the abundance of lactose-metabolizing bacteria that were responsive to dietary adaptation to GOS. This change correlated with clinical outcomes of improved lactose tolerance. PMID:28049818

  3. Increased beta -oxidation but no insulin resistance or glucose intolerance in mice lacking adiponectin.

    PubMed

    Ma, Ke; Cabrero, Agatha; Saha, Pradip K; Kojima, Hideto; Li, Lan; Chang, Benny Hung-Junn; Paul, Antoni; Chan, Lawrence

    2002-09-20

    Previous reports showed that recombinant fragments of adiponectin (adipo) displayed pharmacological effects when injected into rodents, but the relevance of these observations to the physiological function of adipo is unclear. We generated Adipo(-/-) mice by gene targeting. Adipo(-/-) mice are fertile with normal body and fat pad weights. Plasma glucose and insulin levels of Adipo(-/-) and Adipo(+/+) mice are similar under fasting conditions and during an intraperitoneal glucose tolerance test (GTT). Insulin tolerance test (ITT) also produces similar plasma glucose and insulin levels in the two groups of mice. Hyperinsulinemic-euglycemic clamp analysis showed that Adipo(-/-) and Adipo(+/+) mice have similar glucose infusion rates to maintain a similar serum glucose. High-fat diet feeding for 7 months led to similar weight gain and similar GTT and ITT responses. We next measured beta-oxidation and found it to be significantly increased in muscle and liver of Adipo(-/-) mice. In conclusion, our study indicates that absence of adipo causes increased beta-oxidation but does not cause glucose intolerance or insulin resistance in mice.

  4. Lactose intolerance in persistent diarrhoea during childhood: the role of a traditional rice-lentil (Khitchri) and yogurt diet in nutritional management.

    PubMed

    Bhutta, Z A; Nizami, S Q; Isani, Z

    1997-01-01

    Lactose intolerance is frequently encountered in children with persistent diarrhoea (PD). Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil (khitchri) diet alone (KY) or in combination with either soy formula (KY-Soy) a dilute buffalo milk (KY-B), in children (age 6 months-3 years) with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool output was however higher in lactose intolerant children, with the worst results seen with K-Y and buffalo milk combination. While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children.

  5. Symptomatology and growth in infants with cow's milk protein intolerance using two different whey-protein hydrolysate based formulas in a Primary Health Care setting.

    PubMed

    Verwimp, J J; Bindels, J G; Barents, M; Heymans, H S

    1995-09-01

    Both growth and the course of allergic symptoms were evaluated in 79 infants with cow's milk protein intolerance, aged three months or younger, diagnosed by standard elimination/provocation and treated with a whey-hydrolysate based infant formula: Nutrilon Pept or Pepti Junior. The efficacy of both products, in terms of symptomatology and growth, was compared with each other. The products differ in fat source (Pepti Junior 50% of its fat as MCT, Nutrilon Pepti normal LCT fat blend) and the presence of lactose (Pepti Junior: lactose free; Nutrilon Pepti: 40% of its carbohydrate as lactose). The study was part of a large project that aimed at standardising the approach towards cow's milk protein intolerance in Baby Health Clinics. Nearly 50 Baby Health Clinics participated in this project. In this study, growth and symptomatology (skin, respiratory tract, gastrointestinal tract) were monitored during an intervention period of at least 10 weeks. Infants in both feeding groups showed normal growth, and in at least 80% of the infants an improvement of the overall symptomatology could be seen during the intervention period. Most profound were the decreases in prevalence and severity of eczema and infantile colic. No differences in efficacy were found in this study between the two infant formulas. It was concluded that the exclusive use of either whey hydrolysate based infant formula resulted in an improvement of allergic symptoms and in normal growth in infants diagnosed by elimination/provocation for cow's milk protein intolerance in a Primary Health Care setting.

  6. New pharmacological approaches against chronic bowel and bladder problems in paralytics

    PubMed Central

    Guertin, Pierre A

    2016-01-01

    Spinal cord injury (SCI) leads generally to an irreversible loss of sensory functions and voluntary motor control below injury level. Cures that could repair SCI and/or restore voluntary walking have not been yet developed nor commercialized. Beyond the well-known loss of walking capabilities, most SCI patients experience also a plethora of motor problems and health concerns including specific bladder and bowel dysfunctions. Indeed, chronic constipation and urinary retention, two significant life-threatening complications, are typically found in patients suffering of traumatic (e.g., falls or car accidents) or non-traumatic SCI (e.g., multiple sclerosis, spinal tumors). Secondary health concerns associated with these dysfunctions include hemorrhoids, abdominal distention, altered visceral sensitivity, hydronephrosis, kidney failure, urinary tract infections, sepsis and, in some cases, cardiac arrest. Consequently, individuals with chronic SCI are forced to regularly seek emergency and critical care treatments when some of these conditions occur or become intolerable. Increasing evidence supports the existence of a novel experimental approach that may be capable of preventing the occurrence or severity of bladder and bowel problems. Indeed, recent findings in animal models of SCI have revealed that, despite paraplegia or tetraplegia, it remains possible to elicit episodes of micturition and defecation by acting pharmacologically or electrically upon specialized lumbosacral neuronal networks, namely the spinal or sacral micturition center (SMC) and lumbosacral defecation center (LDC). Daily activation of SMC and LDC neurons could potentially become, new classes of minimally invasive treatments (i.e., if orally active) against these dysfunctions and their many life-threatening complications. PMID:26855887

  7. Intolerance of uncertainty correlates with insula activation during affective ambiguity

    PubMed Central

    Simmons, Alan; Matthews, Scott C.; Paulus, Martin P.; Stein, Murray B.

    2009-01-01

    Intolerance of uncertainty (IU), or the increased affective response to situations with uncertain outcomes, is an important component process of anxiety disorders. Increased IU is observed in panic disorder (PD), obsessive compulsive disorder (OCD) and generalized anxiety disorder (GAD), and is thought to relate to dysfunctional behaviors and thought patterns in these disorders. Identifying what brain systems are associated with IU would contribute to a comprehensive model of anxiety processing, and increase our understanding of the neurobiology of anxiety disorders. Here, we used a behavioral task, Wall of Faces (WOF), during functional magnetic resonance imaging (fMRI), which probes both affect and ambiguity, to examine the neural circuitry of IU in fourteen (10 females) college age (18.8 yrs) subjects. All subjects completed the Intolerance of Uncertainty Scale (IUS), Anxiety Sensitivity Index (ASI), and a measure of neuroticism (i.e. the NEO-N). IUS scores but neither ASI nor NEO-N scores, correlated positively with activation in bilateral insula during affective ambiguity. Thus, the experience of IU during certain types of emotion processing may relate to the degree to which bilateral insula processes uncertainty. Previously observed insula hyperactivity in anxiety disorder individuals may therefore be directly linked to altered processes of uncertainty. PMID:18079060

  8. Differentiating intolerance of uncertainty from three related but distinct constructs.

    PubMed

    Rosen, Natalie O; Ivanova, Elena; Knäuper, Bärbel

    2014-01-01

    Individual differences in uncertainty have been associated with heightened anxiety, stress and approach-oriented coping. Intolerance of uncertainty (IU) is a trait characteristic that arises from negative beliefs about uncertainty and its consequences. Researchers have established the central role of IU in the development of problematic worry and maladaptive coping, highlighting the importance of this construct to anxiety disorders. However, there is a need to improve our understanding of the phenomenology of IU. The goal of this paper was to present hypotheses regarding the similarities and differences between IU and three related constructs--intolerance of ambiguity, uncertainty orientation, and need for cognitive closure--and to call for future empirical studies to substantiate these hypotheses. To assist with achieving this goal, we conducted a systematic review of the literature, which also served to identify current gaps in knowledge. This paper differentiates these constructs by outlining each definition and general approaches to assessment, reviewing the existing empirical relations, and proposing theoretical similarities and distinctions. Findings may assist researchers in selecting the appropriate construct to address their research questions. Future research directions for the application of these constructs, particularly within the field of clinical and health psychology, are discussed.

  9. Intergenerational transmission of prejudice, sex role stereotyping, and intolerance.

    PubMed

    O'Bryan, Megan; Fishbein, Harold D; Ritchey, P Neal

    2004-01-01

    The attitudes of 111 ninth and eleventh graders and both of their biological parents were independently assessed for prejudice against people with HIV/ AIDS, homosexuals, Blacks, and fat people, as well as for male and female sex role stereotyping. This study corrected for two shortcomings in previous research: neglecting to assess both parents and assessing only a single domain of prejudice. We addressed the intergenerational transmission of prejudice and stereotyping using three competing models: same-sex, parent equivalent, and differential effects. Using multiple regressions in which parents' scores were entered separately, along with control variables, different maternal and paternal influences were detected. Mothers were the primary influence for prejudice regarding HIV/AIDS, fatness, and race, and fathers were the primary influence for male and female stereotyping and prejudice against homosexuals, supporting the differential effects model. We also established that prejudice and stereotyping in specific domains reflected a more general proclivity to be intolerant. In contrast to prejudice and stereotyping in specific domains, fathers and mothers about equally shaped the adolescents' intolerance, supporting the parent equivalent model.

  10. [Unmet needs: patients with statin intolerance or familial hypercholesterolemia].

    PubMed

    Masana, Luis; Civeira, Fernando

    2016-05-01

    The achievement of low-density lipoprotein (LDL) therapeutic targets is especially difficult in some patients at high cardiovascular risk. These patients include persons with statin intolerance and those with very high LDL cholesterol (LDLc) levels such as persons with familial hypercholesterolemia. The proportion of statin-intolerant patients is between 7% and 29%. Alternative lipid-lowering drugs (including ezetimibe) are less effective and are not free from adverse effects. Both alirocumab, with the ODYSSEY ALTERNATIVE study, and evolocumab, with the GAUSS study, have shown strong lipid-lowering efficacy, with much greater tolerability than currently available alternatives, with the result that a larger number of patients achieve therapeutic targets. In familial hypercholesterolemia, the monogenic metabolic disease most frequently associated with high cardiovascular risk, early intervention is cost-effective. Although statins have substantially improved the prognosis of familial hypercholesterolemia, many affected individuals are far from achieving the recommended therapeutic targets. In this patient group, PCSK9 inhibition with monoclonal antibodies has also been shown to be highly effective in reducing LDLc, especially in heterozygous individuals. The studies performed to date have shown that these drugs are safe and effective and can help many patients with familial hypercholesterolemia to drastically reduce their cardiovascular risk. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Arteriosclerosis. All rights reserved.

  11. [Histamine intolerance - are the criteria of an adverse reaction met?].

    PubMed

    Reese, Imke

    2016-06-01

    Searching the internet for an explaination of recurring symptoms, many people come across the so-called histamine intolerance disorder. Also many practitioners like to diagnose this disorder without making sure that reproducibility, a prerequisite for an adverse reaction, is present. Consequently, presumably affected persons are often advised to follow a low-histamine diet. Depending on the source of information, these diets often avoid a huge variety of foods containing more or less histamine, which has a considerable impact on patient quality of life. While most persons benefit from such a diet in the beginning - this might be due to the change in dietary habits or the expectation of symptom improvement by dieting - in the long run the expected loss of symptoms will not happen. Underlying a diminished capacity for histamine degradation, the lack of partial or complete symptom improvement might be due to the fact that endogenous histamine release is responsible for reactions. The role of ingested histamine is discussed controversially. However, it is more than obvious that the histamine content of a certain food alone is not enough to predict its tolerance.If histamine intolerance is suspected, an individual diagnostic and therapeutic procedure is mandatory in order to minimize avoidance and to preserve a high quality of life. Ideally this is done in a close cooperation between allergologists and nutritionists/dieticians.

  12. Statin Intolerance: A Literature Review and Management Strategies.

    PubMed

    Saxon, David R; Eckel, Robert H

    Statin intolerance is a commonly encountered clinical problem for which useful management strategies exist. Although many patients report statin-related muscle symptoms, studies indicate that the majority of these patients can tolerate a statin upon re-challenge. Alternative statin dosing strategies are an effective way to modify and reintroduce statin therapy for patients reporting adverse symptoms. Correction of vitamin D deficiency and hypothyroidism may improve statin tolerability in some patients. CoQ10 supplementation has been found to be of no benefit for statin-related muscle symptoms in most recent clinical trials. PCSK9 inhibitors are a new therapeutic option that if confirmed as safe and effective by outcomes trials may be of substantial benefit to select patients at high ASCVD risk who are unable to achieve adequate low-density lipoprotein cholesterol (LDL-C) lowering on maximally tolerated statin therapy. Other available medications to lower LDL-C in statin intolerant patients include ezetimibe, bile acid sequestrants, niacin, and fibrates. Published by Elsevier Inc.

  13. Prosthesis intolerance in patients with transfemoral amputation: a videocapillaroscopic study.

    PubMed

    Macchi, Claudio; Cassigoli, Silvia; Lova, Raffaele Molino; Roccuzzo, Aurelio; Miniati, Benedetta; Ceppatelli, Simone; Conti, Andrea A; Gensini, Gian Franco

    2004-06-01

    Videocapillaroscopy is a new technique allowing a noninvasive examination of the capillary framework of the skin by using a contact probe with magnifying lenses and a cold-light epiluminescence system. The aim of this article was to investigate, by videocapillaroscopy, the microcirculation of the skin of the stump in 70 consecutive patients with unilateral transfemoral amputation. Patients were divided into two subgroups according to their tolerance (A) or intolerance (B) to a prosthesis with an Icelandic-Swedish-New York socket. Subgroup A included 48 patients, 17 diabetic and 31 nondiabetic, and subgroup B included 22 patients, 16 diabetic and 6 nondiabetic. In subgroup B, the caliber of capillary loops was significantly larger (mean +/-standard deviation, 23.6 +/-2.04 vs. 16.2 +/-1.96 microm; P < 0.001), neoangiogenesis was significantly more frequent (82%vs. 25%, P < 0.001), and the presence of microaneurysms (64%vs. 15%, P < 0.001) and microhemorrhages (36%vs. 4%, P < 0.001) was also more frequent. Surprisingly, some such diabetes-like microvascular changes were also found in the six nondiabetic patients of subgroup B. By using multiple logistic regression analysis, intolerance to the prosthesis was significantly related to microvascular changes (P = 0.001) but not to diabetes (P = 0.601), although diabetes was unequally distributed in the two subgroups.

  14. Intolerance of sexy peers: intrasexual competition among women.

    PubMed

    Vaillancourt, Tracy; Sharma, Aanchal

    2011-01-01

    Intrasexual competition among males of different species, including humans, is well documented. Among females, far less is known. Recent nonexperimental studies suggest that women are intolerant of attractive females and use indirect aggression to derogate potential rivals. In Study 1, an experimental design was used to test the evolutionary-based hypothesis that women would be intolerant of sexy women and would censure those who seem to make sex too readily available. Results provide strong empirical support for intrasexual competition among women. Using independent raters, blind to condition, we found that almost all women were rated as reacting negatively ("bitchy") to an attractive female confederate when she was dressed in a sexually provocative manner. In contrast, when she was dressed conservatively, the same confederate was barely noticed by the participants. In Study 2, an experimental design was used to assess whether the sexy female confederate from Study 1 was viewed as a sexual rival by women. Results indicated that as hypothesized, women did not want to introduce her to their boyfriend, allow him to spend time alone with her, or be friends with her. Findings from both studies are discussed in terms of evolutionary theory.

  15. Intolerance of uncertainty correlates with insula activation during affective ambiguity.

    PubMed

    Simmons, Alan; Matthews, Scott C; Paulus, Martin P; Stein, Murray B

    2008-01-10

    Intolerance of uncertainty (IU), or the increased affective response to situations with uncertain outcomes, is an important component process of anxiety disorders. Increased IU is observed in panic disorder (PD), obsessive compulsive disorder (OCD) and generalized anxiety disorder (GAD), and is thought to relate to dysfunctional behaviors and thought patterns in these disorders. Identifying what brain systems are associated with IU would contribute to a comprehensive model of anxiety processing, and increase our understanding of the neurobiology of anxiety disorders. Here, we used a behavioral task, Wall of Faces (WOFs), during functional magnetic resonance imaging (fMRI), which probes both affect and ambiguity, to examine the neural circuitry of IU in 14 (10 females) college age (18.8 years) subjects. All subjects completed the Intolerance of Uncertainty Scale (IUS), Anxiety Sensitivity Index (ASI), and a measure of neuroticism (i.e. the NEO-N). IUS scores but neither ASI nor NEO-N scores, correlated positively with activation in bilateral insula during affective ambiguity. Thus, the experience of IU during certain types of emotion processing may relate to the degree to which bilateral insula processes uncertainty. Previously observed insula hyperactivity in anxiety disorder individuals may therefore be directly linked to altered processes of uncertainty.

  16. The Development of Diet-Induced Obesity and Glucose Intolerance in C57Bl/6 Mice on a High-Fat Diet Consists of Distinct Phases

    PubMed Central

    Williams, Lynda M.; Campbell, Fiona M.; Drew, Janice E.; Koch, Christiane; Hoggard, Nigel; Rees, William D.; Kamolrat, Torkamol; Thi Ngo, Ha; Steffensen, Inger-Lise; Gray, Stuart R.; Tups, Alexander

    2014-01-01

    High–fat (HF) diet-induced obesity and insulin insensitivity are associated with inflammation, particularly in white adipose tissue (WAT). However, insulin insensitivity is apparent within days of HF feeding when gains in adiposity and changes in markers of inflammation are relatively minor. To investigate further the effects of HF diet, C57Bl/6J mice were fed either a low (LF) or HF diet for 3 days to 16 weeks, or fed the HF-diet matched to the caloric intake of the LF diet (PF) for 3 days or 1 week, with the time course of glucose tolerance and inflammatory gene expression measured in liver, muscle and WAT. HF fed mice gained adiposity and liver lipid steadily over 16 weeks, but developed glucose intolerance, assessed by intraperitoneal glucose tolerance tests (IPGTT), in two phases. The first phase, after 3 days, resulted in a 50% increase in area under the curve (AUC) for HF and PF mice, which improved to 30% after 1 week and remained stable until 12 weeks. Between 12 and 16 weeks the difference in AUC increased to 60%, when gene markers of inflammation appeared in WAT and muscle but not in liver. Plasma proteomics were used to reveal an acute phase response at day 3. Data from PF mice reveals that glucose intolerance and the acute phase response are the result of the HF composition of the diet and increased caloric intake respectively. Thus, the initial increase in glucose intolerance due to a HF diet occurs concurrently with an acute phase response but these effects are caused by different properties of the diet. The second increase in glucose intolerance occurs between 12 - 16 weeks of HF diet and is correlated with WAT and muscle inflammation. Between these times glucose tolerance remains stable and markers of inflammation are undetectable. PMID:25170916

  17. The development of diet-induced obesity and glucose intolerance in C57BL/6 mice on a high-fat diet consists of distinct phases.

    PubMed

    Williams, Lynda M; Campbell, Fiona M; Drew, Janice E; Koch, Christiane; Hoggard, Nigel; Rees, William D; Kamolrat, Torkamol; Thi Ngo, Ha; Steffensen, Inger-Lise; Gray, Stuart R; Tups, Alexander

    2014-01-01

    High-fat (HF) diet-induced obesity and insulin insensitivity are associated with inflammation, particularly in white adipose tissue (WAT). However, insulin insensitivity is apparent within days of HF feeding when gains in adiposity and changes in markers of inflammation are relatively minor. To investigate further the effects of HF diet, C57Bl/6J mice were fed either a low (LF) or HF diet for 3 days to 16 weeks, or fed the HF-diet matched to the caloric intake of the LF diet (PF) for 3 days or 1 week, with the time course of glucose tolerance and inflammatory gene expression measured in liver, muscle and WAT. HF fed mice gained adiposity and liver lipid steadily over 16 weeks, but developed glucose intolerance, assessed by intraperitoneal glucose tolerance tests (IPGTT), in two phases. The first phase, after 3 days, resulted in a 50% increase in area under the curve (AUC) for HF and PF mice, which improved to 30% after 1 week and remained stable until 12 weeks. Between 12 and 16 weeks the difference in AUC increased to 60%, when gene markers of inflammation appeared in WAT and muscle but not in liver. Plasma proteomics were used to reveal an acute phase response at day 3. Data from PF mice reveals that glucose intolerance and the acute phase response are the result of the HF composition of the diet and increased caloric intake respectively. Thus, the initial increase in glucose intolerance due to a HF diet occurs concurrently with an acute phase response but these effects are caused by different properties of the diet. The second increase in glucose intolerance occurs between 12-16 weeks of HF diet and is correlated with WAT and muscle inflammation. Between these times glucose tolerance remains stable and markers of inflammation are undetectable.

  18. Lactose Intolerance: Exploring Reaction Kinetics Governing Lactose Conversion of Dairy Products within the Undergraduate Laboratory

    ERIC Educational Resources Information Center

    Smart, Jimmy L.

    2008-01-01

    Lactose intolerance is a condition suffered by an estimated 50 million Americans. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African-American, Jewish, Native American, and Mexican-American adults, and 90 percent of Asian-American adults are lactose intolerant. Some populations in Africa…

  19. HRQoL questionnaire evaluation in lactose intolerant patients with adverse reactions to foods.

    PubMed

    Erminia, Ridolo; Ilaria, Baiardini; Tiziana, Meschi; Silvia, Peveri; Antonio, Nouvenne; Pierpaolo, Dall'Aglio; Loris, Borghi

    2013-09-01

    The occurrence of patients with gastrointestinal symptoms attributed either to food allergy or intolerance has significantly increased. Nevertheless, an accurate and detailed case history, a systematic evaluation and the outcomes of specific allergy tests to identify the offending foods, including "in vivo" and "in vitro" allergy tests, are often negative for food allergy and may indicate a lactose intolerance, which is a recurrent condition affecting about 50% of adults. The aims of our study were the following: (1) What is the real incidence of the food hypersensitivity and the primary lactose intolerance in patients with gastrointestinal symptoms, initially referred to allergy or food intolerance? (2) Does lactose intolerance affect the quality of life and compliance to the therapy program? We investigated 262 consecutive patients, 72 men and 190 women. An accurate and detailed history and clinical examination were completed to investigate the offending foods. The evaluation in each patient included: allergy tests, lactose H2 breath test (LHBT) and the HRQoL questionnaire. Five years after the diagnosis of lactose intolerance, a questionnaire on the persistence of gastrointestinal symptoms after lactose ingestion and the diet compliance was distributed. Our results demonstrate an high prevalence of lactose intolerance, more frequent in women; in these patients, bloating and diarrhea are the most reported symptoms. We observe only a significant positive correlation between adverse drug reaction (ADR) and LHBT+ patients, but not an augmented prevalence of food allergy and a negative impact on the HRQoL questionnaire of lactose intolerance.

  20. Discomfort Intolerance: Evaluation of a Potential Risk Factor for Anxiety Psychopathology

    ERIC Educational Resources Information Center

    Schmidt, Norman B.; Richey, J. Anthony; Cromer, Kiara R.; Buckner, Julia D.

    2007-01-01

    Discomfort intolerance, defined as an individual difference in the capacity to tolerate unpleasant bodily sensations, is a construct recently posited as a risk factor for panic and anxiety psychopathology. The present report used a biological challenge procedure to evaluate whether discomfort intolerance predicts fearful responding beyond the…

  1. Studies on Intolerance in American Life. Program in American History and Civilization.

    ERIC Educational Resources Information Center

    Tufts Univ., Medford, MA. Lincoln Filene Center for Citizenship and Public Affairs.

    The narrative selected for this unit on intolerance illustrates the perennial and universal methods for scapegoating. The general teaching objectives are to lead the students: 1) to feelings of tolerance toward individuals and groups who are different; 2) to investigate intolerance in terms of some of its causes: fear, deprivation, threatened…

  2. Discomfort Intolerance: Evaluation of a Potential Risk Factor for Anxiety Psychopathology

    ERIC Educational Resources Information Center

    Schmidt, Norman B.; Richey, J. Anthony; Cromer, Kiara R.; Buckner, Julia D.

    2007-01-01

    Discomfort intolerance, defined as an individual difference in the capacity to tolerate unpleasant bodily sensations, is a construct recently posited as a risk factor for panic and anxiety psychopathology. The present report used a biological challenge procedure to evaluate whether discomfort intolerance predicts fearful responding beyond the…

  3. Relationships among Perceived Racial Stress, Intolerance of Uncertainty, and Worry in a Black Sample

    ERIC Educational Resources Information Center

    Rucker, LaTanya S.; West, Lindsey M.; Roemer, Lizabeth

    2010-01-01

    The purpose of this study was to explore the relationships among chronic worry, perceived racial stress, and intolerance of uncertainty in a sample of adults who racially identify as Black. Intolerance of uncertainty has been associated with worry and generalized anxiety disorder in predominantly White samples. Given that racial stress is likely…

  4. The Intolerance of Uncertainty Index: Replication and Extension with an English Sample

    ERIC Educational Resources Information Center

    Carleton, R. Nicholas; Gosselin, Patrick; Asmundson, Gordon J. G.

    2010-01-01

    Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general…

  5. Prevalence of self-reported lactose intolerance in multiethnic sample of adults

    USDA-ARS?s Scientific Manuscript database

    According to the National Institute of Diabetes and Digestive and Kidney Diseases, between 30 and 50 million Americans have the potential for lactose-intolerance symptoms. However, lactose-intolerance prevalence rates in practical life settings may be lower than originally suggested. The goal of thi...

  6. A Comparison of the 27-Item and 12-Item Intolerance of Uncertainty Scales

    ERIC Educational Resources Information Center

    Khawaja, Nigar G.; Yu, Lai Ngo Heidi

    2010-01-01

    The 27-item Intolerance of Uncertainty Scale (IUS) has become one of the most frequently used measures of Intolerance of Uncertainty. More recently, an abridged, 12-item version of the IUS has been developed. The current research used clinical (n = 50) and non-clinical (n = 56) samples to examine and compare the psychometric properties of both…

  7. Lactose Intolerance: Exploring Reaction Kinetics Governing Lactose Conversion of Dairy Products within the Undergraduate Laboratory

    ERIC Educational Resources Information Center

    Smart, Jimmy L.

    2008-01-01

    Lactose intolerance is a condition suffered by an estimated 50 million Americans. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African-American, Jewish, Native American, and Mexican-American adults, and 90 percent of Asian-American adults are lactose intolerant. Some populations in Africa…

  8. Aspirin intolerance. III. Subtypes, familial occurence, and cross-reactivity with tartarazine.

    PubMed

    Settipane, G A; Pudupakkam, R K

    1975-09-01

    Evidence has been presented supporting the hypothesis that at least 2 different types of mechanisms may be involved in aspirin intolerance, one resulting in bronchospasm and the other producing urticaria/angioedema. Bronchospasm is the predominant symptom of aspirin intolerance in patients who have asthma. In contrast, the predominant symptom of aspirin intolerance in patients who have rhinitis is urticaria/angioedema. In the bronchospastic type of aspirin intolerance, there is a significant correlation with an increased frequency of nasal polyposis, and with a similar ageonset of asthma and aspirin intolerance. These correlations were not present in the urticari/angioedema type. Additional evidence for familial occurrence of aspirin intolerance is presented, and its relationship with subtypes of aaspirin intolerance is discussed. In a double-blind, crossover study with normal control subjects matched by age and sex 15% (6/40) of aspirin-intolerant individuals had significant adverse reactions to tartrazine challenge and not to the placebo. None of the 40 normal control subjects had any adverse reactions.

  9. Promoting Good Campus Relations: Dealing with Hate Crimes and Intolerance. Guidelines

    ERIC Educational Resources Information Center

    Universities UK, 2005

    2005-01-01

    This guidance has been produced to help higher education institutions (HEIs) deal with hate crimes and intolerance. Aiming to replace the previous Committee of Vice-Chancellors and Principals' guidance on extremism and intolerance, this publication provides an overview of the ways in which HEIs can encourage tolerance and respect and ensure that…

  10. The Intolerance of Uncertainty Index: Replication and Extension with an English Sample

    ERIC Educational Resources Information Center

    Carleton, R. Nicholas; Gosselin, Patrick; Asmundson, Gordon J. G.

    2010-01-01

    Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general…

  11. Promoting Good Campus Relations: Dealing with Hate Crimes and Intolerance. Guidelines

    ERIC Educational Resources Information Center

    Universities UK, 2005

    2005-01-01

    This guidance has been produced to help higher education institutions (HEIs) deal with hate crimes and intolerance. Aiming to replace the previous Committee of Vice-Chancellors and Principals' guidance on extremism and intolerance, this publication provides an overview of the ways in which HEIs can encourage tolerance and respect and ensure that…

  12. Relationships among Perceived Racial Stress, Intolerance of Uncertainty, and Worry in a Black Sample

    ERIC Educational Resources Information Center

    Rucker, LaTanya S.; West, Lindsey M.; Roemer, Lizabeth

    2010-01-01

    The purpose of this study was to explore the relationships among chronic worry, perceived racial stress, and intolerance of uncertainty in a sample of adults who racially identify as Black. Intolerance of uncertainty has been associated with worry and generalized anxiety disorder in predominantly White samples. Given that racial stress is likely…

  13. A Comparison of the 27-Item and 12-Item Intolerance of Uncertainty Scales

    ERIC Educational Resources Information Center

    Khawaja, Nigar G.; Yu, Lai Ngo Heidi

    2010-01-01

    The 27-item Intolerance of Uncertainty Scale (IUS) has become one of the most frequently used measures of Intolerance of Uncertainty. More recently, an abridged, 12-item version of the IUS has been developed. The current research used clinical (n = 50) and non-clinical (n = 56) samples to examine and compare the psychometric properties of both…

  14. Vitamin E and Vitamin C supplementation does not prevent glucose intolerance in obese-prone rats

    USDA-ARS?s Scientific Manuscript database

    Obesity-induced glucose intolerance affects over 70 million Americans. Elevated oxidative stress is associated with development of glucose intolerance. In this work, we tested the hypothesis that supplementation with the anti-oxidants vitamin E (d-alpha-tocopherol acetate; 0.4 g/kg diet) and vitamin...

  15. Toward a definition of intolerance of uncertainty: a review of factor analytical studies of the Intolerance of Uncertainty Scale.

    PubMed

    Birrell, Jane; Meares, Kevin; Wilkinson, Andrew; Freeston, Mark

    2011-11-01

    Since its emergence in the early 1990s, a narrow but concentrated body of research has developed examining the role of intolerance of uncertainty (IU) in worry, and yet we still know little about its phenomenology. In an attempt to clarify our understanding of this construct, this paper traces the way in which our understanding and definition of IU have evolved throughout the literature. This paper also aims to further our understanding of IU by exploring the latent variables measures by the Intolerance of Uncertainty Scale (IUS; Freeston, Rheaume, Letarte, Dugas & Ladouceur, 1994). A review of the literature surrounding IU confirmed that the current definitions are categorical and lack specificity. A critical review of existing factor analytic studies was carried out in order to determine the underlying factors measured by the IUS. Systematic searches yielded 9 papers for review. Two factors with 12 consistent items emerged throughout the exploratory studies, and the stability of models containing these two factors was demonstrated in subsequent confirmatory studies. It is proposed that these factors represent (i) desire for predictability and an active engagement in seeking certainty, and (ii) paralysis of cognition and action in the face of uncertainty. It is suggested that these factors may represent approach and avoidance responses to uncertainty. Further research is required to confirm the construct validity of these factors and to determine the stability of this structure within clinical samples.

  16. Mechanisms of Orthostatic Intolerance During Real and Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    1997-01-01

    Session MP1 includes short reports on: (1) Orthostatic Tests after 42 Days of Simulated Weightlessness; (2) Effects of 12 Days Exposure to Simulated Microgravity on Central Circulatory Hemodynamics in the Rhesus Monkey; (3) Increased Sensitivity and Resetting of Baroflex Control of Exercise Heart Rate After Prolonged Bed-Rest; (4) Complex Cardiovascular Dynamics and Deconditioning During Head-down Bed Rest; (5) The Cardiovascular Effects of 6 Hours of Head-down Tilt Upon Athletes and Non-athletes; (6) Individual Susceptibility to Post-spaceflight Orthostatic Intolerance: Contributions of Gender-related and Microgravity-related Factors; (7) Cassiopee Mission 1996: Comparison of Cardiovascular Alteration after Short and Long-term Spaceflights; (8) Cerebral and Femoral Flow Response to LBNP during 6 Month MIR Spaceflights (93-95); and (9) Cerebrovascular Changes due to Spaceflight and Postflight Presyncope.

  17. Fruit-induced FPIES masquerading as hereditary fructose intolerance.

    PubMed

    Fiocchi, Alessandro; Dionisi-Vici, Carlo; Cotugno, Giovanna; Koch, Pierluigi; Dahdah, Lamia

    2014-08-01

    Hereditary fructose intolerance (HFI) symptoms develop at first introduction of fruit during weaning. We report on an infant with suspected HFI who presented with repeated episodes of vomiting and hypotension after ingestion of fruit-containing meals. The first episode occurred at age 4 months. Despite negative genetic testing for HFI, strict avoidance of fruit ingestion resulted in lack of recurrence of symptoms. Oral-fructose-tolerance testing conducted with an apple mousse did not determine hypoglycemia or fructosuria but caused severe hypotension. Allergy evaluations were negative, and the history was diagnostic for fruit-induced food protein-induced enterocolitis syndrome. Because this non-immunoglobulin E-mediated gastrointestinal food hypersensitivity manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy, it may be misinterpreted as HFI. We advise pediatricians to consider food protein-induced enterocolitis syndrome in the differential diagnosis when there is a suspicion of HFI.

  18. Intolerance of Uncertainty and Coping Mechanisms in Nonclinical Young Subjects

    PubMed Central

    DORUK, Ali; DUGENCİ, Muharrem; ERSÖZ, Filiz; ÖZNUR, Taner

    2015-01-01

    Introduction We aimed to explore the relationship between intolerance of uncertainty (IU) and coping mechanisms in a nonclinical sample with the same age and educational level. Methods The Coping Orientations to Problems Experienced (COPE) scale was used to evaluate the coping mechanisms. The IU scale was used to evaluate IU situations. Results We found that the negative impact of uncertainty on the action in female students was greater than males. While female students used more planning, instrumental support, reinterpretation, religion, emotional support, venting, and mental disengagement coping styles, male students used more humor, denial, and alcohol/drug abuse coping styles. Subjects with psychological problems had higher IU scores and used some more coping mechanisms (restraint, acceptance, behavioral disengagement, and alcohol/drug abuse) than the others. Conclusion Our results suggest that healthy subjects use different coping styles and respond differently to uncertainty in both genders.

  19. [Textile intolerance in atopic eczema--a controlled clinical study].

    PubMed

    Diepgen, T L; Stäbler, A; Hornstein, O P

    1990-10-01

    In patients suffering from atopic dermatitis (AD), we often find intolerance reactions against wool, whereas irritation by synthetic fibers is still a matter of discussion. In a randomized clinical study on 55 patients with AD and 31 healthy controls, we investigated the irritative capacity of poncho-like shirts made of 4 different materials (A: cotton; B, C, D: synthetics of different fiber structure). The intensity of itching or discomfort due to repeated wearing of these shirts was evaluated by means of a point system (max.comfort = 10 points, max. discomfort = 1 point). Our study clearly showed that the irritative capacity of synthetic shirts is significantly higher in patients with AD, while cotton shirts were best tolerated. We also observed significant difference regarding the surface structure and diameter of the synthetic fibers under investigation.

  20. The glucose intolerance of acute pancreatitis: hormonal response to arginine.

    PubMed

    Solomon, S S; Duckworth, W C; Jallepalli, P; Bobal, M A; Iyer, R

    1980-01-01

    Patients with acute pancreatitis were studied by arginine infusion at 48--72 h. 7--10 days, and 18--21 days after onset of their illness. Plasma glucose, insulin, and glucagon values were determined. Acute pancreatitis was characterized by fasting hyperglycemia and hyperglucagonemia, associated with relative hyoinsulinemia. Arginine stimulation early in the disease (48--72 h) demonstrated hyperglycemia and hyperglucagonemia, which normalized by 18--21 days. Both phases of the normal biphasic insulin response to arginine were decreased during the initial arginine infusion. By 18--21 days, although the first phase was completely normal, the second phase of insulin secretion remained depressed. Acute pancreatitis is associated with damage to both the endocrine and exocrine pancreas. Glucose intolerance seen with this disease appears to be the result of hyperglucagonemia and relative hypoinsulinemia. Although the healing process at 3 wk is associated with return of plasma glucose and glucagon concentrations to normal, the impaired second phase insulin secretion persists.

  1. [Adults with hereditary fructose intolerance: risks of fructose infusion].

    PubMed

    Steegmanns, I; Rittmann, M; Bayerl, J R; Gitzelmann, R

    1990-04-06

    After her first grand mal seizure a 30-year-old woman was given a fructose infusion by an emergency doctor. On admission to hospital she complained of severe nausea. Ultrasonography revealed hepatosplenomegaly and the gamma-GT concentration was raised to 25 U/l. As hyperinsulinism was suspected an oral glucose tolerance test was suggested, but refused by the patient. She reported marked aversion to all sweet foods. Examination of an endoscopically obtained liver biopsy revealed clear reduction in fructoaldolase activity in liver tissue, i.e. the diagnosis of hereditary fructose intolerance. Three of the patient's siblings were also affected. The widespread use of infusion solutions containing sorbitol and fructose has twice proved acutely hazardous in this patient and is generally life-threatening for persons with an inborn error of metabolism whose pathologic status often remains undiagnosed to an adult age.

  2. Simple method for detection of mutations causing hereditary fructose intolerance.

    PubMed

    Kullberg-Lindh, C; Hannoun, C; Lindh, M

    2002-11-01

    Aldolase B is critical for sugar metabolism, and a catalytic deficiency due to mutations in its gene may result in hereditary fructose intolerance (HFI) syndrome, with hypoglycaemia and severe abdominal symptoms. This report describes two cases of HFI, which were identified by intravenous fructose tolerance test and a new RFLP (restriction fragment length polymorphism) test that detects the two most common mutations, A149P and A174D. The method includes PCR of a 224-base-pair segment of exon 5, a subsequent 3 h incubation with Cac8I and agarose electrophoresis, which reveals either or both of the mutations in one single reaction. The method might be useful for screening of these mutations, which may account for more than 70% of the mutations causing HFI.

  3. [Hereditary background and natural history in glucose-intolerance group].

    PubMed

    Ito, C

    1996-10-01

    For non-obese IGT, frequency of 1st degree DM relatives was 29.9%, a rate higher than normal. NIDDM development rate was higher in IGT with family history of DM (86.9/1000 PY) than in IGT without family history (75.4/1000PY). For IGT-2 (2hr. PG > or = 170 mg/dl), the rate was higher in the group with family history (140.1/1000 PY) than that without family history (113.6/1000 PY). The odds ratio for NIDDM was 1.76 with obesity and 1.55 with family history. With regard to the natural course, plasma glucose (PG) increased slowly with rising of IRI over a long period, then PG increased suddenly without rising IRI and reached NIDDM onset. From these results, intervention trials for prevention of NIDDM are possible during long glucose-intolerance period.

  4. Intolerance of Uncertainty: A Temporary Experimental Induction Procedure

    PubMed Central

    Mosca, Oriana; Lauriola, Marco; Carleton, R. Nicholas

    2016-01-01

    Background and Objectives Intolerance of uncertainty (IU) is a trans-diagnostic construct involved in anxiety and related disorders. Research focused on cross-sectional reporting, manipulating attitudes toward objective and impersonal events or on treatments designed to reduce IU in clinical populations. The current paper presents an experimental procedure for laboratory manipulations of IU and tests mediation hypotheses following the Intolerance of Uncertainty Model. Methods On pre-test, undergraduate volunteers (Study 1, n = 43;68% women. Study 2, n = 169;83.8% women) were asked to provide an idiosyncratic future negative life event. State-IU, Worry, Positive and Negative Affect were assessed after that a standardized procedure was used to identify event’s potential negative consequences. The same variables were assessed on post-test, after that participants were asked to read-through increasing and decreasing IU statements. Results Temporary changes on IU were consistently reproduced in both studies. Participants receiving increasing IU instructions reported greater state-IU, Worry and Negative Affect than those receiving decreasing IU instructions. However, this latter condition was not different from a control one (Study 2). Both studies revealed significant indirect effects of IU induction instructions on Worry and Negative Affect through state-IU. Limitations Both studies used undergraduate psychology students samples, younger than average population and predominantly female. Experimental manipulation and outcome measures belongs to the same semantic domain, uncertainty, potentially limiting generalizability. Conclusions Results supported the feasibility and efficacy of the proposed IU manipulation for non-clinical sample. Findings parallel clinical research showing that state-IU preceded Worry and Negative Affect states. PMID:27254099

  5. Human gut microbiota changes reveal the progression of glucose intolerance.

    PubMed

    Zhang, Xiuying; Shen, Dongqian; Fang, Zhiwei; Jie, Zhuye; Qiu, Xinmin; Zhang, Chunfang; Chen, Yingli; Ji, Linong

    2013-01-01

    To explore the relationship of gut microbiota with the development of type 2 diabetes (T2DM), we analyzed 121 subjects who were divided into 3 groups based on their glucose intolerance status: normal glucose tolerance (NGT; n = 44), prediabetes (Pre-DM; n = 64), or newly diagnosed T2DM (n = 13). Gut microbiota characterizations were determined with 16S rDNA-based high-throughput sequencing. T2DM-related dysbiosis was observed, including the separation of microbial communities and a change of alpha diversity between the different glucose intolerance statuses. To assess the correlation between metabolic parameters and microbiota diversity, clinical characteristics were also measured and a significant association between metabolic parameters (FPG, CRP) and gut microbiota was found. In addition, a total of 28 operational taxonomic units (OTUs) were found to be related to T2DM status by the Kruskal-Wallis H test, most of which were enriched in the T2DM group. Butyrate-producing bacteria (e.g. Akkermansia muciniphila ATCCBAA-835, and Faecalibacterium prausnitzii L2-6) had a higher abundance in the NGT group than in the pre-DM group. At genus level, the abundance of Bacteroides in the T2DM group was only half that of the NGT and Pre-DM groups. Previously reported T2DM-related markers were also compared with the data in this study, and some inconsistencies were noted. We found that Verrucomicrobiae may be a potential marker of T2DM as it had a significantly lower abundance in both the pre-DM and T2DM groups. In conclusion, this research provides further evidence of the structural modulation of gut microbiota in the pathogenesis of diabetes.

  6. Human Gut Microbiota Changes Reveal the Progression of Glucose Intolerance

    PubMed Central

    Zhang, Xiuying; Shen, Dongqian; Fang, Zhiwei; Jie, Zhuye; Qiu, Xinmin; Zhang, Chunfang; Chen, Yingli; Ji, Linong

    2013-01-01

    To explore the relationship of gut microbiota with the development of type 2 diabetes (T2DM), we analyzed 121 subjects who were divided into 3 groups based on their glucose intolerance status: normal glucose tolerance (NGT; n = 44), prediabetes (Pre-DM; n = 64), or newly diagnosed T2DM (n = 13). Gut microbiota characterizations were determined with 16S rDNA-based high-throughput sequencing. T2DM-related dysbiosis was observed, including the separation of microbial communities and a change of alpha diversity between the different glucose intolerance statuses. To assess the correlation between metabolic parameters and microbiota diversity, clinical characteristics were also measured and a significant association between metabolic parameters (FPG, CRP) and gut microbiota was found. In addition, a total of 28 operational taxonomic units (OTUs) were found to be related to T2DM status by the Kruskal-Wallis H test, most of which were enriched in the T2DM group. Butyrate-producing bacteria (e.g. Akkermansia muciniphila ATCCBAA-835, and Faecalibacterium prausnitzii L2-6) had a higher abundance in the NGT group than in the pre-DM group. At genus level, the abundance of Bacteroides in the T2DM group was only half that of the NGT and Pre-DM groups. Previously reported T2DM-related markers were also compared with the data in this study, and some inconsistencies were noted. We found that Verrucomicrobiae may be a potential marker of T2DM as it had a significantly lower abundance in both the pre-DM and T2DM groups. In conclusion, this research provides further evidence of the structural modulation of gut microbiota in the pathogenesis of diabetes. PMID:24013136

  7. Fat Distribution and Glucose Intolerance Among Greenland Inuit

    PubMed Central

    Jørgensen, Marit Eika; Borch-Johnsen, Knut; Stolk, Ronald; Bjerregaard, Peter

    2013-01-01

    OBJECTIVE A high amount of subcutaneous fat is suggested to explain the observation of lower obesity-associated metabolic risk among Inuit than among Europeans. We examined the association between measures of obesity (visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], BMI, waist circumference [WC], and percentage of body fat) and the indices of glucose metabolism (fasting and 2-h glucose levels, insulin resistance per homeostasis model assessment [HOMA-IR], and the insulin sensitivity index [ISI0,120]) among Greenland Inuit. RESEARCH DESIGN AND METHODS A total of 3,108 adult Inuit participated in a population-based study. The examination included a 75-g oral glucose tolerance test and anthropometric measurements. VAT and SAT were measured by ultrasound according to a validated protocol. Information on sociodemographic characteristics and health behaviors was obtained by interview. RESULTS Mean SATs were 1.8 and 3.5 cm in men and women, respectively. Mean VATs were 7.0 and 6.3 cm in men and women, respectively. The total prevalence of type 2 diabetes was 9%. Percentage of body fat generally was most strongly associated with all outcomes. Both SAT and VAT were significantly associated with glucose intolerance, fasting and 2-h plasma glucose levels, HOMA-IR, and ISI0,120. VAT was more strongly associated with all outcomes than was SAT. After further adjustment for BMI or WC, VAT was associated with glucose intolerance and insulin resistance, whereas there was a trend toward a negative or no association with SAT. CONCLUSIONS High mean values of SAT may to a large extent explain the high WC in Inuit populations, and this is suggested to contribute to the lower observed metabolic risk for a given level of obesity. PMID:23656981

  8. Assessment of food chemical intolerance in adult asthmatic subjects.

    PubMed Central

    Hodge, L.; Yan, K. Y.; Loblay, R. L.

    1996-01-01

    BACKGROUND: Identification of food chemical intolerance in asthmatic subjects can be reliably assessed by changes in the forced expiratory volume in one second (FEV1) in response to double blind, placebo controlled challenges on a strict elimination diet. However, this method is cumbersome and time consuming. A study was undertaken to determine whether changes in bronchial responsiveness to histamine following food chemical challenge without an elimination diet might be a faster, more convenient method. METHODS: Eleven adult asthmatic subjects were challenged twice with metabisulphite, aspirin, monosodium glutamate, artificial food colours, sodium nitrite/ nitrate, 0.5% citric acid solution (placebo), and sucrose (placebo) on separate days. During the first set of challenges subjects consumed a normal diet. Bronchial responsiveness to histamine was assessed 90 minutes after each challenge. A greater than twofold increase in bronchial responsiveness was considered positive. For one month prior to and during the second set of challenges subjects followed a strict elimination diet and FEV1 was monitored during and for two hours after each challenge. A fall in FEV1 of 20% or more was considered positive. RESULTS: Of the 77 food chemical challenges performed on an unmodified diet, 20 were positive (six placebo responses). In two subjects it was not possible to perform a histamine test after one of the chemical challenges because of poor spirometric function. Of the 77 food chemical challenges performed on an elimination diet, 11 were positive (no placebo responses). Excluding the two challenges in which there were no corresponding histamine tests, only on two occasions did the positive responses in both methods coincide, giving the unmodified diet method a sensitivity of 22%. CONCLUSIONS: Strict dietary elimination and measurement of FEV1 after double blind food chemical challenge remains the most reliable method for the detection of food chemical intolerance in

  9. Repressive coping and alexithymia in idiopathic environmental intolerance

    PubMed Central

    Zachariae, Robert; Rasmussen, Alice; Johansen, Jeanne Duus; Elberling, Jesper

    2010-01-01

    Objective To examine if the non-expression of negative emotions (i.e., repressive coping) and differences in the ability to process and regulate emotions (i.e., alexithymia) is associated with idiopathic environmental intolerance (IEI). Methods The study included participants who had previously participated in a general population-based study and reported symptoms of environmental intolerance (n = 787) and patients with IEI (n = 237). The participants completed questionnaires assessing IEI, namely, a measure of repressive coping combining scores on the Marlowe–Crowne Social Desirability Scale (MCSDS) and the Taylor Manifest Anxiety Scale (TMAS), the Toronto Alexithymia Scale (TAS-20), and a negative affectivity scale (NAS). Multiple, hierarchical linear regression analyses were conducted using IEI variables as the dependent variables. Results The TMAS and MCSDS scores were independently associated with the IEI variables, but there was no evidence of a role of the repressive coping construct. While the total alexithymia score was unrelated to IEI, the TAS-20 subscale of difficulties identifying feelings (DIF) was independently associated with symptoms attributed to IEI. Negative affectivity was a strong independent predictor of the IEI variables and a mediator of the association between DIF and IEI. Conclusion Our results provide no evidence for a role of repressive coping in IEI, and our hypothesis of an association with alexithymia was only partly supported. In contrast, strong associations between IEI and negative emotional reactions, defensiveness and difficulties identifying feelings were found, suggesting a need for exploring the influence of these emotional reactions in IEI. PMID:21432559

  10. Neuroleptic intolerance in patients with anti-NMDAR encephalitis.

    PubMed

    Lejuste, Florian; Thomas, Laure; Picard, Géraldine; Desestret, Virginie; Ducray, François; Rogemond, Veronique; Psimaras, Dimitri; Antoine, Jean-Christophe; Delattre, Jean-Yves; Groc, Laurent; Leboyer, Marion; Honnorat, Jerome

    2016-10-01

    To precisely describe the initial psychiatric presentation of patients with anti-NMDA receptor (NMDAR) antibodies encephalitis (anti-NMDAR encephalitis) to identify potential clues enhancing its early diagnosis. We retrospectively studied the French Reference Centre medical records of every adult patient with anti-NMDAR encephalitis to specify the patients' initial psychiatric symptoms leading to hospitalization in a psychiatric department and the reasons underlying the diagnosis of anti-NMDAR encephalitis. The medical records of 111 adult patients were reviewed. Psychiatric features were the initial presentation in 65 patients (59%). Among them, several psychiatric manifestations were observed, including visual and auditory hallucinations (n = 26, 40%), depression (n = 15, 23%), mania (n = 5, 8%), acute schizoaffective episode (n = 15, 23%), and eating disorder or addiction (n = 4; 6%). Forty-five patients (40% of total cohort) were first hospitalized in a psychiatric institution (91% women), with a median duration of stay of 9 days (range 0.25-239 days). Among them, 24 patients (53%) had associated discreet neurologic signs at the first evaluation, while 17 additional patients (38%) developed neurologic signs within a few days. Twenty-one patients (47%) were transferred to a medical unit for a suspicion of antipsychotic intolerance characterized by high temperature, muscle rigidity, mutism or coma, and biological results suggesting rhabdomyolysis. Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti-NMDAR encephalitis.

  11. Gluten intolerance: gender- and age-related differences in symptoms.

    PubMed

    Bardella, Maria Teresa; Fredella, Clara; Saladino, Valeria; Trovato, Cristina; Cesana, Bruno Mario; Quatrini, Maurizio; Prampolini, Luigia

    2005-01-01

    Gluten intolerance is a common, immunologically mediated disorder with a widely variable clinical presentation that affects genetically predisposed subjects. Women seem to be more frequently affected although data on sex differences are poor. In this study the prevalence of different clinical pictures according to sex and age is analysed in a large series of patients. A total of 1436 patients with gluten intolerance were retrospectively considered, diagnosed from January 1975 to August 2001 based on compatible small-bowel biopsy and response to a gluten-free diet, plus immunofluorescent detection of granular IgA in papillary derma for dermatitis herpetiformis. The clinical picture at onset (classic, non-classic, silent) and age at diagnosis (< or = 2 years, > 2 and < or = 14 years, > 14 years) was recorded; 362 parents of coeliac probands undergoing a familial screening were also studied. The relations among sex, age class and symptoms were analysed using the chi2 test with Yates's correction. The overall female/male ratio was 2.3:1 but the inter-sex difference was significant only when the diagnosis was made in adulthood where a significant association between iron-deficiency anaemia as manifestation at onset in adult women (34% versus 7%) was found. Low weight, dyspepsia and hypertransaminasaemia were more common in adult men than women (20%, 14% and 7% versus 13%, 3% and 2%, respectively). Dermatitis herpetiformis was present more frequently in men (16% versus 9%). The prevalence of silent cases was 6% in men and 3% in women. Familial screening showed the same prevalence (9.3%) of current coeliac disease in fathers and mothers. Diagnosis of coeliac disease is more frequent in women but physicians' awareness of sex- and age-related differences in clinical presentation could improve diagnostic performances in men.

  12. Neuroleptic intolerance in patients with anti-NMDAR encephalitis

    PubMed Central

    Lejuste, Florian; Thomas, Laure; Picard, Géraldine; Desestret, Virginie; Ducray, François; Rogemond, Veronique; Psimaras, Dimitri; Antoine, Jean-Christophe; Delattre, Jean-Yves; Groc, Laurent; Leboyer, Marion

    2016-01-01

    Objective: To precisely describe the initial psychiatric presentation of patients with anti-NMDA receptor (NMDAR) antibodies encephalitis (anti-NMDAR encephalitis) to identify potential clues enhancing its early diagnosis. Methods: We retrospectively studied the French Reference Centre medical records of every adult patient with anti-NMDAR encephalitis to specify the patients' initial psychiatric symptoms leading to hospitalization in a psychiatric department and the reasons underlying the diagnosis of anti-NMDAR encephalitis. Results: The medical records of 111 adult patients were reviewed. Psychiatric features were the initial presentation in 65 patients (59%). Among them, several psychiatric manifestations were observed, including visual and auditory hallucinations (n = 26, 40%), depression (n = 15, 23%), mania (n = 5, 8%), acute schizoaffective episode (n = 15, 23%), and eating disorder or addiction (n = 4; 6%). Forty-five patients (40% of total cohort) were first hospitalized in a psychiatric institution (91% women), with a median duration of stay of 9 days (range 0.25–239 days). Among them, 24 patients (53%) had associated discreet neurologic signs at the first evaluation, while 17 additional patients (38%) developed neurologic signs within a few days. Twenty-one patients (47%) were transferred to a medical unit for a suspicion of antipsychotic intolerance characterized by high temperature, muscle rigidity, mutism or coma, and biological results suggesting rhabdomyolysis. Conclusions: Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti-NMDAR encephalitis. PMID:27606355

  13. Onboard screening dockside testing as a new means of managing paralytic shellfish poisoning risks in federally closed waters

    NASA Astrophysics Data System (ADS)

    DeGrasse, Stacey; Conrad, Stephen; DiStefano, Paul; Vanegas, Camilo; Wallace, David; Jensen, Pete; Hickey, J. Michael; Cenci, Florence; Pitt, Jaclyn; Deardorff, Dave; Rubio, Fernando; Easy, Dorothy; Donovan, Mary Anne; Laycock, Maurice; Rouse, Debbie; Mullen, John

    2014-05-01

    Paralytic shellfish poisoning (PSP) is the foodborne intoxication associated with the consumption of seafood contaminated with naturally occurring neurotoxins known as paralytic shellfish toxins. To protect public health from this potentially fatal syndrome, harvesting closures are implemented when toxins exceed the regulatory action level. Traditional monitoring programs established by state shellfish authorities allow for timely closures in state waters with minimal negative impacts on industry. However, such monitoring programs are not feasible in federal offshore waters given their distance from shore and the range of their spatial coverage. Thus innovative management strategies were investigated for these offshore resources. Georges Bank, an offshore resource with an estimated market value of more than 3 billion in Atlantic surfclams and ocean quahogs, has been closed to harvesting following a temporary ban in 1989 and a subsequent indefinite closure in 1990 due to the risk of PSP. As a means of managing this risk and allowing harvest of safe shellfish from this important resource, the Onboard Screening Dockside Testing Protocol (referred to as the Protocol) was developed by the US Food and Drug Administration (FDA), National Marine Fisheries Service (NMFS), state shellfish control authorities, and industry. The Protocol, which sets forth control measures to ensure product safety and public health protection, was endorsed by the Interstate Shellfish Sanitation Conference (ISSC) for pilot testing. Briefly, the pilot study Protocol required that (1) the fishing vessel receive a permit from NMFS to harvest in closed waters, (2) a miniμm of five shellfish samples per intended harvest lot be tested for PSP toxins onboard, and (3) harvesting only occur when the samples tested from the intended fishing area are negative using the Jellett Rapid Tests or Abraxis Shipboard ELISA kits. Finally, product landed under the Protocol was confirmed to be safe for consumption

  14. [Lactose intolerance. Its definition, its prevalence in Mexico, and its implications in milk consumption].

    PubMed

    Palma, M; Rosado, J L; López, P; González, C; Valencia, M E

    1996-11-01

    In this document we describe some aspects of lactose and milk intolerance, discuss the results of studies carried out previously in Mexico, and report an investigation whose objective was to quantify the impact of lactose intolerance on the habitual consumption of milk in an open population. The prevalence of lactose intolerance and its effect on the consumption of milk was studied in three regions of Mexico. The design of the study was prospective, randomized, double-blind and crossover. The presence of milk intolerance was investigated in 960 subjects with ages between 6 months and 99 years who, as a function of age, received 240 or 360 mL of intact milk and the same amount of hydrolyzed milk. We quantified the consumption of milk and the presence of symptoms after ingesting the tested milk. Seven percent manifested symptoms with the intact milk but only 2% with the hydrolyzed milk (p < 0.001). The presence of symptoms in the intolerant subjects was significantly associated with a lower consumption of milk in comparison with the tolerant individuals (p < 0.001). On the other hand, the consumption of milk appeared to be only marginally associated with the intolerance and its symptoms. We conclude that lactose intolerance does not appear to be a major factor in determining milk consumption in Mexican healthy populations.

  15. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance.

    PubMed

    Lomer, M C E

    2015-02-01

    Food intolerance is non-immunological and is often associated with gastrointestinal symptoms. To focus on food intolerance associated with gastrointestinal symptoms and critically appraise the literature in relation to aetiology, diagnosis, mechanisms and clinical evidence. A search using the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals within Pubmed, Embase and Scopus was carried out and restricted to human studies published in English. Additionally, references from relevant papers were hand searched for other appropriate studies. Food intolerance affects 15-20% of the population and may be due to pharmacological effects of food components, noncoeliac gluten sensitivity or enzyme and transport defects. There have been significant advances in understanding the scientific basis of gastrointestinal food intolerance due to short-chain fermentable carbohydrates (FODMAPs). The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement followed by gradual food reintroduction. A low FODMAP diet is effective, however, it affects the gastrointestinal microbiota and FODMAP reintroduction to tolerance is part of the management strategy. There is increasing evidence for using a low FODMAP diet in the management of functional gastrointestinal symptoms where food intolerance is suspected. Exclusion diets should be used for as short a time as possible to induce symptom improvement, and should be followed by gradual food reintroduction to establish individual tolerance. This will increase dietary variety, ensure nutritional adequacy and minimise impact on the gastrointestinal microbiota. © 2014 John Wiley & Sons Ltd.

  16. Recent Advances on Lactose Intolerance: Tolerance Thresholds and Currently Available Solutions.

    PubMed

    Corgneau, M; Scher, J; Ritié-Pertusa, L; Le, D T L; Petit, J; Nikolova, Y; Banon, S; Gaiani, C

    2015-12-29

    The genetically-programmed reduction in lactase activity during adulthood affects 70% of the world adult population and can cause severe digestive disorders, which are the sign of lactose intolerance. Lactose intolerance symptoms vary depending on the residual lactase activity, the small bowel transit time, and especially the amount of ingested lactose. To formulate dairy products suitable for the vast majority of lactose intolerants, it is essential to define lactose intolerance threshold. A recent meta-analysis permitted to show that almost all lactose intolerants tolerate 12 g of lactose in one intake and approximately 18 g of lactose spread over the day. The prevalence and severity of lactose intolerance are probably overestimated by the general public. This misconception usually leads to an unnecessary reduction of dairy foodstuff consumption. Nevertheless, dairy products are essential for health mainly due to their calcium content and the positive influence of probiotic bacteria. The formulation of dairy products suitable for most intolerant and suspicious subjects seems necessary. The use of exogenous enzyme preparations, as well as the consumption of lactose-free products or products rich in probiotic bacteria are proposed as symptom-reducing strategies.

  17. Lactose intolerance and African Americans: implications for the consumption of appropriate intake levels of key nutrients.

    PubMed

    2009-10-01

    Lactose intolerance is a complex condition that is complicated by cultural beliefs and perceptions about the consumption of dairy products. These attitudes about dairy may contribute to inadequate intake of key nutrients that may impact conditions that contribute to health disparities in African Americans. While a complex health problem, lactose intolerance is easy to treat. However, no treatment can improve the body's ability to produce lactase. Yet, symptoms can be controlled through dietary strategies. This position paper emphasizes the importance of using patient and provider-level strategies in order to reduce the risks to the health of African Americans that may accrue as a result of dairy nutrient deficiency. Evaluation and assessment of interventions tested is critical so that evidence-based approaches to addressing dairy nutrient deficiency and lactose Intolerance can be created. Lastly, it is essential for physicians to communicate key messages to their patients. Since dairy nutrients address important health concerns, the amelioration of lactose intolerance is an investment in health. Lactose intolerance is common, is easy to treat, and can be managed. It is possible to consume dairy even in the face of a history of maldigestion or lactose intolerant issues. Gradually increasing lactose in the diet--drinking small milk portions with food, eating yogurt, and consuming cheese--are effective strategies for managing lactose intolerance and meeting optimal dairy needs.

  18. Transformation of paralytic shellfish poisoning toxins in Crassostrea gigas and Pecten maximus reference materials.

    PubMed

    Turner, Andrew D; Lewis, Adam M; Hatfield, Robert G; Galloway, Angus W; Higman, Wendy A

    2012-11-01

    Matrix reference materials are an important requirement for the assessment of method performance characteristics and for routine quality control. In the field of marine toxin testing where biological assays have been used and where modern analytical testing methods are now becoming available, this requirement has become an urgent one. Various approaches are utilised for preparation of such materials in the absence of available naturally occurring toxic shellfish samples. Toxin-free shellfish may be artificially fortified through the addition of cultured toxic phytoplankton or shellfish may be incurred through natural feeding on toxic algae in a laboratory environment. Both of these approaches may be potentially affected by issues relating to the degradation or transformation of toxin analytes, so studies were conducted to assess these effects within our laboratory. A range of PSP-toxic shellfish tissues were prepared using the two approaches, in both Pacific oyster (Crassostrea gigas) and king scallops (Pecten maximus). Additionally, sub-samples of incurred Pacific oyster tissue were further treated, through addition of artificial chemical stabilisers and gamma irradiation. Two separate month-long stability trials were conducted at +4 °C on each material. Results highlighted clear evidence for improved stability of materials following shellfish feeding experiments in comparison with the tissues which had been spiked with plankton. In addition, there were clear differences in stability of toxins between the two shellfish species studied. There was evidence for good stability of C1&2 toxins in both the incurred tissues and improved stability of some toxins in tissues which had been subjected to either gamma irradiation or treatment with chemical additives. The results therefore highlighted the benefits of conducting shellfish feeding if suitable stable reference materials are to be prepared containing a full range of PSP toxin analytes. The study also highlighted

  19. Hepatic and renal failure associated with amiodarone infusion in a patient with hereditary fructose intolerance.

    PubMed

    Curran, B J; Havill, J H

    2002-06-01

    Hereditary fructose intolerance is a rare inherited metabolic disorder. Although fructose intolerance usually presents in the paediatric age group, individuals can survive into adulthood by self.manipulation of diet. Hospitalisation can become a high.risk environment for these individuals because of loss of control of their strict dietary constraints and the added danger of administration of medications containing fructose, sucrose and sorbitol. We report a case of hereditary fructose intolerance in an adult presenting with hepatic and renal failure associated with an amiodarone infusion and explore the possibility of polysorbate 80 as a cause of this patient's hepatic and renal failure.

  20. Paralytic shellfish toxin content is related to genomic sxtA4 copy number in Alexandrium minutum strains.

    PubMed

    Stüken, Anke; Riobó, Pilar; Franco, José; Jakobsen, Kjetill S; Guillou, Laure; Figueroa, Rosa I

    2015-01-01

    Dinoflagellates are microscopic aquatic eukaryotes with huge genomes and an unusual cell regulation. For example, most genes are present in numerous copies and all copies seem to be obligatorily transcribed. The consequence of the gene copy number (CPN) for final protein synthesis is, however, not clear. One such gene is sxtA, the starting gene of paralytic shellfish toxin (PST) synthesis. PSTs are small neurotoxic compounds that can accumulate in the food chain and cause serious poisoning incidences when ingested. They are produced by dinoflagellates of the genera Alexandrium, Gymnodium, and Pyrodinium. Here we investigated if the genomic CPN of sxtA4 is related to PST content in Alexandrium minutum cells. SxtA4 is the 4th domain of the sxtA gene and its presence is essential for PST synthesis in dinoflagellates. We used PST and genome size measurements as well as quantitative PCR to analyze sxtA4 CPN and toxin content in 15 A. minutum strains. Our results show a strong positive correlation between the sxtA4 CPN and the total amount of PST produced in actively growing A. minutum cells. This correlation was independent of the toxin profile produced, as long as the strain contained the genomic domains sxtA1 and sxtA4.

  1. Paralytic shellfish toxin content is related to genomic sxtA4 copy number in Alexandrium minutum strains

    PubMed Central

    Stüken, Anke; Riobó, Pilar; Franco, José; Jakobsen, Kjetill S.; Guillou, Laure; Figueroa, Rosa I.

    2015-01-01

    Dinoflagellates are microscopic aquatic eukaryotes with huge genomes and an unusual cell regulation. For example, most genes are present in numerous copies and all copies seem to be obligatorily transcribed. The consequence of the gene copy number (CPN) for final protein synthesis is, however, not clear. One such gene is sxtA, the starting gene of paralytic shellfish toxin (PST) synthesis. PSTs are small neurotoxic compounds that can accumulate in the food chain and cause serious poisoning incidences when ingested. They are produced by dinoflagellates of the genera Alexandrium, Gymnodium, and Pyrodinium. Here we investigated if the genomic CPN of sxtA4 is related to PST content in Alexandrium minutum cells. SxtA4 is the 4th domain of the sxtA gene and its presence is essential for PST synthesis in dinoflagellates. We used PST and genome size measurements as well as quantitative PCR to analyze sxtA4 CPN and toxin content in 15 A. minutum strains. Our results show a strong positive correlation between the sxtA4 CPN and the total amount of PST produced in actively growing A. minutum cells. This correlation was independent of the toxin profile produced, as long as the strain contained the genomic domains sxtA1 and sxtA4. PMID:25983733

  2. Effect of the endoparasite Amoebophrya sp. on toxin content and composition in the paralytic shellfish poisoning dinoflagellate Alexandrium fundyense (Dinophyceae).

    PubMed

    Kim, Sunju; Park, Myung Gil

    2016-01-01

    Members of the Amoebophrya ceratii complex are endoparasitic dinoflagellates that parasitize a number of their dinoflagellate relatives, including toxic and/or harmful algal bloom-forming species. Despite many studies on the occurrence, prevalence, biology and molecular phylogeny of Amoebophrya spp., little attention has been given to toxin dynamics of host population following parasitism. Using Amoebophrya sp. infecting the paralytic shellfish toxin (PSP)-producing dinoflagellate Alexandrium fundyense, we addressed the following questions: (1) does parasitism by Amoebophrya sp. alter toxin content and toxin profiles of the dinoflagellate A. fundyense over the infection cycle? and (2) do parasite dinospores produced at the end of the infection cycle retain host toxins and thus potentially act as a vector to convey PSP toxin through the marine microbial food-web? Toxin time-course experiments showed that the PSP toxin contents did not vary significantly over the infection cycle, but mean toxin content for infected cultures was significantly higher than that for uninfected cultures. Host toxins were not detected in the free-living, dinospore stage of the parasite. Therefore, our results indicate that Amoebophrya sp. does not function as a vector for transferring PSP toxins to higher trophic levels. Rather, Amoebophrya infections appear to play an important role in maintaining healthy ecosystems by transforming potent toxins-producing dinoflagellates into non-toxic dinospores, representing "edible food" for consumers of the marine microbial food-web during toxic algal bloom event. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Vaccine-associated paralytic poliomyelitis in the postelimination era in Latin America and the Caribbean, 1992-2011.

    PubMed

    Landaverde, J Mauricio; Trumbo, Silas Pierson; Danovaro-Holliday, M Carolina; Cochi, Shea E; Gandhi, Raghunathan; Ruiz-Matus, Cuauhtémoc

    2014-05-01

    The Americas interrupted the transmission of poliovirus in 1991; most Latin American and Caribbean (LAC) countries rely on the oral polio vaccine (OPV) to maintain elimination. We estimated the risk of vaccine-associated paralytic polio (VAPP) in LAC for 1992-2011. VAPP cases were identified using LAC's acute flaccid paralysis (AFP) surveillance system. VAPP was defined as any AFP case with residual paralysis 60 days following onset that did not have a clear alternative etiology and with isolation of vaccine-strain poliovirus. Recipient VAPP cases were defined as those with paralysis onset 4-40 days following OPV; cases meeting these criteria but with unknown residual paralysis were added. Nonrecipient VAPP cases were defined as those in individuals with an unknown vaccination status, those in individuals who received 0 doses, or those with paralysis onset outside the 4-40-day interval. Of 40 926 AFP cases reported in LAC from 1992-2011, we identified 72 recipient and 119 nonrecipient VAPP cases. The estimated risk of recipient VAPP was 1 case per 3.15 million newborns (95% confidence interval [CI], 1 case per 2.56-4.10 million newborns), and the estimated overall risk was 1 case per 1.19 million newborns (95% CI, 1 case per 1.04-1.39 million newborns). In this multicountry VAPP analysis in a postelimination period, we found that the risk of VAPP in LAC was lower than previously estimated.

  4. Comparison evaluation of liquid chromatographic and bioassay methods of analysis for determination of paralytic shellfish poisons in shellfish tissues.

    PubMed

    Salter, J E; Timperi, R J; Hennigan, L J; Sefton, L; Reece, H

    1989-01-01

    A liquid chromatographic (LC) method was compared with the AOAC mouse bioassay method (18.086-18.092) for determination of paralytic shellfish toxins in shellfish tissues. Shellfish samples were collected from Massachusetts coastal waters as part of a state surveillance program, and extracts of shellfish meat were analyzed for toxins by using both analytical methods. Overall correlation of the LC and bioassay methods is good (r = 0.943), but for samples with toxicities less than 100 micrograms saxitoxin/100 g shellfish meat, the correlation is significantly less (r = 0.531). Limits of detection are 10 micrograms saxitoxin/100 g shellfish meat and 40 micrograms saxitoxin/100 g shellfish meat for the LC and bioassay methods, respectively. Analytical capacity of the LC method is limited to 12 samples/person-day compared with 30 samples/person-day for the bioassay. Sampling capacity of the LC method could be increased by using a fluorescence detector with a wider response range, which would eliminate the need for dilution of concentrated samples.

  5. Vaccine-associated paralytic poliomyelitis in India during 1999: decreased risk despite massive use of oral polio vaccine.

    PubMed Central

    Kohler, Kathryn A.; Banerjee, Kaushik; Gary Hlady, W.; Andrus, Jon K.; Sutter, Roland W.

    2002-01-01

    OBJECTIVE: Vaccine-associated paralytic poliomyelitis (VAPP) is a rare but serious consequence of the administration of oral polio vaccine (OPV). Intensified OPV administration has reduced wild poliovirus transmission in India but VAPP is becoming a matter of concern. METHODS: We analysed acute flaccid paralysis (AFP) surveillance data in order to estimate the VAPP risk in this country. VAPP was defined as occurring in AFP cases with onset of paralysis in 1999, residual weakness 60 days after onset, and isolation of vaccine-related poliovirus. Recipient VAPP cases were a subset with onset of paralysis between 4 and 40 days after receipt of OPV. FINDINGS: A total of 181 AFP cases met the case definition. The following estimates of VAPP risk were made: overall risk, 1 case per 4.1 to 4.6 million OPV doses administered; recipient risk,1 case per 12.2 million; first-dose recipient risk, 1 case per 2.8 million; and subsequent-dose recipient risk, 1 case per 13.9 million. CONCLUSION: On the basis of data from a highly sensitive surveillance system the estimated VAPP risk in India is evidently lower than that in other countries, notwithstanding the administration of multiple OPV doses to children in mass immunization campaigns. PMID:11984607

  6. Poisson-model analysis of the risk of vaccine-associated paralytic poliomyelitis in Japan between 1971 and 2000.

    PubMed

    Hao, Lixin; Toyokawa, Satoshi; Kobayashi, Yasuki

    2008-03-01

    This study estimates the risk of vaccine-associated paralytic poliomyelitis (VAPP) in Japan between 1971 and 2000. We acquired data regarding the number of VAPP cases from the website of the Ministry of Health, Labour and Welfare, and we estimated the number of oral poliovirus vaccines (OPV) administered based on the reported immunization data. Risk was calculated as the ratio between the number of VAPP cases and the number of OPV doses administered. Both the Runs test and the Poisson model were used to analyze the occurrence of VAPP. Thirty-three cases of VAPP were recorded in Japan between 1971 and 2000; approximately one case occurred per year. There were no statistical changes in temporal trends as regards the occurrence of VAPP between 1971 and 2000. The overall risk for VAPP, including both recipient and contact VAPP, was one case per 2.0 million OPV doses administered. The risk of recipient VAPP was one per 3.7 million doses, among which the first dose posed a much higher risk of one per 2.3 million than that of the subsequent dose. These data indicated that the occurrence of VAPP is rare, but the risk has remained constant for as long as OPV has been used in Japan.

  7. Immunoassay of paralytic shellfish toxins by moving magnetic particles in a stationary liquid-phase lab-on-a-chip.

    PubMed

    Kim, Myoung-Ho; Choi, Suk-Jung

    2015-04-15

    In this study, we devised a stationary liquid-phase lab-on-a-chip (SLP LOC), which was operated by moving solid-phase magnetic particles in the stationary liquid phase. The SLP LOC consisted of a sample chamber to which a sample and reactants were added, a detection chamber containing enzyme substrate solution, and a narrow channel connecting the two chambers and filled with buffer. As a model system, competitive immunoassays of saxitoxin (STX), a paralytic shellfish toxin, were conducted in the SLP LOC using protein G-coupled magnetic particles (G-MPs) as the solid phase. Anti-STX antibodies, STX-horseradish peroxidase conjugate, G-MPs, and a STX sample were added to the sample chamber and reacted by shaking. While liquids were in the stationary state, G-MPs were transported from the sample chamber to the detection chamber by moving a magnet below the LOC. After incubation to allow the enzymatic reaction to occur, the absorbance of the detection chamber solution was found to be reciprocally related to the STX concentration of the sample. Thus, the SLP LOC may represent a novel, simple format for point-of-care testing applications of enzyme-linked immunosorbent assays by eliminating complicated liquid handling steps.

  8. Vaccine-associated paralytic poliomyelitis and BCG-osis in an immigrant child with severe combined immunodeficiency syndrome - Texas, 2013.

    PubMed

    Trimble, Robert; Atkins, Jane; Quigg, Troy C; Burns, Cara C; Wallace, Gregory S; Thomas, Mary; Mangla, Anil T; Infante, Anthony J

    2014-08-22

    Poliovirus transmission has been eliminated in most of the world through the use of inactivated poliovirus vaccine (IPV) and live, attenuated oral poliovirus vaccine (OPV). In the United States, use of OPV was discontinued by the year 2000 because of the potential for vaccine-associated paralytic polio (VAPP); an average of eight cases were reported each year in the United States during 1980-2000. Polio eradication efforts in other parts of the world continue to rely on OPV to take advantage of transmission of poliovirus vaccine strains to unvaccinated persons in the population, lower cost, and ease of administration. In 2013, an infant aged 7 months who recently immigrated to the United States from India was referred to a hospital in San Antonio, Texas. The infant had fever, an enlarging skin lesion in the deltoid region with axillary lymphadenopathy, decreased activity, and inability to bear weight on the left leg, progressing to paralysis of the left leg over a 6-week period. Recognition of lymphopenia on complete blood count led to immune evaluation, which revealed the presence of severe combined immunodeficiency syndrome (SCIDS), an inherited disorder. A history of OPV and bacille Calmette-Guérin (BCG) vaccination in India led to the diagnoses of VAPP and BCG-osis, which were confirmed microbiologically. This report demonstrates the importance of obtaining a comprehensive clinical history in a child who has recently immigrated to the United States, with recognition that differing vaccine practices in other countries might require additional consideration of potential etiologies.

  9. Paul Tessier's technique in the treatment of paralytic lagophthalmos by lengthening of the levator muscle: evaluation of 29 cases.

    PubMed

    Guillou-Jamard, Marie-Reine; Labbé, Daniel; Bardot, Jacques; Benateau, Hervé

    2011-12-01

    Lagophthalmos is the major functional complication of facial paralysis because, in the absence of treatment, it can lead to corneal scarring and blindness. This disorder can be treated in a number of ways, including levator lengthening by aponeurosis interposition, a technique developed by Paul Tessier. We assessed the benefits of this technique, and compared the results to those with other techniques, in particular, the use of gold implants. A total of 29 patients were operated by the same surgeon using levator lengthening by aponeurosis interposition as described by Paul Tessier. Aesthetic and functional results were assessed according to predefined criteria during patient consultation at 1 year and by the patients themselves (questionnaire). We reviewed other surgical techniques used to treat lagophthalmos and compared findings with previous international studies. The use of a gold plate implant remains the most widely used technique for the treatment of lagophthalmos. Although the functional results are good, the implant is always visible, leading to the disappearance of the superior palpebral fold and a risk of exposure and therefore of infection. Levator lengthening, a technique developed by Paul Tessier, allows identical functional results to be obtained, but conserves a natural appearance of the upper eyelid. It is a simple surgical procedure associated with a low morbidity rate. The lengthening of the levator by aponeurosis interposition is a simple, reliable, and easily reproducible technique allowing treatment of paralytic lagophthalmos with good results, in terms of both function and aesthetics.

  10. Assessment of specific binding proteins suitable for the detection of paralytic shellfish poisons using optical biosensor technology.

    PubMed

    Campbell, Katrina; Stewart, Linda D; Doucette, Gregory J; Fodey, Terence L; Haughey, Simon A; Vilariño, Natalia; Kawatsu, Kentaro; Elliott, Christopher T

    2007-08-01

    Paralytic shellfish poisoning (PSP) toxin monitoring in shellfish is currently performed using the internationally accredited AOAC mouse bioassay. Due to ethical and performance-related issues associated with this bioassay, the European Commission has recently published directives extending procedures that may be used for official PSP control. The feasibility of using a surface plasmon resonance optical biosensor to detect PSP toxins in shellfish tissue below regulatory levels was examined. Three different PSP toxin protein binders were investigated: a sodium channel receptor (SCR) preparation derived from rat brains, a monoclonal antibody (GT13-A) raised to gonyautoxin 2/3, and a rabbit polyclonal antibody (R895) raised to saxitoxin (STX). Inhibition assay formats were used throughout. Immobilization of STX to the biosensor chip surface was achieved via amino-coupling. Specific binding and inhibition of binding to this surface was achieved using all proteins tested. For STX calibration curves, 0-1000 ng/mL, IC50 values for each binder were as follows: SCR 8.11 ng/mL; GT13-A 5.77 ng/mL; and R895 1.56 ng/mL. Each binder demonstrated a different cross-reactivity profile against a range of STX analogues. R895 delivered a profile that was most likely to detect the widest range of PSP toxins at or below the internationally adopted regulatory limits.

  11. A highly rapid and simple competitive enzyme-linked immunosorbent assay for monitoring paralytic shellfish poisoning toxins in shellfish.

    PubMed

    Kawatsu, Kentaro; Kanki, Masashi; Harada, Tetsuya; Kumeda, Yuko

    2014-11-01

    Using a streptavidin-coated well plate, a biotin-labelled anti-gonyautoxin 2/3 monoclonal antibody GT-13A, and a decarbamoyl saxitoxin-peroxidase conjugate, a direct competitive enzyme-linked immunosorbent assay (PSP-ELISA) was developed for monitoring paralytic shellfish poisoning (PSP) toxins in shellfish. This assay is simple to perform and can be completed in approximately 20 min. The PSP-ELISA was compared to the mouse bioassay (MBA) for the detection of PSP toxins in shellfish samples (n=83) collected from the coast of Osaka Prefecture, Japan. When positive and negative results were indicated based on the regulatory limit for PSP toxins (4 mouse unit(MU)/g of shellfish meat), the PSP-ELISA results showed a sensitivity of 100% (25 of 25) and a specificity of 89.7% (52 of 58 samples) compared to the MBA results. These results suggest that the PSP-ELISA could be used as a rapid and simple screening method prior to the MBA. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Trophic transfer of paralytic shellfish toxins from the cladoceran (Moina mongolica) to larvae of the fish (Sciaenops ocellatus).

    PubMed

    Jiang, Tian-Jiu; Wang, Da-Zhi; Niu, Tao; Xu, Yi-Xiao

    2007-10-01

    The dynamic transmission and transformation of paralytic shellfish toxins (PSTs) from the toxic dinoflagellate Alexandrium tamarense to the cladoceran Moina mongolica and subsequently to the larvae of the fish Sciaenops ocellatus were investigated under laboratory conditions. The results showed that PSTs could be transferred to S. ocellatus when they preyed on PST-containing M. mongolica. During the experimental period, A. tamarense, M. mongolica and the digestive glands of the fish larvae contained C(1/2) toxins, and the viscera of S. ocellatus contained neoSTX. The proportion of beta toxin (C2) in C(1+2) toxins increased when PSTs were transferred from A. tamarense to M. mongolica, but in the subsequent transfer from M. mongolica to S. ocellatus the proportion of alpha toxin (C1) increased. During depuration, the contents of C1 and C2 toxins in fish larvae decreased with the duration of depuration, but neoSTX remained relatively constant. The present results indicated that, using a cladoceran as the vector, PSTs can be transferred from toxic algae to a high trophic level fish and metabolized in the fish. Future work should address the metabolic characteristics of PSTs in cladocerans and the end result when they are transferred to fishes.

  13. Studies in the Use of Magnetic Microspheres for Immunoaffinity Extraction of Paralytic Shellfish Poisoning Toxins from Shellfish

    PubMed Central

    Devlin, Raymond; Campbell, Katrina; Kawatsu, Kentaro; Elliott, Christopher

    2011-01-01

    Paralytic shellfish poisoning (PSP) is a potentially fatal human health condition caused by the consumption of shellfish containing high levels of PSP toxins. Toxin extraction from shellfish and from algal cultures for use as standards and analysis by alternative analytical monitoring methods to the mouse bioassay is extensive and laborious. This study investigated whether a selected MAb antibody could be coupled to a novel form of magnetic microsphere (hollow glass magnetic microspheres, brand name Ferrospheres-N) and whether these coated microspheres could be utilized in the extraction of low concentrations of the PSP toxin, STX, from potential extraction buffers and spiked mussel extracts. The feasibility of utilizing a mass of 25 mg of Ferrospheres-N, as a simple extraction procedure for STX from spiked sodium acetate buffer, spiked PBS buffer and spiked mussel extracts was determined. The effects of a range of toxin concentrations (20-300 ng/mL), incubation times and temperature on the capability of the immuno-capture of the STX from the spiked mussel extracts were investigated. Finally, the coated microspheres were tested to determine their efficiency at extracting PSP toxins from naturally contaminated mussel samples. Toxin recovery after each experiment was determined by HPLC analysis. This study on using a highly novel immunoaffinity based extraction procedure, using STX as a model, has indicated that it could be a convenient alternative to conventional extraction procedures used in toxin purification prior to sample analysis. PMID:22069687

  14. Paralytic shellfish poisoning (PSP) toxin binders for optical biosensor technology: problems and possibilities for the future: a review

    PubMed Central

    Campbell, K.; Rawn, D.F.K.; Niedzwiadek, B.; Elliott, C.T.

    2011-01-01

    This review examines the developments in optical biosensor technology, which uses the phenomenon of surface plasmon resonance, for the detection of paralytic shellfish poisoning (PSP) toxins. Optical biosensor technology measures the competitive biomolecular interaction of a specific biological recognition element or binder with a target toxin immobilised onto a sensor chip surface against toxin in a sample. Different binders such as receptors and antibodies previously employed in functional and immunological assays have been assessed. Highlighted are the difficulties in detecting this range of low molecular weight toxins, with analogues differing at four chemical substitution sites, using a single binder. The complications that arise with the toxicity factors of each toxin relative to the parent compound, saxitoxin, for the measurement of total toxicity relative to the mouse bioassay are also considered. For antibodies, the cross-reactivity profile does not always correlate to toxic potency, but rather to the toxin structure to which it was produced. Restrictions and availability of the toxins makes alternative chemical strategies for the synthesis of protein conjugate derivatives for antibody production a difficult task. However, when two antibodies with different cross-reactivity profiles are employed, with a toxin chip surface generic to both antibodies, it was demonstrated that the cross-reactivity profile of each could be combined into a single-assay format. Difficulties with receptors for optical biosensor analysis of low molecular weight compounds are discussed, as are the potential of alternative non-antibody-based binders for future assay development in this area. PMID:21623494

  15. Analysis of paralytic shellfish toxins, potential chemical threat agents, in food using hydrophilic interaction liquid chromatography-mass spectrometry.

    PubMed

    Jansson, Daniel; Åstot, Crister

    2015-10-23

    A novel method for determining paralytic shellfish toxin (PST) profiles in food was developed using a combination of silica and strong cation exchange (SCX) solid phase extraction (SPE) coupled to hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS). Besides the risk for natural contamination of seafood and drinking water, PSTs also pose potent threats through intentional contamination of food, due to their high toxicity and the wide distributions of toxin-producing algae. The new preparation method aim to maintain the samples' original toxin profiles by avoiding conditions known to induce interconversion or degradation of the PSTs. The method was evaluated for PST extraction from water, milk, orange juice, apple purée, baby food, and blue mussels (Mytilus edulis). The extracts were found to produce reproducible retention times in HILIC-MS/MS analysis. When an authentic toxic mussel sample was analyzed using the novel method, saxitoxin and gonyautoxin-3 were identified, in agreement with data acquired using the Lawrence pre-column oxidation high-performance liquid chromatography-fluorescence detection (HPLC-FLD) method. Overall recoveries of the PSTs from tested foods by the novel method ranged from 36% to 111%. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. [A case of non-paralytic pontine exotropia due to pontine tegmentum lesion confirmed by magnetic resonance imaging and electronystagmography].

    PubMed

    Mochizuki, A; Yamanouchi, H; Kitamura, K; Nagura, H; Yoshikawa, H

    1990-11-01

    A case with non-paralytic pontine exotropia (NPPE) due to brainstem infarction is reported. A 77-year-old hypertensive man suddenly developed dizziness, double vision, dysarthria, and right ataxic hemiparesis. Oculomotor findings on admission consisted of: (1) full right exotropia in the primary position; (2) complete adductive paralysis of the left eye with slight preservation of convergence; (3) tonic deviation of the right eye to the full abducting position with right-beating nystagmus after an immediate forward gaze. The leftward saccades showed multiple saccades with slow velocity on electronystagmography (ENG). The right exotropia disappeared and the slight adductive paresis of the left eye remained with right monocular nystagmus seven weeks after the onset. Magnetic resonance imaging (MRI), which was performed nine weeks after the onset, disclosed a small lesion with high intensity involving the left medial longitudinal fasciculus (MLF) on T2-weighted spin echo image. The leftward saccades showed multiple saccades with normal velocity eleven weeks after the onset. The hypofunction of unilateral PPRF with ipsilateral MLF lesion probably causes the contralateral NPPE.

  17. Application of rapid test kits for the determination of paralytic shellfish poisoning (PSP) toxins in bivalve molluscs from Great Britain.

    PubMed

    Harrison, Keith; Johnson, Sarah; Turner, Andrew D

    2016-09-01

    Six different commercial rapid screening assays for Paralytic Shellfish Poisoning toxins were assessed with the analysis of shellfish samples from GB. The performance of each kit was assessed through comparison with the current regulatory HPLC method. Samples assessed consisted of a wide variety of shellfish species of importance to the shellfish industry in GB. These had been sourced over a number of years and with a wide variety of geographical origins. One lateral flow immunoassay was found to provide a quick qualitative assessment of PSP toxicity, with a low proportion of false negative results for PSP-positive samples, but with higher numbers of false positives. The performance of the five quantitative ELISA assays varied considerably, with two demonstrating an inappropriate linear range, with others either over-estimating or under-estimating toxicity. One ELISA from R-Biopharm was found to show a good correlation with the HPLC toxicity results. All ELISAs, however, returned some false negative results, most notably for samples containing high proportions of toxins with low cross reactivity to saxitoxin such as GTX1&4. Whilst the lateral flow assays on the market are of particular use to Food Business Operators for end product testing, further work is required in parallel with instrumental testing methods using a larger number of samples to assess the reliability and accuracy of these kits over the long term.

  18. [A great imitator for the allergologist: intolerance to gluten].

    PubMed

    Rousset, H

    2004-03-01

    Intolerance of gluten, resposible for Coeliac disease, is essentially shown by an auto-immune enteropathy, even if the cutaneous manifestation (herpetiform dermatitis) and perhaps certain neurological signs (cerebral syndrome, peripheral neuropathy) may be independent as well as associated with the intestinal illness. This affection is of immunological nature, occuring in a genetic field that predisposes to the illness (familial form: concordance of 70% in homozygote twins; 90% of patients show an HLA molecule of type DQ2, DQ8 in almost all the other cases. The exogenous factor is the gluten content contained in wheat, rye and barley, more precisely by the intermediary "the prolamines" which are the "reactive" element that induces a the same time an inflammatory reaction of type TH11 locally (expressed by the histological aspect of a duodenal biopsy evolving as villous atrophy) and a humoral response with production of anti-gliadine and anti-transglutaminase antibodies (the role of the latter enzyme is intervention in the local transformation of antigens to make them antigenic). It is an illness of adults as well as children and this point must now be emphasized. Recent epidemiological studies insist on a high prevalence (1/300 in Europe). Clinical expression, at the start very polymorphic and so misleading, before the appearance of the more classical signs of malabsorption and development, always feared, towards a lymphoma. These signs are haematological (anemia of various types, hyper platelets by hyposplenism, haemorrhagic signs) cutaneous (herpetiform dermatitis, cutaneous vasculitis) mucosal (aphtose), hepatic (cytolysis), neurophysical (fatigue, troubles of behaviour, cerebral syndrome, neuropathy) and osteo-articulitis (osteopenia, arthralgias, diffuse pains). The association of certain auto-immune illnesses must be emphasized (diabetes, Hashimoto thyroiditis, Gougerot disease, primitive biliary cirrhosis). To think early of the possibility of intolerance to

  19. The Relationship Between Intolerance of Uncertainty, Sensory Sensitivities, and Anxiety in Autistic and Typically Developing Children.

    PubMed

    Neil, Louise; Olsson, Nora Choque; Pellicano, Elizabeth

    2016-06-01

    Guided by a recent theory that proposes fundamental differences in how autistic individuals deal with uncertainty, we investigated the extent to which the cognitive construct 'intolerance of uncertainty' and anxiety were related to parental reports of sensory sensitivities in 64 autistic and 85 typically developing children aged 6-14 years. Intolerance of uncertainty and anxiety explained approximately half the variance in autistic children's sensory sensitivities, but only around a fifth of the variance in typical children's sensory sensitivities. In children with autism only, intolerance of uncertainty remained a significant predictor of children's sensory sensitivities once the effects of anxiety were adjusted for. Our results suggest intolerance of uncertainty is a relevant construct to sensory sensitivities in children with and without autism.

  20. Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update (2016).

    PubMed

    Mancini, G B John; Baker, Steven; Bergeron, Jean; Fitchett, David; Frohlich, Jiri; Genest, Jacques; Gupta, Milan; Hegele, Robert A; Ng, Dominic; Pearson, Glen J; Pope, Janet; Tashakkor, A Yashar

    2016-07-01

    The Canadian Consensus Working Group has updated its evaluation of the literature pertaining to statin intolerance and adverse effects. This overview introduces a pragmatic definition of statin intolerance (goal-inhibiting statin intolerance) that emphasizes the effects of symptoms on achieving nationally vetted goals in patients fulfilling indications for lipid-lowering therapy and cardiovascular risk reduction. The Canadian Consensus Working Group provides a structured framework for avoiding, evaluating and managing goal-inhibiting statin intolerance. Particularly difficult practice situations are reviewed, including management in young and elderly individuals, and in athletes and labourers. Finally, targeted at specialty practitioners, more detailed analyses of specific but more unusual adverse effects ascribed to statins are updated including evidence regarding new-onset diabetes, cognitive dysfunction, cataracts, and the rare but important immune-mediated necrotizing myopathy. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.