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To review the literature comparing functional endoscopic sinus surgery to dupilumab for the treatment of chronic rhinosinusitis with nasal polyps, in terms of symptom control, cost-effectiveness and complications.
Method
A literature review was conducted using PubMed, ScienceDirect and Cochrane databases. Data were extracted manually.
Results
A total of six papers relevant to the main objective were found.
Conclusion
Chronic rhinosinusitis with nasal polyps has a significant impact on patients’ quality of life. Both functional endoscopic sinus surgery and dupilumab achieve comparable disease control and result in good symptom relief. Dupilumab is far more expensive than functional endoscopic sinus surgery and is not considered cost-effective for the time being. This is expected to change after 10 years when the drug patent expires. More research is needed to compare the complications of both treatment modalities.
In the present world a significant threat to human health is posed by zoonotic diseases. Helminth parasites of ruminants are one of the most common zoonotic organisms on the planet. Among them, trichostrongylid nematodes of ruminants, found worldwide, parasitize humans in different parts of the world with varying rates of incidence, particularly among rural and tribal communities with poor hygiene, pastoral livelihood and poor access to health services. In the Trichostrongyloidea superfamily, Haemonchus contortus, Teladorsagia circumcincta, Marshallagia marshalli, Nematodirus abnormalis and Trichostrongylus spp. are zoonotic in nature. Species of the genus Trichostrongylus are the most prevalent gastrointestinal nematode parasites of ruminants that transmit to humans. This parasite is prevalent in pastoral communities around the world and causes gastrointestinal complications with hypereosinophilia which is typically treated with anthelmintic therapy. The scientific literature from 1938 to 2022 revealed the occasional incidence of trichostrongylosis throughout the world with abdominal complications and hypereosinophilia as the predominant manifestation in humans. The primary means of transmission of Trichostrongylus to humans was found to be close contact with small ruminants and food contaminated by their faeces. Studies revealed that conventional stool examination methods such as formalin-ethyl acetate concentration or Willi's technique combined with polymerase chain reaction-based approaches are important for the accurate diagnosis of human trichostrongylosis. This review further found that interleukin 33, immunoglobulin E, immunoglobulin G1, immunoglobulin G2, immunoglobulin M, histamine, leukotriene C4, 6-keto prostaglandin F1α, and thromboxane B2 are vital in the fight against Trichostrongylus infection with mast cells playing a key role. This review focuses on the prevalence, pathogenicity and immunological aspects of Trichostrongylus spp. in humans.
Twenty-four primiparous pregnant pigs were randomly assigned to three handling treatments: Minimal, Positive and Negative. The pigs were moved individually to indoor concrete-floored partial stalls with neck-tethers, 2 days before handling commenced. Positive (stroking and patting on approach to an experimenter) and Negative (brief electric shock of < Is when failing to withdraw from the outstretched hand of an experimenter) handling was imposed for 3min day-1 and the amount of physical contact between handler and pig was recorded. The Minimal treatment group was subjected to routine husbandry practices only. After 3 weeks of the handling treatments and tether-housing, all pigs were catheterized under full surgical anaesthesia. The pigs were allowed 4 days of recovery before collecting the following data: daytime plasma Cortisol concentration profiles, behavioural responses to a human in an arena test, Cortisol responses to human proximity, Cortisol responses to an A CTH-challenge and immunological responses to an injected mitogen.
In the Positive treatment, the amount of physical contact between pig and handler increased during the course of the experiment, while the amount of physical contact did not change in the Negative treatment. There were no effects of treatment on behavioural responses in the arena test. The average daytime concentration of free plasma Cortisol was lower in the Positive treatment than in the Negative or Minimal treatments. The Positive treatment also showed lower total and free plasma Cortisol concentrations pre- and posthuman proximity when compared with the Negative treatment. No differences were found between treatments in total and free plasma Cortisol concentrations following an ACTH challenge. The immunological response was greater in the Positive treatment compared with the Negative treatment and tended to be greater when compared with the Minimal treatment.
It was concluded that the nature of the human-animal relationship affected the physiological stress responses of pregnant pigs to tether-housing. Indications are that a positive human-animal relationship would obviate some of the negative effects of being kept in tether-stalls by lowering the basal cortisol concentration and by increasing immunological responsiveness.
Health is an important aspect of animal welfare, which is difficult to assess at herd level. Clinical examination of individual animals is time-consuming, and most measures of clinical herd health depend significantly on the examiner. Acute phase proteins are produced during inflammatory processes, and could therefore be used as general markers of infection and injury. Our objective was to evaluate whether haptoglobin could be used to monitor the health status of herds at slaughter.
107 groups of 20 slaughter pigs each were examined at two large abattoirs. Clinical signs of tail biting, lameness, injuries, abscesses, pneumonia, pleurisy, hepatitis and gastritis were recorded. The association between elevated haptoglobin concentration in meat juice samples and clinical signs was assessed via multiple logistic regression.
Pigs from groups in which tail biting, lameness, othaematomas, abscesses, pneumonia, pleurisy, pericarditis or condemnations of livers, lungs or carcasses occurred, showed higher levels of haptoglobin than pigs from slaughter groups without any of these clinical signs. In the multiple regression model, only the variables of lameness and tail biting were statistically significant. The haptoglobin test classified 66% of all slaughter groups correctly according to the presence of these clinical signs. These results demonstrate the potential for haptoglobin to be used as a screening test to identify problem herds at slaughter.
Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures.
Method
Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0–12 to examine for bacterial presence or persistence.
Results
No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas.
Conclusion
If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.
The term ‘schizophrenia’ refers to a group of disorders that seem to occur worldwide, with clinical pictures being strikingly similar across cultures. Evolutionary explanations of these disorders are warranted for at least two reasons: the first concerns their prevalence in all known ethnicities; the second relates to the need to explain the paradox as to why the conditions are maintained despite the greatly decreased fecundity of the affected individuals. Accordingly, a plethora of heterogeneous hypotheses – unparalleled among other psychiatric disorders – have been put forth, some of which deal with genetic considerations, others with environmental risk factors, and a few consider the adaptive advantages associated with the genes that predispose to schizophrenia. None of the evolutionary scenarios has the potential to account for the diversity of the symptomatology or to cover all of the biological and non-biological aspects of schizophrenia or schizophrenia spectrum disorders. This chapter aims at discussing the most relevant evolutionary hypotheses of schizophrenia, arguing that a symptom-based approach to psychotic disorders from an evolutionary perspective may improve upon the existing models of schizophrenia.
The immunohistochemistry assay has evolved over many years. Primarily based on an antibody binding to epitopes in tissue sections, the technology has come a long way from its earliest manifestation using direct fluorescence labels. Current polymer technology is the result of many variations and adaptations on technique throughout the years. Indeed, much of its continued development is owed to early pioneers who experimented and overcame technical boundaries. This chapter is a broad discussion about what immunohistochemistry is from the historical perspective, and the individuals who have contributed to its expansion. It includes a journey about protocol adaptations and explanations of their context and applications. This chapter provides a sound basis in which to explore the rest of the book.
A growing body of research implicates inflammation as a potential pathway in the aetiology and pathophysiology of some mental illnesses. A systematic review was conducted to determine the association between parasitic infection and mental illnesses in humans in Africa and reviewed the state of the evidence available. The search focused on publications from Africa documenting the relationship between parasites from two parasite groups, helminths and protozoans, and four classifications of mental illness: mood affective disorders, neurotic and stress-related disorders, schizotypal disorders and unspecified mental illnesses. In the 26 reviewed papers, the prevalence of mental illness was significantly higher in people with parasitic infection compared to those without infection, i.e., 58.2% vs 41.8% (P < 0.001). An overall odds ratio found that the association of having a mental illness when testing positive for a parasitic infection was four times that of people without infection. Whilst the study showed significant associations between parasite infection and mental illness, it also highlights gaps in the present literature on the pathophysiology of mental illness in people exposed to parasite infection. This study highlighted the importance of an integrated intervention for parasitic infection and mental illness.
An increase in peripheral blood eosinophils in helminth infections is expected, and these cells are known to promote immunity against these parasites. However, studies have suggested that in some specific helminths, eosinophils may promote the needs and longevity of these parasites, and their role in these infections remains undefined, including in Toxocara canis infection. Thus, this study aimed to investigate the role of eosinophils in the context of larval migration of T. canis and the immunopathological aspects of infection. For this, we used wild-type mice and mice genetically deficient for the transcription factor GATA-binding factor 1 (GATA1−/−), infected with 1000 eggs of T. canis. At 0, 3, 14 and 63 days post-infection, parasite load, tissue cytokine production, leucocyte profile, bronchoalveolar lavage cells and histopathological analyses were carried out. Collectively, our results demonstrate that the presence of eosinophils mediates susceptibility to T. canis, inducing leucocytosis and the formation of granulomas, increasing the pulmonary and cerebral parasite load, and reducing the number of neutrophils, which may be necessary to control the infection.
This commentary highlighted the background, take-home messages, and impacts of our 2007 British Journal of Nutrition paper entitled “Amino acids and immune function”. In 2003–2004, there was an outbreak of severe acute respiratory syndrome (SARS) caused by SARS coronavirus-1 (CoV-1) in Asian countries. By the mid-2000’s, clinical and experimental evidence indicated important roles for amino acids (AA) in improving innate and adaptive immunities in humans and animals. Based on our long-standing interest in AA metabolism and nutritional immunology, we decided to critically analyze advances in this nutritional field. Furthermore, we proposed a unified mechanism responsible for beneficial effects of AA and their products (including nitric oxide, glutathione, antibodies, and cytokines) on immune responses. We hoped that such integrated knowledge would be helpful for designing AA-based nutritional methods (e.g., supplementation with glutathione, arginine and glutamine) to prevent and treat SARS-like infectious diseases in the future. Our paper laid a framework for subsequent studies to quantify AA metabolism in intestinal bacteria, determine the effects of functional AA on cell-mediated and humoral immunities, and establish a much-needed database of AA composition in foodstuffs. Unexpectedly, COVID-19 (caused by SARS-CoV-2) emerged in December 2019 and has become one of the deadliest pandemics in history. Notably, glutathione, arginine and glutamine have now been exploited to effectively relieve severe respiratory symptoms of COVID-19 in affected patients. Functional AA (e.g., arginine, cysteine, glutamate, glutamine, glycine, taurine and tryptophan) and glutathione, which are all abundant in animal-sourced foodstuffs, are crucial for optimum immunity and health in humans and animals.
The Conclusion contextualizes the argument for a posthumanism mode of being argued for in this book in light of the recent COVID-19 pandemic and especially how the framework of biocapital can help us to understand the racialized economic equality upon which Western democracies rely – systemic injustice made all the more visible by the effects of the pandemic. Working through Roberto Esposito’s critique of the concept of personhood as it has unfolded in Western political theory, and how we might think through his notion of immunitary biopolitics in relation to this global situation, as well as drawing on new work on immunity that requires us to reject previous metaphorical figurations of the immune system in military terms of borders and purity, I show how his critique of personhood aligns with the arguments for posthumanist politics made throughout this book. Both share a critique of rights-based frameworks for ethics and suggest the urgent need for new figurations, new ontologies, new ethics. The book concludes by suggesting that “normal” is not a state to which we should desire to return but that instead the failure of existing systems in the face of the pandemic calls for a renewal of our political imagination through posthumanist theory.
Ascaris lumbricoides, the roundworm, and Trichuris trichiura, the whipworm, are human intestinal nematode parasites; both are soil-transmitted helminths, are often placed together in an epidemiological context and both remain neglected despite high prevalence. Our understanding of parasitic disease continues to be enhanced through animal models. Despite the similarities between whipworm and roundworm, there are key differences between the two species and these have influenced the application of their respective animal models. In the case of T. trichiura, the fact that a murine equivalent, T. muris completes its life cycle in a mouse model has greatly enhanced our knowledge of whipworm biology, pathogenicity and immunology. In contrast, A. lumbricoides and its porcine equivalent, Ascaris suum, lack a rodent model in which the life cycle is completed. However, evidence continues to accumulate demonstrating that mice represent useful models of early Ascaris infection, a key stage of the life cycle. The use of mouse models for both Ascaris and Trichuris has a long history with early pioneers discovering fundamental aspects of each parasite's biology. Novel technologies and perspectives, as outlined in this special issue, demonstrate how through the prism of mouse models, we can continue to explore the similarities and differences between roundworms and whipworms.
Hemophagocytic lymphohistiocytosis (HLH) is a rare immune deregulatory disorder that predominantly presents in children. Here we describe three patients with adult-onset primary HLH whose initial presentations were characterized by neurological features, and we review the literature of published cases. These cases ranged in age from 17 to 30 and presented with a variety of neurological symptoms. One of our cases demonstrated numerous microhemorrhages on MR brain. This is the first published case of adult-onset HLH presenting with cerebral microhemorrhages. In addition, literature review identified five additional patients with isolated central nervous system presentation of primary HLH.
Trichuris spp. (whipworms) are intestinal nematode parasites which cause chronic infections associated with significant morbidities. Trichuris muris in a mouse is the most well studied of the whipworms and research on this species has been approached from a number of different disciplines. Research on T. muris in a laboratory mouse has provided vital insights into the host–parasite interaction through analyses of the immune responses to infection, identifying factors underpinning host susceptibility and resistance. Laboratory studies have also informed strategies for disease control through anthelmintics and vaccine research. On the contrary, research on naturally occurring infections with Trichuris spp. allows the analysis of the host–parasite co-evolutionary relationships and parasite genetic diversity. Furthermore, ecological studies utilizing Trichuris have aided our knowledge of the intricate relationships amongst parasite, host and environment. More recently, studies in wild and semi-wild settings have combined the strengths of the model organism of the house mouse with the complexities of context-dependent physiological responses to infection. This review celebrates the extraordinarily broad range of beneficiaries of whipworm research, from immunologists and parasitologists, through epidemiologists, ecologists and evolutionary biologists to the veterinary and medical communities.
Ascaris lumbricoides and Ascaris suum are helminth parasites of humans and pigs, respectively. The life cycle of Ascaris sets it apart from the other soil-transmitted helminths because of its hepato-tracheal migration. Larval migration contributes to underestimated morbidity in humans and pigs. This migration, coupled with a lack of a murine model in which the Ascaris parasite might complete its life cycle, has undoubtedly contributed to the neglected status of the ascarid. Our knowledge of the epidemiology of adult worm infections had led us to an enhanced understanding of patterns of infection such as aggregation and predisposition; however, the mechanisms underlying these complex phenomena remain elusive. Carefully controlled experiments in defined inbred strains of mice – with enhanced recovery of larvae in tandem with measurements of cellular, histopathological and molecular processes – have greatly enhanced our knowledge of the early phase of infection, a phase crucial to the success or failure of adult worm establishment. Furthermore, the recent development of a mouse model of susceptibility and resistance, with highly consistent and diverging Ascaris larval burdens in the murine lungs, represents the extremes of the host phenotype displayed in the aggregated distribution of worms and provides an opportunity to explore the mechanistic basis that confers predisposition to light and heavy Ascaris infection. Certainly, detailed knowledge of the cellular hepatic and pulmonary responses at the molecular level can be accrued from murine models of infection and, once available, may enhance our ability to develop immunomodulatory therapies to elicit resistance to infection.
This study evaluated whether children with higher adverse childhood experiences (ACE) scores had alterations in immune cell gene expression profiles. RNA sequencing was conducted on dried blood spot samples from 37 generally healthy English-speaking children (age 5–11) who were recruited from well-child visits at a university-affiliated pediatric practice. The Whole Child Assessment was used to assess ACE exposure. Primary analyses examined an a priori-specified composite of 19 pro-inflammatory gene transcripts. Secondary analyses examined a 34-gene composite assessing Type I interferon response, and used Transcript Origin Analyses to identify cellular mechanisms. After controlling for age, body mass index percentile, sex, race/ethnicity, current insurance status, and household smoking exposure, pro-inflammatory gene expression was elevated by 0.094 log2 RNA expression units with each Child-ACE total score point (p = .019). Type I interferon gene expression was similarly upregulated (0.103; p = .008). Transcript origin analyses implicated CD8+ T cell as the primary sources of gene transcripts upregulated, and nonclassical (CD16+) monocytes as sources of downregulated transcripts. These preliminary analyses suggest that parent-reported ACE exposures are associated with increased expression of both inflammatory and interferon gene transcripts in children's circulating blood cells.
Vitamin D deficiency is now a recognised problem affecting multiple physiological functions. The aim of the present study was to evaluate the effect of a single dose of vitamin D3 injection on the inflammatory, muscular damage, metabolic and cardiovascular responses to an acute bout of resistance exercise (RE) in vitamin D-deficient resistance-trained males. Blood samples from fourteen vitamin D-deficient resistance-trained males were obtained during two separate trials: lower vitamin D (LVD) and higher vitamin D (HVD, after vitamin D3 injection). Metabolic, inflammatory, muscle damage and cardiovascular markers were evaluated at baseline, immediately and 1 h after RE. There were significant trial-by-time interactions for insulin and homeostatic model assessment of insulin resistance (HOMA-IR) which significantly (P < 0·05) declined for 1 h after RE in the HVD trial compared with the LVD trial. Homeostasis model assessment of β-cell function (HOMA-β) declines at 1 h post-RE in the HVD trial. There was also a time effect for blood sugar which significantly (P < 0·05) decreased and for creatine kinase, lactate dehydrogenase and IL-6 which increased significantly 1 h post-RE in both trials. There were no significant changes in other inflammatory and cardiovascular markers following both trials. A single injection of vitamin D3 improved insulin resistance and β-cell function following RE in previously vitamin D-deficient resistance-trained males. Conversely, the injection did not change muscle damage and the inflammatory response to acute RE. Intramuscular vitamin D replacement may have key implications for the promotion of glucose metabolism and lowering the risk of diabetes in vitamin D-deficient individuals.
Background: The antiquated standard reference range of 0.15–0.45 g/L for cerebrospinal fluid total protein (CSF-TP) is well entrenched in medical literature and laboratory operating procedures across the world. Methods: We conducted a web-based survey with a response rate of 34.9% through the listserv of the Canadian Neurological Sciences Federation. Additional laboratory reference data were collated by telephone interview of hospital laboratory technologists across Canada. Results: A total of 142 site responses were obtained: 64.1% from academic/tertiary hospitals and 35.9% from community hospitals. A strong majority (80.4%) of both types of institutions reported using a CSF-TP upper reference limit of 0.45 g/L or less. As a rule, no age adjustments were implemented in CSF-TP-level interpretation. Conclusions: Recent well-powered laboratory reference studies have documented CSF-TP upper reference limits that are above 0.6 g/L starting at age 50, with incremental limits partitioned by subsequent decades of age. The conventional 0.45 g/L limit could lead to false positive results. Our survey suggests there is a need to consider a wide adoption of data-driven, rather than historical, reference values.