RESUMEN
BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that is diagnosed based on clinical findings, but can be confirmed with oral food challenge (OFC). OFC is more often performed to assess the development of tolerance. Most studies describing OFCs in FPIES are limited in size. OBJECTIVE: We sought to describe our experience with OFCs using our FPIES protocol. Patients were given one-third of serving size with a 4-hour observation period, followed by home titration to full dose. METHODS: We conducted a retrospective chart review of patients who underwent OFC via the FPIES protocol from 2014 to 2017. Data regarding the history of reaction, age at the time of challenge, and reactions during challenge or with home introduction were collected. RESULTS: A total of 169 OFCs were completed under the FPIES protocol, in 119 patients to 19 different foods. Thirty challenges (18%) were positive, with 17 challenges (10%) during initial challenge and 13 (7.7%) during home dosing. Most reactions during initial challenge required intravenous fluids (IVF), but hypotension was uncommon. One hundred thirty-nine (82%) OFCs were negative with home introduction, indicating tolerance to the challenged foods. The mean age of passing a challenge to milk, soy, and grain was earlier than that of other solid foods. CONCLUSIONS: Our data suggest that our FPIES OFC protocol is safe. Early administration of IVF may prevent the development of hypotension. It is difficult to stratify the risk of severe or delayed reaction based on patient characteristics, and more data are needed to identify those appropriate for home introduction.
Asunto(s)
Proteínas en la Dieta/efectos adversos , Enterocolitis/diagnóstico , Enterocolitis/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/etiología , Alérgenos/administración & dosificación , Niño , Preescolar , Protocolos Clínicos , Proteínas en la Dieta/administración & dosificación , Femenino , Humanos , Lactante , Masculino , Derivación y Consulta , Estudios Retrospectivos , SíndromeRESUMEN
How did humans sleep before the modern era? Because the tools to measure sleep under natural conditions were developed long after the invention of the electric devices suspected of delaying and reducing sleep, we investigated sleep in three preindustrial societies [1-3]. We find that all three show similar sleep organization, suggesting that they express core human sleep patterns, most likely characteristic of pre-modern era Homo sapiens. Sleep periods, the times from onset to offset, averaged 6.9-8.5 hr, with sleep durations of 5.7-7.1 hr, amounts near the low end of those industrial societies [4-7]. There was a difference of nearly 1 hr between summer and winter sleep. Daily variation in sleep duration was strongly linked to time of onset, rather than offset. None of these groups began sleep near sunset, onset occurring, on average, 3.3 hr after sunset. Awakening was usually before sunrise. The sleep period consistently occurred during the nighttime period of falling environmental temperature, was not interrupted by extended periods of waking, and terminated, with vasoconstriction, near the nadir of daily ambient temperature. The daily cycle of temperature change, largely eliminated from modern sleep environments, may be a potent natural regulator of sleep. Light exposure was maximal in the morning and greatly decreased at noon, indicating that all three groups seek shade at midday and that light activation of the suprachiasmatic nucleus is maximal in the morning. Napping occurred on <7% of days in winter and <22% of days in summer. Mimicking aspects of the natural environment might be effective in treating certain modern sleep disorders.
Asunto(s)
Ritmo Circadiano/fisiología , Sueño/fisiología , Bolivia , Países en Desarrollo , Humanos , Luz , Namibia , Estaciones del Año , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Tanzanía , TemperaturaRESUMEN
Pityriasis rosea is a common self-limited dermatologic disorder. It appears to be a nonspecific cutaneous reaction pattern with a large number of causes. Current evidence indicates that a cell-mediated immune mechanism may be important in its pathogenesis.
Asunto(s)
Humanos , Diagnóstico Diferencial , Inmunidad Celular , Infecciones , Pitiriasis , RecurrenciaRESUMEN
In order to assess the effect of agricultural development on nutrition, a survey was conducted in the Plaine of Gonaives (Haiti) where a land irrigation project had been implemented two years previously. The economy of the region is essentially based on agriculture. Drought is the major problem so that the traditional land irrigation system covers only 25 percent of needs. The main objective of the project was directed towards the exploitation of the water table in order to drain water to arable lands, as well as to improve agricultural extension services and export crop production. The Nutrition survey was conducted in October, 1981, and a sample of 108 children, aged 1 to 60 months, were selected from 2 villages which were similar in their ecosystem and social structure and were located inside and outside of the project area respectively. It was found that the agricultural yield per hectare was 5 times higher in the project area than in the control area. No difference was found in nutritional status between areas, assessed either by anthropometric indices or by incidence of stunting and wasting. The following table shows the percentage of malnourished children in each category expressed as per cent of the total (n): AREA: Project - Normal 84.3, Stunted 9.8, Stunted and Wasted 3.9, Wasted 2.0, N 51; AREA: Control - Normal 82.5, Stunted 12.3, Stunted and Wasted 1.8, Wasted 3.5, N 57; AREA: National Survey (1978) - Normal 68.4, Stunted 25.5, Stunted and Wasted 3.0, Wasted 3.4, N 4460. About 85 percent of children were anaemic in both areas and the mean haemoglobin concentration was similar. In children aged 4-5 years, food consumption and therefore protein and energy consumption was higher in the project area, although in both areas, energy and protein consumption were less than the recommended dietary allowance for the Caribbean. This survey shows that an exclusively economic project, even if it improves family income and subsequently food intake, does not necessarily improve nutritional status. It stresses the importance of including components that are more closely related to nutritional status, such as health and education, into a rural development project (AU)